Abstract
BackgroundPrioritization of acutely ill patients in the Emergency Department remains a challenge. We aimed to evaluate whether routine blood tests can predict mortality in unselected patients in an emergency department and to compare risk prediction with a formalized triage algorithm.MethodsA prospective observational cohort study of 12,661 consecutive admissions to the Emergency Department of Nordsjælland University Hospital during two separate periods in 2010 (primary cohort, n = 6279) and 2013 (validation cohort, n = 6383). Patients were triaged in five categories by a formalized triage algorithm. All patients with a full routine biochemical screening (albumin, creatinine, c-reactive protein, haemoglobin, lactate dehydrogenase, leukocyte count, potassium, and sodium) taken at triage were included. Information about vital status was collected from the Danish Central Office of Civil registration.Multiple logistic regressions were used to predict 30-day mortality. Validation was performed by applying the regression models on the 2013 validation cohort.ResultsThirty-day mortality was 5.3%. The routine blood tests had a significantly stronger discriminative value on 30-day mortality compared to the formalized triage (AUC 88.1 [85.7;90.5] vs. 63.4 [59.1;67.5], p < 0.01). Risk stratification by routine blood tests was able to identify a larger number of low risk patients (n = 2100, 30-day mortality 0.1% [95% CI 0.0;0.3%]) compared to formalized triage (n = 1591, 2.8% [95% CI 2.0;3.6%]), p < 0.01.ConclusionsRoutine blood tests were strongly associated with 30-day mortality in acutely ill patients and discriminatory ability was significantly higher than with a formalized triage algorithm. Thus routine blood tests allowed an improved risk stratification of patients presenting in an emergency department.
Highlights
Prioritization of acutely ill patients in the Emergency Department remains a challenge
In 2011 Hillerød Adaptive Process Triage (HAPT) was customized for local conditions and named Danish Emergency Process Triage (DEPT) [18]
Characteristics of the included and excluded patients are presented in Additional file 3 along with vital signs and blood test results
Summary
Risk stratification of patients in the Emergency Department using triage systems has been proposed to meet the above mentioned challenges [1]. These triage systems classify patients into five categories based on vital signs (level of consciousness, arterial blood pressure, heart rate, arterial oxygen saturation, respiratory rate and temperature) [4, 5]. A routine biochemical screening is performed on most patients upon presentation to the modern ED except for those with obvious minor complaints The results of these blood tests are, rarely used in the initial risk assessment even though modern blood analysis techniques allow for the results to be available within 15 min. Many routine tests have a well-known prognostic value in selected patient groups, but their value for initial risk assessment of ED patients have to our knowledge not been investigated in larger groups [10,11,12,13,14]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
