Abstract
BackgroundA spontaneous subarachnoid haemorrhage (SAH) is one of the most critical neurological emergencies a dispatcher can face in an emergency telephone call. No study has yet investigated which symptoms are presented in emergency telephone calls for these patients. We aimed to identify symptoms indicative of SAH and to determine the sensitivity of these and their association (odds ratio, OR) with SAH.MethodsThis was a nested case–control study based on all telephone calls to the medical dispatch center of Copenhagen Emergency Medical Services in a 4-year time period. Patients with SAH were identified in the Danish National Patient Register; diagnoses were verified by medical record review and their emergency telephone call audio files were extracted. Audio files were replayed, and symptoms extracted in a standardized manner. Audio files of a control group were replayed and assessed as well.ResultsWe included 224 SAH patients and 609 controls. Cardiac arrest and persisting unconsciousness were reported in 5.8% and 14.7% of SAH patients, respectively. The highest sensitivity was found for headache (58.9%), nausea/vomiting (46.9%) and neck pain (32.6%). Among conscious SAH patients these symptoms were found to have the strongest association with SAH (OR 27.0, 8.41 and 34.0, respectively). Inability to stand up, speech difficulty, or sweating were reported in 24.6%, 24.2%, and 22.8%. The most frequent combination of symptoms was headache and nausea/vomiting, which was reported in 41.6% of SAH patients. More than 90% of headaches were severe, but headache was not reported in 29.7% of conscious SAH patients. In these, syncope was described by 49.1% and nausea/vomiting by 37.7%.ConclusionHeadache, nausea/vomiting, and neck pain had the highest sensitivity and strongest association with SAH in emergency telephone calls. Unspecific symptoms such as inability to stand up, speech difficulty or sweating were reported in 1 out of 5 calls. Interestingly, 1 in 3 conscious SAH patients did not report headache.Trial registration NCT03980613 (www.clinicaltrials.gov).
Highlights
In many countries, citizens can call an emergency telephone number if they are in urgent need of the emergency medical service (EMS)
Thirty-day survival was 100% for perimesencephalic haemorrhages, 80.39% for haemorrhages with no identified source and 86.16% for all others
Cardiac arrest and persisting unconsciousness were reported in 5.8% and 14.7% of subarachnoid haemorrhage (SAH) patients, respectively
Summary
Citizens can call an emergency telephone number if they are in urgent need of the emergency medical service (EMS). One of the most time-critical neurological emergencies EMDs can face is a spontaneous subarachnoid haemorrhage (SAH). These patients may present with a variety of symptoms. The primary aim of this study was to identify symptoms and combinations of symptoms, indicative of SAH during emergency telephone calls. A spontaneous subarachnoid haemorrhage (SAH) is one of the most critical neurological emergencies a dispatcher can face in an emergency telephone call. No study has yet investigated which symptoms are presented in emergency telephone calls for these patients. We aimed to identify symptoms indicative of SAH and to determine the sensitivity of these and their association (odds ratio, OR) with SAH
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have