Shedding light into the black box of out-of-hospital respiratory distress—A retrospective cohort analysis of discharge diagnoses, prehospital diagnostic accuracy, and predictors of mortality
Background Although respiratory distress is one of the most common complaints of patients requiring emergency medical services (EMS), there is a lack of evidence on important aspects. Objectives Our study aims to determine the accuracy of EMS physician diagnostics in the out-of-hospital setting, ide...
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| description | Background Although respiratory distress is one of the most common complaints of patients requiring emergency medical services (EMS), there is a lack of evidence on important aspects. Objectives Our study aims to determine the accuracy of EMS physician diagnostics in the out-of-hospital setting, identify examination findings that correlate with diagnoses, investigate hospital mortality, and identify mortality-associated predictors. Methods This retrospective observational study examined EMS encounters between December 2015 and May 2016 in the city of Aachen, Germany, in which an EMS physician was present at the scene. Adult patients were included if the EMS physician initially detected dyspnea, low oxygen saturation, or pathological auscultation findings at the scene (n = 719). The analyses were performed by linking out-of-hospital data to hospital records and using binary logistic regressions. Results The overall diagnostic accuracy was 69.9% (485/694). The highest diagnostic accuracies were observed in asthma (15/15; 100%), hypertensive crisis (28/33; 84.4%), and COPD exacerbation (114/138; 82.6%), lowest accuracies were observed in pneumonia (70/142; 49.3%), pulmonary embolism (8/18; 44.4%), and urinary tract infection (14/35; 40%). The overall hospital mortality rate was 13.8% (99/719). The highest hospital mortality rates were seen in pneumonia (44/142; 31%) and urinary tract infection (7/35; 20%). Identified risk factors for hospital mortality were metabolic acidosis in the initial blood gas analysis (odds ratio (OR) 11.84), the diagnosis of pneumonia (OR 3.22) reduced vigilance (OR 2.58), low oxygen saturation (OR 2.23), and increasing age (OR 1.03 by 1 year increase). Conclusions Our data highlight the diagnostic uncertainties and high mortality in out-of-hospital emergency patients presenting with respiratory distress. Pneumonia was the most common and most frequently misdiagnosed cause and showed highest hospital mortality. The identified predictors could contribute to an early detection of patients at risk. |
| doi_str_mv | 10.1371/journal.pone.0271982 |
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Objectives Our study aims to determine the accuracy of EMS physician diagnostics in the out-of-hospital setting, identify examination findings that correlate with diagnoses, investigate hospital mortality, and identify mortality-associated predictors. Methods This retrospective observational study examined EMS encounters between December 2015 and May 2016 in the city of Aachen, Germany, in which an EMS physician was present at the scene. Adult patients were included if the EMS physician initially detected dyspnea, low oxygen saturation, or pathological auscultation findings at the scene (n = 719). The analyses were performed by linking out-of-hospital data to hospital records and using binary logistic regressions. Results The overall diagnostic accuracy was 69.9% (485/694). The highest diagnostic accuracies were observed in asthma (15/15; 100%), hypertensive crisis (28/33; 84.4%), and COPD exacerbation (114/138; 82.6%), lowest accuracies were observed in pneumonia (70/142; 49.3%), pulmonary embolism (8/18; 44.4%), and urinary tract infection (14/35; 40%). The overall hospital mortality rate was 13.8% (99/719). The highest hospital mortality rates were seen in pneumonia (44/142; 31%) and urinary tract infection (7/35; 20%). Identified risk factors for hospital mortality were metabolic acidosis in the initial blood gas analysis (odds ratio (OR) 11.84), the diagnosis of pneumonia (OR 3.22) reduced vigilance (OR 2.58), low oxygen saturation (OR 2.23), and increasing age (OR 1.03 by 1 year increase). Conclusions Our data highlight the diagnostic uncertainties and high mortality in out-of-hospital emergency patients presenting with respiratory distress. Pneumonia was the most common and most frequently misdiagnosed cause and showed highest hospital mortality. The identified predictors could contribute to an early detection of patients at risk.