Elapsed Time in Emergency Medical Services for Patients With Cardiac Complaints
| Autor: | David M. Kent, Joseph P. Newhouse, James M Atkins, Sharon-Lise T. Normand, Harry P. Selker, Joni R. Beshansky, John L. Griffith, Thomas W Concannon |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Emergency Medical Services Pediatrics medicine.medical_specialty Time Factors Heart Diseases Population Risk Assessment Article Health Services Accessibility Odds Sex Factors Residence Characteristics Risk Factors Odds Ratio Emergency medical services Humans Medicine Healthcare Disparities education Aged Retrospective Studies education.field_of_study business.industry Retrospective cohort study Odds ratio Middle Aged Texas Triage Confidence interval Logistic Models Transportation of Patients Female Cardiology and Cardiovascular Medicine Risk assessment business |
| Zdroj: | Circulation: Cardiovascular Quality and Outcomes. 2:9-15 |
| ISSN: | 1941-7705 1941-7713 |
| DOI: | 10.1161/circoutcomes.108.813741 |
| Popis: | Background— In patients with a major cardiac event, the first priority is to minimize time to treatment. For many patients, first contact with the health system is through emergency medical services (EMS). We set out to identify patient-level and neighborhood-level factors that were associated with elapsed time in EMS. Methods and Results— A retrospective cohort study was conducted in 10 municipalities in Dallas County, Tex, from January 1 through December 31, 2004. The data set included 5887 patients with suspected cardiac-related symptoms. The region was served by 29 hospitals and 98 EMS depots. Multivariate models included measures of distance traveled, time of day, day of week, and patient and neighborhood characteristics. The main outcomes were elapsed time in EMS (continuous; in minutes) and delay in EMS (dichotomous; >15 minutes beyond median elapsed time). We found positive associations between patient characteristics and both average elapsed time and delay in EMS care. Variation in average elapsed time was not large enough to be clinically meaningful. However, approximately 11% (n=647) of patients were delayed ≥15 minutes. Women were more likely to be delayed (adjusted odds ratio, 1.52; 95% confidence interval, 1.32 to 1.74), and this association did not change after adjusting for other characteristics, including neighborhood socioeconomic composition. Conclusions— Compared with otherwise similar men, women have 50% greater odds of being delayed in the EMS setting. The determinants of delay should be a special focus of EMS studies in which time to treatment is a priority. |
| Databáze: | OpenAIRE |
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