[Long distance interhospital transport. Accuracy of severity scoring system].
OBJECTIVE
To evaluate the hospital mortality risk for patients transported from a regional hospital to its second-level reference hospital using several scoring systems: Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), SAPS II and APACHE II.


METHODS
Prospective observational study of patients transferred from the Sant Hospital in la Seu d'Urgell to the University Hospital Arnau de Vilanova in Lleida, at a distance of 132 km.


METHODS
Consecutive cohort of 134 patients transferred between October 2005 and July 2007.


METHODS
Several data were collected, such as variables on demography, stay, severity score, diagnosis on admission, destination service and procedures, such as mechanical ventilation, inotropics, sedation, neuromuscular blockers and antiarrhythmics. Variable of result was hospital mortality.


RESULTS
The average transfer time was 105 +/- 14 minutes; 31.6% of the patients were admitted to an ICU; 16 (11,9%) patients died during hospital stay. The APACHE II and SAPS II scores got significantly higher values in those patients who died. The RAPS and REMS scores showed no significant differences among dead and survivors. The higher the APACHE II and SAPS II scores, the higher the proportion of mortality. The RAPS and REMS scores did not prove to have that tendency. Area under ROC curve was higher for APACHE II (0.76; 95% CI, 0.63-0.89) and SAPS II (0.78; 95% CI, 0.67-0.89), compared to those of RAPS (0.59; 95% CI, 0.43-0.75) and REMS (0.63; 95% CI, 0.49-0.78).


CONCLUSIONS
The severity of illness measured with APACHE II and SAPS II is able to identify those patients with a higher predictive of mortality. It is a priority to have the right previous stabilization and the adequately trained team to provide care during the transfer, when facing lengthy journey times.
Badia
Mariona
M
Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova, Lleida, España. marionabadia@wanadoo.es
Armendáriz
Juan José
JJ
Vilanova
Cecilia
C
Sarmiento
Omar
O
Serviá
Luis
L
Trujillano
Javier
J
D000293:Adolescent; D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D014187:Transportation of Patients; D055815:Young Adult