Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark.
Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland.
Scand J Trauma Resusc Emerg Med. 2021 Apr 20;29(1):59. doi: 10.1186/s13049-021-00874-6.
Emergency medical service patients are a vulnerable population and the risk of mortality is considerable. In Denmark, healthcare professionals receive 112-emergency calls and assess the main reason for calling. The main aim was to investigate which of these reasons, i.e. which symptoms or mechanism of injury, contributed to short-term risk of death. Secondary aim was to study 1-30 day-mortality for each symptom/ injury.
Historic population-based cohort study of emergency medical service patients calling 112 in the North Denmark Region between 01.01.2016-31.12.2018. We defined 1-day mortality as death on the same or the following day. The frequency of each symptom and cumulative number of deaths on day 1 and 30 together with 1- and 30-day mortality for each symptom/mechanism of injury is presented in proportions. Poisson regression with robust variance estimation was used to estimate incident rates (IR) of mortality with 95% confidence intervals (CI), crude and age and sex adjusted, mortality rates on day 1 per 100,000 person-year in the population.
The five most frequent reasons for calling 112 were "chest pain" (15.9%), "unclear problem" (11.9%), "accidents" (11.2%), "possible stroke" (10.9%), and "breathing difficulties" (8.3%). Four of these contributed to the highest numbers of deaths: "breathing difficulties" (17.2%), "unclear problem" (13.2%), "possible stroke" (8.7%), and "chest pain" (4.7%), all exceeded by "unconscious adult - possible cardiac arrest" (25.3%). Age and sex adjusted IR of mortality per 100,000 person-year was 3.65 (CI 3.01-4.44) for "unconscious adult - possible cardiac arrest" followed by "breathing difficulties" (0.45, CI 0.37-0.54), "unclear problem"(0.30, CI 0.11-0.17), "possible stroke"(0.13, CI 0.11-0.17) and "chest pain"(0.07, CI 0.05-0.09).
In terms of risk of death on the same day and the day after the 112-call, "unconscious adult/possible cardiac arrest" was the most deadly symptom, about eight times more deadly than "breathing difficulties", 12 times more deadly than "unclear problem", 28 times more deadly than "possible stroke", and 52 times more deadly than "chest pain". "Breathing difficulties" and "unclear problem" as presented when calling 112 are among the top three contributing to short term deaths when calling 112, exceeding both stroke symptoms and chest pain.
急救医疗服务患者是一个弱势群体，死亡率相当高。在丹麦，医护人员接听 112 紧急电话并评估主要呼叫原因。主要目的是调查这些原因中的哪些原因，即哪些症状或损伤机制，导致短期死亡风险。次要目的是研究每个症状/损伤的 1-30 天死亡率。
这是一项基于人群的历史队列研究，研究对象为 2016 年 1 月 1 日至 2018 年 12 月 31 日期间在丹麦北地区拨打 112 的急救医疗服务患者。我们将 1 天死亡率定义为同一天或次日死亡。以比例形式呈现每个症状的频率和第 1 天和第 30 天的累积死亡人数，以及每个症状/损伤机制的 1 天和 30 天死亡率。使用具有稳健方差估计的泊松回归来估计死亡率的发病率（IR），置信区间（CI）为 95%，粗死亡率和年龄及性别调整后，10 万人年的人群中第 1 天的死亡率为每 100,000 人。
拨打 112 的五个最常见原因是“胸痛”（15.9%）、“不明问题”（11.9%）、“事故”（11.2%）、“可能中风”（10.9%）和“呼吸困难”（8.3%）。其中四个导致死亡人数最多：“呼吸困难”（17.2%）、“不明问题”（13.2%）、“可能中风”（8.7%）和“胸痛”（4.7%），均超过“无意识成人-可能心搏骤停”（25.3%）。每 10 万人年调整后的年龄和性别死亡率发病率（IR）为“无意识成人-可能心搏骤停”（3.65，CI 3.01-4.44），其次是“呼吸困难”（0.45，CI 0.37-0.54），“不明问题”（0.30，CI 0.11-0.17），“可能中风”（0.13，CI 0.11-0.17）和“胸痛”（0.07，CI 0.05-0.09）。
就拨打 112 后的当天和次日死亡风险而言，“无意识成人/可能心搏骤停”是最致命的症状，比“呼吸困难”致命性高约 8 倍，比“不明问题”致命性高 12 倍，比“可能中风”致命性高 28 倍，比“胸痛”致命性高 52 倍。拨打 112 时出现的“呼吸困难”和“不明问题”是导致拨打 112 后短期死亡的前三大原因，超过中风症状和胸痛。
