What is the short terme outcome for patients left on scene after the intervention by the SMUR in the Chambéry basin: a descriptive analytical study

Overview & Synopsis

Introduction: The practice of leaving patients on scene by SMUR teams consists of leaving a patient at the site of the intervention after medical assessment, when their condition does not warrant transport to a healthcare facility. While this practice may prove to be a lever for optimizing the prehospital response to emergency room congestion, its safety and effectiveness remain poorly documented in the French healthcare system. The aim of this study was to evaluate the short-term outcome (48 hours and 7 days) in terms of readmission to hospital of patients left at the scene after SMUR intervention in the Chambéry-Aix-les-Bains area, and to identify the factors associated with an unfavorable outcome. Materials and methods: A single-center, retrospective, descriptive, observational epidemiological study was conducted. Patients left at the scene alive after intervention by the SMUR in Chambéry-Aix-les-Bains between January 1 and December 31, 2024, were analyzed. Results: Among the 3,656 calls performed during the period, 119 patients (3.3%) were left in place, and after applying the exclusion criteria, 97 patients were analyzed. The mean age was 48.76 ± 26.77 years, with a slight male predominance (58.8%). The most common reasons were psychiatric (18%) and cardiological (16%). Early return to the emergency department within 7 days concerned 15.5% of patients, including 9.3% within 48 hours. No significant difference was found between patients who returned to the ER and those who did not, although there was a tendency for males (73%) and mental health-related reasons (53.4%) to be overrepresented in the follow-up group. Secondary hospitalizations within 7 days accounted for 9.3% of patients, the SMUR reintervention rate at 7 days was less than 1%, and no unexpected deaths were observed. The average on-site medicalization time was 30.7 ± 1.5 minutes, and was reduced by the presence of additional emergency resources, but increased by the administration of treatment and the distance of the intervention. Conclusion: This study suggests that the decision of non-conveyance, when made after a complete medical assessment, is generally safe, with low complication rates. The favorable outcomes observed seem to confirm the clinical relevance of the referral decision made in the field, with results consistent with the existing literature on the subject. The overrepresentation of mental health-related reasons in this population raises questions about the value of specific post-intervention follow-up and highlights the need for further research, free from the biases inherent in this study, to explore opportunities for improving this practice.