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Romero-Sánchez JM, Sánchez-Almagro CP, White-Ríos M, Paloma-Castro O. Prevalence and clustering of NANDA-I nursing diagnoses in the pre-hospital emergency care setting: A retrospective records review study. J Clin Nurs 2024; 33:3128-3144. [PMID: 38235516 DOI: 10.1111/jocn.16996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/21/2023] [Accepted: 01/07/2024] [Indexed: 01/19/2024]
Abstract
AIM To determine the prevalence and clustering of NANDA-International nursing diagnoses in patients assisted by pre-hospital emergency teams. DESIGN Retrospective descriptive study of electronic record review. METHODS Episodes recorded during 2019, including at least a nursing diagnosis, were recovered from the electronic health records of a Spanish public emergency agency (N = 28,847). Descriptive statistics were used to characterize the sample and determine prevalence. A two-step cluster analysis was used to group nursing diagnoses. A comparison between clusters in sociodemographic and medical problems was performed. Data were accessed in November 2020. RESULTS Risk for falls (00155) (27.3%), Anxiety (00146) (23.2%), Acute pain (00132), Fear (00148) and Ineffective breathing pattern (00032) represented 96.1% of all recorded diagnoses. A six-cluster solution (n = 26.788) was found. Five clusters had a single high-prevalence diagnosis predominance: Risk for falls (00155) in cluster 1, Anxiety (00146) in cluster 2, Fear (00148) in cluster 3, Acute pain (00132) in cluster 4 and Ineffective breathing pattern (00032) in cluster 6. Cluster 5 had several high prevalence diagnoses which co-occurred: Risk for unstable blood glucose level (00179), Ineffective coping (00069), Ineffective health management (00078), Impaired comfort (00214) and Impaired verbal communication (00051). CONCLUSION Five nursing diagnoses accounted for almost the entire prevalence. The identified clusters showed that pre-hospital patients present six patterns of nursing diagnoses. Five clusters were predominated by a predominant nursing diagnosis related to patient safety, coping, comfort, and activity/rest, respectively. The sixth cluster grouped several nursing diagnoses applicable to exacerbations of chronic diseases. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Knowing the prevalence and clustering of nursing diagnoses allows a better understanding of the human responses of patients attended by pre-hospital emergency teams and increases the evidence of individualized/standardized care plans in the pre-hospital clinical setting. IMPACT What problem did the study address? There are different models of pre-hospital emergency care services. The use of standardized nursing languages in the pre-hospital setting is not homogeneous. Studies on NANDA-I nursing diagnoses in the pre-hospital context are scarce, and those available are conducted on small samples. What were the main findings? This paper reports the study with the largest sample among the few published on NANDA-I nursing diagnoses in the pre-hospital care setting. Five nursing diagnoses represented 96.1% of all recorded. These diagnoses were related to patients' safety/protection and coping/stress tolerance. Patients attended by pre-hospital care teams are grouped into six clusters based on the nursing diagnoses, and this classification is independent of the medical conditions the patient suffers. Where and on whom will the research have an impact? Knowing the prevalence of nursing diagnoses allows a better understanding of the human responses of patients treated in the pre-hospital setting, increasing the evidence of individualized and standardized care plans for pre-hospital care. REPORTING METHOD STROBE checklist has been used as a reporting method. NO PATIENT OR PUBLIC CONTRIBUTION Only patients' records were reviewed without further involvement.
