PMID- 33182228 OWN - NLM STAT- MEDLINE DCOM- 20210118 LR - 20210118 IS - 1660-4601 (Electronic) IS - 1661-7827 (Print) IS - 1660-4601 (Linking) VI - 17 IP - 21 DP - 2020 Nov 9 TI - Symptom-Based Dispatching in an Emergency Medical Communication Centre: Sensitivity, Specificity, and the Area under the ROC Curve. LID - 10.3390/ijerph17218254 [doi] LID - 8254 AB - Measuring the performance of emergency medical dispatch tools used in paramedic-staffed emergency medical communication centres (EMCCs) is rarely performed. The objectives of our study were, therefore, to measure the performance and accuracy of Geneva's dispatch system based on symptom assessment, in particular, the performance of ambulance dispatching with lights and sirens (L&S) and to measure the effect of adding specific protocols for each symptom. Methods: We performed a prospective observational study including all emergency calls received at Geneva's EMCC (Switzerland) from 1 January 2014 to 1 July 2019. The risk levels selected during the emergency calls were compared to a reference standard, based on the National Advisory Committee for Aeronautics (NACA) scale, dichotomized to severe patient condition (NACA >/= 4) or stable patient condition (NACA < 4) in the field. The symptom-based dispatch performance was assessed using a receiver operating characteristic (ROC) curve. Contingency tables and a Fagan nomogram were used to measure the performance of the dispatch with or without L&S. Measurements were carried out by symptom, and a group of symptoms with specific protocols was compared to a group without specific protocols. Results: We found an acceptable area under the ROC curve of 0.7474, 95%CI (0.7448-0.7503) for the 148,979 assessments included in the study. Where the severity prevalence was 21%, 95%CI (20.8-21.2). The sensitivity of the L&S dispatch was 87.5%, 95%CI (87.1-87.8); and the specificity was 47.3%, 95%CI (47.0-47.6). When symptom-specific assessment protocols were used, the accuracy of the assessments was slightly improved. Conclusions: Performance measurement of Geneva's symptom-based dispatch system using standard diagnostic test performance measurement tools was possible. The performance was found to be comparable to other emergency medical dispatch systems using the same reference standard. However, the implementation of specific assessment protocols for each symptom may improve the accuracy of symptom-based dispatch systems. FAU - Larribau, Robert AU - Larribau R AUID- ORCID: 0000-0002-5200-4199 AD - Department of Anaesthesiology, Division of Emergency Medicine, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211 Geneva 14, Switzerland. FAU - Chappuis, Victor Nathan AU - Chappuis VN AD - Department of Anaesthesiology, Division of Emergency Medicine, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211 Geneva 14, Switzerland. FAU - Cottet, Philippe AU - Cottet P AD - Department of Anaesthesiology, Division of Emergency Medicine, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211 Geneva 14, Switzerland. FAU - Regard, Simon AU - Regard S AUID- ORCID: 0000-0002-3979-7593 AD - Department of Anaesthesiology, Division of Emergency Medicine, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211 Geneva 14, Switzerland. FAU - Deham, Helene AU - Deham H AD - Department of Anaesthesiology, Division of Emergency Medicine, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211 Geneva 14, Switzerland. FAU - Guiche, Florent AU - Guiche F AD - Department of Anaesthesiology, Division of Emergency Medicine, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211 Geneva 14, Switzerland. FAU - Sarasin, Francois Pierre AU - Sarasin FP AD - Department of Anaesthesiology, Division of Emergency Medicine, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211 Geneva 14, Switzerland. FAU - Niquille, Marc AU - Niquille M AD - Department of Anaesthesiology, Division of Emergency Medicine, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211 Geneva 14, Switzerland. LA - eng PT - Journal Article DEP - 20201109 PL - Switzerland TA - Int J Environ Res Public Health JT - International journal of environmental research and public health JID - 101238455 SB - IM MH - *Communication MH - Emergency Medical Service Communication Systems MH - *Emergency Medical Services MH - Humans MH - Prospective Studies MH - ROC Curve MH - Retrospective Studies MH - Sensitivity and Specificity MH - Switzerland MH - *Triage PMC - PMC7664854 OTO - NOTNLM OT - Fagan nomogram OT - communication centre OT - criteria-based dispatch OT - emergency medical dispatch OT - emergency medicine OT - medical priority dispatch OT - paramedical OT - symptom OT - triage scale COIS- The authors declare no conflict of interest. EDAT- 2020/11/14 06:00 MHDA- 2021/01/20 06:00 PMCR- 2020/11/01 CRDT- 2020/11/13 01:02 PHST- 2020/09/28 00:00 [received] PHST- 2020/11/01 00:00 [revised] PHST- 2020/11/06 00:00 [accepted] PHST- 2020/11/13 01:02 [entrez] PHST- 2020/11/14 06:00 [pubmed] PHST- 2021/01/20 06:00 [medline] PHST- 2020/11/01 00:00 [pmc-release] AID - ijerph17218254 [pii] AID - ijerph-17-08254 [pii] AID - 10.3390/ijerph17218254 [doi] PST - epublish SO - Int J Environ Res Public Health. 2020 Nov 9;17(21):8254. doi: 10.3390/ijerph17218254.