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Lactic acidosis is a clinical status related to clinical worsening. Actually, higher levels of lactate is a well-established trigger of emergency situations. The aim of this work is to build-up a prehospital early warning score to predict 2-day mortality and intensive care unit (ICU) admission, constructed with other components of the lactic acidosis besides the lactate.Prospective, multicenter, observational, derivation-validation cohort study of adults evacuated by ambulance and admitted to emergency department with acute diseases, between January 1st, 2020 and December 31st, 2021. Including six advanced life support, thirty-eight basic life support units, referring to four hospitals (Spain). The primary and secondary outcome of the study were 2-day all-cause mortality and ICU-admission. The prehospital lactic acidosis (PLA) score was derived from the analysis of prehospital blood parameters associated with the outcome using a logistic regression. The calibration, clinical utility, and discrimination of PLA were determined and compared to the performance of each component of the score alone.A total of 3334 patients were enrolled. The final PLA score included: lactate, pCO2, and pH. For 2-day mortality, the PLA showed an AUC of 0.941 (95%CI: 0.914-0.967), a better performance in calibration, and a higher net benefit as compared to the other score components alone. For the ICU admission, the PLA only showed a better performance for AUC: 0.75 (95%CI: 0.706-0.794).Our results showed that PLA predicts 2-day mortality better than other lactic acidosis components alone. Including PLA score in prehospital setting could improve emergency services decision-making.

The evidence about the use of natriuretic peptides (NP) to predict mortality in the pre-hospital setting is limited. The main objective of this study is to assess the ability of point-of-care testing (POCT) N-terminal portion of B-type natriuretic peptide (NT-proBNP) to predict 2-day in-hospital mortality of acute cardiovascular diseases (ACVD).We conducted a multicentric, prospective, observational study in adults with ACVD transferred by ambulance to emergency departments (ED). The primary outcome was 2-day in-hospital mortality. The discrimination capacity of the NT-proBNP was performed through a prediction model trained using a derivation cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic on a validation cohort.A total of 1006 patients were recruited. The median age was 75 (IQR 63-84) years and 421 (41.85%) were females. The 2-day in-hospital mortality was 5.8% (58 cases). The predictive validity of NT-proBNP, for 2-day mortality reached the following AUC: 0.823 (95%CI: 0.758-0.889, p 0.001), and the optimal specificity and sensitivity were 73.1 and 82.7. Predictive power of NT-proBNP obtained an AUC 0.549 (95%CI: 0.432-0.865, p 0.215) for acute heart failure, AUC 0.893 (95%CI: 0.617-0.97, p 0.001) for ischemic heart disease, AUC 0.714 (95%CI: 0.55-0.87, p = 0.0069) for arrhythmia and AUC 0.927 (95%CI: 0.877-0.978, p 0,001) for syncope.POCT NT-proBNP has proven to be a strong predictor of early mortality in ACVD, showing an excellent predictive capacity in cases of syncope. However, this biomarker does not appear to be useful for predicting outcome in patients with acute heart failure.

Background. The aim of this study was to assess the role of prehospital point-of-care N-terminal probrain natriuretic peptide to predict sepsis, septic shock, or in-hospital sepsis-related mortality. Methods. A prospective, emergency medical service-delivered, prognostic, cohort study of adults evacuated by ambulance and admitted to emergency department between January 2020 and May 2021. The discriminative power of the predictive variable was assessed through a prediction model trained using the derivation cohort and evaluated by the area under the curve of the receiver operating characteristic on the validation cohort. Results. A total of 1,360 patients were enrolled with medical disease in the study. The occurrence of sepsis, septic shock, and in-hospital sepsis-related mortality was 6.4% (67 cases), 4.2% (44 cases), and 6.1% (64 cases). Prehospital National Early Warning Score 2 had superior predictive validity than quick Sequential Organ Failure Assessment and N-terminal probrain natriuretic peptide for detecting sepsis and septic shock, but N-terminal probrain natriuretic peptide outperformed both scores in in-hospital sepsis-related mortality estimation. Application of N-terminal probrain natriuretic peptide to subgroups of the other two scores improved the identification of sepsis, septic shock, and sepsis-related mortality in the group of patients with low-risk scoring. Conclusions. The incorporation of N-terminal probrain natriuretic peptide in prehospital care combined with already existing scores could improve the identification of sepsis, septic shock, and sepsis-related mortality.

