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A simple clinical assessment is superior to systematic triage in prediction of mortality in the emergency department

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@article{91597daa49b043a08b037aa3149550c5,
title = "A simple clinical assessment is superior to systematic triage in prediction of mortality in the emergency department",
abstract = "OBJECTIVE: To compare the Danish Emergency Process Triage (DEPT) with a quick clinical assessment (Eyeball triage) as predictors of short-term mortality in patients in the emergency department (ED).METHODS: The investigation was designed as a prospective cohort study conducted at North Zealand University Hospital. All patient visits to the ED from September 2013 to December 2013 except minor injuries were included. DEPT was performed by nurses. Eyeball triage was a quick non-systematic clinical assessment based on patient appearance performed by phlebotomists. Both triage methods categorised patients as green (not urgent), yellow, orange or red (most urgent). Primary analysis assessed the association between triage level and 30-day mortality for each triage method. Secondary analyses investigated the relation between triage level and 48-hour mortality as well as the agreement between DEPT and Eyeball triage.RESULTS: A total of 6383 patient visits were included. DEPT was performed for 6290 (98.5{\%}) and Eyeball triage for 6382 (~100{\%}) of the patient visits. Only patients with both triage assessments were included. The hazard ratio (HR) for 48-hour mortality for patients categorised as yellow was 0.9 (95{\%} CI 0.4 to 1.9) for DEPT compared with 4.2 (95{\%} CI 1.2 to 14.6) for Eyeball triage (green is reference). For orange the HR for DEPT was 2.2 (95{\%} CI 1.1 to 4.4) and 17.1 (95{\%} CI 5.1 to 57.1) for Eyeball triage. For red the HR was 30.9 (95{\%} CI 12.3 to 77.4) for DEPT and 128.7 (95{\%} CI 37.9 to 436.8) for Eyeball triage. For 30-day mortality the HR for patients categorised as yellow was 1.7 (95{\%} CI 1.2 to 2.4) for DEPT and 2.4 (95{\%} CI 1.6 to 3.5) for Eyeball triage. For orange the HR was 2.6 (95{\%} CI 1.8 to 3.6) for DEPT and 7.6 (95{\%} CI 5.1 to 11.2) for Eyeball triage, and for red the HR was 19.1 (95{\%} CI 10.4 to 35.2) for DEPT and 27.1 (95{\%} CI 16.9 to 43.5) for Eyeball triage. Agreement between the two systems was poor (kappa 0.05).CONCLUSION: Agreement between formalised triage and clinical assessment is poor. A simple clinical assessment by phlebotomists is superior to a formalised triage system to predict short-term mortality in ED patients.",
keywords = "Adult, Aged, Aged, 80 and over, Clinical Competence/standards, Cohort Studies, Denmark, Emergency Service, Hospital/organization & administration, Female, Humans, Male, Middle Aged, Mortality/trends, Nursing Assessment/methods, Prospective Studies, Registries/statistics & numerical data, Risk Assessment/methods, Triage/methods",
author = "Iversen, {Anne Kristine Servais} and Michael Kristensen and {\O}stervig, {Rebecca Monett} and Lars K{\o}ber and Gy{\"o}rgy S{\"o}l{\'e}tormos and {Lundager Forberg}, Jakob and Jesper Eugen-Olsen and Rasmussen, {Lars Simon} and Morten Schou and Iversen, {Kasper Karmark}",
note = "{\circledC} Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.",
year = "2019",
month = "2",
doi = "10.1136/emermed-2016-206382",
language = "English",
volume = "36",
pages = "66--71",
journal = "Emergency Medicine Journal",
issn = "1472-0205",
publisher = "B M J Group",
number = "2",

}

RIS

TY - JOUR

T1 - A simple clinical assessment is superior to systematic triage in prediction of mortality in the emergency department

