Weak Links in the Early Chain of Care of Acute Lower Limb Ischaemia in Terms of Recognition and Emergency Management

Autor: Johan Herlitz, Anders Karlsson, Kristian Smidfelt, C Bohm, Joakim Nordanstig, Marcus Langenskiöld
Rok vydání: 2017
Předmět:
Male
Emergency Medical Services
medicine.medical_specialty
Time Factors
Limb salvage
030204 cardiovascular system & hematology
Drug Administration Schedule
Time-to-Treatment
03 medical and health sciences
0302 clinical medicine
Ischemia
Predictive Value of Tests
Risk Factors
Odds Ratio
Humans
Medicine
030212 general & internal medicine
Good outcome
Intensive care medicine
Chain of care
Aged
Retrospective Studies
Aged
80 and over
Emergency management
business.industry
Anticoagulants
Arterial embolus
Heparin
Low-Molecular-Weight
Middle Aged
Limb Salvage
Lower limb ischaemia
body regions
Early Diagnosis
Logistic Models
Treatment Outcome
Lower Extremity
Acute Disease
Multivariate Analysis
Critical Pathways
Female
Surgery
Triage
Cardiology and Cardiovascular Medicine
business
Vascular Surgical Procedures
Zdroj: European Journal of Vascular and Endovascular Surgery. 54:235-240
ISSN: 1078-5884
DOI: 10.1016/j.ejvs.2017.04.010
Popis: Acute lower limb ischaemia (ALLI) is a potentially fatal, limb threatening medical emergency. Early treatment is essential for a good outcome. The aim was to describe the early chain of care in ALLI focusing on lead times and emergency management in order to identify weak links for improvement.This was a retrospective, descriptive case study. This study analysed the medical records of all patients with a main discharge diagnosis of ALLI between January 2009 and December 2014. Predetermined emergency care data on lead times, diagnosis recognition, presenting symptoms, emergency care treatment and outcome were collected for patients who were transported by the Emergency Medical Service (EMS) and those who were not.In total, 552 medical records were audited of which 195 patients fulfilled the inclusion criteria and were analysed. Among them were 117 (60%) transported by the EMS. The median time from symptom onset to revascularisation was 23 (interquartile range [IQR] 10-55; EMS transported) and 93 (IQR 42-152, not EMS transported) hours (p .01). The time from symptom onset to arrival in hospital was 5 (IQR 2-26; EMS transported) and 48 (IQR 6-108; not EMS transported) hours. After arrival in hospital, the median time to first doctor evaluation was 51 (IQR 28-90; EMS transported) and 80 (IQR 44-169; not EMS transported) minutes, p = .01. Low molecular weight heparin (LMWH) was given to 72% of patients in the emergency department (ED) and a multivariate analysis showed that the use of LMWH was associated with a more favourable outcome.Both the time spent in the ED and the time from the onset of symptoms to revascularisation were considerably longer than optimal. Time delays in the early treatment chain can mainly be attributed to "patient delay" and a considerable time spent in hospital before revascularisation. The use of LMWH as an integral part of ED management was associated with a better outcome.
Databáze: OpenAIRE
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