title: Non-specific complaints in the ambulance; predisposing structural factors.
abstract: BACKGROUND
  The pre-hospital assessment non-specific complaint (NSC) often applies to patients whose diagnosis does not match any other specific assessment correlating to particular symptoms or diseases, though some previous studies have found them to be related to serious underlying conditions. The aim was to identify whether the structural factors such as urgency according to the dispatch priority of the Emergency Medical Communication Centre (EMCC) or work load in the Emergency Medical Services (EMS) are predisposing factors for the assessment of NSC instead of a specific assessment.
  
  
  METHODS
  All patients with assessed condition NSCs by the EMS to Södersjukhuset during 2011 (n = 493) were compared with gender- and age-matched controls (n = 493), which were randomly drawn from all patients with specific conditions in the EMS, regarding day of week, time of day and priority set by EMCC with chi-squared tests and multivariate logistic regression models.
  
  
  RESULTS
  Among patients with NSCs, more were females (58 %) and the median age was 82. Almost all patients were categorized with NSCs during the daytime (8 a.m. to 9 p.m.), i.e. 450 (91 %) as compared to 373 (75 %) of those with specific conditions (p < 0.01). The risk of having an EMS dispatched as low priority by the EMCC was almost doubled among patients with NSCs compared to controls (OR 1.97, 95 % CI 1.38-2.79).
  
  
  CONCLUSIONS
  Since patients with NSCs appear most frequently during the hours with most transportations for the EMS, i.e. 10 a.m. to 2 p.m., and the risk of having the assessment NSC was doubled if the EMCC dispatched EMS as low priority, structural factors might be predisposing factors for the assessment.
authors.affiliation: Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. maaret.castren@hus.fi.|Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden. maaret.castren@hus.fi.
authors.forename: Maaret
authors.initials: M
authors.lastname: Castrén
authors.affiliation: Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. lisa.kurland@ki.se.|Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden. lisa.kurland@ki.se.
authors.forename: Lisa
authors.initials: L
authors.lastname: Kurland
authors.affiliation: Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. sofia.liljegard@stud.ki.se.
authors.forename: Sofia
authors.initials: S
authors.lastname: Liljegard
authors.affiliation: Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. therese.djarv@ki.se.|Emergency Department, Karolinska University Hospital, Solna, Sweden. therese.djarv@ki.se.
authors.forename: Therese
authors.initials: T
authors.lastname: Djärv
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D016022:Case-Control Studies; D015984:Causality; D016009:Chi-Square Distribution; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004631:Emergency Medical Service Communication Systems; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D013548:Sweden; D013997:Time Factors; D014218:Triage / Q000379:methods / Q000706:statistics & numerical data*; D055815:Young Adult