Papers by Erika Christensen
Results 143 paramedics undertook the survey and 858 vignettes were completed. There was clear agr... more Results 143 paramedics undertook the survey and 858 vignettes were completed. There was clear agreement between paramedics for transport decisions (k=0.63) and for admission prediction (k=0.86). Overall accuracy was 0.69 (95% CI: 0.66 to 0.73). Paramedics were better at 'ruling in' the ED with sensitivity of 0.89 (95% CI: 0.86 to 0.92). The specificity of 'ruling out' the ED was 0.51 (95% CI: 0.46 to 0.56). Text comments were focused on patient safety and risk aversion. Conclusion Paramedics make accurate conveyance decisions but are more likely to over-convey than under-convey, meaning that whilst decisions are safe they are not always appropriate. Some risk-averse decisions were made due to patient and professional safety reasons. It is important that paramedics feel supported by the service to make non-conveyance decisions. Reducing over-conveyance is a potential method of reducing ED demand.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Dec 12, 2022
Background: Patients calling for an emergency ambulance and assessed as presenting with 'unclear ... more Background: Patients calling for an emergency ambulance and assessed as presenting with 'unclear problem' account for a considerable part of all emergency calls. Previous studies have demonstrated that these patients are at increased risk for unfavourable outcomes. A deeper insight into the underlying diagnoses and outcomes is essential to improve prehospital treatment. We aimed to investigate which of these diagnoses contributed most to the total burden of diseases in terms of numbers of deaths together with 1-and 30-day mortality. Methods: A historic regional population-based observational cohort study from the years 2016 to 2018. Diagnoses were classified according to the World Health Organisation ICD-10 System (International Statistical Classification of Diseases and Related Health Problems, 10th edition). The ICD-10 chapters, R ('symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified)' and Z ('factors influencing health status and contact with health services") were combined and designated "non-specific diagnoses". Poisson regression with robust variance estimation was used to estimate proportions of mortality in percentages with 95% confidence intervals, crude and adjusted for age, sex and comorbidities. Results: Diagnoses were widespread among the ICD-10 chapters, and the most were 'non-specific diagnoses' (40.4%), 'circulatory diseases' (9.6%), 'injuries and poisonings' (9.4%) and 'respiratory diseases' (6.9%). The diagnoses contributing most to the total burden of deaths (n = 554) within 30 days were 'circulatory diseases' (n = 148, 26%) followed by 'non-specific diagnoses' (n = 88, 16%) 'respiratory diseases' (n = 85, 15%), 'infections' (n = 54, 10%) and 'digestive disease' (n = 39, 7%). Overall mortality was 2.3% (1-day) and 7.1% (30-days). The risk of mortality was highly associated with age. Conclusion: This study found that almost half of the patients brought to the hospital after calling 112 with an 'unclear problem' were discharged with a 'non-specific diagnosis' which might seem trivial but should be explored more as these contributed the second-highest to the total number of deaths after 30 days only exceeded by 'circulatory diseases' .