Aims To assess the prognostic accuracy of comorbidity‐adjusted National Early Warning Score in suspected Coronavirus disease 2019 patients transferred from nursing homes by the Emergency Department. Design Multicentre retrospective cohort study. Methods Patients transferred by high‐priority ambulances from nursing homes to Emergency Departments with suspected severe acute respiratory syndrome coronavirus 2 infection, from March 12 to July 31 2020, were considered. Included variables were: clinical covariates (respiratory rate, oxygen saturation, systolic blood pressure, heart rate, temperature, level of consciousness and supplemental oxygen use), the presence of comorbidities and confirmatory analytical diagnosis of severe acute respiratory syndrome coronavirus 2 infection. The primary outcome was a 2‐day mortality rate. The discriminatory capability of the National Early Warning Score was assessed by the area under the receiver operating characteristic curve in two different cohorts, the validation and the revalidation, which were randomly selected from the main cohort. Results A total of 337 nursing homes, 10 advanced life support units, 51 basic life support units and 8 hospitals in Spain entailing 1,324 patients (median age 87 years) was involved in this study. Two‐day mortality was 11.5% (152 cases), with a positivity rate of severe acute respiratory syndrome coronavirus 2 of 51.2%, 77.7% of hospitalization from whom 1% was of intensive care unit admission. The National Early Warning Score results for the revalidation cohort presented an AUC of 0.771, and of 0.885, 0.778 and 0.730 for the low‐, medium‐ and high‐level groups of comorbidities. Conclusion The comorbidity‐adjusted National Early Warning Score provides a good short‐term prognostic criterion, information that can help in the decision‐making process to guide the best strategy for each older adult, under the current pandemic. Impact What problem did the study address? Under the current coronavirus disease 2019 pandemic, targeting older adults at high risk of deterioration in nursing homes remains challenging. What were the main findings? Comorbidity‐adjusted National Early Warning Score helps to forecast the risk of clinical deterioration more accurately. Where and on whom will the research have impact? A high NEWS, with a low level of comorbidity is associated with optimal predictive performance, making these older adults likely to benefit from continued follow up and potentially hospital referral under the current coronavirus disease 2019 pandemic.

Prehospital Respiratory Early Warning Scores to estimate the requirement for advanced respiratory support is needed. To develop a prehospital Respiratory Early Warning Score to estimate the requirement for advanced respiratory support.Multicentre, prospective, emergency medical services (EMS)-delivered, longitudinal cohort derivationvalidation study carried out in 59 ambulances and five hospitals across five Spanish provinces. Adults with acute diseases evaluated, supported and discharged to the Emergency Department with high priority were eligible. The primary outcome was the need for invasive or non-invasive respiratory support (NIRS or IRS) in the prehospital scope at the first contact with the patient. The measures included the following: epidemiological endpoints, prehospital vital signs (respiratory rate, pulse oximetry saturation, fraction of inspired oxygen, systolic and diastolic mean blood pressure, heart rate, tympanic temperature and consciousness level by the GCS).Between 26 Oct 2018 and 26 Oct 2021, we enrolled 5793 cases. For NIRS prediction, the final model of the logistic regression included respiratory rate and pulse oximetry saturation/fraction of inspired oxygen ratio. For the IRS case, the motor response from the Glasgow Coma Scale was also included. The REWS showed an AUC of 0.938 (95% CI: 0.918-0.958), a calibration-in-large of 0.026 and a higher net benefit as compared with the other scores.Our results showed that REWS is a remarkably aid for the decision-making process in the management of advanced respiratory support in prehospital care. Including this score in the prehospital scenario could improve patients' care and optimise the resources' management.

The objective of this study was to design a risk model with variables determined before hospital arrival to predict the risk of serious adverse events in patients with acute poisoning.A preliminary prospective, multicentre cohort study of adults with prehospital diagnosis of acute intoxication was conducted. The study was carried out in the Public Health System of the Community of Castilla-Leon (Spain), including seven advanced life support units and five hospitals, between April 1, 2018, and June 30, 2019. People aged18 years with a main prehospital diagnosis of acute poisoning admitted to a referral hospital on advanced life support were included. The main outcome measure was prehospital and hospital serious adverse events in patients with acute poisoning.We included 221 patients, with a median age of 47 years (interquartile range: 33-61). The most frequent cause of poisoning was psychopharmaceuticals (111 cases, 49.8%): 38 (17.2%) patients had a serious adverse event, with a hospital mortality of 4.1% (nine cases) in the 30 days after the index event. The final model included age ≥65 years (odds ratio [OR]: 9.59, 95% confidence interval [CI]: 3.48-26.45; p 0.001), oxygen saturation/fraction of inspired oxygen index ≤300 (OR: 15.03, 95% CI: 5.74-39.33; p 0.001), and point-of-care lactate ≥4 mmol/L (OR: 7.68, 95% CI: 2.88-20.45; p 0.001). The poisoning Early Warning Score was constructed from these three variables, and 1 point was assigned to each variable. The area under the curve of the score was 0.896 (95% CI: 0.82-0.96; p 0.001).The poisoning Early Warning Score may help in decision-making and promote early identification of high-risk patients with acute poisoning in the prehospital context.

Early warning scores are clinical tools capable of identifying prehospital patients with high risk of deterioration. We sought here to contrast the validity of seven early warning scores in the prehospital setting and specifically, to evaluate the predictive value of each score to determine early deterioration-risk during the hospital stay, including mortality at one, two, three and seven- days since the index event.

Background The National Early Warning Score 2 (NEWS2) scores can help identify clinical deterioration. Objective To assess the predictive capacity of the NEWS2 at prehospital level for the detection of early mortality in the hospital. Methods Prospective multicenter cohort study, in which we compiled a database of observed vital signs between March 1, 2018 and May 30, 2019. We collected demographic data, vital signs (respiration rate, oxygen saturation, supplemental oxygen, temperature, systolic blood pressure, heart rate and level of consciousness), prehospital diagnosis and hospital mortality data. We calculated the AUROC of the NEWS2 for early mortality. Results We included a total of 2335 participants. Median age was 69 years (IQR 54–81 years). The AUC for mortality within one day was 0.862 (95%CI:0.78–0.93), within two days 0.885 (95%CI:0.84–0.92) and within seven days 0.835 (95%CI:0.79–0.87) (in all cases, p Conclusions The NEWS2 performed at prehospital level is a bedside tool for predicting early hospital mortality.

