Comprehensive Summary
This multicenter, cluster-randomized trial evaluated whether the Score Predicting Imminent Delivery (SPID) enhances triage and prehospital management of unexpected out-of-hospital deliveries.The study analyzed 7,782 calls from women ≥33 weeks gestation across 19 French emergency call centers. Calls were managed either via SPID-guided decision-making or standard care, with outcomes compared between groups. The primary outcome was the occurrence of prehospital deliveries without initial dispatch of a physician-staffed mobile ICU, a key marker of high-risk delivery management. Prehospital deliveries without initial ICU dispatch were significantly reduced in the SPID group (0.95%) versus controls (2.01%). Likewise, deliveries occurring without a mobile ICU present on-site were lower in the SPID group (1.92%) compared with controls (3.34%). Overall prehospital delivery rates, call duration, staff satisfaction, and maternal and neonatal complications were comparable between groups.
Outcomes and Implications
Systematic SPID use reduced the incidence of prehospital deliveries occurring without a mobile ICU team. Despite improved triage, call duration, staff satisfaction, and maternal and neonatal complications remained unchanged. These results suggest that SPID can improve first-line triage for cells regarding imminent delivery by decreasing high-risk deliveries without advanced support. Improved dispatch decisions with SPID also led to fewer secondary mobile ICU upgrades. Overall, SPID allows emergency call centers to identify imminent deliveries more accurately, enhancing prehospital triage and preparedness. By minimizing deliveries without on-site advanced support, SPID may improve the safety of unexpected out-of-hospital deliveries.