Association between using a prehospital assessment unit and hospital admission and mortality: a matched cohort study

Signe Amalie Wolthers; Stig Nikolaj Fasmer Blomberg; Niklas Breindahl; Sair Anjum; Daniel Hägi-Pedersen; Annette Ersbøll; Lars Bredevang Andersen; Helle Collatz Christensen

doi:10.1136/bmjopen-2023-075592

Association between using a prehospital assessment unit and hospital admission and mortality: a matched cohort study

Signe Amalie Wolthers, Stig Nikolaj Fasmer Blomberg, Niklas Breindahl, Sair Anjum, Daniel Hägi-Pedersen, Annette Ersbøll, Lars Bredevang Andersen, Helle Collatz Christensen

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

OBJECTIVES: This study aimed to compare hospital admission and 30-day mortality between patients assessed by the prehospital assessment unit (PAU) and patients not assessed by the PAU.

DESIGN: This was a matched cohort study.

SETTING: This study was conducted between November 2021 and October 2022 in Region Zealand, Denmark.

PARTICIPANTS: 989 patients aged >18, assessed by the PAU, were identified, and 9860 patients not assessed by the PAU were selected from the emergency calls using exposure density sampling.

EXPOSURE: Patients assessed by the PAU. The PAU is operated by paramedics with access to point-of-care test facilities. The PAU is an alternative response vehicle without the capability of transporting patients.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was hospital admission within 48 hours after the initial call. The key secondary outcomes were admission within 7 days, 30-day mortality and admission within 6 hours. Descriptive statistical analyses were conducted, and logistic regression models were used to estimate adjusted OR (aOR) and 95% CI.

RESULTS: Among the PAU assessed, 44.1% were admitted within 48 hours, compared with 72.9% of the non-PAU assessed, p<0.001. The multivariable analysis showed a lower risk of admission within 48 hours and 7 days among the PAU patients, aOR 0.31 (95% CI 0.26 to 0.38) and aOR 0.50 (95% CI 0.38 to 0.64), respectively. The 30-day mortality rate was 3.8% in the PAU-assessed patients vs 5.5% in the non-PAU-assessed patients, p=0.03. In the multivariable analysis, no significant difference was found in mortality aOR 0.99 (95% CI 0.71 to 1.42). No deaths were observed in PAU-assessed patients without subsequent follow-up.

CONCLUSION: The recently introduced PAU aims for patient-centred emergency care. The PAU-assessed patients had reduced admissions within 48 hours and 7 days after the initial call. Study findings indicate that the PAU is safe since we identified no significant differences in 30-day mortality.

TRIAL REGISTRATION NUMBER: NCT05654909.

Original language	English
Article number	e075592
Journal	BMJ Open
Volume	13
Issue number	9
Number of pages	9
ISSN	2044-6055
DOIs	https://doi.org/10.1136/bmjopen-2023-075592
Publication status	Published - 2023

Bibliographical note

Keywords

Humans
Cohort Studies
Emergency Medical Services
Hospitalization
Hospitals

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Association between using a prehospital assessment unit and hospital admission and mortality : a matched cohort study. / Wolthers, Signe Amalie; Blomberg, Stig Nikolaj Fasmer; Breindahl, Niklas; Anjum, Sair; Hägi-Pedersen, Daniel; Ersbøll, Annette; Andersen, Lars Bredevang; Christensen, Helle Collatz.

In: BMJ Open, Vol. 13, No. 9, e075592, 2023.

Research output: Contribution to journal › Journal article › Research › peer-review

@article{92a6bb7fb9ac4f6a909b7458a2419b7d,

title = "Association between using a prehospital assessment unit and hospital admission and mortality: a matched cohort study",

abstract = "OBJECTIVES: This study aimed to compare hospital admission and 30-day mortality between patients assessed by the prehospital assessment unit (PAU) and patients not assessed by the PAU.DESIGN: This was a matched cohort study.SETTING: This study was conducted between November 2021 and October 2022 in Region Zealand, Denmark.PARTICIPANTS: 989 patients aged >18, assessed by the PAU, were identified, and 9860 patients not assessed by the PAU were selected from the emergency calls using exposure density sampling.EXPOSURE: Patients assessed by the PAU. The PAU is operated by paramedics with access to point-of-care test facilities. The PAU is an alternative response vehicle without the capability of transporting patients.PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was hospital admission within 48 hours after the initial call. The key secondary outcomes were admission within 7 days, 30-day mortality and admission within 6 hours. Descriptive statistical analyses were conducted, and logistic regression models were used to estimate adjusted OR (aOR) and 95% CI.RESULTS: Among the PAU assessed, 44.1% were admitted within 48 hours, compared with 72.9% of the non-PAU assessed, p<0.001. The multivariable analysis showed a lower risk of admission within 48 hours and 7 days among the PAU patients, aOR 0.31 (95% CI 0.26 to 0.38) and aOR 0.50 (95% CI 0.38 to 0.64), respectively. The 30-day mortality rate was 3.8% in the PAU-assessed patients vs 5.5% in the non-PAU-assessed patients, p=0.03. In the multivariable analysis, no significant difference was found in mortality aOR 0.99 (95% CI 0.71 to 1.42). No deaths were observed in PAU-assessed patients without subsequent follow-up.CONCLUSION: The recently introduced PAU aims for patient-centred emergency care. The PAU-assessed patients had reduced admissions within 48 hours and 7 days after the initial call. Study findings indicate that the PAU is safe since we identified no significant differences in 30-day mortality.TRIAL REGISTRATION NUMBER: NCT05654909.",

