Article Text

Download PDFPDF

Prehospital time and mortality in patients requiring a highest priority emergency medical response: a Danish registry-based cohort study
  1. Elisabeth Helen Anna Mills1,
  2. Kristian Aasbjerg MD, PhD1,
  3. Steen Moeller Hansen MD1,
  4. Kristian Bundgaard Ringgren MB1,
  5. Michael Dahl MD, PhD2,
  6. Bodil Steen Rasmussen2,
  7. Christian Torp-Pedersen3,4,
  8. Peter Søgaard4,
  9. Kristian Kragholm2,5
  1. 1 Department of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
  2. 2 Department of Anaesthesiology and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark
  3. 3 Department of Cardiology and Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
  4. 4 Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
  5. 5 Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Aalborg, Denmark
  1. Correspondence to Dr Elisabeth Helen Anna Mills; e.mills{at}rn.dk

Abstract

Objective To examine the association between time from emergency medical service vehicle dispatch to hospital arrival and 1-day and 30-day mortality.

Design Register-based cohort study.

Setting North Denmark Region (≈8000 km2, catchment population ≈600 000).

Participants We included all highest priority dispatched ambulance transports in North Denmark Region in 2006–2012.

Interventions Using logistic regression and the g-formula approach, we examined the association between time from emergency dispatch to hospital arrival and mortality for presumed heart, respiratory, cerebrovascular and other presumed medical conditions, as well as traffic or other accidents, as classified by emergency dispatch personnel.

Main outcome measures 1-day and 30-day mortality.

Results Among 93 167 individuals with highest priority ambulances dispatched, 1948 (2.1%) were dead before the ambulance arrived and 19 968 (21.4%) were transported to the hospital under highest priority (median total prehospital time from dispatch to hospital arrival 47 min (25%–75%: 35–60 min); 95th percentile 84 min). Among 18 709 with population data, 1-day mortality was 10.9% (n=2038), and was highest for patients with dyspnoea (20.4%) and lowest for patients with traffic accidents (2.8%). Thirty-day mortality was 18.3% and varied between 36.6% (patients with dyspnoea) and 3.7% (traffic accidents). One-day mortality was not associated with total prehospital time, except for presumed heart conditions, where longer prehospital time was associated with decreased mortality: adjusted OR for >60 min vs 0–30 min was 0.61 (95% CI 0.40 to 0.91). For patients with dyspnoea, OR for >60 min vs 0–30 min was 0.90 (95% CI 0.56 to 1.45), for presumed cerebrovascular conditions OR 1.41 (95% CI 0.53 to 3.78), for other presumed medical conditions OR 0.84 (95% CI 0.70 to 1.02), for traffic accidents OR 0.65 (95% CI 0.29 to 1.48) and for other accidents OR 0.84 (95% CI 0.47 to 1.51). Similar findings were found for 30-day mortality.

Conclusions In this study, where time from emergency dispatch to hospital arrival mainly was <80 min, there was no overall relation between this prehospital time measure and mortality.

  • accident & emergency medicine
  • epidemiology
  • cardiology
  • ambulance
  • prehospital medicine

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

View Full Text

Statistics from Altmetric.com

Footnotes

  • Contributors All nine authors have contributed to the manuscript. EHAM, KA, CT-P and KK have drafted the idea. EHAM and KK had full access to the data. EHAM, KA, SMH, KBR, CT-P and KK all contributed to the data analysis. MD, BSR and PS provided clinical insight. EHAM prepared the first draft of the paper. All authors have participated in the revision of the manuscript.

  • Funding The study was supported by the Danish Heart Foundation and the Program for Clinical Research Infrastructure (PROCRIN) established by the Lundbeck Foundation and the Novo Nordisk Foundation. The Danish Heart Foundation and PROCRIN were not involved in the analysis nor in the interpretation of the study.

  • Competing interests SMH is supported by the Danish foundation TrygFonden. CT-P has received grants from Bayer and Biotronic and has received speaker honorarium from Bayer. PS reports research grants and personal fees from Biotronik, personal fees from Novartis, personal fees from AstraZeneca, research grants from GE Healthcare and research grants from EBR Systems. KK has received grants from the Laerdal Foundation and has received speaker’s honoraria from Novartis.

  • Patient consent for publication Not required.

  • Ethics approval Registry-based studies do not require ethical approval in Denmark. Data access and analysis were approved by the Danish Data Protection Agency (reference 2007-58-0015, GEH-2014-019, I-suite 02737).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.