Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study

Magnusson, Carl; Herlitz, Johan; Karlsson, Thomas; Axelsson, Christer

doi:10.1186/s13049-018-0560-8

Cited by 11 publications

(14 citation statements)

References 52 publications

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“…In the present study, RETTS had a sensitivity of 28% and a specificity 95% in cohort A and a sensitivity of 57% and specificity of 51% among infected patients in cohort B. A study of RETTS' association with the final hospital diagnosis in children demonstrated sepsis to be the most frequent inappropriately classified, time-dependant condition [22].…”

Section: Discussionmentioning

confidence: 42%

Scores for sepsis detection and risk stratification – construction of a novel score using a statistical approach and validation of RETTS

et al. 2020

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BackgroundTo allow early identification of patients at risk of sepsis in the emergency department (ED), a variety of risk stratification scores and/or triage systems are used. The first aim of this study was to develop a risk stratification score for sepsis based upon vital signs and biomarkers using a statistical approach. Second, we aimed to validate the Rapid Emergency Triage and Treatment System (RETTS) for sepsis. RETTS combines vital signs with symptoms for risk stratification. MethodsWe retrospectively analysed data from two prospective, observational, multicentre cohorts of patients from studies of biomarkers in ED. A candidate risk stratification score called Sepsis Heparin-binding protein-based Early Warning Score (SHEWS) was constructed using the Least Absolute Shrinkage and Selector Operator (LASSO) method. SHEWS and RETTS were compared to National Early Warning Score 2 (NEWS2) for infection-related organ dysfunction, intensive care or death within the first 72h after admission (i.e. sepsis). Results506 patients with a diagnosed infection constituted cohort A, in which SHEWS was derived and RETTS was validated. 435 patients constituted cohort B of whom 184 had a diagnosed infection where both scores were validated. In both cohorts (A and B), AUC for infectionrelated organ dysfunction, intensive care or death was higher for NEWS2, 0.80 (95% CI 0.76-0.84) and 0.69 (95% CI 0.63-0.74), than RETTS, 0.74 (95% CI 0.70-0.79) and 0.55 (95% CI 0.49-0.60), p = 0.05 and p <0.01, respectively. SHEWS had the highest AUC, 0.73 (95% CI 0.68-0.79) p = 0.32 in cohort B. Citation: Mellhammar L, Linder A, Tverring J, Christensson B, Boyd JH, Åkesson P, et al. (2020) Scores for sepsis detection and risk stratificationconstruction of a novel score using a statistical approach and validation of RETTS. PLoS ONE 15 (2): e0229210. https://doi.org/10. ConclusionsEven with a statistical approach, we could not construct better risk stratification scores for sepsis than NEWS2. RETTS was inferior to NEWS2 for screening for sepsis.

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Section: Discussionmentioning

confidence: 42%

Scores for sepsis detection and risk stratification – construction of a novel score using a statistical approach and validation of RETTS

et al. 2020

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“…Adherence to guidelines in the context of EMS has been shown to be moderate. With adherence to clinical guidelines between 8 and 95%, among which monitoring recommendations are obeyed more frequently than treatment recommendations [36,37]. The adherence issues could relate to the formats of the guidelines, which make them difficult to use in a prehospital setting [24,36].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of non-conveyed patients in emergency medical services (EMS): a one-year prospective descriptive and comparative study in a region of Sweden

