TY - JOUR
T1 - Symptoms presented during emergency telephone calls for patients with spontaneous subarachnoid haemorrhage
AU - Sonne, Asger
AU - Egholm, Sarita
AU - Elgaard, Laurits
AU - Breindahl, Niklas
AU - Jensen, Alice Herrlin
AU - Eskesen, Vagn
AU - Lippert, Freddy
AU - Waldorff, Frans Boch
AU - Lohse, Nicolai
AU - Rasmussen, Lars Simon
N1 - © 2021. The Author(s).
PY - 2021/8/16
Y1 - 2021/8/16
N2 - BACKGROUND: A 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.METHODS: This 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.RESULTS: We 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%.CONCLUSION: Headache, 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 ).
AB - BACKGROUND: A 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.METHODS: This 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.RESULTS: We 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%.CONCLUSION: Headache, 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 ).
KW - Case-Control Studies
KW - Emergencies
KW - Emergency Service, Hospital
KW - Humans
KW - Subarachnoid Hemorrhage/diagnosis
KW - Telephone
KW - Headache
KW - Emergency medical service
KW - Spontaneous subarachnoid haemorrhage
KW - Visitation
KW - Triage
KW - Emergency medical dispatch
KW - Symptoms
UR - http://www.scopus.com/inward/record.url?scp=85112541480&partnerID=8YFLogxK
U2 - 10.1186/s13049-021-00934-x
DO - 10.1186/s13049-021-00934-x
M3 - Journal article
C2 - 34399811
SN - 1757-7241
VL - 29
SP - 118
JO - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
JF - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
IS - 1
M1 - 118
ER -