Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Academic Emergency Medical Service, Region Stockholm, Stockholm, Sweden.
BMC Emerg Med. 2024 Oct 23;24(1):199. doi: 10.1186/s12873-024-01106-7.
It is a challenge for the ambulance service to identify which patients to convey to the emergency department (ED). Ideally this would be the patients with serious conditions requiring further care in the ED. However, patients presenting with non-specific chief complaints are difficult to prioritize and typically have normal or near normal vital signs despite up to one third having underlying serious conditions. The proportion of patients with serious conditions among non-conveyed patients with non-specific chief complaints (NSC) as assessed by ambulance clinicians is not known. Therefore, the primary aim was to study the proportion of serious conditions among conveyed and non-conveyed patients presenting to the ambulance service with NSCs. The secondary aim was to study the mortality rate among patients with NSCs in relation to conveyance and serious and nonserious conditions.
A retrospective cohort study of patients ≥ 18 years of age presenting with NSCs to the ambulance service in Stockholm Region between January 1st, 2013 and December 31st, 2013. Patients were identified via the ambulance service electronic health record and followed via records from the the National Patient Register and Causes of Death Registry at Sweden's National Board for Health and Welfare. Descriptive statistics as well as regression analyses were used.
A total of 4744 patients were included with a median age of 76 years. A serious condition was present in 1398 (29.5%) of the patients. After index assessment by the ambulance service, 3780 (79.7%) were conveyed of which 1334 (35.3%) had serious conditions, compared to 964 (20.3%) who were non-conveyed of which 64 (6.6%) had serious conditions. 30-day mortality was 372 (9.8%) in the conveyance group compared to 32 (3.3%) in the non-conveyance group. If serious conditions were present, the mortality rates were 269 (20.2%) in the conveyance group compared to 11 (17.2%) in the non-conveyance group.
The results show that serious conditions were more than five times more common among conveyed as compared to non-conveyed patients. Mortality rates were three times higher in the conveyance group as compared to the non-conveyance group. Our results suggest that the ambulance personnel play an important role in identifying patients with serious conditions, hence, likely to be in need of treatment in the ED.
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对于救护车服务来说，识别需要送往急诊部（ED）的患者是一项挑战。理想情况下，这应该是那些有严重病情需要在 ED 进一步治疗的患者。然而，出现非特异性主诉的患者很难确定优先级，尽管多达三分之一的患者有潜在的严重病情，但他们的生命体征通常正常或接近正常。由救护车临床医生评估的非特异性主诉（NSC）的非转院患者中严重病情的比例尚不清楚。因此，主要目的是研究在出现 NSC 时被送往救护车服务的患者与未被送往救护车服务的患者中严重病情的比例。次要目的是研究 NSC 患者的死亡率与转院、严重和非严重病情之间的关系。
这是一项回顾性队列研究，研究对象为 2013 年 1 月 1 日至 2013 年 12 月 31 日期间在斯德哥尔摩地区因 NSC 向救护车服务就诊的年龄≥18 岁的患者。患者通过救护车服务的电子健康记录进行识别，并通过瑞典国家卫生局和福利国家的全国患者登记处和死因登记处的记录进行随访。使用描述性统计和回归分析。
共纳入 4744 例患者，中位年龄为 76 岁。1398 例（29.5%）患者存在严重病情。在救护车服务进行指数评估后，3780 例（79.7%）被转院，其中 1334 例（35.3%）有严重病情，而 964 例（20.3%）未被转院，其中 64 例（6.6%）有严重病情。转院组 30 天死亡率为 372 例（9.8%），而非转院组为 32 例（3.3%）。如果存在严重病情，转院组的死亡率为 269 例（20.2%），而非转院组为 11 例（17.2%）。
结果表明，与非转院患者相比，转院患者中严重病情的比例高出五倍以上。与非转院组相比，转院组的死亡率高出三倍。我们的研究结果表明，救护车人员在识别有严重病情的患者方面发挥了重要作用，因此，这些患者可能需要在 ED 接受治疗。
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