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Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature125355
Source
Scand J Trauma Resusc Emerg Med. 2012;20:28
Publication Type
Article
Date
2012
Author
Charlotte Barfod
Marlene Mauson Pankoke Lauritzen
Jakob Klim Danker
György Sölétormos
Jakob Lundager Forberg
Peter Anthony Berlac
Freddy Lippert
Lars Hyldborg Lundstrøm
Kristian Antonsen
Kai Henrik Wiborg Lange
Author Affiliation
Department of Anaesthesia and Intensive Care, Hillerød Hospital, Denmark. cbar@hih.regionh.dk
Source
Scand J Trauma Resusc Emerg Med. 2012;20:28
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Denmark
Emergency Service, Hospital - statistics & numerical data
Female
Hospital Mortality
Humans
Intensive Care Units - statistics & numerical data
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Patient Admission - statistics & numerical data
Prognosis
Prospective Studies
Regression Analysis
Triage - methods - statistics & numerical data
Vital Signs
Young Adult
Abstract
Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT) system and the outcome measures; Admission to Intensive Care Unit (ICU) and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures.
The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT) and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, T(vitals), and presenting complaint, T(complaint). The more urgent of the two determines the final triage category, T(final). We retrieved 6279 unique adult patients admitted through the Emergency Department (ED) from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures.
The covariates, T(vitals), T(complaint) and T(final) were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO(2)), respiratory rate (RR), systolic blood pressure (BP) and Glasgow Coma Score (GCS). Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5%) and 'altered level of consciousness' (10.6%). More than half of the patients had a T(complaint) more urgent than T(vitals), the opposite was true in just 6% of the patients.
The HAPT system is valid in terms of predicting in-hospital mortality and ICU admission in the adult acute population. Abnormal vital signs are strongly associated with adverse outcome, while including the presenting complaint in the triage model may result in over-triage.
Notes
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Cites: Ugeskr Laeger. 2011 Oct 3;173(40):2490-321975184
Cites: J Emerg Med. 2010 Jan;38(1):70-918514465
PubMed ID
22490208 View in PubMed
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Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest.

https://arctichealth.org/en/permalink/ahliterature282560
Source
N Engl J Med. 2017 05 04;376(18):1737-1747
Publication Type
Article
Date
05-04-2017
Author
Kristian Kragholm
Mads Wissenberg
Rikke N Mortensen
Steen M Hansen
Carolina Malta Hansen
Kristinn Thorsteinsson
Shahzleen Rajan
Freddy Lippert
Fredrik Folke
Gunnar Gislason
Lars Køber
Kirsten Fonager
Svend E Jensen
Thomas A Gerds
Christian Torp-Pedersen
Bodil S Rasmussen
Source
N Engl J Med. 2017 05 04;376(18):1737-1747
Date
05-04-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cardiopulmonary Resuscitation
Denmark
Electric Countershock
Female
Humans
Hypoxia, Brain - epidemiology - etiology
Institutionalization - statistics & numerical data
Intention to Treat Analysis
Male
Middle Aged
Nursing Homes
Out-of-Hospital Cardiac Arrest - complications - mortality - therapy
Risk
Survival Analysis
Volunteers
Abstract
The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied.
We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes.
Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period. During the study period, among the 2084 patients who had cardiac arrests that were not witnessed by emergency medical services (EMS) personnel, the rate of bystander CPR increased from 66.7% to 80.6% (P
PubMed ID
28467879 View in PubMed
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Factors Associated With Successful Resuscitation After Out-of-Hospital Cardiac Arrest and Temporal Trends in Survival and Comorbidity.

