Clinical characteristics and course of out‐of‐hospital shock in a national emergency medical services cohort
Abstract Background Shock from medical and traumatic conditions can result in organ injury and death. Limited data describe out‐of‐hospital treatment of shock. We sought to characterize adult out‐of‐hospital shock care in a national emergency medical services (EMS) cohort. Methods This cross‐section...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-08-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12090 |
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| author | Timothy P. George Hei Kit Chan Remle P. Crowe Jeffrey L. Jarvis Jan O. Jansen Ryan M. Huebinger Henry E. Wang |
| author_facet | Timothy P. George Hei Kit Chan Remle P. Crowe Jeffrey L. Jarvis Jan O. Jansen Ryan M. Huebinger Henry E. Wang |
| author_sort | Timothy P. George |
| collection | DOAJ |
| description | Abstract Background Shock from medical and traumatic conditions can result in organ injury and death. Limited data describe out‐of‐hospital treatment of shock. We sought to characterize adult out‐of‐hospital shock care in a national emergency medical services (EMS) cohort. Methods This cross‐sectional study used 2018 data from ESO, Inc. (Austin, TX), a national EMS electronic health record system, containing data from 1289 EMS agencies in the United States. We included adult (age ≥18 years) non‐cardiac arrest patients with shock, defined as initial systolic blood pressure ≤80 mm Hg. We compared patient demographics, clinical characteristics, and response (defined as systolic blood pressure increase) between medical and traumatic shock patients, looking at systolic blood pressure trends over the first 90 minutes of care. Results Among 6,156,895 adult 911 responses, shock was present in 62,867 (1.02%; 95% confidence interval [CI] = 1.01%–1.03%); 54,239 (86.3%) medical and 5978 (9.5%) traumatic, and 2650 unknown. Medical was more common than traumatic shock in women and older patients. The most common injuries associated with traumatic shock were falls (37.6%) and motor vehicle crashes (18.7%). Mean initial and final medical systolic blood pressure were 71 ± 10 mm Hg and 99 ± 24 mm Hg. Systolic blood pressure increased in 88.8% and decreased or did not change in 11.0%. Mean initial and final trauma systolic blood pressure were 71 ± 13 mm Hg and 105 ± 28 mm Hg; systolic blood pressure increased in 90.4% and decreased/did not change in 9.6%. On fractional polynomial modeling, systolic blood pressure changes were greater and faster for trauma than medical shock. Conclusions In this national series, 1 of every 100 EMS encounters involved shock. These findings highlight the current course and care of shock in the out‐of‐hospital setting. |
| format | Article |
| id | doaj-art-2194a1a3d355463081b2d5f1cbc408ae |
| institution | Kabale University |
| issn | 2688-1152 |
| language | English |
| publishDate | 2020-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-2194a1a3d355463081b2d5f1cbc408ae2025-08-20T03:49:08ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522020-08-011443243910.1002/emp2.12090Clinical characteristics and course of out‐of‐hospital shock in a national emergency medical services cohortTimothy P. George0Hei Kit Chan1Remle P. Crowe2Jeffrey L. Jarvis3Jan O. Jansen4Ryan M. Huebinger5Henry E. Wang6McGovern Medical School University of Texas Health Science Center at Houston Houston Texas USADepartment of Biostatistics School of Public Health The University of Texas Health Science Center at Houston Houston Texas USAESO Inc. Austin Texas USAWilliamson County Emergency Medical Services Georgetown Texas USACenter for Injury Science University of Alabama at Birmingham Birmingham Alabama USADepartment of Emergency Medicine The University of Texas Health Science Center at Houston Houston Texas USADepartment of Emergency Medicine The University of Texas Health Science Center at Houston Houston Texas USAAbstract Background Shock from medical and traumatic conditions can result in organ injury and death. Limited data describe out‐of‐hospital treatment of shock. We sought to characterize adult out‐of‐hospital shock care in a national emergency medical services (EMS) cohort. Methods This cross‐sectional study used 2018 data from ESO, Inc. (Austin, TX), a national EMS electronic health record system, containing data from 1289 EMS agencies in the United States. We included adult (age ≥18 years) non‐cardiac arrest patients with shock, defined as initial systolic blood pressure ≤80 mm Hg. We compared patient demographics, clinical characteristics, and response (defined as systolic blood pressure increase) between medical and traumatic shock patients, looking at systolic blood pressure trends over the first 90 minutes of care. Results Among 6,156,895 adult 911 responses, shock was present in 62,867 (1.02%; 95% confidence interval [CI] = 1.01%–1.03%); 54,239 (86.3%) medical and 5978 (9.5%) traumatic, and 2650 unknown. Medical was more common than traumatic shock in women and older patients. The most common injuries associated with traumatic shock were falls (37.6%) and motor vehicle crashes (18.7%). Mean initial and final medical systolic blood pressure were 71 ± 10 mm Hg and 99 ± 24 mm Hg. Systolic blood pressure increased in 88.8% and decreased or did not change in 11.0%. Mean initial and final trauma systolic blood pressure were 71 ± 13 mm Hg and 105 ± 28 mm Hg; systolic blood pressure increased in 90.4% and decreased/did not change in 9.6%. On fractional polynomial modeling, systolic blood pressure changes were greater and faster for trauma than medical shock. Conclusions In this national series, 1 of every 100 EMS encounters involved shock. These findings highlight the current course and care of shock in the out‐of‐hospital setting.https://doi.org/10.1002/emp2.12090emergency medical serviceshypotensionparamedicsresuscitationsepsisshock |
| spellingShingle | Timothy P. George Hei Kit Chan Remle P. Crowe Jeffrey L. Jarvis Jan O. Jansen Ryan M. Huebinger Henry E. Wang Clinical characteristics and course of out‐of‐hospital shock in a national emergency medical services cohort Journal of the American College of Emergency Physicians Open emergency medical services hypotension paramedics resuscitation sepsis shock |
| title | Clinical characteristics and course of out‐of‐hospital shock in a national emergency medical services cohort |
| title_full | Clinical characteristics and course of out‐of‐hospital shock in a national emergency medical services cohort |
| title_fullStr | Clinical characteristics and course of out‐of‐hospital shock in a national emergency medical services cohort |
| title_full_unstemmed | Clinical characteristics and course of out‐of‐hospital shock in a national emergency medical services cohort |
| title_short | Clinical characteristics and course of out‐of‐hospital shock in a national emergency medical services cohort |
| title_sort | clinical characteristics and course of out of hospital shock in a national emergency medical services cohort |
| topic | emergency medical services hypotension paramedics resuscitation sepsis shock |
| url | https://doi.org/10.1002/emp2.12090 |
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