Prehospital Emergency Care最新文献

{"title":"Multidisciplinary Lessons from Palliative Extubations at Home.","authors":"Amelia M Breyre, Megan Grammatico, Alexa Policastro, Charles J Ingram, Elizabeth Prisc, L Scott Sussman, Katherine Couturier","doi":"10.1080/10903127.2024.2420198","DOIUrl":"10.1080/10903127.2024.2420198","url":null,"abstract":"<p><p>Most patients with serious illness prefer to die at home; however, for those requiring ongoing ventilatory support, this preference is often not honored due to the difficulties of arranging a palliative extubation at home. Here we present two cases of successful home palliative extubations, coordinated by a multidisciplinary team including critical care, palliative care, care management, hospice, and emergency medical services (EMS) clinicians. By exploring the operational and regulatory challenges accompanying these cases, we provide a road map for offering mechanically ventilated patients the choice of a death at home and provide truly holistic and patient-centered care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-4"},"PeriodicalIF":4.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Safety of Targeted Temperature Management During Interhospital Transport of Post-Cardiac Arrest Patients.","authors":"Ki Hong Kim, Young Sun Ro, Seulki Choi, Minwoo Kim, Sang Do Shin","doi":"10.1080/10903127.2024.2420881","DOIUrl":"10.1080/10903127.2024.2420881","url":null,"abstract":"<p><strong>Objectives: </strong>Early initiation of targeted temperature management (TTM) is crucial for post-resuscitation care. Although TTM is initiated prior to transport and continued during interhospital transport (IHT), its feasibility and safety during IHT for cardiac arrest patients have not been thoroughly assessed. This study aims to evaluate the feasibility and safety of interhospital TTM for post-resuscitation patients.</p><p><strong>Methods: </strong>A retrospective analysis of post-cardiac arrest patients transported by a dedicated critical care transport team between January 2016 and April 2023 was conducted. Adult patients resuscitated from cardiac arrest without mental recovery were enrolled. The study population was divided into those who received TTM during IHT (IHT-TTM group) and those who did not (non-IHT-TTM group). The primary outcome was body temperature drop during transport, with hypotension, or desaturation during transport considered as secondary outcomes. Multivariable conditional logistic regression analysis was performed after frequency matching.</p><p><strong>Results: </strong>Among 593 post-cardiac arrest patients, 332 were included in the analysis after exclusions. Of these, 44 (13.3%) received TTM during IHT. Conditional logistic regression analysis showed significantly higher likelihood for a drop in body temperature during IHT for the IHT-TTM group, with an odds ratio (OR) of 12.91 (95%CI: 5.28-31.53). No significant association was found for hypotension (OR (95%CI): 0.72 (0.13-3.97)), or desaturation during IHT (0.65 (0.15-2.82)).</p><p><strong>Conclusions: </strong>Administration of TTM during IHT for post-cardiac arrest patients appears to be feasible and safe. These findings support the implementation of dedicated critical care transport systems capable of providing TTM during IHT for post-cardiac arrest patients.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Time to Key Prehospital Interventions Recorded by EMT-Worn video Devices and Sustained Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest.","authors":"Jiun-Wei Chen, Chi-Hsin Chen, Hung-Che Wang, Hao-Teng Jhang, Shang-Ching Yang, Shi-Xuan Zheng, Hsieh-Chih Chen, Chun-Hsien Chen, Edward Pei-Chuan Huang, Chih-Wei Sung","doi":"10.1080/10903127.2024.2410414","DOIUrl":"10.1080/10903127.2024.2410414","url":null,"abstract":"<p><strong>Objectives: </strong>The quality of prehospital resuscitation provided by emergency medical technicians (EMTs) is essential to ensure better outcomes following out-of-hospital cardiac arrests (OHCA). We assessed the quality of prehospital resuscitation by recording time to key prehospital interventions using EMT-worn video devices and investigated its association with outcomes of patients with OHCA.</p><p><strong>Methods: </strong>This retrospective, cross-sectional study included cases of non-traumatic OHCA in adults treated by emergency medical services (EMS) in Hsinchu City, Taiwan, during 2022 and 2023. We used data from high-resolution, chest-mounted wearable cameras to define and measure six quality indices (QIs) for prehospital resuscitation interventions (i.e., time spent recognizing OHCA). To evaluate the association between QI performance and sustained return of spontaneous circulation (ROSC), we used multivariable logistic regression.