Abstract
BackgroundDyspnoea (breathing difficulty) is among the most commonly cited reasons for contacting emergency medical services (EMSs). Dyspnoea is caused by several serious underlying medical conditions and, based on patients individual needs and complex illnesses or injuries, ambulance staff are independently responsible for advanced care provision. Few large-scale prehospital studies have reviewed patients with dyspnoea. This study aimed to describe the characteristics and final outcomes of patients whose main symptom was classified as dyspnoea by the prehospital emergency nurse (PEN).MethodsThis retrospective observational study included patients aged > 16 years whose main symptom was dyspnoea. All the enrolled patients were assessed in the south-western part of Sweden by PENs during January and December, 2017. Of 7260 assignments (9% of all primary missions), 6354 fulfilled the inclusion criteria. Analysis was performed using descriptive statistics, and the tests used were odds ratios and Kaplan-Meier analysis.ResultsThe patients mean age was 73 years, and approximately 56% were women. More than 400 different final diagnostic codes (International Statistical Classification of Diseases and Related Health Problems [ICD]-10th edition) were observed, and 11% of the ICD-10 codes denoted time-critical conditions. The three most commonly observed aetiologies were chronic obstructive pulmonary disease (20.4%), pulmonary infection (17.1%), and heart failure (15%). The comorbidity values were high, with 84.4% having previously experienced dyspnoea. The overall 30-day mortality was 11.1%. More than half called EMSs more than 50 h after symptom onset.ConclusionsAmong patients assessed by PENs due to dyspnoea as the main symptom there were more than 400 different final diagnoses, of which 11% were regarded as time-critical. These patients had a severe comorbidity and 11% died within the first 30 days.
Highlights
Dyspnoea is among the most commonly cited reasons for contacting emergency medical services (EMSs)
Patients with the Emergency signs and symptoms (ESS) code 04 conformed 9% of all primary EMS missions and more than 60% of those patients were hospitalised (Fig. 1)
Men had a higher prevalence of previous heart disease, diabetes and renal disease whereas women had a higher prevalence of previous pulmonary disease, system disease and psychiatric disease (Table 1)
Summary
Dyspnoea (breathing difficulty) is among the most commonly cited reasons for contacting emergency medical services (EMSs). This study aimed to describe the characteristics and final outcomes of patients whose main symptom was classified as dyspnoea by the prehospital emergency nurse (PEN). The American Thoracic Society defines dyspnoea as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity” [2]. In addition to the physiological perspective, severe anxiety and fear are observed commonly in connection with dyspnoea This denotes that PENs have the responsibility of providing care aimed at increasing patients strength and focusing on their existential needs [8,9,10]. We aimed to describe the characteristics and final outcomes, overall and in relation to sex of patients receiving care from PENs and whose main symptom was dyspnoea
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