Wolthers SA, Blomberg SNF, Breindahl N, Anjum S, Hägi-Pedersen D, Ersbøll A, Andersen LB, Christensen HC. Association between using a prehospital assessment unit and hospital admission and mortality: a matched cohort study.
BMJ Open 2023;
13:e075592. [PMID:
37739475 PMCID:
PMC10533654 DOI:
10.1136/bmjopen-2023-075592]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVES
This study aimed to compare hospital admission and 30-day mortality between patients assessed by the prehospital assessment unit (PAU) and patients not assessed by the PAU.
DESIGN
This was a matched cohort study.
SETTING
This study was conducted between November 2021 and October 2022 in Region Zealand, Denmark.
PARTICIPANTS
989 patients aged >18, assessed by the PAU, were identified, and 9860 patients not assessed by the PAU were selected from the emergency calls using exposure density sampling.
EXPOSURE
Patients assessed by the PAU. The PAU is operated by paramedics with access to point-of-care test facilities. The PAU is an alternative response vehicle without the capability of transporting patients.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome was hospital admission within 48 hours after the initial call. The key secondary outcomes were admission within 7 days, 30-day mortality and admission within 6 hours. Descriptive statistical analyses were conducted, and logistic regression models were used to estimate adjusted OR (aOR) and 95% CI.
RESULTS
Among the PAU assessed, 44.1% were admitted within 48 hours, compared with 72.9% of the non-PAU assessed, p<0.001. The multivariable analysis showed a lower risk of admission within 48 hours and 7 days among the PAU patients, aOR 0.31 (95% CI 0.26 to 0.38) and aOR 0.50 (95% CI 0.38 to 0.64), respectively. The 30-day mortality rate was 3.8% in the PAU-assessed patients vs 5.5% in the non-PAU-assessed patients, p=0.03. In the multivariable analysis, no significant difference was found in mortality aOR 0.99 (95% CI 0.71 to 1.42). No deaths were observed in PAU-assessed patients without subsequent follow-up.
CONCLUSION
The recently introduced PAU aims for patient-centred emergency care. The PAU-assessed patients had reduced admissions within 48 hours and 7 days after the initial call. Study findings indicate that the PAU is safe since we identified no significant differences in 30-day mortality.
TRIAL REGISTRATION NUMBER
NCT05654909.
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