Jurado-Palomo Jesús, Sanz-García Ancor, Martín-Conty José Luis, Polonio-López Begoña, López-Izquierdo Raúl, Sáez-Belloso Silvia, Del Pozo Vegas Carlos, Martín-Rodríguez Francisco
Grupo de Investigación ITAS, Faculty of Health Sciences, Universidad de Castilla la Mancha, Avda. Real Fábrica de Seda, s/n, 45600, Talavera de la Reina, Spain.
Hospital General Nuestra Señora del Prado, Talavera de la Reina, Spain.
Intern Emerg Med. 2025 Apr;20(3):887-897. doi: 10.1007/s11739-024-03729-x. Epub 2024 Aug 2.
How prehospital medication predicts patient outcomes is unclear. The aim of this work was to unveil the association between medication burden administration in prehospital care and short, mid, and long-term mortality (2, 30, and 365 day) in unselected acute diseases and to assess the potential of the number of medications administered for short, mid, and long-term mortality prediction. A prospective, multicenter, ambulance-based, cohort study was carried out in adults with unselected acute diseases managed by emergency medical services (EMS). The study was carried out in Spain with 44 ambulances and four hospitals. The principal outcome was cumulative mortality at 2, 30, and 365 days. Epidemiological variables, vital signs, and prehospital medications were collected. Patients were classified into four categories: no medication dispensed in prehospital care, one to two medications, three to four medications, and five or more medications. A total of 6401 patients were selected. The 2-day mortality associated with each group was 0.5%, 1.8%, 6.5%, and 18.8%. The 30-day mortality associated with each group was 3.8%, 6.2%, 13.5%, and 31.9%. The 365-day mortality associated with each group was 11%, 15.3%, 25.2%, and 45.7%. The predictive validity of the number of drugs administered, measured by the area under the curve, was 0.808, 0.720, and 0.660 for 2-, 30-, and 365-day mortality, respectively. Our results showed that prehospital drugs could provide relevant information regarding the mortality prediction of patients. The incorporation of this score could improve the management of high-risk patients by the EMS.
院前用药如何预测患者预后尚不清楚。这项研究的目的是揭示院前护理中用药负担与未选定急性疾病的短期、中期和长期死亡率（2天、30天和365天）之间的关联，并评估用药数量对短期、中期和长期死亡率预测的潜力。我们开展了一项前瞻性、多中心、基于救护车的队列研究，研究对象为接受紧急医疗服务（EMS）治疗的未选定急性疾病的成年人。该研究在西班牙的44辆救护车和4家医院进行。主要结局是2天、30天和365天的累积死亡率。收集了流行病学变量、生命体征和院前用药情况。患者被分为四类：院前护理中未用药、使用一至两种药物、使用三至四种药物以及使用五种或更多药物。共选取了6401例患者。每组的2天死亡率分别为0.5%、1.8%、6.5%和18.8%。每组的30天死亡率分别为3.8%、6.2%、13.5%和31.9%。每组的365天死亡率分别为11%、15.3%、25.2%和45.7%。以曲线下面积衡量，用药数量对2天、30天和365天死亡率的预测效度分别为0.808、0.720和0.660。我们的结果表明，院前用药可为患者死亡率预测提供相关信息。纳入该评分可改善EMS对高危患者的管理。
