Back to Search
Start Over
The impact of prehospital assessment and EMS transport of acute aortic syndrome patients
- Source :
- The American Journal of Emergency Medicine. 36:1188-1194
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- The quality of acute aortic syndrome (AAS) assessment by emergency medical service (EMS) and the incidence and prehospital factors associated with 1-month survival remain unclear.We retrospectively analyzed the data collected for 94,468 patients with non-traumatic medical emergency excluding out-of-hospital cardiac arrest during the period of 2011-2014.Of these transported by EMS, 22,075 had any of the AAS-related symptoms, and 330 had an EMS-assessed risk for AAS; of these, 195 received an in-hospital AAS diagnosis. Of the remaining 21,745 patients without EMS-assessed risk, 166 were diagnosed with AAS. Therefore, the sensitivity and specificity of our EMS-risk assessment for AAS was 54.0% (195/361) and 99.4% (21,579/21,714), respectively. EMS assessed the risk less frequently when patients were elderly and presented with dyspnea and syncope/faintness. Sign of upper extremity ischemia was rarely detected (6.9%) and absence of this sign was associated with lack of EMS-assessed risk. The calculation of modified aortic dissection detection risk score revealed that rigorous assessment based on this score may increase the EMS sensitivity for AAS. The 1-month survival rate was significantly higher in patients admitted to core hospitals with surgical teams for AAS than in those admitted to all other hospitals [87.5% (210/240) vs 69.4% (84/121); P0.01]. Multiple logistic regression analysis demonstrated that Stanford type A, Glasgow coma scale ≤14, and admission to core hospitals providing emergency cardiovascular surgery were associated with 1-month survival.Improvement of AAS survival is likely to be affected by rapid admission to appropriate hospitals providing cardiovascular surgery.
- Subjects :
- Male
Chest Pain
Emergency Medical Services
medicine.medical_specialty
Aortic Diseases
Detection risk
030204 cardiovascular system & hematology
Risk Assessment
Sensitivity and Specificity
Syncope
EMS transport
Time-to-Treatment
03 medical and health sciences
0302 clinical medicine
Japan
medicine
Humans
In patient
030212 general & internal medicine
Survival rate
Aged
Retrospective Studies
Aged, 80 and over
Acute aortic syndrome
Aortic dissection
business.industry
Cardiovascular Surgical Procedures
Incidence (epidemiology)
Syndrome
General Medicine
Middle Aged
medicine.disease
Transportation of Patients
Back Pain
Acute Disease
Emergency medicine
Emergency Medicine
Female
business
Subjects
Details
- ISSN :
- 07356757
- Volume :
- 36
- Database :
- OpenAIRE
- Journal :
- The American Journal of Emergency Medicine
- Accession number :
- edsair.doi.dedup.....e099176dd33e7525cf5704fdb0bc2eef