Telephone Triage and Spontaneous Subarachnoid Haemorrhage; Predictors of Timely Admission to Neurosurgical Care
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 262
- 试验地点
- 1
- 主要终点
- Time from first contact to the Copenhagen Emergency Medical Communications Center to admission to a neurosurgical department in patients with spontaneous subarachnoid haemorrhage.
研究概览
简要总结
Spontaneous subarachnoid haemorrhages (SAH) are a particularly severe type of stroke with a tendency to affect younger individuals than other types of stroke. The condition is time critical as early neurosurgical treatment is needed.
The aim of this study is to determine the delay from when a patient with SAH calls the Emergency Medical Services (EMS) to they are admitted to a neurosurgical department. Further, it is the aim to determine predictors for increased delay and to examine the accuracy of the triage tool used by the EMS.
详细描述
Background:
Spontaneous (non-traumatic) subarachnoid haemorrhage (sSAH) is rare but timely detection is critical. A feared complication is rebleeding, with an overall risk around 4% in the first 24 hours. Early specialized medical, neurosurgical or neuroradiological interventions are required. A Danish study of pre-hospital delay was made in 2010. In this, a median delay of 60 minutes in a pooled population of patients having contacted general practitioners, the emergency phone number or presented directly to the emergency room. Total time from symptom onset to neurosurgical admission was 5 hours 30 minutes.
Reorganizations have since been made in the pre-hospital system to optimize correct and fast triage. A criteria-based dispatch (CBD) system, the Danish Index for Emergency Care (Danish Index), is now used in the Danish Emergency Medical Communications Centers (EMCC). The dispatcher is guided through a list of questions to ask the caller. An algorithm then suggests a prehospital response.
The Danish Index contains 37 main symptom categories, each divided into five degrees of urgency, which again are subdivided into specific symptoms. Headache is a main category with ´acute severe headache´ resulting in the most urgent response; level A.
In Denmark there is one national emergency phone number, ´112´. Depending on your location, your call will be directed to one of the five EMCCs. At the EMCC in the Capital Region of Denmark the Danish Index was introduced in May 2011. In January 2012 an additional phone line, ´1813´, was opened for non-urgent contacts out of general practice (GP) opening hours. At this non-urgent phone-line the Danish Index is used as well. By January 1, 2014, ´112´ and ´1813´ became the only out-of-hours entry points to the health care system.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Other
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients with first-time spontaneous subarachnoid haemorrhage in the Capital Region of Denmark between 1 May 2011 and 31 December 2014 and contact to the Copenhagen EMCC.
排除标准
- 未提供
结局指标
主要结局
Time from first contact to the Copenhagen Emergency Medical Communications Center to admission to a neurosurgical department in patients with spontaneous subarachnoid haemorrhage.
时间窗: For patients admitted between 1 May 2011 and 31 December 2014 a retrospective analysis of time to admission is performed.
To identify predictors for short time to neurosurgical department.
时间窗: For patients admitted between 1 May 2011 and 31 December 2014 a retrospective analysis of emergency medical telephone calls is performed.
In a logistic regression model with time \>/\<4 hours as the dependent variable the following possible predictors are tested: Classic headache (yes/no), age (years), gender (m/f), person who is making the emergency call (patient/bystander).
次要结局
- Sensitivity and positive predictive value of the Danish Index category ´acute severe headache´ for sSAH.(For patients admitted between 1 May 2011 and 31 December 2014 a retrospective analysis of symptoms described in the emergency medical telephone call is performed.)
- Sensitivity and positive predictive value for sSAH of symptoms other than ´acute severe headache´ in the Danish Index.(For patients admitted between 1 May 2011 and 31 December 2014 a retrospective analysis of symptoms described in the emergency medical telephone call is performed.)
- The proportion of patients with ´acute severe headache´, that are admitted to a neurosurgical department within four hours of initial contact to the EMCC.(For patients admitted between 1 May 2011 and 31 December 2014 a retrospective analysis of time to admission is performed.)
- The proportion of emergency calls from sSAH-patients, that trigger a level A response, regardless of which symptom category it is triggered by.(For patients admitted between 1 May 2011 and 31 December 2014 a retrospective analysis of actived responses from the Emergecny Medical Coordination Center is performed.)
研究者
Asger Sonne, MD
Clinical assistant
Rigshospitalet, Denmark