Abstract
BackgroundThe pre-hospital assessment non-specific complaint (NSC) often applies to patients whose diagnosis does not match any other specific assessment correlating to particular symptoms or diseases, though some previous studies have found them to be related to serious underlying conditions. The aim was to identify whether the structural factors such as urgency according to the dispatch priority of the Emergency Medical Communication Centre (EMCC) or work load in the Emergency Medical Services (EMS) are predisposing factors for the assessment of NSC instead of a specific assessment.MethodsAll patients with assessed condition NSCs by the EMS to Södersjukhuset during 2011 (n = 493) were compared with gender- and age-matched controls (n = 493), which were randomly drawn from all patients with specific conditions in the EMS, regarding day of week, time of day and priority set by EMCC with chi-squared tests and multivariate logistic regression models.ResultsAmong patients with NSCs, more were females (58 %) and the median age was 82. Almost all patients were categorized with NSCs during the daytime (8 a.m. to 9 p.m.), i.e. 450 (91 %) as compared to 373 (75 %) of those with specific conditions (p < 0.01). The risk of having an EMS dispatched as low priority by the EMCC was almost doubled among patients with NSCs compared to controls (OR 1.97, 95 % CI 1.38–2.79).ConclusionsSince patients with NSCs appear most frequently during the hours with most transportations for the EMS, i.e. 10 a.m. to 2 p.m., and the risk of having the assessment NSC was doubled if the EMCC dispatched EMS as low priority, structural factors might be predisposing factors for the assessment.
Highlights
The pre-hospital assessment non-specific complaint (NSC) often applies to patients whose diagnosis does not match any other specific assessment correlating to particular symptoms or diseases, though some previous studies have found them to be related to serious underlying conditions
We have used the number of ambulance transportations per time unit as a proxy for work load and assumed that the higher demand for ambulance transports from the Emergency Medical Communication Centre (EMCC), given the fixed number of ambulances, the greater the pressure to shorten each ambulance mission, affecting the lower priority calls from EMCC the most
The frequency of patients with NSCs peaked between approximately 10.00 a.m. and 2.00 p.m. while the frequency of patients with specific conditions had its peak at approximately 9 a.m. as well as the peak for all Emergency Medical Services (EMS) transportations starts around 10.00 a.m (Fig. 1)
Summary
The pre-hospital assessment non-specific complaint (NSC) often applies to patients whose diagnosis does not match any other specific assessment correlating to particular symptoms or diseases, though some previous studies have found them to be related to serious underlying conditions. Patients described as decreased general condition [8], one of several nonspecific presentations incorporated in NSCs, have a higher in-hospital mortality rate, especially in low triage priorities, than all other presenting complaints [4, 8]. This high risk of suffering a serious condition implies a lack of recognition of the seriousness of the condition at hand. We hypothesized that the assessment of NSC was more common than assessments relating to specific conditions during periods of high work load for the EMS or when the EMCC indicates lower priority levels to the EMS. We have used the number of ambulance transportations per time unit as a proxy for work load and assumed that the higher demand for ambulance transports from the EMCC, given the fixed number of ambulances, the greater the pressure to shorten each ambulance mission, affecting the lower priority calls from EMCC the most
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