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Publications (10 of 833) Show all publications
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)
Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2019-02-07Bibliographically 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)
Available from: 2019-04-24 Created: 2019-04-24 Last updated: 2019-04-29Bibliographically approved
Hansson, P.-O., Andersson Hagiwara, M., Herlitz, J., Brink, P. & Wireklint Sundström, B. (2019). Prehospital assessment of suspected stroke and TIA: an observational study.. Acta Neurologica Scandinavica
Open this publication in new window or tab >>Prehospital assessment of suspected stroke and TIA: an observational study.
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2019 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Symptoms related to stroke diverge and may mimic many other conditions.

AIMS: To evaluate clinical findings among patients with a clinical suspicion of stroke in a prehospital setting and find independent predictors of a final diagnosis of stroke or transient ischemic attack (TIA) METHODS: An observational multi-centre study including nine emergency hospitals in western Sweden. All patients transported to hospital by ambulance and in whom a suspicion of stroke was raised by the EMS clinician before hospital admission during a four-month period were included.

RESULTS: Of 1,081 patients, a diagnosis of stroke was confirmed at hospital in 680 patients (63%), while 69 (6%) were diagnosed as TIA and 332 patients (31%) received other final diagnoses. In a multiple logistic regression analysis, factors independently associated with a final diagnosis of stroke or TIA were increasing age, odds ratio (OR) per year: 1.02, p=0.007, a history of myocardial infarction (OR: 1.77, p= 0.01), facial droop (OR: 2.81, p<0.0001), arm weakness (OR: 2.61, p<0.0001), speech disturbance (OR: 1.92, p<0.0001) and high systolic blood pressure (OR: 1.50, p=0.02), while low oxygen saturation was significantly associated with other diagnoses (OR: 0.41, p=0.007). More than half of all patients among patients with both stroke/TIA and other final diagnoses died during the five-year follow-up.

CONCLUSIONS: Seven factors including the three symptoms included in the Face Arm Speech Test (FAST) were significantly associated with a final diagnosis of stroke or TIA in a prehospital assessment of patients with a suspected stroke. This article is protected by copyright. All rights reserved.

Keywords
Emergency Medical Services, diagnosis, mortality, stroke
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:hb:diva-16022 (URN)10.1111/ane.13107 (DOI)31009075 (PubMedID)
Available from: 2019-04-24 Created: 2019-04-24 Last updated: 2019-04-29Bibliographically 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)
Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-04-24Bibliographically approved
Andersson Hagiwara, M., Wireklint Sundström, B., Brink, P., Herlitz, J. & Hansson, P.-O. (2018). A shorter system delay for haemorrhagic stroke than ischaemic stroke among patients who use emergency medical service.. Acta Neurologica Scandinavica
Open this publication in new window or tab >>A shorter system delay for haemorrhagic stroke than ischaemic stroke among patients who use emergency medical service.
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2018 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: We compare various aspects in the early chain of care among patients with haemorrhagic stroke and ischaemic stroke.

MATERIALS & METHODS: The Emergency Medical Services (EMS) and nine emergency hospitals, each with a stroke unit, were included. All patients hospitalised with a first and a final diagnosis of stroke between 15 December 2010 and 15 April 2011 were included. The primary endpoint was the system delay (from call to the EMS until diagnosis). Secondary endpoints were: (i) use of the EMS, (ii) delay from symptom onset until call to the EMS; (iii) priority at the dispatch centre; (iv) priority by the EMS; and (v) suspicion of stroke by the EMS nurse and physician on admission to hospital.

RESULTS: Of 1336 patients, 172 (13%) had a haemorrhagic stroke. The delay from call to the EMS until diagnosis was significantly shorter in haemorrhagic stroke. The patient's decision time was significantly shorter in haemorrhagic stroke. The priority level at the dispatch centre did not differ between the two groups, whereas the EMS nurse gave a significantly higher priority to patients with haemorrhage. There was no significant difference between groups with regard to the suspicion of stroke either by the EMS nurse or by the physician on admission to hospital.

CONCLUSIONS: Patients with a haemorrhagic stroke differed from other stroke patients with a more frequent and rapid activation of EMS.

