To Örebro University

oru.seÖrebro University Publications
Change search
Link to record
Permanent link

Direct link
Publications (10 of 105) Show all publications
Stassen, W., Tsegai, A. & Kurland, L. (2023). A Retrospective Geospatial Simulation Study of Helicopter Emergency Medical Services' Potential Time Benefit Over Ground Ambulance Transport in Northern South Africa.. Air Medical Journal, 42(6), 440-444
Open this publication in new window or tab >>A Retrospective Geospatial Simulation Study of Helicopter Emergency Medical Services' Potential Time Benefit Over Ground Ambulance Transport in Northern South Africa.
2023 (English)In: Air Medical Journal, ISSN 1067-991X, E-ISSN 1532-6497, Vol. 42, no 6, p. 440-444Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: One of the most important benefits of helicopter emergency medical services (HEMS) is a time benefit, either through expedited access to the casualty or a reduction in the transport time to definitive care. However, HEMS utilization does not come without risk to the public and crew or at an insignificant cost. Cost is an essential consideration for health policy decisions, especially in low- to middle-income countries, such as South Africa. The aim of this study was to determine whether there is a time benefit of HEMS dispatch in South Africa compared with simulated driving time. A secondary aim was to determine the distance from the incident site to the hospital at which a time benefit can be guaranteed.

METHODS: A retrospective study was undertaken by comparing the prehospital times of patients who underwent HEMS transportation with simulated ground emergency medical services (GEMS) transportation times. Handwritten patient records of actual flights were reviewed and analyzed. The actual flight times recorded were used to calculate the helicopter transport time, activation to scene time, scene time, and scene to hospital time. Times were assigned based on a nonsimultaneous dispatch model, as is used in South Africa. For each helicopter mission, Google Maps (Google Inc, Mountain View, CA) was used to simulate the fastest ground route from the same location of the incident to the same receiving hospital corrected for typical traffic trends. The actual HEMS and simulated GEMS times were compared using the paired t-test. Linear regression analysis was performed to determine a minimum driving distance at which HEMS provides a time benefit.

RESULTS: A total of 118 HEMS transports were analyzed, the majority of which were trauma related (n = 115, 97%). HEMS transport resulted in a mean time deficit of -15 minutes (95% confidence interval, -18 to -11; P < .05) compared with simulated GEMS drive times. After regression, HEMS transport provides a time benefit at a driving distance greater than 119 km.

CONCLUSION: The current study demonstrated that there was rarely a time benefit for actual primary emergency responses when HEMS was used compared with simulated driving time of GEMS transport. Using a nonsimultaneous dispatch model, a time benefit only occurs when the driving distance from the incident site to the hospital is greater than 119 km. There is an urgent need to critically evaluate HEMS utilization in the South African context.

Place, publisher, year, edition, pages
Elsevier, 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-110966 (URN)10.1016/j.amj.2023.07.005 (DOI)37996179 (PubMedID)2-s2.0-85166942514 (Scopus ID)
Available from: 2024-01-23 Created: 2024-01-23 Last updated: 2024-01-25Bibliographically approved
Strålin, K., Linder, A., Brink, M., Benjaminsson-Nyberg, P., Svefors, J., Bengtsson-Toni, M., . . . Kurland, L. (2023). Design of a national patient-centred clinical pathway for sepsis in Sweden. Infectious Diseases, 55(10), 716-724
Open this publication in new window or tab >>Design of a national patient-centred clinical pathway for sepsis in Sweden
Show others...
2023 (English)In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 55, no 10, p. 716-724Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The World Health Organization has adopted a resolution on sepsis and urged member states to develop national processes to improve sepsis care. In Sweden, sepsis was selected as one of the ten first diagnoses to be addressed, when the Swedish government in 2019 allocated funds for patient-centred clinical pathways in healthcare. A national multidisciplinary working group, including a patient representative, was appointed to develop the patient-centred clinical pathway for sepsis.

METHODS: The working group mapped challenges and needs surrounding sepsis care and included a survey sent to all emergency departments (ED) in Sweden, and then designed a patient-centred clinical pathway for sepsis.

