Diagnosis and mortality in prehospital emergency patients transported to hospital: a population-based and registry-based cohort study

Christensen, Erika Frischknecht; Larsen, Torben; Jensen, Flemming Bøgh; Bendtsen, Mette Dahl; Hansen, Poul Anders; Johnsen, Søren Paaske; Christiansen, Christian Fynbo

doi:10.1136/bmjopen-2016-011558

Cited by 60 publications

(85 citation statements)

References 19 publications

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“…Women more often than men contacted OOH-PC, and a considerable part of calls to OOH-PC concerned children [29][30][31][32]. Two Danish studies on EMS contacts reported similar percentages of calls made by women, but these studies found a slightly lower mean age than found in our study [33,34]. This difference is likely to be due to our stratification into groups (children and adults) and exclusion of patients aged 13-18 years.…”

Section: Comparison With Existing Literaturecontrasting

confidence: 69%

Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

Huibers¹,

Carlsen²,

Moth³

et al. 2019

Preprint

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Background Patients in need of acute healthcare do not always contact the most suitable healthcare service provider. Contacting out-of-hours primary care for an urgent problem may delay care, whereas contacting emergency medical services for a non-urgent problem could ultimately affect patient safety. More insight into patient motives for contacting a specific healthcare provider may help optimise patient flows. This study aims to explore patient motives for contacting out-of-hours primary care and the emergency medical services in Denmark. Methods We conducted a cross-sectional observational study by sending a questionnaires to patients contacting out-of-hours primary care and emergency medical services, both of which can be directly contacted by patients, in two of five Danish regions in 2015. As we aimed to focus on the first access point, the emergency department was not included. The questionnaire included items on patient characteristics, health problem and 26 pre-defined motives. Descriptive analyses of patient characteristics and motives were conducted, stratified by the two healthcare service providers. Factors associated with contacting each of the two service providers were explored in a modified Poisson regression analysis, and adjusted risk ratios were calculated. Results Three key motives for contacting the two service providers were identified: ‘unpleasant symptoms’, ‘perceived need for prompt action’ and ‘perceived most suitable healthcare provider’. Other important motives were ‘need arose outside office hours’ and ‘wanted to talk to a physician’ (out-of-hours primary care) and ‘expected need for ambulance’ and ‘worried’ (emergency medical services). Higher probability of contacting the emergency medical services versus out-of-hours primary care was seen for most motives relating to own assessment and expectations, previous experience and knowledge, and own needs and wishes. Lower probability was seen for most motives relating to perceived barriers and benefits. Conclusions Patient motives for contacting the two healthcare service providers were partly overlapping. The study contributes with new knowledge on the complex decision-making process of patients in need of acute healthcare. This knowledge could help optimise existing healthcare services, such as patient safety and the service level, without increasing healthcare costs.

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Section: Comparison With Existing Literaturecontrasting

confidence: 69%

Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

Huibers¹,

Carlsen²,

Moth³

et al. 2019

Preprint

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“…23 The diagnoses comprising the calculation of the CCI are all extracted from admission at hospitals or outpatient treatments at hospitals. Thus, treatments administered at the general practitioners are not routinely collected at the National Patient register.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Characteristics and prognoses of patients treated by an anaesthesiologist-manned prehospital emergency care unit. A retrospective cohort study

