Standardised data collection in prehospital critical care: a comparison of medical problem categories and discharge diagnoses

Abstract

Background Prehospital medical problem reporting is essential in the management of helicopter emergency medical services (HEMS) operations. The consensus-based template for reporting and documenting in physician-staffed prehospital services exists and the classification of medical problems presented in the template is widely used in research and quality improvement. However, validation of the reported prehospital medical problem is lacking. This study aimed to describe the in-hospital diagnoses, patient characteristics and medical interventions in different categories of medical problems. Methods This retrospective, observational registry study examined the 10 most common in-hospital International Statistical Classification of Disease (ICD-10) diagnoseswithin different prehospital medical problem categories, defined by the HEMS physician/paramedic immediately after the mission was completed. Data were gathered from a national HEMS quality registry and a national hospital discharge registry. Patient characteristics and medical interventions related to different medical problem categories are also described. Results A total of 33,844 patients were included in the analyses. All the medical problem categories included a broad spectrum of ICD-10 diagnoses (the number of diagnosis classes per medical problem category ranged from 73 to 403). The most frequent diagnoses were mainly consistent with the reported medical problems. Overlapping of ICD-10 diagnoses was mostly seen in two medical problem categories: stroke and acute neurology excluding stroke. Additionally, typical patient characteristics and disturbances in vital signs were related to adequate medical problem categories. Conclusions Medical problems reported by HEMS personnel have adequate correspondence to hospital discharge diagnoses. However, the classification of cerebrovascular accidents remains challenging.

A scenario based approach to optimizing cost-effectiveness of physician-staffed Helicopter Emergency Medical Services compared to ground-based Emergency Medical Services in Finland

“…Patients classified as ‘other’ were estimated to have an NNT of 25, informed by FHDB and expert judgment, reflecting the similar intensity of life support to trauma and intubation group. Due to the heterogeneity of patient groups [ 11 ], it is impossible to obtain exact information from this group.…”

“…The patient demographics of the Finnish HEMS system has been assessed in a recent study [ 11 ]. We identified the primary groups of patients that comprise the majority of those assisted by HEMS, with evidence suggesting these groups either gain medical or logistical support from HEMS.…”

Overcoming distance: an exploration of current practices of government and charity-funded critical care transport and retrieval organizations

“…Researchers in Scandinavia have demonstrated the feasibility of gathering detailed and comprehensive data nation-wide on all HEMS missions and treated patients using centralized and bespoke databases and data entry templates [ 55 – 57 ]. They also indicated that a national database is an important data source for research and quality improvement and could provide valuable insights into where HEMS operations could be improved [ 55 – 57 ]. Similarly, Greater Sydney Area HEMS described the long-term effectiveness of their airway registry on the completeness of documentation of prehospital rapid sequence intubation [ 58 ].…”

“…There are well documented challenges associated with conducting prehospital and transport medicine research, including the extensive clinical, ethical, and logistical factors limiting clinical trials and accurate data collection and the inherent heterogeneity of the patient populations and systems that allow for generalization of results. [ 57 , 59 ].…”