Routine blood tests are associated with short term mortality and can improve emergency department triage : A cohort study of >12,000 patients
(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.
(Less)
- author
- publishing date
- 2017-11-28
- 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<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.</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}}, }