[Is the direct admission to the recovery service or to the intensive care unit of patients cared for by the Smur system justified?].
METHODS
The French system of Samu-Smur allows the admission of patients directly in intensive care unit (ICU). The aim of this study is to examine the utility of the Samu-Smur with regard to such direct admission (DA).


METHODS
This retrospective study was performed by the Samu of Paris. Patient details were gathered from three reports: namely hospitalization, transport and regulation reports. These were analysed to decide whether the admission diagnostic was exact, whether the patient's condition was serious, whether the prehospital treatment justified direct admission into an ICU and whether the management was coherent.


RESULTS
In 1997, 409 (31%) cases were studied among the 1,350 admitted patients in ICU. Three groups of patients were classified according to admission to surgical (n = 54), medical (n = 180), cardiological ICU (n = 175). The prehospital diagnosis was confirmed by the hospitalization report in 91% of patients in the all three groups. The patient's condition was found to the serious in all cases. Justification of the treatment was respectively found in 96, 88 and 84% of patients. The coherence of management was confirmed in 94, 96 and 89%.


CONCLUSIONS
This study has shown that Samu-Smur management lead to justified DA in ICU for all patients in the study. Prospective studies are needed to show the advantages of this strategy in term of speed of management and outcome.
Service d'anesthésie-réanimation, Samu de Paris, hôpital Necker Enfants-Malades, 149, rue de Sèvres, 75743 Paris, France. ctelion.necker@invivo.edu
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Télion
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Greffet
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A
Rozenberg
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Lejay
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Jannière
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Carli
D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D005602:France; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards*; D012189:Retrospective Studies