Prehospital time and mortality in patients requiring a highest priority emergency medical response: a Danish registry-based cohort study
Objective To examine the association between time from emergency medical service vehicle dispatch to hospital arrival and 1-day and 30-day mortality.Design Register-based cohort study.Setting North Denmark Region (≈8000 km2, catchment population ≈600 000).Participants We included all highest priorit...
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| Format: | Article |
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BMJ Publishing Group
2019-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/11/e023049.full |
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| author | Kristian Kragholm Christian Torp-Pedersen Peter Søgaard Elisabeth Helen Anna Mills Kristian Aasbjerg Steen Moeller Hansen Kristian Bundgaard Ringgren Michael Dahl Bodil Steen Rasmussen |
| author_facet | Kristian Kragholm Christian Torp-Pedersen Peter Søgaard Elisabeth Helen Anna Mills Kristian Aasbjerg Steen Moeller Hansen Kristian Bundgaard Ringgren Michael Dahl Bodil Steen Rasmussen |
| author_sort | Kristian Kragholm |
| collection | DOAJ |
| description | Objective To examine the association between time from emergency medical service vehicle dispatch to hospital arrival and 1-day and 30-day mortality.Design Register-based cohort study.Setting North Denmark Region (≈8000 km2, catchment population ≈600 000).Participants We included all highest priority dispatched ambulance transports in North Denmark Region in 2006–2012.Interventions Using logistic regression and the g-formula approach, we examined the association between time from emergency dispatch to hospital arrival and mortality for presumed heart, respiratory, cerebrovascular and other presumed medical conditions, as well as traffic or other accidents, as classified by emergency dispatch personnel.Main outcome measures 1-day and 30-day mortality.Results Among 93 167 individuals with highest priority ambulances dispatched, 1948 (2.1%) were dead before the ambulance arrived and 19 968 (21.4%) were transported to the hospital under highest priority (median total prehospital time from dispatch to hospital arrival 47 min (25%–75%: 35–60 min); 95th percentile 84 min). Among 18 709 with population data, 1-day mortality was 10.9% (n=2038), and was highest for patients with dyspnoea (20.4%) and lowest for patients with traffic accidents (2.8%). Thirty-day mortality was 18.3% and varied between 36.6% (patients with dyspnoea) and 3.7% (traffic accidents). One-day mortality was not associated with total prehospital time, except for presumed heart conditions, where longer prehospital time was associated with decreased mortality: adjusted OR for >60 min vs 0–30 min was 0.61 (95% CI 0.40 to 0.91). For patients with dyspnoea, OR for >60 min vs 0–30 min was 0.90 (95% CI 0.56 to 1.45), for presumed cerebrovascular conditions OR 1.41 (95% CI 0.53 to 3.78), for other presumed medical conditions OR 0.84 (95% CI 0.70 to 1.02), for traffic accidents OR 0.65 (95% CI 0.29 to 1.48) and for other accidents OR 0.84 (95% CI 0.47 to 1.51). Similar findings were found for 30-day mortality.Conclusions In this study, where time from emergency dispatch to hospital arrival mainly was <80 min, there was no overall relation between this prehospital time measure and mortality. |
| format | Article |
| id | doaj-art-ca53c03669da4adaa84719adb539141d |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-ca53c03669da4adaa84719adb539141d2024-11-30T15:25:11ZengBMJ Publishing GroupBMJ Open2044-60552019-11-0191110.1136/bmjopen-2018-023049Prehospital time and mortality in patients requiring a highest priority emergency medical response: a Danish registry-based cohort studyKristian Kragholm0Christian Torp-Pedersen1Peter Søgaard2Elisabeth Helen Anna Mills3Kristian Aasbjerg4Steen Moeller Hansen5Kristian Bundgaard Ringgren6Michael Dahl7Bodil Steen Rasmussen8Department of Cardiology, North Denmark Regional Hospital & Aalborg University Hospital, Aalborg, DenmarkDepartment of Cardiology, Nordsjællands Hospital, Copenhagen, DenmarkDepartment of Cardiology, Aalborg University Hospital, Aalborg, Denmark2 Department of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark1 Department of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark1 Department of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark7 Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark2 Department of Anaesthesiology and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark7 Department of Anaesthesiology and Intensive Care Medicine, Aalborg University Hospital, Aalborg, DenmarkObjective To examine the association between time from emergency medical service vehicle dispatch to hospital arrival and 1-day and 30-day mortality.Design Register-based cohort study.Setting North Denmark Region (≈8000 km2, catchment population ≈600 000).Participants We included all highest priority dispatched ambulance transports in North Denmark Region in 2006–2012.Interventions Using logistic regression and the g-formula approach, we examined the association between time from emergency dispatch to hospital arrival and mortality for presumed heart, respiratory, cerebrovascular and other presumed medical conditions, as well as traffic or other accidents, as classified by emergency dispatch personnel.Main outcome measures 1-day and 30-day mortality.Results Among 93 167 individuals with highest priority ambulances dispatched, 1948 (2.1%) were dead before the ambulance arrived and 19 968 (21.4%) were transported to the hospital under highest priority (median total prehospital time from dispatch to hospital arrival 47 min (25%–75%: 35–60 min); 95th percentile 84 min). Among 18 709 with population data, 1-day mortality was 10.9% (n=2038), and was highest for patients with dyspnoea (20.4%) and lowest for patients with traffic accidents (2.8%). Thirty-day mortality was 18.3% and varied between 36.6% (patients with dyspnoea) and 3.7% (traffic accidents). One-day mortality was not associated with total prehospital time, except for presumed heart conditions, where longer prehospital time was associated with decreased mortality: adjusted OR for >60 min vs 0–30 min was 0.61 (95% CI 0.40 to 0.91). For patients with dyspnoea, OR for >60 min vs 0–30 min was 0.90 (95% CI 0.56 to 1.45), for presumed cerebrovascular conditions OR 1.41 (95% CI 0.53 to 3.78), for other presumed medical conditions OR 0.84 (95% CI 0.70 to 1.02), for traffic accidents OR 0.65 (95% CI 0.29 to 1.48) and for other accidents OR 0.84 (95% CI 0.47 to 1.51). Similar findings were found for 30-day mortality.Conclusions In this study, where time from emergency dispatch to hospital arrival mainly was <80 min, there was no overall relation between this prehospital time measure and mortality.https://bmjopen.bmj.com/content/9/11/e023049.full |
| spellingShingle | Kristian Kragholm Christian Torp-Pedersen Peter Søgaard Elisabeth Helen Anna Mills Kristian Aasbjerg Steen Moeller Hansen Kristian Bundgaard Ringgren Michael Dahl Bodil Steen Rasmussen Prehospital time and mortality in patients requiring a highest priority emergency medical response: a Danish registry-based cohort study BMJ Open |
| title | Prehospital time and mortality in patients requiring a highest priority emergency medical response: a Danish registry-based cohort study |
| title_full | Prehospital time and mortality in patients requiring a highest priority emergency medical response: a Danish registry-based cohort study |
| title_fullStr | Prehospital time and mortality in patients requiring a highest priority emergency medical response: a Danish registry-based cohort study |
| title_full_unstemmed | Prehospital time and mortality in patients requiring a highest priority emergency medical response: a Danish registry-based cohort study |
| title_short | Prehospital time and mortality in patients requiring a highest priority emergency medical response: a Danish registry-based cohort study |
| title_sort | prehospital time and mortality in patients requiring a highest priority emergency medical response a danish registry based cohort study |
| url | https://bmjopen.bmj.com/content/9/11/e023049.full |
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