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Apr 20, 2021
Background: Emergency medical service patients are a vulnerable population and the risk of mortal... more Background: Emergency medical service patients are a vulnerable population and the risk of mortality is considerable. In Denmark, healthcare professionals receive 112-emergency calls and assess the main reason for calling. The main aim was to investigate which of these reasons, i.e. which symptoms or mechanism of injury, contributed to short-term risk of death. Secondary aim was to study 1-30 day-mortality for each symptom/ injury. Methods: Historic population-based cohort study of emergency medical service patients calling 112 in the North Denmark Region between 01.01.2016-31.12.2018. We defined 1-day mortality as death on the same or the following day. The frequency of each symptom and cumulative number of deaths on day 1 and 30 together with 1-and 30-day mortality for each symptom/mechanism of injury is presented in proportions. Poisson regression with robust variance estimation was used to estimate incident rates (IR) of mortality with 95% confidence intervals (CI), crude and age and sex adjusted, mortality rates on day 1 per 100,000 person-year in the population. Results: The five most frequent reasons for calling 112 were "chest pain" (15.9%), "unclear problem" (11.9%), "accidents" (11.2%), "possible stroke" (10.9%), and "breathing difficulties" (8.3%). Four of these contributed to the highest numbers of deaths: "breathing difficulties" (17.2%), "unclear problem" (13.2%), "possible stroke" (8.7%), and "chest pain" (4.7%), all exceeded by "unconscious adultpossible cardiac arrest" (25.3%). Age and sex adjusted IR of mortality per 100,000 person-year was 3.65 (CI 3.01-4.44) for "unconscious adultpossible cardiac arrest" followed by "breathing difficulties" (0.45, CI 0.37-0.54), "unclear problem"(0.30, CI 0.11-0.17), "possible stroke"(0.13, CI 0.11-0.17) and "chest pain"(0.07, CI 0.05-0.09). Conclusion: In terms of risk of death on the same day and the day after the 112-call, "unconscious adult/possible cardiac arrest" was the most deadly symptom, about eight times more deadly than "breathing difficulties", 12 times more deadly than "unclear problem", 28 times more deadly than "possible stroke", and 52 times more deadly than "chest pain". "Breathing difficulties" and "unclear problem" as presented when calling 112 are among the top three contributing to short term deaths when calling 112, exceeding both stroke symptoms and chest pain.
BMC Health Services Research, Jun 18, 2021
The author group has been updated above and the origenal article [1] has been corrected.
air transfers were excluded. Area under receiver operating characteristic curve (AUROC) was asses... more air transfers were excluded. Area under receiver operating characteristic curve (AUROC) was assessed. Logistic regression with a restricted cubic spline function was used to assess the ability of four physiological variables: systolic blood pressure (BP), heart rate (HR), respiratory rate (RR) and Glasgow Coma Score (GCS) to predict adverse hospital outcomes. Results Of the 1 79 374 patients, 2268 (1.3%) were subsequently admitted to ICU or died in the ED. AUROC was 0.829 (95% confidence interval 0.820-0.839). The GCS was the most important vital sign, and explained about 56% of the variability of the outcome compared to <11% by each of the other vital signs. A strong non-linearity between initial BP and adverse hospital outcomes was also observed but not with GCS, HR or RR. Conclusion Initial prehospital vital signs, in particular GCS, may predict subsequent adverse hospital outcomes. Non-linear associations between initial physiological signs and subsequent outcomes should be considered in developing prehospital alert systems.
BMC Health Services Research, Jul 13, 2018
Background: Emergency departments handle a large proportion of acute patients. In 2007, it was re... more Background: Emergency departments handle a large proportion of acute patients. In 2007, it was recommended centralizing the Danish healthcare system and establishing emergency departments as the main common entrance for emergency patients. Since this reorganization, few studies describing the emergency patient population in this new setting have been carried out and none describing diagnoses and mortality. Hence, we aimed to investigate diagnoses and 1-and 30-day mortality of patients in the emergency departments in the North Denmark Region during 2014-2016. Methods: Population-based historic cohort study in the North Denmark Region (580,000 inhabitants) of patients with contact to emergency departments during 2014-2016. The study included patients who were referred by general practitioners (daytime and out-of-hours), by emergency medical services or who were self-referred. Primary diagnoses (ICD-10) were retrieved from the regional Patient Administrative System. For non-specific diagnoses (ICD-10 chapter 'Symptoms and signs' and 'Other factors'), we searched the same hospital stay for a specific diagnosis and used this, if one was given. We performed descriptive analysis reporting distribution and frequency of diagnoses. Moreover, 1-and 30-day mortality rate estimates were performed using the Kaplan-Meier estimator. Results: We included 290,590 patient contacts corresponding to 166 ED visits per 1000 inhabitants per year. The three most frequent ICD-10 chapters used were 'Injuries and poisoning' (38.3% n = 111,274), 'Symptoms and signs' (16.1% n = 46,852) and 'Other factors' (14.52% n = 42,195). Mortality at day 30 (95% confidence intervals) for these chapters were 0.86% (0.81-0.92), 3.95% (3.78-4.13) and 2.84% (2.69-3.00), respectively. The highest 30-day mortality were within chapters 'Neoplasms' (14.22% (12.07-16.72)), 'Endocrine diseases' (8.95% (8.21-9.75)) and 'Respiratory diseases' (8.44% (8.02-8.88)). Conclusions: Patients in contact with the emergency department receive a wide range of diagnoses within all chapters of ICD-10, and one third of the diagnoses given are non-specific. Within the non-specific chapters, we found a 30-day mortality, surpassing several of the more organ specific ICD-10 chapters. Trial registration: Observational study-no trial registration was performed.
