Table 5 - uploaded by Amee Cooper
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Objectives:
This paper aims to examine whether an adaptation of the International Classification of Disease (ICD) coding system can be applied retrospectively to final paramedic assessment data in an ambulance dataset with a view to developing more fine-grained, clinically relevant case definitions than are available through point-of-call data.
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Context in source publication
Context 1
... table shows that the two most common injuries after a bicycle collision are a fracture and graze/abrased skin. Table 5 shows the calls prioritised to the MPDS version 11.3 category of 'unconscious' and subcategories 'unconsciousÀ unconscious' and 'unconsciousÀnot alert' with the associated final assessment by paramedics as an ICD-10-AM code. This table highlights the fine-grained, clinically relevant case defini- tions obtained by using paramedic assessment compared with data obtained from point-of-call. ...
Citations
... The causes of health and life emergencies include illness cases and injuries that can be distinguished on the basis of diagnoses made by qualified and authorised medical personnel. Diagnoses are made on the basis of uniform codification that enables reliable reporting and comparison of medical cases encountered both in the pre-hospital setting and throughout the healthcare system [3,4]. This is precisely the role served by the International Statistical Classification of Diseases and Related Health Problems International Classification of Diseases-ICD [5]. ...
Background: Despite organised efforts, the COVID-19 pandemic had a significant impact on the health status of the population and health services including the emergency medical system. The objective of the study was to investigate, based on the Emergency Medical Teams’ (EMT) interventions, the impact of the COVID-19 pandemic on health and life emergencies resulting from illness cases and injuries of Polish females and males. Material and Methods: The data under analysis concern EMT interventions carried out in central and eastern Poland from 1 January 2017 to 31 December 2022 (n = 226,038). The study used descriptive statistics, the Mann–Whitney U Test, and the Chi-square test. Results: A significant increase was observed in the proportion of EMT interventions (p < 0.001) to patients with illness cases (80.30% vs. 83.17%) and a decrease in interventions to patients with injuries (19.70% vs. 16.83%) during the pandemic as compared to the pre-pandemic period. As for illness cases, the patients’ ages during both periods were similar (Me = 66.00 vs. 66.00, p = 0.071). On the other hand, during the pandemic, injuries mainly affected elderly patients as compared to the pre-pandemic period (Me = 50.00 vs. 47.00, p < 0.001). The increase in the proportion of EMT interventions to patients with illness cases and the decrease in patients with injuries during the pandemic, as compared to the pre-pandemic period, concerned the area of intervention, patient’s sex, and age. During the pandemic period, a significantly lower proportion of patients transported to the hospital (p < 0.001) and an increase in the proportion of patients left at the place of call (p < 0.001) were noted. Conclusions: The restrictions aimed at preventing the spread of the SARS-CoV-2 virus contributed to a reduced number of injuries without, however, reducing the number of illness cases. During the pandemic, the elderly were affected by injuries. The study indicates the need for further in-depth analyses to prepare the pre-hospital care system in Poland for the occurrence of other or similar emergencies.
... Te ICD-10 classifcation enables the identifcation of a disease or health problem and communication of medical personnel. In addition the ICD-10 codifcation allows for reliable reporting and comparison of medical cases encountered in the prehospital setting and in the entire healthcare industry [11]. Te diagnoses made by EMTs are often general and result from limited diagnostic capabilities on board ambulances. ...
... Tey allow action to be taken to help the patient in a life and health emergency. Tere is no doubt that the diagnoses made at the scene of the call according to the ICD-10 classifcation are more detailed and clinically relevant than the reasons for the call given by the calling ambulance [11]. ...
... S00-T98-Injury, poisoning, and certain other consequences of external causes (32.4%); and I00-I99-Diseases of the circulatory system (7.9%). However, Cantwell et al. [11], based on data from 2008 to 100.00 * A00-B99 � Certain infectious and parasitic diseases; C00-D48 � Neoplasms; D50-D89 � Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism; E00-E90 � Endocrine, nutritional, and metabolic diseases; F00-F99 � Mental and behavioural disorders; G00-G99 � Diseases of the nervous system; H00-H59 � Diseases of the eye and eye appendages; H60-H95 � Diseases of the ear and mastoid process; I00-I99 � Diseases of the circulatory system; J00-J99 � Diseases of the respiratory system; K00-K93 � Diseases of the digestive system; L00-L99 � Diseases of the skin and subcutaneous tissue; M00-M99 � Diseases of the musculoskeletal system and connective tissue; N00-N99 � Diseases of the genitourinary system; O00-O99 � Pregnancy, childbirth, and the puerperium; P00-P96 � Certain conditions originating in the perinatal period; Q00-Q99 � Congenital malformations, deformations, and chromosomal abnormalities; R00-R99 � Symptoms, signs, and abnormal clinical and laboratory fndings, not elsewhere classifed; S00-T98 � Injury, poisoning, and certain other consequences of external causes; V01-Y98 � External causes of morbidity and mortality; Z00-Z99 � Factors infuencing health status and contact with health services. Pearson Chi 2 � 146.32, df � 40, p < 0.0001. ...
