Department of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
Department of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark.
BMJ Open. 2019 Nov 21;9(11):e023049. doi: 10.1136/bmjopen-2018-023049.
To examine the association between time from emergency medical service vehicle dispatch to hospital arrival and 1-day and 30-day mortality.
Register-based cohort study.
North Denmark Region (≈8000 km, catchment population ≈600 000).
We included all highest priority dispatched ambulance transports in North Denmark Region in 2006-2012.
Using logistic regression and the g-formula approach, we examined the association between time from emergency dispatch to hospital arrival and mortality for presumed heart, respiratory, cerebrovascular and other presumed medical conditions, as well as traffic or other accidents, as classified by emergency dispatch personnel.
1-day and 30-day mortality.
Among 93 167 individuals with highest priority ambulances dispatched, 1948 (2.1%) were dead before the ambulance arrived and 19 968 (21.4%) were transported to the hospital under highest priority (median total prehospital time from dispatch to hospital arrival 47 min (25%-75%: 35-60 min); 95th percentile 84 min). Among 18 709 with population data, 1-day mortality was 10.9% (n=2038), and was highest for patients with dyspnoea (20.4%) and lowest for patients with traffic accidents (2.8%). Thirty-day mortality was 18.3% and varied between 36.6% (patients with dyspnoea) and 3.7% (traffic accidents). One-day mortality was not associated with total prehospital time, except for presumed heart conditions, where longer prehospital time was associated with decreased mortality: adjusted OR for >60 min vs 0-30 min was 0.61 (95% CI 0.40 to 0.91). For patients with dyspnoea, OR for >60 min vs 0-30 min was 0.90 (95% CI 0.56 to 1.45), for presumed cerebrovascular conditions OR 1.41 (95% CI 0.53 to 3.78), for other presumed medical conditions OR 0.84 (95% CI 0.70 to 1.02), for traffic accidents OR 0.65 (95% CI 0.29 to 1.48) and for other accidents OR 0.84 (95% CI 0.47 to 1.51). Similar findings were found for 30-day mortality.
In this study, where time from emergency dispatch to hospital arrival mainly was <80 min, there was no overall relation between this prehospital time measure and mortality.
探讨从紧急医疗服务车辆派遣到医院到达的时间与 1 天和 30 天死亡率之间的关系。
基于注册的队列研究。
丹麦北部地区（约 8000km，覆盖人口约 60 万）。
我们纳入了 2006-2012 年丹麦北部地区所有最高优先级派遣的救护车转运患者。
使用逻辑回归和 g 公式方法，我们根据紧急调度人员的分类，检查了从紧急调度到医院到达的时间与预期的心脏、呼吸、脑血管和其他预期医疗状况以及交通或其他事故导致的死亡率之间的关系。
1 天和 30 天死亡率。
在 93167 名接受最高优先级救护车派遣的患者中，有 1948 名（2.1%）在救护车到达前死亡，19968 名（21.4%）在医院接受最高优先级转运（中位数总院前时间从派遣到医院到达为 47 分钟（25%-75%：35-60 分钟）；第 95 个百分位数为 84 分钟）。在 18709 名有人群数据的患者中，1 天死亡率为 10.9%（n=2038），呼吸困难患者的死亡率最高（20.4%），交通事故患者的死亡率最低（2.8%）。30 天死亡率为 18.3%，在呼吸困难患者（36.6%）和交通事故患者（3.7%）之间差异较大。1 天死亡率与总院前时间无关，除了预期的心脏疾病，其中较长的院前时间与死亡率降低相关：>60 分钟与 0-30 分钟的调整比值比为 0.61（95%CI 0.40-0.91）。对于呼吸困难患者，>60 分钟与 0-30 分钟的比值比为 0.90（95%CI 0.56-1.45），预期的脑血管疾病比值比为 1.41（95%CI 0.53-3.78），其他预期的医疗状况比值比为 0.84（95%CI 0.70-1.02），交通事故比值比为 0.65（95%CI 0.29-1.48），其他事故比值比为 0.84（95%CI 0.47-1.51）。30 天死亡率也有类似的发现。
在这项研究中，从紧急调度到医院到达的时间主要<80 分钟，因此，这一院前时间测量与死亡率之间没有总体关系。
