Pre-hospital predictors of an adverse outcome among patients with dyspnoea as the main symptom assessed by pre-hospital emergency nurses - a retrospective observational study

Pre-hospital predictors of an adverse outcome among patients with dyspnoea as the main symptom assessed by pre-hospital emergency nurses - a retrospective observational study

: Dyspnoea, Epidemiology, Adverse outcome, Time-sensitive diagnosis, Ambulance, Emergency medical
service, Pre-hospital emergency nurse

Background: Dyspnoea is one of the most common reasons for patients contacting emergency medical services
(EMS). Pre-hospital Emergency Nurses (PENs) are independently responsible for advanced care and to meet these
patients individual needs. Patients with dyspnoea constitute a complex group, with multiple different final
diagnoses and with a high risk of death. This study aimed to describe on-scene factors associated with an increased
risk of a time-sensitive final diagnosis and the risk of death.
Methods: A retrospective observational study including patients aged ≥16 years, presenting mainly with dyspnoea
was conducted. Patients were identified thorough an EMS database, and were assessed by PENs in the southwestern part of Sweden during January to December 2017. Of 7260 missions (9% of all primary missions), 6354
were included. Among those, 4587 patients were randomly selected in conjunction with adjusting for unique
patients with single occasions. Data were manually collected through both EMS- and hospital records and final
diagnoses were determined through the final diagnoses verified in hospital records. Analysis was performed using
multiple logistic regression and multiple imputations.
Results: Among all unique patients with dyspnoea as the main symptom, 13% had a time-sensitive final diagnosis.
The three most frequent final time-sensitive diagnoses were cardiac diseases (4.1% of all diagnoses), infectious/
inflammatory diseases (2.6%), and vascular diseases (2.4%). A history of hypertension, renal disease, symptoms of
pain, abnormal respiratory rate, impaired consciousness, a pathologic ECG and a short delay until call for EMS were
associated with an increased risk of a time-sensitive final diagnosis. Among patients with time-sensitive diagnoses,
approximately 27% died within 30 days. Increasing age, a history of renal disease, cancer, low systolic blood
pressures, impaired consciousness and abnormal body temperature were associated with an increased risk of death.
(Continued on next page)

Wivica Kauppi , Johan Herlitz, Thomas Karlsson, Carl Magnusson, Lina Palmér and Christer Axelsson

BMC Emergency Medicine

(2020) 20:89

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