https://arctichealth.org/en/permalink/ahliterature264009
Source
Ann Emerg Med. 2015 May;65(5):523-531.e2
Publication Type
Article
Interactive/Multimedia
Date
May-2015
Author
Helle Søholm
Christian Hassager
Freddy Lippert
Matilde Winther-Jensen
Jakob Hartvig Thomsen
Hans Friberg
John Bro-Jeppesen
Lars Køber
Jesper Kjaergaard
Source
Ann Emerg Med. 2015 May;65(5):523-531.e2
Date
May-2015
Language
English
Publication Type
Article
Interactive/Multimedia
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cardiopulmonary Resuscitation - mortality
Comorbidity
Databases, Factual
Denmark - epidemiology
Female
Humans
Logistic Models
Male
Middle Aged
Out-of-Hospital Cardiac Arrest - epidemiology - mortality - therapy
Patient Admission
Registries
Retrospective Studies
Young Adult
Abstract
Out-of-hospital cardiac arrest has an overall poor prognosis. We sought to identify what temporal trends and influencing factors existed for this condition in one region.
We studied consecutive out-of-hospital cardiac arrest patients from 2007 to 2011 with attempted resuscitation in Copenhagen. From an Utstein database, we assessed survival to admission and comorbidity with the Charlson comorbidity index from the National Patient Registry and employment status from the Danish Rational Economic Agents Model database. We used logistic regression analyses to identify factors associated with outcome.
Of a total of 2,527 attempted resuscitations in out-of-hospital cardiac arrest patients, 40% (n=1,015) were successfully resuscitated and admitted to the hospital. The strongest independent factors associated with successful resuscitation were shockable primary rhythm (multivariate odds ratio [OR]=3.9; 95% confidence interval [CI] 3.1 to 5.0), witnessed arrest (multivariate OR=3.5; 95% CI 2.7 to 4.6), and out-of-hospital cardiac arrest in a public area (multivariate OR=2.1; 95% CI 1.6 to 2.8), whereas no comorbidity (multivariate OR=1.1; 95% CI 0.8 to 1.45), sex (multivariate OR=1.14; 95% CI 0.91 to 1.44), and employment status (multivariate OR=1.17; 95% CI 0.89 to 1.56) were not independently associated with outcome. The number of patients with a high comorbidity burden (Charlson comorbidity index =3) increased during the study period (P trend
PubMed ID
25544733 View in PubMed
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The formation and design of the 'Acute Admission Database'- a database including a prospective, observational cohort of 6279 patients triaged in the emergency department in a larger Danish hospital.

https://arctichealth.org/en/permalink/ahliterature125354
Source
Scand J Trauma Resusc Emerg Med. 2012;20:29
Publication Type
Article
Date
2012
Author
Charlotte Barfod
Marlene Mauson Pankoke Lauritzen
Jakob Klim Danker
György Sölétormos
Peter Anthony Berlac
Freddy Lippert
Lars Hyldborg Lundstrøm
Kristian Antonsen
Kai Henrik Wiborg Lange
Author Affiliation
Department of Anaesthesia and Intensive Care, Hillerød Hospital, Hillerød, Denmark. cbar@hih.regionh.dk
Source
Scand J Trauma Resusc Emerg Med. 2012;20:29
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Databases, Factual
Denmark
Emergency Service, Hospital - statistics & numerical data
Female
Hospital Mortality
Humans
Intensive Care Units - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Middle Aged
Outcome Assessment (Health Care)
Patient Admission - statistics & numerical data
Patient Discharge - statistics & numerical data
Prospective Studies
Severity of Illness Index
Triage - statistics & numerical data
Abstract
Management and care of the acutely ill patient has improved over the last years due to introduction of systematic assessment and accelerated treatment protocols. We have, however, sparse knowledge of the association between patient status at admission to hospital and patient outcome. A likely explanation is the difficulty in retrieving all relevant information from one database. The objective of this article was 1) to describe the formation and design of the 'Acute Admission Database', and 2) to characterize the cohort included.
All adult patients triaged at the Emergency Department at Hillerød Hospital and admitted either to the observationary unit or to a general ward in-hospital were prospectively included during a period of 22 weeks. The triage system used was a Danish adaptation of the Swedish triage system, ADAPT. Data from 3 different data sources was merged using a unique identifier, the Central Personal Registry number; 1) Data from patient admission; time and date, vital signs, presenting complaint and triage category, 2) Blood sample results taken at admission, including a venous acid-base status, and 3) Outcome measures, e.g. length of stay, admission to Intensive Care Unit, and mortality within 7 and 28 days after admission.
In primary triage, patients were categorized as red (4.4%), orange (25.2%), yellow (38.7%) and green (31.7%). Abnormal vital signs were present at admission in 25% of the patients, most often temperature (10.5%), saturation of peripheral oxygen (9.2%), Glasgow Coma Score (6.6%) and respiratory rate (4.8%). A venous acid-base status was obtained in 43% of all patients. The majority (78%) had a pH within the normal range (7.35-7.45), 15% had acidosis (pH 7.45). Median length of stay was 2 days (range 1-123). The proportion of patients admitted to Intensive Care Unit was 1.6% (95% CI 1.2-2.0), 1.8% (95% CI 1.5-2.2) died within 7 days, and 4.2% (95% CI 3.7-4.7) died within 28 days after admission.
Despite challenges of data registration, we succeeded in creating a database of adequate size and data quality. Future studies will focus on the association between patient status at admission and patient outcome, e.g. admission to Intensive Care Unit or in-hospital mortality.
Notes
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Cites: J Trauma. 2009 Apr;66(4):1040-419359912
PubMed ID
22490233 View in PubMed
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Medical dispatchers recognise substantial amount of acute stroke during emergency calls.

