Prospective application of risk scores in the interhospital transport of patients.

We carried out a prospective evaluation of 172 patients using our own risk score for patients transferred from the emergency department of a community hospital in Tudela, Spain, to main centres, during 1988. Although the data go back almost 10 years, this scoring has not been internationally published and is at present widely applied in Spain. Patients scoring less than 7 points were transferred under specialized nursing supervision (Group I), and those scoring equal to or over 7 points were transferred in a specially equipped intensive care unit surface ambulance and supervised by a physician and a nurse (Group II). There were 102 patients in Group I and 70 in Group II. Complications arising during transfer were defined as minor or serious. A low overall incidence of complications was recorded--a total of 29 cases (16.9% of all transfers). The incidence of complications was significantly higher in Group II patients (p < 0.005). One patient from Group II died during transport. All patients from Group II were admitted to the ICUs compared with only 20 (18.6%) from Group I (p < 0.001). Of a total of 23 deaths in hospital, nine were from Group I and 14 from Group II. During the first 24 hours after admission, six patients died from Group II and none from Group I. The application of risk scores has permitted to assign effectively technical and human resources for a safe interhospital transfer of critically ill patients.