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Martín-Rodríguez F, Sanz-García A, Castro-Portillo E, Delgado-Benito JF, Del Pozo Vegas C, Ortega Rabbione G, Martín-Herrero F, Martín-Conty JL, López-Izquierdo R. Prehospital troponin as a predictor of early clinical deterioration. Eur J Clin Invest 2021; 51:e13591. [PMID: 34002363 DOI: 10.1111/eci.13591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/01/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Elevated troponin T (cTnT) values are associated with comorbidities and early mortality, in both cardiovascular and noncardiovascular diseases. The objective of this study is to evaluate the prognostic accuracy of the sole utilization of prehospital point-of-care cardiac troponin T to identify the risk of early in-hospital deterioration, including mortality within 28 days. METHODS We conducted a prospective, multicentric, controlled, ambulance-based, observational study in adults with acute diseases transferred with high priority by ambulance to emergency departments, between 1 January and 30 September 2020. Patients with hospital diagnosis of acute coronary syndrome were excluded. The discriminative power of the predictive cTnT was assessed through a discrimination model trained using a derivation cohort and evaluated by the area under the curve of the receiver operating characteristic on a validation cohort. RESULTS A total of 848 patients were included in our study. The median age was 68 years (25th-75th percentiles: 50-81 years), and 385 (45.4%) were women. The mortality rate within 28 days was 12.4% (156 cases). The predictive ability of cTnT to predict mortality presented an area under the curve of 0.903 (95% CI: 0.85-0.954; P < .001). Risk stratification was performed, resulting in three categories with the following optimal cTnT cut-off points: high risk greater than or equal to 100, intermediate risk 40-100 and low risk less than 40 ng/L. In the high-risk group, the mortality rate was 61.7%, and on the contrary, the low-risk group presented a mortality of 2.3%. CONCLUSIONS The implementation of a routine determination of cTnT on the ambulance in patients transferred with high priority to the emergency department can help to stratify the risk of these patients and to detect unknown early clinical deterioration.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Advanced Life Support Unit, Gerencia de Emergencias Sanitarias, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain.,Advanced Clinical Simulation Center, Medicine Faculty, Valladolid University, Valladolid, Spain
| | - Ancor Sanz-García
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain
| | - Enrique Castro-Portillo
- Emergency Department, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Salamanca, Spain
| | - Juan F Delgado-Benito
- Advanced Life Support Unit, Gerencia de Emergencias Sanitarias, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Carlos Del Pozo Vegas
- Emergency Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Salamanca, Spain
| | - Guillermo Ortega Rabbione
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Francisco Martín-Herrero
- Department of Cardiology, Complejo Asistencial de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Salamanca, Spain
| | - José Luis Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Salamanca, Spain
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Alberdi-Iglesias A, Martín-Rodríguez F, Ortega Rabbione G, Rubio-Babiano AI, Núñez-Toste MG, Sanz-García A, del Pozo Vegas C, Castro Villamor MA, Martín-Conty JL, Jorge-Soto C, López-Izquierdo R. Role of SpO2/FiO2 Ratio and ROX Index in Predicting Early Invasive Mechanical Ventilation in COVID-19. A Pragmatic, Retrospective, Multi-Center Study. Biomedicines 2021; 9:biomedicines9081036. [PMID: 34440240 PMCID: PMC8392288 DOI: 10.3390/biomedicines9081036] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 12/21/2022] Open
Abstract
The ability of COVID-19 to compromise the respiratory system has generated a substantial proportion of critically ill patients in need of invasive mechanical ventilation (IMV). The objective of this paper was to analyze the prognostic ability of the pulse oximetry saturation/fraction of inspired oxygen ratio (SpO2/FiO2) and the ratio of SpO2/FiO2 to the respiratory rate–ROX index–as predictors of IMV in an emergency department in confirmed COVID-19 patients. A multicenter, retrospective cohort study was carried out in four provinces of Spain between March and November 2020. The discriminative power of the predictive variable was assessed through a prediction model trained using a derivation sub-cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC) on the validation sub-cohort. A total of 2040 patients were included in the study. The IMV rate was 10.1%, with an in-hospital mortality rate of 35.3%. The performance of the SpO2/FiO2 ratio was better than the ROX index–AUC = 0.801 (95% CI 0.746–0.855) and AUC = 0.725 (95% CI 0.652–0.798), respectively. In fact, a direct comparison between AUCs resulted in significant differences (p = 0.001). SpO2 to FiO2 ratio is a simple and promising non-invasive tool for predicting risk of IMV in patients infected with COVID-19, and it is realizable in emergency departments.
