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18. Linking Ambulance Records with Hospital and Death Index Data to Evaluate Patient Outcomes

Author

Andrew,Emily, Cox,Shelley, and Smith,Karen

Subjects
Short Report, International Journal of General Medicine, ambulance, General Medicine, prehospital, outcomes, data linkage
Abstract

Emily Andrew,1,2,* Shelley Cox,1,2,* Karen Smith1– 3 1Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia; 2Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; 3Department of Paramedicine, Monash University, Victoria, Australia*These authors contributed equally to this workCorrespondence: Emily Andrew Email emily.andrew@ambulance.vic.gov.auObjective: Linkage of electronic administrative datasets is becoming increasingly common, offering a powerful resource for research and analysis. However, routine linkage of prehospital data with emergency department (ED) presentation and hospital admission datasets is rare. We describe a methodology used to link ambulance data with hospital ED presentations, admissions, and death records, and examine potential biases between matched and unmatched patients.Methods: Iterative deterministic linkage methodologies were employed to link clinical, operational, and secondary triage ambulance data to ED presentations, hospital admissions, and death records in Victoria, Australia. Descriptive analyses and standardised differences were used to examine potential biases between matched and unmatched patients.Results: A total of 2,813,913 ambulance records were available for linkage. Of the patients that were transported to a public ED (n=1,753,268), 83.3% matched with an ED record. Only small differences were observed between matched and unmatched patients for sex, year, time of day and attending crew type. The data elements with the largest standardised differences were patient age (0.25) and paramedic diagnosis (0.25). Matched patients were older (mean ± standard deviation: 55.6± 25.7 vs 49.0± 26.0 years) and more likely to have a paramedic-suspected cardiac, respiratory, neurological, or gastrointestinal/genitourinary condition, suspected infection/sepsis, or pain.Conclusion: This linked dataset will facilitate a large body of research into prehospital care and patient outcomes. Although future analysis of matched patients should acknowledge the linkage error rate, our findings suggest that results are likely to be generalisable to the broader ambulance population.Keywords: ambulance, prehospital, data linkage, outcomes

Published
2022

19. LidocAine Versus Opioids In MyocarDial infarction: the AVOID-2 randomized controlled trial

Author

Fernando, Himawan, primary, Nehme, Ziad, additional, Milne, Catherine, additional, O’Brien, Jessica, additional, Bernard, Stephen, additional, Stephenson, Michael, additional, Myles, Paul S, additional, Lefkovits, Jeffrey, additional, Peter, Karlheinz, additional, Brennan, Angela, additional, Dinh, Diem, additional, Andrew, Emily, additional, Taylor, Andrew J, additional, Smith, Karen, additional, and Stub, Dion, additional

Published
2022
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20. Temperature-related chest pain presentations and future projections with climate change

Author

Dawson, Luke P., primary, Andrew, Emily, additional, Nehme, Ziad, additional, Bloom, Jason, additional, Cox, Shelley, additional, Anderson, David, additional, Stephenson, Michael, additional, Lefkovits, Jeffrey, additional, Taylor, Andrew J., additional, Kaye, David, additional, Guo, Yuming, additional, Smith, Karen, additional, and Stub, Dion, additional

Published
2022
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21. Risk-standardized mortality metric to monitor hospital performance for chest pain presentations

Author

Dawson, Luke P, primary, Andrew, Emily, additional, Nehme, Ziad, additional, Bloom, Jason, additional, Okyere, Daniel, additional, Cox, Shelley, additional, Anderson, David, additional, Stephenson, Michael, additional, Lefkovits, Jeffrey, additional, Taylor, Andrew J, additional, Kaye, David, additional, Smith, Karen, additional, and Stub, Dion, additional

Published
2022
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26. Gender Disparities in Cardiogenic Shock Treatment and Outcomes

Author

Bloom, Jason E., primary, Andrew, Emily, additional, Nehme, Ziad, additional, Beale, Anna, additional, Dawson, Luke P., additional, Shi, William Y., additional, Vriesendorp, Pieter A., additional, Fernando, Himawan, additional, Noaman, Samer, additional, Cox, Shelley, additional, Stephenson, Michael, additional, Anderson, David, additional, Chan, William, additional, Kaye, David M., additional, Smith, Karen, additional, and Stub, Dion, additional

Published
2022
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27. Determining the sensitivity of emergency dispatcher and paramedic diagnosis of stroke: statewide registry linkage study

Author

Eliakundu, Amminadab L., primary, Cadilhac, Dominique A., additional, Kim, Joosup, additional, Kilkenny, Monique F., additional, Bagot, Kathleen L., additional, Andrew, Emily, additional, Cox, Shelley, additional, Bladin, Christopher F., additional, Stephenson, Michael, additional, Pesavento, Lauren, additional, Sanders, Lauren, additional, Clissold, Ben, additional, Ma, Henry, additional, and Smith, Karen, additional

Published
2022
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28. The influence of ambulance offload time on 30‐day risks of death and re‐presentation for patients with chest pain