et al. 2017

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ObjectiveWhen planning and dimensioning an emergency medical system, knowledge of the population serviced is vital. The amount of literature concerning the prehospital population is sparse. In order to add to the current body of literature regarding prehospital treatment, thus aiding future public health planning, we describe the workload of a prehospital anaesthesiologist-manned mobile emergency care unit (MECU) and the total population it services in terms of factors associated with mortality.ParticipantsThe study is a register-based study investigating all missions carried out by a MECU operating in a mixed urban/rural area in Denmark from 1 May 2006 to 31 December 2014. Information on missions was extracted from the local MECU registry and linked at the individual level to the Danish population-based databases, the National Patient Registry and the Civil Registration System.Primary and secondary outcome measuresPrimary outcome measures were number of missions and number of patient contacts. Secondary patient variables were mortality and association between mortality and age, sex, comorbidity, prior admission to hospital and response time.ResultsThe MECU completed 41 513 missions (mean 13.1 missions/day) having 32 873 patient contacts, corresponding to 19.2 missions and 15.2 patient encounters per 1000 patient years. Patient variables: the median age was 57 years (range 0–108 years), 42.8% (42.3% to 43.4%) were women. For patients admitted to hospital alive, 30-day mortality was 5.7% (5.4% to 6.0%); 90-day mortality was 8.1% (7.8% to 8.5%) while 2-year mortality was 16.4% (16.0% to 16.8%). Increasing age, male sex, comorbidity and prior admission to hospital but not response time were associated with mortality.ConclusionsMortality following an incident requiring the assistance of a MECU was high in the first 2 years following the incident. MECU response time assessed as a continuous parameter was not associated with patient outcome.

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“…In 2006 the North Denmark Region was the rst to implement an electronic prehospital medical record (amPHI ®). The patient data are accessible for the healthcare staff at the EMCC and incorporated into the hospitals' electronic medical record [3].…”

Section: Study Settingmentioning

confidence: 99%

“…However, actual knowledge about the disease pattern in patients attended by emergency ambulances is scarce, due to limited prehospital patient data. In the North Denmark Region, we established a linkage between patient data from ambulance runs and hospital diagnoses [3], examining patients brought to the hospital by ambulance after calling the national emergency number 112. The two non-speci c diagnostic groups, R ('symptoms, signs and abnormal clinical and laboratory ndings, not elsewhere classi ed') and Z ('factors in uencing health status and contact with health services') in the International Classi cation of Diseases, 10 th edition (ICD-10) [4], together constituted one-third of the hospital diagnoses given to the included patients [3].…”

Section: Introductionmentioning

confidence: 99%

Non-specific diagnoses are frequent in patients hospitalized after calling 112 and their mortality is high – a register-based Danish cohort study

Nielsen

Lorenzen

et al. 2020

Preprint

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Background The number of patients calling for an ambulance increases. A considerable number of patients receive a non-specific diagnosis at discharge from the hospital, and this could imply less serious acute conditions, but the mortality has only scarcely been studied. The aim of this study was to examine the most frequent sub-diagnoses among patients with hospital non-specific diagnoses after calling 112 and their subsequent mortality.Methods A historical cohort study of patients brought to the hospital by ambulance after calling 112 in 2007-2014 and diagnosed with a non-specific diagnosis, chapter R or Z, in the International Classification of Diseases, 10th edition (ICD-10). 1-day and 30-day mortality was analyzed by survival analyses and compared by the log-rank test. Results We included 74,847 ambulance runs in 53,937 unique individuals. The most frequent diagnoses were ‘unspecified disease’ (Z039), constituting 47.0 % (n 35,279). In children 0-9 years old, ‘febrile convulsions’ was the most frequent non-specific diagnosis used in 54.3 % (n 1,602). Overall, 1- and 30-day mortality was 2.2 % (n 1,205) and 6.0 % (n 3,258). The highest mortality was in the diagnostic group ‘suspected cardiovascular disease’ (Z035) and ‘unspecified disease’ (Z039) with 1-day mortality 2.6 % (n 43) and 2.4 % (n 589), and 30 day mortality of 6.32 % (n 104) and 8.1 % (n 1,975).Conclusion Among patients calling an ambulance and discharged with non-specific diagnoses the 1- and 30-day mortality, despite modest mortality percentages lead to a high number of deaths.

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Diagnosis and mortality in prehospital emergency patients transported to hospital: a population-based and registry-based cohort study

Cited by 60 publications

References 19 publications

Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

Characteristics and prognoses of patients treated by an anaesthesiologist-manned prehospital emergency care unit. A retrospective cohort study

Non-specific diagnoses are frequent in patients hospitalized after calling 112 and their mortality is high – a register-based Danish cohort study

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