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Affiliation(s)
- Ana Alberdi-Iglesias
- Emergency Department, Valladolid University Clinical Hospital, Castilla y León Regional Health Management (SACYL), 47005 Valladolid, Spain; (A.A.-I.); (A.I.R.-B.); (M.G.N.-T.); (C.d.P.V.)
| | - Francisco Martín-Rodríguez
- Advanced Clinical Simulation Centre, Advanced Life Support Unit, Emergency Medical Services, Faculty of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain
- Correspondence: ; Tel.: +34-983-423-023
| | - Guillermo Ortega Rabbione
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), C/Diego de León, 62, 28006 Madrid, Spain; (G.O.R.); (A.S.-G.)
| | - Ana I. Rubio-Babiano
- Emergency Department, Valladolid University Clinical Hospital, Castilla y León Regional Health Management (SACYL), 47005 Valladolid, Spain; (A.A.-I.); (A.I.R.-B.); (M.G.N.-T.); (C.d.P.V.)
| | - María G. Núñez-Toste
- Emergency Department, Valladolid University Clinical Hospital, Castilla y León Regional Health Management (SACYL), 47005 Valladolid, Spain; (A.A.-I.); (A.I.R.-B.); (M.G.N.-T.); (C.d.P.V.)
| | - Ancor Sanz-García
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), C/Diego de León, 62, 28006 Madrid, Spain; (G.O.R.); (A.S.-G.)
| | - Carlos del Pozo Vegas
- Emergency Department, Valladolid University Clinical Hospital, Castilla y León Regional Health Management (SACYL), 47005 Valladolid, Spain; (A.A.-I.); (A.I.R.-B.); (M.G.N.-T.); (C.d.P.V.)
| | - Miguel A. Castro Villamor
- Centro de Simulación Clínica Avanzada, Facultad de Medicina, Universidad de Valladolid, 47005 Valladolid, Spain;
| | - José L. Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain;
| | - Cristina Jorge-Soto
- Grupo de Investigación CLINURSID, Facultad de Enfermería, Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), c/Dulzaina, 2, 47012 Valladolid, Spain;
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Martín-Rodríguez F, Sanz-García A, Alberdi Iglesias A, Ortega Rabbione G, Del Pozo Vegas C, de la Torre-Díez I, Fernández Bayón G, Delgado Benito JF, Gómez-Escolar Pérez M, García Cortés JJ, López-Izquierdo R. Mortality risk model for patients with suspected COVID-19 based on information available from an emergency dispatch center. Emergencias 2021; 33:265-272. [PMID: 34251139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To develop and validate a scale to stratify risk of 2-day mortality based on data collected during calls to an emergency dispatch center from patients with suspected coronavirus disease 2019 (COVID-19). MATERIAL AND METHODS Retrospective multicenter study of consecutive patients over the age of 18 years with suspected COVID-19 who were transported from home over the course of 3 months after telephone interviews with dispatchers. We analyzed clinical and epidemiologic variables and comorbidities in relation to death within 2 days of the call. Using data from the development cohort, we built a risk model by means of logistic regression analysis of categorical variables that were independently associated with 2-day mortality. The scale was validated first in a validation cohort in the same province and then in a cohort in a different province. RESULTS A total of 2320 patients were included. The mean age was 79 years, and 49.8% were women. The overall 2-day mortality rate was 22.6% (376 deaths of patients with severe acute respiratory syndrome coronavirus 2 infection). The model included the following factors: age, location (rural location as a protective factor), institutionalization, desaturation, lung sounds (rhonchi), and altered mental status. The area under the receiver operating characteristic curve for death within 2 days was 0.763 (95% CI, 0.725-0.802; P .001). Mortality in patients at high risk (more than 2.4 points on the scale) was 60%. CONCLUSION This risk scale derived from information available to an emergency dispatch center is applicable to patients with suspected COVID-19. It can stratify patients by risk of early death (within 2 days), possibly helping with decision making regarding whether to transport from home or what means of transport to use, and destination.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Gerencia de Emergencias Sanitarias, Gerencia Regional de Salud de Castilla y León (SACYL), España. Facultad de Medicina, Universidad de Valladolid, Valladolid, España
| | | | - Ana Alberdi Iglesias
- Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), España
| | | | - Carlos Del Pozo Vegas
- Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), España
| | - Isabel de la Torre-Díez
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad de Valladolid, Valladolid, España
| | - Germán Fernández Bayón
- Hospital de Medina del Campo, Gerencia Regional de Salud de Castilla y León (SACYL), España
| | | | | | | | - Raúl López-Izquierdo
- Hospital Universitario Río Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL)