keywords = "Humans, Cohort Studies, Emergency Medical Services, Hospitalization, Hospitals",

author = "Wolthers, {Signe Amalie} and Blomberg, {Stig Nikolaj Fasmer} and Niklas Breindahl and Sair Anjum and Daniel H{\"a}gi-Pedersen and Annette Ersb{\o}ll and Andersen, {Lars Bredevang} and Christensen, {Helle Collatz}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2023",

doi = "10.1136/bmjopen-2023-075592",

language = "English",

volume = "13",

journal = "BMJ Open",

issn = "2044-6055",

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TY - JOUR

T1 - Association between using a prehospital assessment unit and hospital admission and mortality

T2 - a matched cohort study

AU - Wolthers, Signe Amalie

AU - Blomberg, Stig Nikolaj Fasmer

AU - Breindahl, Niklas

AU - Anjum, Sair

AU - Hägi-Pedersen, Daniel

AU - Ersbøll, Annette

AU - Andersen, Lars Bredevang

AU - Christensen, Helle Collatz

PY - 2023

Y1 - 2023

N2 - OBJECTIVES: This study aimed to compare hospital admission and 30-day mortality between patients assessed by the prehospital assessment unit (PAU) and patients not assessed by the PAU.DESIGN: This was a matched cohort study.SETTING: This study was conducted between November 2021 and October 2022 in Region Zealand, Denmark.PARTICIPANTS: 989 patients aged >18, assessed by the PAU, were identified, and 9860 patients not assessed by the PAU were selected from the emergency calls using exposure density sampling.EXPOSURE: Patients assessed by the PAU. The PAU is operated by paramedics with access to point-of-care test facilities. The PAU is an alternative response vehicle without the capability of transporting patients.PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was hospital admission within 48 hours after the initial call. The key secondary outcomes were admission within 7 days, 30-day mortality and admission within 6 hours. Descriptive statistical analyses were conducted, and logistic regression models were used to estimate adjusted OR (aOR) and 95% CI.RESULTS: Among the PAU assessed, 44.1% were admitted within 48 hours, compared with 72.9% of the non-PAU assessed, p<0.001. The multivariable analysis showed a lower risk of admission within 48 hours and 7 days among the PAU patients, aOR 0.31 (95% CI 0.26 to 0.38) and aOR 0.50 (95% CI 0.38 to 0.64), respectively. The 30-day mortality rate was 3.8% in the PAU-assessed patients vs 5.5% in the non-PAU-assessed patients, p=0.03. In the multivariable analysis, no significant difference was found in mortality aOR 0.99 (95% CI 0.71 to 1.42). No deaths were observed in PAU-assessed patients without subsequent follow-up.CONCLUSION: The recently introduced PAU aims for patient-centred emergency care. The PAU-assessed patients had reduced admissions within 48 hours and 7 days after the initial call. Study findings indicate that the PAU is safe since we identified no significant differences in 30-day mortality.TRIAL REGISTRATION NUMBER: NCT05654909.

AB - OBJECTIVES: This study aimed to compare hospital admission and 30-day mortality between patients assessed by the prehospital assessment unit (PAU) and patients not assessed by the PAU.DESIGN: This was a matched cohort study.SETTING: This study was conducted between November 2021 and October 2022 in Region Zealand, Denmark.PARTICIPANTS: 989 patients aged >18, assessed by the PAU, were identified, and 9860 patients not assessed by the PAU were selected from the emergency calls using exposure density sampling.EXPOSURE: Patients assessed by the PAU. The PAU is operated by paramedics with access to point-of-care test facilities. The PAU is an alternative response vehicle without the capability of transporting patients.PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was hospital admission within 48 hours after the initial call. The key secondary outcomes were admission within 7 days, 30-day mortality and admission within 6 hours. Descriptive statistical analyses were conducted, and logistic regression models were used to estimate adjusted OR (aOR) and 95% CI.RESULTS: Among the PAU assessed, 44.1% were admitted within 48 hours, compared with 72.9% of the non-PAU assessed, p<0.001. The multivariable analysis showed a lower risk of admission within 48 hours and 7 days among the PAU patients, aOR 0.31 (95% CI 0.26 to 0.38) and aOR 0.50 (95% CI 0.38 to 0.64), respectively. The 30-day mortality rate was 3.8% in the PAU-assessed patients vs 5.5% in the non-PAU-assessed patients, p=0.03. In the multivariable analysis, no significant difference was found in mortality aOR 0.99 (95% CI 0.71 to 1.42). No deaths were observed in PAU-assessed patients without subsequent follow-up.CONCLUSION: The recently introduced PAU aims for patient-centred emergency care. The PAU-assessed patients had reduced admissions within 48 hours and 7 days after the initial call. Study findings indicate that the PAU is safe since we identified no significant differences in 30-day mortality.TRIAL REGISTRATION NUMBER: NCT05654909.

KW - Humans

KW - Cohort Studies

KW - Emergency Medical Services

KW - Hospitalization

KW - Hospitals

U2 - 10.1136/bmjopen-2023-075592

DO - 10.1136/bmjopen-2023-075592

M3 - Journal article

C2 - 37739475

VL - 13

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 9

M1 - e075592

ER -