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Prevalence of clinical deterioration in the pre-hospital setting

Emma Bourke-Matas1,2, Tan Doan2,3, Kelly-Ann Bowles1

  • 1Department of Paramedicine, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia.

Emergency Medicine Australasia : EMA
|October 25, 2024
PubMed

Insights

Pre-hospital clinical deterioration and adverse events (AEs) were found to be low. However, nearly half of patients with AEs did not meet early warning score thresholds, indicating a need for better detection methods.

Area of Science:

  • Emergency Medicine
  • Pre-hospital Care
  • Patient Safety

Background:

  • Early recognition of patient deterioration in pre-hospital settings is crucial for timely intervention.
  • Undetected deterioration can lead to profound negative outcomes.
  • Understanding the prevalence of pre-hospital clinical deterioration is essential.

Purpose of the Study:

  • To investigate the prevalence of pre-hospital clinical deterioration.
  • To determine the incidence of adverse events (AEs) within three days of pre-hospital care.
  • To identify patient characteristics associated with AEs.

Main Methods:

  • Retrospective cohort study of adult patients attended by Queensland Ambulance Service (2018-2020).
  • Utilized early warning scores (NEWS, MEWS, Q-ADDS) to identify clinical deterioration from vital signs.
  • Linked hospital data to identify adverse events.

Main Results:

  • Pre-hospital clinical deterioration observed in 2.7%-4% of patients.
  • Prevalence of adverse events (AEs) was 3.2%.
  • Nearly 50% of patients experiencing AEs did not meet established early warning score thresholds.

Conclusions:

  • The prevalence of pre-hospital clinical deterioration and subsequent AEs is low.
  • Standardized criteria are needed for defining pre-hospital clinical deterioration.
  • Further research should evaluate the performance of early warning scores in this setting.
Abstract

Keywords:
adverse eventclinical deteriorationearly warning scoreout‐of‐hospitalpre‐hospital

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