</p><p><strong>Results: </strong>Of 745 patients eligible for this study, 187 (25.1%) achieved sustained ROSC. Six core QIs were analyzed: recognition of OHCA (median time: 9.0 s), time from recognizing OHCA to initiating cardiopulmonary resuscitation (cardiopulmonary resuscitation [CPR]; 9.0 s), automated external defibrillator setup (34.0 s), time from recognizing OHCA to beginning ventilation (160.0 s), advanced airway management (300 s), and deploying a mechanical CPR device (50 s). The performance of the six QIs were not associated with sustained ROSC (Adjusted odds ratio [95% confidence interval]: 1.00 [0.99-1.00], 0.99 [0.98-1.00], 1.00 [1.00-1.01], 1.00 [1.00-1.00], 1.00 [1.00-1.00], and 0.99 [0.99-1.00], respectively).</p><p><strong>Conclusions: </strong>This study describes the rate of sustained ROSC and time to key interventions captured by EMT-worn video devices in non-traumatic OHCA patients. Although we found no direct link between QI performance and improved OHCA outcomes, this study highlights the potential of video-assisted QIs to enhance the documentation and understanding of prehospital resuscitation processes. These findings suggest that further refinement and application of these QIs could support more effective resuscitation strategies and training programs.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Pediatric Prehospital Opioid Encounters and Social Vulnerability.","authors":"Stephen Sandelich, Garrett Cavaliere, Christopher Buresh, Susan Boehmer, Joshua Glasser, Ian Klansek, Aaron Tolpin","doi":"10.1080/10903127.2024.2424335","DOIUrl":"10.1080/10903127.2024.2424335","url":null,"abstract":"<p><strong>Objectives: </strong>This study explores the relationship between socioeconomic factors and pediatric opioid-related emergencies requiring naloxone administration in the prehospital setting, an escalating public health concern.</p><p><strong>Methods: </strong>A retrospective analysis of the National Emergency Medical Services Information System (NEMSIS) database was conducted, examining data from pediatric opioid-related EMS activations between January 2018 and December 2021. The Social Vulnerability Index (SVI) was used to gauge each incident's socioeconomic context and assess correlations between SVI scores and the likelihood of opioid-related activations and naloxone interventions.</p><p><strong>Results: </strong>A total of 7,789 pediatric opiate-related EMS activations were identified. Lower socioeconomic status (SES) areas (higher SVI scores) exhibited a decreased rate of opioid-related activations compared to lower SVI-scored areas but an increased frequency of naloxone administration. The analysis demonstrated that as socioeconomic status (SES) improves, the likelihood of opioid-related activations increases significantly supported by a significant negative linear trend (Estimate = -0.2971, SE = 0.1172, z = -2.54, <i>p</i> = 0.0112. On the other hand, naloxone administration was more frequently required in lower SES areas, suggesting an increased emergency response in these (Estimate = 0.05806, SE = 0.2403, <i>z</i> = 0.24, <i>p</i> = 0.8091).</p><p><strong>Conclusions: </strong>The analysis highlights a statistically significant correlation between the SES of an area and pediatric opioid-related EMS activations, yet an inverse correlation with the likelihood of naloxone administration. These findings demonstrate that in lower socioeconomic areas, the total number of opiate-related EMS activations is lower; however, naloxone was more likely to be deployed during those activations. This underscores the need for further research to understand the disparities in opioid crisis management across different socioeconomic landscapes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2024 Systematic Review of Evidence-Based Guidelines for Prehospital Care.","authors":"Christian Martin-Gill, P Daniel Patterson, Christopher T Richards, Anjali J Misra, Benjamin T Potts, Rebecca E Cash","doi":"10.1080/10903127.2024.2412299","DOIUrl":"10.1080/10903127.2024.2412299","url":null,"abstract":"<p><strong>Objectives: </strong>Evidence-based guidelines (EBGs) are widely recognized as valuable tools to aggregate and translate scientific knowledge into clinical care. High-quality EBGs can also serve as important components of dissemination and implementation efforts focused on educating emergency medical services (EMS) clinicians about current evidence-based prehospital clinical care practices and operations. We aimed to perform the third biennial systematic review of prehospital EBGs to identify and assess the quality of prehospital EBGs published since 2021.