부산대학교 도서관

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jemermed.2007.11.054 Byline: Kristin Kuzma ([cor]), Karl A. Sporer, Glen E. Michael, Glen M. Youngblood Keywords: Emergency Medical Services; paramedic; peripheral intravenous catheter; infusions; intravenous; Emergency Medical Technicians; utilization Abstract: Prior studies have found that > 50% of prehospital intravenous catheters (i.v.s) were unutilized for treatment; however, few data are available regarding which patients benefit. The objective of this study was to examine the association between i.v. utilization in the field, paramedic primary impression, and patient presentation. Prehospital records for 34,585 patients were evaluated for i.v. placement and utilization in the field. Logistic regression was used to evaluate the association of primary impression, systolic blood pressure, heart rate, respiratory rate, Glasgow Coma Scale score, skin sign color, and capillary refill with placement and utilization. Intravenous catheters were placed in 60% of patients, but only 17% of the total was utilized. Examples of primary impressions with frequent initiation and low utilization (n = number in group, % of total with i.v. placed, % of total used): post-seizure (n = 989, 72%, 9%); weakness/dizzy/nausea (n = 3092, 69%, 20%), syncope/near-syncope (n = 2034, 81%, 26%), and abdominal pain (n = 1554, 70%, 14%). Fifty-eight percent with normal vital signs received an i.v. and 28-30% were utilized; hypotension: 80% received i.v. (odds ratio [OR] 1.211, p = 0.012), 70% utilized; hypertension: 61% received i.v. (OR 1.060, p = 0.027), 28% utilized; bradycardia: 82% received i.v. (OR 1.588, p < 0.0001), 51% utilized; tachycardia: 66% received i.v. (OR 1.152, p = 0.001), 33% utilized; bradypnea: 93% received i.v. (OR 1.638, p = 0.051), 86% utilized; tachypnea: 70% (OR 1.120, p = 0.024), 33% utilized. A Glasgow Coma Scale score < 15: 76% received i.v. (OR 1.672, p < 0.0001), 32% utilized. Abnormal skin color: 79% received i.v. (OR 1.691, p < 0.0001), 42% utilized. Certain primary impressions are associated with high i.v. initiation rates but infrequent utilization. High utilization rates were associated with hypotension, bradycardia, bradypnea, and abnormal skin signs. Study of high-frequency, low-utilization groups could reduce unnecessary i.v. placement. Author Affiliation: ([cor]) Case Western Reserve University, School of Medicine, Cleveland, Ohio (a ) Department of Medicine, University of California, San Francisco, San Francisco, California (a ) Department of Emergency Services, San Francisco General Hospital, San Francisco, California (As.) San Mateo County Emergency Medical Services Agency, San Mateo, California Article History: Received 26 March 2006; Revised 25 June 2007; Accepted 6 November 2007 Article Note: (footnote) Dr. Sporer receives compensation for medical direction from American Health and Safety Training, Inc. and the San Mateo Emergency Medical Services Agency.