Prehospital time and mortality in patients requiring a highest priority emergency medical response: a Danish registry-based cohort study

Mills, Elisabeth Helen Anna; Aasbjerg, Kristian; Hansen, S.; Ringgren, Kristian Bundgaard; Dahl, Mads Ronald; Rasmussen, Bodil Steen; Torp‐Pedersen, Christian; Søgaard, Peter; Kragholm, Kristian

doi:10.1136/bmjopen-2018-023049

Cited by 23 publications

(18 citation statements)

References 32 publications

(39 reference statements)

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“…In a Danish study on patients with dyspnoea, the 1-day mortality did not increase with a total transport time of > 30 min. However, for cerebrovascular conditions, a total at-the-scene time of > 60 min increased short-term mortality, suggesting faster transportation times in such cases [44]. A short at-the-scene time is essential for several conditions where definitive care is required in the hospital.…”

Section: Discussionmentioning

confidence: 99%

Pre-hospital triage performance and emergency medical services nurse’s field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study

Magnusson

Herlitz

Axelsson

2020

Scand J Trauma Resusc Emerg Med

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Background In Sweden, the rapid emergency triage and treatment system (RETTS-A) is used in the pre-hospital setting. With RETTS-A, patients triaged to the lowest level could safely be referred to a lower level of care. The national early warning score (NEWS) has also shown promising results internationally. However, a knowledge gap in optimal triage in the pre-hospital setting persists. This study aimed to evaluate RETTS-A performance, compare RETTS-A with NEWS and NEWS 2, and evaluate the emergency medical service (EMS) nurse’s field assessment with the physician’s final hospital diagnosis. Methods A prospective, observational study including patients (≥16 years old) transported to hospital by the Gothenburg EMS in 2016. Three comparisons were made: 1) Combined RETTS-A levels orange and red (high acuity) compared to a predefined reference emergency, 2) RETTS-A high acuity compared to NEWS and NEWS 2 score ≥ 5, and 3) Classification of pre-hospital nurse’s field assessment compared to hospital physician’s diagnosis. Outcomes of the time-sensitive conditions, mortality and hospitalisation were examined. The statistical tests included Mann–Whitney U test and Fisher’s exact test, and several binary classification tests were determined. Results Overall, 4465 patients were included (median age 69 years; 52% women). High acuity RETTS-A triage showed a sensitivity of 81% in prediction of the reference patient with a specificity of 64%. Sensitivity in detecting a time-sensitive condition was highest with RETTS-A (73%), compared with NEWS (37%) and NEWS 2 (35%), and specificity was highest with NEWS 2 (83%) when compared with RETTS-A (54%). The negative predictive value was higher in RETTS-A (94%) compared to NEWS (91%) and NEWS 2 (92%). Eleven per cent of the final diagnoses were classified as time-sensitive while the nurse’s field assessment was appropriate in 84% of these cases. Conclusions In the pre-hospital triage of EMS patients, RETTS-A showed sensitivity that was twice as high as that of both NEWS and NEWS 2 in detecting time-sensitive conditions, at the expense of lower specificity. However, the proportion of correctly classified low risk triaged patients (green/yellow) was higher in RETTS-A. The nurse’s field assessment of time-sensitive conditions was appropriate in the majority of cases.

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Section: Discussionmentioning

confidence: 99%

Pre-hospital triage performance and emergency medical services nurse’s field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study

Magnusson

Herlitz

Axelsson

2020

Scand J Trauma Resusc Emerg Med

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“…In addition, MacKenzie et al showed in their study that, especially for the younger, more severely injured patients, treatment at a TC is not only more effective but also cost-effective, which underlines the importance of bringing the severely injured to a TC [23]. Studies show that especially the most severely injured patients, with ISS ≥ 25, hemodynamically instable and patients with severe traumatic brain injury (AIS ≥ 3), benefit the most from proper hospital triage, demonstrating lower mortality rates for these patients when brought to a TC [24][25][26][27]. Reducing under-triage should therefore be given priority.…”

Section: Discussionmentioning

confidence: 99%

The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

Dijkink

Zwet

Krijnen

et al. 2021

Eur J Trauma Emerg Surg

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Background Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time. Methods All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008–2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS. Results The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63–74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC. Conclusion Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.

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“…Lansom and colleagues reported that prehospital intubation prolonged total prehospital time by 25 min, but shortened the time from arrival at the emergency department to the initiation of computed tomography imaging by 11 min [18]. In patients with heart disease, mortality was decreased to an adjusted odds ratio of 0.49-0.73 when total prehospital time was shortened [19]. Trauma mortality is decreased by shortening the scene time to < 50% of the total prehospital time [20].…”

Section: Discussionmentioning

confidence: 99%

Intubation during a medevac flight: safety and effect on total prehospital time in the helicopter emergency medical service system

Maeyama

Naito

Guyette

et al. 2020

Scand J Trauma Resusc Emerg Med

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Introduction The Helicopter Emergency Medical Service (HEMS) commonly intubates patients who require advanced airway support prior to takeoff. In-flight intubation (IFI) is avoided because it is considered difficult due to limited space, difficulty communicating, and vibration in flight. However, IFI may shorten the total prehospital time. We tested whether IFI can be performed safely by the HEMS. Methods We conducted a retrospective cohort study in adult patients transported from 2010 to 2017 who received prehospital, non-emergent intubation from a single HEMS. We divided the cohort in two groups, patients intubated during flight (flight group, FG) and patients intubated before takeoff (ground group, GG). The primary outcome was the proportion of successful intubations. Secondary outcomes included total prehospital time and the incidence of complications. Results We analyzed 376 patients transported during the study period, 192 patients in the FG and 184 patients in the GG. The intubation success rate did not differ between the two groups (FG 189/192 [98.4%] vs. GG 179/184 [97.3%], p = 0.50). There were also no differences in hypoxia (FG 4/117 [3.4%] vs. GG 4/95 [4.2%], p = 1.00) or hypotension (FG 6/117 [5.1%] vs. GG 5/95 [5.3%], p = 1.00) between the two groups. Scene time and total prehospital time were shorter in the FG (scene time 7 min vs. 14 min, p < 0.001; total prehospital time 33.5 min vs. 40.0 min, p < 0.001). Conclusions IFI was safely performed with high success rates, similar to intubation on the ground, without increasing the risk of hypoxia or hypotension. IFI by experienced providers shortened transportation time, which may improve patient outcomes.

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Prehospital time and mortality in patients requiring a highest priority emergency medical response: a Danish registry-based cohort study

Cited by 23 publications

References 32 publications

Pre-hospital triage performance and emergency medical services nurse’s field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study

Pre-hospital triage performance and emergency medical services nurse’s field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study

The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

Intubation during a medevac flight: safety and effect on total prehospital time in the helicopter emergency medical service system

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