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Routine blood tests are associated with short term mortality and can improve emergency department triage : A cohort study of >12,000 patients

Kristensen, Michael ; Iversen, Anne Kristine Servais ; Gerds, Thomas Alexander ; Østervig, Rebecca ; Linnet, Jakob Danker ; Barfod, Charlotte ; Lange, Kai Henrik Wiborg ; Sölétormos, György ; Forberg, Jakob Lundager LU and Eugen-Olsen, Jesper , et al. (2017) In Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 25(1).
Abstract

Background: Prioritization of acutely ill patients in the Emergency Department remains a challenge. We aimed to evaluate whether routine blood tests can predict mortality in unselected patients in an emergency department and to compare risk prediction with a formalized triage algorithm. Methods: A prospective observational cohort study of 12,661 consecutive admissions to the Emergency Department of Nordsjælland University Hospital during two separate periods in 2010 (primary cohort, n=6279) and 2013 (validation cohort, n=6383). Patients were triaged in five categories by a formalized triage algorithm. All patients with a full routine biochemical screening (albumin, creatinine, c-reactive protein, haemoglobin, lactate dehydrogenase,... (More)

Background: Prioritization of acutely ill patients in the Emergency Department remains a challenge. We aimed to evaluate whether routine blood tests can predict mortality in unselected patients in an emergency department and to compare risk prediction with a formalized triage algorithm. Methods: A prospective observational cohort study of 12,661 consecutive admissions to the Emergency Department of Nordsjælland University Hospital during two separate periods in 2010 (primary cohort, n=6279) and 2013 (validation cohort, n=6383). Patients were triaged in five categories by a formalized triage algorithm. All patients with a full routine biochemical screening (albumin, creatinine, c-reactive protein, haemoglobin, lactate dehydrogenase, leukocyte count, potassium, and sodium) taken at triage were included. Information about vital status was collected from the Danish Central Office of Civil registration. Multiple logistic regressions were used to predict 30-day mortality. Validation was performed by applying the regression models on the 2013 validation cohort. Results: Thirty-day mortality was 5.3%. The routine blood tests had a significantly stronger discriminative value on 30-day mortality compared to the formalized triage (AUC 88.1 [85.7;90.5] vs. 63.4 [59.1;67.5], p<0.01). Risk stratification by routine blood tests was able to identify a larger number of low risk patients (n=2100, 30-day mortality 0.1% [95% CI 0.0;0.3%]) compared to formalized triage (n=1591, 2.8% [95% CI 2.0;3.6%]), p<0.01. Conclusions: Routine blood tests were strongly associated with 30-day mortality in acutely ill patients and discriminatory ability was significantly higher than with a formalized triage algorithm. Thus routine blood tests allowed an improved risk stratification of patients presenting in an emergency department.

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publishing date
type
Contribution to journal
publication status
published
keywords
Acute patients, Biomarkers, Emergency medicine, Risk stratification, Triage
in
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
volume
25
issue
1
article number
115
publisher
BioMed Central (BMC)
external identifiers
  • pmid:29179764
  • scopus:85035138997
ISSN
1757-7241
DOI
10.1186/s13049-017-0458-x
language
English
LU publication?
no
additional info
Funding Information: LSR has received funding from the TrygFonden. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2017 The Author(s). Copyright: Copyright 2017 Elsevier B.V., All rights reserved.
id
c51fde6f-80a9-480f-9252-14dcde3c38d6
date added to LUP
2021-03-30 08:19:21
date last changed
2024-02-20 03:10:20
@article{c51fde6f-80a9-480f-9252-14dcde3c38d6,
  abstract     = {{<p>Background: Prioritization of acutely ill patients in the Emergency Department remains a challenge. We aimed to evaluate whether routine blood tests can predict mortality in unselected patients in an emergency department and to compare risk prediction with a formalized triage algorithm. Methods: A prospective observational cohort study of 12,661 consecutive admissions to the Emergency Department of Nordsjælland University Hospital during two separate periods in 2010 (primary cohort, n=6279) and 2013 (validation cohort, n=6383). Patients were triaged in five categories by a formalized triage algorithm. All patients with a full routine biochemical screening (albumin, creatinine, c-reactive protein, haemoglobin, lactate dehydrogenase, leukocyte count, potassium, and sodium) taken at triage were included. Information about vital status was collected from the Danish Central Office of Civil registration. Multiple logistic regressions were used to predict 30-day mortality. Validation was performed by applying the regression models on the 2013 validation cohort. Results: Thirty-day mortality was 5.3%. The routine blood tests had a significantly stronger discriminative value on 30-day mortality compared to the formalized triage (AUC 88.1 [85.7;90.5] vs. 63.4 [59.1;67.5], p&lt;0.01). Risk stratification by routine blood tests was able to identify a larger number of low risk patients (n=2100, 30-day mortality 0.1% [95% CI 0.0;0.3%]) compared to formalized triage (n=1591, 2.8% [95% CI 2.0;3.6%]), p&lt;0.01. Conclusions: Routine blood tests were strongly associated with 30-day mortality in acutely ill patients and discriminatory ability was significantly higher than with a formalized triage algorithm. Thus routine blood tests allowed an improved risk stratification of patients presenting in an emergency department.</p>}},
  author       = {{Kristensen, Michael and Iversen, Anne Kristine Servais and Gerds, Thomas Alexander and Østervig, Rebecca and Linnet, Jakob Danker and Barfod, Charlotte and Lange, Kai Henrik Wiborg and Sölétormos, György and Forberg, Jakob Lundager and Eugen-Olsen, Jesper and Rasmussen, Lars Simon and Schou, Morten and Køber, Lars and Iversen, Kasper}},
  issn         = {{1757-7241}},
  keywords     = {{Acute patients; Biomarkers; Emergency medicine; Risk stratification; Triage}},
  language     = {{eng}},
  month        = {{11}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine}},
  title        = {{Routine blood tests are associated with short term mortality and can improve emergency department triage : A cohort study of >12,000 patients}},
  url          = {{http://dx.doi.org/10.1186/s13049-017-0458-x}},
  doi          = {{10.1186/s13049-017-0458-x}},
  volume       = {{25}},
  year         = {{2017}},
}