Prehospital early warning scores are associated with requirement for medical retrieval services
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Keywords

Early warning score
prehospital
retrieval medicine
ambulance
rural

How to Cite

1.
Smith J, Andrew E, Smith K. Prehospital early warning scores are associated with requirement for medical retrieval services . Australasian Journal of Paramedicine [Internet]. 2022Apr.10 [cited 2022Aug.12];19. Available from: https://ajp.paramedics.org/index.php/ajp/article/view/956

Abstract

Objective: Prehospital early warning scores (EWSs) can accurately identify patients at risk of clinical deterioration. We hypothesised that EWSs can identify patients during the prehospital phase who will subsequently require clinical escalation via medical retrieval.

Methods: A retrospective observational study of adult patients attended in 2018 by Ambulance Victoria in rural regions was conducted. We calculated EWSs using National Early Warning Score 2 (NEWS2) and Rapid Emergency Medicine Score (REMS) methods. Primary outcome was activation of Adult Retrieval Victoria (ARV) within 24h of ambulance attendance. We evaluated sensitivity and specificity for each score, and used multivariable logistic regression analysis to assess the independent association between EWSs and ARV activation.

Results: 71 401 patients were included, of which 607 (0.9%) required ARV activation within 24h. Sensitivity and specificity of NEWS2 were 0.484 (95% CI 0.444–0.525) and 0.806 (95% CI 0.803–0.809) respectively, compared with 0.552 (95% CI 0.511–0.592) and 0.508 (95% CI 0.504–0.512) respectively for REMS. After adjustment for remoteness, distance to hospital, sex, age and hospital service level, a medium/high risk score according to the NEWS2 (OR 4.12; 95% CI 3.50–4.85, p<0.001) and REMS (OR 2.92, 95% CI 2.26–3.77) was associated with ARV activation. Odds of ARV activation increased with remoteness and decreasing service level of the receiving hospital.

Conclusions: Prehospital NEWS2 and REMS were associated with medical retrieval within 24h of ambulance attendance. EWSs may allow early identification of ambulance patients requiring medical retrieval, thus facilitating earlier activation and reduced time to definitive care.

https://doi.org/10.33151/ajp.19.956
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References

McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M. Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards. Cochrane Database Syst Rev 2007 Jul 18;3:CD005529. https://doi.org/10.1002/14651858.CD005529.pub2.

Nannan Panday RS, Minderhoud TC, Alam N, Nanayakkara PWB. Prognostic value of early warning scores in the emergency department (ED) and acute medical unit (AMU): a narrative review. Eur J Intern Med 2017;45:20–31.

Fullerton JN, Price CL, Silvey NE, Brace SJ, Perkins GD. Is the Modified Early Warning Score (MEWS) superior to clinician judgement in detecting critical illness in the pre-hospital environment? Resuscitation 2012;83:557–62.

Williams TA, Tohira H, Finn J, Perkins GD, Ho KM. The ability of early warning scores (EWS) to detect critical illness in the prehospital setting: a systematic review. Resuscitation 2016;102:35–43.

Silcock DJ, Corfield AR, Gowens PA, Rooney KD. Validation of the National Early Warning Score in the prehospital setting. Resuscitation 2015;89:31–5.

Abbott TE, Cron N, Vaid N, Ip D, Torrance HD, Emmanuel J. Pre-hospital National Early Warning Score (NEWS) is associated with in-hospital mortality and critical care unit admission: a cohort study. Ann Med Surg 2018;27:17–21.

Hoikka M, Silfvast T, Ala-Kokko TI. Does the prehospital National Early Warning Score predict the short-term mortality of unselected emergency patients? Scand J Trauma Resusc Emerg Med 2018;26:48.

Shaw J, Fothergill RT, Clark S, Moore F. Can the prehospital National Early Warning Score identify patients most at risk from subsequent deterioration? Emerg Med J 2017;34:533–7.

Olsson T, Terént A, Lind L. Rapid Emergency Medicine Score: a new prognostic tool for in‐hospital mortality in nonsurgical emergency department patients. J Intern Med 2004;255:579–87.

Kennedy MP, Wilson K, Gabbe BJ, Straney L, Bailey M. Retrieval Rapid Emergency Medical Score in retrieval medicine. Emerg Med Australas 2015;27:584–9.

Royal College of Physicians. National Early Warning Score (NEWS) 2: standardising the assessment of acute-illness severity in the NHS. London: Royal College of Physicians, 2017.

Nolan B, Tien H, Haas B, Saskin R, Nathens A. The Rapid Emergency Medicine Score: a critical appraisal of its measurement properties and applicability to the air retrieval environment. Air Med J 2019;38:154–60.

Martín-Rodríguez F, Castro-Villamor MÁ, del Pozo Vegas C, Martín-Conty JL, Mayo-Iscar A, Delgado Benito JF, et al. Analysis of the early warning score to detect critical or high-risk patients in the prehospital setting. Intern Emerg Med 2019 Jun; 14(4): 581–9.

Booth SM, Bloch M. An evaluation of a new prehospital pre-alert guidance tool. Emerg Med J 2012;30:820–3.

Brown E, Bleetman A. Ambulance alerting to hospital: the need for clearer guidance. Emerg Med J 2006;23:811–4.

Leeuwenburg T, Hall J. Tyranny of distance and rural prehospital care: is there potential for a national rural responder network? Emerg Med Australas 2015;27:481–4.

Laatz D, Welzel T, Stassen W. Developing a South African Helicopter Emergency Medical Service Activation Screen (SAHAS): A Delphi study. Afr J Emerg Med 2019;9:1–7.

Pancer Z, Moore M, Wenham JT, Burridge M. The challenge of generalist care in remote Australia: beyond aeromedical retrieval. Aust J Rural Health 2018;26:188–93.

Ambulance Victoria. Adult Retrieval Victoria: reference manual. Melbourne: Ambulance Victoria, 2017 [updated 2 Mar 2018, cited 30 Oct 2019]. Available from: https://www.ambulance.vic.gov.au/about-us/our-services/adult-retrieval-victoria/.

Langford S. Transporting your patient: guidelines for organising and preparing patients for transport by air. Jandakot: Royal Flying Doctor Service, 2015.

Ambulance Victoria. Ambulance Victoria: annual report 2018–2019. Melbourne: Ambulance Victoria, 2019 [updated Aug 2019, cited 30 Oct 2019]. Available from: https://www.ambulance.vic.gov.au/about-us/our-performance/.

Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation 2013;84:465–70.

Alter SM, Infinger A, Swanson D, Studnek JR. Evaluating clinical care in the prehospital setting: is Rapid Emergency Medicine Score the missing metric of EMS? Am J Emerg Med 2017;35:218–21.

Australian Institute of Health and Welfare. Rural, regional and remote health: a guide to remoteness classifications. Canberra: Australian Institute of Health and Welfare, 2004 [updated 30 Nov 2017, cited 30 Sep 2019]. Cat. no. PHE 53. Available from: https://www.aihw.gov.au/reports/rural-remote-australians/guide-to-remoteness-classifications/contents/table-of-contents.

Bulut M, Cebicci H, Sigirli D, Sak A, Durmus O, Top AA, et al. The comparison of modified early warning score with rapid emergency medicine score: a prospective multicentre observational cohort study on medical and surgical patients presenting to emergency department. Emerg Med J 2013;31:476–81.

Pirneskoski J, Kuisma M, Olkkola KT, Nurmi J. Prehospital National Early Warning Score predicts early mortality. Acta Anaesthesiol Scand 2019 May; 63(5):676–83.