The influence of ambulance offload time on 30-day risks of death and re-presentation for patients with chest pain.
Acute coronary syndrome
Emergency services, medical
Public health
Transportation of patients
Treatment outcome
Journal
The Medical journal of Australia
ISSN: 1326-5377
Titre abrégé: Med J Aust
Pays: Australia
ID NLM: 0400714
Informations de publication
Date de publication:
05 09 2022
05 09 2022
Historique:
revised:
15
02
2022
received:
25
10
2021
accepted:
14
03
2022
pubmed:
24
6
2022
medline:
9
9
2022
entrez:
23
6
2022
Statut:
ppublish
Résumé
To assess whether ambulance offload time influences the risks of death or ambulance re-attendance within 30 days of initial emergency department (ED) presentations by adults with non-traumatic chest pain. Population-based observational cohort study of consecutive presentations by adults with non-traumatic chest pain transported by ambulance to Victorian EDs, 1 January 2015 - 30 June 2019. Adults (18 years or older) with non-traumatic chest pain, excluding patients with ST elevation myocardial infarction (pre-hospital electrocardiography) and those who were transferred between hospitals or not transported to hospital (eg, cardiac arrest or death prior to transport). Primary outcome: 30-day all-cause mortality (Victorian Death Index data). Transport by ambulance with chest pain to ED within 30 days of initial ED presentation. We included 213 544 people with chest pain transported by ambulance to EDs (mean age, 62 [SD, 18] years; 109 027 women [51%]). The median offload time increased from 21 (IQR, 15-30) minutes in 2015 to 24 (IQR, 17-37) minutes during the first half of 2019. Three offload time tertiles were defined to include approximately equal patient numbers: tertile 1 (0-17 minutes), tertile 2 (18-28 minutes), and tertile 3 (more than 28 minutes). In multivariable models, 30-day risk of death was greater for patients in tertile 3 than those in tertile 1 (adjusted rates, 1.57% v 1.29%; adjusted risk difference, 0.28 [95% CI, 0.16-0.42] percentage points), as was that of a second ambulance attendance with chest pain (adjusted rates, 9.03% v 8.15%; adjusted risk difference, 0.87 [95% CI, 0.57-1.18] percentage points). Longer ambulance offload times are associated with greater 30-day risks of death and ambulance re-attendance for people presenting to EDs with chest pain. Improving the speed of ambulance-to-ED transfers is urgently required.
Identifiants
pubmed: 35738570
doi: 10.5694/mja2.51613
pmc: PMC9545565
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
253-259Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2022 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.
Références
Lancet. 2013 Jul 20;382(9888):195-6
pubmed: 23878856
CJEM. 2019 Jul;21(4):505-512
pubmed: 30841940
Eur Heart J. 2018 Apr 1;39(13):1065-1074
pubmed: 29452351
J Clin Med. 2020 May 09;9(5):
pubmed: 32397560
Emerg Med Australas. 2020 Apr;32(2):271-280
pubmed: 31867883
CJEM. 2015 Nov;17(6):670-8
pubmed: 25994045
Int J Gen Med. 2022 Jan 13;15:567-572
pubmed: 35046714
N Engl J Med. 2017 Jun 8;376(23):2235-2244
pubmed: 28528569
Australas Emerg Nurs J. 2017 Nov;20(4):153-160
pubmed: 29054574
Ann Emerg Med. 2021 Jul;78(1):113-122
pubmed: 33972127
Ann Am Thorac Soc. 2019 Jan;16(1):22-28
pubmed: 30230362
JAMA. 2011 Jun 15;305(23):2440-7
pubmed: 21666277
Med J Aust. 2015 May 4;202(8):427-32
pubmed: 25929506
Stroke. 2021 May;52(5):1724-1732
pubmed: 33657854
Ann Epidemiol. 2022 Aug;72:32-39
pubmed: 35513303
Ann Emerg Med. 2019 Sep;74(3):345-356
pubmed: 31229391
Circulation. 2017 Nov 14;136(20):1895-1907
pubmed: 28893843
Prehosp Emerg Care. 2011 Oct-Dec;15(4):555-61
pubmed: 21870947
Emerg Med Australas. 2015 Jun;27(3):216-24
pubmed: 25940975
Health Care Manag Sci. 2019 Dec;22(4):658-675
pubmed: 29982911