• Emma Bourke-Matas, Tan Doan, Kelly-Ann Bowles, and Emma Bosley.
• Department of Paramedicine, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia.
• Emerg Med Australas. 2024 Oct 25.

ObjectiveImproved understanding of the deteriorating patient in the pre-hospital setting may result in earlier recognition and response. Considering the effects of undetected deterioration are profound, it is fundamental to report the prevalence of pre-hospital clinical deterioration to advance our understanding. The present study investigated the prevalence of pre-hospital clinical deterioration and adverse events (AEs) within 3 days of the pre-hospital episode of care.MethodsThis retrospective cohort study was based on pre-hospital incidents involving adult patients attended by Queensland Ambulance Service between 1 January 2018 and 31 December 2020. Due to lacking a standardised definition of pre-hospital clinical deterioration, established early warning scores (NEWS, MEWS and Q-ADDS) were calculated from pre-hospital vital signs to identify clinical deterioration. Linked hospital data were used to identify the occurrence of an AE.ResultsSome degree of physiological derangement was initially observed in over half of the patients, and pre-hospital clinical deterioration was seen in 2.7%-4% of patients. The prevalence of AEs was 3.2%. Patients that experienced an AE were more likely to be male, elderly, suffering from a medical (non-trauma) condition, and had a greater burden of disease. Concerningly, almost 50% of patients that suffered an AE did not meet escalation thresholds of NEWS, MEWS or Q-ADDS.ConclusionsThe present study found the prevalence of pre-hospital clinical deterioration and AEs subsequent to pre-hospital episodes of care to be low. Future research should prioritise using standardised criteria to define pre-hospital clinical deterioration and evaluate the performance of early warning scores.© 2024 The Author(s). Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.

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