Implementing a nationwide criteria-based emergency medical dispatch system: a register-based follow-up study.
Implementing a nationwide criteria-based emergency medical dispatch system: a register-based follow-up study.
复制标题
DOI：
10.1186/1757-7241-21-53
复制
发表时间：
2013-07-09
期刊：
影响因子：
--
通讯作者：
Christensen EF
中科院分区：
文献类型：
--
作者：
Andersen MS;Johnsen SP;Sørensen JN;Jepsen SB;Hansen JB;Christensen EF
丹麦最近实施了基于标准的全国紧急医疗调度(EMD)系统。我们描述了这个系统，并通过分析住院和病例死亡风险，研究了它根据患者病情的严重程度对患者进行分类的能力。这是一项基于登记的跟踪研究，对6个月内所有1-1-2呼叫进行了分类，这些呼叫根据丹麦指数-新的基于标准的调度协议-进行分类。丹麦指数数据与来自国家登记处的医院和生命状况数据相联系。使用精确的方法计算了具有二项数据的比例的可信区间(95%)。为了检验趋势，我们使用了沃尔德检验。根据丹麦指数评级，67,135名接受救护车服务的患者可以获得紧急程度的信息。急诊A级(n = 34,489例)占51.4%，急诊B级占46.3%(n = 31,116例)，急诊C级占2.1%(n = 1,391例)，急诊D级占0.2%(n = 139例)。对于急诊A级，从接到电话到派出救护车的中位数时间，S为2分1秒，到达S的中位时间为6分11分。55,270名患者的入院和病死率数据可用。急诊A级患者入院风险为64.4%(95%CI = 为63.8~64.9)。有一个明显的趋势(p <； 0.001)，即急诊程度较低的患者的入院风险较低。急诊A级患者在1-1-2呼叫的同一天的病例死亡风险为4.4%(95%CI = 4.1-4.6)。与急诊B-D级患者相比，急诊A级患者的相对病死率为14.3(95%CI：11.5-18.0)。大多数患者被评估为丹麦指数紧急A级或B级。紧急A级患者的病死率和入院风险显著高于紧急B-D级患者。因此，新实施的丹麦基于标准的调度系统似乎将入院和死亡风险较高的患者分流到最高级别的紧急情况。需要进一步的研究来确定分流过度和分流不足的程度以及预后因素。
A criteria-based nationwide Emergency Medical Dispatch (EMD) system was recently implemented in Denmark. We described the system and studied its ability to triage patients according to the severity of their condition by analysing hospital admission and case-fatality risks. This was a register-based follow-up study of all 1-1-2 calls in a 6-month period that were triaged according to the Danish Index – the new criteria-based dispatch protocol. Danish Index data were linked with hospital and vital status data from national registries. Confidence intervals (95%) for proportions with binomial data were computed using exact methods. To test for trend the Wald test was used. Information on level of emergency according to the Danish Index rating was available for 67,135 patients who received ambulance service. Emergency level A (urgent cases) accounted for 51.4% (n = 34,489) of patients, emergency level B for 46.3% (n = 31,116), emergency level C for 2.1% (n = 1,391) and emergency level D for 0.2% (n = 139). For emergency level A, the median time from call receipt to ambulance dispatch was 2 min 1 s, and the median time to arrival was 6 min 11 s. Data concerning admission and case fatality was available for 55,270 patients. The hospital admission risk for emergency level A patients was 64.4% (95% CI = 63.8-64.9). There was a significant trend (p < 0.001) towards lower admission risks for patients with lower levels of emergency. The case fatality risk for emergency level A patients on the same day as the 1-1-2 call was 4.4% (95% CI = 4.1-4.6). The relative case-fatality risk among emergency level A patients compared to emergency level B–D patients was 14.3 (95% CI: 11.5-18.0). The majority of patients were assessed as Danish Index emergency level A or B. Case fatality and hospital admission risks were substantially higher for emergency level A patients than for emergency level B–D patients. Thus, the newly implemented Danish criteria-based dispatch system seems to triage patients with high risk of admission and death to the highest level of emergency. Further studies are needed to determine the degree of over- and undertriage and prognostic factors.
登录
查看更多内容
影响因子：
6.5
作者：
Kuisma, M;Holmström, P;Boyd, J
通讯作者：
Boyd, J
影响因子：
--
作者：
Mohan, Deepika;Rosengart, Matthew R.;Barnato, Amber E.
通讯作者：
Barnato, Amber E.
影响因子：
6.5
作者：
Castren, M.;Karlsten, R.;Garcia-Castrill Riego, L.
通讯作者：
Garcia-Castrill Riego, L.
影响因子：
6.2
作者：
Newgard, Craig D.;Schmicker, Robert H.;Hedges, Jerris R.;Trickett, John P.;Davis, Daniel P.;Bulger, Eileen M.;Aufderheide, Tom P.;Minei, Joseph P.;Hata, J. Steven;Gubler, K. Dean;Brown, Todd B.;Yelle, Jean-Denis;Bardarson, Berit;Nichol, Graham
通讯作者：
Nichol, Graham
影响因子：
6.5
作者：
Castren, M.;Bohm, K.;Karlsten, R.
通讯作者：
Karlsten, R.