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Andersson Hagiwara, M., Magnusson, C., Herlitz, J., Seffel, E., Axelsson, C., Munters, M., . . . Nilsson, L. (2019). Adverse events in prehospital emergency care: a trigger tool study. BMC Emergency Medicine, 19(1)
Open this publication in new window or tab >>Adverse events in prehospital emergency care: a trigger tool study
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2019 (English)In: BMC Emergency Medicine, Vol. 19, no 1Article in journal (Refereed) Published
Abstract [en]

Prehospital emergency care has developed rapidly during the past decades. The care is given in a complex context which makes prehospital care a potential high-risk activity when it comes to patient safety. Patient safety in the prehospital setting has been only sparsely investigated. The aims of the present study were 1) To investigate the incidence of adverse events (AEs) in prehospital care and 2) To investigate the factors contributing to AEs in prehospital care.

Keywords
Emergency medical service, Adverse events, Patient safety, Trigger tool, Prehospital
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-15726 (URN)10.1186/s12873-019-0228-3 (DOI)000462228100001 ()30678636 (PubMedID)2-s2.0-85060553010 (Scopus ID)
Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2020-01-31Bibliographically approved
Alsholm, L., Axelsson, C., Andersson Hagiwara, M., Niva, M., Claesson, L., Herlitz, J., . . . Jood, K. (2019). Interrupted transport by the emergency medical service in stroke/transitory ischemic attack: A consequence of changed treatment routines in prehospital emergency care.. Brain and Behavior, Article ID e01266.
Open this publication in new window or tab >>Interrupted transport by the emergency medical service in stroke/transitory ischemic attack: A consequence of changed treatment routines in prehospital emergency care.
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2019 (English)In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, article id e01266Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: The discovery that not all patients who call for the emergency medical service (EMS) require transport to hospital has changed the structure of prehospital emergency care. Today, the EMS clinician at the scene already distinguishes patients with a time-critical condition such as stroke/transitory ischemic attack (TIA) from patients without. This highlights the importance of the early identification of stroke/TIA.

AIM: To describe patients with a final diagnosis of stroke/TIA whose transport to hospital was interrupted either due to a lack of suspicion of the disease by the EMS crew or due to refusal by the patient or a relative/friend.

METHODS: Data were obtained from a register in Gothenburg, covering patients hospitalised due to a final diagnosis of stroke/TIA. The inclusion criterion was that patients were assessed by the EMS but were not directly transported to hospital by the EMS.

RESULTS: Among all the patients who were assessed by the EMS nurse and subsequently diagnosed with stroke or TIA in 2015, the transport of 34 of 1,310 patients (2.6%) was interrupted. Twenty-five of these patients, of whom 20 had a stroke and five had a TIA, are described in terms of initial symptoms and outcome. The majority had residual symptoms at discharge from hospital. Initial symptoms were vertigo/disturbed balance in 11 of 25 cases. Another three had symptoms perceived as a change in personality and three had a headache.

CONCLUSION: From this pilot study, we hypothesise that a fraction of patients with stroke/TIA who call for the EMS have their direct transport to hospital interrupted due to a lack of suspicion of the disease by the EMS nurse at the scene. These patients appear to have more vague symptoms including vertigo and disturbed balance. Instruments to identify these patients at the scene are warranted.

Keywords
EMS, stroke/TIA, transport
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:hb:diva-16016 (URN)10.1002/brb3.1266 (DOI)30980519 (PubMedID)2-s2.0-85065760015 (Scopus ID)
Available from: 2019-04-24 Created: 2019-04-24 Last updated: 2020-01-29Bibliographically approved
Holmén, J., Herlitz, J., Jimenez-Herrera, M., Karlsson, T. & Axelsson, C. (2019). Passive leg raising in out-of-hospital cardiac arrest.. Resuscitation, 137, 94-101, Article ID S0300-9572(18)30888-8.
Open this publication in new window or tab >>Passive leg raising in out-of-hospital cardiac arrest.
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2019 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 137, p. 94-101, article id S0300-9572(18)30888-8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The use of passive leg raising (PLR) in cardiopulmonary resuscitation (CPR) is sometimes discussed and even recommended. The effect of this intervention has never been properly addressed. We planned to determine whether PLR in out-of-hospital cardiac arrest (OHCA) is associated with an improved survival to 30 days.

METHODS: In eight districts in western Sweden, we introduced PLR within five minutes after the start of CPR, among patients with OHCA. Patients in whom PLR was not performed, within the same district, served as a control group. Thirty-day survival was the primary endpoint. A propensity score analysis, as well as a standard multivariate analysis, was used to assess possible differences between the two groups.

