Incidence and predictors of adverse events and outcomes for adult critically ill patients transferred by paramedics to a tertiary care medical facility
Abdullah Alabdali1, Chetan Trivedy2, Nawfal Aljerian3, Peter K Kimani4, Richard Lilford5
1 Division of Health Sciences, Warwick Medical School, University of Warwick, UK; Department of Emergency Medical Services, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
2 Center of Applied Health Research and Delivery, Warwick Medical School, University of Warwick, UK
3 College of Medicine, King Saud Bin Abdulaziz University for Health Sciences; Department of Emergency Medicine, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
4 Statistics and Epidemiology Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, UK
5 Pro-Dean (Research), Warwick Medical School, University of Warwick Coventry, UK
Department of Emergency Medical Services, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh
Objective: The aim of this study was to determine the incidence of adverse events and patients' outcomes in inter-facility critical care transfers by paramedics.
Methods: We conducted a retrospective cohort study of adults undergoing inter-facility transfer to a tertiary medical facility by paramedics. We included all patients transferred between 1st June, 2011 and 31st December, 2014. The primary outcome is in-transit adverse event and the secondary outcome is in-hospital mortality. Multiple logistic regression models were fitted to assess predictor variables for adverse events and in-hospital mortality.
Results: The incidence of adverse events was 13.7% (31/227 patients had in-transit adverse event); the most common adverse events reported were desaturation and hypotension. A unit increase in risk score for transported patients (RSTP) significantly increased the occurrence of adverse events (adjusted odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.07–1.72 and adjusted P = 0.01). Compared to medical patients, cardiac patients were less likely to develop adverse events (adjusted OR: 0.117, 95% CI: 0.02–0.52 and adjusted P < 0.01). The in-hospital mortality was 30.4% and 30-day survival was 68.1%. For two patients whose age differed by 1 year, the older patient was more likely to die (adjusted OR: 1.03, 95% CI: 1.01–1.05 and P < 0.01) and a unit increase in RSTP significantly increased occurrence of in-hospital mortality (adjusted OR: 1.30, 95% CI: 1.0–1.60 and P = 0.01).
Conclusion: The incidence of adverse events was 13.7%. The most common observed adverse events were desaturation and hypotension. In-hospital mortality was 30.4% and 30-day survival was 68.1%.