Symptoms presented during emergency telephone calls for patients with spontaneous subarachnoid haemorrhage

Asger Sonne, Sarita Egholm, Laurits Elgaard, Niklas Breindahl, Alice Herrlin Jensen, Vagn Eskesen, Freddy Lippert, Frans Boch Waldorff, Nicolai Lohse, Lars Simon Rasmussen, Asger Sonne, Sarita Egholm, Laurits Elgaard, Niklas Breindahl, Alice Herrlin Jensen, Vagn Eskesen, Freddy Lippert, Frans Boch Waldorff, Nicolai Lohse, Lars Simon Rasmussen

Abstract

Background: 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.

Methods: This 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.

Results: We 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%.

Conclusion: Headache, 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 ).

Keywords: Emergency medical dispatch; Emergency medical service; Headache; Spontaneous subarachnoid haemorrhage; Symptoms; Telephone; Triage; Visitation.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Inclusion flow chart for study of patients with subarachnoid haemorrhage (SAH). n number, EMDC Emergency Medical Coordination Center
Fig. 2
Fig. 2
Symptoms reported by patients with spontaneous subarachnoid haemorrhage and controls, in calls to the Emergency Medical Coordination Center. Crude odds ratios are presented with 95% confidence intervals. Two hundred twenty-four cases were included of which 178 were conscious. N number, OR odds ratio, 95% CI 95% confidence interval

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Source: PubMed

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