Department of Clinical Medicine, Centre for Prehospital and Emergency Research, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark.
Department of Respiratory Diseases, Aalborg University Hospital, Mølleparkvej 4, Aalborg, Denmark.
Scand J Trauma Resusc Emerg Med. 2020 Apr 3;28(1):24. doi: 10.1186/s13049-020-0715-2.
Acute dyspnoea is common among ambulance patients, but little is known of the patients' experience of symptom. We aimed to investigate ambulance patients initial perceived intensity of acute dyspnoea, and whether they experienced relief during prehospital treatment. Furthermore, to investigate the validity and feasibility of using a subjective dyspnoea score in the ambulance, and its association with objectively measured vital signs.
We performed a prospective observational study in the North Denmark Region from 1. July 2017 to 30. March 2019. We studied patients over the age of 18 to whom an ambulance was dispatched. Patients with acute dyspnoea assessed either at the emergency call or by ambulance professionals on scene were included. Patients were asked to assess dyspnoea on a 0 to 10 verbal numeric rating scale at the primary contact with the ambulance personnel and immediately before release at the scene or arrival at the hospital. Patients received usual prehospital medical treatment. We used visual inspection and Wilcoxon matched-pairs signed-ranks test, to assess dyspnoea scores and change hereof. Scatterplots and linear regression analyses were used to assess associations between the dyspnoea score and vital signs.
We included 3199 patients with at least one dyspnoea score. Of these, 2219 (69%) had two registered dyspnoea scores. The initial median dyspnoea score for all patients was median 8 (interquartile range 6-10). In 1676 (76%) of patients with two scores, the first score decreased from 8 (6-9) to 4 (2-5) during prehospital treatment. The score was unchanged for 370 (17%) and increased for 51 (2%) patients. Higher respiratory rate, blood pressure, and heart rate was seen with higher dyspnoea scores whereas blood oxygen saturation lowered.
We found that acute dyspnoea scored by ambulance patients, was high on a verbal numerical rating scale but decreased before arrival at hospital, suggesting relief of symptoms. The acute dyspnoea score was statistically associated with vital signs, but of limited clinical relevance; this stresses the importance of patients' experience of symptoms. To this end, the dyspnoea scale appears feasible in the prehospital setting.
急性呼吸困难在救护车患者中很常见，但对于患者的症状体验知之甚少。我们旨在调查救护车患者最初感知的急性呼吸困难的严重程度，以及他们在院前治疗过程中是否感到症状缓解。此外，我们还调查了在救护车上使用主观呼吸困难评分的有效性和可行性，以及其与客观测量的生命体征的相关性。
我们在 2017 年 7 月 1 日至 2019 年 3 月 30 日期间在丹麦北部地区进行了一项前瞻性观察研究。我们研究了被派往救护车的年龄在 18 岁以上的患者。包括在紧急呼叫时或由救护车专业人员在现场评估有急性呼吸困难的患者。患者在与救护车人员首次接触时以及在现场释放或到达医院前，被要求使用 0 到 10 的数字评分量表评估呼吸困难程度。患者接受了常规的院前医疗治疗。我们使用视觉检查和 Wilcoxon 配对符号等级检验，评估呼吸困难评分及其变化。散点图和线性回归分析用于评估呼吸困难评分与生命体征之间的相关性。
我们纳入了 3199 名至少有一次呼吸困难评分的患者。其中，2219 名（69%）有两次记录的呼吸困难评分。所有患者的初始中位数呼吸困难评分为 8（四分位距 6-10）。在有两次评分的 1676 名患者中，第一次评分从 8（6-9）降至 4（2-5）。370 名患者的评分不变，51 名患者的评分增加。较高的呼吸频率、血压和心率与较高的呼吸困难评分相关，而血氧饱和度降低。
我们发现，救护车患者的急性呼吸困难评分在数字评分量表上较高，但在到达医院前有所下降，表明症状缓解。急性呼吸困难评分与生命体征有统计学相关性，但临床相关性有限；这强调了患者对症状体验的重要性。为此，呼吸困难量表在院前环境中是可行的。
