Introduction: Nursing homes regularly call emergency medical services (EMS) for residents with life-threatening emergencies. Most of them are transferred to an emergency room (ER). In many cases, these are end-of-life situations as the patient’s death seems imminent, and transfer to the ER is likely to be uncomfortable and unnecessary. This study aimed to identify, among NH residents, risk factors of short-term death (48 hours) at the time of the EMS call. Methods: This study included all incoming calls for NH residents to an EMS between May 9, 2022, and May 8, 2023. Age, gender, dependency level, vital signs, destination (left on scene or hospitalized), and vital status at 48 hours were collected. Comparisons were made using Chi-2 tests and analyses of variance. Multivariate analyses were performed using top-down stepwise logistic regression. Results: One thousand eight hundred and twenty-two patients were included. The average age was 87.6 years. Sixty-six percent were very dependent. Three-quarters of calls resulted in hospitalization. Patients left on scene were significantly older (89 years) and more dependent (73%) than those hospitalized (respectively 87 years and 59% – p < 10 -3 ). At 48 hours, 20% of patients were left on scene, and 16% of hospitalized patients had died. Five risk factors of short-term death were identified: initial oxygen saturation ≤ 90%, initial blood pressure < 70 mmHg, respiratory distress as the main chief complaint, being very dependent, and age ≥ 90 years. Conclusion: Identifying risk factors of short-term death in NH residents could enable EMS to more often consider keeping the patients on scene with appropriate palliative care. This could be achieved with the help of a clinical prediction tool, yet to be validated by other surveys.
Ursat et al. (Sun,) studied this question.