Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: an observational study
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Date
2016
Journal Title
Journal ISSN
Volume Title
Publisher
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Abstract
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.
Description
Keywords
Dyspnoea, Ambulance, Emergency department, Epidemiology
Citation
Kelly, A. M., Holdgate, A., Keijzers, G., Klim, S., Graham, C. A., Craig, S., ... & Laribi, S. (2016). Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: an observational study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 24(1), 1-7. DOI 10.1186/s13049-016-0305-5