Diagnosis and mortality in prehospital emergency patients transported to hospital: a population-based and registry-based cohort study
Diagnosis and mortality in prehospital emergency patients transported to hospital: a population-based and registry-based cohort study
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DOI：
10.1136/bmjopen-2016-011558
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发表时间：
2016-01-01
期刊：
影响因子：
2.9
通讯作者：
Christiansen, Christian Fynbo
中科院分区：
文献类型：
--
作者：
Christensen, Erika Frischknecht;Larsen, Thomas Mulvad;Christiansen, Christian Fynbo
目的：关于呼叫救护车后患者的知识仅限于亚组，如心脏骤停、心肌梗死、创伤和中风患者，而包括所有诊断的基于人群的研究很少。我们研究了所有患者的诊断模式和死亡率的救护车送到医院后，紧急呼叫。设计：登记为基础的队列研究。设置和参与者：我们包括2007年至2014年期间在北丹麦地区（580 000居民）的紧急呼叫后派遣的救护车送到医院的患者。我们根据国际疾病分类第10版（ICD-10）的章节报告了医院诊断，并研究了呼叫后第1天和第30天的死亡情况。队列特征和诊断进行了描述，Kaplan-Meier方法被用来估计死亡率和95%CIs.Results：在所有，148757例患者，平均年龄52.9（SD 24.3）岁。最常见的ICD-10诊断章节是：“损伤和中毒”（30.0%），以及2个非特异性诊断章节：“症状和异常发现，不另分类”（17.5%）和“影响健康状况和与保健服务接触的因素”其次是“循环系统疾病”（10.6%）及“呼吸系统疾病”（6.7%）。总体1天死亡率为1.8%（CI 1.7%至1.8%），30天死亡率为4.7%（CI 4.6%至4.8%）。"循环系统疾病“的1天死亡率最高，为7.7%（置信区间7.3%至8.1%），有1，209人死亡。30天后，死亡人数最多的是循环系统疾病（2313人）、呼吸系统疾病（1148人）、“症状和异常发现，未另分类”（1119人）和“损伤和中毒”（741人），30天死亡率分别为14.7%、11.6%、4.3%和1.7%。在这项基于人群的研究中，患者在拨打1-1-2后住院期间的诊断分布在ICD-10的所有章节中。诊断组之间的死亡率差异很大。非特异性诊断占患者的三分之一，并在死亡总数方面导致死亡。
Objective: Knowledge about patients after calling for an ambulance is limited to subgroups, such as patients with cardiac arrest, myocardial infarction, trauma and stroke, while population-based studies including all diagnoses are few. We examined the diagnostic pattern and mortality among all patients brought to hospital by ambulance after emergency calls.Design: Registry-based cohort study.Setting and participants: We included patients brought to hospital in an ambulance dispatched after emergency calls during 2007-2014 in the North Denmark Region (580 000 inhabitants). We reported hospital diagnosis according to the chapters of the International Classification of Diseases, 10th Edition (ICD-10), and studied death on days 1 and 30 after the call. Cohort characteristics and diagnoses were described, and the Kaplan-Meier method was used to estimate mortality and 95% CIs.Results: In total, 148 757 patients were included, mean age 52.9 (SD 24.3) years. The most frequent ICD-10 diagnosis chapters were: 'injury and poisoning' (30.0%), and the 2 non-specific diagnosis chapters: 'symptoms and abnormal findings, not elsewhere classified' (17.5%) and 'factors influencing health status and contact with health services' (14.1%), followed by 'diseases of the circulatory system' (10.6%) and 'diseases of the respiratory system' (6.7%). The overall 1-day mortality was 1.8% (CI 1.7% to 1.8%) and 30-day mortality 4.7% (CI 4.6% to 4.8%). 'Diseases of the circulatory system' had the highest 1-day mortality of 7.7% (CI 7.3% to 8.1%) accounting for 1209 deaths. After 30 days, the highest number of deaths were among circulatory diseases (2313), respiratory diseases (1148), 'symptoms and abnormal findings, not elsewhere classified' (1119) and 'injury and poisoning' (741), and 30 days mortality in percentage was 14.7%, 11.6%, 4.3% and 1.7%, respectively.Conclusions: Patients' diagnoses from hospital stay after calling 1-1-2 in this population-based study were distributed across all ICD-10 chapters. Mortality varied widely between diagnostic groups. Non-specific diagnoses accounted for one-third of the patients and contributed to mortality in terms of total number of deaths.