Association between patient signs and symptoms and critical care center admissions in prehospital settings: a retrospective observational study

Abstract

Background The system to ensure the quality of care when doctors entrust prehospital care to qualified non-doctors is called Medical Control (MC) in Japan. There have been few previous studies that have focused on prehospital care as a way to predict admission to critical care centers. Therefore, we attempted to clarify the factors in prehospital settings that predict admission to critical care centers. We believe that this will help establish an MC system, including the role of emergency medical technicians (EMTs) and doctors in selecting emergency transport destinations. Methods This retrospective observational study included 1685 adult patients admitted through the Emergency Department (ED) of a 700-bed tertiary care facility over a 9-month period. The main predictive variables were prehospital patient factors, which were broadly categorized into vital signs, signs of shock, and respiratory symptoms. Prehospital patient factors were collected from prehospital records registered in electronic medical records, and a multivariate logistic regression model was used to analyze the association between prehospital patient factors and admission to the critical care center. Results A total of 1,685 patients who did not meet the exclusion criteria out of 2,353 patients transported by emergency were analyzed: 350 patients were admitted to the critical care center, 642 patients were admitted to the general ward, and 693 patients returned home. The subjects were patients who were rushed to the ED, and patient data were collected from electronic medical records and emergency transport forms. The level of consciousness, cyanosis, skin wetness, and coldness at the time of contact with emergency services were significantly associated with admission to the critical care center (OR 0.92 [0.87–0.97], p = 0.001; OR 2.93 [1.75–4.92], p < 0.001; OR 3.87 [2.63–5.67], p < 0.001; OR 9.57 [5.18–18.3], p < 0.001). Conclusion In a prehospital setting, the level of consciousness and signs of shock were suggested to be associated with admission to critical care centers.