Comparison of the medical priority dispatch system to an out-of-hospital patient acuity score.
BACKGROUND
Although the Medical Priority Dispatch System (MPDS) is widely used by emergency medical services (EMS) dispatchers to determine dispatch priority, there is little evidence that it reflects patient acuity. The Canadian Triage and Acuity Scale (CTAS) is a standard patient acuity scale widely used by Canadian emergency departments and EMS systems to prioritize patient care requirements.


OBJECTIVE
To determine the relationship between MPDS dispatch priority and out-of-hospital CTAS.


METHODS
All emergency calls on a large urban EMS communications database for a one-year period were obtained. Duplicate calls, nonemergency transfers, and canceled calls were excluded. Sensitivity and specificity to detect high-acuity illness, as well as positive predictive value (PPV) and negative predictive value (NPV), were calculated for all protocols.


RESULTS
Of 197,882 calls, 102,582 met inclusion criteria. The overall sensitivity of MPDS was 68.2% (95% confidence interval [CI] = 67.8% to 68.5%), with a specificity of 66.2% (95% CI = 65.7% to 66.7%). The most sensitive protocol for detecting high acuity of illness was the breathing-problem protocol, with a sensitivity of 100.0% (95% CI = 99.9% to 100.0%), whereas the most specific protocol was the one for psychiatric problems, with a specificity of 98.1% (95% CI = 97.5% to 98.7%). The cardiac-arrest protocol had the highest PPV (92.6%, 95% CI = 90.3% to 94.3%), whereas the convulsions protocol had the highest NPV (85.9%, 95% CI = 84.5% to 87.2%). The best-performing protocol overall was the cardiac-arrest protocol, and the protocol with the overall poorest performance was the one for unknown problems. Sixteen of the 32 protocols performed no better than chance alone at identifying high-acuity patients.


CONCLUSIONS
The Medical Priority Dispatch System exhibits at least moderate sensitivity and specificity for detecting high acuity of illness or injury. This performance analysis may be used to identify target protocols for future improvements.
Feldman
Michael J
MJ
Sunnybrook-Osler Center for Prehospital Care, 10 Carlson Court, Suite 640, Toronto, Ontario, Canada. mfeldman@socpc.ca
Verbeek
P Richard
PR
Lyons
David G
DG
Chad
Sandra J
SJ
Craig
Alan M
AM
Schwartz
Brian
B
D002985:Clinical Protocols; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006323:Heart Arrest / Q000175:diagnosis; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis; D009864:Ontario; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014218:Triage / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data*