Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.
Ambulance Victoria, Melbourne, Victoria, Australia.
Emerg Med Australas. 2023 Feb;35(1):48-55. doi: 10.1111/1742-6723.14053. Epub 2022 Aug 2.
There are currently limited data to inform the management of patients transported by emergency medical services (EMS) with dyspnoea. We aimed to describe the incidence, aetiology and outcomes of patients transported by EMS for dyspnoea using a large population-based sample and to identify factors associated with 30-day mortality.
Consecutive EMS attendances for dyspnoea in Victoria, Australia from January 2015 to June 2019 were included. Data were individually linked to hospital and mortality records to determine incidence, diagnoses, and outcomes. Factors associated with 30-day mortality were assessed using multivariable logistic regression.
During the study period, there were 2 505 324 cases attended by EMS, of whom 346 228 (14%) met inclusion criteria for dyspnoea. The incidence of EMS attendances for dyspnoea was 1566 per 100 000 person-years, and was higher in females, older patients and socially disadvantaged areas. Of the 271 204 successfully linked cases (median age 76 years; 51% women), 79% required hospital admission with a 30-day mortality of 9%. The most common final diagnoses (and 30-day mortality rates) were lower respiratory tract infection (13%, mortality 11%), chronic obstructive pulmonary disease (13%, mortality 6.4%), heart failure (9.1%, mortality 9.8%), arrhythmias (3.9%, mortality 4.4%), acute coronary syndromes (3.9%, mortality 9.5%) and asthma (3.2%, mortality 0.5%). Predictors of mortality included older age, male sex, pre-existing chronic kidney disease, heart failure or cancer, abnormal respiratory status or vital signs and pre-hospital intubation.
Dyspnoea is a common presentation with a broad range of causes and is associated with high rates of hospitalisation and death.
目前，关于因呼吸困难由紧急医疗服务（EMS）转运的患者的管理数据有限。本研究旨在使用大型基于人群的样本描述因呼吸困难由 EMS 转运的患者的发生率、病因和结局，并确定与 30 天死亡率相关的因素。
纳入 2015 年 1 月至 2019 年 6 月澳大利亚维多利亚州因呼吸困难由 EMS 转运的连续病例。通过个体数据链接至医院和死亡记录，以确定发生率、诊断和结局。使用多变量逻辑回归评估与 30 天死亡率相关的因素。
在研究期间，EMS 共处理了 2505324 例病例，其中 346228 例（14%）符合呼吸困难纳入标准。因呼吸困难由 EMS 转运的发生率为每 100000 人年 1566 例，在女性、老年患者和社会弱势群体中更高。在 271204 例成功链接的病例中（中位数年龄 76 岁；51%为女性），79%需要住院治疗，30 天死亡率为 9%。最常见的最终诊断（和 30 天死亡率）是下呼吸道感染（13%，死亡率 11%）、慢性阻塞性肺疾病（13%，死亡率 6.4%）、心力衰竭（9.1%，死亡率 9.8%）、心律失常（3.9%，死亡率 4.4%）、急性冠状动脉综合征（3.9%，死亡率 9.5%）和哮喘（3.2%，死亡率 0.5%）。死亡的预测因素包括年龄较大、男性、预先存在的慢性肾脏病、心力衰竭或癌症、异常呼吸状态或生命体征以及院前插管。
呼吸困难是一种常见的表现，病因广泛，与高住院率和死亡率相关。
