Serious conditions among conveyed and non-conveyed patients presenting with nonspecific chief complaints to the ambulance service.

IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE
Robert Ivic-Morén, Katarina Bohm, Veronica Vicente, Emelie Arvidsson, Maaret Castrén, Lisa Kurland
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引用次数: 0

Abstract

Background: It is a challenge for the ambulance service to identify which patients to convey to the emergency department (ED). Ideally this would be the patients with serious conditions requiring further care in the ED. However, patients presenting with non-specific chief complaints are difficult to prioritize and typically have normal or near normal vital signs despite up to one third having underlying serious conditions. The proportion of patients with serious conditions among non-conveyed patients with non-specific chief complaints (NSC) as assessed by ambulance clinicians is not known. Therefore, the primary aim was to study the proportion of serious conditions among conveyed and non-conveyed patients presenting to the ambulance service with NSCs. The secondary aim was to study the mortality rate among patients with NSCs in relation to conveyance and serious and nonserious conditions.

Method: A retrospective cohort study of patients ≥ 18 years of age presenting with NSCs to the ambulance service in Stockholm Region between January 1st, 2013 and December 31st, 2013. Patients were identified via the ambulance service electronic health record and followed via records from the the National Patient Register and Causes of Death Registry at Sweden's National Board for Health and Welfare. Descriptive statistics as well as regression analyses were used.

Results: A total of 4744 patients were included with a median age of 76 years. A serious condition was present in 1398 (29.5%) of the patients. After index assessment by the ambulance service, 3780 (79.7%) were conveyed of which 1334 (35.3%) had serious conditions, compared to 964 (20.3%) who were non-conveyed of which 64 (6.6%) had serious conditions. 30-day mortality was 372 (9.8%) in the conveyance group compared to 32 (3.3%) in the non-conveyance group. If serious conditions were present, the mortality rates were 269 (20.2%) in the conveyance group compared to 11 (17.2%) in the non-conveyance group.

Conclusion: The results show that serious conditions were more than five times more common among conveyed as compared to non-conveyed patients. Mortality rates were three times higher in the conveyance group as compared to the non-conveyance group. Our results suggest that the ambulance personnel play an important role in identifying patients with serious conditions, hence, likely to be in need of treatment in the ED.

Trial registration: N/A.

向救护车服务提出非特异性主诉的转运病人和非转运病人的严重病情。
背景:对于救护车服务来说,确定哪些病人需要送往急诊科(ED)是一项挑战。最理想的情况是将病情严重、需要在急诊科接受进一步治疗的患者送往急诊科。然而,主诉无特异性的患者很难被优先考虑,他们通常生命体征正常或接近正常,尽管多达三分之一的患者有潜在的严重疾病。根据救护车临床医生的评估,在非特异性主诉(NSC)的非转运患者中,病情严重的患者所占比例尚不清楚。因此,研究的主要目的是了解因非特异性主诉而向救护车求诊的转运病人和非转运病人中病情严重的比例。次要目的是研究非典患者的死亡率与运送方式、严重和非严重病情的关系:方法:对2013年1月1日至2013年12月31日期间斯德哥尔摩地区因非典而就诊的18岁以上患者进行回顾性队列研究。研究人员通过救护车服务电子健康记录确定患者身份,并通过瑞典国家卫生和福利委员会的国家患者登记和死亡原因登记记录对患者进行跟踪调查。研究采用了描述性统计和回归分析:结果:共纳入了 4744 名患者,中位年龄为 76 岁。1398名患者(29.5%)病情严重。经救护车评估后,3780 名(79.7%)患者被转送,其中 1334 名(35.3%)病情严重,而 964 名(20.3%)患者未被转送,其中 64 名(6.6%)病情严重。转运组的 30 天死亡率为 372(9.8%),而非转运组为 32(3.3%)。如果病情严重,运送组的死亡率为 269(20.2%),而非运送组为 11(17.2%):结果表明,与非转运病人相比,转运病人出现严重病情的比例高出五倍多。转运组的死亡率是非转运组的三倍。我们的结果表明,救护人员在识别病情严重的患者方面发挥着重要作用,因此他们很可能需要在急诊室接受治疗:不适用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Emergency Medicine
BMC Emergency Medicine Medicine-Emergency Medicine
CiteScore
3.50
自引率
8.00%
发文量
178
审稿时长
29 weeks
期刊介绍: BMC Emergency Medicine is an open access, peer-reviewed journal that considers articles on all urgent and emergency aspects of medicine, in both practice and basic research. In addition, the journal covers aspects of disaster medicine and medicine in special locations, such as conflict areas and military medicine, together with articles concerning healthcare services in the emergency departments.
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