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BACKGROUND: Prehospital vital sign documentation in paediatric patients is incomplete, especially in patients ≤ 2 years. The aim of the study was to increase vital sign registration in paediatric patients through specific educational initiatives. METHODS: Prospective quasi-experimental study with interrupted time-series design in the North Denmark and South Denmark regions. The study consecutively included all children aged < 18 years attended by the emergency medical service (EMS) from 1 July 2019 to 31 December 2021. Specific educational initiatives were conducted only in the North Denmark EMS and included video learning and classroom training based on the European Paediatric Advanced Life Support principles. The primary outcome was the proportion of patients who had their respiratory rate, peripheral capillary oxygen saturation, heart rate and level of consciousness recorded at least twice. We used a binomial regression model stratified by age groups to compare proportions of the primary outcome in the pre- and post-intervention periods in each region. RESULTS: In North Denmark, 7551 patients were included, while 15,585 patients from South Denmark were used as a reference. Virtually all of the North Denmark EMS providers completed the video learning (98.7%). The total study population involved patients aged ≤ 2 months (5.5%), 3-11 months (7.4%), 1-2 years (18.8%), 3-7 years (16.2%) and ≥ 8 years (52.1%). In the intervention region, the primary outcome increased from the pre- to the post-intervention period from 35.3% to 40.5% [95% CI for difference 3.0;7.4]. There were large variations in between age groups with increases from 18.8% to 27.4% [95% CI for difference 5.3;12.0] among patients aged ≤ 2 years, from 33.5% to 43.7% [95% CI for difference 4.9;15.5] among patients aged 3-7 years and an insignificant increase among patients aged ≥ 8 years (from 46.4% to 47.9% [95% CI for difference - 1.7;4.7]). In the region without the specific educational interventions, proportions were steady for all age groups throughout the entire study period. CONCLUSIONS: Mandatory educational initiatives for EMS providers were associated with an increase in the extent of vital sign registration in paediatric patients ≤ 7 years. Incomplete vital registration was associated with, but not limited to non-urgent cases.
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Servicios Médicos de Urgencia , Humanos , Niño , Estudios Prospectivos , Frecuencia Cardíaca , Frecuencia Respiratoria , DocumentaciónRESUMEN
INTRODUCTION: In 2006, the North Denmark Region implemented the electronic prehospital patient medical record (PPR), amPHI, in the region's prehospital emergency medical service. In 2015, a new nationwide version was implemented. Our aim was to investigate the completeness and correctness of registrations of vital sign data in the PPR after the initial introduction and after the implementation of the new PPR version. METHODS: This was a descriptive registry-based study including patients to whom an ambulance was dispatched after an emergency call in the North Denmark Region in the periods 2007-2014 and 2016-2017. We examined vital sign data defined as blood pressure (BP), heart rate (HR), blood oxygen saturation (SpO2), respiratory rate (RR), Glasgow Coma Scale (GCS) score and numeric rating scale (NRS) for pain. We defined incorrect vital sign values according to clinical plausibility. We used a trend analysis and Pearson's χ2. RESULTS: We included 253,169 PPRs. The proportion of PPR with registration of vital signs from 2007-2014 compared with 2016-2017 was BP: 73-86%, 81-82%; HR: 76-88%, 82-83%; SpO2: 72-85%, 82-83%; RR: 34-82%, 77-79%; GCS score: 54-92%, 81-84%; NRS for pain: 0-16%, 24-26%. The increase from 2007-2014 and 2016-2017 was significant as were the differences between 2014 and 2016. We found few defined outliers (0.5%). CONCLUSIONS: The completeness of registration increased gradually but decreased slightly after implementation of the new version. A high completeness combined with few implausible outliers and concordance indicate correctness of the vital sign registrations. FUNDING: none. TRIAL REGISTRATION: Approval for the use of data was given by the medical director of the Emergency Medical Services, the North Denmark Region.
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Ambulancias , Documentación/métodos , Registros Electrónicos de Salud/estadística & datos numéricos , Signos Vitales , Dinamarca , Servicio de Urgencia en Hospital , Escala de Coma de Glasgow , Humanos , Modelos Lineales , Estudios RetrospectivosRESUMEN
OBJECTIVE: Breathing difficulties and respiratory diseases have been under-reported in Emergency Medical Services research, despite these conditions being prevalent with substantial mortality. Our aim was two-fold; 1) to investigate the diagnostic pattern and mortality among EMS patients to whom an ambulance was dispatched due to difficulty breathing, and 2) to investigate the initial symptoms and mortality for EMS patients diagnosed with respiratory diseases in hospital. METHODS: Population-based historic cohort study in the North Denmark Region 2012-2015. We included two patient groups; 1) patients calling the emergency number with breathing difficulty as main symptom, and 2) patients diagnosed with respiratory diseases in hospital following an emergency call. Main outcome was estimated 1- and 30-day mortality rates. RESULTS: There were 3803 patients with the symptom breathing difficulty, nearly half were diagnosed with respiratory diseases 47.3%, followed by circulatory diseases 13.4%, and symptoms and signs 12.0%. The 1-day mortality rate was highest for circulatory diseases, then respiratory diseases and other factors. Over-all 30-day mortality was 13.2%, and the highest rate was for circulatory diseases (17.7%) then respiratory diseases and other factors. A total of 4014 patients were diagnosed with respiratory diseases, 44.8% had the symptom breathing difficulty, 13.4% unclear problems and 11.3%. chest pain/heart disease. 1-day mortality rates were highest for decreased consciousness, then breathing difficulties and unclear problem. Over-all 30-day mortality rates were 12.5%, the highest with symptoms of decreased consciousness (19.1%), then unclear problem and breathing difficulty. There was an overlap of 1797 patients between the two groups. CONCLUSIONS: The over-all mortality rates alongside the distribution of symptoms and diagnoses, suggest the breathing difficulty patient group is complex and has severe health problems. These findings may be able to raise awareness towards the patient group, and thereby increase focus on diagnostics and treatment to improve the patient outcome.