</p><p><strong>Methods: </strong>We systematically searched Ovid Medline and EMBASE from January 1, 2021, to June 6, 2023, for publications relevant to prehospital care, based on an organized review of the literature, and focused on providing recommendations for clinical care or operations. Included guidelines were appraised using the National Academy of Medicine (NAM) criteria for high-quality guidelines and scored using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Tool.</p><p><strong>Results: </strong>We identified 33 new guidelines addressing clinical and operational topics of EMS medicine. The most addressed EMS core content areas were time-life critical conditions (<i>n</i> = 17, 51.5%), special clinical considerations (<i>n</i> = 15, 45%), and injury (<i>n</i> = 12, 36%). Seven (21%) guidelines included all elements of the National Academy of Medicine (NAM) criteria for high-quality guidelines, including the full reporting of a systematic review of the evidence. Guideline appraisals by the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool demonstrated modest compliance to reporting recommendations and similar overall quality compared to previously identified guidelines (mean overall domain score 67%, SD 12%), with Domain 5 (\"Applicability\") scoring the lowest of the six AGREE II domains (mean score of 53%, SD 13%).</p><p><strong>Conclusions: </strong>This updated systematic review identified and appraised recent guidelines addressing prehospital care and identifies important targets for education of EMS personnel. Continued opportunities exist for prehospital guideline developers to include comprehensive evidence-based reporting into guideline development to facilitate widespread implementation of high-quality EBGs in EMS systems and incorporate the best available scientific evidence into initial education and continued competency activities.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adrenal Insufficiency With Hypoglycemia in a Medically Complex Pediatric Patient.","authors":"Kevin T Argentieri, Christine M Brent, Stacey K Noel","doi":"10.1080/10903127.2024.2417364","DOIUrl":"10.1080/10903127.2024.2417364","url":null,"abstract":"<p><p>Medically complex children present a low frequency but often high acuity patient population for emergency medical services (EMS) personnel. We present a case of a 12-year-old male with Duchenne muscular dystrophy and adrenal agenesis found unresponsive. Detailed history-taking was crucial for diagnostic accuracy and this patient's favorable outcome. This case highlights the importance of recognizing adrenal insufficiency-induced hypoglycemia in patients presenting with altered mental status. EMS personnel should be trained to identify and manage adrenal insufficiency, using detailed histories and on-scene medical oversight to improve outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-4"},"PeriodicalIF":2.1,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital Trauma Compendium: Traumatic Pneumothorax Care - a position statement and resource document of NAEMSP.","authors":"John W Lyng, Caitlin Ward, Matthew Angelidis, Amelia Breyre, Ross Donaldson, Kenji Inaba, Maria J Mandt, Nichole Bosson","doi":"10.1080/10903127.2024.2416978","DOIUrl":"https://doi.org/10.1080/10903127.2024.2416978","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Emergency Medical Services (EMS) clinicians manage patients with traumatic pneumothoraces. These may be simple pneumothoraces that are less clinically impactful, or tension pneumothoraces that disturb perfusion, lead to shock, and impart significant risk for morbidity and mortality. Needle thoracostomy is the most common EMS treatment of tension pneumothorax, but despite the potentially life-saving value of needle thoracostomy, reports indicate frequent misapplication of the procedure as well as low rates of successful decompression. This has led some to question the value of prehospital needle thoracostomy and has prompted consideration of alternative approaches to management (e.g., simple thoracostomy, tube thoracostomy). EMS clinicians must determine when pleural decompression is indicated and optimize the safety and effectiveness of the procedure. Further, there is also ambiguity regarding EMS management of open pneumothoraces. To provide evidence-based guidance on the management of traumatic pneumothoraces in the EMS setting, NAEMSP performed a structured literature review and developed the following recommendations supported by the evidence summarized in the