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Affiliation(s)
- José Manuel Romero-Sánchez
- Nursing and Physiotherapy Department, Faculty of Nursing and Physiotherapy, Universidad de Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, Spain
| | - César Pedro Sánchez-Almagro
- Medical Emergency Center 061 (CES 061), Andalusian Health Service, Provincial Service 061 in Cádiz, Regional Government of Andalusia, Cádiz, Spain
| | - Melanie White-Ríos
- Hospital Punta de Europa, Andalusian Health Service, Algeciras, Cádiz, Spain
| | - Olga Paloma-Castro
- Nursing and Physiotherapy Department, Faculty of Nursing and Physiotherapy, Universidad de Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, Spain
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Spek M, Venekamp RP, Erkelens DCA, van Smeden M, Wouters LTCM, den Ruijter HM, Rutten FH, Zwart DL. Shortness of breath as a diagnostic factor for acute coronary syndrome in male and female callers to out-of-hours primary care. Heart 2024; 110:425-431. [PMID: 37827560 DOI: 10.1136/heartjnl-2023-323220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/23/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE Chest discomfort and shortness of breath (SOB) are key symptoms in patients with acute coronary syndrome (ACS). It is, however, unknown whether SOB is valuable for recognising ACS during telephone triage in the out-of-hours primary care (OHS-PC) setting. METHODS A cross-sectional study performed in the Netherlands. Telephone triage conversations were analysed of callers with chest discomfort who contacted the OHS-PC between 2014 and 2017, comparing patients with SOB with those who did not report SOB. We determine the relation between SOB and (1) High urgency allocation, (2) ACS and (3) ACS or other life-threatening diseases. RESULTS Of the 2195 callers with chest discomfort, 1096 (49.9%) reported SOB (43.7% men, 56.3% women). In total, 15.3% men (13.2% in those with SOB) and 8.4% women (9.2% in those with SOB) appeared to have ACS. SOB compared with no SOB was associated with high urgency allocation (75.9% vs 60.8%, OR: 2.03; 95% CI 1.69 to 2.44, multivariable OR (mOR): 2.03; 95% CI 1.69 to 2.44), but not with ACS (10.9% vs 12.0%; OR: 0.90; 95% CI 0.69 to 1.17, mOR: 0.91; 95% CI 0.70 to 1.19) or 'ACS or other life-threatening diseases' (15.0% vs 14.1%; OR: 1.07; 95% CI 0.85 to 1.36, mOR: 1.09; 95% CI 0.86 to 1.38). For women the relation with ACS was 9.2% vs 7.5%, OR: 1.25; 95% CI 0.83 to 1.88, and for men 13.2% vs 17.4%, OR: 0.72; 95% CI 0.51 to 1.02. For 'ACS or other life-threatening diseases', this was 13.0% vs 8.5%, OR: 1.60; 95% CI 1.10 to 2.32 for women, and 7.5% vs 20.8%, OR: 0.81; 95% CI 0.59 to 1.12 for men. CONCLUSIONS Men and women with chest discomfort and SOB who contact the OHS-PC more often receive high urgency than those without SOB. This seems to be adequate in women, but not in men when considering the risk of ACS or other life-threatening diseases.
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Affiliation(s)
- Michelle Spek
- Department of General Practice and Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Roderick P Venekamp
- Department of General Practice and Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Daphne C A Erkelens
- Department of General Practice and Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Maarten van Smeden
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Loes T C M Wouters
- Department of General Practice and Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Frans H Rutten
- Department of General Practice and Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Dorien L Zwart
- Department of General Practice and Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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Davis LL, McCoy TP, Riegel B, McKinley S, Doering LV, Moser DK. Association of Symptoms and Mode of Transportation to Emergency Department in Patients With Acute Coronary Syndrome. Dimens Crit Care Nurs 2023; 42:95-103. [PMID: 36720034 PMCID: PMC9897491 DOI: 10.1097/dcc.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) with symptoms matching their expectations of a heart attack are more likely to use emergency medical services (EMS) than not. OBJECTIVE To determine whether presenting symptom clusters are associated with EMS use in ACS patients and if EMS use or symptom clusters are associated with prehospital delay. METHODS This secondary analysis used data from the PROMOTION trial, a randomized clinical trial that enrolled 3522 subjects with a history of or at risk for ACS from 5 sites in the United States, Australia, and New Zealand. Subjects were randomized to usual care or an educational intervention to reduce prehospital delay. During the 2-year follow-up, subjects admitted for ACS were asked about symptoms, time of symptom onset, and mode of transportation to the hospital. Symptoms were grouped into classic ACS, pain symptoms, and stress symptoms clusters. RESULTS Of 3522 subjects enrolled, 331 sought care for ACS during follow-up; 278 had transportation mode documented; 121 (44%) arrived via EMS. Classic ACS plus pain symptoms (adjusted odds ratio [AOR], 2.66; P = .011), classic ACS plus stress symptoms (AOR, 2.61; P = .007), and classic ACS plus both pain and stress symptoms (AOR, 3.90; P = .012) were associated with higher odds of EMS use versus classic ACS symptoms alone. Emergency medical services use resulted in a 68.5-minute shorter median delay (P = .002) versus non-EMS use. Symptom clusters were not predictive of delay time in the adjusted model (P = .952). DISCUSSION Although chest symptoms were the most prevalent symptoms for most (85%), the combination of classic ACS symptoms with other symptom clusters was associated with higher EMS use. Further research is needed to determine whether a combination of symptom clusters helps patients correctly interpret ACS symptoms to better understand how symptom clusters influence EMS use.
