Triage - Symptoms and Other Predictors in an All-comer Emergency Department Population; (EKBB 236/13) (EMERGE IV)

University Hospital Basel

Status: Completed

Conditions: Triage Risk Stratification

Treatments: Other: Clinical Frailty Scale; Other: physicians rating of severity of illness; Diagnostic Test: Assessment of vital signs; Other: Assessment of suspected diagnosis and differential diagnoses; Other: Impaired mobility on presentation (IMOP); Other: Assessment of symptoms patients presenting when admitted to ED; Other: Reason for patient presentation at ED

Study type: Observational

Funder types: Other

Identifiers

NCT03892551

PB_2019_00008 me19Bingisser;

Details and patient eligibility

About

This study is to develop a tool capable of improved risk prediction regarding the 30-day mortality. Based on vital signs, impaired mobility on presentation (IMOP), Clinical Frailty Scale (CFS) and patients' symptomatology three risk categories (low, intermediate, high risk) will be established.

Full description

Most Emergency Departments (EDs) perform an initial risk stratification of patients, called Triage. Establishing a diagnosis is key for the administration of the appropriate treatment and the following disposition decision. The earlier and the more accurate the final diagnosis is established, the shorter the time to treatment and time to disposition, and thus, the more efficient the patient flow. New ways to improve diagnosis accuracy early on in patients' ED visits are needed. Although a great number of well validated and widely used triage systems exists, to this date no gold standard in triage risk stratification has been established. Most of the existing triage systems rely on the measurement of vital signs and a list of chief complaints.

This study is to develop a tool capable of improved risk prediction regarding the 30-day mortality. Based on vital signs, impaired mobility on presentation (IMOP), Clinical Frailty Scale (CFS) and patients' symptomatology three risk categories (low, intermediate, high risk) will be established.

According to acuity patients undergo triage or directly proceed to the treatment unit. Patients awaiting triage will be approached by a member of the study personnel and will be verbally informed about the study. Afterwards, patients will be interviewed asking about their symptoms and their reason for presentation. Patients in need of immediate therapy will receive therapy before start of the interview. Following the interview, patients undergo routine triage.The physician performing initial triage will be asked to rate how ill patients appear to be using a numeric scale ranging from 0 (perfect condition) to 10 (extremely ill). Treating physician's will be asked to state their suspected diagnosis as well as differential diagnoses. Follow-up to assess 30-day and 1-year mortality rate and date of death will start one year after the end of the inclusion period.

Enrollment: 7,309 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• patients presenting to the ED of the University Hospital Basel and awaiting triage

Exclusion criteria

• unwillingness to participate
• insufficient ability to communicate with the study personnel.

Trial design

7,309 participants in 1 patient group

patients admitted to emergency ward

Description:

all patients admitted to the emergency ward and awaiting triage are observed

Treatment:

Diagnostic Test: Assessment of vital signs

Other: Assessment of suspected diagnosis and differential diagnoses

Other: Clinical Frailty Scale

Other: Reason for patient presentation at ED

Other: Assessment of symptoms patients presenting when admitted to ED

Other: physicians rating of severity of illness

Other: Impaired mobility on presentation (IMOP)