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Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department-a prospective cohort study

Barfod, Charlotte ; Lauritzen, Marlene Mauson Pankoke ; Danker, Jakob Klim ; Sölétormos, György ; Forberg, Jakob Lundager LU ; Berlac, Peter Anthony ; Lippert, Freddy ; Lundstrøm, Lars Hyldborg ; Antonsen, Kristian and Lange, Kai Henrik Wiborg (2012) In Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 20. p.1-10
Abstract
Background
Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT) system and the outcome measures; Admission to Intensive Care Unit (ICU) and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures.
Methods
The HAPT system is a minor modification of the... (More)
Background
Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT) system and the outcome measures; Admission to Intensive Care Unit (ICU) and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures.
Methods
The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT) and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, Tvitals, and presenting complaint, Tcomplaint. The more urgent of the two determines the final triage category, Tfinal. We retrieved 6279 unique adult patients admitted through the Emergency Department (ED) from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures.
Results
The covariates, Tvitals, Tcomplaint and Tfinal were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO2), respiratory rate (RR), systolic blood pressure (BP) and Glasgow Coma Score (GCS). Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5%) and 'altered level of consciousness' (10.6%). More than half of the patients had a Tcomplaint more urgent than Tvitals, the opposite was true in just 6% of the patients.
Conclusion
The HAPT system is valid in terms of predicting in-hospital mortality and ICU admission in the adult acute population. Abnormal vital signs are strongly associated with adverse outcome, while including the presenting complaint in the triage model may result in over-triage. (Less)
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author
; ; ; ; ; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
in
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
volume
20
article number
28
pages
1 - 10
publisher
BioMed Central (BMC)
external identifiers
  • scopus:84859510189
ISSN
1757-7241
DOI
10.1186/1757-7241-20-28.
language
English
LU publication?
no
id
83f852cc-d435-466c-a7cd-ae2e6a1e2f09
date added to LUP
2021-03-29 13:14:17
date last changed
2022-06-21 14:51:38
@article{83f852cc-d435-466c-a7cd-ae2e6a1e2f09,
  abstract     = {{Background<br/>Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT) system and the outcome measures; Admission to Intensive Care Unit (ICU) and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures.<br/>Methods<br/>The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT) and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, Tvitals, and presenting complaint, Tcomplaint. The more urgent of the two determines the final triage category, Tfinal. We retrieved 6279 unique adult patients admitted through the Emergency Department (ED) from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures.<br/>Results<br/>The covariates, Tvitals, Tcomplaint and Tfinal were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO2), respiratory rate (RR), systolic blood pressure (BP) and Glasgow Coma Score (GCS). Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5%) and 'altered level of consciousness' (10.6%). More than half of the patients had a Tcomplaint more urgent than Tvitals, the opposite was true in just 6% of the patients.<br/>Conclusion<br/>The HAPT system is valid in terms of predicting in-hospital mortality and ICU admission in the adult acute population. Abnormal vital signs are strongly associated with adverse outcome, while including the presenting complaint in the triage model may result in over-triage.}},
  author       = {{Barfod, Charlotte and Lauritzen, Marlene Mauson Pankoke and Danker, Jakob Klim and Sölétormos, György and Forberg, Jakob Lundager and Berlac, Peter Anthony and Lippert, Freddy and Lundstrøm, Lars Hyldborg and Antonsen, Kristian and Lange, Kai Henrik Wiborg}},
  issn         = {{1757-7241}},
  language     = {{eng}},
  pages        = {{1--10}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine}},
  title        = {{Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department-a prospective cohort study}},
  url          = {{http://dx.doi.org/10.1186/1757-7241-20-28.}},
  doi          = {{10.1186/1757-7241-20-28.}},
  volume       = {{20}},
  year         = {{2012}},
}