Triage - Symptoms and Other Predictors in an All-comer Emergency Department Population

Summary

This study is to evaluate a tool capable of improved risk prediction regarding the 30-day mortality. The primary objective of this study is hospitalization, ICU-admission, morbidity and mortality in correlation with external validation of International Early Warning Score (IEWS) and decision-making processes regarding diagnosis, treatment and disposition in the ED.

Conditions

• Triage Risk Stratification

Interventions

DIAGNOSTIC_TEST

Assessment of vital signs

heart rate, blood pressure, body temperature, respiration rate, peripheral capillary haemoglobin oxygen saturation)

DIAGNOSTIC_TEST

Assessment of patient mobility at presentation

Patients are asked how they assess their own mobility: - Stable walking without aids or limited mobility with aids (walking aid, wheelchair, lying down).

DIAGNOSTIC_TEST

Assessment of level of consciousness by AVPUC scale

Assessment of level of consciousness by AVPUC scale (alert, new confusion, verbal, pain, unresponsive, new confusion)

DIAGNOSTIC_TEST

Assessment of symptoms patients presenting when admitted to ED

Questionnaire with a predefined list of 37 symptoms

DIAGNOSTIC_TEST

Assessment of what matters most in patients of 65 years and older

Patients over the age of 65 are asked the following: "generally asked: what matters most to you at the moment?" and "why is that important for you?".

DIAGNOSTIC_TEST

Assessment of Decision-making in senior physicians

Questionnaire consisting of 10 questions about the decision-making processes in the emergency department and the factors that form the basis of their decisions regarding the diagnosis, treatment, and disposition of the patient.

DIAGNOSTIC_TEST

Pain Numeric Rating Scale (NRS)

The NRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain ('0' representing one pain extreme (e.g. "no pain") to '10' representing the other pain extreme (e.g. "pain as bad as you can imagine"))

DIAGNOSTIC_TEST

Clinical Frailty Scale (CFS)

The CFS is a commonly used score to assess frailty. It was developed within the Canadian Study of Health and Aging and consists of a 9-level ordinal scale ranging from very fit (score 1) to living with very severe frailty (score 8), and score 9 reserved for those who are terminally ill.

DIAGNOSTIC_TEST

Peripheral Perfusion Index (PPI)

The PPI is derived from the photoplethysmography signal of pulse oximetry and represents the ratio between the pulsatile component (arterial compartment) and the non-pulsatile component (non-arterial tissues) of the light detected by the sensor. PPI can provide information for resuscitation in shock, outcome prediction in critically ill patients and may serve as an adjunct triage tool.

DIAGNOSTIC_TEST

Capillary Refill Time (CRT)

CRT provides a standardized assessment of capillary flow dynamics and is most assessed at the fingertip in clinical practice. A prolonged CRT in patients with septic, traumatic and cardiogenic shock has been associated with increased mortality and might be used as a resuscitation target in patients with septic shock.

DIAGNOSTIC_TEST

Mottling Score (MS)

Mattling is a characteristic discoloration of the skin resulting from reduced skin blood flow and has been shown to be associated with tissue hypoperfusion. The MS provides a simple scale (0-5) to characterize the extent of skin mottling around the knee and the severity of mottling is associated with adverse outcomes.

DIAGNOSTIC_TEST

Mental health complaints

Mental health complaints require safe, efficient risk stratification to distinguish primary psychiatric conditions from medical causes or comorbidities. Because current medical screening practices are inconsistent and unvalidated, this study will use prospective routine ED data to evaluate triage assessments of psychiatric likelihood and identify opportunities for standardized, evidence-based screening.

DIAGNOSTIC_TEST

Altered mental status - a vital sign

Delirium is a common and high-risk condition in older ED patients, and early detection is crucial to improve short- and long-term outcomes. This study will use routinely collected ED screening data (modified Confusion Assessment Method for the Emergency Department (mCAM-ED) and the four-item Abbreviated Mental Test (AMT-4)) to describe delirium prevalence and evaluate delirium identification in the emergency setting.

Sponsors & Collaborators

• University Hospital, Basel, Switzerland

  lead OTHER

Principal Investigators

• Roland Bingisser, Prof. Dr. med. · University Hospital Basel, Department of Emergency Medicine

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2022-05-17

Primary Completion

2026-05-27

Completion

2026-12-31

Countries

• Switzerland

Study Locations