https://arctichealth.org/en/permalink/ahliterature279344
Source
Scand J Trauma Resusc Emerg Med. 2016 Jul 07;24:89
Publication Type
Article
Date
Jul-07-2016
Author
Søren Viereck
Thea Palsgaard Møller
Helle Klingenberg Iversen
Hanne Christensen
Freddy Lippert
Source
Scand J Trauma Resusc Emerg Med. 2016 Jul 07;24:89
Date
Jul-07-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Denmark - epidemiology
Emergency Medical Service Communication Systems - organization & administration
Emergency Medical Services - methods
Female
Humans
Incidence
Male
Middle Aged
Registries
Stroke - diagnosis - epidemiology
Triage - methods
Abstract
Immediate recognition of stroke symptoms is crucial to ensure timely access to revascularisation therapy. Medical dispatchers ensure fast admission to stroke facilities by prioritising the appropriate medical response. Data on medical dispatchers' ability to recognise symptoms of acute stroke are therefore critical in organising emergency stroke care. We aimed to describe the sensitivity and positive predictive value of medical dispatchers' ability to recognise acute stroke during emergency calls, and to identify factors associated with recognition.
This was an observational study of 2653 consecutive unselected patients with a final diagnosis of stroke or transient ischemic attack (TIA). All admitted through the Emergency Medical Services Copenhagen, during a 2-year study period (2012-2014). Final diagnoses were matched with dispatch codes from the Emergency Medical Dispatch Centre. Sensitivity and positive predictive value were calculated. The effect of age, gender, and time-of-day was analysed using multivariable logistic regression.
The sensitivity was 66.2 % (95 % CI: 64.4 %-68.0 %), and the positive predictive value was 30.2 % (95 % CI: 29.1 %-31.4 %). The multivariable logistic regression analyses showed that emergency calls during daytime and a final diagnosis of TIA vs. intracerebral haemorrhage (ICH), was positively associated with recognition of stroke (OR 2.70, 95 % CI: 2.04-3.57).
This study reports a high rate of stroke recognition compared to other studies ranging from 31% to 74%. The high sensitivity is likely the result of a profound reorganisation of the Emergency Medical ServicesCopenhagen, including the introduction of EMDs with a medical profession, and a criteria-based dispatch tool. A recognition rate of 100 % is not obtainable without an inappropriate amount of false positive cases.
We report an overall high recognition of stroke by medical dispatchers. A final diagnosis of TIA, compared to ICH, was positively associated with recognition of acute stroke. Emergency medical dispatchers serve as the essential first step in ensuring fast-track stroke treatment, which would promote timely acute therapy.
Unique identifier: NCT02191514.
PubMed ID
27388490 View in PubMed
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Out-of-hospital cardiac arrests and outdoor air pollution exposure in Copenhagen, Denmark.

https://arctichealth.org/en/permalink/ahliterature116995
Source
PLoS One. 2013;8(1):e53684
Publication Type
Article
Date
2013
Author
Janine Wichmann
Fredrik Folke
Christian Torp-Pedersen
Freddy Lippert
Matthias Ketzel
Thomas Ellermann
Steffen Loft
Author Affiliation
Section of Environmental Health, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark. stl@sund.ku.dk
Source
PLoS One. 2013;8(1):e53684
Date
2013
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Air Pollution - adverse effects - statistics & numerical data
Denmark - epidemiology
Disease Susceptibility
Environmental Exposure - adverse effects - statistics & numerical data
Female
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest - epidemiology - etiology
Particulate Matter - adverse effects - analysis
Sex Distribution
Time Factors
Abstract
Cardiovascular disease is the number one cause of death globally and air pollution can be a contributing cause. Acute myocardial infarction and cardiac arrest are frequent manifestations of coronary heart disease. The objectives of the study were to investigate the association between 4 657 out-of-hospital cardiac arrests (OHCA) and hourly and daily outdoor levels of PM(10), PM(2.5), coarse fraction of PM (PM(10-2.5)), ultrafine particle proxies, NO(x), NO(2), O(3) and CO in Copenhagen, Denmark, for the period 2000-2010. Susceptible groups by age and sex was also investigated. A case-crossover design was applied. None of the hourly lags of any of the pollutants were significantly associated with OHCA events. The strongest association with OHCA events was observed for the daily lag4 of PM(2.5), lag3 of PM(10), lag3 of PM(10-2.5), lag3 of NO(x) and lag4 of CO. An IQR increase of PM(2.5) and PM(10) was associated with a significant increase of 4% (95% CI: 0%; 9%) and 5% (95% CI: 1%; 9%) in OHCA events with 3 days lag, respectively. None of the other daily lags or other pollutants was significantly associated with OHCA events. Adjustment for O(3) slightly increased the association between OHCA and PM(2.5) and PM(10). No susceptible groups were identified.
Notes
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PubMed ID
23341975 View in PubMed
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Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest.