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0271982</identifier><identifier>PMID: 35921383</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Accuracy ; Acidosis ; Acute coronary syndromes ; Asthma ; Biology and Life Sciences ; Blood gas analysis ; Care and treatment ; Chronic obstructive pulmonary disease ; Cohort analysis ; Datasets ; Diagnosis ; Diagnostic systems ; Dyspnea ; Embolism ; Emergency medical care ; Emergency medical services ; Evaluation ; Gas analysis ; Hospitals ; Infections ; Medical care ; Medical diagnosis ; Medicine and Health Sciences ; Metabolic acidosis ; Mortality ; Oxygen ; Oxygen content ; Patients ; People and Places ; Physical Sciences ; Physicians ; Pneumonia ; Professional ethics ; Pulmonary embolisms ; Quality management ; Respiration ; Respiratory distress syndrome ; Risk analysis ; Risk factors ; Saturation ; Statistical analysis ; Urinary tract ; Variables ; Vigilance</subject><ispartof>PloS one, 2022-08, Vol.17 (8), p.e0271982-e0271982</ispartof><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>2022 Spörl et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 Spörl et al 2022 Spörl et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c548t-240b0c9f422b5c9e880b4c8b9ed1cd3d99b85b23014d0c118c345346c3e6889d3</cites><orcidid>0000-0002-6179-9333</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9348717/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9348717/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,865,886,2103,2929,23868,27926,27927,53793,53795</link.rule.ids></links><search><contributor>Veldhuizen, Ruud AW</contributor><creatorcontrib>Spörl, Patrick</creatorcontrib><creatorcontrib>Beckers, Stefan K</creatorcontrib><creatorcontrib>Rossaint, Rolf</creatorcontrib><creatorcontrib>Felzen, Marc</creatorcontrib><creatorcontrib>Schröder, Hanna</creatorcontrib><title>Shedding light into the black box of out-of-hospital respiratory distress—A retrospective cohort analysis of discharge diagnoses, prehospital diagnostic accuracy, and predictors of mortality</title><title>PloS one</title><description>Background Although respiratory distress is one of the most common complaints of patients requiring emergency medical services (EMS), there is a lack of evidence on important aspects. Objectives Our study aims to determine the accuracy of EMS physician diagnostics in the out-of-hospital setting, identify examination findings that correlate with diagnoses, investigate hospital mortality, and identify mortality-associated predictors. Methods This retrospective observational study examined EMS encounters between December 2015 and May 2016 in the city of Aachen, Germany, in which an EMS physician was present at the scene. Adult patients were included if the EMS physician initially detected dyspnea, low oxygen saturation, or pathological auscultation findings at the scene (n = 719). The analyses were performed by linking out-of-hospital data to hospital records and using binary logistic regressions. Results The overall diagnostic accuracy was 69.9% (485/694). The highest diagnostic accuracies were observed in asthma (15/15; 100%), hypertensive crisis (28/33; 84.4%), and COPD exacerbation (114/138; 82.6%), lowest accuracies were observed in pneumonia (70/142; 49.3%), pulmonary embolism (8/18; 44.4%), and urinary tract infection (14/35; 40%). The overall hospital mortality rate was 13.8% (99/719). The highest hospital mortality rates were seen in pneumonia (44/142; 31%) and urinary tract infection (7/35; 20%). Identified risk factors for hospital mortality were metabolic acidosis in the initial blood gas analysis (odds ratio (OR) 11.84), the diagnosis of pneumonia (OR 3.22) reduced vigilance (OR 2.58), low oxygen saturation (OR 2.23), and increasing age (OR 1.03 by 1 year increase). Conclusions Our data highlight the diagnostic uncertainties and high mortality in out-of-hospital emergency patients presenting with respiratory distress. Pneumonia was the most common and most frequently misdiagnosed cause and showed highest hospital mortality. The identified predictors could contribute to an early detection of patients at risk.