RESULTS: We identified 3554 patients with OHCA from the eight districts. Forty-four percent were treated with PLR during CPR. Patients who received PLR differed from those who did not, by having more risk factors for an adverse outcome (fewer crew-witnessed cases, more OHCA at home, a greater need for medication and prolonged delays to treatment). The overall survival to 30 days was 7.9% among patients who received PLR versus 13.5% among those who did not. A comparison of the groups, using propensity score matching, revealed a 30 -day survival of 8.6% in the PLR group versus 8.2% in the control group (odds ratio 1.07; 95% confidence interval 0.80-1.44).

CONCLUSION: In an observational study, we introduced PLR as an addition to standard treatment in patients with OHCA. We did not find any evidence that this treatment improves survival to 30 days.

Keywords
CPR (cardiopulmonary resuscitation), Cardiac arrest, Cardiac arrest registry, OHCA (out-of-hospital cardiac arrest), Passive leg raising, Resuscitation, The Swedish Registry for Cardiopulmonary Resuscitation
National Category
Cardiac and Cardiovascular Systems
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22171 (URN)10.1016/j.resuscitation.2019.02.017 (DOI)000461593400014 ()30790693 (PubMedID)2-s2.0-85062059970 (Scopus ID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-20Bibliographically approved
Azeli, Y., Barberia, E., Jimenez Herrera, M., Ameijide, A., Axelsson, C. & Bardaji, A. (2019). Serious injuries secondary to cardiopulmonary resuscitation: incidence and associated factors.. Emergencias, 31(5), 327-334, Article ID 31625304.
Open this publication in new window or tab >>Serious injuries secondary to cardiopulmonary resuscitation: incidence and associated factors.
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2019 (English)In: Emergencias, Vol. 31, no 5, p. 327-334, article id 31625304Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:

To determine the incidence of serious rib cage damage (SRD) and serious visceral damage (SVD) secondary to cardiopulmonary resuscitation (CPR) and to explore associated factors.

MATERIAL AND METHODS:

We analyzed data from the prospective registry of cases of sudden death in Tarragona, Spain (the ReCaPTa study). Cases were collected from multiple surveillance sources. In this study we included the cases of autopsied nonsurvivors after attempted manual CPR between April 2014 and May 2016. A specific protocol to detect injuries secondary to CPR was used during the autopsies.

RESULTS:

We analyzed 109 cases. The mean age at death was 63 years and 32.1% were women. SRD were found in 63.3% and SVD in 14.7%. The group with SRD were significantly older (63 vs 59 years, P=.031) and included higher percentages of persons with a chest circumference over 101 cm (56.5 vs 30%, P=.016) and a waist circumference over 100 cm (62.3 vs 37.5%, P=.017). A multivariable analysis confirmed chest circumference over 101 cm as the only risk factor for SRD (odds ratio [OR], 2.45; 95% CI, 1.03-5.84) and female sex as the only risk factor for SVD (OR, 5.02; 95% CI, 1.18-21.25).

CONCLUSION:

Women and any patient with a chest circumference greater than 101 cm are at greater risk for serious injuries related to CPR.

Keywords
Thoracic injuries, Cardiopulmonary resuscitation, Fracturas costales, Lesiones torácicas, Reanimación cardiopulmonar, Rib fracture
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22360 (URN)000490045100007 ()31625304 (PubMedID)2-s2.0-85073601179 (Scopus ID)
Available from: 2020-01-02 Created: 2020-01-02 Last updated: 2020-01-29Bibliographically approved
Andersson, J.-O., Nasic, S., Herlitz, J., Hjertonsson, E. & Axelsson, C. (2019). The intensity of pain in the prehospital setting is most strongly reflected in the respiratory rate among physiological parameters.. American Journal of Emergency Medicine, 37(12), 2125-2131, Article ID S0735-6757(19)30038-5.
Open this publication in new window or tab >>The intensity of pain in the prehospital setting is most strongly reflected in the respiratory rate among physiological parameters.
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2019 (English)In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 37, no 12, p. 2125-2131, article id S0735-6757(19)30038-5Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In order to treat pain optimally, the Emergency Medical Service (EMS) clinician needs to be able to make a reasonable estimation of the severity of the pain. It is hypothesised that various physiological parameters will change as a response to pain.

AIM: In a cohort of patients who were seen by EMS clinicians, to relate the patients' estimated intensity of pain to various physiological parameters.

METHODS: Patients who called for EMS due to pain in a part of western Sweden were included. The intensity of pain was assessed according to the visual analogue scale (VAS) or the Numerical Rating Scale (NRS). The following were assessed the same time as pain on EMS arrival: heart rate, systolic and diastolic blood pressure, respiratory rate, moist skin and paleness.