https://arctichealth.org/en/permalink/ahliterature270661
Source
Circ Cardiovasc Qual Outcomes. 2015 May;8(3):268-76
Publication Type
Article
Date
May-2015
Author
Helle Søholm
Jesper Kjaergaard
John Bro-Jeppesen
Jakob Hartvig-Thomsen
Freddy Lippert
Lars Køber
Niklas Nielsen
Magaly Engsig
Morten Steensen
Michael Wanscher
Finn Michael Karlsen
Christian Hassager
Source
Circ Cardiovasc Qual Outcomes. 2015 May;8(3):268-76
Date
May-2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Denmark - epidemiology
Female
Humans
Male
Middle Aged
Neurologic Examination
Out-of-Hospital Cardiac Arrest - mortality
Prognosis
Quality of Health Care - statistics & numerical data
Resuscitation
Retrospective Studies
Tertiary Care Centers - statistics & numerical data
Abstract
Studies have found higher survival rates after out-of-hospital cardiac arrest and admission to tertiary heart centers. The aim was to examine the level-of-care at tertiary centers compared with nontertiary hospitals and the association with outcome after out-of-hospital cardiac arrest.
Consecutive out-of-hospital cardiac arrest patients (n=1078) without ST-segment-elevation myocardial infarction admitted to tertiary centers (54%) and nontertiary hospitals (46%) were included (2002-2011). Patient charts were reviewed focusing on level-of-care and comorbidity. Survival to discharge differed significantly with 45% versus 24% of patients discharged alive (P
PubMed ID
25944632 View in PubMed
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The significance of clinical experience on learning outcome from resuscitation training-a randomised controlled study.

https://arctichealth.org/en/permalink/ahliterature153870
Source
Resuscitation. 2009 Feb;80(2):238-43
Publication Type
Article
Date
Feb-2009
Author
Morten Lind Jensen
Freddy Lippert
Rasmus Hesselfeldt
Maria Birkvad Rasmussen
Simon Skibsted Mogensen
Michael Kammer Jensen
Torben Frost
Charlotte Ringsted
Author Affiliation
Centre for Clinical Education, Copenhagen University Hospital, Rigshospitalet, Denmark. morten.lind.jensen@gmail.com
Source
Resuscitation. 2009 Feb;80(2):238-43
Date
Feb-2009
Language
English
Publication Type
Article
Keywords
Adult
Cardiopulmonary Resuscitation - education
Clinical Competence
Denmark
Educational Measurement
Female
Humans
Male
Physicians
Prospective Studies
Retention (Psychology)
Single-Blind Method
Abstract
The impact of clinical experience on learning outcome from a resuscitation course has not been systematically investigated.
To determine whether half a year of clinical experience before participation in an Advanced Life Support (ALS) course increases the immediate learning outcome and retention of learning.
This was a prospective single blinded randomised controlled study of the learning outcome from a standard ALS course on a volunteer sample of the entire cohort of newly graduated doctors from Copenhagen University. The outcome measurement was ALS-competence assessed using a validated composite test including assessment of skills and knowledge.
The intervention was half a year of clinical work before an ALS course. The intervention group received the course after a half-year of clinical experience. The control group participated in an ALS course immediately following graduation.
Invitation to participate was accepted by 154/240 (64%) graduates and 117/154 (76%) completed the study. There was no difference between the intervention and control groups with regard to the immediate learning outcome. The intervention group had significantly higher retention of learning compared to the control group, intervention group mean 82% (CI 80-83), control group mean 78% (CI 76-80), P=0.002. The magnitude of this difference was medium (effect size=0.57).
Half a year of clinical experience, before participation in an ALS course had a small but statistically significant impact on the retention of learning, but not on the immediate learning outcome.
PubMed ID
19058890 View in PubMed
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Using e-learning for maintenance of ALS competence.

