The “unclear problem” category: an analysis of its patient and dispatch characteristics and its trend over time

Abstract

Background An effective emergency medical dispatch process is vital to provide appropriate prehospital care to patients. It increases patient safety and ensures the sustainable use of medical resources. Although Copenhagen has a sophisticated emergency medical services (EMS) system with a significant focus on public welfare, more than 10% of emergency cases are still being categorized as an "unclear problem category" (UPC) and are thus not categorized as "symptom-specific". Therefore, the objective of this research is to gain a better understanding of the patient and dispatch characteristics of emergency cases categorized as "unclear". Methods This register-based study based on medical emergency cases data describes patient and dispatch characteristics of emergency cases categorized as “unclear” through the use of numbers and proportions. Moreover, these cases were compared to non UPC cases. Use of UPC was stratified by month to determine the impact of alerting medical dispatchers to reduce its use. Results From 296,398 included cases UPC accounted for 11.4% of the cases. The median age of those triaged with the UPC was 66 years vs 58 years for individuals triaged with other symptom-specific categories. Moreover, after having been triaged with the UPC, 9,661 (34.7%) of the dispatched EMS vehicles ended up being cancelled. Sensitizing medical dispatchers about the use of the UPC likely contributed to the decreased use of the UPC over time. Conclusion The UPC has different dispatch characteristics than the symptom-specific categories, with potential negative effects on the medical dispatch process. Moreover, the median age of individuals triaged with the UPC is higher than those triaged with symptom-specific categories. Nonetheless, the use of the UPC decreased throughout the study period after the medical dispatchers were alerted about the implications of its use.

Diagnoses and mortality among prehospital emergency patients calling 112 with unclear problems: a population-based cohort study from Denmark

“…The Danish Index encompasses the criterion ‘unclear problem’ for patients calling with symptoms that cannot be categorised as a specific criterion such as chest pain or breathing difficulty [ 9 ]. Previous studies have reported ‘unclear problem’ to account for a considerable part of all emergency calls, ranging between 11 and 19% [ 6 , 10 , 11 ]. We recently documented that ‘unclear problem’ was the third most deadly criterion for patients calling for an ambulance, only exceeded by ‘possible cardiac arrest’ and ‘breathing difficulties’ [ 6 ].…”

Treat and release: an observational study of non-conveyed high-acuity dispatches in a Danish emergency medical system

“…The most frequent chief complaint was "chest pain", followed by "impaired consciousness" and "unclear problems", with the latter accounting for 11.6% of all patients. Previous studies have demonstrated that patients presenting with unclear or unspecific complaints are older [25]. Further, it has been shown that a significant proportion of those presenting with unspecific complaints sustained underlying severe conditions associated with increased morbidity and mortality [26].…”

Registered prodromal symptoms of out-of-hospital cardiac arrest among patients calling the medical helpline services

“…"Unclear problems" was the largest part of the unspecified category, its characteristics has been described elsewhere. [32] The presence of non-specific complaints also underline the difficulty for healthcare professionals to perceive a life-threatening symptom/condition. On the other hand, 12.5% of all OHCA patients that called within 30 days also had a face-to-face visit with their GPs.…”