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Abstract: FR-PO784

Predicting Who Needs Urgent Dialysis Prior to Ambulance Transport to the Emergency Department

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Tennankore, Karthik K., Dalhousie University/NS Health Authority, Halifax, Nova Scotia, Canada
  • Vinson, Amanda Jean, Dalhousie University/NS Health Authority, Halifax, Nova Scotia, Canada
  • Bartolacci, John Enrico, Dalhousie University, Halifax, Nova Scotia, Canada
  • Goldstein, Judah, Dalhousie University, Halifax, Nova Scotia, Canada
  • Clark, David, London Health Sciences Centre, London, Ontario, Canada
Background

Chronic hemodialysis patients who require ambulance transport to the emergency department (ambulance-ED) may subsequently need urgent dialysis. However, little is known about predictors of urgent dialysis based on patient factors identified prior to ED transport. The purpose of this study was to develop a risk prediction model for urgent dialysis after ambulance-ED based on patient characteristics identified at the time of paramedic assessment.

Methods

We analyzed a cohort of incident thrice-weekly hemodialysis patients between 2009-2013 (last follow-up of 2015) who experienced one or more ambulance-ED events. Chief complaint, vital sign parameters and time from last dialysis to ambulance dispatch was assessed for all patients at the time of paramedic assessment prior to ED transport. Urgent dialysis was defined as a need for dialysis within 24 hours of an ambulance-ED in a monitored setting or among patients with an initial ED potassium of >6.5 mmol/L. Associations with urgent dialysis were analyzed using logistic regression. A risk prediction model was created and internally validated.

Results

Among 197 patients, there were 624 ambulance-ED events and 87 episodes of urgent dialysis. Weakness as a presenting complaint (OR 4.62, 95% CI 1.23-17.29), >24 hours since last dialysis (OR 2.09, 95% CI 1.15-3.81), and triage vitals (heart rate <60 beats/minute (OR 3.06, 95% CI 1.09-8.61), systolic blood pressure >160 mmHg (OR 2.37, 95% CI 1.32-4.25), respiratory rate ≥20 breaths/minute (OR 2.00, 95% CI 1.06-3.75) and oxygen saturation <90% (OR 3.04, 95% CI 1.55 – 5.94)) were associated with an increased need for urgent dialysis after ambulance-ED. A risk prediction model incorporating these variables had very good discrimination (C-statistic: 0.81, 95% CI 0.76-0.86). The negative predictive value for not needing urgent dialysis was 93.6% using the optimal cut point (≥15% predicted probability). Of the patients who were predicted to need urgent dialysis but were transported to a dialysis incapable facility, 31% required a second transport for urgent dialysis.

Conclusion

We created a risk prediction model for urgent dialysis after ambulance-ED based on patient characteristics at the time of paramedic assessment. This model has the potential to guide dialysis patient transport to dialysis-capable facilities when needed.