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Martín-Rodríguez F, López-Izquierdo R, Portillo Rubiales RM, Fadrique Millán LN, Carbajosa Rodríguez V, Sanz-García A, Ortega Rabbione G, Polonio-López B, Villamor MÁC, Martín-Conty JL. Blood Biomarkers for Assessing Headaches in Healthcare Workers after Wearing Biological Personal Protective Equipment in a COVID-19 Field Hospital. J Pers Med 2021. [PMID: 33406767 DOI: 10.21203/rs.3.rs-55229/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) has led to a pandemic, which among other things, has highlighted biosafety as a key cornerstone in the management of disease transmission. The aim of this work was to analyze the role played by different blood biomarkers in predicting the appearance of headaches in healthcare workers wearing personal protective equipment (PPE) in a COVID-19 treatment unit. A prospective cohort study of 38 healthcare workers was performed during April 2020. Blood analysis, performed just before the start of a 4 hour shift, was carried out on all volunteers equipped with PPE. At the end of their shifts and after decontamination, they were asked if they had suffered from headache in order to obtain a binary outcome. The baseline creatinine value reflected a specific odds ratio of 241.36 (95% CI: 2.50-23,295.43; p = 0.019) and an area under the curve (AUC) value of 0.737 (95%CI: 0.57-0.90; p < 0.01). Blood creatinine is a good candidate for predicting the appearance of a de novo headache in healthcare workers after wearing PPE for four hours in a COVID-19 unit.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Advanced Clinical Simulation Centre, Faculty of Medicine, Universidad de Valladolid, Advanced Life Support Unit, Emergency Medical Services, 47005 Valladolid, Spain
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), c/ Dulzaina, 2, 47012 Valladolid, Spain
| | - Raquel M Portillo Rubiales
- C.S. de Tordesillas, Gerencia de Atención Primaria de Valladolid Oeste, Gerencia Regional de Salud de Castilla y León (SACYL), Crta. de Valladolid s/n, 47100 Tordesillas, Valladolid, Spain
| | - Laura N Fadrique Millán
- Emergency Department, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), c/ Dulzaina, 2, 47012 Valladolid, Spain
| | - Virginia Carbajosa Rodríguez
- Emergency Department, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), c/ Dulzaina, 2, 47012 Valladolid, Spain
| | - Ancor Sanz-García
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), C/ Diego de León 62, 28006 Madrid, Spain
| | - Guillermo Ortega Rabbione
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), C/ Diego de León 62, 28006 Madrid, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain
| | - Miguel Ángel Castro Villamor
- C.S. Delicias I Gerencia de Atención Primaria de Valladolid Oeste, Gerencia Regional de Salud de Castilla y León (SACYL), Pª Juan Carlos I, 18, 47013 Valladolid, Spain
| | - José L Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain
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Martín-Rodríguez F, López-Izquierdo R, Portillo Rubiales RM, Fadrique Millán LN, Carbajosa Rodríguez V, Sanz-García A, Ortega Rabbione G, Polonio-López B, Castro Villamor MÁ, Martín-Conty JL. Blood Biomarkers for Assessing Headaches in Healthcare Workers after Wearing Biological Personal Protective Equipment in a COVID-19 Field Hospital. J Pers Med 2021; 11:jpm11010027. [PMID: 33406767 PMCID: PMC7823801 DOI: 10.3390/jpm11010027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/22/2020] [Accepted: 12/30/2020] [Indexed: 01/10/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) has led to a pandemic, which among other things, has highlighted biosafety as a key cornerstone in the management of disease transmission. The aim of this work was to analyze the role played by different blood biomarkers in predicting the appearance of headaches in healthcare workers wearing personal protective equipment (PPE) in a COVID-19 treatment unit. A prospective cohort study of 38 healthcare workers was performed during April 2020. Blood analysis, performed just before the start of a 4 hour shift, was carried out on all volunteers equipped with PPE. At the end of their shifts and after decontamination, they were asked if they had suffered from headache in order to obtain a binary outcome. The baseline creatinine value reflected a specific odds ratio of 241.36 (95% CI: 2.50–23,295.43; p = 0.019) and an area under the curve (AUC) value of 0.737 (95%CI: 0.57–0.90; p < 0.01). Blood creatinine is a good candidate for predicting the appearance of a de novo headache in healthcare workers after wearing PPE for four hours in a COVID-19 unit.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Advanced Clinical Simulation Centre, Advanced Life Support Unit, Emergency Medical Services, Faculty of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain;
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), c/Dulzaina, 2, 47012 Valladolid, Spain; (L.N.F.M.); (V.C.R.)
