title: Epidemiology of Shortness of Breath in Prehospital Patients in Andhra Pradesh, India.
abstract: BACKGROUND
  Shortness of breath is a frequent reason for patients to request prehospital emergency medical services and is a symptom of many life-threatening conditions. To date, there is limited information on the epidemiology of, and outcomes of patients seeking emergency medical services for, shortness of breath in India.
  
  
  OBJECTIVE
  This study describes the characteristics and outcomes of patients with a chief complaint of shortness of breath transported by a public ambulance service in the state of Andhra Pradesh, India.
  
  
  METHODS
  This prospective, observational study enrolled patients with a chief complaint of shortness of breath during twenty-eight, 12-h periods. Demographic and clinical data were collected from emergency medical technicians using a standardized questionnaire. Follow-up information was collected at 48-72 h and 30 days.
  
  
  RESULTS
  Six hundred and fifty patients were enrolled during the study period. The majority of patients were male (63%), from rural communities (66%), and of lower socioeconomic status (78%). Prehospital interventions utilized included oxygen (76%), physician consultation (40%), i.v. placement (15%), nebulized medications (13%), cardiopulmonary resuscitation (5%), and bag-mask ventilation (4%). Mortality ratios before hospital arrival, at 48-72 h, and 30 days were 12%, 27%, and 35%, respectively. Forty-six percent of patients were confirmed to have survived to 30 days. Predictors of death before hospital arrival were symptoms of chest pain (16% vs. 12%; p < 0.05) recent symptoms of upper respiratory infection (7.5% vs. 4%; p < 0.05), history of heart disease (14% vs. 7%; p < 0.05), and prehospital hypotension, defined as systolic blood pressure <90 mm Hg (6.3% vs. 3.7%; p < 0.05).
  
  
  CONCLUSIONS
  Among individuals seeking prehospital emergency medical services in India, the chief complaint of shortness of breath is associated with a substantial early and late mortality, which may be in part due to the underutilization of prehospital interventions.
authors.affiliation: Department of Emergency Medicine, University of California San Francisco, San Francisco, California.
authors.forename: Mary P
authors.initials: MP
authors.lastname: Mercer
authors.affiliation: Division of Emergency Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Swaminatha V
authors.initials: SV
authors.lastname: Mahadevan
authors.affiliation: Division of Emergency Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Pirrotta
authors.affiliation: GVK-Emergency Management Research Institute, Hyderabad, India.
authors.forename: G V
authors.initials: GV
authors.lastname: Ramana Rao
authors.affiliation: GVK-Emergency Management Research Institute, Hyderabad, India.
authors.forename: Sreeram
authors.initials: S
authors.lastname: Sistla
authors.affiliation: GVK-Emergency Management Research Institute, Hyderabad, India.
authors.forename: Bhanuprasad
authors.initials: B
authors.lastname: Nampelly
authors.affiliation: GVK-Emergency Management Research Institute, Hyderabad, India.
authors.forename: Rajini
authors.initials: R
authors.lastname: Danthala
authors.affiliation: Division of Emergency Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Anne N T
authors.initials: AN
authors.lastname: Strehlow
authors.affiliation: Division of Emergency Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Strehlow
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D002637:Chest Pain / Q000453:epidemiology; D004417:Dyspnea / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D016019:Survival Analysis; D055815:Young Adult
keywords: international EMS; prehospital; shortness of breath