Trends in Symptom, Diagnostic Pattern and Mortality in Emergency Ambulance Patients from 2017-2023: A comparison of older versus younger patients

Background:
Demand for ambulances has increased over the past decade and various factors are associated with this trend, including accessibility of primary care and ageing populations. We aimed to investigate trends over the years with special focus on old patients calling for an ambulance, including contact prevalence, symptoms, contact to hospital, hospital diagnoses and 1 and 30-day mortality in a seven-year period from 2017-2023.
Methods:
A historical population-based observational cohort study from the North Denmark Region. We included all emergency call patients with known civil registration number. Symptoms were categorized according to the Danish Index for Emergency Care (DI) assessed by healthcare professionals at the call. Hospital diagnoses were classified according to the WHO ICD-10 system. The patients were divided into two separate groups: patients aged 65 and older (old group) and patients from 0-64 years old (the others). We defined 1 day mortality as death within the same or the following day from the emergency call, and 30-day mortality to include all patients who died within 30 days, including 1-day mortality patients. Descriptive statistics in terms of numbers and percentages were used to compare changes over time and changes between the two groups.
Results:
The study showed an increase in emergency call patients of nearly 20 % from 30,347 patients in 2017 to 36,283 patients in 2023. The largest increase was found for the old group with an 34% increase compared to 8% in the others. The percentages of patients with contact to the hospital decreased for both groups; from 87% - 82% for the old group and from 84% - 75% for the others.
The symptom unclear problem decreased with 9% compared to 6%. There was a 9% increase in stroke-symptoms for the old group compared to 5% for the others.
Overall, the hospital diagnoses were approximately equally distributed between the two years for both groups. However, the diagnoses circulatory diseases and respiratory diseases decreased 3% for the old group. The opposite was found for the non-specific diagnoses with a 3% increase for both groups.
Overall, the changes in 1 and 30-day mortality showed a minor decline for both groups.
Discussion & Conclusions:
The study showed an increased demand for ambulances from 2017- 2023. This was mainly due to an increase in patients over 65 years. The fall in DI unclear problem can possible be explained by a targeted attention to reduce use of the criteria at the Emergency Medical Coordination Centre. There have been campaigns to increase the awareness of stroke which might affect the increase in DI possible stroke. It would be relevant to investigate comorbidity and the severity of diseases, which is expected to increase due to an ageing population.