Which symptoms pose the highest risk in patients calling for an ambulance? A population-based cohort study from Denmark

Abstract Background Emergency medical service patients are a vulnerable population and the risk of mortality is considerable. In Denmark, healthcare professionals receive 112-emergency calls and assess the main reason for calling. The main aim was to investigate which of these reasons, i.e. which symptoms or mechanism of injury, contributed to short-term risk of death. Secondary aim was to study 1-30 day-mortality for each symptom/ injury.Methods Historic population-based cohort study of emergency medical service patients calling 112 in the North Denmark Region between 01.01.2016–31.12.2018. We defined 1-day mortality as death on the same or the following day. The frequency of each symptom and cumulative number of deaths on day 1 and 30 together with 1- and 30-day mortality for each symptom/mechanism of injury is presented in proportions. Poisson regression with robust variance estimation was used to estimate incident rates (IR) of mortality with 95% confidence intervals (CI), crude and age and sex adjusted, mortality rates on day 1 per 100,000 person-year in the population.Results The five most frequent reasons for calling 112 were “chest pain” (15.9%), “unclear problem” (11.9%), “accidents” (11.2%), “possible stroke” (10.9%), and “breathing difficulties” (8.3%). Four of these contributed to the highest numbers of deaths: “breathing difficulties” (17.2%), “unclear problem” (13.2%), “possible stroke” (8.7%), and “chest pain” (4.7%), all exceeded by “unconscious adult – possible cardiac arrest” (25.3%). Age and sex adjusted IR per 100,000 person-year was 3.65 (CI 3.01-4.44) for “unconscious adult – possible cardiac arrest” followed by “breathing difficulties” (0.45, CI 0.37-0.54), “unclear problem”(0.30, CI 0.11-0.17), “possible stroke”(0.13 , CI 0.11-0.17) and “chest pain”(0.07, CI 0.05-0.09). Conclusion In terms of risk of death on the same day and the day after the 112-call, “unconscious adult/possible cardiac arrest” was the most deadly symptom, about eight times more deadly than “breathing difficulties”, 12 times more deadly than “unclear problem”, 28 times more deadly than “possible stroke”, and 52 times more deadly than “chest pain”. “Breathing difficulties” and “unclear problem” as presented when calling 112 are among the top three contributing to short term deaths when calling 112, exceeding both stroke symptoms and chest pain.

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Which symptoms pose the highest risk in patients calling for an ambulance? A population-based cohort study from Denmark

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00874-6 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Stine Ibsen ◽

Tim Alex Lindskou ◽

Christian H. Nickel ◽

Torben Kløjgård ◽

Erika Frischknecht Christensen ◽

...

Keyword(s):

Cardiac Arrest ◽

Cohort Study ◽

Chest Pain ◽

Emergency Medical Service ◽

Medical Service ◽

Population Based ◽

Mechanism Of Injury ◽

Short Term ◽

Risk Of Death ◽

Age And Sex

Abstract Background Emergency medical service patients are a vulnerable population and the risk of mortality is considerable. In Denmark, healthcare professionals receive 112-emergency calls and assess the main reason for calling. The main aim was to investigate which of these reasons, i.e. which symptoms or mechanism of injury, contributed to short-term risk of death. Secondary aim was to study 1–30 day-mortality for each symptom/ injury. Methods Historic population-based cohort study of emergency medical service patients calling 112 in the North Denmark Region between 01.01.2016–31.12.2018. We defined 1-day mortality as death on the same or the following day. The frequency of each symptom and cumulative number of deaths on day 1 and 30 together with 1- and 30-day mortality for each symptom/mechanism of injury is presented in proportions. Poisson regression with robust variance estimation was used to estimate incident rates (IR) of mortality with 95% confidence intervals (CI), crude and age and sex adjusted, mortality rates on day 1 per 100,000 person-year in the population. Results The five most frequent reasons for calling 112 were “chest pain” (15.9%), “unclear problem” (11.9%), “accidents” (11.2%), “possible stroke” (10.9%), and “breathing difficulties” (8.3%). Four of these contributed to the highest numbers of deaths: “breathing difficulties” (17.2%), “unclear problem” (13.2%), “possible stroke” (8.7%), and “chest pain” (4.7%), all exceeded by “unconscious adult – possible cardiac arrest” (25.3%). Age and sex adjusted IR of mortality per 100,000 person-year was 3.65 (CI 3.01–4.44) for “unconscious adult – possible cardiac arrest” followed by “breathing difficulties” (0.45, CI 0.37–0.54), “unclear problem”(0.30, CI 0.11–0.17), “possible stroke”(0.13, CI 0.11–0.17) and “chest pain”(0.07, CI 0.05–0.09). Conclusion In terms of risk of death on the same day and the day after the 112-call, “unconscious adult/possible cardiac arrest” was the most deadly symptom, about eight times more deadly than “breathing difficulties”, 12 times more deadly than “unclear problem”, 28 times more deadly than “possible stroke”, and 52 times more deadly than “chest pain”. “Breathing difficulties” and “unclear problem” as presented when calling 112 are among the top three contributing to short term deaths when calling 112, exceeding both stroke symptoms and chest pain.