RESULTS: The working group decided to focus on the following four areas: (1) sepsis alert for early detection and management optimisation for the most severely ill sepsis patients in the ED; (2) accurate sepsis diagnosis coding; (3) structured information to patients at discharge after sepsis care and (4) structured telephone follow-up after sepsis care. A health-economic analysis indicated that the implementation of the clinical pathway for sepsis will most likely not drive costs. An important aspect of the clinical pathway is implementing continuous monitoring of performance and process indicators. A national working group is currently building up such a system for monitoring, focusing on extraction of this information from the electronic health records systems.

CONCLUSION: A national patient-centred clinical pathway for sepsis has been developed and is currently being implemented in Swedish healthcare. We believe that the clinical pathway and the accompanying monitoring will provide a more efficient and equal sepsis care and improved possibilities to monitor and further develop sepsis care in Sweden.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
SOFA score, Sepsis, clinical pathway, discharge coding, sepsis alert, sepsis recovery
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-107467 (URN)10.1080/23744235.2023.2234033 (DOI)001035690300001 ()37477232 (PubMedID)2-s2.0-85163827076 (Scopus ID)
Available from: 2023-08-09 Created: 2023-08-09 Last updated: 2024-01-16Bibliographically approved
Becker, J., Kurland, L., Höglund, E. & Hugelius, K. (2023). Dynamic ambulance relocation: a scoping review. BMJ Open, 13(12), Article ID e073394.
Open this publication in new window or tab >>Dynamic ambulance relocation: a scoping review
2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 12, article id e073394Article, review/survey (Refereed) Published
Abstract [en]

Objectives Dynamic ambulance relocation means that the operators at a dispatch centre place an ambulance in a temporary location, with the goal of optimising coverage and response times in future medical emergencies. This study aimed to scope the current research on dynamic ambulance relocation.

Design A scoping review was conducted using a structured search in PubMed, Scopus and Web of Science. In total, 21 papers were included.

Results Most papers described research with experimental designs involving the use of mathematical models to calculate the optimal use and temporary relocations of ambulances. The models relied on several variables, including distances, locations of hospitals, demographic-geological data, estimation of new emergencies, emergency medical services (EMSs) working hours and other data. Some studies used historic ambulance dispatching data to develop models. Only one study reported a prospective, real-time evaluation of the models and the development of technical systems. No study reported on either positive or negative patient outcomes or real-life chain effects from the dynamic relocation of ambulances.

Conclusions Current knowledge on dynamic relocation of ambulances is dominated by mathematical and technical support data that have calculated optimal locations of ambulance services based on response times and not patient outcomes. Conversely, knowledge of how patient outcomes and the working environment are affected by dynamic ambulance dispatching is lacking. This review has highlighted several gaps in the scientific coverage of the topic. The primary concern is the lack of studies reporting on patient outcomes, and the limited knowledge regarding several key factors, including the optimal use of ambulances in rural areas, turnaround times, domino effects and aspects of working environment for EMS personnel. Therefore, addressing these knowledge gaps is important in future studies.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-110434 (URN)10.1136/bmjopen-2023-073394 (DOI)2-s2.0-85179899873 (Scopus ID)
Available from: 2023-12-18 Created: 2023-12-18 Last updated: 2024-02-23Bibliographically approved
Brown, R., Kurland, L. & Lojo Rial, C. (2023). How should we train emergency physicians for Quality and Safety activities?. European journal of emergency medicine, 30(6), 391-392
Open this publication in new window or tab >>How should we train emergency physicians for Quality and Safety activities?
2023 (English)In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 30, no 6, p. 391-392Article in journal, Editorial material (Refereed) Published
Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2023
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-108396 (URN)10.1097/MEJ.0000000000001081 (DOI)001089396400005 ()37729042 (PubMedID)2-s2.0-85175356708 (Scopus ID)
Available from: 2023-09-21 Created: 2023-09-21 Last updated: 2024-01-16Bibliographically approved
Tuerxun, K., Eklund, D., Wallgren, U., Dannenberg, K., Repsilber, D., Kruse, R., . . . Kurland, L. (2023). Predicting sepsis using a combination of clinical information and molecular immune markers sampled in the ambulance. Scientific Reports, 13(1), Article ID 14917.
Open this publication in new window or tab >>Predicting sepsis using a combination of clinical information and molecular immune markers sampled in the ambulance
Show others...
2023 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 13, no 1, article id 14917Article in journal (Refereed) Published
Abstract [en]

