Use of suPAR Algorithm for the ED Decision Making

Study Overview
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Brief Summary
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Will the use of a clinical decision algorithm in the ED improve discharge or admission decisions.

Detailed Description
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Background Crowding and readmissions are common challenges in Emergency departments across Europe. The decision whether to admit or discharge the patient is challenging and is often based on clinical signs and symptoms e.g. blood pressure, pulse, respiratory rate, oxygen saturation and temperature. But some patients are unnecessarily admitted and may have been better off if sent home. Other patients may be discharged without - and one out of five patients are readmitted within a month raising the question whether the patient should have been admitted at first presentation in the ED. suPAR is a strong prognostic biomarker measured routinely in acute medical patients in some emergency department (ED) settings.suPAR is a broadly applicable biomarker of risk, and it has been developed an algorithm for simple interpretation of suPAR in clinical decisions for the study. Objective To evaluate the use of a clinical decision algorithm in the ED with the aim of improving discharge or admission decisions.

Official Title
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Use of Algorithm for Safer and More Efficient Decision Making in the ED

Conditions
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Critical Illness

Intervention / Treatment
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* Diagnostic Test: suPAR algoritm


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients above 18 years who are having blood taken for biochemical analysis when attending the ED Exclusion Criteria: Acute medical patients that do not have blood drawn for routine biochemical testing. Pregnant Under 18 years old Terminally ill patients.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 104 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| suPAR algoritm control<br>Control arm (Meilahti hospital): Samples are collected and suPAR measured but no algorithm is implemented. | Diagnostic Test: suPAR algoritm<br>* All medical patients attending to the ED and who will have blood drawn for routine examination will be part of the study. In patients with low suPAR (green group, suPAR below 3 ng/ml) and in patients with high suPAR (red group, suPAR > 6 ng/mL) the Intervention will be carried out<br>|
| suPAR algoritm intervention<br>Intervention arm (Jorvi Hospital). According the algorithm when admitting a patient with suPAR below 3 ng/ml, physician should answer the following question Are you sure it is the right decision to admit this patient? Please discuss this with a senior physician. If discharging a patient with suPAR above 6 ng/ml, physician should answer the following question Are you sure it is the right decision to discharge this patient? Please discuss this with a senior physician. | Diagnostic Test: suPAR algoritm<br>* All medical patients attending to the ED and who will have blood drawn for routine examination will be part of the study. In patients with low suPAR (green group, suPAR below 3 ng/ml) and in patients with high suPAR (red group, suPAR > 6 ng/mL) the Intervention will be carried out<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Discharges | Number of discharges from the ED within 24 hours | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Admissions | Number of admissions to hospital | 30 days | 
| Length of stay | Length of stay during admission | 30 days | 
| Readmissions | Number of readmissions | 1,7 and 30 days | 
| Mortality | Number of Mortality | 30 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ED, Critical illness, Decision making, POC test, suPAR