Triage Risk Stratification
Conditions
Keywords
risk prediction, Electronic triage systems (ETS), undertriage, overtriage
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.
Interventions
Questionnaire with a predefined list of 35 symptoms
OTHERReason for patient presentation at ED
Exploratory interview assessing reason for patient presentation at ED
OTHERphysicians rating of severity of illness
numeric scale ranging from 0 (perfect condition) to 10 (extremely ill)
DIAGNOSTIC_TESTAssessment of vital signs
Assessment of vital signs (heart rate, blood pressure, body temperature, respiration rate, peripheral capillary haemoglobin oxygen saturation)
Assessment of frailty by Clinical Frailty Scale (CFS): assess patients' frailty level from 1, very fit, to 9, terminally ill
OTHERImpaired mobility on presentation (IMOP)
Assessment of IMOP: defined as being unable to stand unaided or walk without help
OTHERAssessment of suspected diagnosis and differential diagnoses
Assessment of treating physician's suspected diagnosis and differential diagnoses. Answers will be recorded in free text form.
Sponsors
University Hospital, Basel, Switzerland
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 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
| Measure | Time frame | Description |
|---|---|---|
| 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 |
| 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 |
| 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 |
| 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 |
Countries
Switzerland
Outcome results
None listed