Abstract
BackgroundTriage systems are used in emergency medical services to systematically prioritize prehospital resources according to individual patient conditions. Previous studies have shown cases of preventable deaths in emergency medical services even when triage systems are used, indicating a potential undertriage among some conditions. The aim of this study was to investigate the triage level among patients diagnosed with perforated peptic ulcer (PPU) or peptic ulcer bleeding (PUB).MethodsIn a three-year period in Central Denmark Region, all patients hospitalized within 24 h after a 1-1-2 emergency call and who subsequently received either a PPU or a PUB (hereinafter combined and referred to as PPU/PUB) or a First Hour Quintet (FHQ: respiratory failure, stroke, trauma, cardiac chest pain, and cardiac arrest) diagnosis were investigated. A modified Poisson regression was used to estimate the relative risk of receiving the highest and lowest prehospital response level. Also, a linear regression analysis was used to estimate the relative risk of 30-day mortality.ResultsOf 8658 evaluated patients, 263 were diagnosed with PPU/PUB. After adjusting for relevant confounding variables, patients diagnosed with PPU/PUB were less likely to receive ambulance transportation compared to patients diagnosed with stroke, RR = 1.41 (CI: 1.28–1.56); trauma, RR = 1.28 (CI: 1.15–1.42); cardiac chest pain, RR = 1.47 (CI: 1.33–1.62); and cardiac arrest, RR = 1.44 (CI: 1.31–1.42). Among patients diagnosed with PPU/PUB, 6.5% (CI: 3.3–9.7) did not receive ambulance transportation. The proportion of patients not receiving ambulance transportation was higher among patients diagnosed with PPU/PUB compared to patients diagnosed with an FHQ diagnosis. The 30-day mortality rate among patients diagnosed with PPU/PUB was 7.8% (CI: 4.2–11.1). This was lower than the 30-day mortality rate among patients diagnosed with respiratory failure (P = 0.010), stroke (P = 0.001), and cardiac arrest (P < 0.001), but comparable to the 30-day mortality among patients diagnosed with cardiac chest pain (P = 0.080) and trauma (P = 0.281).ConclusionAmong patients calling 1-1-2, fewer patients diagnosed with PPU/PUB received ambulance transportation than patients diagnosed with FHQ diagnoses, despite a high mortality among patients diagnosed with PPU/PUB.
Highlights
Triage systems are used in emergency medical services to systematically prioritize prehospital resources according to individual patient conditions
After adjusting for age, sex, Charlson Comorbidity Index (CCI) score, and time of 1-1-2 call, the study showed that patients diagnosed with peptic ulcer (PPU)/ peptic ulcer bleeding (PUB) were less likely to receive a level A triage compared to patients diagnosed with stroke, relative risks (RR) = 1.41 (CI: 1.28–1.56); trauma, RR = 1.28 (CI: 1.15–1.42); cardiac chest pain, RR = 1.47 (CI: 1.33–1.62); and cardiac arrest, RR = 1.44 (CI: 1.31– 1.42)
The risk of level E triage was higher among patients diagnosed with PPU/PUB compared to patients diagnosed with a First Hour Quintet (FHQ) diagnosis except for patients diagnosed with respiratory failure, (RR = 0.60 (CI: 0.35–1.05), Table 2)
Summary
Triage systems are used in emergency medical services to systematically prioritize prehospital resources according to individual patient conditions. Previous studies have shown cases of preventable deaths in emergency medical services even when triage systems are used, indicating a potential undertriage among some conditions. Triage systems are used in emergency medical services (EMS) for systematic prioritization of prehospital resources according to the presumed severity and urgency of the individual patient’s condition. A previous Danish study suggested cases of preventable deaths in EMS despite applying the Danish Index, indicating a potential undertriage among some conditions [2]. This has been demonstrated in a Finnish EMS system [3]. Identifying other high-risk diseases may discover conditions susceptible for undertriage
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More From: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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