通过电话向急救医疗呼叫中心报告呼吸困难时早期需要呼吸支持的预测因素：一项回顾性队列研究。
Predictive factors for early requirement of respiratory support through phone call to Emergency Medical Call Centre for dyspnoea: a retrospective cohort study.
机构信息
Emergency Department, Toulouse University Hospital.
CERPOP - EQUITY, INSERM.
出版信息
Eur J Emerg Med. 2023 Dec 1;30(6):432-437. doi: 10.1097/MEJ.0000000000001066. Epub 2023 Aug 9.
BACKGROUND
Acute dyspnoea is a common symptom in Emergency Medicine, and severity assessment is difficult during the first time the patient calls the Emergency Medical Call Centre.
OBJECTIVE
To identify predictive factors regarding the need for early respiratory support in patients who call the Emergency Medical Call Centre for dyspnoea.
DESIGN, SETTINGS AND PARTICIPANTS: This retrospective cohort study carried out in the Emergency Medical Call Centre of the University Hospital of Toulouse from 1 July to 31 December 2019. Patients over the age of 15 who call the Emergency Medical Call Centre regarding dyspnoea and who were registered at the University Hospital or died before admission were included in our study.
OUTCOME MEASURE AND ANALYSIS
The primary end-point was early requirement of respiratory support [including high-flow oxygen, non-invasive ventilation (NIV) or mechanical ventilation after intubation] that was initiated by the physicians staffed ambulance before admission to the hospital or within 3 h after being admitted. Associations with patients' characteristics identified during Emergency Medical Call Centre calls were assessed with a backward stepwise logistic regression after multiple imputations for missing values.
MAIN RESULTS
During the 6-month inclusion period, 1425 patients called the Emergency Medical Call Centre for respiratory issues. After excluding 38 calls, 1387 were analyzed, including 208 (15%) patients requiring respiratory support. The most frequent respiratory support used was NIV (75%). Six independent predictive factors of requirement of respiratory support were identified: chronic β2-mimetics medication [odds ratio (OR) = 2.35, 95% confidence interval (CI) 1.61-3.44], polypnea (OR = 5.78, 95% CI 2.74-12.22), altered ability to speak (OR = 2.35, 95% CI 1.55-3.55), cyanosis (OR = 2.79, 95% CI 1.81-4.32), sweats (OR = 1.93, 95% CI 1.25-3) and altered consciousness (OR = 1.8, 95% CI 1.1-3.08).
CONCLUSION
During first calls for dyspnoea, six predictive factors are independently associated with the risk of early requirement of respiratory support.
背景
急性呼吸困难是急诊医学中的常见症状，患者首次拨打急救医疗呼叫中心时，其严重程度评估较为困难。
目的
确定与呼叫急救医疗呼叫中心的呼吸困难患者早期需要呼吸支持相关的预测因素。
设计、地点和参与者：本回顾性队列研究于 2019 年 7 月 1 日至 12 月 31 日在图卢兹大学医院的急救医疗呼叫中心进行。纳入标准为年龄>15 岁，因呼吸困难拨打急救医疗呼叫中心，且在大学医院登记或在入院前死亡的患者。
结局测量和分析
主要结局是由配备医生的救护车在入院前或入院后 3 小时内开始的早期呼吸支持[包括高流量吸氧、无创通气（NIV）或气管插管后机械通气]的需求。使用向后逐步逻辑回归评估急救医疗呼叫中心呼叫期间识别的患者特征与结局之间的关联，对于缺失值采用多重插补进行分析。
主要结果
在 6 个月的纳入期间，有 1425 名患者因呼吸问题拨打急救医疗呼叫中心。排除 38 次呼叫后，分析了 1387 次呼叫，其中 208 次（15%）患者需要呼吸支持。最常使用的呼吸支持是 NIV（75%）。确定了需要呼吸支持的 6 个独立预测因素：慢性β2-激动剂药物[比值比（OR）=2.35，95%置信区间（CI）1.61-3.44]、多呼吸（OR=5.78，95%CI 2.74-12.22）、言语能力改变（OR=2.35，95%CI 1.55-3.55）、发绀（OR=2.79，95%CI 1.81-4.32）、出汗（OR=1.93，95%CI 1.25-3）和意识改变（OR=1.8，95%CI 1.1-3.08）。
结论
在首次因呼吸困难拨打急救电话时，有 6 个预测因素与早期需要呼吸支持的风险独立相关。
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