Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: An observational study

Anne Maree Kelly; Anna Holdgate; Gerben Keijzers; Sharon Klim; Colin A. Graham; Simon Craig; Win Sen Kuan; Peter Jones; Charles Lawoko; Said Laribi; Richard McNulty; David Lord Cowell; Nitin Jain; Tracey De Villecourt; Kendall Lee; Dane Chalkley; Lydia Lozzi; Stephen Edward Asha; Martin Duffy; Gina Watkins; David Rosengren; Jae Thone; Shane Martin; Ulrich Orda; Ogilvie Thom; Frances Kinnear; Michael Watson; Rob Eley; Alison Ryan; Douglas Gordon Morel; Jeremy Furyk; Richard D B Smith; Michelle Grummisch; Robert Meek; Pamela Rosengarten; Barry Chan; Helen Haythorne; Peter Archer; Kathryn Wilson; Jonathan Knott; Peter Ritchie; Michael Bryant; Stephen MacDonald; Mlungisi Mahlangu; Michael Scott; Thomas Cheri; Mai Nguyen; Melvin S Y Chor; Chi Pang Wong; Tai Wai Wong; Ling Pong Leung; Chan Ka Man; Ismail Mohd Saiboon; Nik Hisamuddin Rahman; Wee Yee Lee; Francis Chun Yue Lee; Shaun E. Goh; Kerrie Russell

doi:10.1186/s13049-016-0305-5

Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: An observational study

Anne Maree Kelly^*, Anna Holdgate, Gerben Keijzers, Sharon Klim, Colin A. Graham, Simon Craig, Win Sen Kuan, Peter Jones, Charles Lawoko, Said Laribi, Richard McNulty, David Lord Cowell, Nitin Jain, Tracey De Villecourt, Kendall Lee, Dane Chalkley, Lydia Lozzi, Stephen Edward Asha, Martin Duffy, Gina WatkinsDavid Rosengren, Jae Thone, Shane Martin, Ulrich Orda, Ogilvie Thom, Frances Kinnear, Michael Watson, Rob Eley, Alison Ryan, Douglas Gordon Morel, Jeremy Furyk, Richard D B Smith, Michelle Grummisch, Robert Meek, Pamela Rosengarten, Barry Chan, Helen Haythorne, Peter Archer, Kathryn Wilson, Jonathan Knott, Peter Ritchie, Michael Bryant, Stephen MacDonald, Mlungisi Mahlangu, Michael Scott, Thomas Cheri, Mai Nguyen, Melvin S Y Chor, Chi Pang Wong, Tai Wai Wong, Ling Pong Leung, Chan Ka Man, Ismail Mohd Saiboon, Nik Hisamuddin Rahman, Wee Yee Lee, Francis Chun Yue Lee, Shaun E. Goh, Kerrie Russell

^*Corresponding author for this work

Faculty of Health Sciences & Medicine

Research output: Contribution to journal › Article › Research › peer-review

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Abstract

Background: This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance.

Methods: This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics and comparisons of proportions.

Results: One thousand seven patients met inclusion criteria. Median age was 74 years (IQR 61-68) and 46.1 % were male. There was a high rate of co-morbidity and chronic medication use. The most common ED diagnoses were lower respiratory tract infection (including pneumonia, 22.7 %), cardiac failure (20.5%) and exacerbation of chronic obstructive pulmonary disease (19.7 %). ED disposition was hospital admission (including ICU) for 76.4 %, ICU admission for 5.6 % and death in ED in 0.9 %. Overall in-hospital mortality among admitted patients was 6.5 %.

Discussion: Patients transported by ambulance with shortness of breath make up a significant proportion of ambulance caseload and have high comorbidity and high hospital admission rate. In this study, >60 % were accounted for by patients with heart failure, lower respiratory tract infection or COPD, but there were a wide range of diagnoses. This has implications for service planning, models of care and paramedic training.

Conclusion: This study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services.