The role of the emergency medical system is to provide assistance to every person in a state in the event of a sudden threat to health and life. Emergency medical teams (EMTs) are an important element of this system, making diagnoses based on the International Classification of Diseases (ICD-10). The study was aimed at analysing the causes of EMT intervention based on groups of diagnoses codified according to the ICD-10. The analysis was based on data from 116,278 EMT interventions in central-eastern Poland in 2017-2019. The research showed that EMT most often made diagnoses based on groups of ICD-10 codes: R00-R99-Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (39.11%); S00-T98-Injury, poisoning, and certain other consequences of external causes (18.23%); and I00-I99-Diseases of the circulatory system (15.57%). The analysis of the obtained results showed statistically significant differences (p<0.0001) regarding the area of intervention (urban, rural), sex, age of the patient, and the method of completion of the activities by EMTs in relation to the group of ICD-10 diagnoses for the diagnosis. The conducted study showed the actual reasons for EMT calls. The use of the ICD-10 classification has practical application in EMTs, as it enables the identification of a disease or health problem.
... On the other hand, Białczak et al. [12] indicate, among others, the main reasons for EMS intervention, among others, cardiovascular diseases (36.1%) and injuries (20.1%). On the other hand, Cantwell et al. [21], based on the data of the ambulance service in Melbourne (Australia) from 2008-2011, based on the ICD-10 codification, indicate the most common reasons for EMS interventions are circulatory system disorders (15.6%), injuries, and poisoning (13.5%) as well as diseases of the nervous system (10.4%). The most common diagnoses made by EMS teams based on the ICD-10 codification in Northern Denmark in 2007-2014 are S-T-Injury, poisoning, and certain other consequences of external causes (in the range of 26.3% to 34.0%), R-Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (from 14.7% to 28.0%), Z-Factors influencing health status and contact with health services (9.6% to 16.5%) and I-Diseases of the circulatory system (9.5-11.5%) ...
Introduction:
Accidents and emergencies in the workplace account for a significant proportion of emergency calls worldwide. The specificity of these events is often associated with hazards at a given workplace. Patients do not always require hospitalization; therefore, the characteristics of events can only be determined from the perspective of emergency medical services teams. The aim of the study was to analyze calls and the course of emergency ambulance interventions to patients at their workplace.
Material and methods:
The study was conducted based on a retrospective analysis of data contained in the medical records of the ambulance service from central Poland from 2015-2018. From all interventions (n = 155,993), 1601 calls to work were selected, and the urgency code, time of day and year, patients' sex, general condition, as well as diagnoses according to the International Classification of Diseases-ICD-10 and the method of ending the call were considered.
Results:
The mean age of patients in the study group was 42.4 years (SD ± 13.5). The majority were men (n = 918; 57.3%). The number of calls increased in the autumn (n = 457; 28.5%) and in the morning (n = 609; 38.0%). The main reasons for the intervention were illnesses (ICD-10 group: R-'symptoms') and injuries (ICD-10 group: S, T-'injuries'). Calls at workplaces most often ended with the patient being transported to the hospital (78.8%), and least often with his death (0.8%).
Conclusions:
The patient profile in the workplace indicates middle-aged men who fall ill in the fall, requiring transport to the hospital and further diagnostics.
... They converted data for the assessment made by the ambulance staff against the Australian modification of ICD-10. [27] This is an interesting method for ambulance services without access to hospital diagnoses, though it seems as a huge work. The lack of studies on hospital diagnoses in emergency ambulance service patients makes comparisons difficult, however a few studies find similar trends in emergency patients in hospital. ...
... The location of the EMS attendance was classified as "metropolitan" or "regional/rural" according to the Australian Department of Immigration postcode classification [22]. At the point of call, urgency categories are assigned as per the Medical Priority Dispatch System [23] [24] and used to determine the type of response received; code 1 (lights and sirens response), code 2 (acute but not time critical response) and code 3 (non-urgent, routine response). In the current study, the time of the emergency call request was grouped into four 6 hour time periods (2400 to <0600 hours, 0600 to <1200 hours, 1200 to <1800 and 1800 hours to < 2400 hours). ...
