Evidence map›Paper›PMID 29654018›Full record

ArticleBMJ open2018

Reducing early infant mortality in India: results of a prospective cohort of pregnant women using emergency medical services.

Corey B Bills, Jennifer A Newberry, Gary Darmstadt, Elizabeth A Pirrotta, G V Ramana Rao, S V Mahadevan, Matthew C Strehlow

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 1 pooled it
3.6field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.

  1. Pooled it
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  5. Observational
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  9. Suspected Miscarriage in the Experience of Emergency Medical Services Teams-Preliminary Study.International journal of environmental research and public health · 2021
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 2 countries.

Corey B BillsDepartment of Emergency Medicine, University of California, San Francisco, California, USA.
Jennifer A NewberryDepartment of Emergency Medicine, Stanford University, Stanford, California, USA.
Gary DarmstadtDepartment of Pediatrics, Stanford University, Stanford, California, USA.
Elizabeth A PirrottaDepartment of Emergency Medicine, Stanford University, Stanford, California, USA.
G V Ramana RaoGVK Emergency Management and Research Institute, Secunderabad, Telangana, India.
S V MahadevanDepartment of Emergency Medicine, Stanford University, Stanford, California, USA.
Matthew C StrehlowDepartment of Emergency Medicine, Stanford University, Stanford, California, USA.
Stanford University · USGVK Emergency Management and Research Institute · INUniversity of California, San Francisco · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo describe the demographic characteristics and clinical outcomes of neonates born within 7 days of public ambulance transport to hospitals across five states in India.

designProspective observational study.

settingFive Indian states using a centralised emergency medical services (EMS) agency that transported 3.1 million pregnant women in 2014.

participantsOver 6 weeks in 2014, this study followed a convenience sample of 1431 neonates born to women using a public-private ambulance service for a 'pregnancy-related' problem. Initial calls were deemed 'pregnancy related' if categorised by EMS dispatchers as 'pregnancy', 'childbirth', 'miscarriage' or 'labour pains'. Interfacility transfers, patients absent on ambulance arrival, refusal of care and neonates born to women beyond 7 days of using the service were excluded.

main outcome measuresdeath at 2, 7 and 42 days after delivery.

resultsAmong 1684 women, 1411 gave birth to 1431 newborns within 7 days of initial ambulance transport. Median maternal age at delivery was 23 years (IQR 21-25). Most mothers were from rural/tribal areas (92.5%) and lower social (79.9%) and economic status (69.9%). Follow-up rates at 2, 7 and 42 days were 99.8%, 99.3% and 94.1%, respectively. Cumulative mortality rates at 2, 7 and 42 days follow-up were 43, 53 and 62 per 1000 births, respectively. The perinatal mortality rate (PMR) was 53 per 1000. Preterm birth (OR 2.89, 95% CI 1.67 to 5.00), twin deliveries (OR 2.80, 95% CI 1.10 to 7.15) and caesarean section (OR 2.21, 95% CI 1.15 to 4.23) were the strongest predictors of mortality.

conclusionsThe perinatal mortality rate associated with this cohort of patients with high-acuity conditions of pregnancy was nearly two times the most recent rate for India as a whole (28 per 1000 births). EMS data have the potential to provide more robust estimates of PMR, reduce inequities in timely access to healthcare and increase facility-based care through service of marginalised populations.

Indexed as

Emergency Medical ServicesInfant MortalityPrenatal CareAdolescentCesarean SectionFemaleHumansIndiaInfantInfant, NewbornPregnancyProspective StudiesYoung AdultEmergency Medical Services (ems)IndiaMaternal MedicineNeonatal Mortality

Identifiers

PMID29654018
PMCPMC5905760
OpenAlexW2797783906

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.