https://arctichealth.org/en/permalink/ahliterature149944
Source
Resuscitation. 2009 Aug;80(8):903-8
Publication Type
Article
Date
Aug-2009
Author
Morten Lind Jensen
Frederik Mondrup
Freddy Lippert
Charlotte Ringsted
Author Affiliation
Centre for Clinical Education, Copenhagen University and Capital Region, Rigshospitalet, Denmark. morten.lind.jensen@gmail.com
Source
Resuscitation. 2009 Aug;80(8):903-8
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Adult
Advanced Cardiac Life Support - education
Clinical Competence - standards
Denmark
Education, Distance - methods
Female
Humans
Male
Reproducibility of Results
Abstract
A well-suited e-learning program might be a feasible strategy to maintain competence following a resuscitation course.
This study had 2 aims: (1) to examine the effect of an e-learning program as a booster of competence acquired from an Advanced Life Support (ALS) course. (2) To identify factors related to the use of the e-learning program.
The study contained two parts pertaining to the two aims. The first part was a prospective single blinded randomised controlled study on junior doctors. The intervention was the monthly use of an e-learning program during one year and effect was measured as ALS-competence, a composite of a knowledge and skills test. The second part was a telephone interview of the intervention group. An interview guide was constructed based on existing knowledge of e-learning. In order to identify factors explaining the use of e-learning a univariate correlation was used to select significant variables to be included in a multiple regression analysis.
Of the 134 invited to participate, 103 accepted the invitation. There were 79/103 (77%) participants, 40/51 in the intervention group and 39/52 in the control group. There was no difference between the groups with regards to ALS competence. Only 'social interaction' was an individually significant factor influencing the use of the e-learning program.
This study did not demonstrate an effect of an e-learning program as a booster of competence acquired from an ALS course. The primary factor influencing the use of e-learning was the lack of social interaction.
PubMed ID
19570601 View in PubMed
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Why and when citizens call for emergency help: an observational study of 211,193 medical emergency calls.

https://arctichealth.org/en/permalink/ahliterature272908
Source
Scand J Trauma Resusc Emerg Med. 2015;23:88
Publication Type
Article
Date
2015
Author
Thea Palsgaard Møller
Annette Kjær Ersbøll
Janne Schurmann Tolstrup
Doris Østergaard
Søren Viereck
Jerry Overton
Fredrik Folke
Freddy Lippert
Source
Scand J Trauma Resusc Emerg Med. 2015;23:88
Date
2015
Language
English
Publication Type
Article
Keywords
Ambulances - utilization
Databases, Factual
Denmark
Emergencies
Emergency Medical Service Communication Systems - utilization
Emergency Medical Services - utilization
Female
Humans
Incidence
Male
Poisson Distribution
Quality Control
Retrospective Studies
Risk factors
Seasons
Time Factors
Urban Health Services - organization & administration
Urban Population
Abstract
A medical emergency call is citizens' access to pre-hospital emergency care and ambulance services. Emergency medical dispatchers are gatekeepers to provision of pre-hospital resources and possibly hospital admissions. We explored causes for access, emergency priority levels, and temporal variation within seasons, weekdays, and time of day for emergency calls to the emergency medical dispatch center in Copenhagen in a two-year study period (December 1(st), 2011 to November 30(th), 2013).
Descriptive analysis was performed for causes for access and emergency priority levels. A Poisson regression model was used to calculate adjusted ratio estimates for the association between seasons, weekdays, and time of day overall and stratified by emergency priority levels.
We analyzed 211,193 emergency calls for temporal variation. Of those, 167,635 calls were eligible for analysis of causes and emergency priority level. "Unclear problem" was the most frequent category (19%). The five most common causes with known origin were categorized as "Wounds, fractures, minor injuries" (13%), "Chest pain/heart disease" (11%), "Accidents" (9%), "Intoxication, poisoning, drug overdose" (8%), and "Breathing difficulties" (7%). The highest emergency priority levels (Emergency priority level A and B) were assigned in 81% of calls. In the analysis of temporal variation, the total number of calls peaked at wintertime (26%), Saturdays (16%), and during daytime (39%).
The pattern of citizens' contact causes fell into four overall categories: unclear problems, medical problems, intoxication and accidents. The majority of calls were urgent. The magnitude of unclear problems represents a modifiable factor and highlights the potential for further improvement of supportive dispatch priority tools or educational interventions at dispatch centers. Temporal variation was identified within seasons, weekdays and time of day and reflects both system load and disease occurrence. Data on contact patterns could be utilized in a public health perspective, benchmarking of EMS systems, and ultimately development of best practice in the area of emergency medicine.
Notes
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PubMed ID
26530307 View in PubMed
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