Defining the Outcome Measures for Out‐of‐hospital...

Defining the Outcome Measures for Out‐of‐hospital Trials in Acute Pulmonary Edema

Abstract

Abstract Objective: Comparing studies of the effectiveness of out‐of‐hospital interventions in acute pulmonary edema (APE) is difficult due to the diversity of outcome measures used in the literature. The objective of this study was to define a set of clinically relevant outcome measures for future out‐of‐hospital trials in APE. Methods: A Medline search and hand‐search of bibliographies was undertaken to develop a list of APE outcome measures. A survey was mailed to a sample of 227 Canadian emergency physicians using the Dillman methodology, requesting that respondents select clinically relevant outcome measures from this list and rank them by importance. A selection frequency of ≥70% and a median ranking score were used to determine relevant outcome measures. Results: The Medline and bibliography search identified 21 APE outcome measures. The survey response rate was 71%. Outcome measures selected most frequently were heart rate, respiratory rate, respiratory distress scale, subjective dyspnea scale, out‐of‐hospital intubation, emergency department (ED) intubation, survival to discharge, and out‐of‐hospital mortality. The median ranking score identified a similar set of measures: heart rate, respiratory rate, respiratory distress scale, subjective dyspnea scale, out‐of‐hospital intubation rate, and ED intubation rate. There was no significant difference in outcome selection between physicians who worked in communities with and without advanced out‐of‐hospital care. Conclusions: Clinically relevant out‐of‐hospital APE outcome measures were identified and endorsed by a representative survey of Canadian emergency physicians. Clinicians appear to favor short‐term and non‐mortality outcomes for out‐of‐hospital interventions. The use of this set of APE outcome measures may improve the design and comparability of future out‐of‐hospital trials.