RESULTS: In all, 19,908 patients (≥18 years), were studied (51% women). There were significant associations between intensity of pain and the respiratory rate (r = 0.198; p < 0.0001), heart rate (r = 0.037; p < 0.0001), systolic blood pressure (r = -0.029; p < 0.0001), moist skin (r = 0.143; p < 0.0001) and paleness (r = 0.171; p < 0.0001). The strongest association was found with respiratory rate among patients aged 18-64 years (r = 0.258; p < 0.0001).

CONCLUSION: In the prehospital setting, there were significant but weak correlations between intensity of pain and physiological parameters. The most clinically relevant association was found with an increased respiratory rate and presence of pale and moist skin among patients aged < 65 years. Among younger patients, respiratory rate may support in the clinical evaluation of pain.

Keywords
Intensity, Pain, Prehospital setting, Vital parameters
National Category
Anesthesiology and Intensive Care
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22176 (URN)10.1016/j.ajem.2019.01.032 (DOI)000502581800002 ()30718118 (PubMedID)2-s2.0-85060890032 (Scopus ID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2020-01-28Bibliographically approved
Magnusson, C., Herlitz, J., Karlsson, T., Jimenez Herrera, M. & Axelsson, C. (2019). The performance of EMS triage (RETTS-P) and the agreement between the field assessment and final hospital diagnosis: a prospective observational study among children <16 years.. BMC Pediatrics, 19(500), Article ID 31842832.
Open this publication in new window or tab >>The performance of EMS triage (RETTS-P) and the agreement between the field assessment and final hospital diagnosis: a prospective observational study among children <16 years.
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2019 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 19, no 500, article id 31842832Article in journal (Refereed) Published
Abstract [en]

Background

The rapid triage and treatment system for paediatrics (RETTS-p) has been used by the emergency medical services (EMS) in the west of Sweden since 2014. The performance of the RETTS-p in the pre-hospital setting and the agreement between the EMS nurse’s field assessment and the hospital diagnosis is unknown. The aim of this study was to evaluate the performance of the RETTS-p in the EMS and the agreement between the EMS field assessment and the hospital diagnosis.

Methods

A prospective observational study was conducted among 454 patients < 16 years of age who were assessed and transported to the PED. Two instruments were used for comparison: 1) Classification of an emergent patient according to predefined criteria as compared to the RETTS-p and 2) Agreement between the EMS nurse’s field assessment and the hospital diagnosis.

Results

Among all children, 11% were identified as having vital signs associated with an increased risk of death and 7% were diagnosed in hospital with a potentially life-threatening condition. Of the children triaged with RETTS-p (85.9%), 149 of 390 children (38.2%) were triaged to RETTS-p red or orange (life-threatening, potentially life-threatening), of which 40 (26.8%) children were classified as emergent. The hospitalised children were triaged with the highest frequency to level yellow (can wait; 41.5%). In children with RETTS-p red or orange, the sensitivity for a defined emergent patient was 66.7%, with a corresponding specificity of 67.0%. The EMS field assessment was in agreement with the final hospital diagnosis in 80% of the cases.

Conclusions

The RETTS-p sensitivity in this study is considered moderate. Two thirds of the children triaged to life threatening or potentially life threatening were later identified as non-emergent. Of those, one in six was discharged from the PED without any intervention. Further, one third of the children were under triaged, the majority were found in the yellow triage level (can wait). The highest proportion of hospitalised patients was found in the yellow triage level. Our result is in agreement with previous studies using other triage instruments. A computerised decision support system might help the EMS triage to increase sensitivity and specificity.

National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22354 (URN)10.1186/s12887-019-1857-0 (DOI)31842832 (PubMedID)
Projects
Doktorsavhandling. Prehospital bedömning
Available from: 2020-01-02 Created: 2020-01-02 Last updated: 2020-01-14Bibliographically approved
Sjösten, O., Nilsson, J., Herlitz, J., Axelsson, C., Jiménez-Herrera, M. & Andersson Hagiwara, M. (2019). The prehospital assessment of patients with a final hospital diagnosis of sepsis: Results of an observational study. Australasian Emergency Care
Open this publication in new window or tab >>The prehospital assessment of patients with a final hospital diagnosis of sepsis: Results of an observational study
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2019 (English)In: Australasian Emergency Care, ISSN 2588-994XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Background

Sepsis is a severe condition which affects 300–800/100,000 persons each year. There are indications that the prehospital identification of patients with sepsis is difficult. The aim of the study was, among patients with a final hospital diagnosis of sepsis, to compare emergency medical service (EMS) field assessments of patients in whom there was a prehospital suspicion of sepsis with those without this suspicion.

Methods

The study had a retrospective, observational design. The data used in the study were retrieved from the prehospital and hospital medical records of patients with a final hospital diagnosis of sepsis, transported to hospital by the EMS within a region in the south west of Sweden during a period of one year.

