Symptom, diagnosis and mortality among respiratory emergency medical service patients

Abstract

Objective: Breathing difficulties and respiratory diseases have been under-reported in Emergency Medical Services research, despite these conditions being prevalent with substantial mortality. Our aim was two-fold; 1) to investigate the diagnostic pattern and mortality among EMS patients to whom an ambulance was dispatched due to difficulty breathing, and 2) to investigate the initial symptoms and mortality for EMS patients diagnosed with respiratory diseases in hospital.

Methods: Population-based historic cohort study in the North Denmark Region 2012-2015. We included two patient groups; 1) patients calling the emergency number with breathing difficulty as main symptom, and 2) patients diagnosed with respiratory diseases in hospital following an emergency call. Main outcome was estimated 1- and 30-day mortality rates.

Results: There were 3803 patients with the symptom breathing difficulty, nearly half were diagnosed with respiratory diseases 47.3%, followed by circulatory diseases 13.4%, and symptoms and signs 12.0%. The 1-day mortality rate was highest for circulatory diseases, then respiratory diseases and other factors. Over-all 30-day mortality was 13.2%, and the highest rate was for circulatory diseases (17.7%) then respiratory diseases and other factors. A total of 4014 patients were diagnosed with respiratory diseases, 44.8% had the symptom breathing difficulty, 13.4% unclear problems and 11.3%. chest pain/heart disease. 1-day mortality rates were highest for decreased consciousness, then breathing difficulties and unclear problem. Over-all 30-day mortality rates were 12.5%, the highest with symptoms of decreased consciousness (19.1%), then unclear problem and breathing difficulty. There was an overlap of 1797 patients between the two groups.

Conclusions: The over-all mortality rates alongside the distribution of symptoms and diagnoses, suggest the breathing difficulty patient group is complex and has severe health problems. These findings may be able to raise awareness towards the patient group, and thereby increase focus on diagnostics and treatment to improve the patient outcome.

Fig 1. Flowchart for included ambulance runs.

The included (white boxes) and excluded (grey boxes) ambulance runs and corresponding number of patients in the study period).

Fig 2. Symptoms and diagnoses overview.

Diagram showing the relation between symptoms when calling the emergency number 1-1-2 (green circles) and primary diagnoses given in hospital, following a 1-1-2 call and dispatched ambulance (blue circles). Shows number of patients and percentage of corresponding group. Circle sizes are relative to number of patients.

Fig 3. Primary diagnoses in hospital and age.

Graph of individual primary diagnoses given in hospital according to ICD-10 main chapters. The graph includes 3 803 patients to whom an emergency ambulance was dispatched due the symptom breathing difficulty. ICD-10: International Classification of Diseases, 10th edition.

Fig 4. Symptom and age.

Graph of individual symptoms when calling 1-1-2 according to age. The graph includes 4 014 patients diagnosed with respiratory diseases in hospital, following an emergency 1-1-2 call and dispatched ambulance.