title: The Relationship between Clinical Outcome in Subarachnoidal Hemorrhage Patients with Emergency Medical Service Usage and Interhospital Transfer.
abstract: Prompt diagnosis and appropriate transport of patients with subarachnoid hemorrhage (SAH) is critical. We aimed to study differences in clinical outcomes by emergency medical services (EMS) usage and interhospital transfer in patients with SAH. We analyzed the CAVAS (CArdioVAscular disease Surveillance) database which is an emergency department-based, national cohort of cardiovascular disease in Korea. Eligible patients were adults with non-traumatic SAH diagnosed between January 2007 and December 2012. We excluded those whose EMS use and intershopital transfer data was unknown. The primary and secondary outcomes were mortality and neurologic status at discharge respectively. We compared the outcomes between each group using multivariable logistic regressions, adjusting for sex, age, underlying disease, visit time and social history. Of 5,461 patients with SAH, a total of 2,645 were enrolled. Among those, 258 used EMS and were transferred from another hospital, 686 used EMS only, 1,244 were transferred only, and 457 did not use EMS nor were transferred. In the regression analysis, mortality was higher in patients who used EMS and were transferred (OR 1.40, 95% CI 1.02-1.92), but neurologic disability was not meaningfully different by EMS usage and interhospital transfer. In Korea, SAH patients' mortality is higher in the case of EMS use or receiving interhospital transfer.
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea.
authors.forename: Sang Hwa
authors.identifier: 0000-0002-7294-0427
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea.
authors.forename: Kyoung Jun
authors.identifier: 0000-0002-0027-6352
authors.initials: KJ
authors.lastname: Song
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea.
authors.forename: Sang Do
authors.identifier: 0000-0003-4953-2916
authors.initials: SD
authors.lastname: Shin
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
authors.forename: Young Sun
authors.identifier: 0000-0003-3634-9573
authors.initials: YS
authors.lastname: Ro
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
authors.forename: Min Jung
authors.identifier: 0000-0003-3561-9308
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, UC Davis Medical Center(JFH), Davis, CA, USA.
authors.forename: James F
authors.identifier: 0000-0003-3270-2720
authors.initials: JF
authors.lastname: Holmes
mesh_terms: D000328:Adult; D000368:Aged; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000628:therapy*
keywords: Emergency Medical Services; Interhospital Transfer; Mortality; Subarachnoid Haemorrhage