Serious Conditions Among Patients with Non-specific Chief Complaints in the Pre-hospital Setting: a Retrospective Cohort Study

Overview

Journal Scand J Trauma Resusc Emerg Med

Publisher Biomed Central

Specialty Emergency Medicine

Date 2020 Jul 31

PMID 32727586

Citations 11

Authors

Robert Ivic

Lisa Kurland

Veronica Vicente

Maaret Castren

Katarina Bohm

Affiliations

Soon will be listed here.

Abstract

Background: Emergency Medical Services (EMS) are faced daily with patients presenting with a non-specific chief complaints (NSC); i.e. decreased general condition, general malaise, sense of illness, or just being unable to cope with usual daily activities. Patients presenting with NSCs often have normal vital signs. It has previously been established that however, NSCs may have a serious underlying condition that has yet to be identified. The primary outcome of this study was to determine the prevalence of serious conditions in patients presenting with NSCs to the EMS.

Method: A retrospective cohort study of patients ≥18 years of age who were reported as presenting with chief complaints compatible with NSCs to the EMS in Stockholm Region and transported to an emergency department between January 1st, 2013 and December 31st, 2013. Patients were identified via the EMS electronic health care record and followed via records from the National Patient Registry and Causes of Death Registry at Sweden's National Board for Health and Welfare. The definition of serious condition was defined by expert consensus. Descriptive statistics as well as regression analyses were used.

Results: A total of 3780 patients were included, with a median age of 77 years. A serious condition was present in 35.3% of the patients. The in-hospital mortality rate for the group with serious conditions was 10.1% (OR 6.8, CI 95%, 4.1-11.3), and the 30-day mortality rate was 20.2% (OR 3.1, CI 95%, 2.3-4.0). In the group with no serious conditions the rates were 1.0 and 4.2%, respectively. The total hospitalization rate was 67.6%. The presence of serious conditions as well as increased mortality rates were associated with Rapid Emergency Triage and Treatment system (RETTS) as well as National Early Warning Score (NEWS) irrespective of triage score.

Conclusion: More than one-third of the patients presenting with NSCs to EMS had a serious underlying condition which was associated with increased mortality and hospitalization rates.

Trial Registration: Not applicable.

Citing Articles

Serious conditions among conveyed and non-conveyed patients presenting with nonspecific chief complaints to the ambulance service.

Ivic-Moren R, Bohm K, Vicente V, Arvidsson E, Castren M, Kurland L BMC Emerg Med. 2024; 24(1):199.

PMID: 39443901 PMC: 11515605. DOI: 10.1186/s12873-024-01106-7.

Treat and release: an observational study of non-conveyed high-acuity dispatches in a Danish emergency medical system.

Wolthers S, Mikaelsson T, Holgersen M, Blomberg S, Andersen L, Mikkelsen S Intern Emerg Med. 2024; 19(8):2283-2292.

PMID: 38748389 PMC: 11582337. DOI: 10.1007/s11739-024-03618-3.

Elderly patients with non-specific complaints at the emergency department have a high risk for admission and 30-days mortality.

Erwander K, Ivarsson K, Olsson M, Agvall B BMC Geriatr. 2024; 24(1):5.

PMID: 38172691 PMC: 10762826. DOI: 10.1186/s12877-023-04621-7.

Older Adults, the "Social Admission," and Nonspecific Complaints in the Emergency Department: Protocol for a Scoping Review.

Furlong K, ODonnell K, Farrell A, Mercer S, Norman P, Parsons M JMIR Res Protoc. 2023; 12:e38246.

PMID: 36920467 PMC: 10132007. DOI: 10.2196/38246.

Diagnoses and mortality among prehospital emergency patients calling 112 with unclear problems: a population-based cohort study from Denmark.

Ibsen S, Dam-Huus K, Nickel C, Christensen E, Sovso M Scand J Trauma Resusc Emerg Med. 2022; 30(1):70.

PMID: 36503609 PMC: 9743502. DOI: 10.1186/s13049-022-01052-y.

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