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diagnostics
care pathway
prehospital
professional
clinical skills
management

How accurate is the prehospital diagnosis of hyperventilation syndrome?

02 November 2020
Features
02 November 2020
Volume 12 · Issue 11

Abstract

Background:

The literature suggests that hyperventilation syndrome (HVS) should be diagnosed and treated prehospitally.

Aim:

To determine diagnostic accuracy of HVS by paramedics and emergency medical technicians using hospital doctors' diagnosis as the reference standard.

Methods:

A retrospective audit was carried out of routine data using linked prehospital and in-hospital patient records of adult patients (≥18 years) transported via emergency ambulance to two emergency departments in the UK from 1 January 2012–31 December 2013. Accuracy was measured using sensitivity, specificity, positive and negative predictive values (NPV/PPVs) and likelihood ratios (LRs) with 95% confidence intervals.

Results:

A total of 19 386 records were included in the analysis. Prehospital clinicians had a sensitivity of 88% (95% CI [82–92%]) and a specificity of 99% (95% CI [99–99%]) for diagnosing HVS, with PPV 0.42 (0.37, 0.47), NPV 1.00 (1.00, 1.00), LR+ 75.2 (65.3, 86.5) and LR− 0.12 (0.08, 0.18).

Conclusions:

Paramedics and emergency medical technicians are able to diagnose HVS prehospitally with almost perfect specificity and good sensitivity.

Hyperventilation syndrome (HVS) is a collection of physical and biochemical reactions from an unnecessarily increased respiratory rate with an unknown or benign aetiology, which can be triggered by anxiety in the absence of external factors (Raphael and Dippenaar, 2019: 45). HVS is the term used for almost a century to describe this phenomenon, which encompasses a wide variety of symptoms and is diagnosed by excluding organic causes for these symptoms (Wilson, 2018).

Despite the difficulty surrounding HVS diagnosis and, particularly, the lack of HVS decision-making tools available for prehospital clinicians, the literature suggests that HVS should be diagnosed and treated prehospitally to avoid costly attendances to accident and emergency (A&E) departments (Pfortmueller et al, 2015).

The aim of this diagnostic research study was to measure how accurately paramedics and emergency medical technicians (EMTs) in the prehospital setting diagnosed HVS.

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Sensitivity and specificity
Hyperventilation syndrome
Panic attack
Emergency medical services
Diagnostic accuracy
Clinical diagnosis