ObjectiveKnowledge about patients after calling for an ambulance is limited to subgroups, such as patients with cardiac arrest, myocardial infarction, trauma and stroke, while population-based studies including all diagnoses are few. We examined the diagnostic pattern and mortality among all patients brought to hospital by ambulance after emergency calls.DesignRegistry-based cohort study.Setting and participantsWe included patients brought to hospital in an ambulance dispatched after emergency calls during 2007–2014 in the North Denmark Region (580 000 inhabitants). We reported hospital diagnosis according to the chapters of the International Classification of Diseases, 10th Edition (ICD-10), and studied death on days 1 and 30 after the call. Cohort characteristics and diagnoses were described, and the Kaplan-Meier method was used to estimate mortality and 95% CIs.ResultsIn total, 148 757 patients were included, mean age 52.9 (SD 24.3) years. The most frequent ICD-10 diagnosis chapters were: ‘injury and poisoning’ (30.0%), and the 2 non-specific diagnosis chapters: ‘symptoms and abnormal findings, not elsewhere classified’ (17.5%) and ‘factors influencing health status and contact with health services’ (14.1%), followed by ‘diseases of the circulatory system’ (10.6%) and ‘diseases of the respiratory system’ (6.7%). The overall 1-day mortality was 1.8% (CI 1.7% to 1.8%) and 30-day mortality 4.7% (CI 4.6% to 4.8%). ‘Diseases of the circulatory system’ had the highest 1-day mortality of 7.7% (CI 7.3% to 8.1%) accounting for 1209 deaths. After 30 days, the highest number of deaths were among circulatory diseases (2313), respiratory diseases (1148), ‘symptoms and abnormal findings, not elsewhere classified’ (1119) and ‘injury and poisoning’ (741), and 30 days mortality in percentage was 14.7%, 11.6%, 4.3% and 1.7%, respectively.ConclusionsPatients' diagnoses from hospital stay after calling 1-1-2 in this population-based study were distributed across all ICD-10 chapters. Mortality varied widely between diagnostic groups. Non-specific diagnoses accounted for one-third of the patients and contributed to mortality in terms of total number of deaths.

ObjectiveDemand for ambulances is growing. Nevertheless, knowledge is limited regarding diagnoses and outcomes in patients receiving emergency ambulances. This study aims to examine time trends in diagnoses and mortality among patients transported with emergency ambulance to hospital.DesignPopulation-based cohort study with linkage of Danish national registries.SettingThe North Denmark Region in 2007–2014.ParticipantsCohort of 148 757 patients transported to hospital by ambulance after calling emergency services.Main outcome measuresThe number of emergency ambulance service patients, distribution of their age, sex, hospital diagnoses, comorbidity, and 1-day and 30-day mortality were assessed by calendar year. Poisson regression with robust variance estimation was used to estimate both age-and sex-adjusted relative risk of death and prevalence ratios for Charlson Comorbidity Index (CCI) to allow comparison by year, with 2007 as reference year.ResultsThe annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48.6%, respectively. The proportion of injuries gradually declined, non-specific diagnoses increased, especially the last year. Proportion of patients with high comorbidity (CCI≥3) increased from 6.4% in 2007 to 9.4% in 2014, corresponding to an age- and sex-adjusted prevalence ratio of 1.27 (95% CI 1.16 to 1.39). The 1-day and 30 day mortality decreased from 2.40% to 1.21% and from 5.01% to 4.36%, respectively, from 2007 to 2014, corresponding to age-adjusted and sex-adjusted relative risk of 0.43 (95% CI 0.37 to 0.50) and 0.72 (95% CI 0.66 to 0.79), respectively.ConclusionDuring the 8-year period, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased.

Objective Breathing difficulties and respiratory diseases have been under-reported in Emergency Medical Services research, despite these conditions being prevalent with substantial mortality. Our aim was two-fold; 1) to investigate the diagnostic pattern and mortality among EMS patients to whom an ambulance was dispatched due to difficulty breathing, and 2) to investigate the initial symptoms and mortality for EMS patients diagnosed with respiratory diseases in hospital. Methods Population-based historic cohort study in the North Denmark Region 2012–2015. We included two patient groups; 1) patients calling the emergency number with breathing difficulty as main symptom, and 2) patients diagnosed with respiratory diseases in hospital following an emergency call. Main outcome was estimated 1- and 30-day mortality rates. Results There were 3803 patients with the symptom breathing difficulty , nearly half were diagnosed with respiratory diseases 47.3%, followed by circulatory diseases 13.4%, and symptoms and signs 12.0%. The 1-day mortality rate was highest for circulatory diseases , then respiratory diseases and o ther factors . Over-all 30-day mortality was 13.2%, and the highest rate was for circulatory diseases (17.7%) then respiratory diseases and other factors . A total of 4014 patients were diagnosed with respiratory diseases , 44.8% had the symptom breathing difficulty , 13.4% unclear problems and 11.3%. chest pain/heart disease . 1-day mortality rates were highest for decreased consciousness , then breathing difficulties and unclear problem . Over-all 30-day mortality rates were 12.5%, the highest with symptoms of decreased consciousness (19.1%), then unclear problem and breathing difficulty . There was an overlap of 1797 patients between the two groups. Conclusions The over-all mortality rates alongside the distribution of symptoms and diagnoses, suggest the breathing difficulty patient group is complex and has severe health problems. These findings may be able to raise awareness towards the patient group, and thereby increase focus on diagnostics and treatment to improve the patient outcome.