et al. 2020

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Background There has been an increasing demand for emergency medical services (EMS), and a growing number of patients are not conveyed; i.e., they are referred to levels of care other than ambulance conveyance to the emergency department. Patient safety issues have been raised regarding the ability of EMS to decide not to convey patients. To improve non-conveyance guidelines, information is needed about patients who are not conveyed by EMS. Therefore, the purpose of this study was to describe and compare the proportion and characteristics of non-conveyed EMS patients, together with assignment data. Methods A descriptive and comparative consecutive cohort design was undertaken. The decision of whether to convey patients was made by EMS according to a region-specific non-conveyance guideline. Non-conveyed patients’ medical record data were prospectively gathered from February 2016 to January 2017. Analyses was conducted using the chi-squared test, two-sample t test, proportion test and Mann-Whitneys U-test. Results Out of the 23,250 patients served during the study period, 2691 (12%) were not conveyed. For non-conveyed adults, the most commonly used Emergency Signs and Symptoms (ESS) codes were unspecific symptoms/malaise, abdomen/flank/groin pain, and breathing difficulties. For non-conveyed children, the most common ESS codes were breathing difficulties and fever of unclear origin. Most of the non-conveyed patients had normal vital signs. Half of all patients with a designated non-conveyance level of care were referred to self-care. There were statistically significant differences between men and women. Conclusions Fewer patients were non-conveyed in the studied region compared to national and international non-conveyance rates. The differences seen between men and women were not of clinical significance. Follow-up studies are needed to understand what effect patient outcome so that guidelines might improve.

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“…Thus, it is vital to encourage EMS providers to comprehensively examine the infant regardless of the possibly transient symptoms described by the caregivers. Indeed, even though EMS personnel did study vital signs more often than in the previously reported studies [ 13 , 24 , 33 ]; only heart rate, temperature and peripheral oxygen saturation reached over 50% coverage.…”

Section: Discussionmentioning

confidence: 78%

“…The complaints leading to EMS contacts were different in infants, as compared to those reported in the overall pediatric population [ 15 , 24 ]. Whereas dyspnea is among the leading causes for EMS contacts in children overall, infants had additional frequent EMS contacts due to choking.…”

Section: Discussionmentioning

confidence: 99%

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Why do infants need out-of-hospital emergency medical services? A retrospective, population-based study

Oulasvirta

Harve‐Rytsälä

Lääperi

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background The challenges encountered in emergency medical services (EMS) contacts with children are likely most pronounced in infants, but little is known about their out-of-hospital care. Our primary aim was to describe the characteristics of EMS contacts with infants. The secondary aims were to examine the symptom-based dispatch system for nonverbal infants, and to observe the association of unfavorable patient outcomes with patient and EMS mission characteristics. Methods In a population-based 5-year retrospective cohort of all 1712 EMS responses for infants (age < 1 year) in Helsinki, Finland (population 643,000, < 1-year old population 6548), we studied 1) the characteristics of EMS missions with infants; 2) mortality within 12 months; 3) pediatric intensive care unit (PICU) admissions; 4) medical state of the infant upon presentation to the emergency department (ED); 5) any medication or respiratory support given at the ED; 6) hospitalization; and 7) surgical procedures during the same hospital visit. Results 1712 infants with a median age of 6.7 months were encountered, comprising 0.4% of all EMS missions. The most common complaints were dyspnea, low-energy falls, and choking. Two infants died on-scene. The EMS transported 683 (39.9%) infants. One (0.1%) infant died during the 12-month follow-up period. Ninety-one infants had abnormal clinical examination upon arrival at the ED. PICU admissions (n = 28) were associated with young age (P < 0.01), a history of prematurity or problems in the neonatal period (P = 0.01), and previous EMS contacts within 72 h (P = 0.04). The adult-derived dispatch codes did not associate with the final diagnoses of the infants. Conclusions Infants form a small but distinct group in pediatric EMS care, with specific characteristics differing from the overall pediatric population. Many EMS contacts with infants were nonurgent or medically unjustified, possibly reflecting an unmet need for other family services. The use of adult-derived symptom codes for dispatching is not optimal for infants. Unfavorable patient outcomes were rare. Risk factors for such outcomes include quickly renewed contacts, young age and health problems in the neonatal period.

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Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study

Cited by 11 publications

References 52 publications

Scores for sepsis detection and risk stratification – construction of a novel score using a statistical approach and validation of RETTS

Scores for sepsis detection and risk stratification – construction of a novel score using a statistical approach and validation of RETTS

Characteristics of non-conveyed patients in emergency medical services (EMS): a one-year prospective descriptive and comparative study in a region of Sweden

Why do infants need out-of-hospital emergency medical services? A retrospective, population-based study

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