Andersen M S, Christensen E F, Jepsen S B, Nørtved J, Hansen J B, Johnsen S P
Research Department, Prehospital Emergency Medical Services, Aarhus, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Acta Anaesthesiol Scand. 2016 Mar;60(3):370-9. doi: 10.1111/aas.12654. Epub 2015 Dec 9.
Emergency Medical Dispatchers make decisions based on limited information. We aimed to investigate if adding demographic and hospitalization history information to the dispatch process improved precision.
This 30-day follow-up study evaluated time-critical emergencies in contact with the emergency phone number 112 in Denmark during 18 months. 'Time-critical' was defined as suspected First Hour Quintet (FHQ) (cardiac arrest, chest pain, stroke, difficulty breathing, trauma). The association of age, sex, and hospitalization history with adverse outcomes was examined using logistic regression. The predictive ability was assessed via area under the curve (AUC) and Hosmer-Lemeshow tests.
Of 59,943 patients (median age 63 years, 45% female), 44-45.5% had at least one chronic condition, 3880 (6.47%) died the day or the day after (primary outcome) calling 112. Age 30-59 was associated with increased adjusted odds ratio (OR) of death on day 1 of 3.59 [2.88-4.47]. Male sex was associated with an increased adjusted OR of death on day 1 of 1.37 [1.28-1.47]. Previous hospitalization with nutritional deficiencies (adjusted OR 2.07 [1.47-2.92]) and severe chronic liver disease (adjusted OR 2.02 [1.57-2.59]) was associated with a higher risk of death. For trauma patients, the discriminative ability of the model showed an AUC of 0.74 for death on day 1.
Increasing age, male sex, and hospitalization history was associated with increased risk of death on day 1 for FHQ 112 callers. Additional efforts are warranted to clarify the role for risk prediction tools in emergency medical dispatch.
紧急医疗调度员基于有限信息做出决策。我们旨在研究在调度过程中添加人口统计学和住院史信息是否能提高准确性。
这项为期30天的随访研究评估了丹麦18个月内拨打紧急电话号码112的时间紧迫型紧急情况。“时间紧迫型”定义为疑似首小时五联症（FHQ）（心脏骤停、胸痛、中风、呼吸困难、创伤）。使用逻辑回归分析年龄、性别和住院史与不良结局之间的关联。通过曲线下面积（AUC）和霍斯默-莱梅肖检验评估预测能力。
在59943名患者（中位年龄63岁，45%为女性）中，44%-45.5%至少有一种慢性病，3880名（6.47%）在拨打112当天或次日死亡（主要结局）。30-59岁年龄组在第1天死亡的调整优势比（OR）增加3.59[2.88-4.47]。男性在第1天死亡的调整OR增加1.37[1.28-1.47]。既往因营养缺乏住院（调整OR 2.07[1.47-2.92]）和严重慢性肝病住院（调整OR 2.02[1.57-2.59]）与死亡风险较高相关。对于创伤患者，该模型对第1天死亡的判别能力显示AUC为0.74。
年龄增加、男性以及住院史与拨打112的FHQ患者第1天死亡风险增加相关。有必要进一步努力阐明风险预测工具在紧急医疗调度中的作用。
