Prehospital triage of patients diagnosed with perforated peptic ulcer or peptic ulcer bleeding: an observational study of patients calling 1-1-2

Abstract

BackgroundTriage systems are used in emergency medical services to systematically prioritize prehospital resources according to individual patient conditions. Previous studies have shown cases of preventable deaths in emergency medical services even when triage systems are used, indicating a potential undertriage among some conditions. The aim of this study was to investigate the triage level among patients diagnosed with perforated peptic ulcer (PPU) or peptic ulcer bleeding (PUB).MethodsIn a three-year period in Central Denmark Region, all patients hospitalized within 24 h after a 1-1-2 emergency call and who subsequently received either a PPU or a PUB (hereinafter combined and referred to as PPU/PUB) or a First Hour Quintet (FHQ: respiratory failure, stroke, trauma, cardiac chest pain, and cardiac arrest) diagnosis were investigated. A modified Poisson regression was used to estimate the relative risk of receiving the highest and lowest prehospital response level. Also, a linear regression analysis was used to estimate the relative risk of 30-day mortality.ResultsOf 8658 evaluated patients, 263 were diagnosed with PPU/PUB. After adjusting for relevant confounding variables, patients diagnosed with PPU/PUB were less likely to receive ambulance transportation compared to patients diagnosed with stroke, RR = 1.41 (CI: 1.28–1.56); trauma, RR = 1.28 (CI: 1.15–1.42); cardiac chest pain, RR = 1.47 (CI: 1.33–1.62); and cardiac arrest, RR = 1.44 (CI: 1.31–1.42). Among patients diagnosed with PPU/PUB, 6.5% (CI: 3.3–9.7) did not receive ambulance transportation. The proportion of patients not receiving ambulance transportation was higher among patients diagnosed with PPU/PUB compared to patients diagnosed with an FHQ diagnosis. The 30-day mortality rate among patients diagnosed with PPU/PUB was 7.8% (CI: 4.2–11.1). This was lower than the 30-day mortality rate among patients diagnosed with respiratory failure (P = 0.010), stroke (P = 0.001), and cardiac arrest (P < 0.001), but comparable to the 30-day mortality among patients diagnosed with cardiac chest pain (P = 0.080) and trauma (P = 0.281).ConclusionAmong patients calling 1-1-2, fewer patients diagnosed with PPU/PUB received ambulance transportation than patients diagnosed with FHQ diagnoses, despite a high mortality among patients diagnosed with PPU/PUB.

Disparities in prehospital and emergency surgical care among patients with perforated ulcers and a history of mental illness: a nationwide cohort study

“…However, an important system-related factor may also be the role of stigma and diagnostic overshadowing (e.g., assuming that a symptom is due to coexisting mental health condition rather than exploring the cause of the patient's symptoms) [ 13 – 16 , 20 ] . Another Danish study, investigating EMS responses among selected emergency diseases, found an overall tendency among patients with perforated ulcers, to receive a lower urgency of EMS response compared to other time-dependent diseases, i.e., only 64% of patients received an immediate EMS response [ 40 ]. Hence, recognizing the severity of symptoms in perforated peptic ulcers may be difficult for both patients and health professionals, regardless of mental health history.…”