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Backer Z, Nashed B, Khan AA, Issa M, Mahat K. Acute ST-Elevation Myocardial Infarction Presenting With Persistent Vomiting. Cureus 2022; 14:e26920. [PMID: 35983402 PMCID: PMC9376207 DOI: 10.7759/cureus.26920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/30/2022] Open
Abstract
Atypical presentations of acute coronary syndrome (ACS) have been commonly known to occur but are often excluded in the differential when other diagnoses seem more likely. Female gender, patients with diabetes, hypertension, age greater than 55, and a history of smoking are some of the risk factors that have been associated with noncharacteristic presentations of ACS. This often leads to misdiagnosis and overall increased mortality. Patients with risk factors for atypical presentations of myocardial infarctions should mandate a low threshold for suspicion and undergo evaluation with EKG and troponins for prompt diagnosis and early intervention.
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Hayajneh AA, Rababa M, Al-Rawashedeh S. Time to Seek Care and Hospital Length of Stay Among Older Adults With Acute Coronary Syndrome During the COVID-19 Pandemic. Clin Nurs Res 2021; 31:364-375. [PMID: 34412541 DOI: 10.1177/10547738211040167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prevalence of prehospital delay is high among older adults with acute coronary syndrome (ACS). The current study aimed to examine the associated factors of prehospital delay among patients with ACS during the COVID-19 pandemic. This cross-sectional study was conducted on a convenience sample of 300 older adults with ACS admitted to the emergency department in Jordan. Data were collected from June 1 to September 1, 2020. Bivariate and multivariate analyses were used to explore the predictors of prehospital delay. Being widowed, educational level, pain intensity, the gradual onset of ACS symptoms, symptoms lasting for more than 30 minutes, patients' feeling anxious about their ACS symptoms, patients' perceiving their symptoms to be particularly dangerous, history of myocardial infarction (MI), and mode of transportation were associated with the time taken before seeking emergency care. Significant predictors of time to seek help were chief complaint of chest pain or palpitations, abrupt onset of symptoms, the associated symptom of vertigo, and a higher number of chronic illnesses; they explained about 17.9% of the variance in the time to seek care. The average time to seek care among patients with ACS during the COVID-19 pandemic was found to be longer than the average time reported by studies conducted prior the pandemic. Improved understanding of the associations between prehospital delay is crucial for optimal ACS patient outcomes under the impacts of the COVID-19 pandemic.
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Affiliation(s)
- Audai A Hayajneh
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Rababa
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Sami Al-Rawashedeh
- Department of Community and Mental Health, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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Carnesten H, Asp M, Holmberg M. Caring approach for patients with chest pain - Swedish registered nurses' lived experiences in Emergency Medical Services. Int J Qual Stud Health Well-being 2021; 16:1901449. [PMID: 33779530 PMCID: PMC8009108 DOI: 10.1080/17482631.2021.1901449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose: Encountering patients with chest pain iscommon for Registered Nurses (RNs) in Emergency Medical Services (EMS) who are responsible for the patient’s medical and nursing care . From a lifeworld perspective, bodily illness is related to existential suffering, requiring knowledge to asses the situation from a holistic perspective . The aim of this study is to describe the caring approach when RNs encounter patients with chest pain. Methods: A phenomenological methodology to capture RNs’ lived experiences was chosen. Seven qualitative in-depth interviews were conducted at three ambulance stations in Sweden. Results: The essence of the caring approach while encountering patients with chest pain comprises two constituents; “trust based on confidence and competence” and “the collegial striving towards the best possible care”. Trust is two-parted; trust in oneself, and striving towards gaining the patient’s trust . Competence and experience when combined, develop into confidence especially in stressful situations. The caring approach is nurtured in a well-functioning collegial team. Conclusions: This study contributes to understanding the caring approach based on the specific patient’s lifeworld in holistic EMS care. By trusting oneself, the patient, and one’s colleague, RNs in EMS shift focus from medical-orientated care to a holistic lifeworld caring approach. . More research is needed on trust as a phenomenon in EMS, both from caregivers’ and patients’ perspectives.
