Accuracy of early shock recognition by paramedics: a multicenter prospective observational study in Japan

Objective: Early recognition of shock status by paramedics significantly affects patient prognosis; however, its accuracy remains unclear. This study assessed the diagnostic accuracy of paramedics in classifying shock and the characteristics of misdiagnoses. Materials and Methods: This multicenter prospective observational study compared the on-scene shock diagnoses of paramedics between July 2022 and June 2023 with those of physicians upon hospital arrival. Results: The overall diagnostic accuracy for shock revealed substantial agreement (k=0.64), whereas diagnosis by category ranged from slight to moderate agreement (k=0.11-0.51). Patients without systolic hypotension were more frequently missed during diagnosis. Conclusions: Enhanced clinical education is needed to improve the accuracy of shock diagnosis by paramedics.