PreHospen- Centre for Pre-hospital Research, Faculty of Caring, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.
Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
BMC Emerg Med. 2020 Nov 10;20(1):89. doi: 10.1186/s12873-020-00384-1.
Dyspnoea is one of the most common reasons for patients contacting emergency medical services (EMS). Pre-hospital Emergency Nurses (PENs) are independently responsible for advanced care and to meet these patients individual needs. Patients with dyspnoea constitute a complex group, with multiple different final diagnoses and with a high risk of death. This study aimed to describe on-scene factors associated with an increased risk of a time-sensitive final diagnosis and the risk of death.
A retrospective observational study including patients aged ≥16 years, presenting mainly with dyspnoea was conducted. Patients were identified thorough an EMS database, and were assessed by PENs in the south-western part of Sweden during January to December 2017. Of 7260 missions (9% of all primary missions), 6354 were included. Among those, 4587 patients were randomly selected in conjunction with adjusting for unique patients with single occasions. Data were manually collected through both EMS- and hospital records and final diagnoses were determined through the final diagnoses verified in hospital records. Analysis was performed using multiple logistic regression and multiple imputations.
Among all unique patients with dyspnoea as the main symptom, 13% had a time-sensitive final diagnosis. The three most frequent final time-sensitive diagnoses were cardiac diseases (4.1% of all diagnoses), infectious/inflammatory diseases (2.6%), and vascular diseases (2.4%). A history of hypertension, renal disease, symptoms of pain, abnormal respiratory rate, impaired consciousness, a pathologic ECG and a short delay until call for EMS were associated with an increased risk of a time-sensitive final diagnosis. Among patients with time-sensitive diagnoses, approximately 27% died within 30 days. Increasing age, a history of renal disease, cancer, low systolic blood pressures, impaired consciousness and abnormal body temperature were associated with an increased risk of death.
Among patients with dyspnoea as the main symptom, age, previous medical history, deviating vital signs, ECG pattern, symptoms of pain, and a short delay until call for EMS are important factors to consider in the prehospital assessment of the combined risk of either having a time-sensitive diagnosis or death.
呼吸困难是患者联系急诊医疗服务（EMS）的最常见原因之一。院前急救护士（PENs）独立负责高级护理，并满足这些患者的个体需求。呼吸困难的患者构成了一个复杂的群体，有多种不同的最终诊断，且死亡风险较高。本研究旨在描述与时间敏感的最终诊断风险增加和死亡风险相关的现场因素。
这是一项回顾性观察研究，纳入了主要表现为呼吸困难且年龄≥16 岁的患者。患者通过 EMS 数据库确定，并由瑞典西南部的 PENs 在 2017 年 1 月至 12 月期间进行评估。在 7260 次任务中（占所有初级任务的 9%），纳入了 6354 次任务。在这些任务中，随机选择了 4587 名患者，并结合单次就诊的独特患者进行了调整。数据通过 EMS 记录和医院记录进行手动收集，最终诊断通过医院记录中核实的最终诊断确定。分析采用多因素逻辑回归和多重插补法。
在所有以呼吸困难为主要症状的独特患者中，有 13%的患者有时间敏感的最终诊断。三个最常见的时间敏感的最终诊断是心脏病（所有诊断的 4.1%）、传染病/炎症（2.6%）和血管疾病（2.4%）。高血压、肾脏疾病、疼痛症状、异常呼吸频率、意识障碍、异常心电图和 EMS 呼叫延迟较短与时间敏感的最终诊断风险增加相关。在有时间敏感诊断的患者中，大约 27%的患者在 30 天内死亡。年龄增长、肾脏疾病史、癌症、低收缩压、意识障碍和体温异常与死亡风险增加相关。
在以呼吸困难为主要症状的患者中，年龄、既往病史、生命体征异常、心电图模式、疼痛症状以及 EMS 呼叫延迟较短是在院前评估时间敏感诊断或死亡的综合风险时需要考虑的重要因素。
