Pre-hospital predictors of an adverse outcome among patients with dyspnoea as the main symptom assessed by pre-hospital emergency nurses - a retrospective observational study

Abstract

Background Dyspnoea is one of the most common reasons for patients contacting emergency medical services (EMS). Pre-hospital Emergency Nurses (PENs) are independently responsible for advanced care and to meet these patients individual needs. Patients with dyspnoea constitute a complex group, with multiple different final diagnoses and with a high risk of death. This study aimed to describe on-scene factors associated with an increased risk of a time-sensitive final diagnosis and the risk of death. Methods A retrospective observational study including patients aged ≥16 years, presenting mainly with dyspnoea was conducted. Patients were identified thorough an EMS database, and were assessed by PENs in the south-western part of Sweden during January to December 2017. Of 7260 missions (9% of all primary missions), 6354 were included. Among those, 4587 patients were randomly selected in conjunction with adjusting for unique patients with single occasions. Data were manually collected through both EMS- and hospital records and final diagnoses were determined through the final diagnoses verified in hospital records. Analysis was performed using multiple logistic regression and multiple imputations. Results Among all unique patients with dyspnoea as the main symptom, 13% had a time-sensitive final diagnosis. The three most frequent final time-sensitive diagnoses were cardiac diseases (4.1% of all diagnoses), infectious/inflammatory diseases (2.6%), and vascular diseases (2.4%). A history of hypertension, renal disease, symptoms of pain, abnormal respiratory rate, impaired consciousness, a pathologic ECG and a short delay until call for EMS were associated with an increased risk of a time-sensitive final diagnosis. Among patients with time-sensitive diagnoses, approximately 27% died within 30 days. Increasing age, a history of renal disease, cancer, low systolic blood pressures, impaired consciousness and abnormal body temperature were associated with an increased risk of death. Conclusions Among patients with dyspnoea as the main symptom, age, previous medical history, deviating vital signs, ECG pattern, symptoms of pain, and a short delay until call for EMS are important factors to consider in the prehospital assessment of the combined risk of either having a time-sensitive diagnosis or death.

Shedding Light Into The Black Box of Out-of-Hospital Respiratory Emergencies – A Retrospective Cohort Analysis of Discharge Diagnoses, Prehospital Diagnostic Accuracy, And Predictors of Mortality

“…Two former emergency department studies that included patients with any complaint also found that decreased vigilance was an independent risk factor for 30-day mortality (3,18). The same conclusion was made in an EMS study of patients with the complaint of dyspnea (19). Two of these studies (3,19) similarly reported that low oxygen saturation was a risk factor for mortality.…”

“…Two of these studies (3,19) similarly reported that low oxygen saturation was a risk factor for mortality. Patients with dyspnea have a higher risk of death with increasing age, which has also been shown by previous studies (9,19).…”

Clinical Predictors of Mortality in Prehospital Distress Calls by Emergency Medical Service Subscribers

“…Prior studies that assessed prehospital predictors of mortality demonstrated similar results: older age and low SBP [4][5][6][7][8][9][10] significantly increased mortality rates. In certain studies, increasing age [8] or low SBP [10] was indexed as part of an overall score of prehospital determinants that later was later used to assess mortality in the prehospital setting.…”

Can a Healthcare Quality Improvement Initiative Reduce Disparity in the Treatment Delay among ST-Segment Elevation Myocardial Infarction Patients with Different Arrival Modes? Evidence from 33 General Hospitals and Their Anticipated Impact on Healthcare during Disasters and Public Health Emergencies

“…due to the unavailability of relevant data for the patients. However, a previous publication suggested that these variables are not associated with in-hospital delay but might be associated with pre-hospital delay and mortality [27]. Moreover, in terms of measuring the effect on the in-hospital delay rather than clinical outcomes, we adjusted for Killip classification, which is positively associated with medical history of patients [16,28] and could account for the partial confounding effect of medical history.…”