PMID- 24691947
OWN - NLM
STAT- MEDLINE
DCOM- 20141229
LR  - 20211021
IS  - 1432-055X (Electronic)
IS  - 0003-2417 (Linking)
VI  - 63
IP  - 5
DP  - 2014 May
TI  - [Prediction of further hospital treatment for emergency patients by emergency 
      medical service physicians].
PG  - 394-400
LID - 10.1007/s00101-014-2313-z [doi]
AB  - INTRODUCTION: Prehospital assessment of illness and injury severity with the 
      National Advisory Committee for Aeronautics (NACA) score and hospital pre-arrival 
      notification of a patient who is likely to need intensive care unit (ICU) or 
      intermediate care unit (IMC) admission are both common in Germany's 
      physician-staffed emergency medical services (EMS) system. AIM: This study aimed 
      at comparing the prehospital evaluation of severity of disease or injuries by EMS 
      physicians and the subsequent clinical treatment in unselected emergency 
      department (ED) patients. MATERIAL AND METHODS: This study involved a prospective 
      observational analysis of patients transported to the ED of an academic level I 
      hospital escorted by an EMS physician over a period of 6 months (February-July 
      2011). The physician's qualification and the patient's NACA score were documented 
      and the EMS physician was asked to predict whether the patient would need 
      hospital admission and, if so, to the general ward, IMC or ICU. After the ED 
      treatment, discharge or admission, outcome and length of hospital and ICU or IMC 
      stay were documented. RESULTS: A total of 378 mostly non-trauma patients (88 %) 
      treated by experienced EMS physicians could be enrolled. The number of patients 
      discharged from the ED decreased, while the number of patients admitted to the 
      ICU increased with higher NACA scores. Prehospital prediction of discharge or 
      admission, IMC or ICU treatment by EMS physicians was accurate in 47 % of the 
      patients. In 40 % of patients a lower level of care was sufficient while 12 % 
      needed treatment on a higher level of care than that predicted by EMS physicians. 
      Of the patients 39 % who were predicted to be discharged after ED treatment, were 
      admitted to hospital and 48 % of patients predicted to be admitted to the IMC 
      were admitted to the general ward. Patients predicted to be admitted to the ICU 
      were admitted to the ICU in 75 %. Higher NACA scores were associated with 
      increased mortality and a longer hospital IMC or ICU length of stay, but 
      significant differences were only found between patients with NACA V versus VI 
      scores or patients predicted to be treated on the IMC versus the ICU. 
      CONCLUSIONS: Prehospital NACA scores indicate the need for inpatient treatment, 
      but neither hospital discharge or admission nor need of IMC or ICU admission 
      after initial ED treatment could be sufficiently predicted by EMS physicians. 
      Thus, hospital prenotification in order to predispose IMC or ICU capacities does 
      not seem to be useful in cases where an ED can reassess admitted EMS patients.
FAU - Bernhard, M
AU  - Bernhard M
AD  - Zentrale Notaufnahme/Notaufnahmestation, Universitatsklinikum Leipzig AoR, 
      Liebigstr. 20, 04103, Leipzig, Deutschland, 
      Michael.Bernhard@medizin.uni-leipzig.de.
FAU - Trautwein, S
AU  - Trautwein S
FAU - Stepan, R
AU  - Stepan R
FAU - Zahn, P
AU  - Zahn P
FAU - Greim, C-A
AU  - Greim CA
FAU - Gries, A
AU  - Gries A
LA  - ger
PT  - English Abstract
PT  - Journal Article
PT  - Observational Study
TT  - Notarztliche Einschatzung der klinischen Weiterversorgung von Notfallpatienten.
DEP - 20140403
PL  - Germany
TA  - Anaesthesist
JT  - Der Anaesthesist
JID - 0370525
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Child
MH  - Child, Preschool
MH  - Critical Care
MH  - Emergency Medical Services/*statistics & numerical data
MH  - Emergency Service, Hospital/*statistics & numerical data
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Middle Aged
MH  - Patients
MH  - Physicians
MH  - Prognosis
MH  - Prospective Studies
MH  - Trauma Severity Indices
MH  - Young Adult
EDAT- 2014/04/03 06:00
MHDA- 2014/12/30 06:00
CRDT- 2014/04/03 06:00
PHST- 2013/08/30 00:00 [received]
PHST- 2014/02/15 00:00 [accepted]
PHST- 2014/01/05 00:00 [revised]
PHST- 2014/04/03 06:00 [entrez]
PHST- 2014/04/03 06:00 [pubmed]
PHST- 2014/12/30 06:00 [medline]
AID - 10.1007/s00101-014-2313-z [doi]
PST - ppublish
SO  - Anaesthesist. 2014 May;63(5):394-400. doi: 10.1007/s00101-014-2313-z. Epub 2014 
      Apr 3.