Effect of the score predicting imminent delivery on the management of unexpected out-of-hospital obstetrical deliveries: a cluster randomized clinical trial.
Agnes Ricard-Hibon, Vivien Brenckmann, Judith Gorlicki, Louis Soulat, Gilles Bagou, Catherine Pradeau, Fabrice Louvet, Emilien Arnaud, Xavier Combes, Eva Weinzorn, Eric Lecarpentier, Roch Joly, Sybille Goddet, Clothilde Martin, Line Jacob, Thierry Roupioz, Muriel Vergne, Laure Abensur Vuillaume, Charlene Duchanois, Jeanne-Marie Amalric, Toni Alfaiate, Lucie Biard, Frederic Adnet
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引用次数: 0
Abstract
Background and importance: Early identification of imminent deliveries is crucial for guiding the decision to dispatch emergency medical team to the prehospital setting.
Objective: To study whether the use of the score predicting imminent delivery (SPID) at the emergency call center reduces the risk of prehospital delivery occurring without the presence of a physician-staffed mobile ICU team.
Design, setting, and participants: Prospective multicenter cluster randomized controlled trial in 19 call centers in France. Calls from pregnant woman in labor with at least 33 weeks of amenorrhea were eligible. The emergency call center responses included medical advice, transport to the hospital by personal means or ambulance, or dispatch of the mobile ICU team.
Intervention: In the intervention group, the use of the SPID was mandatory to guide decision-making.
Outcomes measures and analysis: The primary outcome was the rate of prehospital deliveries occurring without the initial dispatch of a mobile ICU team. The secondary endpoints included the prehospital deliveries rate without the presence of a mobile ICU team on site, call duration, satisfaction score, and maternal and neonatal mortality.
Main results: A total of 7782 pregnant women were included in the intention-to-treat analysis (3773 control and 4009 intervention), including 523 (7.0%) prehospital deliveries (6.3% intervention and 7.6% control) and a 22.3% rate of mobile ICU dispatch decision (20.8% intervention group and 23.8% control). Prehospital delivery without initial dispatch of a mobile ICU was less frequent in the intervention group compared to control: 0.95 vs. 2.01% [odds ratio (OR) 0.46; 95% confidence interval (CI), 0.31-0.70]. There was also a lower rate of prehospital delivery without the presence of a mobile ICU team on site in the intervention group: 1.92 vs. 3.34% (OR = 0.58; 95% CI, 0.42-0.82). There was no significant difference in the other secondary endpoints.
Conclusion: In this multicenter randomized controlled trial, the systematic use of the SPID was associated with a reduction of prehospital deliveries occurring without the presence of a mobile ICU team.
期刊介绍：
The European Journal of Emergency Medicine is the official journal of the European Society for Emergency Medicine. It is devoted to serving the European emergency medicine community and to promoting European standards of training, diagnosis and care in this rapidly growing field.
Published bimonthly, the Journal offers original papers on all aspects of acute injury and sudden illness, including: emergency medicine, anaesthesiology, cardiology, disaster medicine, intensive care, internal medicine, orthopaedics, paediatrics, toxicology and trauma care. It addresses issues on the organization of emergency services in hospitals and in the community and examines postgraduate training from European and global perspectives. The Journal also publishes papers focusing on the different models of emergency healthcare delivery in Europe and beyond. With a multidisciplinary approach, the European Journal of Emergency Medicine publishes scientific research, topical reviews, news of meetings and events of interest to the emergency medicine community.
Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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