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Affiliation(s)
- Hillewi Carnesten
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Margareta Asp
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Mats Holmberg
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden.,Department of Ambulance Service, Region of Sörmland, Eskilstuna, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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Magnusson C, Gärskog J, Lökholm E, Stenström J, Wetter R, Axelsson C, Andersson Hagiwara M, Packendorff N, Jood K, Karlsson T, Herlitz J. Prediction of a time-sensitive condition among patients with dizziness assessed by the emergency medical services. BMC Emerg Med 2021; 21:38. [PMID: 33765940 PMCID: PMC7995789 DOI: 10.1186/s12873-021-00423-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/24/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Dizziness is a relatively common symptom among patients who call for the emergency medical services (EMS). AIM To identify factors of importance for the early identification of a time-sensitive condition behind the symptom of dizziness among patients assessed by the EMS. METHODS All patients assessed by the EMS and triaged using Rapid Emergency Triage and Treatment (RETTS) for adults code 11 (=dizziness) in the 660,000 inhabitants in the Municipality of Gothenburg, Sweden, in 2016, were considered for inclusion. The patients were divided into two groups according to the final diagnosis (a time-sensitive condition, yes or no). RESULTS There were 1536 patients who fulfilled the inclusion criteria, of which 96 (6.2%) had a time-sensitive condition. The majority of these had a stroke/transitory ischaemic attack (TIA). Eight predictors of a time-sensitive condition were identified. Three were associated with a reduced risk: 1) the dizziness was of a rotatory type, 2) the dizziness had a sudden onset and 3) increasing body temperature. Five were associated with an increased risk: 1) sudden onset of headache, 2) a history of head trauma, 3) symptoms of nausea or vomiting, 4) on treatment with anticoagulants and 5) increasing systolic blood pressure. CONCLUSION Among 1536 patients who were triaged by the EMS for dizziness, 6.2% had a time-sensitive condition. On the arrival of the EMS, eight factors were associated with the risk of having a time-sensitive condition. All these factors were linked to the type of symptoms or to clinical findings on the arrival of the EMS or to the recent clinical history.
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Affiliation(s)
- C Magnusson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Gärskog
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - E Lökholm
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Stenström
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - R Wetter
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - C Axelsson
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - M Andersson Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - N Packendorff
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K Jood
- Department of Clinical Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - T Karlsson
- Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Herlitz
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
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An analysis of the descriptors of acute myocardial infarction used by South Africans when calling for an ambulance from a private emergency call centre. Afr J Emerg Med 2020; 10:203-208. [PMID: 33299749 PMCID: PMC7700975 DOI: 10.1016/j.afjem.2020.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/18/2020] [Accepted: 06/18/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction Acute myocardial infarction (AMI) is a time sensitive emergency. In resource limited settings, prompt identification and management of patients experiencing AMI in the pre-hospital setting may minimise the negative consequences associated with overburdened emergency medical and hospital services. Expedited care thus, in part, relies on the dispatch of appropriate pre-hospital medical providers by emergency medical dispatchers. Identification of these patients in call centres is challenging due to a highly diverse South African society, with multiple languages, cultures, and levels of education. The aim of this study was therefore, to describe the terms used by members of the South African public when calling for an ambulance for patients suffering an AMI. Methods In this qualitative study, we performed content analysis to identify keywords and phrases that callers used to describe patients who were experiencing an advanced life support (ALS) paramedic-diagnosed AMI. Using the unique case reference number of randomly selected AMI cases, original voice recordings between the caller and emergency medical dispatcher at the time of the emergency were extracted and transcribed verbatim. Descriptors of AMI were identified, coded and categorised using content analysis, and quantified. Results Of the 50 randomly selected calls analysed, 5 were not conducted in English. The descriptors used by callers were found to fall into three categories; Pain: Thorax, No pain: Thorax and Ill- health. The code that occurred most often was no pain, heart related (n = 16; 23.2%), followed by the code describing pain in the chest (n = 15; 21.7%). Conclusion South African callers use a consistent set of descriptors when requesting an ambulance for a patient experiencing an AMI. The most common of these are non-pain descriptors related to the heart. These descriptors may ultimately be used in developing validated algorithms to assist dispatch decisions. In this way, we hope to expedite the correct level of care to these time- critical patients and prevent the unnecessary dispatch of limitedly available ALS paramedics to inappropriate cases.