- Correspondence: ; Tel.: +34-647946325
| | - Raquel M. Portillo Rubiales
- C.S. de Tordesillas, Gerencia de Atención Primaria de Valladolid Oeste, Gerencia Regional de Salud de Castilla y León (SACYL), Crta. de Valladolid s/n, 47100 Tordesillas, Valladolid, Spain;
| | - Laura N. Fadrique Millán
- Emergency Department, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), c/Dulzaina, 2, 47012 Valladolid, Spain; (L.N.F.M.); (V.C.R.)
| | - Virginia Carbajosa Rodríguez
- Emergency Department, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), c/Dulzaina, 2, 47012 Valladolid, Spain; (L.N.F.M.); (V.C.R.)
| | - Ancor Sanz-García
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), C/Diego de León, 62, 28006 Madrid, Spain; (A.S.-G.); (G.O.R.)
| | - Guillermo Ortega Rabbione
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), C/Diego de León, 62, 28006 Madrid, Spain; (A.S.-G.); (G.O.R.)
| | - Begoña Polonio-López
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain; (B.P.-L.); (J.L.M.-C.)
| | - Miguel Ángel Castro Villamor
- C.S. Delicias I Gerencia de Atención Primaria de Valladolid Oeste, Gerencia Regional de Salud de Castilla y León (SACYL), Pª Juan Carlos I, 18, 47013 Valladolid, Spain;
| | - José L. Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain; (B.P.-L.); (J.L.M.-C.)
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Martín-Rodríguez F, López-Izquierdo R, Medina-Lozano E, Ortega Rabbione G, Del Pozo Vegas C, Carbajosa Rodríguez V, Castro Villamor MÁ, Sánchez-Soberon I, Sanz-García A. Accuracy of prehospital point-of-care lactate in early in-hospital mortality. Eur J Clin Invest 2020; 50:e13341. [PMID: 32648960 DOI: 10.1111/eci.13341] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/21/2020] [Accepted: 07/05/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Emergency medical services (EMS) routinely face complex scenarios where decisions should be taken with limited clinical information. The development of fast, reliable and easy to perform warning biomarkers could help in such decision-making processes. The present study aims at characterizing the validity of point-of-care lactate (pLA) during prehospital tasks for predicting in-hospital mortality within two days after the EMS assistance. MATERIALS AND METHODS Prospective, multicentric, ambulance-based and controlled observational study without intervention, including six advanced life support and five hospitals. The pLA levels were recorded during EMS assistance of adult patients. The validity of pLA to determine the in-hospital mortality was assessed by the area under the curve (AUC) of the receiver operating curve (ROC). RESULTS A total of 2997 patients were considered in the study, with a median of 69 years (IQR 54-81) and 41.4% of women. The median pLA value was 2.7 mmol/L (1.9-3.8) in survivors and 5.7 mmol/L (4.4-7.6) in nonsurvivors. The global discrimination level of pLA reached an AUC of 0.867, being 1.9 mmol/L and 4 mmol/L the cut-off point for low and high mortality. The discrimination value of pLA was not affected by sex, age or pathology. CONCLUSIONS Our results highlight the clinical importance of prehospital pLA to determine the in-hospital risk of mortality. The incorporation of pLA into the EMS protocols could improve the early identification of risky patients, leading to a better care of such patients.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Advanced Clinical Simulation Center, School of Medicine, Valladolid University, Valladolid, Spain.,Emergency Medical Services-SACYL, Paseo Hospital Militar, Valladolid, Spain
| | - Raúl López-Izquierdo
- Advanced Clinical Simulation Center, School of Medicine, Valladolid University, Valladolid, Spain.,Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Elena Medina-Lozano
- Advanced Clinical Simulation Center, School of Medicine, Valladolid University, Valladolid, Spain
| | - Guillermo Ortega Rabbione
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa (IIS-IP), Madrid, Spain.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), CABA, Argentina
| | | | | | | | | | - Ancor Sanz-García
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa (IIS-IP), Madrid, Spain
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Martín-Rodríguez F, Sanz-García A, Medina-Lozano E, Castro Villamor MÁ, Carbajosa Rodríguez V, Del Pozo Vegas C, Fadrique Millán LN, Rabbione GO, Martín-Conty JL, López-Izquierdo R. The Value of Prehospital Early Warning Scores to Predict in - Hospital Clinical Deterioration: A Multicenter, Observational Base-Ambulance Study. PREHOSP EMERG CARE 2020; 25:597-606. [PMID: 32820947 DOI: 10.1080/10903127.2020.1813224] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Early warning scores are clinical tools capable of identifying prehospital patients with high risk of deterioration. We sought here to contrast the validity of seven early warning scores in the prehospital setting and specifically, to evaluate the