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

Completed

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

• Registration Number: NCT03892551
• Lead Sponsor: University Hospital, Basel, Switzerland

Brief Summary

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.

Detailed 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.

Study Timeline

• Study Start: 2019-03-18
• Study First Submitted: 2019-03-20
• Study First Submitted QC: 2019-03-25
• Study First Posted: 2019-03-27
• Primary Completion: 2020-11-30
• Study Completion: 2020-11-30
• Status Verified: 2022-05
• Last Update Submitted: 2022-05-24
• Last Update Posted: 2022-05-25

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 7309

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.

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
patients admitted to emergency ward	Assessment of vital signs	all patients admitted to the emergency ward and awaiting triage are observed
patients admitted to emergency ward	Assessment of suspected diagnosis and differential diagnoses	all patients admitted to the emergency ward and awaiting triage are observed
patients admitted to emergency ward	Assessment of symptoms patients presenting when admitted to ED	all patients admitted to the emergency ward and awaiting triage are observed
patients admitted to emergency ward	physicians rating of severity of illness	all patients admitted to the emergency ward and awaiting triage are observed
patients admitted to emergency ward	Clinical Frailty Scale	all patients admitted to the emergency ward and awaiting triage are observed
patients admitted to emergency ward	Reason for patient presentation at ED	all patients admitted to the emergency ward and awaiting triage are observed
patients admitted to emergency ward	Impaired mobility on presentation (IMOP)	all patients admitted to the emergency ward and awaiting triage are observed

Primary Outcome Measures

Name	Time	Method
30-day mortality	within 30 days of the day of presentation to the ED	30-day mortality is defined as death within 30 days of the day of presentation to the ED

Secondary Outcome Measures

Name	Time	Method
Number of institutionalisations	within 365 days of the day of presentation to the ED	Institutionalisation is defined as no time spent at home during 365 days following presentation
Number of ICU-admissions	day of presentation to the ED	ICU-admission is defined as any direct admission to the ICU of the University Hospital of Basel
Number of hospitalizations	day of presentation to the ED	Hospitalization is defined as the direct admission from the ED to any hospital in-patient department with a stay of over 24 hours
Death rate (In-hospital mortality)	from day of presentation to the ED to day of hospital discharge (assessed within 365 days of the day of presentation to the ED)	In-hospital mortality is defined as death occurring during presentation to the ED and hospital discharge

Trial Locations

Locations (1)

Department of Emergency Medicine, University Hospital Basel; 🇨🇭 Basel, Switzerland