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Background <p>Dyspnea is a common, high-acuity presentation in emergency medicine and is associated with substantial short-term mortality. Early etiological diagnosis remains challenging in the prehospital setting, particularly in physician-staffed mobile intensive care unit (MICU) systems.</p> Methods <p>We conducted a retrospective, single-center study of adults managed by a physician-staffed MICU for dyspnea in Orléans, France, between 2023 and 2024. Agreement between the prehospital MICU working diagnosis and the first in-hospital coded diagnosis was assessed among patients with paired diagnostic data using percent agreement and Cohen’s kappa with bootstrap 95% confidence intervals. Prehospital management was retrospectively assessed against key principles of acute dyspnea management. Modified Poisson regression with robust variance was used to explore 28-day mortality.</p> Results <p>Among 318 patients, 313 had paired diagnostic data. Overall agreement was 83.4% (261/313) with a Cohen’s kappa of 0.79 (95% bootstrap CI 0.74–0.84). The most frequent prehospital diagnostic categories were acute heart failure, acute COPD exacerbation, pneumonia, and asthma exacerbation. Among patients with paired diagnoses, 45 died within 28 days (14.4%). Mortality was higher in discordant than concordant cases (23.1% [12/52] vs. 12.6% [33/261]; crude RR: 1.83, 95% CI 1.01–3.29). In adjusted complete cases analysis (<i>n</i> = 269; 41 deaths), the association was attenuated aRR: 1.59 (95% CI 0.83–3.05). Prehospital management was judged consistent in 75.0% of discordant cases.</p> Conclusions <p>In this selected MICU population, agreement between prehospital working diagnoses and first in-hospital coded diagnoses was substantial. Most discordant cases still received consistent prehospital management. The association between discordance and 28-day mortality was attenuated after adjustment.</p>

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Diagnostic agreement between prehospital and in-hospital diagnoses for dyspnea: a retrospective study in a French prehospital emergency medical service

  • 期刊论文

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  • 发表日期：

    2026年6月23日

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  • Malik El-Boudali,
  • Prabakar Vaittinada Ayar,
  • Geoffroy Rousseau,
  • Dounia Hamdouche,
  • Romain Jouffroy,
  • Vincent Garrouste

摘要

Background

Dyspnea is a common, high-acuity presentation in emergency medicine and is associated with substantial short-term mortality. Early etiological diagnosis remains challenging in the prehospital setting, particularly in physician-staffed mobile intensive care unit (MICU) systems.

Methods

We conducted a retrospective, single-center study of adults managed by a physician-staffed MICU for dyspnea in Orléans, France, between 2023 and 2024. Agreement between the prehospital MICU working diagnosis and the first in-hospital coded diagnosis was assessed among patients with paired diagnostic data using percent agreement and Cohen’s kappa with bootstrap 95% confidence intervals. Prehospital management was retrospectively assessed against key principles of acute dyspnea management. Modified Poisson regression with robust variance was used to explore 28-day mortality.

Results

Among 318 patients, 313 had paired diagnostic data. Overall agreement was 83.4% (261/313) with a Cohen’s kappa of 0.79 (95% bootstrap CI 0.74–0.84). The most frequent prehospital diagnostic categories were acute heart failure, acute COPD exacerbation, pneumonia, and asthma exacerbation. Among patients with paired diagnoses, 45 died within 28 days (14.4%). Mortality was higher in discordant than concordant cases (23.1% [12/52] vs. 12.6% [33/261]; crude RR: 1.83, 95% CI 1.01–3.29). In adjusted complete cases analysis (n = 269; 41 deaths), the association was attenuated aRR: 1.59 (95% CI 0.83–3.05). Prehospital management was judged consistent in 75.0% of discordant cases.

Conclusions

In this selected MICU population, agreement between prehospital working diagnoses and first in-hospital coded diagnoses was substantial. Most discordant cases still received consistent prehospital management. The association between discordance and 28-day mortality was attenuated after adjustment.