Sepsis is a time dependent condition. Screening tools based on clinical parameters have been shown to increase the identification of sepsis. The aim of current study was to evaluate the additional predictive value of immunological molecular markers to our previously developed prehospital screening tools. This is a prospective cohort study of 551 adult patients with suspected infection in the ambulance setting of Stockholm, Sweden between 2017 and 2018. Initially, 74 molecules and 15 genes related to inflammation were evaluated in a screening cohort of 46 patients with outcome sepsis and 50 patients with outcome infection no sepsis. Next, 12 selected molecules, as potentially synergistic predictors, were evaluated in combination with our previously developed screening tools based on clinical parameters in a prediction cohort (n = 455). Seven different algorithms with nested cross-validation were used in the machine learning of the prediction models. Model performances were compared using posterior distributions of average area under the receiver operating characteristic (ROC) curve (AUC) and difference in AUCs. Model variable importance was assessed by permutation of variable values, scoring loss of classification as metric and with model-specific weights when applicable. When comparing the screening tools with and without added molecular variables, and their interactions, the molecules per se did not increase the predictive values. Prediction models based on the molecular variables alone showed a performance in terms of AUCs between 0.65 and 0.70. Among the molecular variables, IL-1Ra, IL-17A, CCL19, CX3CL1 and TNF were significantly higher in septic patients compared to the infection non-sepsis group. Combing immunological molecular markers with clinical parameters did not increase the predictive values of the screening tools, most likely due to the high multicollinearity of temperature and some of the markers. A group of sepsis patients was consistently miss-classified in our prediction models, due to milder symptoms as well as lower expression levels of the investigated immune mediators. This indicates a need of stratifying septic patients with a priori knowledge of certain clinical and molecular parameters in order to improve prediction for early sepsis diagnosis.Trial registration: NCT03249597. Registered 15 August 2017.

Place, publisher, year, edition, pages
Nature Portfolio, 2023
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-108188 (URN)10.1038/s41598-023-42081-6 (DOI)001066443900002 ()37691028 (PubMedID)2-s2.0-85170487168 (Scopus ID)
Funder
Örebro UniversityNyckelfondenLaerdal Foundation for Acute MedicineKnowledge Foundation, 20160044 20200017
Note

This study was supported by grants from Nyckelfonden, Laerdal, Falck Foundation, Knowledge Foundation (20160044, 20200017), the Emergency Department of Södersjukhuset, Stockholm, and Örebro University.

Available from: 2023-09-11 Created: 2023-09-11 Last updated: 2024-01-16Bibliographically approved
Wu, L., Chen, X., Khalemsky, A., Li, D., Zoubeidi, T., Lauque, D., . . . Bellou, A. (2023). The Association between Emergency Department Length of Stay and In-Hospital Mortality in Older Patients Using Machine Learning: An Observational Cohort Study. Journal of Clinical Medicine, 12(14), Article ID 4750.
Open this publication in new window or tab >>The Association between Emergency Department Length of Stay and In-Hospital Mortality in Older Patients Using Machine Learning: An Observational Cohort Study
Show others...
2023 (English)In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 12, no 14, article id 4750Article in journal (Refereed) Published
Abstract [en]

The association between emergency department (ED) length of stay (EDLOS) with in-hospital mortality (IHM) in older patients remains unclear. This retrospective study aims to delineate the relationship between EDLOS and IHM in elderly patients. From the ED patients (n = 383,586) who visited an urban academic tertiary care medical center from January 2010 to December 2016, 78,478 older patients (age ≥60 years) were identified and stratified into three age subgroups: 60-74 (early elderly), 75-89 (late elderly), and ≥90 years (longevous elderly). We applied multiple machine learning approaches to identify the risk correlation trends between EDLOS and IHM, as well as boarding time (BT) and IHM. The incidence of IHM increased with age: 60-74 (2.7%), 75-89 (4.5%), and ≥90 years (6.3%). The best area under the receiver operating characteristic curve was obtained by Light Gradient Boosting Machine model for age groups 60-74, 75-89, and ≥90 years, which were 0.892 (95% CI, 0.870-0.916), 0.886 (95% CI, 0.861-0.911), and 0.838 (95% CI, 0.782-0.887), respectively. Our study showed that EDLOS and BT were statistically correlated with IHM (p < 0.001), and a significantly higher risk of IHM was found in low EDLOS and high BT. The flagged rate of quality assurance issues was higher in lower EDLOS ≤1 h (9.96%) vs. higher EDLOS 7 h <t≤ 8 h (1.84%). Special attention should be given to patients admitted after a short stay in the ED and a long BT, and new concepts of ED care processes including specific areas and teams dedicated to older patients care could be proposed to policymakers.