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Packendorff N, Gustavsson V, Magnusson C, Andersson Hagiwara M, Jood K, Herlitz J, Axelsson C. Outcome among patients who call the emergency medical service (EMS) due to dizziness. Australas Emerg Care 2020; 24:61-66. [PMID: 32682695 DOI: 10.1016/j.auec.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/05/2020] [Accepted: 07/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient with dizziness are challenging in prehospital care. The aim was to describe final diagnosis among patients assessed by EMS as suffering from dizziness with focus on time-critical conditions. METHODS Consecutive patients assessed by an EMS clinician during 12 months in a single large EMS system in Gothenburg, Sweden (660,000 inhabitants), were assessed. The study comprised patients given ESS code 11 dizziness. The main end-point was the final diagnosis (ICD code). RESULTS There were 58,575 primary missions, of which 2,048 (3.5%) were assessed as ESS code 11 (dizziness). Of these, 161 (8%) were excluded. Among the remaining 1887 cases, there were 230 different ICD codes and 96 (5%) had a time-critical condition. The majority (88%) had a cerebrovascular disease. The most typical symptoms among time-critical conditions were an acute onset (63%) and nausea, vomiting (61%). When compared with non-time-critical conditions, those with time-critical conditions were older and had a higher median systolic blood pressure at EMS arrival. CONCLUSION Among primary missions by the EMS, 3.5% had dizziness. Of these, 5% had a time-critical condition and the majority had a cerebrovascular disease. Instruments to identify time-critical conditions among patients seen by EMS due to dizziness are required.
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Affiliation(s)
| | | | - Carl Magnusson
- Institute of Medicine, Department of Molecular and Clinical Medicine, The Sahlgrenska Academy, Gothenburg University, SE-405 30 Gothenburg, Sweden.
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden.
| | - Katarina Jood
- Department of Clinical Neuroscience and Physiology, The Sahlgrenska Academy University of Gothenburg, SE-405 30 Gothenburg, Sweden.
| | - Johan Herlitz
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden.
| | - Christer Axelsson
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden.
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Holmberg M, Andersson H, Winge K, Lundberg C, Karlsson T, Herlitz J, Wireklint Sundström B. Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome: a study on patients with acute chest pain and presumed acute coronary syndrome. BMC Cardiovasc Disord 2018; 18:216. [PMID: 30486789 PMCID: PMC6260754 DOI: 10.1186/s12872-018-0957-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 11/16/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To decrease the morbidity burden of cardiovascular disease and to avoid the development of potentially preventable complications, early assessment and treatment of acute coronary syndrome (ACS) are important. The aim of this study has therefore been to explore the possible association between patients' estimated intensity of chest pain when first seen by the ambulance crew in suspected ACS, and the subsequent outcome before and after arrival in hospital. METHODS Data was collected both prospectively and retrospectively. The inclusion criteria were chest pain raising suspicion of ACS and a reported intensity of pain ≥4 on the visual analogue scale. RESULTS All in all, 1603 patients were included in the study. Increased intensity of chest pain was related to: 1) more heart-related complications before hospital admission; 2) a higher proportion of heart failure, anxiety and chest pain after hospital admission; 3) a higher proportion of acute myocardial infarction and 4) a prolonged hospitalisation. However, there was no significant association with mortality neither in 30 days nor in three years. Adjustment for possible confounders including age, a history of smoking and heart failure showed similar results. CONCLUSION The estimated intensity of chest pain reported by the patients on admission by the ambulance team was associated with the risk of complications prior to hospital admission, heart failure, anxiety and chest pain after hospital admission, the final diagnosis and the number of days in hospital. TRIAL REGISTRATION ClinicalTrials.gov 151:2008/4564 Identifier: NCT00792181. Registred 17 November 2008 'retrospectively registered'.
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Affiliation(s)
- Mats Holmberg
- Department of Ambulance Service, Sörmland County Council, Eskilstuna, Sweden
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
- PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Henrik Andersson
- PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Karin Winge
- Ambulance Department, South Älvsborgs Hospital, Borås, Sweden
| | | | - Thomas Karlsson
- Health Metrics at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Herlitz
- PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Birgitta Wireklint Sundström
- PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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