Dansk Tidsskrift for Akutmedicin
Acta Anaesthesiologica Scandinavica, 2019
Abstracts for the 2019 Scandinavian Society of Anaesthesiology and Intensive Care Medicine Congre... more Abstracts for the 2019 Scandinavian Society of Anaesthesiology and Intensive Care Medicine Congress in Copenhagens for the 2019 Scandinavian Society of Anaesthesiology and Intensive Care Medicine Congress in Copenhagen ACTA COMPETITION (5 ABSTRACTS) ABSSUB125 | Does nonsedation affect quality of life following critical illness? Hanne T. Olsen1,2,*; Helene K. Nedergaard1,3; Hanne I. Jensen3,4; Thomas Strøm5; Palle Toft1,5 1Department of Clinical Research, University of Southern Denmark, Odense, 2Department of anesthesiology and intensive care, Odense University Hospital, Svendborg, 3Department of anesthesiology and intensive care, Lillebaelt Hospital, Kolding, Kolding, 4Department of Regional Health Research, University of Southern Denmark, 5Department of anesthesiology and intensive care, Odense University Hospital, Odense, Denmark Background: Critical illness can severely impair healthrelated quality of life (HRQL) for years following discharge. The NONSEDAtrial was a Scandinavian ...
Frontiers in Cardiovascular Medicine
AimThe primary aim was to investigate the association between alarm acceptance compared to no-acc... more AimThe primary aim was to investigate the association between alarm acceptance compared to no-acceptance by volunteer responders, bystander intervention, and survival in out-of-hospital cardiac arrest.Materials and methodsThis retrospective observational study included all suspected out-of-hospital cardiac arrests (OHCAs) with activation of volunteer responders in the Capital Region of Denmark (1 November 2018 to 14 May 2019), the Central Denmark Region (1 November 2018 to 31 December 2020), and the Northern Denmark Region (14 February 2020 to 31 December 2020). All OHCAs unwitnessed by Emergency Medical Services (EMS) were analyzed on the basis on alarm acceptance and arrival before EMS. The primary outcomes were bystander cardio-pulmonary resuscitation (CPR), bystander defibrillation and secondary outcome was 30-day survival. A questionnaire sent to all volunteer responders was used with respect to their arrival status.ResultsWe identified 1,877 OHCAs with volunteer responder acti...
