Reliability of prehospital patient classification in helicopter emergency medical service missions

Heino, Anssi; Laukkanen-Nevala, Päivi; Raatiniemi, Lasse; Tommila, Miretta; Nurmi, Jouni; Olkinuora, Anna; Virkkunen, Ilkka; Iirola, Timo

doi:10.1186/s12873-020-00338-7

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…Our study has several limitations. Firstly, this retrospective registry study increases susceptibility to different biases, as reporting airway management is prone to subjective factors, the database is unvalidated, and no external referee is used during pre-hospital care [ 39 ]. Secondly, when studying a HEMS intervention in a pre-hospital setting, several confounding factors are challenging to take in to account for the statistical analysis.…”

Section: Discussionmentioning

confidence: 99%

Intubation first-pass success in a high performing pre-hospital critical care system is not associated with 30-day mortality: a registry study of 4496 intubation attempts

Ljungqvist

Pirneskoski

Saviluoto

et al. 2022

Scand J Trauma Resusc Emerg Med

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Background Lower intubation first-pass success (FPS) rate is associated with physiological deterioration, and FPS is widely used as a quality indicator of the airway management of a critically ill patient. However, data on FPS’s association with survival is limited. We aimed to investigate if the FPS rate is associated with 30-day mortality or physiological complications in a pre-hospital setting. Furthermore, we wanted to describe the FPS rate in Finnish helicopter emergency medical services. Methods This was a retrospective observational study. Data on drug-facilitated intubation attempts by helicopter emergency medical services were gathered from a national database and analysed. Multivariate logistic regression, including known prognostic factors, was performed to assess the association between FPS and 30-day mortality, collected from population registry data. Results Of 4496 intubation attempts, 4082 (91%) succeeded on the first attempt. The mortality rates in FPS and non-FPS patients were 34% and 38% (P = 0.21), respectively. The adjusted odds ratio of FPS for 30-day mortality was 0.88 (95% CI 0.66–1.16). Hypoxia after intubation and at the time of handover was more frequent in the non-FPS group (12% vs. 5%, P < 0.001, and 5% vs. 3%, P = 0.01, respectively), but no significant differences were observed regarding other complications. Conclusion FPS is not associated with 30-day mortality in pre-hospital critical care delivered by advanced providers. It should therefore be seen more as a process quality indicator instead of a risk factor of poor outcome, at least considering the current limitations of the parameter.

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Section: Discussionmentioning

confidence: 99%

Intubation first-pass success in a high performing pre-hospital critical care system is not associated with 30-day mortality: a registry study of 4496 intubation attempts

Ljungqvist

Pirneskoski

Saviluoto

et al. 2022

Scand J Trauma Resusc Emerg Med

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“…Distinction between symptom and disease diagnosis in referrals must be interpreted with caution. In a prehospital setting in helicopter medical services in Finland, ICPC-2 coding was tested for inter-rater reliability for six written fictional cases [ 23 ]. The researchers found an overall agreement of only 52%.…”

Section: Discussionmentioning

confidence: 99%

Reasons for acute referrals to hospital from general practitioners and out-of-hours doctors in Norway: a registry-based observational study