accompanying resource document.NAEMSP recommends:EMS identification of a tension pneumothorax must be guided by a combination of risk factors and physical findings, which may be augmented by diagnostic technologies.EMS clinicians should recognize the differences in the clinical presentation of a tension pneumothorax in spontaneously breathing patients and in patients receiving positive pressure ventilation.EMS clinicians should not perform pleural decompression in patients with simple pneumothoraces but should perform pleural decompression in patients with tension pneumothorax, if within the clinician's scope of practice.When within scope of practice, EMS clinicians should use needle thoracostomy as the primary strategy for pleural decompression of tension pneumothorax in most cases. EMS clinicians should take a patient-individualized approach to performing needle thoracostomy, influenced by factors known to impact chest wall thickness and risk for iatrogenic injury.Simple thoracostomy and tube thoracostomy may be used by highly trained EMS clinicians in select clinical settings with appropriate medical oversight and quality assurance.EMS systems must investigate and adopt strategies to confirm successful pleural decompression at the time thoracostomy is performed.Pleural decompression should be performed for patients with traumatic out-of-hospital circulatory arrest (TOHCA) if there are clinical signs of tension pneumothorax or suspicion thereof due to significant thoraco-abdominal trauma. Empiric bilateral decompression, however, is not routinely indicated in the absence of such findings.EMS clinicians should not routinely perform pleural decompression of suspected or confirmed simple pneumothorax prior to air-medical transport in most situations.EMS clinicians may consider plac","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-35"},"PeriodicalIF":2.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caring for Transgender and Gender Diverse Prehospital Patients: A NAEMSP Position Statement and Resource Document.","authors":"Timothy Hong, Veronica Case, Andra M Farcas, Denise Whitfield, Gregory Muller, Shira A Schlesinger, Ameera S Haamid, Mikaela T Middleton, Amelia Breyre, Phudit Buaprasert, Kimberly Whitten-Chung, Kaia J C Lichtenbelt, Anjni P Joiner, Carolina Pereira, John Brown","doi":"10.1080/10903127.2024.2411723","DOIUrl":"10.1080/10903127.2024.2411723","url":null,"abstract":"<p><p>Transgender and gender diverse (TGD) people have long faced significant barriers to safely accessing medical care-especially gender-affirming care, which has been shown to strikingly improve health outcomes like suicidality and depression. In the prehospital setting, gender-affirming care amounts to showing respect for the TGD patient's identified gender and maintaining a safe environment that fosters a positive therapeutic relationship throughout the encounter. This represents a challenge for many Emergency Medical Services (EMS) systems due to the lack of TGD-specific training for EMS clinicians, a paucity of TGD-specific research to inform EMS education and clinical care, and in some cases the resistance of EMS clinicians to such training. Transgender and gender diverse people are facing a regression in legal access to essential medical care. With this position statement, NAEMSP joins other professional medical societies in providing recommendations to improve care for TGD patients, thereby affirming TGD individuals' right to exist as their authentic selves, as well as their entitlement to the same high-quality prehospital medical care as their cisgender peers.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coffee and Cases (C&C) - Enhancing Knowledge Creation and Sharing for Organizational Learning From Clinical Debriefs in a Helicopter Emergency Medical Service: A Quality Improvement Study.","authors":"Robert Lloyd, Jacob Tant, Clare Richmond, Natalie May, Shannon Townsend, Robin Pap","doi":"10.1080/10903127.2024.2417842","DOIUrl":"10.1080/10903127.2024.2417842","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this quality improvement (QI) study was to improve organizational learning from clinical debriefs known as \"Coffee and Cases\" (C&C) in a helicopter emergency medical service (HEMS) by increasing weekly learning summaries (LS) and documented learning points (DLP) as well as the dissemination thereof by at least 50% from baseline.