Predicting outcome for ambulance patients with dyspnea: a prospective cohort study

Lübcke, Kenneth; Kløjgaard, Torben Anders; Laursen, Birgitte Schantz; Mikkelsen, Søren; Weinreich, Ulla Møller; Christensen, Erika Frischknecht

doi:10.1002/emp2.12036

Cited by 5 publications

(8 citation statements)

References 22 publications

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“…[1,20,40] The diversity in identi cation methods highlights the diagnostic challenges of prehospital respiratory distress. [19,20,28,41] A reliable and straightforward prehospital identi er is essential not only for facilitating timely interventions [7,11,42,43] but also for ensuring accurate identi cation of patients for research purposes. [43,44] The need for inhaled bronchodilator treatment serves as an effective prehospital marker for signi cant respiratory distress.…”

Section: Discussionmentioning

confidence: 99%

Final Diagnoses and Mortality Rates Among Patients Receiving Inhaled Bronchodilators During Ambulance Transportation

Hagenau,

Mulvad,

Valentin

et al. 2024

Preprint

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Objectives: To assess final diagnoses and mortality rates (30-day and 1-year) in patients requiring inhaled bronchodilators administered by ambulance personnel. Methods: In a retrospective observational cohort study, patients experiencing respiratory distress and treated with inhaled bronchodilators in the prehospital setting within the Central Denmark Region during 2018-2019 were included. Results: The study included 6,318 ambulance transports, comprising 3,686 cases of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), 234 with community-acquired pneumonia (CAP), 320 with heart disease (HD), 233 adults with asthma, 1,674 with various other primary ICD-10 diagnoses (other ≥18 years), and 171 patients under 18 years. The 30-day mortality rate for all patients was 10.7% (95% CI 9.8-11.6), with zero deaths within 30 days among adults with asthma and those under 18. Excluding low mortality groups, AECOPD patients had the lowest 30-day mortality at 10.2% (95% CI 9.1-11.3), and HD patients the highest at 15.3% (95% CI 10.6-19.9). The 1-year overall mortality rate increased to 32.1% (95% CI 30.2-34.0), with mortality staying low for asthma and under-18 groups, while differences between other groups lessened and became insignificant. Conclusions: Patients requiring inhaled bronchodilator treatment in ambulances exhibit notably high mortality rates at 30 days and 1 year, except for those with asthma or under 18. The need for prehospital bronchodilators could serve as a clear and unmistakable marker for moderate to severe respiratory distress, enabling early intervention.

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Section: Discussionmentioning

confidence: 99%

Final Diagnoses and Mortality Rates Among Patients Receiving Inhaled Bronchodilators During Ambulance Transportation

Hagenau,

Mulvad,

Valentin

et al. 2024

Preprint

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“…However, it was evaluated in a small cohort of healthy volunteers and patients admitted to Internal Medicine Services, not in patients who call the Emergency Medical Call Centre. Other studies were carried out in pre-hospital settings in order to assess dyspnoea severity requiring initial vital parameters that are not available during the first phone call [9,10]. However, polypnea remains a significant risk factor for severe dyspnoea.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies show risk factors that contribute to identify high-risk dyspneic patients but also require access to initial vital parameters (i.e. respiration rate or SpO 2 ) [9,10]. Whereas this remains impossible for patients who call the Emergency Medical Call Centre for the first time.…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for early requirement of respiratory support through phone call to Emergency Medical Call Centre for dyspnoea: a retrospective cohort study

Balen,

Lamy,

Fraisse

et al. 2023

European Journal of Emergency Medicine

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Background Acute dyspnoea is a common symptom in Emergency Medicine, and severity assessment is difficult during the first time the patient calls the Emergency Medical Call Centre. Objective To identify predictive factors regarding the need for early respiratory support in patients who call the Emergency Medical Call Centre for dyspnoea. Design, settings and participants This retrospective cohort study carried out in the Emergency Medical Call Centre of the University Hospital of Toulouse from 1 July to 31 December 2019. Patients over the age of 15 who call the Emergency Medical Call Centre regarding dyspnoea and who were registered at the University Hospital or died before admission were included in our study. Outcome measure and analysis The primary end-point was early requirement of respiratory support [including high-flow oxygen, non-invasive ventilation (NIV) or mechanical ventilation after intubation] that was initiated by the physicians staffed ambulance before admission to the hospital or within 3 h after being admitted. Associations with patients’ characteristics identified during Emergency Medical Call Centre calls were assessed with a backward stepwise logistic regression after multiple imputations for missing values. Main results During the 6-month inclusion period, 1425 patients called the Emergency Medical Call Centre for respiratory issues. After excluding 38 calls, 1387 were analyzed, including 208 (15%) patients requiring respiratory support. The most frequent respiratory support used was NIV (75%). Six independent predictive factors of requirement of respiratory support were identified: chronic β2-mimetics medication [odds ratio (OR) = 2.35, 95% confidence interval (CI) 1.61–3.44], polypnea (OR = 5.78, 95% CI 2.74–12.22), altered ability to speak (OR = 2.35, 95% CI 1.55–3.55), cyanosis (OR = 2.79, 95% CI 1.81–4.32), sweats (OR = 1.93, 95% CI 1.25–3) and altered consciousness (OR = 1.8, 95% CI 1.1–3.08). Conclusion During first calls for dyspnoea, six predictive factors are independently associated with the risk of early requirement of respiratory support.

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“…This study is a supplement to a previous Danish project concerning patients with dyspnea transported to the hospital by ambulance [ 6 , 14 , 15 ]. In that study, a verbal numerical rating scale (0–10) was implemented.…”

Section: Methodsmentioning

confidence: 99%

How Patients Who Are Transported by Ambulance Experience Dyspnea and the Use of a Dyspnea Scale: A Qualitative Study

et al. 2022

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Approximately 7% of all dispatched ambulances in Denmark are for patients for whom breathing difficulties are the main cause for using ambulance services. Objective measurements are routinely carried out in the ambulances, but little is known of the patients’ subjective experience of dyspnea. The purpose of this study was to investigate how patients with acute dyspnea, transported to hospital by ambulance, experience their situation, along with their experience of the use of a dyspnea scale. The study was carried out in the North Denmark Region. Transcribed patient interviews and field notes were analyzed and interpreted with inspiration from Paul Ricoeur. For interviews, we included 12 patients with dyspnea who were transported to the hospital by ambulance: six women and six men all aged 60 years or above. Observations were made over six ambulance transports related to dyspnea. Three themes emerged: “anxiety”, “reassurance in the ambulance” and “acceptance of the dyspnea measurements in the ambulance”. Several patients expressed anxiety due to their dyspnea, which was substantiated by observations in the ambulance. The patients expressed different perspectives on what improved the situation (treatment, reassurance by ambulance professionals). The patients and the ambulance personnel were, in general, in favor of the dyspnea scale.

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Predicting outcome for ambulance patients with dyspnea: a prospective cohort study

Cited by 5 publications

References 22 publications

Final Diagnoses and Mortality Rates Among Patients Receiving Inhaled Bronchodilators During Ambulance Transportation

Final Diagnoses and Mortality Rates Among Patients Receiving Inhaled Bronchodilators During Ambulance Transportation

Predictive factors for early requirement of respiratory support through phone call to Emergency Medical Call Centre for dyspnoea: a retrospective cohort study

How Patients Who Are Transported by Ambulance Experience Dyspnea and the Use of a Dyspnea Scale: A Qualitative Study

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