BMJ Open (Sep 2023)

Association between using a prehospital assessment unit and hospital admission and mortality: a matched cohort study

  • Stig Nikolaj Fasmer Blomberg,
  • Daniel Hägi-Pedersen,
  • Niklas Breindahl,
  • Signe Amalie Wolthers,
  • Sair Anjum,
  • Annette Ersbøll,
  • Lars Bredevang Andersen,
  • Helle Collatz Christensen

DOI
https://doi.org/10.1136/bmjopen-2023-075592
Journal volume & issue
Vol. 13, no. 9

Abstract

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Objectives This study aimed to compare hospital admission and 30-day mortality between patients assessed by the prehospital assessment unit (PAU) and patients not assessed by the PAU.Design This was a matched cohort study.Setting This study was conducted between November 2021 and October 2022 in Region Zealand, Denmark.Participants 989 patients aged >18, assessed by the PAU, were identified, and 9860 patients not assessed by the PAU were selected from the emergency calls using exposure density sampling.Exposure Patients assessed by the PAU. The PAU is operated by paramedics with access to point-of-care test facilities. The PAU is an alternative response vehicle without the capability of transporting patients.Primary and secondary outcome measures The primary outcome was hospital admission within 48 hours after the initial call. The key secondary outcomes were admission within 7 days, 30-day mortality and admission within 6 hours. Descriptive statistical analyses were conducted, and logistic regression models were used to estimate adjusted OR (aOR) and 95% CI.Results Among the PAU assessed, 44.1% were admitted within 48 hours, compared with 72.9% of the non-PAU assessed, p<0.001. The multivariable analysis showed a lower risk of admission within 48 hours and 7 days among the PAU patients, aOR 0.31 (95% CI 0.26 to 0.38) and aOR 0.50 (95% CI 0.38 to 0.64), respectively. The 30-day mortality rate was 3.8% in the PAU-assessed patients vs 5.5% in the non-PAU-assessed patients, p=0.03. In the multivariable analysis, no significant difference was found in mortality aOR 0.99 (95% CI 0.71 to 1.42). No deaths were observed in PAU-assessed patients without subsequent follow-up.Conclusion The recently introduced PAU aims for patient-centred emergency care. The PAU-assessed patients had reduced admissions within 48 hours and 7 days after the initial call. Study findings indicate that the PAU is safe since we identified no significant differences in 30-day mortality.Trial registration number NCT05654909.