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Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007−2014: a population-based cohort study from the North Denmark Region

BMJ Open ◽

10.1136/bmjopen-2016-014508 ◽

2017 ◽

Vol 7 (8) ◽

pp. e014508 ◽

Cited By ~ 17

Author(s):

Erika Frischknecht Christensen ◽

Mette Dahl Bendtsen ◽

Thomas Mulvad Larsen ◽

Flemming Bøgh Jensen ◽

Tim Alex Lindskou ◽

...

Keyword(s):

Cohort Study ◽

Relative Risk ◽

Population Based ◽

Ambulance Service ◽

Annual Number ◽

Adjusted Relative Risk ◽

Risk Of Death ◽

The North ◽

Emergency Ambulance ◽

Age And Sex

ObjectiveDemand for ambulances is growing. Nevertheless, knowledge is limited regarding diagnoses and outcomes in patients receiving emergency ambulances. This study aims to examine time trends in diagnoses and mortality among patients transported with emergency ambulance to hospital.DesignPopulation-based cohort study with linkage of Danish national registries.SettingThe North Denmark Region in 2007–2014.ParticipantsCohort of 148 757 patients transported to hospital by ambulance after calling emergency services.Main outcome measuresThe number of emergency ambulance service patients, distribution of their age, sex, hospital diagnoses, comorbidity, and 1-day and 30-day mortality were assessed by calendar year. Poisson regression with robust variance estimation was used to estimate both age-and sex-adjusted relative risk of death and prevalence ratios for Charlson Comorbidity Index (CCI) to allow comparison by year, with 2007 as reference year.ResultsThe annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48.6%, respectively. The proportion of injuries gradually declined, non-specific diagnoses increased, especially the last year. Proportion of patients with high comorbidity (CCI≥3) increased from 6.4% in 2007 to 9.4% in 2014, corresponding to an age- and sex-adjusted prevalence ratio of 1.27 (95% CI 1.16 to 1.39). The 1-day and 30 day mortality decreased from 2.40% to 1.21% and from 5.01% to 4.36%, respectively, from 2007 to 2014, corresponding to age-adjusted and sex-adjusted relative risk of 0.43 (95% CI 0.37 to 0.50) and 0.72 (95% CI 0.66 to 0.79), respectively.ConclusionDuring the 8-year period, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased.

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Prehospital pediatric emergencies in Austrian helicopter emergency medical service – a nationwide, population-based cohort study

Wiener klinische Wochenschrift ◽

10.1007/s00508-011-0006-z ◽

2011 ◽

Vol 123 (17-18) ◽

pp. 552-558 ◽

Cited By ~ 9

Author(s):

Harald F. Selig ◽

Helmut Trimmel ◽

Wolfgang G. Voelckel ◽

Michael Hüpfl ◽

Gerhard Trittenwein ◽

...

Keyword(s):

Cohort Study ◽

Emergency Medical Service ◽

Medical Service ◽

Helicopter Emergency Medical Service ◽

Population Based ◽

Pediatric Emergencies ◽

Emergency Medical

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Physician staffed emergency medical service for children: a retrospective population-based registry cohort study in Odense region, Southern Denmark

BMJ Open ◽

10.1136/bmjopen-2020-037567 ◽

2020 ◽

Vol 10 (8) ◽

pp. e037567

Author(s):

Morten Føhrby Overgaard ◽

Anssi Heino ◽

Sofie Allerød Andersen ◽

Owain Thomas ◽

Johan Holmén ◽

...