Original language	English
Article number	113
Journal	Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Volume	24
Issue number	1
DOIs	https://doi.org/10.1186/s13049-016-0305-5
Publication status	Published - 22 Sept 2016

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Epidemiology, prehospital care and outcomes of patients arriving by ambulance with Final published version, 334 KBLicence: CC BY

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Kelly, A. M., Holdgate, A., Keijzers, G., Klim, S., Graham, C. A., Craig, S., Kuan, W. S., Jones, P., Lawoko, C., Laribi, S., McNulty, R., Cowell, D. L., Jain, N., De Villecourt, T., Lee, K., Chalkley, D., Lozzi, L., Asha, S. E., Duffy, M., ... Russell, K. (2016). Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: An observational study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 24(1), Article 113. https://doi.org/10.1186/s13049-016-0305-5

@article{e92c43f5a9f84d259ceea7eb032c0d35,

title = "Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: An observational study",

abstract = "Background: This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance. Methods: This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics and comparisons of proportions. Results: One thousand seven patients met inclusion criteria. Median age was 74 years (IQR 61-68) and 46.1 % were male. There was a high rate of co-morbidity and chronic medication use. The most common ED diagnoses were lower respiratory tract infection (including pneumonia, 22.7 %), cardiac failure (20.5%) and exacerbation of chronic obstructive pulmonary disease (19.7 %). ED disposition was hospital admission (including ICU) for 76.4 %, ICU admission for 5.6 % and death in ED in 0.9 %. Overall in-hospital mortality among admitted patients was 6.5 %. Discussion: Patients transported by ambulance with shortness of breath make up a significant proportion of ambulance caseload and have high comorbidity and high hospital admission rate. In this study, >60 % were accounted for by patients with heart failure, lower respiratory tract infection or COPD, but there were a wide range of diagnoses. This has implications for service planning, models of care and paramedic training. Conclusion: This study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services.",

author = "Kelly, {Anne Maree} and Anna Holdgate and Gerben Keijzers and Sharon Klim and Graham, {Colin A.} and Simon Craig and Kuan, {Win Sen} and Peter Jones and Charles Lawoko and Said Laribi and Richard McNulty and Cowell, {David Lord} and Nitin Jain and {De Villecourt}, Tracey and Kendall Lee and Dane Chalkley and Lydia Lozzi and Asha, {Stephen Edward} and Martin Duffy and Gina Watkins and David Rosengren and Jae Thone and Shane Martin and Ulrich Orda and Ogilvie Thom and Frances Kinnear and Michael Watson and Rob Eley and Alison Ryan and Morel, {Douglas Gordon} and Jeremy Furyk and Smith, {Richard D B} and Michelle Grummisch and Robert Meek and Pamela Rosengarten and Barry Chan and Helen Haythorne and Peter Archer and Kathryn Wilson and Jonathan Knott and Peter Ritchie and Michael Bryant and Stephen MacDonald and Mlungisi Mahlangu and Michael Scott and Thomas Cheri and Mai Nguyen and Chor, {Melvin S Y} and Wong, {Chi Pang} and Wong, {Tai Wai} and Leung, {Ling Pong} and Man, {Chan Ka} and Saiboon, {Ismail Mohd} and Rahman, {Nik Hisamuddin} and Lee, {Wee Yee} and Lee, {Francis Chun Yue} and Goh, {Shaun E.} and Kerrie Russell",

year = "2016",

month = sep,

day = "22",

doi = "10.1186/s13049-016-0305-5",

language = "English",

volume = "24",

journal = "Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine",

issn = "1757-7241",

publisher = "BioMed Central",

number = "1",

}

Kelly, AM, Holdgate, A, Keijzers, G, Klim, S, Graham, CA, Craig, S, Kuan, WS, Jones, P, Lawoko, C, Laribi, S, McNulty, R, Cowell, DL, Jain, N, De Villecourt, T, Lee, K, Chalkley, D, Lozzi, L, Asha, SE, Duffy, M, Watkins, G, Rosengren, D, Thone, J, Martin, S, Orda, U, Thom, O, Kinnear, F, Watson, M, Eley, R, Ryan, A, Morel, DG, Furyk, J, Smith, RDB, Grummisch, M, Meek, R, Rosengarten, P, Chan, B, Haythorne, H, Archer, P, Wilson, K, Knott, J, Ritchie, P, Bryant, M, MacDonald, S, Mahlangu, M, Scott, M, Cheri, T, Nguyen, M, Chor, MSY, Wong, CP, Wong, TW, Leung, LP, Man, CK, Saiboon, IM, Rahman, NH, Lee, WY, Lee, FCY, Goh, SE & Russell, K 2016, 'Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: An observational study', Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 24, no. 1, 113. https://doi.org/10.1186/s13049-016-0305-5

TY - JOUR

T1 - Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: An observational study

AU - Kelly, Anne Maree

AU - Holdgate, Anna

AU - Keijzers, Gerben

AU - Klim, Sharon

AU - Graham, Colin A.

