Clinical Outcomes for Prehospital Patients Assessed as Assaulted at 9-1-1 Call Taking

Clinical Outcomes for Prehospital Patients Assessed as Assaulted at 9-1-1 Call Taking: A Retrospective Cohort Study of the Role of Patient Sex

Introduction: Paramedics play an important role in assessing, treating, and connecting assault victims to further care. There is evidence of differential treatment between sexes in health care, but little is known in the paramedic setting. 

Objective: Explore the association between sex and outcomes in adult assault victims who presented via 9-1-1. 

Methods: Retrospective cohort study of adults assessed as an assault (Protocol 04 in the Medical Priority Dispatch System) at the initial 9-1-1 call, excluding sexual assaults and stun guns. Study settings were two large paramedic systems (Calgary, AB 2018-2021 and Montreal, QC 2015-2020) with linked paramedic data to health system outcomes. Exposure was sex of the patient with the outcomes of transport to the Emergency Department (ED), 2-day mortality, and survival to hospital discharge. Multivariable modeling adjusted for age, time-sensitive paramedic interventions, MPDS determinant, and calendar year. 

Results: A total of 4,219 (56.5% male) and 7,371 (64% male) patients met inclusion respectively in Calgary and Montreal. The median age was 36 years (IQR 27, 48) with 404 (10%) high priority (Delta) events in Calgary, and 37 years (IQR 26, 51) and 489 (7%) in Montreal. Of those transported or who sought care after non-transport, 92 (2%) and 197 (3%) presented to the ED as the highest priority (Canadian Triage and Acuity Scale—CTAS 1). Mortality rates were low for both cohorts (< 1%), which precluded modeling. The adjusted odds of being transported as a male was 1.59 (95% CI 1.40–1.82) times that of a female in Calgary, and 1.43 (95% CI 1.29–1.58) in Montreal. 

Conclusions: After controlling for patient age, acuity, and year, male victims of assault had greater odds of being transported to an ED than female victims. Mortality and clinical severity were low for all patients. Future research should explore residual confounding by severity, and other potential explanations for the observed sex bias.