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Characteristics of out-of-hospital shock care.
MedLine Citation:
PMID:  21705898     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE:: Regionalization of care is a potential strategy for the management of shock. There are no data describing the regional distribution of patients with out-of-hospital shock. We sought to describe the incidence, demographic, clinical, and regional characteristics of patients with traumatic and nontraumatic medical shock treated by out-of-hospital emergency medical services. DESIGN:: Descriptive study using Pennsylvania statewide emergency medical services patient care data. SETTING:: Commonwealth of Pennsylvania, 2006-2008. PATIENTS:: Adult (age ≥18 yrs) noncardiac arrest patients with shock, defined as initial systolic blood pressure ≤80 mm Hg. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: We compared patient characteristics, demographics, emergency medical services treatment, and regional differences between traumatic and nontraumatic medical shock. Of 3,327,306 adult nonarrest patients, 42,941 (1.29%; 95% confidence interval, 1.28% to 1.30%) had shock in the field, including 39,424 with medical shock and 3517 with traumatic shock. Patients with medical shock were more likely to be older, female, and treated by rural emergency medical services agencies and experienced longer transport times. County-level annual shock rates varied for medical (median, 99; interquartile range, 44-273; range, 5-1634) and traumatic (median, seven; interquartile range, 3-18; range, 0-300) cases. Per-capita shock rates varied for medical (median, 105 per 100,000 population; interquartile range, 83-128; range, 37-263) and traumatic (median, seven per 100,000 population; interquartile range, 5-10; range, 0-39) cases. The correlation between county-level total annual medical and traumatic shock rates was strong (ρ = .80). CONCLUSIONS:: While sharing similar regional distributions, key differences exist between emergency medical services patients with traumatic and nontraumatic shock. These differences identify opportunities for and barriers to regionalizing emergency medical services care of patients with shock.
Authors:
Henry E Wang; Nathan I Shapiro; Donald M Yealy
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-23
Journal Detail:
Title:  Critical care medicine     Volume:  -     ISSN:  1530-0293     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-6-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Department of Emergency Medicine (HEW), University of Alabama at Birmingham, Birmingham, AL; the Department of Emergency Medicine (NIS), Beth Israel Deaconess Medical Center, Boston, MA; and the Department of Emergency Medicine (DMY), University of Pittsburgh, Pittsburgh, PA.
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