Place, publisher, year, edition, pages
MDPI, 2023
Keywords
Boarding time, emergency department, in-hospital mortality, length of stay, machine learning, older adults
National Category
Nursing Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-107484 (URN)10.3390/jcm12144750 (DOI)001037443600001 ()37510865 (PubMedID)2-s2.0-85166332423 (Scopus ID)
Note

This research was supported by the Youth Science Fund of the National Natural Science Foundation of China (Grant No. 61802149).

Available from: 2023-08-09 Created: 2023-08-09 Last updated: 2024-01-16Bibliographically approved
Schell, C. O., Wellhagen, A., Lipcsey, M., Kurland, L., Bjurling-Sjöberg, P., Stålsby Lundborg, C., . . . Baker, T. (2023). The burden of critical illness among adults in a Swedish region-a population-based point-prevalence study. European Journal of Medical Research, 28(1), Article ID 322.
Open this publication in new window or tab >>The burden of critical illness among adults in a Swedish region-a population-based point-prevalence study
Show others...
2023 (English)In: European Journal of Medical Research, ISSN 0949-2321, E-ISSN 2047-783X, Vol. 28, no 1, article id 322Article in journal (Refereed) Published
Abstract [en]

Background: Patients with critical illness have a high risk of mortality. Key decision-making in the health system affecting the outcomes of critically ill patients requires epidemiological evidence, but the burden of critical illness is largely unknown. This study aimed to estimate the prevalence of critical illness in a Swedish region. Secondary objectives were to estimate the proportion of hospital inpatients who are critically ill and to describe the in-hospital location of critically ill patients.

Methods: A prospective, multi-center, population-based, point-prevalence study on specific days in 2017-2018. All adult (> 18 years) in-patients, regardless of admitting specially, in all acute hospitals in Sörmland, and the patients from Sörmland who had been referred to university hospitals, were included. Patients in the operating theatres, with a psychiatric cause of admission, women in active labor and moribund patients, were excluded. All participants were examined by trained data collectors. Critical illness was defined as "a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and a potential for reversibility". The presence of one or more severely deranged vital signs was used to classify critical illness. The prevalence of critical illness was calculated as the number of critically ill patients divided by the number of adults in the region.

Results: A total of 1269 patients were included in the study. Median age was 74 years and 50% of patients were female. Critical illness was present in 133 patients, resulting in an adult population prevalence of critical illness per 100,000 people of 19.4 (95% CI 16.4-23.0). The proportion of patients in hospital who were critically ill was 10.5% (95% CI 8.8-12.3%). Among the critically ill, 125 [95% CI 94.0% (88.4-97.0%)] were cared for in general wards.

Conclusions. The prevalence of critical illness was higher than previous, indirect estimates. One in ten hospitalized patients were critically ill, the large majority of which were cared for in general wards. This suggests a hidden burden of critical illness of potential public health, health system and hospital management significance.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-108194 (URN)10.1186/s40001-023-01279-0 (DOI)001064985300003 ()37679836 (PubMedID)2-s2.0-85170177206 (Scopus ID)
Funder
Karolinska Institute
Note

Funding agencies:

Centre for Clinical Research Soermland, Uppsala University, Sweden (COS) DLL-652801

Regional Research Council Mid Sweden (COS, AW) RFR-931271

 

Available from: 2023-09-11 Created: 2023-09-11 Last updated: 2024-01-16Bibliographically approved
Torlén Wennlund, K., Kurland, L., Olanders, K., Castrén, M. & Bohm, K. (2022). A registry-based observational study comparing emergency calls assessed by emergency medical dispatchers with and without support by registered nurses. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 30(1), Article ID 1.
Open this publication in new window or tab >>A registry-based observational study comparing emergency calls assessed by emergency medical dispatchers with and without support by registered nurses
Show others...
2022 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 30, no 1, article id 1Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The requirement concerning formal education for emergency medical dispatcher (EMD) is debated and varies, both nationally and internationally. There are few studies on the outcomes of emergency medical dispatching in relation to professional background. This study aimed to compare calls handled by an EMD with and without support by a registered nurse (RN), with respect to priority level, accuracy, and medical condition.

