Long-Term Mortality of Emergency Medical Services Patients - 29/08/17
, Christian J. Terkelsen, MD, DmSc c, Jan N. Sørensen, MD e, Søren B. Jepsen, MD f, Søren P. Johnsen, MD, PhD d, Erika F. Christensen, MD g, Mikkel S. Andersen, MD, PhD a, bAbstract |
Study objective |
Emergency medical services (EMS) provides out-of-hospital care to patients with life-threatening conditions, but the long-term outcomes of EMS patients are unknown. We seek to determine the long-term mortality of EMS patients in Denmark.
Methods |
We analyzed linked EMS, hospital, and vital status data from 3 of 5 geographic regions in Denmark. We included events from July 1, 2011, to December 31, 2012. We classified EMS events according to primary dispatch category (unconsciousness/cardiac arrest, accidents/trauma, chest pain, dyspnea, neurologic symptoms, and other EMS patients). The primary outcome was 1-year mortality adjusted for age, sex, and Charlson comorbidity index.
Results |
Among 142,125 EMS events, primary dispatch categories were unconsciousness or cardiac arrest 5,563 (3.9%), accidents or trauma 40,784 (28.7%), chest pain 20,945 (14.7%), dyspnea 9,607 (6.8%), neurologic symptoms 17,804 (12.5%), and other EMS patients 47,422 (33.4%). One-year mortality rates were unconscious or cardiac arrest 54.7% (95% confidence interval [CI] 53.4% to 56.1%), accidents or trauma 7.8 (95% CI 7.5% to 8.1%), chest pain 8.5% (95% CI 8.1% to 9.0%), dyspnea 27.7% (95% CI 26.7% to 28.7%), neurologic symptoms 14.1% (95% CI 13.6% to 14.7%), and other EMS patients 11.1% (95% CI 10.8% to 11.4%). Compared with other EMS conditions, adjusted 1-year mortality was higher in unconsciousness or cardiac arrest (risk ratio [RR] 2.6; 95% CI 2.5 to 2.7), dyspnea (RR 1.5; 95% CI 1.4 to 1.5), and in neurologic symptoms (RR 1.1; 95% CI 1.0 to 1.1), but lower in chest pain (RR 0.6; 95% CI 0.6 to 0.7) and accidents or trauma (RR 0.8; 95% CI 0.8 to 0.8).
Conclusion |
EMS patients with unconsciousness or cardiac arrest, dyspnea, and neurologic symptoms are at highest risk of long-term mortality. Our results suggest a potential for outcome improvement in these patients.
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| Please see page 367 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Henry E. Wang, MD, MS |
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| Author contributions: MTB, CJT, SPJ, EFC, and MSA designed the study. JNS, SBJ, and MSA were responsible for data collection. MTB and MSA conducted data management and data analysis. MTB drafted the article, and CJT, JNS, SBJ, SPJ, EFC, and MSA revised it. MTB takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). Dr. Bøtker receives lecture fees from USabcd A/S and royalties for electronic learning published by USabcd.org. The Prehospital Emergency Medical Services, Central Denmark Region, and the Health Research fund of the Central Denmark Region funded the study. TrygFonden, an independent foundation, funded original data extraction. |
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Vol 70 - N° 3
P. 366 - septembre 2017 Retour au numéro
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