</description><subject>Accuracy</subject><subject>Acidosis</subject><subject>Acute coronary syndromes</subject><subject>Asthma</subject><subject>Biology and Life Sciences</subject><subject>Blood gas analysis</subject><subject>Care and treatment</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Cohort analysis</subject><subject>Datasets</subject><subject>Diagnosis</subject><subject>Diagnostic systems</subject><subject>Dyspnea</subject><subject>Embolism</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Evaluation</subject><subject>Gas analysis</subject><subject>Hospitals</subject><subject>Infections</subject><subject>Medical care</subject><subject>Medical diagnosis</subject><subject>Medicine and Health Sciences</subject><subject>Metabolic acidosis</subject><subject>Mortality</subject><subject>Oxygen</subject><subject>Oxygen content</subject><subject>Patients</subject><subject>People and Places</subject><subject>Physical Sciences</subject><subject>Physicians</subject><subject>Pneumonia</subject><subject>Professional ethics</subject><subject>Pulmonary embolisms</subject><subject>Quality management</subject><subject>Respiration</subject><subject>Respiratory distress syndrome</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Saturation</subject><subject>Statistical analysis</subject><subject>Urinary tract</subject><subject>Variables</subject><subject>Vigilance</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk91qFDEUxwdRbK2-gWBAEIXumo_5yNwIS_FjoVCw6m3IJJmZ1Oxkm2RK986H8IF8Fp_Es92xdKUXkos5c_LL_-ScnJNlzwmeE1aRtxd-DIN087UfzBzTitScPsgOSc3orKSYPbxjH2RPYrzAuGC8LB9nB6yoKWGcHWa_znujtR065GzXJ2SH5FHqDWqcVN9R46-Rb5Ef08y3s97HtU3SoWDACDL5sEHaxgT_8fePnwvYSAEgo5K9Mkj53oeEJFxzE23cKgGtehk6A5bsBh9NPEbrYG6lJ3eyCkmlxiDV5hgU9BbSVkHIG50VCEtn0-Zp9qiVLppn0_co-_rh_ZeTT7PTs4_Lk8XpTBU5TzOa4warus0pbQpVG85xkyve1EYTpZmu64YXDWWY5BorQrhiecHyUjFTcl5rdpS92OmunY9iKn4UtKyrklWMYSCWO0J7eSHWwa5k2Agvrbhx-NAJGSAvZwTBSkE02hpJc3iIhjMsizY3uJSaUAla76ZoY7MyWpkhBen2RPd3BtuLzl-JmuW8IhUIvJ4Egr8cTUxiBZU3zsnB-HG6d5VDIwH68h_0_uwmqpOQgB1aD3HVVlQsKkJZWWFOgZrfQ8HSZmUVdGprwb934M3eAWCSuU6dHGMUy_PP_8-efdtnX91heyNd6qN3Y7J-iPtgvgMVNG4Mpr0tMsFiO2h_qyG2gyamQWN_AHtbHyc</recordid><startdate>20220803</startdate><enddate>20220803</enddate><creator>Spörl, 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light into the black box of out-of-hospital respiratory distress—A retrospective cohort analysis of discharge diagnoses, prehospital diagnostic accuracy, and predictors of mortality</title><author>Spörl, Patrick ; Beckers, Stefan K ; Rossaint, Rolf ; Felzen, Marc ; Schröder, Hanna</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c548t-240b0c9f422b5c9e880b4c8b9ed1cd3d99b85b23014d0c118c345346c3e6889d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Accuracy</topic><topic>Acidosis</topic><topic>Acute coronary syndromes</topic><topic>Asthma</topic><topic>Biology and Life Sciences</topic><topic>Blood gas analysis</topic><topic>Care and treatment</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Cohort analysis</topic><topic>Datasets</topic><topic>Diagnosis</topic><topic>Diagnostic systems</topic><topic>Dyspnea</topic><topic>Embolism</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Evaluation</topic><topic>Gas analysis</topic><topic>Hospitals</topic><topic>Infections</topic><topic>Medical care</topic><topic>Medical diagnosis</topic><topic>Medicine and Health Sciences</topic><topic>Metabolic acidosis</topic><topic>Mortality</topic><topic>Oxygen</topic><topic>Oxygen content</topic><topic>Patients</topic><topic>People and Places</topic><topic>Physical Sciences</topic><topic>Physicians</topic><topic>Pneumonia</topic><topic>Professional ethics</topic><topic>Pulmonary embolisms</topic><topic>Quality management</topic><topic>Respiration</topic><topic>Respiratory distress syndrome</topic><topic>Risk analysis</topic><topic>Risk factors</topic><topic>Saturation</topic><topic>Statistical analysis</topic><topic>Urinary tract</topic><topic>Variables</topic><topic>Vigilance</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Spörl, 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Hanna</au><au>Veldhuizen, Ruud AW</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Shedding light into the black box of out-of-hospital respiratory distress—A retrospective