title: Accuracy of working diagnosis by paramedics for patients presenting with dyspnoea.
abstract: OBJECTIVE
  The present study aims to determine the agreement between paramedic and ED or hospital working diagnosis in dyspnoeic patients.
  
  
  METHODS
  Non-consecutive written patient report forms were retrospectively audited for patients suffering from dyspnoea, who were transported to a tertiary hospital ED by ambulance paramedics. Accuracy of the paramedic working diagnosis was assessed by comparing agreement with either the primary or secondary ED diagnoses or hospital discharge diagnosis.
  
  
  RESULTS
  The study cohort was 293 patients. Exact agreement between paramedic versus ED or hospital diagnosis was 64%, 95% CI 58-69, k = 0.58, 95% CI 0.52-0.64. Only 226 (77%) had a 'clearly documented' paramedic diagnosis. Among these, agreement with either ED or hospital diagnosis was 79%, and there was a trend towards more agreement as paramedic level of practice increased (74%, 78% and 87% for Basic, Intermediate and ALS paramedics, respectively, P = 0.07). Conversely, ALS paramedics were less likely to document a working diagnosis (30/98, 31%) compared with Intermediate (22/102, 23%) and BLS paramedics (15/93, 16%), P = 0.008. Diagnostic agreement varied according to medical condition, from anaphylaxis (100%) and asthma (86%) to acute pulmonary oedema (46%).
  
  
  CONCLUSIONS
  There was moderate agreement between paramedic and ED or hospital diagnosis. The number of cases with no clearly documented working diagnosis suggested that a singular working diagnosis may not always serve the complexity of presentation of some dyspnoea patients: more open descriptors such as 'mixed disease' or 'atypical features' should be encouraged.
authors.affiliation: St John Ambulance, Auckland, New Zealand.
authors.forename: Andrew
authors.initials: A
authors.lastname: Christie
authors.affiliation: Discipline of Paramedicine, School of Clinical Sciences, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand.
authors.forename: Brenda
authors.initials: B
authors.lastname: Costa-Scorse
authors.affiliation: Emergency Department, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Mike
authors.initials: M
authors.lastname: Nicholls
authors.affiliation: Emergency Department, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Jones
authors.affiliation: Discipline of Paramedicine, School of Clinical Sciences, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand. ghowie@aut.ac.nz.
authors.forename: Graham
authors.identifier: http://orcid.org/0000-0001-6907-8074
authors.initials: G
authors.lastname: Howie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel; D004417:Dyspnea / Q000175:diagnosis*; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: ambulance; diagnosis; dyspnoea; paramedic; shortness of breath