METHODS: A retrospective observational study, performed on registry data from specific regions during 2015. The ambulance personnel's first assessment of the priority level and medical condition was used as the reference standard. Outcomes were: the proportion of calls dispatched with a priority in concordance with the ambulance personnel's assessment; over- and undertriage; the proportion of most adverse over- and undertriage; sensitivity, specificity and predictive values for each of the ambulance priorities; proportion of calls dispatched with a medical condition in concordance with the ambulance personnel's assessment. Proportions were reported with 95% confidence intervals. χ2-test was used for comparisons. P-levels < 0.05 were regarded as significant.

RESULTS: A total of 25,025 calls were included (EMD n = 23,723, EMD + RN n = 1302). Analyses relating to priority and medical condition were performed on 23,503 and 21,881 calls, respectively. A dispatched priority in concordance with the ambulance personnel's assessment were: EMD n = 11,319 (50.7%) and EMD + RN n = 481 (41.5%) (p < 0.01). The proportion of overtriage was equal for both groups: EMD n = 5904, EMD + RN n = 306, (26.4%) p = 0.25). The proportion of undertriage for each group was: EMD n = 5122 (22.9%) and EMD + RN n = 371 (32.0%) (p < 0.01). Sensitivity for the most urgent priority was 54.6% for EMD, compared to 29.6% for EMD + RN (p < 0.01), and specificity was 67.3% and 84.8% (p < 0.01) respectively. A dispatched medical condition in concordance with the ambulance personnel's assessment were: EMD n = 13,785 (66.4%) and EMD + RN n = 697 (62.2%) (p = 0.01).

CONCLUSIONS: A higher precision of emergency medical dispatching was not observed when the EMD was supported by an RN. How patient safety is affected by the observed divergence in dispatched priorities is an area for future research.

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Emergency Medical Communication Center, Emergency medical dispatch, Emergency medical dispatcher, Emergency medical services, Pre-hospital triage, Registered nurse
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-96412 (URN)10.1186/s13049-021-00987-y (DOI)000741023200002 ()35012595 (PubMedID)2-s2.0-85122755121 (Scopus ID)
Funder
The Karolinska Institutet's Research FoundationSwedish Research Council, 20190939
Available from: 2022-01-12 Created: 2022-01-12 Last updated: 2024-01-17Bibliographically approved
Cheng, I., Andersson, J., Lundqvist, C. & Kurland, L. (2022). An observational pilot study: Prevalence and cost of high frequency emergency department users at Örebro University Hospital, Sweden. PLOS ONE, 17(9), Article ID e0274622.
Open this publication in new window or tab >>An observational pilot study: Prevalence and cost of high frequency emergency department users at Örebro University Hospital, Sweden
2022 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 9, article id e0274622Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is little research on high frequency emergency department users (HEDU) in Sweden. We aim to determine the prevalence and costs of HEDU compared to non-HEDU at Örebro University Hospital (ÖUH). Additionally, we will determine the factors and outcomes associated with being a HEDU.

METHODS: This was a retrospective, observational cohort study of ED patients presenting to ÖUH, Sweden between 2018-19. Analyses used electronic registry, ambulance, and cost data. The definition for HEDU was ≥4 visits/year. HEDUs were categorized further into Repeat, High and Super HEDU with 4-7, 8-18 and ≥19 visits/year, respectively. We used multivariable logistic regression to determine the adjusted odds ratios for factors and outcomes between HEDU and non-HEDU.