Aim of the study: To assess the prognostic ability of the National Early Warning Score 2 (NEWS2) at three time points of care -at the emergency scene (NEWS2-1), just before starting the transfer by ambulance to the hospital (NEWS2- 2), and at the hospital triage box (NEWS2-3)- to estimate in-hospital mortality after two days since the index event.Methods: Prospective, multicenter, ambulance-based, cohort ongoing study in adults (>18 years) consecutively attended by advanced life support (ALS) and evacuated with high-priority to the emergency departments (ED) between October 2018 and May 2021. Vital sign measures were used to calculate the NEWS2 score at each time point, then this score was entered in a logistic regression model as the single predictor. Two outcomes were considered: first, all-cause mortality of the patients within 2 days of presentation to EMS, and second, unplanned ICU admission. The calibration and scores comparison was performed by representing the predicted vs the observed risk curves according to NEWS score value.Results: 4943 patients were enrolled. Median age was 69 years (interquartile range 53- 81). The NEWS2-3 presented the better performance for all-cause two-day in-hospital mortality with an AUC of 0.941 (95% CI: 0.917-0.964), showing statistical differences with both the NEWS2-1 (0.872 (95% CI: 0.833-0.911); p < 0.003) and with the NEWS2- 2 (0.895 (95% CI: 0.866-0.925; p < 0.05). The calibration and scores comparison results showed that the NEWS2-3 was the best predictive score followed by the NEWS2-2 and the NEWS2-1, respectively.Conclusions: The NEWS2 has an excellent predictive performance. The score showed a very consistent response over time with the difference between "at the emergency scene" and "pre-evacuation" presenting the sharpest change with decreased threshold values, thus displaying a drop in the risk of acute clinical impairment.

INTRODUCTION The knowledge of the prognostic value of prehospital lactate (PLA) is limited. Our objective was to evaluate the predictive capacity of PLA to predict early mortality (within 48 h) from the index event in acute cardiovascular disease (ACVD). METHODS Prospective, longitudinal, multicenter, observational study in patients, attended by advanced life support units, transferred to the emergency department of their reference hospital and diagnosed with ACVD. We collected demographic, physiological, clinical, analytical variables, main cardiological diagnosis, and data on hospital admission and early mortality. The main outcome variable was mortality from any cause within 2 days. RESULTS Between March 1, 2018 and January 31, 2019, a total of 492 patients were included in our study. Early mortality after the index event within the first 48 h affected 27 patients (5.5%). The most frequent cause of care demand was chest pain with 223 cases (45.3%). The predictive power of PLA to discriminate mortality at 2 days obtained an area under the curve of 0.911 (95% confidence interval [CI]: 0.83-0.98, P

Introduction:In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center.Hypothesis/Problem:The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs.Methods:This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours.Results:From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2).Conclusion:Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).

Prehospital Emergency Medical Services must attend to patients with complex physiopathological situations with little data and in the shortest possible time. The objective of this work was to study lactic acid values and their usefulness in the prehospital setting to help in clinical decision-making.We conducted a longitudinal prospective, observational study on patients over 18 years of age who, after being evaluated by the Advanced Life Support Unit, were taken to the hospital between April and June 2018. We analyzed demographic variables, prehospital lactic acid values and early mortality (30 days). The area under the curve of the receiver operating characteristic was calculated for the prehospital value of lactic acid.A total of 279 patients were included in our study. The median age was 68 years (interquartile range: 54-80 years). Overall 30-day mortality was 9% (25 patients). The area under the curve for lactic acid to predict overall mortality at 30 days of care was 0.82 (95% CI: 0.76-0.89). The lactate value with the best sensitivity and specificity overall was 4.25 mmol/L with a sensitivity of 84% (95% CI: 65.3-93.6) and specificity of 70% (95% CI: 65.0-76.1).The level of lactic acid can be a complementary tool in the field of prehospital emergencies that will guide us early in the detection of critical patients.

Aims The aim of this study was to compare the ability to predict 2-, 7-, 14-, and 30-day in-hospital mortality of lactate vs the National Early Warning Score 2 (NEWS2) vs the arithmetic sum of the NEWS2 plus the numerical value of lactate (NEWS2-L). Methods This was a prospective, multicentric, emergency department delivery, pragmatic cohort study. To determine the predictive capacity of lactate, we calculated the NEWS2 and NEWS2-L in adult patients (aged >18 years) transferred with high priority by ambulance to the emergency department in five hospitals of Castilla y Leon (Spain) between November 1, 2019, and September 30, 2020. The area under the receiver operating characteristic curve of each of the scales was calculated in terms of mortality for every time frame (2, 7, 14, and 30 days). We determined the cut-off point of each scale that offered highest sensitivity and specificity using the Youden index. Results A total of 1716 participants were included, and the in-hospital mortality rates at 2, 7, 14, and 30 days were of 7.8% (134 cases), 11.6% (200 cases), 14.2% (243 cases), and 17.2% (295 cases), respectively. The best cut-off point determined in the NEWS2 was 6.5 points (sensitivity of 97% and specificity of 59%), and for lactate, the cut-off point was 3.3 mmol/L (sensitivity of 79% and specificity of 72%). Finally, the combined NEWS2-L showed a cut-off point of 11.7 (sensitivity of 86% and a specificity of 85%). The area under the receiver operating characteristic curve of the NEWS2, lactate, and NEWS2-L in the validation cohort for 2-day mortality was 0.889, 0.856, and 0.923, respectively (p Conclusions The new score generated, NEWS2-L, obtained better statistical results than its components (NEWS2 and lactate) separately.

