Abstract
ObjectivesThe prehospital research field has focused on studying patient survival in cardiac arrest, as well as acute coronary syndrome, stroke, and trauma. There is little known about the overall short-term mortality and its predictability in unselected prehospital patients. This study examines whether a prehospital National Early Warning Score (NEWS) predicts 1-day and 30-day mortalities.MethodsData from all emergency medical service (EMS) situations were coupled to the mortality data obtained from the Causes of Death Registry during a six-month period in Northern Finland. NEWS values were calculated from first clinical parameters obtained on the scene and patients were categorized to the low, medium and high-risk groups accordingly. Sensitivities, specificities, positive predictive values (PPVs), negative predictive values (NPVs), and likelihood ratios (PLRs and NLRs) were calculated for 1-day and 30-day mortalities at the cut-off risks.ResultsA total of 12,426 EMS calls were included in the study. The overall 1-day and 30-day mortalities were 1.5 and 4.3%, respectively. The 1-day mortality rate for NEWS values ≤12 was lower than 7% and for values ≥13 higher than 20%. The high-risk NEWS group had sensitivities for 1-day and 30-day mortalities 0.801 (CI 0.74–0.86) and 0.42 (CI 0.38–0.47), respectively.ConclusionIn prehospital environment, the high risk NEWS category was associated with 1-day mortality well above that of the medium and low risk NEWS categories. This effect was not as noticeable for 30-day mortality. The prehospital NEWS may be useful tool for recognising patients at early risk of death, allowing earlier interventions and responds to these patients.
Highlights
Prompt emergency identification and correct risk assessment are corner stones of a successful emergency medical service (EMS) system
The EMS responded to a total of 16,177 missions during the study period
In 303 cases (1.9%), the unique personal identification number was lacking and a link to follow-up data was not available. After excluding these and the other emergencies fulfilling the exclusion criteria, 12,426 missions representing 7620 individual patients were included in the final analysis
Summary
Prompt emergency identification and correct risk assessment are corner stones of a successful emergency medical service (EMS) system. [1] While the use of early warning scores (EWS) has been shown to be feasible for predicting mortality and deterioration of hospitalized patients [2], it is unclear whether the use of early warning scores in the prehospital setting is. The use of NEWS in prehospital setting may facilitate earlier identification. The prehospital NEWS was shown to predict 48-h mortality. This study aimed to examine the accuracy of the prehospitally implemented NEWS in predicting 1-day and 30-day mortalities in an unselected EMS population. A secondary aim was to describe the causes of death in this prehospital patient population
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have