Author

Dawson, Luke P, primary, Andrew, Emily, additional, Stephenson, Michael, additional, Nehme, Ziad, additional, Bloom, Jason, additional, Cox, Shelley, additional, Anderson, David, additional, Lefkovits, Jeffrey, additional, Taylor, Andrew J, additional, Kaye, David, additional, Smith, Karen, additional, and Stub, Dion, additional

Published
2022
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29. Development and validation of a comprehensive early risk prediction model for patients with undifferentiated acute chest pain

Author

Dawson, Luke P., primary, Andrew, Emily, additional, Nehme, Ziad, additional, Bloom, Jason, additional, Liew, Danny, additional, Cox, Shelley, additional, Anderson, David, additional, Stephenson, Michael, additional, Lefkovits, Jeffrey, additional, Taylor, Andrew J., additional, Kaye, David, additional, Cullen, Louise, additional, Smith, Karen, additional, and Stub, Dion, additional

Published
2022
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32. Impact of prehospital opioid dose on angiographic and clinical outcomes in acute coronary syndromes

Author

Fernando, Himawan, primary, Nehme, Ziad, additional, Dinh, Diem, additional, Andrew, Emily, additional, Brennan, Angela, additional, Shi, William, additional, Bloom, Jason, additional, Duffy, Stephen James, additional, Shaw, James, additional, Peter, Karlheinz, additional, Nadurata, Voltaire, additional, Chan, William, additional, Layland, Jamie, additional, Freeman, Melanie, additional, Van Gaal, William, additional, Bernard, Stephen, additional, Lefkovits, Jeffrey, additional, Liew, Danny, additional, Stephenson, Michael, additional, Smith, Karen, additional, and Stub, Dion, additional

Published
2022
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33. Association of Socioeconomic Status With Outcomes and Care Quality in Patients Presenting With Undifferentiated Chest Pain in the Setting of Universal Health Care Coverage

Author

Dawson, Luke P., primary, Andrew, Emily, additional, Nehme, Ziad, additional, Bloom, Jason, additional, Biswas, Sinjini, additional, Cox, Shelley, additional, Anderson, David, additional, Stephenson, Michael, additional, Lefkovits, Jeffrey, additional, Taylor, Andrew J., additional, Kaye, David, additional, Smith, Karen, additional, and Stub, Dion, additional

Published
2022
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34. Supplemental Material - Linking Data From the Australian Stroke Clinical Registry With Ambulance and Emergency Administrative Data in Victoria

Author

Eliakundu, Amminadab L., Smith, Karen, Kilkenny, Monique F., Kim, Joosup, Bagot, Kathleen L., Andrew, Emily, Cox, Shelley, Bladin, Christopher F., and Cadilhac, Dominique A.

Subjects
111099 Nursing not elsewhere classified, FOS: Health sciences
Abstract

Supplemental Material for Linking Data From the Australian Stroke Clinical Registry With Ambulance and Emergency Administrative Data in Victoria by Amminadab L Eliakundu, Karen Smith, Monique F. Kilkenny, Joosup Kim, Kathleen L. Bagot, Emily Andrew, Shelley Cox, Christopher F. Bladin, and Dominique A. Cadilhac in The Journal of Health Care Organization, Provision, and Financing

Published
2022
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35. Incidence and Outcomes of Nontraumatic Shock in Adults Using Emergency Medical Services in Victoria, Australia

Author

Bloom, Jason E., primary, Andrew, Emily, additional, Dawson, Luke P., additional, Nehme, Ziad, additional, Stephenson, Michael, additional, Anderson, David, additional, Fernando, Himawan, additional, Noaman, Samer, additional, Cox, Shelley, additional, Milne, Catherine, additional, Chan, William, additional, Kaye, David M., additional, Smith, Karen, additional, and Stub, Dion, additional

Published
2022
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36. Sex differences in prehospital analgesia in patients presenting with acute coronary syndromes and their association with clinical outcomes

Author

Nan Tie, Emilia, primary, Fernando, Himawan, additional, Nehme, Ziad, additional, Dinh, Diem, additional, Andrew, Emily, additional, Brennan, Angela, additional, Zaman, Sarah, additional, Liew, Danny, additional, Stephenson, Michael, additional, Lefkovits, Jeffrey, additional, Peter, Karlheinz, additional, Duffy, Stephen J., additional, Shaw, James, additional, Smith, Karen, additional, and Stub, Dion, additional

Published
2022
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41. Age as a predictor of clinical outcomes and determinant of therapeutic measures for emergency medical services treated cardiogenic shock.

