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A simple clinical assessment is superior to systematic triage in prediction of mortality in the emergency department
  1. Anne Kristine Servais Iversen1,
  2. Michael Kristensen2,
  3. Rebecca Monett Østervig3,
  4. Lars Køber4,
  5. György Sölétormos5,
  6. Jakob Lundager Forberg6,
  7. Jesper Eugen-Olsen7,
  8. Lars Simon Rasmussen3,
  9. Morten Schou8,
  10. Kasper Karmark Iversen8
  1. 1 Department of Obstetrics and Gynecology, Rigshospitalet, Kobenhavn, Denmark
  2. 2 Department of Internal Medicine, Amager Hospital, Copenhagen, Denmark
  3. 3 Department of Anesthesia, Centre of Head and Orthopedics Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  4. 4 Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  5. 5 Department of Clinical Biochemistry, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark
  6. 6 Department of Emergency Medicine and Prehospital Care, Helsingborg Hospital, Helsingborg, Sweden
  7. 7 Clinical Research Centre, University of Copenhagen, Hvidovre, Denmark
  8. 8 Department of Cardiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Anne Kristine Servais Iversen, Department of Obstetrics and Gynecology, Rigshospitalet, Kobenhavn 2200, Denmark; anneksiversen{at}gmail.com

Abstract

Objective To compare the Danish Emergency Process Triage (DEPT) with a quick clinical assessment (Eyeball triage) as predictors of short-term mortality in patients in the emergency department (ED).

Methods The investigation was designed as a prospective cohort study conducted at North Zealand University Hospital. All patient visits to the ED from September 2013 to December 2013 except minor injuries were included. DEPT was performed by nurses. Eyeball triage was a quick non-systematic clinical assessment based on patient appearance performed by phlebotomists. Both triage methods categorised patients as green (not urgent), yellow, orange or red (most urgent). Primary analysis assessed the association between triage level and 30-day mortality for each triage method. Secondary analyses investigated the relation between triage level and 48-hour mortality as well as the agreement between DEPT and Eyeball triage.

Results A total of 6383 patient visits were included. DEPT was performed for 6290 (98.5%) and Eyeball triage for 6382 (~100%) of the patient visits. Only patients with both triage assessments were included. The hazard ratio (HR) for 48-hour mortality for patients categorised as yellow was 0.9 (95% CI 0.4 to 1.9) for DEPT compared with 4.2 (95% CI 1.2 to 14.6) for Eyeball triage (green is reference). For orange the HR for DEPT was 2.2 (95% CI 1.1 to 4.4) and 17.1 (95% CI 5.1 to 57.1) for Eyeball triage. For red the HR was 30.9 (95% CI 12.3 to 77.4) for DEPT and 128.7 (95% CI 37.9 to 436.8) for Eyeball triage. For 30-day mortality the HR for patients categorised as yellow was 1.7 (95% CI 1.2 to 2.4) for DEPT and 2.4 (95% CI 1.6 to 3.5) for Eyeball triage. For orange the HR was 2.6 (95% CI 1.8 to 3.6) for DEPT and 7.6 (95% CI 5.1 to 11.2) for Eyeball triage, and for red the HR was 19.1 (95% CI 10.4 to 35.2) for DEPT and 27.1 (95% CI 16.9 to 43.5) for Eyeball triage. Agreement between the two systems was poor (kappa 0.05).

Conclusion Agreement between formalised triage and clinical assessment is poor. A simple clinical assessment by phlebotomists is superior to a formalised triage system to predict short-term mortality in ED patients.

  • triage
  • emergency department utilisation
  • emergency department
  • death/mortality
  • emergency department operations

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Footnotes

  • Contributors KKI is the primary initiator of the ’Triage study' and wrote the first draft of the study protocol. AKSI wrote the manuscript, performed the statistical analyses and participated in the data collection. MK and RMØ participated in the data collection and critically revised the manuscript. LK, GS, JLF, JE-O, LSR and MS participated with interpretation of the data and critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was conducted according to Danish ethical regulations and was approved by the Danish Data Protection Agency, journal number: HIH2013028.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at The abstract was presented as a poster at the Danish Emergency Medicine Conference, Odense, Denmark, 20-21 November 2014, as well as the American Academy of Emergency Medicine, Scientific Assembly, Austin, Texas, USA, 28 February to 4 March 2015.

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