FINDINGS: Of all ÖUH ED patients, 6.1% were HEDU and accounted for 22.4% of ED visits and associated costs. Compared to the mean cost of non-HEDU, the Repeat, High and Super HEDU were more costly by factors of 4, 8 and 27, respectively. The HEDUs were more likely to be male, self-referred, present with abdominal pain, arrive by ambulance, at night and from the Örebro municipal region. Super HEDU were more likely to be of adult age and assigned lower acuity scores. HEDU were more likely to be directed to the surgical zone, less likely to receive radiologic imaging or achieve a 4-hr time target. In contrast to the Repeat and High HEDU, Super HEDU were less likely to be admitted, but more likely to leave without being seen.

CONCLUSION: ÖUH has a HEDU population with associated factors and outcomes. They account for a substantial proportion of ED costs compared to non-HEDU.

Place, publisher, year, edition, pages
PLOS, 2022
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-101418 (URN)10.1371/journal.pone.0274622 (DOI)000892087100092 ()36107928 (PubMedID)2-s2.0-85137925501 (Scopus ID)
Available from: 2022-09-23 Created: 2022-09-23 Last updated: 2024-01-16Bibliographically approved
Wallgren, U. M., Järnbert-Pettersson, H., Sjölin, J. & Kurland, L. (2022). Association between variables measured in the ambulance and in-hospital mortality among adult patients with and without infection: a prospective cohort study. BMC Emergency Medicine, 22(1), Article ID 185.
Open this publication in new window or tab >>Association between variables measured in the ambulance and in-hospital mortality among adult patients with and without infection: a prospective cohort study
2022 (English)In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 22, no 1, article id 185Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Patients presenting with infection to the ambulance are common, but risk factors for poor outcome are not known. The primary aim of the current study was to study the association between variables measured in the ambulance and mortality among adult patients with and without infection. The secondary aim was to study the association between these variables and mortality in a subgroup of patients who developed sepsis within 36 h.

METHODS: Prospective cohort study of 553 ambulance patients with, and 318 patients without infection, performed in Stockholm during 2017-2018. The association between 21 variables (8 keywords related to medical history, 6 vital signs, 4 blood tests, and age, gender, comorbidity) and in-hospital mortality was analysed using logistic regression.

RESULTS: Among patients with infection, inability of the patient to answer questions relating to certain symptoms such as pain and gastrointestinal symptoms was significantly associated with mortality in univariable analysis, in addition to oxygen saturation < 94%, heart rate > 110 /min, Glasgow Coma Scale (GCS) < 15, soluble urokinase Plasminogen Activator Receptor (suPAR) 4.0-7.9 ng/mL, suPAR ≥ 8.0 ng/mL and a Charlson comorbidity score ≥ 5. suPAR ≥ 8.0 ng/mL remained significant in multivariable analysis (OR 25.4; 95% CI, 3.2-199.8). Among patients without infection, suPAR ≥ 8.0 ng/mL and a Charlson comorbidity score ≥ 5 were significantly associated with mortality in univariable analysis, while suPAR ≥ 8.0 ng/mL remained significant in multivariable analysis (OR 56.1; 95% CI, 4.5-700.0). Among patients who developed sepsis, inability to answer questions relating to pain remained significant in multivariable analysis (OR 13.2; 95% CI, 2.2-78.9), in addition to suPAR ≥ 8.0 ng/mL (OR 16.1; 95% CI, 2.0-128.6).

CONCLUSIONS: suPAR ≥ 8.0 ng/mL was associated with mortality in patients presenting to the ambulance both with and without infection and in those who developed sepsis. Furthermore, the inability of the ambulance patient with an infection to answer questions relating to specific symptoms was associated with a surprisingly high mortality. These results suggest that suPAR and medical history are valuable tools with which to identify patients at risk of poor outcome in the ambulance and could potentially signal the need of enhanced attention.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT03249597. Registered 15 August 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03249597 .

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022
Keywords
Emergency care, Emergency medical services, Infection, Mortality, Prehospital, Sepsis
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-102429 (URN)10.1186/s12873-022-00746-x (DOI)000886964800003 ()36418966 (PubMedID)2-s2.0-85142435309 (Scopus ID)
Funder
Örebro University
Note

Funding agencies:

Laerdal, Falck Foundation

Emergency Department of Södersjukhuset, Stockholm, Örebro University

Nyckelfonden

Available from: 2022-11-28 Created: 2022-11-28 Last updated: 2024-01-16Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3290-4111

Search in DiVA

Show all publications