Abstract
ObjectiveBreathing difficulties and respiratory diseases have been under-reported in Emergency Medical Services research, despite these conditions being prevalent with substantial mortality. Our aim was two-fold; 1) to investigate the diagnostic pattern and mortality among EMS patients to whom an ambulance was dispatched due to difficulty breathing, and 2) to investigate the initial symptoms and mortality for EMS patients diagnosed with respiratory diseases in hospital.MethodsPopulation-based historic cohort study in the North Denmark Region 2012–2015. We included two patient groups; 1) patients calling the emergency number with breathing difficulty as main symptom, and 2) patients diagnosed with respiratory diseases in hospital following an emergency call. Main outcome was estimated 1- and 30-day mortality rates.ResultsThere were 3803 patients with the symptom breathing difficulty, nearly half were diagnosed with respiratory diseases 47.3%, followed by circulatory diseases 13.4%, and symptoms and signs 12.0%. The 1-day mortality rate was highest for circulatory diseases, then respiratory diseases and other factors. Over-all 30-day mortality was 13.2%, and the highest rate was for circulatory diseases (17.7%) then respiratory diseases and other factors. A total of 4014 patients were diagnosed with respiratory diseases, 44.8% had the symptom breathing difficulty, 13.4% unclear problems and 11.3%. chest pain/heart disease. 1-day mortality rates were highest for decreased consciousness, then breathing difficulties and unclear problem. Over-all 30-day mortality rates were 12.5%, the highest with symptoms of decreased consciousness (19.1%), then unclear problem and breathing difficulty. There was an overlap of 1797 patients between the two groups.ConclusionsThe over-all mortality rates alongside the distribution of symptoms and diagnoses, suggest the breathing difficulty patient group is complex and has severe health problems. These findings may be able to raise awareness towards the patient group, and thereby increase focus on diagnostics and treatment to improve the patient outcome.
Highlights
BackgroundRespiratory failure is one of the “First Hour Quintet” which have been defined as the five time-critical conditions where immediate prehospital care by the Emergency Medical Services (EMS) yield the greatest effect, albeit rarely studied [1,2]
A total of 4014 patients were diagnosed with respiratory diseases, 44.8% had the symptom breathing difficulty, 13.4% unclear problems and 11.3%. chest pain/heart disease. 1-day mortality rates were highest for decreased consciousness, breathing difficulties and unclear
After exclusion of missing values, errors and multiple runs (Fig 1.), we included a total of 3 803 EMS patients who called 1-1-2 due to the symptom breathing problem and 4 014 EMS patients who were diagnosed with respiratory diseases in hospital
Summary
BackgroundRespiratory failure is one of the “First Hour Quintet” (alongside cardiac arrest, myocardial infarction, trauma, and stroke) which have been defined as the five time-critical conditions where immediate prehospital care by the Emergency Medical Services (EMS) yield the greatest effect, albeit rarely studied [1,2]. Previous studies have estimated that dyspnoea and difficulty in breathing led to 5.8% - 7.3% of all dispatched ambulances, and was the fourth most frequent cause for the most urgent EMS responses [5,6]. In a Danish study, patients with dyspnoea as cause for dispatching an ambulance were found to have the second highest cumulative mortality rates (1-day: 4.6% and 30-day: 12.3%) among the EMS patients, only surpassed by the symptom of unconsciousness/cardiac arrest [7]. Few studies have reported outcome measurements, but a recent Danish study found that while 30-day mortality rate among EMS patients diagnosed with cardiovascular diseases, decreased from 20.1% in 2007 to 12.2% in 2014, the mortality rate was unchanged and substantial, around 12.5%, during the same period for EMS patients with respiratory diseases
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