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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
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). Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study.. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1), Article ID 88.
Open this publication in new window or tab >>Initial assessment, level of care and outcome among children who were seen by emergency medical 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, article id 88Article in journal (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
Children, EMS nurse, Level of care, Patient safety, Pre-hospital assessment, Triage
National Category
Other Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15531 (URN)10.1186/s13049-018-0560-8 (DOI)000447850100002 ()30340502 (PubMedID)2-s2.0-85055076048 (Scopus ID)
Available from: 2018-12-20 Created: 2018-12-20 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/0000-0003-4139-6235

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