</p><p><strong>Methods: </strong>The problem analysis for sub-optimal organizational learning from C&C identified several factors, including lack of responsibility, poor documentation quality, and limited sharing of learning points. Using the Model for Improvement (MFI), interventions enhanced the learning environment, and improved documentation and dissemination. Changes included dedicated computers, introducing standardized processes, a newsletter, and a searchable DLP database. Statistical process control (SPC) charts were used to assess the effectiveness of interventions.</p><p><strong>Results: </strong>Prior to interventions (August 2022 to January 2023), baseline mean counts of weekly DLPs, LSs, DLPs internally disseminated, and DLPs openly disseminated were 3.18, 2.67, 3.18, and 2.96, respectively. Plan-Do-Study-Act (PDSA) cycles included declaring C&C as a non-clinical portfolio, redesigning documentation processes, initiating monthly newsletters, developing a DLP repository, and designing a C&C visual brand. Signals of special cause variation showed improvements, with mean counts increasing. Weekly DLPs increased to 14.92, LSs to 5.2, internally disseminated C&C Snippets to 11.88, and openly disseminated C&C Snippets to 8.64.</p><p><strong>Conclusions: </strong>Recognizing barriers to effective knowledge creation and sharing, our QI study aimed to increase weekly DLPs and LSs by 50% from baseline. It aligned with the relationship between knowledge management and organizational learning, emphasizing the importance of utilizing knowledge for improved performance. Our interventions enhanced the learning environment, ensured robust capturing of learning points and effective communication thereof, ultimately contributing toward improving organizational dissemination of learning from clinical debriefs. Our QI study demonstrates how enhanced knowledge creation and sharing can widen the benefits of learning from clinical team debriefs.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital Delta Shock Index Predicts Mortality and Need for Life Saving Interventions in Trauma Patients.","authors":"Philip W Walker, James F Luther, Stephen R Wisniewski, Joshua B Brown, Ernest E Moore, Martin Schreiber, Bellal Joseph, Chad T Wilson, Brian G Harbrecht, Daniel G Ostermayer, Bryan Cotton, Richard Miller, Mayur Patel, Christian Martin-Gill, Jason L Sperry, Francis X Guyette","doi":"10.1080/10903127.2024.2412841","DOIUrl":"10.1080/10903127.2024.2412841","url":null,"abstract":"<p><strong>Objectives: </strong>The delta shock index (ΔSI), defined as the change in shock index (SI) over time, is associated with hospital morbidity and mortality, but prehospital studies about ΔSI are limited. We investigate the association of prehospital ΔSI with mortality and resource utilization, hypothesizing that increases in SI among field trauma patients are associated with increased mortality and blood product transfusion.</p><p><strong>Methods: </strong>We performed a multicenter, retrospective, observational study from the Linking Investigators in Trauma and Emergency Services (LITES) network. We obtained data from January 2017 to June 2021. We fit logistic regression models to evaluate the association between an increase ΔSI > 0.1 and 28-day mortality and blood product transfusion within 4 h of emergency department (ED) arrival. We used negative binomial models to evaluate the association between ΔSI > 0.1 and days in hospital, intensive care unit (ICU), and on ventilator (up to 28 days).</p><p><strong>Results: </strong>We identified 33,219 prehospital patients. We excluded burn patients and those without documented prehospital or ED heart rate or blood pressure, resulting in 30,511 cases for analysis. In adjusted analysis for the primary outcome of 28-day mortality, patients who had a ΔSI > 0.1 based on initial vital signs were 31% more likely to die (adjusted odds ratio (AOR) of 1.31, 95% CI 1.21-1.41) compared to those patients who had a ΔSI ≤0.1. These patients also spent 16% more days in hospital (adjusted incident rate ratio (AIRR) 1.16, 95% CI 1.14-1.19), 34% more days in ICU (AIRR 1.34, 95% CI 1.28-1.41), and 61% more days on ventilator (ARR 1.61, 95% CI 1.47-1.75). Additionally, patients with a ΔSI > 0.1 had higher odds of receiving blood products (AOR 2.00, 95% CI 1.88-2.12) within 4 h of ED arrival. Models fit excluding hypotensive patients performed similarly.</p><p><strong>Conclusions: </strong>An increase of greater than 0.1 in the ΔSI was associated with increased 28-day mortality; increased days in hospital, in ICU, and on ventilator; and increased need for blood product transfusion within 4 h of ED arrival. This association held true for initially normotensive patients. Validation and implementation are needed to incorporate ΔSI into prehospital and ED triage.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}