BackgroundPatients with proximal femoral neck fracture have a high short-term mortality, a high risk of postoperative complications, and impaired quality of life. One of the challenges related to the prehospital treatment of these patients is to administer systemic opioids fast and properly. Effective analgesic prehospital treatment ought be initiated rapidly in order to alleviate the stress that follows acute pain, to facilitate transportation, and to improve quality of care. The objectives of this study were to explore the prevalence of prehospital administration of intravenous fentanyl to patients with proximal femoral neck fracture in the ambulances and to assess risk factors for analgesic non-treatment.MethodsThis was a register-based observational cohort study of patients with proximal femoral neck fracture from the North Denmark Region transported by ambulance. The patients were identified via the Danish Interdisciplinary Hip Fracture Registry over a 3-year period from 1 July 2011 to 30 June 2014. This hospital registry contains data on several patient characteristics used for the risk factor analysis. Data on prehospital treatment (intravenous fentanyl) and patient monitoring were registered in an electronic prehospital patient record. A modified Poisson regression with robust standard errors was carried out with intravenous fentanyl as the primary binary outcome and the following explanatory variables: age, sex, Charlson Comorbidity Index score, housing, body mass index, type of fracture, fracture displacement, prior consultation with general practitioner, dispatch triage level, and time with ambulance personnel.ResultsIn total, 2,140 patients with proximal femoral neck fracture were transported by ambulance, of which 584 (27.3%, 95% CI: 25.4-29.2) were treated with intravenous fentanyl. Risk factors for non-treatment were: older age, male sex (RR 0.77, 95% CI: 0.64-0.91), institutional housing (RR 0.72, 95% CI: 0.56-0.92), medial fracture (RR 0.74, 95% CI: 0.60-0.92), short time with ambulance personnel, Charlson Comorbidity Index score > 1, year of fracture (2011), low levels of urgency at dispatch, and if seen by general practitioners prior to transport.DiscussionEducation of ambulance personnel in assessing and treating patients with hip fracture seems to be required. Also, future studies should consider alternative or supportive pain treatment options with suitable analgesic effects and side effects.ConclusionsFew patients with proximal femoral neck fracture were treated with intravenous fentanyl, and several risk factors were associated with prehospital analgesic non-treatment. Future prospective studies should explore covariates of socioeconomic, cultural, and psychological origin to provide further insight into the multifactorial causes of non-treatment of acute pain.

AimIn the light of increasing demand for emergency medical services (EMS)1 and a scarcity of studies about repeated EMS users,2 we aimed to examine the extent of repeated users and compare their characteristics and diagnoses with one-time users. Additional knowledge about repeated users may help identify appropriate alternative interventions.MethodsPopulation-based cohort study on patients to whom an emergency ambulance was dispatched after an emergency call in the North Denmark Region (5 80 000 inhabitants), 2012–2013. Each patient was included at first ambulance dispatch and followed one year. One-time users (one ambulance dispatched) were compared to repeated users divided into: moderate (2–4), frequent (5–9), and super users (≥10). Hospital diagnoses according to ICD-10 were retrieved.ResultsWe identified 36 210 patients corresponding to 46 203 emergency ambulances dispatched within the one-year follow-up. The results below are presented according to the four groups: one-time, moderate, frequent, and super users. Percentage of patients (ambulances): 83.2% (65.2%), 15.8% (28.9%), 0.9% (4.2%), 0.1% (1.7%). Male gender: 53%, 56%, 59%, 62%. Median age (interquartile range): 55 (29–72), 61 (41–77), 55 (40–71), 52 (37–68). Charlson comorbidity index ≥3: 3%, 12%, 16%, 13%. Percentage diagnosed with mental disorders (ICD-10 chapter 5; n=2,149): 4%, 6%, 12%, 19%. Respiratory diseases (ICD-10 chapter 10; n=3,033): 5%, 9%, 14%, 25%. Injuries, poisoning, and external causes (ICD-10 chapter 19, n=11,709): 33%, 20%, 15%, 9%.ConclusionRepeated EMS users constituted 16.8% of patients (34.8% of ambulances). Compared to one-time users, repeated users were more often male, had higher comorbidity, were more often diagnosed with mental and respiratory illnesses, and less often with injuries, poisoning, and external causes.ReferencesChristensen EF, Larsen TM, Jensen FB, Bendtsen MD, Hansen PA, Johnsen SP, et al. Diagnosis and mortality in prehospital emergency patients transported to hospital: a population-based and registry-based cohort study. BMJ Open2016;6(7):e011558.Scott J, Strickland AP, Warner K, Dawson P. Frequent callers to and users of emergency medical systems: a systematic review. Emerg Med J2014Aug;31(8):684–91.Conflict of interestNone declared.FundingNone declared.