Is the direct admission for patients in intensive care unit by Samu-Smur system justified?

Study design: The French system of Samu-Smur allows the admission of patien ts directly in intensive care unit (ICU). The aim of this study is to exami ne the utility of the Samu-Smur with regard to such direct admission (DA). Patients and methods: This retrospective study was performed by the Samu of Paris. Patient details were gathered from three reports : namely hospitali sation, transport and regulation reports. These were analysed to decide whe ther the admission diagnostic was exact, whether the patient's condition wa s serious, whether the prehospital treatment justified direct admission int o an ICU and whether the management was coherent. Results: In 1997, 409 (31%) cases were studied among the 1,350 admitted pat ients in ICU. Three groups of patients were classified according to admissi on to surgical (n = 54), medical (n = 180), cardiological ICU (n = 175). Th e prehospital diagnosis was confirmed by the hospitalisation report in 91% of patients in the all three groups. The patient's condition was found to t he serious in all cases. Justification of the treatment was respectively fo und in 96, 88 and 84% of patients. The coherence of management was confirme d in 94, 96 and 89%. Discusssion: This study has shown that Samu-Smur management lead to justifi e DA in ICU for all patients in the study. Prospective studies are needed t o show the advantages of this strategy in term of speed of management and o utcome. (C) 2000 Editions scientifiques et medicales Elsevier SAS.