Elbaz-Greener Gabby, Carasso Shemy, Maor Elad, Gallimidi Lior, Yarkoni Merav, Wijeysundera Harindra C, Abend Yitzhak, Dagan Yinon, Lerman Amir, Amir Offer
Hadassah Medical Center, Cardiology Department, Faculty of Medicine, Hebrew University Jerusalem, Jerusalem 91905, Israel.
Baruch-Pade Poriya Medical Center, Cardiology Department, Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 52100, Israel.
J Clin Med. 2021 Nov 17;10(22):5355. doi: 10.3390/jcm10225355.
(1) Introduction: Most studies rely on in-hospital data to predict cardiovascular risk and do not include prehospital information that is substantially important for early decision making. The aim of the study was to define clinical parameters in the prehospital setting, which may affect clinical outcomes. (2) Methods: In this population-based study, we performed a retrospective analysis of emergency calls that were made by patients to the largest private emergency medical services (EMS) in Israel, SHL Telemedicine Ltd., who were treated on-site by the EMS team. Demographics, clinical characteristics, and clinical outcomes were analyzed. Mortality was evaluated at three time points: 1, 3, and 12 months' follow-up. The first EMS prehospital measurements of the systolic blood pressure (SBP) were recorded and analyzed. Logistic regression analyses were performed. (3) Results: A total of 64,320 emergency calls were included with a follow-up of 12 months post index EMS call. Fifty-five percent of patients were men and the mean age was 70.2 ± 13.1 years. During follow-up of 12 months, 7.6% of patients died. Age above 80 years (OR 3.34; 95% CI 3.03-3.69, < 0.005), first EMS SBP ≤ 130 mm Hg (OR 2.61; 95% CI 2.36-2.88, < 0.005), dyspnea at presentation (OR 2.55; 95% CI 2.29-2.83, < 0001), and chest pain with ischemic ECG changes (OR 1.95; 95% CI 1.71-2.23, < 0.001) were the highest predictors of 1 month mortality and remained so for mortality at 3 and 12 months. In contrast, history of hypertension and first EMS prehospital SBP ≥ 160 mm Hg were significantly associated with decreased mortality at 1, 3 and 12 months. (4) Conclusions: We identified risk predictors for all-cause mortality in a large cohort of patients during prehospital EMS calls. Age over 80 years, first EMS-documented prehospital SBP < 130 mm Hg, and dyspnea at presentation were the most profound risk predictors for short- and long-term mortality. The current study demonstrates that in prehospital EMS call settings, several parameters can be used to improve prioritization and management of high-risk patients.
（1）引言：大多数研究依靠住院数据来预测心血管风险，未纳入对早期决策至关重要的院前信息。本研究的目的是确定院前环境中可能影响临床结局的临床参数。（2）方法：在这项基于人群的研究中，我们对以色列最大的私人紧急医疗服务机构SHL远程医疗有限公司接到的患者紧急呼叫进行了回顾性分析，这些患者由紧急医疗服务团队在现场进行治疗。分析了人口统计学、临床特征和临床结局。在三个时间点评估死亡率：随访1个月、3个月和12个月。记录并分析首次紧急医疗服务时的院前收缩压（SBP）测量值。进行了逻辑回归分析。（3）结果：共纳入64320次紧急呼叫，对索引紧急医疗服务呼叫后12个月进行随访。55%的患者为男性，平均年龄为70.2±13.1岁。在12个月的随访期间，7.6%的患者死亡。80岁以上（比值比3.34；95%置信区间3.03 - 3.69，P<0.005）、首次紧急医疗服务时的院前收缩压≤130 mmHg（比值比2.61；95%置信区间2.36 - 2.88，P<0.005）、就诊时呼吸困难（比值比2.55；95%置信区间2.29 - 2.83，P<0.001）以及伴有缺血性心电图改变的胸痛（比值比1.95；95%置信区间1.71 - 2.23,P<0.001）是1个月死亡率的最高预测因素，在3个月和12个月死亡率预测中依然如此。相比之下，高血压病史和首次紧急医疗服务时的院前收缩压≥160 mmHg与1个月、3个月和12个月时死亡率降低显著相关。（4）结论：我们确定了一大群患者在院前紧急医疗服务呼叫期间全因死亡率的风险预测因素。80岁以上、首次紧急医疗服务记录的院前收缩压<130 mmHg以及就诊时呼吸困难是短期和长期死亡率的最显著风险预测因素。当前研究表明，在院前紧急医疗服务呼叫环境中，几个参数可用于改善高危患者的优先级确定和管理。
