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, Carl; Herlitz, Johan; Axelsson, Christer

doi:10.1186/s13049-020-00766-1

Cited by 23 publications

(27 citation statements)

References 52 publications

(60 reference statements)

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“…These findings agree with those of Rawshani et al who concluded that EMDs without a professional medical background had a higher consumption of pre-hospital resources [ 12 ]. The reported distribution of dispatched priority varied in previous Swedish studies [ 23 , 29 , 30 ], and the current study shows the same pattern for EMD as reported recently [ 26 ].…”

Section: Discussionsupporting

confidence: 86%

“…Hence, calling a dispatch decision “correct” or not is not entirely appropriate, because the true condition of the patient is not known at the time of the call. Furthermore, the performance of the reference standard, RETTS, in predicting high acuity patients as Red or Orange in the pre-hospital setting has been found as being over 80%, with a lower sensitivity in elderly, and a corresponding 64% specificity [ 26 ]. Although, as the same reference was used for both groups, it will not impact on the results.…”

Section: Discussionmentioning

confidence: 99%

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A registry-based observational study comparing emergency calls assessed by emergency medical dispatchers with and without support by registered nurses

Wennlund

Kurland

Olanders

et al. 2022

Scand J Trauma Resusc Emerg Med

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Background The requirement concerning formal education for emergency medical dispatcher (EMD) is debated and varies, both nationally and internationally. There are few studies on the outcomes of emergency medical dispatching in relation to professional background. This study aimed to compare calls handled by an EMD with and without support by a registered nurse (RN), with respect to priority level, accuracy, and medical condition. Methods A retrospective observational study, performed on registry data from specific regions during 2015. The ambulance personnel’s first assessment of the priority level and medical condition was used as the reference standard. Outcomes were: the proportion of calls dispatched with a priority in concordance with the ambulance personnel’s assessment; over- and undertriage; the proportion of most adverse over- and undertriage; sensitivity, specificity and predictive values for each of the ambulance priorities; proportion of calls dispatched with a medical condition in concordance with the ambulance personnel’s assessment. Proportions were reported with 95% confidence intervals. χ2-test was used for comparisons. P-levels < 0.05 were regarded as significant. Results A total of 25,025 calls were included (EMD n = 23,723, EMD + RN n = 1302). Analyses relating to priority and medical condition were performed on 23,503 and 21,881 calls, respectively. A dispatched priority in concordance with the ambulance personnel’s assessment were: EMD n = 11,319 (50.7%) and EMD + RN n = 481 (41.5%) (p < 0.01). The proportion of overtriage was equal for both groups: EMD n = 5904, EMD + RN n = 306, (26.4%) p = 0.25). The proportion of undertriage for each group was: EMD n = 5122 (22.9%) and EMD + RN n = 371 (32.0%) (p < 0.01). Sensitivity for the most urgent priority was 54.6% for EMD, compared to 29.6% for EMD + RN (p < 0.01), and specificity was 67.3% and 84.8% (p < 0.01) respectively. A dispatched medical condition in concordance with the ambulance personnel’s assessment were: EMD n = 13,785 (66.4%) and EMD + RN n = 697 (62.2%) (p = 0.01). Conclusions A higher precision of emergency medical dispatching was not observed when the EMD was supported by an RN. How patient safety is affected by the observed divergence in dispatched priorities is an area for future research.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

A registry-based observational study comparing emergency calls assessed by emergency medical dispatchers with and without support by registered nurses

Wennlund

Kurland

Olanders

et al. 2022

Scand J Trauma Resusc Emerg Med

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“…In this study, critically ill patients were defined according to the RETTS, which is the system that was used for risk assessment in most EDs in Sweden at the time of patient inclusion. In the prehospital setting, the system has been associated with both over- and undertriage [ 32 ]. However, among patients aged > 65 years, specificity is increasing at the expense of decreasing sensitivity [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors of short- and long-term mortality in critically ill, older adults admitted to the emergency department: an observational study

