title: Accuracy of prehospital diagnoses by emergency physicians:  comparison with discharge diagnosis.
abstract: OBJECTIVE
  A correct prehospital diagnosis of emergency patients is crucial as it determines initial treatment, admitting specialty, and subsequent treatment. We evaluated the diagnostic accuracy of emergency physicians.
  
  
  METHODS
  All patients seen by six emergency physicians staffing the local emergency ambulance and rescue helicopter services during an 8-month period were studied. The ambulance and helicopter physicians had 3 and 4 years, respectively, training in anesthesia and intensive care medicine. The admission diagnoses were compared with the discharge diagnoses for agreement. Time of day of the emergency call, patients' age, and sex, living conditions, and presenting symptoms were evaluated as contributing factors.
  
  
  RESULTS
  Three hundred and fifty-five ambulance and 241 helicopter deployment protocols were analyzed. The overall degree of agreement between initial and discharge diagnoses was 90.1% with no difference attributable to years of experience. The lowest agreement rate was seen in neurological disorders (81.5%), with a postictal state after an unobserved seizure often being diagnosed as a cerebrovascular accident. Inability to obtain a complete medical history (e.g. elderly patients, patients in nursing homes, neurological impairment) was associated with a lower agreement rate between initial and discharge diagnoses (P<0.05).
  
  
  CONCLUSIONS
  Medical history, physical examination, ECG, and blood glucose enabled a correct diagnosis in most cases, but some were impossible to resolve without further technical and laboratory investigations. Only a few were definitively incorrect. A detailed medical history is essential. Neurological disorders can present with misleading symptoms and when the diagnosis is not clear it is better to assume the worst case.
authors.affiliation: Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical Center, Göttingen, Germany. jheuer@med.uni-goettingen.de
authors.forename: Jan Florian
authors.initials: JF
authors.lastname: Heuer
authors.forename: Dennis
authors.initials: D
authors.lastname: Gruschka
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Crozier
authors.forename: Annalen
authors.initials: A
authors.lastname: Bleckmann
authors.forename: Enno
authors.initials: E
authors.lastname: Plock
authors.forename: Onnen
authors.initials: O
authors.lastname: Moerer
authors.forename: Michael
authors.initials: M
authors.lastname: Quintel
authors.forename: Markus
authors.initials: M
authors.lastname: Roessler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003951:Diagnostic Errors; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010818:Practice Patterns, Physicians'; D055815:Young Adult