AU - Craig, Simon

AU - Kuan, Win Sen

AU - Jones, Peter

AU - Lawoko, Charles

AU - Laribi, Said

AU - McNulty, Richard

AU - Cowell, David Lord

AU - Jain, Nitin

AU - De Villecourt, Tracey

AU - Lee, Kendall

AU - Chalkley, Dane

AU - Lozzi, Lydia

AU - Asha, Stephen Edward

AU - Duffy, Martin

AU - Watkins, Gina

AU - Rosengren, David

AU - Thone, Jae

AU - Martin, Shane

AU - Orda, Ulrich

AU - Thom, Ogilvie

AU - Kinnear, Frances

AU - Watson, Michael

AU - Eley, Rob

AU - Ryan, Alison

AU - Morel, Douglas Gordon

AU - Furyk, Jeremy

AU - Smith, Richard D B

AU - Grummisch, Michelle

AU - Meek, Robert

AU - Rosengarten, Pamela

AU - Chan, Barry

AU - Haythorne, Helen

AU - Archer, Peter

AU - Wilson, Kathryn

AU - Knott, Jonathan

AU - Ritchie, Peter

AU - Bryant, Michael

AU - MacDonald, Stephen

AU - Mahlangu, Mlungisi

AU - Scott, Michael

AU - Cheri, Thomas

AU - Nguyen, Mai

AU - Chor, Melvin S Y

AU - Wong, Chi Pang

AU - Wong, Tai Wai

AU - Leung, Ling Pong

AU - Man, Chan Ka

AU - Saiboon, Ismail Mohd

AU - Rahman, Nik Hisamuddin

AU - Lee, Wee Yee

AU - Lee, Francis Chun Yue

AU - Goh, Shaun E.

AU - Russell, Kerrie

PY - 2016/9/22

Y1 - 2016/9/22

N2 - Background: This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance. Methods: This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics and comparisons of proportions. Results: One thousand seven patients met inclusion criteria. Median age was 74 years (IQR 61-68) and 46.1 % were male. There was a high rate of co-morbidity and chronic medication use. The most common ED diagnoses were lower respiratory tract infection (including pneumonia, 22.7 %), cardiac failure (20.5%) and exacerbation of chronic obstructive pulmonary disease (19.7 %). ED disposition was hospital admission (including ICU) for 76.4 %, ICU admission for 5.6 % and death in ED in 0.9 %. Overall in-hospital mortality among admitted patients was 6.5 %. Discussion: Patients transported by ambulance with shortness of breath make up a significant proportion of ambulance caseload and have high comorbidity and high hospital admission rate. In this study, >60 % were accounted for by patients with heart failure, lower respiratory tract infection or COPD, but there were a wide range of diagnoses. This has implications for service planning, models of care and paramedic training. Conclusion: This study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services.

AB - Background: This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance. Methods: This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics and comparisons of proportions. Results: One thousand seven patients met inclusion criteria. Median age was 74 years (IQR 61-68) and 46.1 % were male. There was a high rate of co-morbidity and chronic medication use. The most common ED diagnoses were lower respiratory tract infection (including pneumonia, 22.7 %), cardiac failure (20.5%) and exacerbation of chronic obstructive pulmonary disease (19.7 %). ED disposition was hospital admission (including ICU) for 76.4 %, ICU admission for 5.6 % and death in ED in 0.9 %. Overall in-hospital mortality among admitted patients was 6.5 %. Discussion: Patients transported by ambulance with shortness of breath make up a significant proportion of ambulance caseload and have high comorbidity and high hospital admission rate. In this study, >60 % were accounted for by patients with heart failure, lower respiratory tract infection or COPD, but there were a wide range of diagnoses. This has implications for service planning, models of care and paramedic training. Conclusion: This study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services.

UR - http://www.scopus.com/inward/record.url?scp=85001129878&partnerID=8YFLogxK

U2 - 10.1186/s13049-016-0305-5

DO - 10.1186/s13049-016-0305-5

M3 - Article

C2 - 27658711

AN - SCOPUS:85001129878

SN - 1757-7241

VL - 24

JO - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

JF - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

IS - 1

M1 - 113

ER -

Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: An observational study

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