Routine blood tests are associated with short term mortality and can improve emergency department triage: a cohort study of >12,000 patients

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

SN - 1757-7241

VL - 25

SP - 1

EP - 8

JO - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

JF - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

M1 - 115

ER -