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© The Author(s). 2017. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

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, 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.

Details

Title
Routine blood tests are associated with short term mortality and can improve emergency department triage: a cohort study of >12,000 patients
Author
Kristensen, Michael 1 ; Iversen, Anne Kristine Servais 2 ; Gerds, Thomas Alexander 3 ; Østervig, Rebecca 4 ; Linnet, Jakob Danker 5 ; Barfod, Charlotte 6 ; Lange, Kai Henrik Wiborg 7 ; Sölétormos, György 8 ; Forberg, Jakob Lundager 9 ; Eugen-Olsen, Jesper 10 ; Rasmussen, Lars Simon 6 ; Schou, Morten 11 ; Køber, Lars 12 ; Iversen, Kasper 11 

 Sjællands Universitetshospital Køge, Department of Emergency Medicine, Køge, Denmark (GRID:grid.416055.3) (ISNI:0000 0004 0630 0610); Nordsjællands Hospital, Copenhagen University Hospital, Department of Cardiology, Endocrinology and Nephrology, Copenhagen, Denmark (GRID:grid.416055.3) 
 Nordsjællands Hospital, Copenhagen University Hospital, Department of Cardiology, Endocrinology and Nephrology, Copenhagen, Denmark (GRID:grid.416055.3); Herlev Hospital, Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark (GRID:grid.416055.3) 
 University of Copenhagen, Department of Biostatistics, Copenhagen, Denmark (GRID:grid.5254.6) (ISNI:0000 0001 0674 042X) 
 Nordsjællands Hospital, Copenhagen University Hospital, Department of Cardiology, Endocrinology and Nephrology, Copenhagen, Denmark (GRID:grid.5254.6); Herlev Hospital, Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark (GRID:grid.5254.6) 
 Sjællands Universitetshospital Køge, Department of Anaesthesia, Køge, Denmark (GRID:grid.416055.3) (ISNI:0000 0004 0630 0610) 
 Rigshospitalet, University of Copenhagen, Department of Anaesthesia, Centre of Head and Orthopaedics Surgery, Copenhagen, Denmark (GRID:grid.475435.4) 
 Nordsjællands Hospital, Department of Anaesthesia, Hillerød, Denmark (GRID:grid.414092.a) (ISNI:0000 0004 0626 2116) 
 Nordsjælland Hospital, Department of Research, Hillerød, Denmark (GRID:grid.414092.a) 
 Department of Prehospital and In-Hospital Emergency Medicine – Helsingborg Hospital, Helsingborg, Sweden (GRID:grid.413823.f) (ISNI:0000 0004 0624 046X) 
10  Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (GRID:grid.413823.f) 
11  Nordsjællands Hospital, Copenhagen University Hospital, Department of Cardiology, Endocrinology and Nephrology, Copenhagen, Denmark (GRID:grid.475435.4); Herlev Hospital, Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark (GRID:grid.475435.4) 
12  Rigshospitalet, University of Copenhagen, Department of Cardiology, Copenhagen, Denmark (GRID:grid.475435.4) 
Pages
115
Publication year
2017
Publication date
Dec 2017
Publisher
Springer Nature B.V.
ISSN
17577241
e-ISSN
15007480
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2788451336
Copyright
© The Author(s). 2017. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.