cohort analysis of discharge diagnoses, prehospital diagnostic accuracy, and predictors of mortality</atitle><jtitle>PloS one</jtitle><date>2022-08-03</date><risdate>2022</risdate><volume>17</volume><issue>8</issue><spage>e0271982</spage><epage>e0271982</epage><pages>e0271982-e0271982</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Background Although respiratory distress is one of the most common complaints of patients requiring emergency medical services (EMS), there is a lack of evidence on important aspects. Objectives Our study aims to determine the accuracy of EMS physician diagnostics in the out-of-hospital setting, identify examination findings that correlate with diagnoses, investigate hospital mortality, and identify mortality-associated predictors. Methods This retrospective observational study examined EMS encounters between December 2015 and May 2016 in the city of Aachen, Germany, in which an EMS physician was present at the scene. Adult patients were included if the EMS physician initially detected dyspnea, low oxygen saturation, or pathological auscultation findings at the scene (n = 719). The analyses were performed by linking out-of-hospital data to hospital records and using binary logistic regressions. Results The overall diagnostic accuracy was 69.9% (485/694). The highest diagnostic accuracies were observed in asthma (15/15; 100%), hypertensive crisis (28/33; 84.4%), and COPD exacerbation (114/138; 82.6%), lowest accuracies were observed in pneumonia (70/142; 49.3%), pulmonary embolism (8/18; 44.4%), and urinary tract infection (14/35; 40%). The overall hospital mortality rate was 13.8% (99/719). The highest hospital mortality rates were seen in pneumonia (44/142; 31%) and urinary tract infection (7/35; 20%). Identified risk factors for hospital mortality were metabolic acidosis in the initial blood gas analysis (odds ratio (OR) 11.84), the diagnosis of pneumonia (OR 3.22) reduced vigilance (OR 2.58), low oxygen saturation (OR 2.23), and increasing age (OR 1.03 by 1 year increase). Conclusions Our data highlight the diagnostic uncertainties and high mortality in out-of-hospital emergency patients presenting with respiratory distress. Pneumonia was the most common and most frequently misdiagnosed cause and showed highest hospital mortality. The identified predictors could contribute to an early detection of patients at risk.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>35921383</pmid><doi>10.1371/journal.pone.0271982</doi><tpages>e0271982</tpages><orcidid>https://orcid.org/0000-0002-6179-9333</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Accuracy Acidosis Acute coronary syndromes Asthma Biology and Life Sciences Blood gas analysis Care and treatment Chronic obstructive pulmonary disease Cohort analysis Datasets Diagnosis Diagnostic systems Dyspnea Embolism Emergency medical care Emergency medical services Evaluation Gas analysis Hospitals Infections Medical care Medical diagnosis Medicine and Health Sciences Metabolic acidosis Mortality Oxygen Oxygen content Patients People and Places Physical Sciences Physicians Pneumonia Professional ethics Pulmonary embolisms Quality management Respiration Respiratory distress syndrome Risk analysis Risk factors Saturation Statistical analysis Urinary tract Variables Vigilance |
| title | Shedding light into the black box of out-of-hospital respiratory distress—A retrospective cohort analysis of discharge diagnoses, prehospital diagnostic accuracy, and predictors of mortality |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-17T20%3A24%3A14IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Shedding%20light%20into%20the%20black%20box%20of%20out-of-hospital%20respiratory%20distress%E2%80%94A%20retrospective%20cohort%20analysis%20of%20discharge%20diagnoses,%20prehospital%20diagnostic%20accuracy,%20and%20predictors%20of%20mortality&rft.jtitle=PloS%20one&rft.au=Sp%C3%B6rl,%20Patrick&rft.date=2022-08-03&rft.volume=17&rft.issue=8&rft.spage=e0271982&rft.epage=e0271982&rft.pages=e0271982-e0271982&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0271982&rft_dat=%3Cgale_plos_%3EA712367082%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2697637330&rft_id=info:pmid/35921383&rft_galeid=A712367082&rft_doaj_id=oai_doaj_org_article_10cc5b22fea24138b830a5f4e06ad12a&rfr_iscdi=true |