Effect of the score predicting imminent delivery on the management of unexpected out-of-hospital obstetrical deliveries: a cluster randomized clinical trial.
European Journal of Emergency Medicine · 2024-08-04 · Randomised trial
Abstract
BACKGROUND AND IMPORTANCE: Early identification of imminent deliveries is crucial for guiding the decision to dispatch emergency medical team to the prehospital setting. OBJECTIVE: To study whether the use of the score predicting imminent delivery (SPID) at the emergency call center reduces the risk of prehospital delivery occurring without the presence of a physician-staffed mobile ICU team. DESIGN, SETTING, AND PARTICIPANTS: Prospective multicenter cluster randomized controlled trial in 19 call centers in France. Calls from pregnant woman in labor with at least 33 weeks of amenorrhea were eligible. The emergency call center responses included medical advice, transport to the hospital by personal means or ambulance, or dispatch of the mobile ICU team. INTERVENTION: In the intervention group, the use of the SPID was mandatory to guide decision-making. OUTCOMES MEASURES AND ANALYSIS: The primary outcome was the rate of prehospital deliveries occurring without the initial dispatch of a mobile ICU team. The secondary endpoints included the prehospital deliveries rate without the presence of a mobile ICU team on site, call duration, satisfaction score, and maternal and neonatal mortality. MAIN RESULTS: A total of 7782 pregnant women were included in the intention-to-treat analysis (3773 control and 4009 intervention), including 523 (7.0%) prehospital deliveries (6.3% intervention and 7.6% control) and a 22.3% rate of mobile ICU dispatch decision (20.8% intervention group and 23.8% control). Prehospital delivery without initial dispatch of a mobile ICU was less frequent in the intervention group compared to control: 0.95 vs. 2.01% [odds ratio (OR) 0.46; 95% confidence interval (CI), 0.31-0.70]. There was also a lower rate of prehospital delivery without the presence of a mobile ICU team on site in the intervention group: 1.92 vs. 3.34% (OR = 0.58; 95% CI, 0.42-0.82). There was no significant difference in the other secondary endpoints. CONCLUSION: In this multicenter randomized controlled trial, the systematic use of the SPID was associated with a reduction of prehospital deliveries occurring without the presence of a mobile ICU team.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Dispatchers & call takers · Neonates · Pregnant patients · Prehospital physicians · Time intervals · Triage instruments
Related articles
- Is ambulance telephone triage using advanced medical priority dispatch protocols able to identify patients with acute stroke correctly? (Emerg Med J, 2009)
- Video-assisted versus telephone-only pediatric emergency calls: a predefined substudy of the cluster randomized CAM-VISION trial. (Scand J Trauma Resusc Emerg Med, 2026)
- Emergency medical dispatchers' experiences of using the Medical Priority Dispatch System telephone triage to identify maternity emergencies: a qualitative focus group study. (BMJ Open, 2024)
- Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study. (BMC Emerg Med, 2024)
- [Assessment of imminence of unplanned out-of-hospital deliveries in Guadeloupe: experience of the mobile emergency and resuscitation service of Pointe-à-Pitre]. (J Gynecol Obstet Biol Reprod (Paris), 2014)
- Dispatchers impression plus Medical Priority Dispatch System reduced dispatch centre times in cases of out of hospital cardiac arrest. Pre-alert--a prospective, cluster randomized trial. (Resuscitation, 2013)