Key Points Question Can the prehospital ratio of oxygen saturation measured by pulse oximetry (Spo2) to fraction of inspired oxygen (Fio2) be used to model early in-hospital mortality? Findings Data from 3606 patients were analyzed in a prognostic study. The Spo2 to Fio2 ratio had a statistically significant area under the curve of 0.890 for the prediction of 2-day mortality. Meaning This study suggests that the prehospital Spo2 to Fio2 ratio allows for the identification of patients at risk of in-hospital deterioration., Importance The early identification of patients at high risk of clinical deterioration represents one of the greatest challenges for emergency medical services (EMS). Objective To assess whether use of the ratio of prehospital oxygen saturation measured by pulse oximetry (Spo2) to fraction of inspired oxygen (Fio2) measured during initial contact by EMS with the patient (ie, the first Spo2 to Fio2 ratio) and 5 minutes before the patient’s arrival at the hospital (ie, the second Spo2 to Fio2 ratio) can predict the risk of early in-hospital deterioration. Design, Setting, and Participants A prospective, derivation-validation prognostic cohort study of 3606 adults with acute diseases referred to 5 tertiary care hospitals in Spain was conducted between October 26, 2018, and June 30, 2020. Eligible patients were recruited from among all telephone requests for EMS assistance for adults who were later evacuated with priority in advanced life support units to the referral hospitals during the study period. Main Outcomes and Measures The primary outcome was hospital mortality from any cause within the first, second, third, or seventh day after EMS transport to the hospital. The main measure was the Spo2 to Fio2 ratio. Results A total of 3606 participants comprised 2 separate cohorts: the derivation cohort (3081 patients) and the validation cohort (525 patients). The median age was 69 years (interquartile range, 54-81 years), and 2122 patients (58.8%) were men. The overall mortality rate of the patients in the study cohort ranged from 3.6% for 1-day mortality (131 patients) to 7.1% for 7-day mortality (256 patients). The best model performance was for 2-day mortality with the second Spo2 to Fio2 ratio with an area under the curve of 0.890 (95% CI, 0.829-0.950; P, This prognostic study assesses whether use of the ratio of prehospital oxygen saturation to fraction of inspired oxygen measured by emergency medical services can predict the risk of early in-hospital deterioration.

Producción Científica, Background: To adapt the Sequential Organ Failure Assessment (SOFA) score to fit the prehospital care needs; to do that, the SOFA was modified by replacing platelets and bilirubin, by lactate, and tested this modified SOFA (mSOFA) score in its prognostic capacity to assess the mortality-risk at 2 days since the first Emergency Medical Service (EMS) contact. Methods: Prospective, multicentric, EMS-delivery, ambulance-based, pragmatic cohort study of adults with acute diseases, referred to two tertiary care hospitals (Spain), between January 1st and December 31st, 2020. The discriminative power of the predictive variable was assessed through a prediction model trained using the derivation cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC) on the validation cohort. Results: A total of 1114 participants comprised two separated cohorts recruited from 15 ambulance stations. The 2-day mortality rate (from any cause) was 5.9% (66 cases). The predictive validity of the mSOFA score was assessed by the calculation of the AUC of ROC in the validation cohort, resulting in an AUC of 0.946 (95% CI, 0.913–0.978, p < .001), with a positive likelihood ratio was 23.3 (95% CI, 0.32–46.2). Conclusions: Scoring systems are now a reality in prehospital care, and the mSOFA score assesses multiorgan dysfunction in a simple and agile manner either bedside or en route. Patients with acute disease and an mSOFA score greater than 6 points transferred with high priority by EMS represent a high early mortality group., Gerencia Regional de Salud de Castilla y León (grants GRS 1678/A/18 and GRS 1903/A/19)

One of the challenges in the emergency department (ED) is the early identification of patients with a higher risk of clinical deterioration. The objective is to evaluate the prognostic capacity of &Delta, LA (correlation between prehospital lactate (pLA) and hospital lactate (hLA)) with respect to in-hospital two day mortality. We conducted a pragmatic, multicentric, prospective and blinded-endpoint study in adults who consecutively attended and were transported in advanced life support with high priority from the scene to the ED. The corresponding area under the receiver operating characteristics curve (AUROC) was obtained for each of the outcomes. In total, 1341 cases met the inclusion criteria. The median age was 71 years (interquartile range: 54&ndash, 83 years), with 38.9% (521 cases) females. The total 2 day mortality included 106 patients (7.9%). The prognostic precision for the 2 day mortality of pLA and hLA was good, with an AUROC of 0.800 (95% CI: 0.74&ndash, 0.85, p &lt, 0.001) and 0.819 (95% CI: 0.76&ndash, 0.86, 0.001), respectively. Of all patients, 31.5% (422 cases) had an &Delta, LA with a decrease of &lt, 10%, of which a total of 66 patients (15.6%) died. A lactate clearance &ge, 10% is associated with a lower risk of death in the ED, and this value could potentially be used as a guide to determine if a severely injured patient is improving in response to the established treatment.

