title: Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: an observational study.
abstract: BACKGROUND
  This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance.
  
  
  METHODS
  This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics and comparisons of proportions.
  
  
  RESULTS
  One thousand seven patients met inclusion criteria. Median age was 74 years (IQR 61-68) and 46.1 % were male. There was a high rate of co-morbidity and chronic medication use. The most common ED diagnoses were lower respiratory tract infection (including pneumonia, 22.7 %), cardiac failure (20.5%) and exacerbation of chronic obstructive pulmonary disease (19.7 %). ED disposition was hospital admission (including ICU) for 76.4 %, ICU admission for 5.6 % and death in ED in 0.9 %. Overall in-hospital mortality among admitted patients was 6.5 %.
  
  
  CONCLUSIONS
  Patients transported by ambulance with shortness of breath make up a significant proportion of ambulance caseload and have high comorbidity and high hospital admission rate. In this study, >60 % were accounted for by patients with heart failure, lower respiratory tract infection or COPD, but there were a wide range of diagnoses. This has implications for service planning, models of care and paramedic training.
  
  
  CONCLUSIONS
  This study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services.
authors.affiliation: Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine, Australia. anne-maree.kelly@wh.org.au.|School of Medicine-Western Clinical School, The University of Melbourne, Parkville, Australia. anne-maree.kelly@wh.org.au.
authors.forename: Anne Maree
authors.identifier: http://orcid.org/0000-0002-4655-5023
authors.initials: AM
authors.lastname: Kelly
authors.affiliation: Department of Emergency Medicine, Liverpool Hospital, University of New South Wales (Southwest Clinical School), Sydney, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Holdgate
authors.affiliation: Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia.|School of Medicine, Bond University, Gold Coast, QLD, Australia.|School of Medicine, Griffith University, Gold Coast, QLD, Australia.
authors.forename: Gerben
authors.initials: G
authors.lastname: Keijzers
authors.affiliation: Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Klim
authors.affiliation: Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR.
authors.forename: Colin A
authors.initials: CA
authors.lastname: Graham
authors.affiliation: Emergency Department, Monash Medical Centre, Clayton, Australia.|School of Clinical Sciences, Monash University, Clayton, Australia.|Murdoch Children's Research Institute, Parkville, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Craig
authors.affiliation: Emergency Medicine Department, National University Health System, Singapore, Singapore.|Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Win Sen
authors.initials: WS
authors.lastname: Kuan
authors.affiliation: Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Jones
authors.affiliation: Statistical Consulting Service, Graduate Research Centre, Victoria University, Footscray, Australia.
authors.forename: Charles
authors.initials: C
authors.lastname: Lawoko
authors.affiliation: Emergency Medicine Department, Tours University Hospital, 37044, Tours, France.
authors.forename: Said
authors.initials: S
authors.lastname: Laribi
keywords: Ambulance; Dyspnoea; Emergency department; Epidemiology