Frequency of in-office emergencies in primary care

Clare Liddy; Heather Dreise; Isabelle Gaboury

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Table 1

Descriptive characteristics of calls: Of the 272 752 emergency calls received during the study period, 181 674 (67%) were code 04 (life-threatening emergency*) calls, and 3033 (2%) of the code 04 calls were from FPs’ offices; mean age of patients was 51.48 (SD 21.66) years and mean distance to the closest emergency department was 11.95 (SD 7.51) km.

CHARACTERISTICS	NO. OF CALLS (%)N = 3033
Age of patient, y
• 0–18 (pediatric)	264 (8.7)
• 19–55	1319 (43.5)
• > 55	1450 (47.8)
Male patients	1389 (45.8)
Season
• Winter (Jan-Mar)	801 (26.4)
• Spring (Apr-Jun)	801 (26.4)
• Summer (Jul-Sep)	697 (23.0)
• Fall (Oct-Dec)	734 (24.2)
Distance to closest emergency department, km
• 0–14	2635 (86.9)
• 15–29	361 (11.9)
• ≥30	37 (1.2)

↵* A call is categorized by the 911 dispatch going through the Ambulance Response Information System II Dispatch Priority Card Index (DCPI) algorithm to determine the urgency of the call. The DCPI is implemented with software programs that are standard across the province of Ontario for all communications centres for 911 calls.

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Table 2

Frequency of primary complaints and mean age of patients: N = 3033.

BODY SYSTEM AFFECTED	TOTAL NO. OF CALLS (%)	MEAN AGE OF PATIENT, Y (SD)
Cardiovascular (ischemic pain, palpitations, CHF, cardiac medical, cardiac trauma, etc)	992 (32.7)	58.76 (14.89)
Other (general illness or weakness, other medical or trauma, infectious disease, hypothermia or exposure, near drowning, etc)	607 (20.0)	53.10 (21.57)
Respiratory (respiratory distress, respiratory disease, inhalation injury, obstruction or foreign body, etc)	388 (12.8)	49.49 (28.06)
CNS (post ictal, syncope, TIA, stroke, headache, psychiatric, behavioural, head trauma, etc)	386 (12.7)	46.45 (24.09)
Endocrine (local allergic reaction, anaphylaxis, diabetic emergency, etc)	214 (7.1)	33.49 (20.32)
GI (abdominal pain NYD, nausea, vomiting, etc)	200 (6.6)	48.93 (20.39)
MSK (back pain, paralysis or spinal trauma, chest wall pain)	125 (4.1)	48.53 (23.86)
Hematologic (major and minor hemorrhage, hypotension, etc)	48 (1.6)	58.17 (20.38)
Genitourinary (gynecologic emergency, obstetric emergency, etc)	44 (1.5)	36.48 (16.34)
Pharmacologic (poisoning or toxic exposure, alcohol intoxication, overdose, etc)	29 (< 0.1)	36.62 (12.46)

CHF congestive heart failure, CNS central nervous system, GI gastrointestinal, MSK musculoskeletal, NYD not yet diagnosed, TIA transient ischemic attack.

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Table 3

Seasonal variation in the primary complaint of emergencies presenting to community medical clinics: Percentages might not add to 100% owning to rounding.

PRIMARY COMPLAINT	WINTER (JAN-MAR), %	SPRING (APR-JUN), %	SUMMER (JUL-SEP), %	FALL (OCT-DEC), %
Cardiovascular	26.7	26.6	22.7	24.0
Central nervous system	25.1	28.8	23.6	22.5
Respiratory	32.0^*	25.3	15.5^*	27.3^*
Gastrointestinal	21.0	29.0	26.0	24.0
Genitourinary	15.9	34.1	29.5	20.5
Musculoskeletal	28.8^*	21.6	22.4	27.2^*
Endocrine	20.1	30.4	29.4	20.1
Hematologic	35.4	16.7	27.1	20.8
Pharmacologic	34.5^*	10.3	20.7	34.5^*
Other	26.5	24.9	23.9	24.7