Aims
This study examines prehospital Emergency Medical Service (EMS) utilisation and patterns of demand for hyperglycaemia management, including characteristics of individuals and factors related to hospital transport.
Materials and methods
A state-wide, community-based observational study of all patients requiring prehospital EMS for hyperglycaemia during a 7 year study period (Jan 2009–Dec 2015) using electronic data from the Ambulance Victoria data warehouse was conducted. Pre-specified variables related to patient demographics, comorbidities, examination findings, paramedic treatment and transport outcomes were obtained. Logistic regression was used to assess factors associated with transport to hospital.
Results
There were 11,417 cases of hyperglycaemia attended by paramedics during the study period, accounting for 0.3–0.4% of the total annual EMS caseload, and equating to 0.54 attendances per 100 people with diabetes in the state of Victoria, Australia, per year. There was a significant increase in annual utilisation, with a rate ratio of 1.62 between 2009 (2.42 cases per 10,000 population) and 2015 (3.91 cases per 10,000 population). Fifty-one percent of cases had type 2 diabetes, 37% had type 1 diabetes, 4% had diabetes with the type unspecified and 8% had no recorded history of diabetes. Ninety percent of cases were transported to hospital. Factors associated with increased odds of transport to hospital included no known history of diabetes, regional/rural locations, case time between 0600 and <1800 hours, increasing number of comorbidities and increasingly unstable vital sign observations.
Conclusion
There is substantial utilisation of prehospital EMS for hyperglycaemia. With increased population prevalence of diabetes predicted, further research on opportunities for prevention, as well as optimal management in the prehospital environment is warranted.
... The methods we used were based on data and procedures that have been described previously 2,20 . ...
... Although point-of-call EMS dispatch coding is an easily obtainable source of data, final assessments by paramedics provide more fine-grained, clinically relevant, case definitions. 12 We found little published evidence of patterns in daily and weekly EMS demand and even less analysis of those patterns using data from paramedic assessment as opposed to dispatch coding. 12 Our group's recent systematic review of the literature found only five studies that reported demand distribution patterns by time of day and four studies that reported by day of week. ...
... 12 We found little published evidence of patterns in daily and weekly EMS demand and even less analysis of those patterns using data from paramedic assessment as opposed to dispatch coding. 12 Our group's recent systematic review of the literature found only five studies that reported demand distribution patterns by time of day and four studies that reported by day of week. 13 Only two studies graphically represented the pattern of overall or total EMS demand across the day 14,15 and only one study graphically represented distribution patterns by day of week. ...
... We defined cases as medical/trauma/unknown on the basis of the CN and FPA listed on the electronic patient record. 12 We categorized cases in which the CN matched an ICD-10-Australian Modification external cause of injury code as trauma and cases without a traumatic CN and an FPA listed as "other," "unknown problem," or "no problem identified" were categorized as "unknown." All other cases were categorized as medical. ...
Abstract Objective. We examined temporal variations in overall Emergency Medical Services (EMS) demand, as well as medical and trauma cases separately. We analyzed cases according to time of day and day of week to determine whether population level demand demonstrates temporal patterns that will increase baseline knowledge for EMS planning. Methods. We conducted a secondary analysis of data from the Ambulance Victoria data warehouse covering the period 2008-2011. We included all cases of EMS attendance which resulted in 1,203,803 cases for review. Data elements comprised age, gender, date and time of call to the EMS emergency number along with the clinical condition of the patient. We employed Poisson regression to analyze case numbers and trigonometric regression to quantify distribution patterns. Results. EMS demand exhibited a bimodal distribution with the highest peak at 10:00 and a second smaller peak at 19:00. The highest number of cases occurred on Fridays, and the lowest on Tuesdays and Wednesdays. However, the distribution of cases throughout the day differed by day of week. Distribution patterns on Fridays, Saturdays and Sundays differed significantly from the rest of the week (p < 0.001). When categorized into medical or trauma cases, medical cases were more frequent during working hours and involved patients of higher mean age (57 years vs. 49 years for trauma, p < 0.001). Trauma cases peaked on Friday and Saturday nights around midnight. Conclusion. Day of week EMS demand distribution patterns reveal differences that can be masked in aggregate data. Day of week EMS demand distribution patterns showed not only which days have differences in demand but the times of day at which the demand changes. Patterns differed by case type as well. These differences in distribution are important for EMS demand planning. Increased understanding of EMS demand patterns is imperative in a climate of ever-increasing demand and fiscal constraints. Further research is needed into the effect of age and case type on EMS demand.
