Clinical Predictors of Mortality in Prehospital Distress Calls by Emergency Medical Service Subscribers

(1) Introduction: Most studies rely on in-hospital data to predict cardiovascular risk and do not include prehospital information that is substantially important for early decision making. The aim of the study was to define clinical parameters in the prehospital setting, which may affect clinical ou...

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Autores principales:	Gabby Elbaz-Greener, Shemy Carasso, Elad Maor, Lior Gallimidi, Merav Yarkoni, Harindra C. Wijeysundera, Yitzhak Abend, Yinon Dagan, Amir Lerman, Offer Amir
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	prehospital mortality octogenarians hypertension paradox outcome Medicine R
Acceso en línea:	https://doaj.org/article/81554116e7f64650ac9f241542bd4842
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spelling	oai:doaj.org-article:81554116e7f64650ac9f241542bd48422021-11-25T18:02:02ZClinical Predictors of Mortality in Prehospital Distress Calls by Emergency Medical Service Subscribers10.3390/jcm102253552077-0383https://doaj.org/article/81554116e7f64650ac9f241542bd48422021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5355https://doaj.org/toc/2077-0383(1) Introduction: Most studies rely on in-hospital data to predict cardiovascular risk and do not include prehospital information that is substantially important for early decision making. The aim of the study was to define clinical parameters in the prehospital setting, which may affect clinical outcomes. (2) Methods: In this population-based study, we performed a retrospective analysis of emergency calls that were made by patients to the largest private emergency medical services (EMS) in Israel, SHL Telemedicine Ltd., who were treated on-site by the EMS team. Demographics, clinical characteristics, and clinical outcomes were analyzed. Mortality was evaluated at three time points: 1, 3, and 12 months’ follow-up. The first EMS prehospital measurements of the systolic blood pressure (SBP) were recorded and analyzed. Logistic regression analyses were performed. (3) Results: A total of 64,320 emergency calls were included with a follow-up of 12 months post index EMS call. Fifty-five percent of patients were men and the mean age was 70.2 ± 13.1 years. During follow-up of 12 months, 7.6% of patients died. Age above 80 years (OR 3.34; 95% CI 3.03–3.69, <i>p</i> < 0.005), first EMS SBP ≤ 130 mm Hg (OR 2.61; 95% CI 2.36–2.88, <i>p</i> < 0.005), dyspnea at presentation (OR 2.55; 95% CI 2.29–2.83, <i>p</i> < 0001), and chest pain with ischemic ECG changes (OR 1.95; 95% CI 1.71–2.23, <i>p</i> < 0.001) were the highest predictors of 1 month mortality and remained so for mortality at 3 and 12 months. In contrast, history of hypertension and first EMS prehospital SBP ≥ 160 mm Hg were significantly associated with decreased mortality at 1, 3 and 12 months. (4) Conclusions: We identified risk predictors for all-cause mortality in a large cohort of patients during prehospital EMS calls. Age over 80 years, first EMS-documented prehospital SBP < 130 mm Hg, and dyspnea at presentation were the most profound risk predictors for short- and long-term mortality. The current study demonstrates that in prehospital EMS call settings, several parameters can be used to improve prioritization and management of high-risk patients.Gabby Elbaz-GreenerShemy CarassoElad MaorLior GallimidiMerav YarkoniHarindra C. WijeysunderaYitzhak AbendYinon DaganAmir LermanOffer AmirMDPI AGarticleprehospital mortalityoctogenarianshypertension paradoxoutcomeMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5355, p 5355 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	prehospital mortality octogenarians hypertension paradox outcome Medicine R
spellingShingle	prehospital mortality octogenarians hypertension paradox outcome Medicine R Gabby Elbaz-Greener Shemy Carasso Elad Maor Lior Gallimidi Merav Yarkoni Harindra C. Wijeysundera Yitzhak Abend Yinon Dagan Amir Lerman Offer Amir Clinical Predictors of Mortality in Prehospital Distress Calls by Emergency Medical Service Subscribers
description	(1) Introduction: Most studies rely on in-hospital data to predict cardiovascular risk and do not include prehospital information that is substantially important for early decision making. The aim of the study was to define clinical parameters in the prehospital setting, which may affect clinical outcomes. (2) Methods: In this population-based study, we performed a retrospective analysis of emergency calls that were made by patients to the largest private emergency medical services (EMS) in Israel, SHL Telemedicine Ltd., who were treated on-site by the EMS team. Demographics, clinical characteristics, and clinical outcomes were analyzed. Mortality was evaluated at three time points: 1, 3, and 12 months’ follow-up. The first EMS prehospital measurements of the systolic blood pressure (SBP) were recorded and analyzed. Logistic regression analyses were performed. (3) Results: A total of 64,320 emergency calls were included with a follow-up of 12 months post index EMS call. Fifty-five percent of patients were men and the mean age was 70.2 ± 13.1 years. During follow-up of 12 months, 7.6% of patients died. Age above 80 years (OR 3.34; 95% CI 3.03–3.69, <i>p</i> < 0.005), first EMS SBP ≤ 130 mm Hg (OR 2.61; 95% CI 2.36–2.88, <i>p</i> < 0.005), dyspnea at presentation (OR 2.55; 95% CI 2.29–2.83, <i>p</i> < 0001), and chest pain with ischemic ECG changes (OR 1.95; 95% CI 1.71–2.23, <i>p</i> < 0.001) were the highest predictors of 1 month mortality and remained so for mortality at 3 and 12 months. In contrast, history of hypertension and first EMS prehospital SBP ≥ 160 mm Hg were significantly associated with decreased mortality at 1, 3 and 12 months. (4) Conclusions: We identified risk predictors for all-cause mortality in a large cohort of patients during prehospital EMS calls. Age over 80 years, first EMS-documented prehospital SBP < 130 mm Hg, and dyspnea at presentation were the most profound risk predictors for short- and long-term mortality. The current study demonstrates that in prehospital EMS call settings, several parameters can be used to improve prioritization and management of high-risk patients.
format	article
author	Gabby Elbaz-Greener Shemy Carasso Elad Maor Lior Gallimidi Merav Yarkoni Harindra C. Wijeysundera Yitzhak Abend Yinon Dagan Amir Lerman Offer Amir
author_facet	Gabby Elbaz-Greener Shemy Carasso Elad Maor Lior Gallimidi Merav Yarkoni Harindra C. Wijeysundera Yitzhak Abend Yinon Dagan Amir Lerman Offer Amir
author_sort	Gabby Elbaz-Greener
title	Clinical Predictors of Mortality in Prehospital Distress Calls by Emergency Medical Service Subscribers
title_short	Clinical Predictors of Mortality in Prehospital Distress Calls by Emergency Medical Service Subscribers
title_full	Clinical Predictors of Mortality in Prehospital Distress Calls by Emergency Medical Service Subscribers
title_fullStr	Clinical Predictors of Mortality in Prehospital Distress Calls by Emergency Medical Service Subscribers
title_full_unstemmed	Clinical Predictors of Mortality in Prehospital Distress Calls by Emergency Medical Service Subscribers
title_sort	clinical predictors of mortality in prehospital distress calls by emergency medical service subscribers
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/81554116e7f64650ac9f241542bd4842
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Clinical Predictors of Mortality in Prehospital Distress Calls by Emergency Medical Service Subscribers

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