Introduction High-fidelity clinical simulation has implied a revolution in health science training. Despite its benefits, some drawbacks could hinder the learning process, especially the anxiety produced during such scenarios. Objectives The aim of the present work is to develop a predictive model capable of determining which students will present high levels of anxiety. Design We performed a randomized, sham-controlled, blinded trial in which students were randomly assigned to four scenarios and played one of two possible roles. Methods Before and after the simulation we assessed the anxiety level along with physiological and analytical parameters. The main analyzed outcome was an increase of ≥25% in anxiety compared with baseline. Results The type of scenario or the role played had no effect on anxiety. The predictive model presented an Area Under the Receiver Operating Characteristics of 0.798 (95% CI: 0.69–0.90; p Conclusions Our results showed that the anxiety level developed during simulation could be predicted. The application of this predictive model when associated to appropriate techniques to deal with increased anxiety levels could improve the learning process of medical students during simulations.

Background More recently, due to the coronavirus disease 2019 pandemic, health care workers have to deal with clinical situations wearing personal protective equipment (PPE); however, there is a question of whether everybody will tolerate PPE equally. The main objective of this study was to develop a risk model to predict whether health care workers will tolerate wearing PPE, C category, 4B/5B/6B type, during a 30-minute simulation. Methods A nonexperimental simulation study was conducted at the Advanced Simulation Center, Faculty of Medicine, Valladolid University (Spain) from April 3rd to 28th, 2017. Health care students and professionals were equipped with PPE and performed a 30-minute simulation. Anthropometric, physiological, and analytical variables and anxiety levels were measured before and after simulation. A scoring model was constructed. Results Ninety-six volunteers participated in the study. Half the sample presented metabolic fatigue in the 20 minutes after finishing the simulation. The predictive model included female sex, height, muscle and bone mass, and moderate level of physical activity. The validity of the main model using all the variables presented an area under the curve of 0.86 (95% confidence interval: 0.786–0.935), and the validity of the model had an area under the curve of 0.725 (95% confidence interval: 0.559–0.89). Conclusions Decision-making in biohazard incidents is a challenge for emergency team leaders. Knowledge of health care workers' physiological tolerance of PPE could improve their performance., Highlights • The model determines which health care worker will develop fatigue. • During the simulation, half of the sample (n = 48) developed fatigue. • Being a woman and having moderate or high level of activity are positive factors against metabolic fatigue.

Background: The purpose of the study was to determine to what degree the health habits of university students influence their physiological response during a 10-min high-intensity exercise. Methods: We conducted a cross-sectional cohort study with 59 health science students, in which we analyzed their adherence to a Mediterranean and low-fat diet, as well as their activity levels. We correlated these factors with the physiological response (lactic acid and heart rate) and a series of anthropometric parameters in intense physical activity (cardiopulmonary resuscitation (CPR) for 10 min) in three scenarios: extreme cold, extreme heat and a control situation at room temperature. Results: The results of this study demonstrate that in university students, a greater adherence to the Mediterranean diet was associated with a better response to physical exercise, in this case, 10-min CPR, in hostile environments. Conclusions: Following healthy eating guidelines improves physical performance and delays the appearance of fatigue, both are important aspects for a better performance of CPR.

Background Emergency medical services (EMS) routinely face complex scenarios where decisions should be taken with limited clinical information. The development of fast, reliable and easy to perform warning biomarkers could help in such decision-making processes. The present study aims at characterizing the validity of point-of-care lactate (pLA) during prehospital tasks for predicting in-hospital mortality within two days after the EMS assistance. Materials and methods Prospective, multicentric, ambulance-based and controlled observational study without intervention, including six advanced life support and five hospitals. The pLA levels were recorded during EMS assistance of adult patients. The validity of pLA to determine the in-hospital mortality was assessed by the area under the curve (AUC) of the receiver operating curve (ROC). Results A total of 2997 patients were considered in the study, with a median of 69 years (IQR 54-81) and 41.4% of women. The median pLA value was 2.7 mmol/L (1.9-3.8) in survivors and 5.7 mmol/L (4.4-7.6) in nonsurvivors. The global discrimination level of pLA reached an AUC of 0.867, being 1.9 mmol/L and 4 mmol/L the cut-off point for low and high mortality. The discrimination value of pLA was not affected by sex, age or pathology. Conclusions Our results highlight the clinical importance of prehospital pLA to determine the in-hospital risk of mortality. The incorporation of pLA into the EMS protocols could improve the early identification of risky patients, leading to a better care of such patients.

The consequences of wearing biosafety equipment by healthcare professionals during their work and the prediction of such consequences need to be assessed. To analyze the role played by different blood biomarkers in predicting the appearance of headaches in healthcare workers wearing personal protective equipment (PPE) in a COVID-19 treatment unit, a Prospective cohort study of 38 healthcare workers from a convalescence unit of patients with COVID-19 in a field hospital was performed during April 2020. Blood analysis was carried out before the start of the 4 hours shift of the volunteers equipped with PPE. After decontamination, there were asked if they had suffered from headache, obtaining the binary outcome. This study included 38 participants with a median age of 29 years (25th-75th percentile: 26-44 years old), 73.7% female (28 cases). 44.7% (17 cases) had a headache after wearing PPE for 4 hours. The baseline creatinine value reflected a specific odds ratio in the regression model of 241.36 (95% CI: 2.50-23,295.43; p=0.019), and an AUC of 0.737 (95%CI: 0.57-0.90; pde novo headache in healthcare workers after wearing PPE for 4 hours in a COVID – 19 unit.

