Prior emergency medical services utilization is a risk factor for in-hospital death among patients with substance misuse: a retrospective cohort study.

BACKGROUND: Substance misuse poses a significant public health challenge, characterized by premature morbidity and mortality, and heightened healthcare utilization. While studies have demonstrated that previous hospitalizations and emergency department visits are associated with increased mortality in patients with substance misuse, it is unknown whether prior utilization of emergency medical service (EMS) is similarly associated with poor outcomes among this population. The objective of this study is to determine the association between EMS utilization in the 30 days before a hospitalization or emergency department visit and in-hospital outcomes among patients with substance misuse. METHODS: We conducted a retrospective analysis of adult emergency department visits and hospitalizations (referred to as a hospital encounter) between 2017 and 2021 within the Substance Misuse Data Commons, which maintains electronic health records from substance misuse patients seen at two University of Wisconsin hospitals, linked with state agency, claims, and socioeconomic datasets. Using regression models, we examined the association between EMS use and the outcomes of in-hospital death, hospital length of stay, intensive care unit (ICU) admission, and critical illness events, defined by invasive mechanical ventilation or vasoactive drug administration. Models were adjusted for age, comorbidities, initial severity of illness, substance misuse type, and socioeconomic status. RESULTS: Among 19,402 encounters, individuals with substance misuse who had at least one EMS incident within 30 days of a hospital encounter experienced a higher likelihood of in-hospital mortality (OR 1.52, 95% CI [1.05 - 2.14]) compared to those without prior EMS use, after adjusting for confounders. Using EMS in the 30 days prior to an encounter was associated with a small increase in hospital length of stay but was not associated with ICU admission or critical illness events. CONCLUSIONS: Individuals with substance misuse who have used EMS in the month preceding a hospital encounter are at an increased risk of in-hospital mortality. Enhanced monitoring of EMS users in this population could improve overall patient outcomes.

The Use of Predictive Modeling to Compare Prehospital eCPR Strategies.

The duration of low flow prior to initiation of extracorporeal cardiopulmonary resuscitation (eCPR) appears to influence survival. Strategies to reduce the low-flow interval for out-of-hospital cardiac arrest have been focused on expediting patient transport to the hospital or initiating extracorporeal support in the prehospital setting. To date, a direct comparison of low-flow interval between these strategies has not been made. To attempt this comparison, a model was created to predict low-flow intervals for each strategy at different locations across the city of Albuquerque, New Mexico. The data, specific to Albuquerque, suggest that a prehospital cannulation strategy consistently outperforms an expedited transport strategy, with an estimated difference in low-flow interval of 34.3 to 37.2 minutes, depending on location. There is no location within the city in which an expedited transport strategy results in a shorter low-flow interval than prehospital cannulation. It would be rare to successfully initiate eCPR by either strategy in fewer than 30 minutes from the time of patient collapse. Using a prehospital cannulation strategy, the entire coverage area could be eligible for eCPR within 60 minutes of patient collapse. The use of predictive modeling can be a low-cost solution to assist with strategic deployment of prehospital resources and may have potential for real-time decision support for prehospital clinicians.