A newly developed, easy-to-use prehospital drug-derived score compared with three conventional scores: A prospective multicenter study

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Clinical Investigation Pub Date : 2024-10-07 DOI:10.1111/eci.14329

Jesús Jurado-Palomo, José Luis Martin-Conty, Begoña Polonio-López, Juan J. Bernal-Jiménez, Rosa Conty-Serrano, Michele Dileone, Miguel A. Castro Villamor, Carlos del Pozo Vegas, Raúl López-Izquierdo, Cristina Rivera-Picón, Francisco Martín-Rodríguez, Ancor Sanz-García

{"title":"A newly developed, easy-to-use prehospital drug-derived score compared with three conventional scores: A prospective multicenter study","authors":"Jesús Jurado-Palomo, José Luis Martin-Conty, Begoña Polonio-López, Juan J. Bernal-Jiménez, Rosa Conty-Serrano, Michele Dileone, Miguel A. Castro Villamor, Carlos del Pozo Vegas, Raúl López-Izquierdo, Cristina Rivera-Picón, Francisco Martín-Rodríguez, Ancor Sanz-García","doi":"10.1111/eci.14329","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>The use of medications by emergency medical services (EMS) is increasing. Conventional scores are time-consuming and therefore difficult to use in an emergency setting. For early decision-making, an easy-to-use score based on the medications administered by the EMS may have prognostic value. The primary objective of this study was to develop the prehospital drug-derived score (PDDS) for 2-day mortality.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A prospective, multicenter, ambulance-based cohort study was conducted in adults with undifferentiated acute diseases treated by EMS and transferred to the emergency department. Demographic data, prehospital diagnosis data, prehospital medication and variables for the calculation of the National Early Warning Score 2 (NEWS2), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) were collected. The PDDS was developed and validated, establishing three levels of risk of 2-day mortality. The predictive capability of each score was determined by the area under the curve of the receiver operating characteristic curve (AUROC) and compared using the Delong's test (<i>p</i>-value).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 6401 patients were included. The PDDS included age and the use of norepinephrine, analgesics, neuromuscular blocking agents, diuretics, antihypertensive agents, tranexamic acid, and bicarbonate. The AUROC of PDDS was .86 (95% CI: .816–.903) versus NEWS2 .866 (95% CI: .822–.911), <i>p</i> = .828; versus REMS .885 (95% CI: .845–.924), <i>p</i> = .311; versus RAPS .886 (95% CI: .846–.926), <i>p</i> = .335, respectively.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>The newly developed easy-to-use prehospital drug-derived PDDS score has an excellent predictive value of early mortality. The PDDS score was comparable to the conventional risk scores and therefore might serve as an alternative score in the prehospital emergency setting.</p>\n </section>\n </div>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"55 1","pages":""},"PeriodicalIF":4.4000,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628643/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Clinical Investigation","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/eci.14329","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

The use of medications by emergency medical services (EMS) is increasing. Conventional scores are time-consuming and therefore difficult to use in an emergency setting. For early decision-making, an easy-to-use score based on the medications administered by the EMS may have prognostic value. The primary objective of this study was to develop the prehospital drug-derived score (PDDS) for 2-day mortality.

Methods

A prospective, multicenter, ambulance-based cohort study was conducted in adults with undifferentiated acute diseases treated by EMS and transferred to the emergency department. Demographic data, prehospital diagnosis data, prehospital medication and variables for the calculation of the National Early Warning Score 2 (NEWS2), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) were collected. The PDDS was developed and validated, establishing three levels of risk of 2-day mortality. The predictive capability of each score was determined by the area under the curve of the receiver operating characteristic curve (AUROC) and compared using the Delong's test (p-value).

Results

A total of 6401 patients were included. The PDDS included age and the use of norepinephrine, analgesics, neuromuscular blocking agents, diuretics, antihypertensive agents, tranexamic acid, and bicarbonate. The AUROC of PDDS was .86 (95% CI: .816–.903) versus NEWS2 .866 (95% CI: .822–.911), p = .828; versus REMS .885 (95% CI: .845–.924), p = .311; versus RAPS .886 (95% CI: .846–.926), p = .335, respectively.

Conclusion

The newly developed easy-to-use prehospital drug-derived PDDS score has an excellent predictive value of early mortality. The PDDS score was comparable to the conventional risk scores and therefore might serve as an alternative score in the prehospital emergency setting.

Abstract Image

查看原文本刊更多论文

一种新开发的、易于使用的院前药物衍生评分与三种传统评分的比较：前瞻性多中心研究。

导言：紧急医疗服务（EMS）的用药量在不断增加。传统的评分方法耗时较长，因此难以在急救环境中使用。对于早期决策而言，基于急救医疗服务用药的易用评分可能具有预后价值。本研究的主要目的是开发院前药物衍生评分（PDDS），用于预测 2 天死亡率：方法：对接受急救服务并转入急诊科的未分化急性病成人进行了一项前瞻性、多中心、基于救护车的队列研究。研究收集了人口统计学数据、院前诊断数据、院前用药以及用于计算国家预警评分 2 (NEWS2)、快速急诊医学评分 (REMS) 和快速急性生理评分 (RAPS) 的变量。开发并验证了 PDDS，将 2 天死亡风险分为三个等级。每个评分的预测能力由接收者操作特征曲线下面积（AUROC）决定，并使用德龙检验（P值）进行比较：共纳入 6401 名患者。PDDS包括年龄和去甲肾上腺素、镇痛剂、神经肌肉阻滞剂、利尿剂、降压药、氨甲环酸和碳酸氢盐的使用情况。PDDS的AUROC为0.86（95% CI：0.816-0.903），NEWS2为0.866（95% CI：0.822-0.911），P = 0.828；REMS为0.885（95% CI：0.845-0.924），P = 0.311；RAPS为0.886（95% CI：0.846-0.926），P = 0.335：结论：新开发的易于使用的院前药物衍生 PDDS 评分对早期死亡率具有很好的预测价值。PDDS 评分与传统风险评分相当，因此可作为院前急救环境中的替代评分。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

期刊介绍： EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.