Abstract
BackgroundEmergency Medical Services (EMS) are faced daily with patients presenting with non-specific chief complaints (NSC). Patients presenting with NSCs often have normal vital signs. It has previously been established that NSCs may have a serious underlying condition that has yet to be identified. The aim of the current study was to determine if soluble urokinase plasminogen activator receptor (suPAR) and lactate could be used to identify serious conditions among patients presenting with NSCs to the EMS. The secondary aim was to describe the prognostic value for mortality in the group.MethodA blinded prospective observational cohort study was conducted of patients brought to the ED by ambulance after calling the national emergency number 112 and who were assessed as having NSC by the EMS. Biomarkers were measured during index EMS assessment before transportation to the ED. Patients were followed via EMS and hospital electronic health records. Descriptive and logistic regression analyses were used.ResultsA total of 414 patients were included, with a median age of 82 years. A serious condition was present in 15.2% of the patients. Elevated suPAR above 3 ng/ml had a positive likelihood ratio (LR+) of 1.17 and a positive predictive value (PPV) of 17.3% as being predictive of a prevalent serious condition. Elevated suPAR above 9 ng/ml had LR+ 4.67 and a PPV of 16.7% as being predictive of 30-day mortality. Lactate was not significantly predictive.ConclusionPre-hospital suPAR and lactate cannot differentiate serious conditions in need of urgent treatment and assessment in the ED among patients presenting with non-specific chief complaints. suPAR has shown to be predictive of 30-day mortality, which could add some value to the clinical assessment.Trial registrationNCT03089359. Registered 20 March 2017, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03089359.
Highlights
Emergency Medical Services (EMS) are faced daily with patients presenting with non-specific chief complaints (NSC)
Pre-hospital soluble urokinase plasminogen activator receptor (suPAR) and lactate cannot differentiate serious conditions in need of urgent treatment and assessment in the Emergency Department (ED) among patients presenting with non-specific chief complaints. suPAR has shown to be predictive of 30-day mortality, which could add some value to the clinical assessment
Patients presenting with non-specific chief complaints (NSC) are often assessed as having an “affected general health condition” or “decreased general condition”, “a general malaise”, “a sense of illness”, or “just being unable to cope with usual daily activities”, and often present with near normal vital signs [1,2,3]
Summary
Emergency Medical Services (EMS) are faced daily with patients presenting with non-specific chief complaints (NSC). Patients presenting with non-specific chief complaints (NSC) are often assessed as having an “affected general health condition” or “decreased general condition”, “a general malaise”, “a sense of illness”, or “just being unable to cope with usual daily activities”, and often present with near normal vital signs [1,2,3]. It is not known how many present to the EMS with NSCs, NSC’s have been studied in the pre-hospital setting and a majority of the NSCs arrive at an ED by ambulance [4, 5] and most often during the daytime [5]. In addition to the triage systems used, biomarkers could be a feasible supplemental tool
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