Results

Among patients with a final diagnosis of sepsis (n = 353), the EMS identified the condition in 36% of the cases. These patients were characterised by more abnormal vital signs (a higher respiratory rate and heart rate and more frequent temperature abnormalities) and were more ambitiously assessed (more lung auscultations and more assessments of the degree of consciousness).

Conclusion

The EMS was already able to identify 36% of patients with a final diagnosis of sepsis in the prehospital phase. There were minor differences in the prehospital assessment between patients who were identified by the EMS nurse and those who were not.

Keywords
EMS, Sepsis, Assessment, Prehospital
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:hb:diva-16010 (URN)10.1016/j.auec.2019.02.002 (DOI)000484350700009 ()2-s2.0-85062804551 (Scopus ID)
Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2020-01-29Bibliographically approved
Holmén, J., Herlitz, J. & Axelsson, C. (2018). Immediate coronary intervention in prehospital cardiac arrest-Aiming to save lives.. American Heart Journal, 202, 144-147, Article ID S0002-8703(18)30158-3.
Open this publication in new window or tab >>Immediate coronary intervention in prehospital cardiac arrest-Aiming to save lives.
2018 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 202, p. 144-147, article id S0002-8703(18)30158-3Article in journal (Refereed) Published
National Category
Cardiac and Cardiovascular Systems
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15534 (URN)10.1016/j.ahj.2018.05.008 (DOI)000439985300022 ()29921418 (PubMedID)2-s2.0-85050506276 (Scopus ID)
Available from: 2018-12-20 Created: 2018-12-20 Last updated: 2019-01-11Bibliographically approved
Holmén, J., Herlitz, J. & Axelsson, C. (2018). Immediatecoronary intervention in prehospital cardiac arrest-Aiming to save lives.. American Heart Journal, 202, 144-147
Open this publication in new window or tab >>Immediatecoronary intervention in prehospital cardiac arrest-Aiming to save lives.
2018 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 202, p. 144-147Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-15413 (URN)10.1016/j.ahj.2018.05.008 (DOI)000439985300022 ()29921418 (PubMedID)2-s2.0-85050506276 (Scopus ID)
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2019-01-14Bibliographically approved
Magnusson, C., Herlitz, J., Karlsson, T. & Axelsson, C. (2018). Initialassessment, level of care and outcome among children who were seen by emergencymedical services: a prospective observational study.. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1), 88
Open this publication in new window or tab >>Initialassessment, level of care and outcome among children who were seen by emergencymedical services: a prospective observational study.
2018 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, no 1, p. 88-Article in journal, Editorial material (Refereed) Published
Abstract [en]

BACKGROUND:

The assessment of children in the Emergency Medical Service (EMS) is infrequent representing 5.4% of the patients in an urban area in the western part of Sweden. In Sweden, patients are assessed on scene by an EMS nurse whom independently decides on interventions and level of care. To aid the EMS nurse in the assessment a triage instrument, Rapid Emergency Triage and Treatment System-paediatrics (RETTS-p) developed for Emergency Department (ED) purpose has been in use the last 5 years. The aim of this study was to evaluate the EMS nurse assessment, management, the utilisation of RETTS-p and patient outcome.

METHODS:

A prospective, observational study was performed on 651 children aged < 16 years from January to December 2016. Statistical tests used in the study were Mann-Whitney U test, Fisher's exact test and Spearman's rank statistics.

RESULTS:

The dispatch centre indexed life-threatening priority in 69% of the missions but, of all children, only 6.1% were given a life threatening RETTS-p red colour by the EMS nurse. A total of 69.7% of the children were transported to the ED and, of these, 31.7% were discharged without any interventions. Among the non-conveyed patients, 16 of 197 (8.1%) visited the ED within 72 h but only two were hospitalised. Full triage, including five out of five vital signs measurements and an emergency severity index, was conducted in 37.6% of all children. A triage colour was not present in 146 children (22.4%), of which the majority were non-conveyed. The overall 30-day mortality rate was 0.8% (n = 5) in children 0-15 years.

CONCLUSIONS:

Despite the incomplete use of all vital signs according to the RETTS-p, the EMS nurse assessment of children appears to be adapted to the clinical situation in most cases and the patients appear to be assessed to the appropriate level of care but indicating an over triage. It seems that the RETTS-p with full triage is used selectively in the pre-hospital assessment of children with a risk of death during the first 30 days of less than 1%.

Keywords
Triage, Children, Pre-hospital assessment, Patient safety, EMS nurse, Level of care
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15412 (URN)10.1186/s13049-018-0560-8 (DOI)000447850100002 ()30340502 (PubMedID)2-s2.0-85055076048 (Scopus ID)
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2019-01-14Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6505-9132

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