Keywords
EMS, prehospital, stroke, system delay
National Category
Clinical Medicine
Identifiers
urn:nbn:se:hb:diva-13521 (URN)10.1111/ane.12895 (DOI)000429693800010 ()29315463 (PubMedID)2-s2.0-85040200414 (Scopus ID)
Available from: 2018-01-17 Created: 2018-01-17 Last updated: 2018-12-07Bibliographically approved
Hirlekar, G., Jonsson, M., Karlsson, T., Hollenberg, J., Albertsson, P. & Herlitz, J. (2018). Analysis of data for comorbidity and survival in out-of-hospital cardiac arrest.. Data in Brief, 21, 1541-1551
Open this publication in new window or tab >>Analysis of data for comorbidity and survival in out-of-hospital cardiac arrest.
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2018 (English)In: Data in Brief, E-ISSN 2352-3409, Vol. 21, p. 1541-1551Article in journal (Refereed) Published
Abstract [en]

The data presented in this article is supplementary to the research article titled "Comorbidity and survival in out-of-hospital cardiac arrest" (Hirlekar et al., 2018). The data contains information of how Charlson Comorbidity Index (CCI) is calculated and coded from ICD-10 codes. Multivariable logistic regression was used in the analysis of association between comorbidity and return of spontaneous circulation. We present baseline characteristics of patients found in VF/VT. All patients with non-missing data on all baseline variables are analyzed separately. We compare the baseline characteristics of patients with and without complete data set. Analysis of when comorbidity was identified in relation to outcome is also shown.

National Category
Anesthesiology and Intensive Care
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15529 (URN)10.1016/j.dib.2018.11.010 (DOI)30480066 (PubMedID)2-s2.0-85056458784 (Scopus ID)
Available from: 2018-12-20 Created: 2018-12-20 Last updated: 2019-01-14Bibliographically approved
Holmberg, M., Andersson, H., Winge, K., Lundberg, C., Karlsson, T., Herlitz, J. & Wireklint Sundström, B. (2018). Association between the reported intensityof an acute symptom at first prehospital assessment and the subsequent outcome:a study on patients with acute chest painand presumed acute coronary syndrome. BMC Cardiovascular Disorders, 1-10, Article ID 18:216.
Open this publication in new window or tab >>Association between the reported intensityof an acute symptom at first prehospital assessment and the subsequent outcome:a study on patients with acute chest painand presumed acute coronary syndrome
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2018 (English)In: BMC Cardiovascular Disorders, p. 1-10, article id 18:216Article in journal (Refereed) Published
Abstract [en]

Background: To decrease the morbidity burden of cardiovascular disease and to avoid the development ofpotentially preventable complications, early assessment and treatment of acute coronary syndrome (ACS) areimportant. The aim of this study has therefore been to explore the possible association between patients’ estimatedintensity of chest pain when first seen by the ambulance crew in suspected ACS, and the subsequent outcomebefore and after arrival in hospital.

Methods: Data was collected both prospectively and retrospectively. The inclusion criteria were chest pain raisingsuspicion of ACS and a reported intensity of pain ≥4 on the visual analogue scale.

Results: All in all, 1603 patients were included in the study. Increased intensity of chest pain was related to: 1) moreheart-related complications before hospital admission; 2) a higher proportion of heart failure, anxiety and chest painafter hospital admission; 3) a higher proportion of acute myocardial infarction and 4) a prolonged hospitalisation.However, there was no significant association with mortality neither in 30 days nor in three years. Adjustment forpossible confounders including age, a history of smoking and heart failure showed similar results.

Conclusion: The estimated intensity of chest pain reported by the patients on admission by the ambulance team wasassociated with the risk of complications prior to hospital admission, heart failure, anxiety and chest pain after hospitaladmission, the final diagnosis and the number of days in hospital.

National Category
Nursing
Identifiers
urn:nbn:se:hb:diva-15352 (URN)10.1186/s12872-018-0957-3 (DOI)000451531300001 ()30486789 (PubMedID)
Available from: 2018-11-30 Created: 2018-11-30 Last updated: 2018-12-07Bibliographically approved
Elfwén, L., Lagedal, R., James, S., Jonsson, M., Jensen, U., Ringh, M., . . . Nordberg, P. (2018). Coronary angiography in out-of-hospital cardiac arrest without ST elevation on ECG-Short- and long-term survival.. American Heart Journal, 200, 90-95, Article ID S0002-8703(18)30081-4.
Open this publication in new window or tab >>Coronary angiography in out-of-hospital cardiac arrest without ST elevation on ECG-Short- and long-term survival.
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2018 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 200, p. 90-95, article id S0002-8703(18)30081-4Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The potential benefit of early coronary angiography in out-of-hospital cardiac arrest (OHCA) patients without ST elevation on ECG is unclear. The aim of this study was to evaluate the association between early coronary angiography and survival in these patients.

METHODS: Nationwide observational study between 2008 and 2013. Included were patients admitted to hospital after witnessed OHCA, with shockable rhythm, age 18 to 80 years and unconscious. Patients with ST-elevation on ECG were excluded. Patients that underwent early CAG (within 24 hours) were compared with no early CAG (later during the hospital stay or not at all). Outcomes were survival at 30 days, 1 year, and 3 years. Multivariate analysis included pre-hospital factors, comorbidity and ECG-findings.