predictive value of each score to determine early deterioration-risk during the hospital stay, including mortality at one, two, three and seven- days since the index event. Methods: A prospective multicenter observational based-ambulance study of patients treated by six advanced life support emergency services and transferred to five Spanish hospitals between October 1, 2018 and December 31, 2019. We collected demographic, clinical, and laboratory variables. Seven risk score were constructed based on the analysis of prehospital variables associated with death within one, two, three and seven days since the index event. The area under the receiver operating characteristics was used to determine the discriminant validity of each early warning score. Results: A total of 3,273 participants with acute diseases were accurately linked. The median age was 69 years (IQR, 54-81 years), 1,348 (41.1%) were females. The overall mortality rate for patients in the study cohort ranged from 3.5% for first-day mortality (114 cases), to 7% for seven-day mortality (228 cases). The scores with the best performances for one-day mortality were Vitalpac Early Warning Score with an area under the receiver operating characteristic (AUROC) of 0.873 (95% CI: 0.81-0.9), for two-day mortality, Triage Early Warning Score with an AUROC of 0.868 (95% CI: 0.83-0.9), for three and seven-days mortality the Modified Rapid Emergency Medicine Score with an AUROC of 0.857 (0.82-0.89) and 0.833 (95% CI: 0.8-0.86). In general, there were no significant differences between the scores analyzed. Conclusions: All the analyzed scores have a good predictive capacity for early mortality, and no statistically significant differences between them were found. The National Early Warning Score 2, at the clinical level, has certain advantages. Early warning scores are clinical tools that can help in the complex decision-making processes during critical moments, so their use should be generalized in all emergency medical services.
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Martín-Rodríguez F, Sanz-García A, Ortega Moreno L, Del Pozo Vegas C, Castro-Villamor MA, Martín-Conty JL, López-Izquierdo R, Ortega Rabbione G. Risk for early death in acutely ill older adults attended by prehospital emergency medical services. Emergencias 2020; 32:177-184. [PMID: 32395925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To develop and validate a prehospital risk model to predict early in-hospital mortality (#48 hours) in patients aged 65 years or older. MATERIAL AND METHODS Prospective multicenter observational study in a cohort of patients aged 65 years or older attended by advanced life support emergency services and transferred to 5 Spanish hospitals between April 2018 and July 2019. We collected demographic, clinical and laboratory variables. A risk score was constructed and validated based on the analysis of prehospital variables associated with death within 48 hours. Predictors were selected by logistic regression. RESULTS A total of 1759 patients were recruited. The median age was 79 years (interquartile range, 72-85 years), and 766 (43.5%) were women. One hundred eight patients (6.1%) died within 48 hours. Predictors in the Prehospital Older Adults Warning Scale (POAWS) were age, systolic blood pressure, temperature, the ratio of oxygen saturation to the fraction of inspired oxygen, score on the Glasgow coma scale, and lactic acid concentration in venous blood. The area under the receiver operating characteristic curve of the model to predict early mortality was 0.853 (95% CI, 0.80-0.91; P<.001). Mortality in patients at high risk (POAWS score, >7) was 69%. CONCLUSION The prehospital POAWS score can be used to stratify risk for death within 48 hours in patients aged 65 years or older.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Centro de Simulación Clínica Avanzada, Facultad de Medicina, Universidad de Valladolid, Valladolid, España. Unidad Móvil de Emergencias, Gerencia de Emergencias Sanitarias de Castilla y León (SACYL), Valladolid, España
| | - Ancor Sanz-García
- Unidad de Análisis de Datos (UAD) del Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, España
| | - Lorena Ortega Moreno
- Unidad de Enfermedad Inflamatoria Intestinal del Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, España. Departamento de Medicina, Universidad Autónoma de Madrid, España
| | | | - Miguel A Castro-Villamor
- Centro de Simulación Clínica Avanzada, Facultad de Medicina, Universidad de Valladolid, Valladolid, España
| | | | - Raúl López-Izquierdo
- Centro de Simulación Clínica Avanzada, Facultad de Medicina, Universidad de Valladolid, Valladolid, España. Servicio de Urgencias, Hospital Universitario Río Hortega (SACYL), Valladolid, España
| | - Guillermo Ortega Rabbione
- Unidad de Análisis de Datos (UAD) del Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, España
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