RT info:eu-repo/semantics/doctoralThesis
T1 Estudio de factores predictores precoces de mortalidad a corto y largo plazo en pacientes agudos trasportados por los servicios de emergencia prehospitalarios
A1 Enríquez De Salamanca Gambara, RodrIgo
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Urgencias médicas
K1 Prehospital emergency
K1 Emergencia prehospitalaria
K1 Long term mortality
K1 Mortalidad a largo plazo
K1 Predictive models
K1 Modelos predictivos
K1 32 Ciencias Médicas
AB Introduction: The development of predictive models for patients treated by emergency medical services (EMS) is booming in the field of emergencies. However, how these models evolve over time has not been studied. The objective of this work is to identify factors that influence mortality in the short, medium and long term, and to derive and validate a predictive model for each moment of mortality.Methods: Three multicenter, prospective, observational, controlled and ambulance studies have been designed of adult patients transferred by ambulance to the emergency services (ED) for any cause. A total of six Advanced Life Support (ALS) units, 38 Basic Life Support (BLS) units and five hospitals in Spain were included. Physiological, biochemical, demographic variables and reasons for transfer were collected. The first study carried out was a longitudinal analysis to determine the factors associated with long-term mortality (from any cause). The second was a comparative study between different early warning and long-term mortality scales. The last was a study of predictors of mortality among cohorts of deceased patients in the short, medium and long term.Results E1: 1,406 patients. One-year mortality: 21.6% (n = 304). Mortality <48 hours: 5.2%; between day 2 and 30: 5.3%; between day 31 and: 11.1%. Low Glasgow values, high lactate levels, high blood urea nitrogen (BUN) levels, low oxygen saturation, high respiratory rate, as well as advanced age and having circulatory and neurological diseases were factors of risk for long-term mortality.Results E2: 2674 patients The primary outcome was long-term mortality with 1-year follow-up. Scores compared: National Early Warning Score 2, VitalPAC early alert score, modified rapid emergency medicine score (MREMS), Sepsis-related Organ Failure Assessment, Cardiac Arrest Risk Triage Score, Rapid Acute Physiology Score and Triage Early Warning Score. Discriminant power [area under the receiver operating characteristic curve (AUC)] and decision curve analysis (DCA) were used to compare scores. Additionally, a Cox regression and the Kaplan-Meier method were used. The MREMS had the highest AUC of 0.77 (95% confidence interval, 0.75-0.79), significantly higher than those of the other EWS. It also showed the best performance in DCA and the highest hazard ratio for 1-year mortality [3.56 (2.94-4.31) for MREMS between 9 and 18 points, and 11.71 (7.21 -19.02) for MREMS > 18].E3 results: 4,830 patients. Non-cumulative mortalities at 30, 180 and 365 days were 10.8%, 6.6% and 3.5%, respectively. The best predictive value was shown for 30-day mortality (AUC = 0.930; 95% CI: 0.919-0.940), followed by 180-day mortality (AUC = 0.852; 95% CI: 0.832-0.871) and at 365 days (AUC = 0.806; 95% CI: 0.778-0.833).Conclusions: Rapid identification of patients at risk of long-term worsening could provide an opportunity to personalize care through targeted follow-up. Among the seven EWS evaluated, the use of the MREMS presented better characteristics for predicting 1-year mortality; However, all these scores present moderate performances. There are early characteristics that help the rapid characterization of patients at risk of mortality in the short, medium or long term could help EMS to improve the treatment of patients suffering from acute illnesses.
YR 2024
FD 2024
LK https://uvadoc.uva.es/handle/10324/75241
UL https://uvadoc.uva.es/handle/10324/75241
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 14-abr-2025