Symptoms presented during emergency telephone calls for patients with spontaneous subarachnoid haemorrhage

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Freddy Lippert¹  Alice Herrlin Jensen²  Asger Sonne²  Sarita Egholm²  Niklas Breindahl²  Laurits Elgaard²  Lars Simon Rasmussen³  Nicolai Lohse⁴  Vagn Eskesen⁵  Frans Boch Waldorff⁶ 

[1] Copenhagen Emergency Medical Services, Copenhagen, Denmark;Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark;Department of Anaesthesia, section 6011, Center of Head and Orthopaedics, Rigshospitalet, Inge Lehmanns Vej 6, 2100, Copenhagen, Denmark;Department of Anaesthesia, section 6011, Center of Head and Orthopaedics, Rigshospitalet, Inge Lehmanns Vej 6, 2100, Copenhagen, Denmark;Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark;Department of Emergency Medicine, Copenhagen University Hospital – Nordsjællands Hospital, Hillerød, Denmark;Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark;Department of Neurosurgery, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark;Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark;The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark;

关键词: Spontaneous subarachnoid haemorrhage;    Emergency medical service;    Emergency medical dispatch;    Symptoms;    Headache;    Telephone;    Triage;    Visitation;   

DOI  :  10.1186/s13049-021-00934-x

来源: Springer

【 摘 要 】

BackgroundA spontaneous subarachnoid haemorrhage (SAH) is one of the most critical neurological emergencies a dispatcher can face in an emergency telephone call. No study has yet investigated which symptoms are presented in emergency telephone calls for these patients. We aimed to identify symptoms indicative of SAH and to determine the sensitivity of these and their association (odds ratio, OR) with SAH.MethodsThis was a nested case–control study based on all telephone calls to the medical dispatch center of Copenhagen Emergency Medical Services in a 4-year time period. Patients with SAH were identified in the Danish National Patient Register; diagnoses were verified by medical record review and their emergency telephone call audio files were extracted. Audio files were replayed, and symptoms extracted in a standardized manner. Audio files of a control group were replayed and assessed as well.ResultsWe included 224 SAH patients and 609 controls. Cardiac arrest and persisting unconsciousness were reported in 5.8% and 14.7% of SAH patients, respectively. The highest sensitivity was found for headache (58.9%), nausea/vomiting (46.9%) and neck pain (32.6%). Among conscious SAH patients these symptoms were found to have the strongest association with SAH (OR 27.0, 8.41 and 34.0, respectively). Inability to stand up, speech difficulty, or sweating were reported in 24.6%, 24.2%, and 22.8%. The most frequent combination of symptoms was headache and nausea/vomiting, which was reported in 41.6% of SAH patients. More than 90% of headaches were severe, but headache was not reported in 29.7% of conscious SAH patients. In these, syncope was described by 49.1% and nausea/vomiting by 37.7%.ConclusionHeadache, nausea/vomiting, and neck pain had the highest sensitivity and strongest association with SAH in emergency telephone calls. Unspecific symptoms such as inability to stand up, speech difficulty or sweating were reported in 1 out of 5 calls. Interestingly, 1 in 3 conscious SAH patients did not report headache.Trial registration NCT03980613 (www.clinicaltrials.gov).

【 授权许可】

CC BY