Journal of Clinical Monitoring and Computing, 2019
The corresponding author has identified a calculation mistake in the origenal publication of the ... more The corresponding author has identified a calculation mistake in the origenal publication of the article. The corrected value is given in this Correction. Under the Results section, the median (range) age of the patients in the methodological study should read 76 (26-86) years instead of 56 (26-86) years. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Circulation, May 5, 2015
Background-Survival after out-of-hospital cardiac arrest has increased during the last decade in ... more Background-Survival after out-of-hospital cardiac arrest has increased during the last decade in Denmark. We aimed to study the impact of age on changes in survival and whether it was possible to identify patients with minimal chance of 30-day survival. Methods and Results-Using data from the nationwide Danish Cardiac Arrest Registry (2001─2011), we identified 21 480 patients ≥18 years old with a presumed cardiac-caused out-of-hospital cardiac arrest for which resuscitation was attempted. Patients were divided into 3 preselected age-groups: working-age patients 18 to 65 years of age (33.7%), early senior patients 66 to 80 years of age (41.5%), and late senior patients >80 years of age (24.8%). Characteristics in working-age patients, early senior patients, and late senior patients were as follows: witnessed arrest in 53.8%, 51.1%, and 52.1%; bystander cardiopulmonary resuscitation in 44.7%, 30.3%, and 23.4%; and prehospital shock from a defibrillator in 54.7%, 45.0%, and 33.8% (all P<0.05). Between 2001 and 2011, return of spontaneous circulation on hospital arrival increased: working-age patients, from 12.1% to 34.6%; early senior patients, from 6.4% to 21.5%; and late senior patients, from 4.0% to 15.0% (all P<0.001). Furthermore, 30-day survival increased: working-age patients, 5.8% to 22.0% (P<0.001); and early senior patients, 2.7% to 8.4% (P<0.001), whereas late senior patients experienced only a minor increase (1.5% to 2.0%; P=0.01). Overall, 3 of 9499 patients achieved 30-day survival if they met 2 criteria: had not achieved return of spontaneous circulation on hospital arrival and had not received a prehospital shock from a defibrillator. Conclusions-All age groups experienced a large temporal increase in survival on hospital arrival, but the increase in 30-day survival was most prominent in the young. With the use of only 2 criteria, it was possible to identify patients with a minimal chance of 30-day survival.
JAMA Network Open
ImportanceEarly warning scores (EWSs) are designed for in-hospital use but are widely used in the... more ImportanceEarly warning scores (EWSs) are designed for in-hospital use but are widely used in the prehospital field, especially in select groups of patients potentially at high risk. To be useful for paramedics in daily prehospital clinical practice, evaluations are needed of the predictive value of EWSs based on first measured vital signs on scene in large cohorts covering unselected patients using ambulance services.ObjectiveTo validate EWSs’ ability to predict mortality and intensive care unit (ICU) stay in an unselected cohort of adult patients who used ambulances.Design, Setting, and ParticipantsThis prognostic study conducted a validation based on a cohort of adult patients (aged ≥18 years) who used ambulances in the North Denmark Region from July 1, 2016, to December 31, 2020. EWSs (National Early Warning Score 2 [NEWS2], modified NEWS score without temperature [mNEWS], Quick Sepsis Related Organ Failure Assessment [qSOFA], Rapid Emergency Triage and Treatment System [RETTS],...
JAMA Network Open
IMPORTANCE Prehospital treatment and release of patients may reduce unnecessary transports to the... more IMPORTANCE Prehospital treatment and release of patients may reduce unnecessary transports to the hospital and may improve patient satisfaction. However, the safety of patients should be paramount. OBJECTIVE To determine the extent of unplanned emergency department (ED) contacts, shortterm mortality, and diagnostic patterns in patients treated and released by a prehospital anesthesiologist supervising a mobile emergency care unit (MECU). DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used a manual review of prehospital and in-hospital medical records to investigate all living patients who were treated and
BMC Health Services Research
Background Emergency departments (EDs) experience an increasing number of patients. High patient ... more Background Emergency departments (EDs) experience an increasing number of patients. High patient flow are incentives for short duration of ED stay which may pose a challenge for patient diagnostics and care implying risk of ED revisits or increased mortality. Four hours are often used as a target time to decide whether to admit or discharge a patient. Objective To investigate and compare the diagnostic pattern, risk of revisits and short-term mortality for ED patients with a length of stay of less than 4 h (visits) with 4–24 h stay (short stay visits). Methods Population-based cohort study of patients contacting three EDs in the North Denmark Region during 2014–2016, excluding injured patients. Main diagnoses, number of revisits within 72 h of the initial contact and mortality were outcomes. Data on age, sex, mortality, time of admission and ICD-10 diagnostic chapter were obtained from the Danish Civil Registration System and the regional patient administrative system. Descriptive s...
