Bourke-Matas Emma, Doan Tan, Bowles Kelly-Ann, Bosley Emma
Department of Paramedicine, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia.
Department of Health, Emergency Services Complex, Queensland Ambulance Service, Brisbane, Queensland, Australia.
Emerg Med Australas. 2025 Feb;37(1):e14511. doi: 10.1111/1742-6723.14511. Epub 2024 Oct 25.
Improved understanding of the deteriorating patient in the pre-hospital setting may result in earlier recognition and response. Considering the effects of undetected deterioration are profound, it is fundamental to report the prevalence of pre-hospital clinical deterioration to advance our understanding. The present study investigated the prevalence of pre-hospital clinical deterioration and adverse events (AEs) within 3 days of the pre-hospital episode of care.
This retrospective cohort study was based on pre-hospital incidents involving adult patients attended by Queensland Ambulance Service between 1 January 2018 and 31 December 2020. Due to lacking a standardised definition of pre-hospital clinical deterioration, established early warning scores (NEWS, MEWS and Q-ADDS) were calculated from pre-hospital vital signs to identify clinical deterioration. Linked hospital data were used to identify the occurrence of an AE.
Some degree of physiological derangement was initially observed in over half of the patients, and pre-hospital clinical deterioration was seen in 2.7%-4% of patients. The prevalence of AEs was 3.2%. Patients that experienced an AE were more likely to be male, elderly, suffering from a medical (non-trauma) condition, and had a greater burden of disease. Concerningly, almost 50% of patients that suffered an AE did not meet escalation thresholds of NEWS, MEWS or Q-ADDS.
The present study found the prevalence of pre-hospital clinical deterioration and AEs subsequent to pre-hospital episodes of care to be low. Future research should prioritise using standardised criteria to define pre-hospital clinical deterioration and evaluate the performance of early warning scores.
更好地了解院前环境中病情恶化的患者，可能会带来更早的识别和应对。鉴于未被发现的病情恶化影响深远，报告院前临床恶化的发生率对于增进我们的理解至关重要。本研究调查了院前护理事件发生后3天内院前临床恶化和不良事件（AE）的发生率。
这项回顾性队列研究基于昆士兰救护服务中心在2018年1月1日至2020年12月31日期间接诊的成年患者的院前事件。由于缺乏院前临床恶化的标准化定义，通过院前生命体征计算既定的早期预警评分（NEWS、MEWS和Q-ADDS）来识别临床恶化。关联的医院数据用于确定AE的发生情况。
最初在超过半数的患者中观察到某种程度的生理紊乱，2.7%-4%的患者出现院前临床恶化。AE的发生率为3.2%。发生AE的患者更可能为男性、老年人、患有内科（非创伤性）疾病且疾病负担更重。令人担忧的是，几乎50%发生AE的患者未达到NEWS、MEWS或Q-ADDS的升级阈值。
本研究发现院前护理事件后院前临床恶化和AE的发生率较低。未来的研究应优先使用标准化标准来定义院前临床恶化，并评估早期预警评分的性能。
