The Value of Prehospital Early Warning Scores to Predict in - Hospital Clinical Deterioration: A Multicenter, Observational Base-Ambulance Study.

OBJECTIVES: Early warning scores are clinical tools capable of identifying prehospital patients with high risk of deterioration. We sought here to contrast the validity of seven early warning scores in the prehospital setting and specifically, to evaluate the predictive value of each score to determine early deterioration-risk during the hospital stay, including mortality at one, two, three and seven- days since the index event. Methods: A prospective multicenter observational based-ambulance study of patients treated by six advanced life support emergency services and transferred to five Spanish hospitals between October 1, 2018 and December 31, 2019. We collected demographic, clinical, and laboratory variables. Seven risk score were constructed based on the analysis of prehospital variables associated with death within one, two, three and seven days since the index event. The area under the receiver operating characteristics was used to determine the discriminant validity of each early warning score. Results: A total of 3,273 participants with acute diseases were accurately linked. The median age was 69 years (IQR, 54-81 years), 1,348 (41.1%) were females. The overall mortality rate for patients in the study cohort ranged from 3.5% for first-day mortality (114 cases), to 7% for seven-day mortality (228 cases). The scores with the best performances for one-day mortality were Vitalpac Early Warning Score with an area under the receiver operating characteristic (AUROC) of 0.873 (95% CI: 0.81-0.9), for two-day mortality, Triage Early Warning Score with an AUROC of 0.868 (95% CI: 0.83-0.9), for three and seven-days mortality the Modified Rapid Emergency Medicine Score with an AUROC of 0.857 (0.82-0.89) and 0.833 (95% CI: 0.8-0.86). In general, there were no significant differences between the scores analyzed. Conclusions: All the analyzed scores have a good predictive capacity for early mortality, and no statistically significant differences between them were found. The National Early Warning Score 2, at the clinical level, has certain advantages. Early warning scores are clinical tools that can help in the complex decision-making processes during critical moments, so their use should be generalized in all emergency medical services.

Estudio comparativo de la punción arterial ecoguiada frente a la técnica clásica / Comparative study between ultrasound-guided arterial puncture vs. the traditional technique

OBJETIVO: analizar los beneficios de la punción arterial ecoguiada (PAE) frente a la técnica de punción clásica (TPC) en cuanto al porcentaje de éxito en el primer intento de punción, siendo objetivos secundarios el tiempo empleado y el grado de dolor autorreferido. MATERIAL Y MÉTODO: estudio experimental controlado y aleatorizado de comparación entre la TPC y la PAE en pacientes mayores de catorce años que precisaron de extracción de sangre arterial. Muestreo probabilístico de 208 pacientes. Las variables analizadas fueron: el éxito a la primera punción, el tiempo empleado en realizar la técnica y el dolor autorreferido por el paciente postpunción medido a través de la escala visual numérica. RESULTADOS: se obtuvieron dos grupos de pacientes: 105 so-metidos a PAE y 103 a TPC, sin diferencias significativas en la edad y el sexo. El éxito en el primer intento de punción fue de 87,6% con la PAE frente al 58,3% con la TCP (p< 0,000); el tiempo empleado fue menor de 4 minutos en el 97,1% de PAE vs 75,7% de TPC (p< 0,001) y el dolor autorreferido fue valorado con una media de 3,1±2,2 después de la PAE vs 4,7±2,6 tras la TPC (p< 0,001). CONCLUSIONES: la PAE reduce el número de punciones para la obtención de la muestra arterial y disminuye el dolor autorreferido. La reducción de los tiempos diagnósticos, junto con la seguridad de obtención de sangre arterial, contribuye a una atención de Enfermería de mayor calidad

OBJECTIVE: to analyze the benefits of Ultrasound-Guided Arterial Puncture (UGAP) vs. Traditional Puncture Technique (TPT), in terms of success rate at the first puncture attempt, with time required and self-reported pain level as secondary objectives. MATERIALS AND METHOD: experimental study, controlled and randomized, between UGAP and TPT in patients over 14-year-old which required arterial blood extraction. Probability sample of 208 patients. Those variables analyzed were: success at first puncture, time required to conduct the technique, and post-puncture pain, self-reported by patients through the Visual Numeric Scale. RESULTS: two groups of patients were recruited: 105 undergoing UGAP and 103 undergoing TPT. There were no significant differences in age and gender. Success at the first puncture attempt was 87.6% with UGAP vs 58.3% with TPT (p< 0.000); the time required was under 4 minutes for 97.1% of UGAP vs 75.7% for TPT (p< 0.001), and self-reported pain was assessed with a mean of 3.1±2.2 after UGAP vs 4.7±2.6 after TPT (p< 0.001). CONCLUSIONS: UGAP reduces the number of punctures for acquiring the arterial sample, and reduces self-reported pain. A reduction in diagnostic times, as well as the safety in acquiring arterial blood, will contribute to a higher quality in Nursing care