Can Emergency Medical Services Providers Predict Critical Illness?

Emergency medical services (EMS) providers use mechanism of injury and physiologic criteria to determine the level of in-hospital expertise that trauma patients need. To identify clinical predictors of critical illness (defined as severe sepsis, use of mechanical ventilation, or death during hospitalization) in patients without trauma or cardiac arrest, these authors retrospectively reviewed records for adult patients who were transported by a single EMS system in Washington State from 2002 through 2006. Patients were randomly divided into a development cohort (87,000 patients) and a validation cohort (58,000).

Critical illness occurred in approximately 5% of patients in each group. In the development cohort, multivariate analysis identified…