To develop and validate a prehospital risk model to predict early in-hospital mortality (#48 hours) in patients aged 65 years or older.Prospective multicenter observational study in a cohort of patients aged 65 years or older attended by advanced life support emergency services and transferred to 5 Spanish hospitals between April 2018 and July 2019. We collected demographic, clinical and laboratory variables. A risk score was constructed and validated based on the analysis of prehospital variables associated with death within 48 hours. Predictors were selected by logistic regression.A total of 1759 patients were recruited. The median age was 79 years (interquartile range, 72-85 years), and 766 (43.5%) were women. One hundred eight patients (6.1%) died within 48 hours. Predictors in the Prehospital Older Adults Warning Scale (POAWS) were age, systolic blood pressure, temperature, the ratio of oxygen saturation to the fraction of inspired oxygen, score on the Glasgow coma scale, and lactic acid concentration in venous blood. The area under the receiver operating characteristic curve of the model to predict early mortality was 0.853 (95% CI, 0.80-0.91; P.001). Mortality in patients at high risk (POAWS score,7) was 69%.The prehospital POAWS score can be used to stratify risk for death within 48 hours in patients aged 65 years or older.Diseñar y validar un modelo predictivo de mortalidad hospitalaria precoz (# 48 horas) en pacientes $ 65 años y basado en variables determinadas a nivel prehospitalario.Estudio multicéntrico de cohorte prospectivo y observacional. Se incluyeron pacientes $ 65 años atendidos por unidades de soporte vital avanzado y trasladados a un servicio de urgencias hospitalario. Se recogieron variables demográficas, clínicas y analíticas. Se construyó y validó una escala de puntuación mediante la categorización de las variables seleccionadas mediante regresión logística en función de la mortalidad en # 48 horas.Se reclutaron 1.759 pacientes, la edad mediana fue de 79 años (RIC 72-85), 766 eran mujeres (43,5%), y fallecieron 108 pacientes (6,1%) en # 48 horas. El modelo predictivo –escala POAWS (Prehospital Older Adults Warning Score)– incluyó la edad, presión arterial sistólica, temperatura, saturación de oxígeno en relación con la fracción inspirada de oxígeno, escala de coma de Glasgow y ácido láctico en sangre venosa. El área bajo la curva de la característica operativa del receptor para la mortalidad en # 48 horas fue de 0,853 (IC 95%: 0,80-0,91; p0,001). La mortalidad en los pacientes de alto riesgo (7 puntos en la escala) fue del 69%.La escala POAWS desarrollada en el presente estudio puede ser de utilidad para estratificar el riesgo de muerte de los patientes de 65 o más años durante las 48 horas siguientes a la atención en el ámbito prehospitalario.

The early warning score can help to prevent, recognize and act at the first signs of clinical and physiological deterioration. The objective of this study is to evaluate different scales for use in the prehospital setting and to select the most relevant one by applicability and capacity to predict mortality in the first 48 h. A prospective longitudinal observational study was conducted in patients over 18 years of age who were treated by the advanced life support unit and transferred to the emergency department between April and July 2018. We analyzed demographic variables as well as the physiological parameters and clinical observations necessary to complement the EWS. Subsequently, each patient was followed up, considering their final diagnosis and mortality data. A total of 349 patients were included in our study. Early mortality before the first 48 h affected 27 patients (7.7%). The scale with the best capacity to predict early mortality was the National Early Warning Score 2, with an area under the curve of 0.896 (95% CI 0.82-0.97). The score with the lowest global classification error was 10 points with sensitivity of 81.5% (95% CI 62.7-92.1) and specificity of 88.5% (95% CI 84.5-91.6). The early warning score studied (except modified early warning score) shows no statistically significant differences between them; however, the National Early Warning Score 2 is the most used score internationally, validated at the prehospital scope and with a wide scientific literature that supports its use. The Prehospital Emergency Medical Services should include this scale among their operative elements to complement the structured and objective evaluation of the critical patient.

The objective of this study was to assess whether the use of prehospital lactate (pLA) can increase the prognostic accuracy of the National Early Warning Score 2 (NEWS2) to detect the risk of death within 48 h. A prospective, multicenter study in adults treated consecutively by the emergency medical services (EMS) included six advanced life support (ALS) services and five hospitals. Patients were assigned to one of four groups according to their risk of mortality (low, low-medium, medium, and high), as determined by the NEWS2 score. For each group, the validity of pLA in our cohort was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. In this study, 3081 participants with a median age of 69 years (Interquartile range (IQR): 54&ndash, 81) were included. The two-day mortality was 4.4% (137 cases). The scale derived from the implementation of the pLA improved the capacity of the NEWS2 to discriminate low risk of mortality, with an AUC of 0.910 (95% CI: 0.87&ndash, 0.94, p &lt, 0.001). The risk stratification provided by the NEWS2 can be improved by incorporating pLA measurement to more accurately predict the risk of mortality in patients with low risk.

