Prehospital characteristics of COVID-19 patients transported by emergency medical service and the predictors of a prehospital sudden deterioration in Addis Ababa, Ethiopia

Lemlem Beza Demisse; Ararso Baru Olani; Micheal Alemayehu; Menbeu Sultan

doi:10.1186/s12245-022-00463-z

Prehospital characteristics of COVID-19 patients transported by emergency medical service and the predictors of a prehospital sudden deterioration in Addis Ababa, Ethiopia

Int J Emerg Med. 2022 Oct 28;15(1):60. doi: 10.1186/s12245-022-00463-z.

Authors

Lemlem Beza Demisse¹, Ararso Baru Olani², Micheal Alemayehu³, Menbeu Sultan⁴

Affiliations

¹ Department of Emergency Medicine, Addis Ababa University, Addis Ababa, Ethiopia. lemnene33@yahoo.com.
² College of Medicine and Health Science, Arbaminch University, Po. Box: 2021, Arbaminch, Ethiopia.
³ Tirunesh Beijing Hospital, Addis Ababa, Ethiopia.
⁴ Department of Emergency Medicine and Critical Care, St. Paul's hospital millennium medical College, Addis Ababa, Ethiopia.

Abstract

Background: Severally ill COVID-19 patients may require urgent transport to a specialized facility for advanced care. Prehospital transport is inherently risky; the patient's health may deteriorate, and potentially fatal situations may arise. Hence, early detection of clinically worsening patients in a prehospital setting may enable selecting the best receiving facility, arranging for swift transportation, and providing the most accurate and timely therapies. The incidence and predictors of abrupt prehospital clinical deterioration among critically ill patients in Ethiopia are relatively limited.

Study objectives: This study was conducted to determine the incidence of sudden clinical deterioration during prehospital transportation and its predictors.

Methods: A prospective cohort study of 591 COVID-19 patients transported by a public EMS in Addis Ababa. For data entry, Epi data V4.2 and SPSS V 25 were used for analysis. To control the effect of confounders, the candidate variables for multivariable analysis were chosen using a p 0.25 inclusion threshold from the bivariate analysis. A statistically significant association was declared at adjusted relative risk (ARR) ≠ 1 with a 95 % confidence interval (CI) and a p value < 0.05 after adjusting for potential confounders.

Results: The incidence of prehospital sudden clinical deterioration in this study was 10.8%. The independent predictors of prehospital sudden clinical deterioration were total prehospital time [ARR 1.03 (95%; CI 1.00-1.06)], queuing delays [ARR 1.03 (95%; CI 1.00-1.06)], initial prehospital respiratory rate [ARR 1.07 (95% CI 1.01-1.13)], and diabetic mellitus [ARR 1.06 (95%; CI 1.01-1.11)].

Conclusion: In the current study, one in every ten COVID-19 patients experienced a clinical deterioration while an EMS provider was present. The factors that determined rapid deterioration were total prehospital time, queueing delays, the initial respiratory rate, and diabetes mellitus. Queueing delays should be managed in order to find a way to decrease overall prehospital time. According to this finding, more research on prehospital intervention and indicators of prehospital clinical deterioration in Ethiopia is warranted.

Keywords: Addis Ababa; COVID-19; Ethiopia; Prehospital; Sudden clinical deterioration.