{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T23:37:21Z","timestamp":1787701041334,"version":"build-2784847793"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>One third of ambulance patients receive non-specific diagnoses in hospital. Mortality is 3\u20134%, however due to the high patient volume this group accounts for 20% of all deaths at day 30. Non-specific diagnoses do not provide much information on causes for death. Vital signs at first contact with ambulance personnel can act as a proxy for the patient\u2019s condition. Thus, we aimed to describe the prevalence of abnormal vital signs, as determined by a modified NEWS2, in ambulance patients who received a non-specific hospital diagnosis. Secondly, we examined the association between vital signs, NEWS2 scores, type of non-specific diagnosis, and mortality among these patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Register-based historic cohort study of ambulance patients aged 16+ in the North Denmark Region during 2012\u20132016, who received a non-specific diagnosis (ICD-10 chapters R or Z) at hospital. We used NEWS2 scores to determine if first vital signs were normal or deviating (including critical). Mortality was estimated with the Kaplan-Meier estimator. Association between vital signs and mortality was evaluated by logistic regression.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We included 41,539 patients, 20.9% (N = 8,691) had normal vital signs, 16.3% (N = 6,766) had incomplete vital sign registration, 62.8% (N = 26,082) had deviating vital signs, and of these 6.8% (N = 1,779) were critical. If vital signs were incompletely registered or deviating, mortality was higher compared to normal vital signs. Patients with critical vital signs displayed the highest crude 48-hour and 30-day mortality (7.0% (5.9\u20138.3) and 13.4% (11.9\u201315.1)). Adjusting for age, sex, and comorbidity did not change that pattern. Across all vital sign groups, despite severity, the most frequent diagnosis assigned was Z039 <jats:italic>observation for suspected disease or condition unspecified<\/jats:italic>.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Most ambulance patients with non-specific diagnoses had normal or non-critical deviating vital signs and low mortality. Around 4% had critical vital signs and high mortality, not explained by age or comorbidity.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0293762","type":"journal-article","created":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T17:45:33Z","timestamp":1698860733000},"page":"e0293762","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Critically deviating vital signs among patients with non-specific diagnoses\u2013A register-based historic cohort study"],"prefix":"10.1371","volume":"18","author":[{"given":"Mia Car\u00f8e","family":"S\u00f8rensen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten Breinholt","family":"S\u00f8vs\u00f8","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika Frischknecht","family":"Christensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9607-7859","authenticated-orcid":true,"given":"Tim Alex","family":"Lindskou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,11,1]]},"reference":[{"key":"pone.0293762.ref001","volume-title":"European Journal of Emergency Medicine","author":"OS Gunnarsdottir","year":"2007"},{"key":"pone.0293762.ref002","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2318-11-62","article-title":"Features and outcomes of unplanned hospital admissions of older people due to ill-defined (R-coded) conditions: Retrospective analysis of hospital admissions data in England","volume":"11","author":"B Walsh","year":"2011","journal-title":"BMC Geriatr"},{"key":"pone.0293762.ref003","doi-asserted-by":"crossref","first-page":"409","DOI":"10.2147\/CLEP.S338149","article-title":"Profiling Bispebjerg Acute Cohort: Database Formation, Acute Contact Characteristics of a Metropolitan Hospital, and Comparisons to Urban and Rural Hospitals in Denmark","volume":"14","author":"R Gregersen","year":"2022","journal-title":"Clin Epidemiol"},{"issue":"6","key":"pone.0293762.ref004","first-page":"855","article-title":"Chief Complaints, Underlying Diagnoses, and Mortality in Adult, Non-trauma Emergency Department Visits: A Population-based, Multicenter Cohort Study","volume":"23","author":"M Dan Arvig","year":"2022","journal-title":"Western Journal of Emergency Medicine"},{"issue":"7","key":"pone.0293762.ref005","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-011558","article-title":"Diagnosis and mortality in prehospital emergency patients transported to hospital: A population-based and registry-based cohort study","volume":"6","author":"EF Christensen","year":"2016","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0293762.ref006","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-019-4419-0","article-title":"General practitioners\u2019 and out-of-hours doctors\u2019 role as gatekeeper in emergency admissions to somatic hospitals in Norway: Registry-based observational study","volume":"19","author":"J Blinkenberg","year":"2019","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0293762.ref007","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-017-2156-9","article-title":"Readmission and mortality in patients discharged with a diagnosis of medical observation and evaluation (Z03*-codes) from an acute admission unit in Denmark: A prospective cohort study","volume":"17","author":"KM Hansen","year":"2017","journal-title":"BMC Health Serv Res"},{"key":"pone.0293762.ref008","unstructured":"Poulsen NR, Kl\u00f8jg\u00e5rd TA, L\u00fcbcke K, Lindskou TA, S\u00f8vs\u00f8 MB, Christensen EF. 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