Background : Biohazard incidents are ordinary situations usually managed by health systems with the mandatory priority of preventing the spread of the pathogen. Health care workers in charge of dealing with these situations must be equipped with personal protective equipment (PPE) for her/his own security. The main objective of this study was developing a risk model to predict whether health care workers will tolerate wearing PPE, III category, 4B / 5B / 6B type, against biological risks during a 30 minutes intervention. Methods : A preliminary, prospective, simulation study, without intervention was conducted at the Advanced Simulation Center at the Medicine Faculty of Valladolid University (Spain) from April 3rd to 28th, 2017. Students and professional's health care were equipped with a PPE and performed a 30 minutes-long biohazard simulation. Anthropometric, physiological, analytical variables, and anxiety levels were measured pre- and post-simulation. A scoring model was constructed by using the estimate regression coefficients of the significant variables obtained from a multivariate model of the logistic regression for the outcome variable. Results : 96 volunteers with median age of 26 years (25th-75th percentile: 22-41 years) of which 56 (58.3%) were women enter into the test. Half of the sample presented metabolic fatigue after 20 minutes of finishing the simulation. The predictive model included female sex, height, both muscle and bone mass and moderate level of physical activity. The validity of the main model using all the variables presented an area under the curve (AUC) of 0.86 (95%CI: 0.786-0.935), and the validity of the model presented an AUC of 0.725 (95%CI: 0.559-0.89). Conclusions : Decision-making in biohazard incidents is a challenge for emergency team leaders. An a priori knowledge of physiological tolerance of wearing a PPE of the health care workers could improve their performance. The model presented here could help in the assessment of the worker response under biohazard conditions.

Introducción:Realizar de una forma adecuada una reanimación cardiopulmonar precisa unos conocimientos técnicos y unas mínimas condiciones físicas. Realizar esta reanimación un equipo de protección individual frente a riesgos biológicos nivel D colocado aumenta el sobresfuerzo al que se ven sometidos los reanimadores.El objetivo de este estudio es comprobar la existencia de un patrón de mala tolerancia fisiológica al uso de los equipos de protección nivel D, categoría 4-5-6B para la actuación en incidentes con riesgo biológico objetivado mediante la medición del índice de perfusión antes y después de una reanimación simulada.Material y métodos:Se ha realizado un estudio cuasiexperimental no controlado sobre 96 voluntarios elegidos mediante un muestreo aleatorio estratificado por sexo, nivel de formación y categoría profesional, estudiantes de Medicina y Enfermería y profesionales Médicos y Enfermeros. Se realizó una toma del índice de perfusión antes de realizar la reanimación y otra después de la reanimación simulada.Resultados:Un 15% de los voluntarios presentaron un índice de perfusión posterior más bajo al basal, lo que se traduce en una situación de vasoconstricción periférica después de la realización del ejercicio físico que supuso el caso clínico, cuando lo esperable era una vasodilatación para aumentar la perfusión. Conclusiones: Extrapolando estos datos, podemos concluir que, en la muestra de estudio que nos ocupa, los voluntarios que presentan menos índice de perfusión al finalizar que al comenzar no toleran bien el esfuerzo que supone el caso clínico. ABSTRACT: Introduction: Perform a cardiopulmonary resuscitation requires technical knowledge and minimal physical conditions. Perform this resuscitation a team of individual protection against biological risks level D placed increases the overexertionthat encourage rescuers are subjected.The objective of this study is to prove the existence of a pattern of poor physiological tolerance to the use of personal protective equipment level D, category 4-5-6B for action in incidents with biological risk objectified by measuring the perfusion index before and after a simulated resuscitation.Material and methods:We have performed a quasiexperimental not controlled on 96 volunteers chosen through a random sampling, stratified by sex, level of education and professional category, medical and nursing students and professionals doctors and nurses.A decision of the perfusion index before performing the resuscitation and other simulated after resuscitation.Results:A 15% of the volunteers presented a perfusion index lower back to baseline, which translates into a situation of peripheral vasoconstriction after the completion of the physical exercise that involved the clinical case, when expected was a vasodilatation to Increase perfusion.Conclussion:Extrapolating these data, we can conclude that, in the sample for the study, the volunteers who have less perfusion index at the end of that at the beginning do not tolerate well the effort involved in the case.

Introduction. Certain professions, such as those related to emergency services, have usually been performed by men, progressively incorporating women into these professions. The main objective of our study was to determine, according to gender, how the use of level D biohazard personal protection equipment (PPE) affects emergency professionals during the performance of resuscitation. Materials and Methods. An uncontrolled quasi-experimental study was performed on 96 volunteers selected by means of random sampling stratified by gender. Baseline and final vital signs of the assessment activity were analyzed. This activity involves volunteers performing a simulated resuscitation in a controlled environment whilst wearing personal protective suits in a biohazard situation. Results. Analyzing the physiological tolerance pattern parameter by parameter, and according to gender, through a univariate model, we can observe that there is no interaction between tolerance and gender; that is, having good or bad tolerance does not depend on gender. Conclusion. This specialized skilled work can be performed by any properly trained professional.