Keyword(s):

Heart Rate ◽

Cohort Study ◽

Emergency Medical Service ◽

Medical Service ◽

Service Providers ◽

Age Distribution ◽

Population Based ◽

Emergency Medical ◽

Population Based Registry ◽

Vital Parameters

ObjectivesThe aim of this study is to determine diagnostic patterns in the prehospital paediatric population, age distribution, the level of monitoring and the treatment initiated in the prehospital paediatric case. Hypothesis was that advanced prehospital interventions are rare in the paediatric patient population.SettingWe performed a retrospective population-based registry cohort study of children attended by a physician-staffed emergency medical service (EMS) unit (P-EMS), in the Odense area of Denmark during a 10-year study period.ParticipantsWe screened 44 882 EMS contacts and included 5043 children. Patient characteristics, monitoring and interventions performed by the P-EMS crews were determined.ResultsWe found that paediatric patients were a minority among patients attended by P-EMS units: 11.2% (10.9 to 11.5) (95% CI) of patients were children. The majority of the children were <5 years old; one-third being <2 years old. Respiratory problems, traffic accidents and febrile seizures were the three most common dispatch codes. Oxygen supplementation, intravenous access and application of a cervical collar were the three most common interventions. Oxygen saturation and heart rate were documented in more than half of the cases, but more than one-third of the children had no vital parameters documented. Only 22% of the children had respiratory rate, saturation, heart rate and blood pressure documented. Prehospital invasive procedures such as tracheal intubation (n=74), intraosseous access (n=22) and chest drainage (n=2) were infrequently performed.ConclusionPrehospital paediatric contacts are uncommon, more frequently involving smaller children. Monitoring or at least documentation of basic vital parameters is infrequent and may be an area for improvement. Advanced and potentially life-saving prehospital interventions provide a dilemma since these likely occur too infrequently to allow service providers to maintain their technical skills working solely in the prehospital environment.

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Multimorbidity Burden in Rheumatoid Arthritis: A Population-Based Cohort Study

The Journal of Rheumatology ◽

10.3899/jrheum.200971 ◽

2021 ◽

pp. jrheum.200971

Author(s):

Tina M. Gunderson ◽

Elena Myasoedova ◽

John M. Davis ◽

Cynthia S. Crowson

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Cumulative Incidence ◽

Index Date ◽

Population Based ◽

Olmsted County ◽

Risk Of Death ◽

Age And Sex ◽

Chronic Comorbidities

Objective To estimate the prevalence and incidence of multimorbidity in a populationbased cohort of patients with rheumatoid arthritis (RA) compared to subjects without RA. Methods Residents of Olmsted County, Minnesota with incident RA by 1987 ACR criteria in 1999-2013 were compared to age and sex-matched non-RA subjects from the same population. Twenty-five chronic comorbidities from a combination of the Charlson, Elixhauser and Rheumatic Disease Comorbidity Indexes were included, excluding rheumatic comorbidities. Aalen-Johansen methods were used to estimate the cumulative incidence of multimorbidity (2 or more chronic comorbidities) or substantial multimorbidity (5 or more), adjusting for the competing risk of death. Results The study included 597 patients with RA and 594 non-RA subjects (70% female, 90% Caucasian, mean age 55.5 years). At incidence/index date, the prevalence of multimorbidity was higher in RA than non-RA subjects (38% RA vs. 32% non-RA, p=0.021) while prevalence of substantial multimorbidity was similar (5% RA vs. 4% non- RA, p=0.68). During follow-up (median 11.6 years RA, 11.3 years non-RA), more RA patients developed multimorbidity (214 RA vs. 188 non-RA; adjusted hazard ratio (HR): 1.39; 95% confidence interval (CI):1.14–1.69). By 10 years after RA incidence/index, the cumulative incidence of multimorbidity was 56.5% among the RA patients (95%CI: 56.5-62.3%) compared with 47.9% among the non-RA (95%CI:42.8-53.7%). RA patients showed no evidence of increase in incidence of substantial multimorbidity (adjusted HR: 1.17; 95%CI: 0.93-1.47). Conclusion Patients with RA have both a higher prevalence of multimorbidity at the time of RA incidence as well as increased incidence thereafter.

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