RESULTS: In total, 799 OHCA patients fulfilled the inclusion criteria, of which 275 (34%) received early CAG versus 524 (66%) with no early CAG. In the early CAG group, the proportion of patients with an occluded coronary artery was 27% and 70% had at least one significant coronary stenosis (defined as narrowing of coronary lumen diameter of ≥50%). The 30-day survival rate was 65% in early CAG group versus 52% with no early CAG (P < .001). The adjusted OR was 1.42 (95% CI 1.00-2.02). The one-year survival rate was 62% in the early CAG group versus 48% in the no early CAG group with the adjusted hazard ratio of 1.35 (95% CI 1.04-1.77).

CONCLUSION: In this population of bystander-witnessed cases of out-of-hospital cardiac arrest with shockable rhythm and ECG without ST elevation, early coronary angiography may be associated with improved short and long term survival.

National Category
Anesthesiology and Intensive Care
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15537 (URN)10.1016/j.ahj.2018.03.009 (DOI)000434948300013 ()29898854 (PubMedID)2-s2.0-85045905010 (Scopus ID)
Available from: 2018-12-20 Created: 2018-12-20 Last updated: 2019-01-14Bibliographically approved
Zijlstra, J. A., Koster, R. W., Blom, M. T., Lippert, F. K., Svensson, L., Herlitz, J., . . . Hollenberg, J. (2018). Different defibrillation strategies in survivors after out-of-hospital cardiac arrest.. Heart, 104(23), 1929-1936
Open this publication in new window or tab >>Different defibrillation strategies in survivors after out-of-hospital cardiac arrest.
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2018 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 104, no 23, p. 1929-1936Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In the last decade, there has been a rapid increase in the dissemination of automated external defibrillators (AEDs) for prehospital defibrillation of out-of-hospital cardiac arrest patients. The aim of this study was to study the association between different defibrillation strategies on survival rates over time in Copenhagen, Stockholm, Western Sweden and Amsterdam, and the hypothesis was that non-EMS defibrillation increased over time and was associated with increased survival.

METHODS: We performed a retrospective analysis of four prospectively collected cohorts of out-of-hospital cardiac arrest patients between 2008 and 2013. Emergency medical service (EMS)-witnessed arrests were excluded.

RESULTS: A total of 22 453 out-of-hospital cardiac arrest patients with known survival status were identified, of whom 2957 (13%) survived at least 30 days postresuscitation. Of all survivors with a known defibrillation status, 2289 (81%) were defibrillated, 1349 (59%) were defibrillated by EMS, 454 (20%) were defibrillated by a first responder AED and 429 (19%) were defibrillated by an onsite AED and 57 (2%) were unknown. The percentage of survivors defibrillated by first responder AEDs (from 13% in 2008 to 26% in 2013, p<0.001 for trend) and onsite AEDs (from 14% in 2008 to 30% in 2013, p<0.001 for trend) increased. The increased use of these non-EMS AEDs was associated with the increase in survival rate of patients with a shockable initial rhythm.

CONCLUSION: Survivors of out-of-hospital cardiac arrest are increasingly defibrillated by non-EMS AEDs. This increase is primarily due to a large increase in the use of onsite AEDs as well as an increase in first-responder defibrillation over time. Non-EMS defibrillation accounted for at least part of the increase in survival rate of patients with a shockable initial rhythm.

Keywords
cardiac arrest, ventricular fibrillation
National Category
Anesthesiology and Intensive Care
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15536 (URN)10.1136/heartjnl-2017-312622 (DOI)000451279500008 ()29903805 (PubMedID)2-s2.0-85056620114 (Scopus ID)
Available from: 2018-12-20 Created: 2018-12-20 Last updated: 2019-01-11Bibliographically approved
Årestedt, K., Allert, C., Djucanovic, I., Israelsson, J., Schildmeijer, K., Agerström, J., . . . Bremer, A. (2018). Health Related Quality of Life Among In-Hospital Cardiac Arrest Survivors in Working Age. In: : . Paper presented at The Congress of the European Resuscitation Council, Bologna, Italy. September 20–22, 2018..
Open this publication in new window or tab >>Health Related Quality of Life Among In-Hospital Cardiac Arrest Survivors in Working Age
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2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Other Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15663 (URN)
Conference
The Congress of the European Resuscitation Council, Bologna, Italy. September 20–22, 2018.
Available from: 2019-01-13 Created: 2019-01-13 Last updated: 2019-01-14Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4139-6235

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