Routine blood tests are associated with short term mortality and can improve emergency department triage: a cohort study of >12,000 patients
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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; Eugen-Olsen, Jesper; Rasmussen, Lars Simon; Schou, Morten; Køber, Lars; Iversen, Kasper.
I: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Bind 25, 115, 28.11.2017, s. 1-8.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Routine blood tests are associated with short term mortality and can improve emergency department triage
T2 - a cohort study of >12,000 patients
AU - Kristensen, Michael
AU - Iversen, Anne Kristine Servais
AU - Gerds, Thomas Alexander
AU - Østervig, Rebecca
AU - Linnet, Jakob Danker
AU - Barfod, Charlotte
AU - Lange, Kai Henrik Wiborg
AU - Sölétormos, György
AU - Forberg, Jakob Lundager
AU - Eugen-Olsen, Jesper
AU - Rasmussen, Lars Simon
AU - Schou, Morten
AU - Køber, Lars
AU - Iversen, Kasper
PY - 2017/11/28
Y1 - 2017/11/28
N2 - 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.
AB - 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.
KW - Journal Article
U2 - 10.1186/s13049-017-0458-x
DO - 10.1186/s13049-017-0458-x
M3 - Journal article
C2 - 29179764
VL - 25
SP - 1
EP - 8
JO - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
JF - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
SN - 1757-7241
M1 - 115
ER -
ID: 189104295