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Analysis of Mortality Among Patients Attended by Mobile Emergency Service in Paraná Between 2019 and 2020 – Observational Study

Authors: Erika F. S. B. Ludwig, Aroldo Gavioli, et al.

DOI: https://doi.org/10.1590/SciELOPreprints.10275

Date Posted: 31 October 2024

Reviewed by Nyirabwimana FRANCOISE

Study Design: Quantitative Observational, cross-sectional

1. Summary of the Study

This study investigates mortality among 13,326 patients assisted by the in Paraná from 2019 to 2020. It focuses on how response time, type of support, and regional service distribution affect outcomes, particularly prehospital mortality. Advanced statistical tools such as Kaplan-Meier survival curves and Cox regression were applied. Notably, mortality was higher in 2020 (vs. 2019).

2. Strengths

✅ Timely and relevant topic, especially given the COVID-19 pandemic’s impact on emergency services.

✅ Robust dataset: Over 13,000 service records analyzed.

✅ Statistical rigor: Use of Kaplan-Meier, Log-rank, Cox regression models.

✅ Policy relevance: Provides clear insights into regional inequalities and resource allocation.

✅ Well-defined variables: Includes prehospital mortality, response times, patient demographics, and system structure.

3. Areas for Improvement

🔹 A. Abstract

The abstract is clear and well-structured, but the confidence intervals (CIs) in the hazard ratios should be fully reported (currently shown as IC95% only without actual values in some places).

Include p-values for clarity on statistical significance.

🔹 B. Introduction

Very informative and thorough.

Could be slightly more concise to better guide the reader to the problem and objective.

🔹 C. Methods

·       Excellent detail about the structure of SAMU services and regional differences.

·       Limitations in data completeness were acknowledged, but it would be helpful to report how missing data were handled statistically.

·       Clarify if patients dead on arrival were excluded from the survival analysis, and if so, why.

🔹 D. Results

·       Well-structured and statistically sound.

🔹 E. Discussion

The interpretation is insightful and supported by external literature.

The section could benefit from a clearer structure: group the discussion under “Principal findings,” “Comparison with other studies,” “Implications,” and “Limitations.”

🔹 F. Limitations

Well-acknowledged (e.g., incomplete data, manual form filling).

Consider discussing the generalizability of findings to other regions or contexts.

4. Minor Suggestions

Improve English grammar slightly in the translated abstract for fluency.

Ensure consistency in units of time (e.g., minutes) across all tables and figures.

Consider merging some long paragraphs for easier readability.

5. Conclusion and Recommendation

This preprint presents important evidence on how emergency medical response characteristics affect patient survival. It is especially valuable for health system managers in Brazil and other countries with regionalized prehospital systems. With minor revisions for clarity and structure, this work is publishable in a peer-reviewed journal.

6. Final Recommendation

·       Clarifying CIs and p-values in the abstract

·       Enhancing readability and structure in the discussion

·       Explaining statistical treatment of missing data

Competing interests

Ensures transparency and integrity in the review process