A newly developed, easy‐to‐use prehospital drug‐derived score compared with three conventional scores: A prospective multicenter study

• Published in: European journal of clinical investigation 2024-10, Vol.55 (1), p.e14329-n/a
• Main Authors: Jurado‐Palomo, Jesús, Martin‐Conty, José Luis, Polonio‐López, Begoña, Bernal‐Jiménez, Juan J., Conty‐Serrano, Rosa, Dileone, Michele, Castro Villamor, Miguel A., Pozo Vegas, Carlos, López‐Izquierdo, Raúl, Rivera‐Picón, Cristina, Martín‐Rodríguez, Francisco, Sanz‐García, Ancor
• Format: Article
• Language: English
• Subjects: acute disease; Adult; Aged; Aged, 80 and over; Analgesics; Analgesics - therapeutic use; Antihypertensive Agents - therapeutic use; Antihypertensives; Area Under Curve; Bicarbonates; Decision making; Demographic variables; Diuretics; Diuretics - therapeutic use; Early Warning Score; Emergency medical care; Emergency Medical Services; Emergency warning programs; Female; Humans; Male; Middle Aged; Mortality; Norepinephrine; Original; point‐of‐care medication; Prospective Studies; risk assessment; Risk levels; ROC Curve; Tranexamic Acid - therapeutic use
• ISSN: 0014-2972; 1365-2362; 1365-2362
• DOI: 10.1111/eci.14329

Introduction The use of medications by emergency medical services (EMS) is increasing. Conventional scores are time‐consuming and therefore difficult to use in an emergency setting. For early decision‐making, an easy‐to‐use score based on the medications administered by the EMS may have prognostic value. The primary objective of this study was to develop the prehospital drug‐derived score (PDDS) for 2‐day mortality. Methods A prospective, multicenter, ambulance‐based cohort study was conducted in adults with undifferentiated acute diseases treated by EMS and transferred to the emergency department. Demographic data, prehospital diagnosis data, prehospital medication and variables for the calculation of the National Early Warning Score 2 (NEWS2), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) were collected. The PDDS was developed and validated, establishing three levels of risk of 2‐day mortality. The predictive capability of each score was determined by the area under the curve of the receiver operating characteristic curve (AUROC) and compared using the Delong's test (p‐value). Results A total of 6401 patients were included. The PDDS included age and the use of norepinephrine, analgesics, neuromuscular blocking agents, diuretics, antihypertensive agents, tranexamic acid, and bicarbonate. The AUROC of PDDS was .86 (95% CI: .816–.903) versus NEWS2 .866 (95% CI: .822–.911), p = .828; versus REMS .885 (95% CI: .845–.924), p = .311; versus RAPS .886 (95% CI: .846–.926), p = .335, respectively. Conclusion The newly developed easy‐to‐use prehospital drug‐derived PDDS score has an excellent predictive value of early mortality. The PDDS score was comparable to the conventional risk scores and therefore might serve as an alternative score in the prehospital emergency setting. A total of 6401 patients were included in this prospective, multicenter, ambulance‐based cohort study conducted in adults with unselected acute diseases. Advanced age and the use of certain medications were significant indicators of increased mortality risk. The primary outcome was cumulative all‐cause mortality at 2 days postindex prehospitalization (understood as the first advanced life support encounter with the patient on‐scene). The predictive capability of the prehospital drug‐derived score (PDDS) had an AUROC of .86 (95% CI: .817–.903), which is comparable to the other conventional scores. This score can help emergency medical service professionals in th