Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: an observational study
Anne Maree Kelly, Anna Holdgate, Gerben Keijzers, Sharon Klim, Colin A Graham, Simon Craig, Win Sen Kuan, Peter Jones, Charles Lawoko, Said Laribi, AANZDEM study group, Richard McNulty, DavidLord Cowell, Anna Holdgate, Nitin Jain, Tracey De Villecourt, Kendall Lee, Dane Chalkley, Lydia Lozzi, StephenEdward Asha, Martin Duffy, Gina Watkins, David Rosengren, Jae Thone, Shane Martin, Ulrich Orda, Ogilvie Thom, Frances Kinnear, Michael Watson, Rob Eley, Alison Ryan, DouglasGordon Morel, Jeremy Furyk, RichardD B Smith, Michelle Grummisch, Robert Meek, Pamela Rosengarten, Barry Chan, Helen Haythorne, Peter Archer, Simon Craig, Kathryn Wilson, Jonathan Knott, Peter Ritchie, Michael Bryant, Stephen MacDonald, Mlungisi Mahlangu, Peter Jones, Michael Scott, Thomas Cheri, Mai Nguyen, ColinA Graham, MelvinS Y Chor, ChiPang Wong, TaiWai Wong, Ling-Pong Leung, ChanKa Man, IsmailMohd Saiboon, NikHisamuddin Rahman, WeeYee Lee, FrancisChun Yue Lee, ShaunE Goh, WinSen Kuan, Sharon Klim, Kerrie Russell, Anne-Maree Kelly, Gerben Keijzers, Charles Lawoko, Anne Maree Kelly, Anna Holdgate, Gerben Keijzers, Sharon Klim, Colin A Graham, Simon Craig, Win Sen Kuan, Peter Jones, Charles Lawoko, Said Laribi, AANZDEM study group, Richard McNulty, DavidLord Cowell, Anna Holdgate, Nitin Jain, Tracey De Villecourt, Kendall Lee, Dane Chalkley, Lydia Lozzi, StephenEdward Asha, Martin Duffy, Gina Watkins, David Rosengren, Jae Thone, Shane Martin, Ulrich Orda, Ogilvie Thom, Frances Kinnear, Michael Watson, Rob Eley, Alison Ryan, DouglasGordon Morel, Jeremy Furyk, RichardD B Smith, Michelle Grummisch, Robert Meek, Pamela Rosengarten, Barry Chan, Helen Haythorne, Peter Archer, Simon Craig, Kathryn Wilson, Jonathan Knott, Peter Ritchie, Michael Bryant, Stephen MacDonald, Mlungisi Mahlangu, Peter Jones, Michael Scott, Thomas Cheri, Mai Nguyen, ColinA Graham, MelvinS Y Chor, ChiPang Wong, TaiWai Wong, Ling-Pong Leung, ChanKa Man, IsmailMohd Saiboon, NikHisamuddin Rahman, WeeYee Lee, FrancisChun Yue Lee, ShaunE Goh, WinSen Kuan, Sharon Klim, Kerrie Russell, Anne-Maree Kelly, Gerben Keijzers, Charles Lawoko
Abstract
Background: This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance.
Methods: This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics and comparisons of proportions.
Results: One thousand seven patients met inclusion criteria. Median age was 74 years (IQR 61-68) and 46.1 % were male. There was a high rate of co-morbidity and chronic medication use. The most common ED diagnoses were lower respiratory tract infection (including pneumonia, 22.7 %), cardiac failure (20.5%) and exacerbation of chronic obstructive pulmonary disease (19.7 %). ED disposition was hospital admission (including ICU) for 76.4 %, ICU admission for 5.6 % and death in ED in 0.9 %. Overall in-hospital mortality among admitted patients was 6.5 %.
Discussion: Patients transported by ambulance with shortness of breath make up a significant proportion of ambulance caseload and have high comorbidity and high hospital admission rate. In this study, >60 % were accounted for by patients with heart failure, lower respiratory tract infection or COPD, but there were a wide range of diagnoses. This has implications for service planning, models of care and paramedic training.
Conclusion: This study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services.
Keywords: Ambulance; Dyspnoea; Emergency department; Epidemiology.
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Source: PubMed