Blinkenberg

Hetlevik

Sandvik

et al. 2022

BMC Health Serv Res

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Background General practitioners (GPs) and out-of-hours (OOH) doctors are gatekeepers to acute hospital admissions in many healthcare systems. The aim of the present study was to investigate the whole range of reasons for acute referrals to somatic hospitals from GPs and OOH doctors and referral rates for the most common reasons. We wanted to explore the relationship between some common referral diagnoses and the discharge diagnosis, and associations with patient’s gender, age, and GP or OOH doctor referral. Methods A registry-based study was performed by linking national data from primary care in the physicians’ claims database with hospital services data in the Norwegian Patient Registry (NPR). The referring GP or OOH doctor was defined as the physician who had sent a claim for the patient within 24 h prior to an acute hospital stay. The reason for referral was defined as the ICPC-2 diagnosis used in the claim; the discharge diagnoses (ICD-10) came from NPR. Results Of all 265,518 acute hospital referrals from GPs or OOH doctors in 2017, GPs accounted for 43% and OOH doctors 57%. The overall referral rate per contact was 0.01 from GPs and 0.11 from OOH doctors, with large variations by referral diagnosis. Abdominal pain (D01) (8%) and chest pain (A11) (5%) were the most frequent referral diagnoses. For abdominal pain and chest pain referrals the most frequent discharge diagnosis was the corresponding ICD-10 symptom diagnosis, whereas for pneumonia-, appendicitis-, acute myocardial infarction- and stroke referrals the corresponding disease diagnosis was most frequent. Women referred with chest pain were less likely to be discharged with ischemic heart disease than men. Conclusions The reasons for acute referral to somatic hospitals from GPs and OOH doctors comprise a wide range of reasons, and the referral rates vary according to the severity of the condition and the different nature between GP and OOH services. Referral rates for OOH contacts were much higher than for GP contacts. Patient age, gender and referring service influence the relationship between referral and discharge diagnosis.

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“…By this, the EBS aims to evaluate the true benefit of EMS for single patients. In contrast, other scores and classifications used in prehospital settings, such as the American Society of Anesthesiologists Physical Status Classification System (ASA-PS) or NACA [ 5 , 6 , 9 ], describe patient background characteristics and acute clinical status. However, these scores do not evaluate the influence of prehospital care and were not originally built or implemented for prehospital use, so their reliability in prehospital settings is questionable [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the everyday use of the HBS in Finnish HEMS for over two decades, its validity has not been studied at all, and reliability has been studied only recently [ 5 , 6 ]. According to study results, the HBS’s inter-rater reliability was noticed to vary from poor to substantial or almost perfect, and mean difference between raters and reference values were substantial [ 5 , 6 ]. As the scoring is guided by exemplar interventions, it can be argued, that the reliability could be improved by more detailed and comprehensive examples.…”

Section: Introductionmentioning

confidence: 99%

The development of emergency medical services benefit score: a European Delphi study

Heino

Raatiniemi

Iirola

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background The helicopter emergency services (HEMS) Benefit Score (HBS) is a nine-level scoring system developed to evaluate the benefits of HEMS missions. The HBS has been in clinical use for two decades in its original form. Advances in prehospital care, however, have produced demand for a revision of the HBS. Therefore, we developed the emergency medical services (EMS) Benefit Score (EBS) based on the former HBS. As reflected by its name, the aim of the EBS is to measure the benefits produced by the whole EMS systems to patients. Methods This is a four-round, web-based, international Delphi consensus study with a consensus definition made by experts from seven countries. Participants reviewed items of the revised HBS on a 5-point Likert scale. A content validity index (CVI) was calculated, and agreement was defined as a 70% CVI. Study included experts from seven European countries. Of these, 18 were prehospital expert panellists and 11 were in-hospital commentary board members. Results The first Delphi round resulted in 1248 intervention examples divided into ten diagnostic categories. After removing overlapping examples, 413 interventions were included in the second Delphi round, which resulted in 38 examples divided into HBS categories 3–8. In the third Delphi round, these resulted in 37 prehospital interventions, examples of which were given revised version of the score. In the fourth and final Delphi round, the expert panel was given an opportunity to accept or comment on the revised scoring system. Conclusions The former HBS was revised by a Delphi methodology and EBS developed to represent its structural purpose better. The EBS includes 37 exemplar prehospital interventions to guide its clinical use. Trial registration The study permission was requested and granted by Turku University Hospital (decision number TP2/010/18).

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Reliability of prehospital patient classification in helicopter emergency medical service missions

Cited by 4 publications

References 14 publications

Intubation first-pass success in a high performing pre-hospital critical care system is not associated with 30-day mortality: a registry study of 4496 intubation attempts

Intubation first-pass success in a high performing pre-hospital critical care system is not associated with 30-day mortality: a registry study of 4496 intubation attempts

Reasons for acute referrals to hospital from general practitioners and out-of-hours doctors in Norway: a registry-based observational study

The development of emergency medical services benefit score: a European Delphi study

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