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The influence of time on the accuracy of healthcare personnel to diagnose paediatric cardiac arrest by pulse palpation.

Resuscitation 2010 June
AIM: To determine time and accuracy diagnosing paediatric cardiac arrest (CA) by pulse palpation.

MATERIALS AND METHODS: Blinded rescuers (82 nurses, 71 doctors) palpated for a brachial pulse in 17 children (1 day-11 years) with non-pulsatile extracorporeal circulation for CA or cardiac failure. Timed rescuer decisions (pulse present/absent) were compared with non-blinded investigator decisions.

RESULTS: CA on 55 occasions was diagnosed by 42 (76%) rescuers in mean (+/-SD) time 30+/-19s. Experienced rescuers diagnosed CA in 25+/-14s, inexperienced rescuers in 37+/-24s (p=0.042). CA absent on 98 occasions was confirmed by 77 (79%) rescuers in 13+/-13s. Experienced rescuers confirmed absent CA in 9+/-5s, inexperienced rescuers in 21+/-19s (p=0.0001). Diagnosis of CA compared to confirmation of absence took longer by all rescuers (p<0.0001), experienced rescuers (p<0.0001) and inexperienced rescuers (p=0.018). Twenty-eight of 33 (85%) experienced doctors diagnosed CA or confirmed absence in 13+/-9s, 49 of 61 (80%) experienced nurses in 15+/-12s, 11 of 21 (52%) inexperienced nurses in 18+/-15s and 31 of 38 (82%) inexperienced doctors in 30+/-24s. Overall accuracy was 78% (95%CI 71-84%), sensitivity 0.76 (95%CI 0.64-0.86) and specificity 0.79 (95%CI 0.69-0.86). Experienced doctors were 85% accurate, inexperienced doctors 82%, experienced nurses 80%, inexperienced nurses 52%. Rescuers diagnosing quickly (<10s) had 90% accuracy, in 11-20s 77% accuracy and in 21-30s 62.5% accuracy (p=0.015).

CONCLUSIONS: Diagnosis of cardiac arrest by pulse palpation alone is unreliable. At least 30s is required but accuracy and speed are related to clinical experience.

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