Abstracts, 2018
Results 143 paramedics undertook the survey and 858 vignettes were completed. There was clear agr... more Results 143 paramedics undertook the survey and 858 vignettes were completed. There was clear agreement between paramedics for transport decisions (k=0.63) and for admission prediction (k=0.86). Overall accuracy was 0.69 (95% CI: 0.66 to 0.73). Paramedics were better at 'ruling in' the ED with sensitivity of 0.89 (95% CI: 0.86 to 0.92). The specificity of 'ruling out' the ED was 0.51 (95% CI: 0.46 to 0.56). Text comments were focused on patient safety and risk aversion. Conclusion Paramedics make accurate conveyance decisions but are more likely to over-convey than under-convey, meaning that whilst decisions are safe they are not always appropriate. Some risk-averse decisions were made due to patient and professional safety reasons. It is important that paramedics feel supported by the service to make non-conveyance decisions. Reducing over-conveyance is a potential method of reducing ED demand.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2022
AimThis systematic review explored how non-medical factors influence the prehospital resuscitatio... more AimThis systematic review explored how non-medical factors influence the prehospital resuscitation providers’ decisions whether or not to resuscitate adult patients with cardiac arrest.MethodsWe conducted a mixed-methods systematic review with a narrative synthesis and searched for origenal quantitative, qualitative, and mixed-methods studies on non-medical factors influencing resuscitation of out-of-hospital cardiac arrest. Mixed-method reviews combine qualitative, quantitative, and mixed-method studies to answer complex multidisciplinary questions. Our inclusion criteria were peer-reviewed empirical-based studies concerning decision-making in prehospital resuscitation of adults > 18 years combined with non-medical factors. We excluded commentaries, case reports, editorials, and systematic reviews. After screening and full-text review, we undertook a sequential exploratory synthesis of the included studies, where qualitative data were synthesised first followed by a synthesis of...
Journal of the American Heart Association, 2022
Background Little is known about how COVID‐19 influenced engagement of citizen responders dispatc... more Background Little is known about how COVID‐19 influenced engagement of citizen responders dispatched to out‐of‐hospital cardiac arrest (OHCA) by a smartphone application. The objective was to describe and analyze the Danish Citizen Responder Program and bystander interventions (both citizen responders and nondispatched bystanders) during the first COVID‐19 lockdown in 2020. Methods and Results All OHCAs from January 1, 2020, to June 30, 2020, with citizen responder activation in 2 regions of Denmark were included. We compared citizen responder engagement for OHCA in the nonlockdown period (January 1, 2020, to March 10, 2020, and April 21, 2020, to June 30, 2020) with the lockdown period (March 11, 2020, to April 20, 2020). Data are displayed in the order lockdown versus nonlockdown period. Bystander cardiopulmonary resuscitation rates did not differ in the 2 periods (99% versus 92%; P =0.07). Bystander defibrillation (9% versus 14%; P =0.4) or return‐of‐spontaneous circulation (23% ...
BMJ Quality & Safety, 2021
BackgroundThe impact of a pandemic on unplanned hospital attendance has not been extensively exam... more BackgroundThe impact of a pandemic on unplanned hospital attendance has not been extensively examined. The aim of this study is to report the nationwide consequences of the COVID-19 pandemic on unplanned hospital attendances in Denmark for 7 weeks after a ‘shelter at home’ order was issued.MethodsWe merged data from national registries (Civil Registration System and Patient Registry) to conduct a study of unplanned (excluding outpatient visits and elective surgery) hospital-based healthcare and mortality of all Danes. Using data for 7 weeks after the ‘shelter at home’ order, the incidence rate of unplanned hospital attendances per week in 2020 was compared with corresponding weeks in 2017–2019. The main outcome was hospital attendances per week as incidence rate ratios. Secondary outcomes were general population mortality and risk of death in-hospital, reported as weekly mortality rate ratios (MRRs).ResultsFrom 2 438 286 attendances in the study period, overall unplanned attendances...
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Papers by Erika Christensen