Author

Xiaoman Xiao, Bloom, Jason E., Andrew, Emily, Dawson, Luke P., Nehme, Ziad, Stephenson, Michael, Anderson, David, Fernando, Himawan, Noaman, Samer, Cox, Shelley, Chan, William, Kaye, David M., Smith, Karen, and Stub, Dion

Subjects
CAUSES of death, CONFIDENCE intervals, AGE distribution, REGRESSION analysis, TREATMENT effectiveness, COMPARATIVE studies, CARDIOGENIC shock, EMERGENCY medical services, DESCRIPTIVE statistics, RESEARCH funding, ODDS ratio, ANGIOGRAPHY, LONGITUDINAL method, EVALUATION
Abstract

BACKGROUND The impact of age on outcomes in cardiogenic shock (CS) is poorly described in the pre-hospital setting. We assessed the impact of age on outcomes of patients treated by emergency medical services (EMS). METHODS This population-based cohort study included consecutive adult patients with CS transported to hospital by EMS. Successfully linked patients were stratified into tertiles by age (18-63, 64-77, and > 77 years). Predictors of 30-day mortality were assessed through regression analyses. The primary outcome was 30-day all-cause mortality. RESULTS A total of 3523 patients with CS were successfully linked to state health records. The average age was 68 ± 16 years and 1398 (40%) were female. Older patients were more likely to have comorbidities including pre-existing coronary artery disease, hypertension, dyslipidemia, diabetes mellitus, and cerebrovascular disease. The incidence of CS was significantly greater with increasing age (incidence rate per 100,000 person years 6.47 [95% CI: 6.1-6.8] in age 18-63 years, 34.34 [32.4-36.4] in age 64-77 years, 74.87 [70.6-79.3] in age > 77 years, P < 0.001). There was a step-wise increase in the rate of 30-day mortality with increasing age tertile. After adjustment, compared to the lowest age tertile, patients aged > 77 years had increased risk of 30-day mortality (adjusted hazard ratio = 2.26 [95% CI: 1.96-2.60]). Older patients were less likely to receive inpatient coronary angiography. CONCLUSION Older patients with EMS-treated CS have significantly higher rates of short-term mortality. The reduced rates of invasive interventions in older patients underscore the need for further development of systems of care to improve outcomes for this patient group. [ABSTRACT FROM AUTHOR]

Published
2023
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43. Dysphagia: An updated guide to investigation.

Author

ANDREW, EMILY and WONG, MAY

Subjects
*DEGLUTITION disorders, *ESOPHAGEAL motility disorders, *BARRETT'S esophagus, *AMYOTROPHIC lateral sclerosis, *SUDDEN onset of disease
Abstract

The article focuses on Dysphagia which is difficulty in swallowing. Topics include classification of dysphagia on the basis of location along the oesophageal tract, investigation of dysphagia through video fluoroscopy, gastroscopy, and high-resolution oesophageal manometry, and its treatment which is multifaceted and involves diet modification.

Published
2022

48. Predictors of hospital prenotification for STEMI and association of prenotification with outcomes.

Author

Blusztein, David, Dinh, Diem, Stub, Dion, Dawson, Luke, Brennan, Angela, Reid, Christopher, Smith, Karen, Nehme, Ziad, Andrew, Emily, Bernard, Stephen, and Lefkovits, Jeffrey

Abstract

Background: Delay to reperfusion in ST-elevation myocardial infarction (STEMI) is detrimental, but can be minimised with prehospital notification by ambulance to the treating hospital. We aimed to assess whether prenotification was associated with improved first medical contact to balloon times (FMC-BT) and whether this resulted in better clinical outcomes. We also aimed to identify factors associated with use of prenotification.Methods: This was a retrospective study of prospective Victorian Cardiac Outcomes Registry data for patients undergoing primary percutaneous coronary intervention for STEMI from 2013-2018. Postcardiac arrest were excluded. Patients were grouped by whether they arrived by ambulance with prenotification (group 1), arrived by ambulance without prenotification (group 2) or self-presented (group 3). We compared groups by FMC-BT, incidence of major adverse cardiac and cerebrovascular events (MACCE), mortality and factors associated with the use of prenotification.Results: 2891 patients were in group 1 (79.3% male), 1620 in group 2 (75.7% male) and 1220 in group 3 (82.9% male). Patients who had prenotification were more likely to present in-hours (p=0.004) and self-presenters had lowest rates of cardiogenic shock (p<0.001). Prenotification had shorter FMC-BT than without prenotification (104 min vs 132 min, p<0.001) Self-presenters had superior clinical outcomes, with no difference between ambulance groups. Groups 1 and 2 had similar 30-day MACCE outcomes (7.4% group 1 vs 9.1% group 2, p=0.05) and similar mortality (4.6% group 1 vs 5.9% group 2, p=0.07). In multivariable analysis, male gender, right coronary artery culprit and in-hours presentation independently predicted use of prenotification (all p<0.05).Conclusion: Differences in clinical characteristics, particularly gender, time of presentation and culprit vessel may influence ambulance prenotification. Ambulance cohorts have high-risk features and worse outcomes compared with self-presenters. Improving system inequality in prehospital STEMI diagnosis is recommended for fastest STEMI treatment. [ABSTRACT FROM AUTHOR]

Published
2022
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50. Sex Differences in Prehospital Delays in Patients With ST‐Segment–Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Author

Stehli, Julia, primary, Dinh, Diem, additional, Dagan, Misha, additional, Duffy, Stephen J., additional, Brennan, Angela, additional, Smith, Karen, additional, Andrew, Emily, additional, Nehme, Ziad, additional, Reid, Christopher M., additional, Lefkovits, Jeffrey, additional, Stub, Dion, additional, and Zaman, Sarah, additional

Published
2021
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