et al. 2022

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Background In the future, we can expect an increase in older patients in emergency departments (ED) and acute wards. The main purpose of this study was to identify predictors of short- and long-term mortality in the ED and at hospital discharge. Methods This is a retrospective, observational, single-center, cohort study, involving critically ill older adults, recruited consecutively in an ED. The primary outcome was mortality. All patients were followed for 6.5–7.5 years. The Cox proportional hazards model was used. Results Regarding all critically ill patients aged ≥ 70 years and identified in the ED (n = 402), there was a significant association between mortality at 30 days after ED admission and unconsciousness on admission (HR 3.14, 95% CI 2.09–4.74), hypoxia on admission (HR 2.51, 95% CI 1.69–3.74) and age (HR 1.06 per year, 95% CI 1.03–1.09), (all p < 0.001). Of 402 critically ill patients aged ≥ 70 years and identified in the ED, 303 were discharged alive from hospital. There was a significant association between long-term mortality and the Charlson Comorbidity Index (CCI) > 2 (HR 1.90, 95% CI 1.46–2.48), length of stay (LOS) > 7 days (HR 1.72, 95% CI 1.32–2.23), discharge diagnosis of pneumonia (HR 1.65, 95% CI 1.24–2.21) and age (HR 1.08 per year, 95% CI 1.05–1.10), (all p < 0.001). The only symptom or vital sign associated with long-term mortality was hypoxia on admission (HR 1.70, 05% CI 1.30–2.22). Conclusions Among critically ill older adults admitted to an ED and discharged alive the following factors were predictive of long-term mortality: CCI > 2, LOS > 7 days, hypoxia on admission, discharge diagnosis of pneumonia and age. The following factors were predictive of mortality at 30 days after ED admission: unconsciousness on admission, hypoxia and age. These data might be clinically relevant when it comes to individualized care planning, which should take account of risk prediction and estimated prognosis.

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“…Of the 15 included studies, 8 were conducted in the ED (27)(28)(29)(30)(31)(32)(33)(34), and 7 in the prehospital setting (11,(35)(36)(37)(38)(39)(40). Nine studies were prospective cohort (28, 30-34, 36-38), ve were retrospective cohort (11,27,29,35,39), and one study followed a pragmatic clinical trial design (40). In the ED setting, all studies except one examined the use of MEWS (34), with two reporting on NEWS (29,34).…”

Section: Characteristics Of Articles Includedmentioning

confidence: 99%

The use of Early Warning System Scores in Pre-Hospital and Emergency Department Settings to Predict Clinical Deterioration: s Systematic Review and Meta-Analysis

Guan

Lee

Begg

et al. 2021

Preprint

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Background: It is unclear which Early Warning System (EWS) score best predicts in-hospital deterioration when applied in the emergency department (ED) or pre-hospital setting. Methods: This systematic review and meta-analysis assessed the predictive abilities of five commonly used EWS scores: National Early Warning Score (NEWS) and its updated version NEWS2, Modified Early Warning Score (MEWS), Rapid Acute Physiological Score (RAPS) and Cardiac Arrest Risk Triage (CART). Outcomes of interest included admission to ICU, up-to-≥3-day and 30-day mortality. Pooled estimates were calculated using DerSimonian and Laird random-effects models, constructed by type of EWS score, cut-off points, outcomes, and study setting. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-regressions investigated between study heterogeneity. Funnel plots tested for publication bias. Results: A total of 11,565 articles was identified, of which 15 were included. Eight and seven articles conducted in the ED and pre-hospital settings, respectively. In the ED, MEWS and NEWS at cut-off points of 3, 4, or 6 had similar pooled diagnostic odds ratios (DOR) to predict 30-day mortality, ranging from 4.05 (Confidence Interval (CI) 2.35–6.99) to 6.48 (95% CI 1.83–22.89), p = 0.757. The ability of MEWS (cut-off point ≥ 3) to predict ICU admission had a similar pooled DOR of 5.54 (95% CI 2.02–15.21). In the pre-hospital setting, EWS scores failed to predict 30-day mortality. Using high cut-off points of 5, 7, or 9, their predictability improved when assessing up-to-≥3-day mortality with DOR ranging from 11.60 (95%, CI 9.75–13.88) to 20.37 (95% CI 13.16–31.52).Publication bias was not detected. Participants’ age explained 92% of between-study variance. Conclusion: EWS scores’ predictability of clinical deterioration improves when applied on patient populations that are already in the ED or hospital. The high thresholds used and the scores’ failure to predict 30-day mortality make them less suited for use in the pre-hospital setting.

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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

Cited by 23 publications

References 52 publications

A registry-based observational study comparing emergency calls assessed by emergency medical dispatchers with and without support by registered nurses

A registry-based observational study comparing emergency calls assessed by emergency medical dispatchers with and without support by registered nurses

Predictors of short- and long-term mortality in critically ill, older adults admitted to the emergency department: an observational study

The use of Early Warning System Scores in Pre-Hospital and Emergency Department Settings to Predict Clinical Deterioration: s Systematic Review and Meta-Analysis

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