Background:
People recently released from prison engage with emergency healthcare at greater rates than the general population. While retention in opioid agonist treatment (OAT) is associated with substantial reductions in the risk of opioid-related mortality postrelease, it is unknown how OAT affects contact with emergency healthcare. In a cohort of men who injected drugs regularly prior to imprisonment, we described rates of contact with ambulance services and EDs, and their associations with use of OAT, in the 3 months after release from prison.
Methods:
Self-report data from a prospective observational cohort of men who regularly injected drugs before a period of sentenced imprisonment, recruited between September 2014 and May 2016, were linked to state-wide ambulance and ED records over a 3-month postrelease period in Victoria, Australia. We used generalised linear models to estimate associations between OAT use (none/interrupted/retained) and contact with ambulance and EDs postrelease, adjusted for other covariates.
Results:
Among 265 participants, we observed 77 ambulance contacts and 123 ED contacts over a median of 98 days of observation (IQR 87-125 days). Participants who were retained in OAT between prison release and scheduled 3-month postrelease follow-up interviews had lower rates of contact with ambulance (adjusted incidence rate ratio (AIRR) 0.33, 95% CI 0.14 to 0.76) and ED (AIRR 0.43, 95% CI 0.22 to 0.83), compared with participants with no OAT use postrelease. Participants with interrupted OAT use did not differ from those with no OAT use in rates of contact with ambulance or ED.
Conclusion:
We found lower rates of contact with emergency healthcare after release among people retained in OAT, but not among people reporting interrupted OAT use, underscoring the benefits of postrelease OAT retention. Strategies to improve accessibility and support OAT retention after leaving prison are important for men who inject drugs.
Background:
One-third of Australia's population reside in rural and remote areas. This audit aims to describe all-causes of mortality in rural general surgical patients, and identify areas of improvement.
Methods:
This is a retrospective multi-centre study involving four South Australian hospitals (Mt Gambier, Whyalla, Port Augusta, and Port Lincoln). All general surgical inpatients admitted from June 2014 to September 2019 were analysed to identify all-cause of mortality.
Results:
A total of 80 mortalities were recorded out of 26 996 admissions. The overall mortality rate of 0.3% was the same as the 2020 Victorian state-wide Audit of Surgical Mortality. No mortality was secondary to trauma. Mean age was 79 ± 11 years and ASA was 3.9 ± 1. Malignancy was associated in over a third of cases (41.2%), mostly colorectal and pancreatic. Most cases were related to general surgical subspecialties: colorectal (51.3%), upper gastrointestinal (21.3%), hepatopancreaticobiliary (13.8%); however, there were also vascular (6.3%) and urology (3.8%) cases. The most common causes of mortality were large bowel obstruction (13.4%), ischemic bowel (10.4%), and small bowel obstruction (7.5%). Majority of mortality were beyond the surgeon's control (73.8%). Of the 21 potentially preventable mortalities, 42.9% were attributed to aspiration pneumonia and decompensated heart failure. Only one (1.3%) mortality case was due to pulmonary embolism.
Conclusion:
Rural general surgical mortalities occur in older, comorbid patients. Rural surgeons should be equipped to manage basic subspeciality conditions. To further reduce mortalities, clear protocols to prevent aspiration pneumonia and resuscitation associated fluid overload are needed.
Background:
Although people who inject drugs (PWID) have been described as frequent users of emergency services, the majority of research is cross-sectional and involves records from a single emergency department (ED).
Objectives:
We describe characteristics of state-wide ED presentations in a cohort of PWID, and compare presentation rates to the general population. We also examine characteristics associated with frequent ED use.
Methods:
We used data from a retrospective linkage of public ED presentations from a cohort of 678 PWID between January 2008 and June 2013. Common principal diagnoses were described using the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) chapter headings. The ED presentation trend was estimated using negative-binomial regression. Characteristics associated with frequent use of EDs were identified using generalized estimating equations (GEEs).
Results:
There were 3437 presentations over 4163.5 person-years (PY) and the most common principal diagnosis was injury, poisoning and other externalities (19%). ED presentations increased by 4% every six months (95% confidence interval (CI) 0.1%-0.8%) and were three times greater than the general population. A quarter (24%) of the cohort presented frequently, and they were more likely to have noninjury-related diagnoses and be aged below 30 years, and less likely to have nonurgent presentations and be male.
Conclusions:
PWID use EDs at a higher rate than the general population, and typically present with injuries and mental and behavioral disorders. Referrals to drug treatment, mental health, and social support services can improve patient care and reduce the burden on EDs.