To evaluate the ability of the prehospital National Early Warning Score 2 Lactate (preNEWS2-L) to predict early mortality, defined as death within 48 hours of the index event. We also explored the predictive capacity of the score for 7- and 30-day all-cause mortality.Prospective, observational longitudinal study in patients attended by ambulance responders and transferred to the emergency departments of reference hospitals. We collected demographic, physiologic, clinical, and analytical data and the main diagnosis. The main outcome measure was all-cause mortality.s. A total of 707 patients were included. Thirty-seven patients (5.2%) died within 48 hours of the index event. The area under the receiver operating characteristic curve (AUC) for the preNEWS2-L score's prediction of early death was 0.91 (95% CI, 0.83-0.96). The AUCs for death within 7 and 30 days were 0.86 (95% CI, 0.79-0.92) and 0.82 (95% CI, 0.76-0.87), respectively, showing that the score's ability to predict death decreases by almost 10% between 48 hours and 30 days.The preNEWS2-L is a useful prognostic tool that can be assessed quickly and easily in prehospital settings.Evaluar la capacidad de la escala Pre-hospital National Early Warning Score 2 lactate (preNEWS2-L) para predecir la mortalidad precoz (antes de 48 h) desde el suceso índice. Además, como objetivo secundario, analizar el rendimiento de la nueva escala para la mortalidad a 7 y 30 días por cualquier causa.Estudio observacional, prospectivo y longitudinal de pacientes que son atendidos por unidades móviles de emergencias y trasladados a los servicios de urgencias de su hospital de referencia. Se recogieron variables demográficas, fisiológicas, clínicas, analíticas y de diagnóstico principal. La variable de resultado principal fue la mortalidad por cualquier causa.Se incluyeron 707 pacientes. La mortalidad precoz tras el suceso índice antes de las primeras 48 h fue de 37 pacientes (5,2%). La escala preNEWS2-L obtuvo un área bajo la curva (ABC) de la característica operativa del receptor (COR) de 0,91 (IC 95%: 0,83-0,96; p0,001), 0,86 (IC 95%: 0,79-0,92; p0,001) y 0,82 (IC 95%: 0,76- 0,87; p0,0017) para la mortalidad a 2, 7 y 30 días, respectivamente. Su capacidad de valorar la mortalidad desciende prácticamente un 10% entre el ABC-ROC a los 2 días y el ABC a los 30 días.La escala generada, denominada preNEWS2-L, puede ser considerada una herramienta pronóstico muy útil para ser usada en el medio prehospitalario, por facilidad de manejo, rápida obtención y capacidad de predicción.

The coronavirus disease 2019 (COVID-19) has led to a pandemic, which among other things, has highlighted biosafety as a key cornerstone in the management of disease transmission. The aim of this work was to analyze the role played by different blood biomarkers in predicting the appearance of headaches in healthcare workers wearing personal protective equipment (PPE) in a COVID-19 treatment unit. A prospective cohort study of 38 healthcare workers was performed during April 2020. Blood analysis, performed just before the start of a 4 hour shift, was carried out on all volunteers equipped with PPE. At the end of their shifts and after decontamination, they were asked if they had suffered from headache in order to obtain a binary outcome. The baseline creatinine value reflected a specific odds ratio of 241.36 (95% CI: 2.50&ndash, 23,295.43, p = 0.019) and an area under the curve (AUC) value of 0.737 (95%CI: 0.57&ndash, 0.90, p &lt, 0.01). Blood creatinine is a good candidate for predicting the appearance of a de novo headache in healthcare workers after wearing PPE for four hours in a COVID-19 unit.

The objective of this study was to analyze and compare the usefulness of quick sequential organ failure assessment score (qSOFA) and sequential organ failure assessment (SOFA) scores for the detection of early (two-day) mortality in patients transported by emergency medical services (EMSs) to the emergency department (ED) (infectious and non-infectious). We performed a multicentric, prospective and blinded end-point study in adults transported with high priority by ambulance from the scene to the ED with the participation of five hospitals. For each score, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was calculated. We included 870 patients in the final cohort. The median age was 70 years (IQR 54&ndash, 81 years), and 338 (38.8%) of the participants were women. Two-day mortality was 8.3% (73 cases), and 20.9% of cases were of an infectious pathology. For two-day mortality, the qSOFA presented an AUC of 0.812 (95% CI: 0.75&ndash, 0.87, p &lt, 0.001) globally with a sensitivity of 84.9 (95% CI: 75.0&ndash, 91.4) and a specificity of 69.4 (95% CI: 66.1&ndash, 72.5), and a SOFA of 0.909 (95% CI: 0.86&ndash, 0.95, 0.001) with sensitivity of 87.7 (95% CI: 78.2&ndash, 93.4) and specificity of 80.7 (95% CI: 77.4&ndash, 83.3). The qSOFA score can serve as a simple initial assessment to detect high-risk patients, and the SOFA score can be used as an advanced tool to confirm organ dysfunction.

Aim of the Study. To evaluate the ability of the prehospital National Early Warning Score 2 scale (NEWS2) to predict early mortality (within 48 hours) after the index event based on the triage priority assigned for any cause in the emergency department. Methods. This is a multicenter longitudinal observational cohort study on patients attending Advanced Life Support units and transferred to the emergency department of their reference hospital. We collected demographic, physiological, and clinical variables, main diagnosis, and hospital triage level as well as mortality. The main outcome variable was mortality from any cause within two days of the index event. Results. Between April 1 and November 30, 2018, a total of 1054 patients were included in our study. Early mortality within the first 48 hours after the index event affected 55 patients (5.2%), of which 23 cases (41.8%) had causes of cardiovascular origin. In the stratification by triage levels, the AUC of the NEWS2 obtained for short-term mortality varied between 0.77 (95% CI: 0.65-0.89) for level I and 0.94 (95% CI: 0.79-1) for level III. Conclusions. The Prehospital Emergency Medical Services should evaluate the implementation of the NEWS2 as a routine evaluation, which, together with the structured hospital triage system, effectively serves to predict early mortality and detect high-risk patients.

We present two cases of thoracic actinomycosis which bronchoscopically resembled a bronchial tumoration, existing simultaneously in both cases a foreign body located at the intermediate bronchium. We discuss the characteristics of the disease and we review the literature on this topic.