Incidence and predictors of adverse events and outcomes for adult critically ill patients transferred by paramedics to a tertiary care medical facility

Objective: The aim of this study was to determine the incidence of adverse events and patients’ outcomes in inter‑facility critical care transfers by paramedics. Methods: We conducted a retrospective cohort study of adults undergoing inter‑facility transfer to a tertiary medical facility by paramedics. We included all patients transferred between 1st June, 2011 and 31st December, 2014. The primary outcome is in‑transit adverse event and the secondary outcome is in‑hospital mortality. Multiple logistic regression models were fitted to assess predictor variables for adverse events and in‑hospital mortality. Results: The incidence of adverse events was 13.7% (31/227 patients had in‑transit adverse event); the most common adverse events reported were desaturation and hypotension. A unit increase in risk score for transported patients (RSTP) significantly increased the occurrence of adverse events (adjusted odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.07–1.72 and adjusted P = 0.01). Compared to medical patients, cardiac patients were less likely to develop adverse events (adjusted OR: 0.117, 95% CI: 0.02–0.52 and adjusted P < 0.01). The in‑hospital mortality was 30.4% and 30-day survival was 68.1%. For two patients whose age differed by 1 year, the older patient was more likely to die (adjusted OR: 1.03, 95% CI: 1.01–1.05 and P < 0.01) and a unit increase in RSTP significantly increased occurrence of in‑hospital mortality (adjusted OR: 1.30, 95% CI: 1.0–1.60 and P = 0.01). Conclusion: The incidence of adverse events was 13.7%. The most common observed adverse events were desaturation and hypotension. In‑hospital mortality was 30.4% and 30-day survival was 68.1%