AU - Iversen, Anne Kristine Servais

AU - Kristensen, Michael

AU - Østervig, Rebecca Monett

AU - Køber, Lars

AU - Sölétormos, György

AU - Lundager Forberg, Jakob

AU - Eugen-Olsen, Jesper

AU - Rasmussen, Lars Simon

AU - Schou, Morten

AU - Iversen, Kasper Karmark

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PY - 2019/2

Y1 - 2019/2

N2 - OBJECTIVE: To compare the Danish Emergency Process Triage (DEPT) with a quick clinical assessment (Eyeball triage) as predictors of short-term mortality in patients in the emergency department (ED).METHODS: The investigation was designed as a prospective cohort study conducted at North Zealand University Hospital. All patient visits to the ED from September 2013 to December 2013 except minor injuries were included. DEPT was performed by nurses. Eyeball triage was a quick non-systematic clinical assessment based on patient appearance performed by phlebotomists. Both triage methods categorised patients as green (not urgent), yellow, orange or red (most urgent). Primary analysis assessed the association between triage level and 30-day mortality for each triage method. Secondary analyses investigated the relation between triage level and 48-hour mortality as well as the agreement between DEPT and Eyeball triage.RESULTS: A total of 6383 patient visits were included. DEPT was performed for 6290 (98.5%) and Eyeball triage for 6382 (~100%) of the patient visits. Only patients with both triage assessments were included. The hazard ratio (HR) for 48-hour mortality for patients categorised as yellow was 0.9 (95% CI 0.4 to 1.9) for DEPT compared with 4.2 (95% CI 1.2 to 14.6) for Eyeball triage (green is reference). For orange the HR for DEPT was 2.2 (95% CI 1.1 to 4.4) and 17.1 (95% CI 5.1 to 57.1) for Eyeball triage. For red the HR was 30.9 (95% CI 12.3 to 77.4) for DEPT and 128.7 (95% CI 37.9 to 436.8) for Eyeball triage. For 30-day mortality the HR for patients categorised as yellow was 1.7 (95% CI 1.2 to 2.4) for DEPT and 2.4 (95% CI 1.6 to 3.5) for Eyeball triage. For orange the HR was 2.6 (95% CI 1.8 to 3.6) for DEPT and 7.6 (95% CI 5.1 to 11.2) for Eyeball triage, and for red the HR was 19.1 (95% CI 10.4 to 35.2) for DEPT and 27.1 (95% CI 16.9 to 43.5) for Eyeball triage. Agreement between the two systems was poor (kappa 0.05).CONCLUSION: Agreement between formalised triage and clinical assessment is poor. A simple clinical assessment by phlebotomists is superior to a formalised triage system to predict short-term mortality in ED patients.

AB - OBJECTIVE: To compare the Danish Emergency Process Triage (DEPT) with a quick clinical assessment (Eyeball triage) as predictors of short-term mortality in patients in the emergency department (ED).METHODS: The investigation was designed as a prospective cohort study conducted at North Zealand University Hospital. All patient visits to the ED from September 2013 to December 2013 except minor injuries were included. DEPT was performed by nurses. Eyeball triage was a quick non-systematic clinical assessment based on patient appearance performed by phlebotomists. Both triage methods categorised patients as green (not urgent), yellow, orange or red (most urgent). Primary analysis assessed the association between triage level and 30-day mortality for each triage method. Secondary analyses investigated the relation between triage level and 48-hour mortality as well as the agreement between DEPT and Eyeball triage.RESULTS: A total of 6383 patient visits were included. DEPT was performed for 6290 (98.5%) and Eyeball triage for 6382 (~100%) of the patient visits. Only patients with both triage assessments were included. The hazard ratio (HR) for 48-hour mortality for patients categorised as yellow was 0.9 (95% CI 0.4 to 1.9) for DEPT compared with 4.2 (95% CI 1.2 to 14.6) for Eyeball triage (green is reference). For orange the HR for DEPT was 2.2 (95% CI 1.1 to 4.4) and 17.1 (95% CI 5.1 to 57.1) for Eyeball triage. For red the HR was 30.9 (95% CI 12.3 to 77.4) for DEPT and 128.7 (95% CI 37.9 to 436.8) for Eyeball triage. For 30-day mortality the HR for patients categorised as yellow was 1.7 (95% CI 1.2 to 2.4) for DEPT and 2.4 (95% CI 1.6 to 3.5) for Eyeball triage. For orange the HR was 2.6 (95% CI 1.8 to 3.6) for DEPT and 7.6 (95% CI 5.1 to 11.2) for Eyeball triage, and for red the HR was 19.1 (95% CI 10.4 to 35.2) for DEPT and 27.1 (95% CI 16.9 to 43.5) for Eyeball triage. Agreement between the two systems was poor (kappa 0.05).CONCLUSION: Agreement between formalised triage and clinical assessment is poor. A simple clinical assessment by phlebotomists is superior to a formalised triage system to predict short-term mortality in ED patients.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Clinical Competence/standards

KW - Cohort Studies

KW - Denmark

KW - Emergency Service, Hospital/organization & administration

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Mortality/trends

KW - Nursing Assessment/methods

KW - Prospective Studies

KW - Registries/statistics & numerical data

KW - Risk Assessment/methods

KW - Triage/methods

UR - http://www.scopus.com/inward/record.url?scp=85055036806&partnerID=8YFLogxK

U2 - 10.1136/emermed-2016-206382

DO - 10.1136/emermed-2016-206382

M3 - Journal article

VL - 36

SP - 66

EP - 71

JO - Emergency Medicine Journal

JF - Emergency Medicine Journal

SN - 1472-0205

IS - 2

ER -

ID: 55461444