Triage - Symptoms and Other Predictors in an All-comer Emergency Department Population; (EKBB 236/13)

Study Overview
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Brief Summary
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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
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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.

Official Title
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Triage - Symptoms and Other Predictors in an All-comer Emergency Department Population (EMERGE IV)

Conditions
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Triage Risk Stratification

Intervention / Treatment
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* Other: Assessment of symptoms patients presenting when admitted to ED
* Other: Reason for patient presentation at ED
* Other: physicians rating of severity of illness
* Diagnostic Test: Assessment of vital signs
* Other: Clinical Frailty Scale
* Other: Impaired mobility on presentation (IMOP)
* Other: Assessment of suspected diagnosis and differential diagnoses


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| patients admitted to emergency ward<br>all patients admitted to the emergency ward and awaiting triage are observed | Other: Assessment of symptoms patients presenting when admitted to ED<br>* Questionnaire with a predefined list of 35 symptoms<br>Other: Reason for patient presentation at ED<br>* Exploratory interview assessing reason for patient presentation at ED<br>Other: physicians rating of severity of illness<br>* numeric scale ranging from 0 (perfect condition) to 10 (extremely ill)<br>Diagnostic Test: Assessment of vital signs<br>* Assessment of vital signs (heart rate, blood pressure, body temperature, respiration rate, peripheral capillary haemoglobin oxygen saturation)<br>Other: Clinical Frailty Scale<br>* Assessment of frailty by Clinical Frailty Scale (CFS): assess patients' frailty level from 1, very fit, to 9, terminally ill<br>Other: Impaired mobility on presentation (IMOP)<br>* Assessment of IMOP: defined as being unable to stand unaided or walk without help<br>Other: Assessment of suspected diagnosis and differential diagnoses<br>* Assessment of treating physician's suspected diagnosis and differential diagnoses. Answers will be recorded in free text form.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 30-day mortality | 30-day mortality is defined as death within 30 days of the day of presentation to the ED | within 30 days of the day of presentation to the ED | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of hospitalizations | Hospitalization is defined as the direct admission from the ED to any hospital in-patient department with a stay of over 24 hours | day of presentation to the ED | 
| Number of ICU-admissions | ICU-admission is defined as any direct admission to the ICU of the University Hospital of Basel | day of presentation to the ED | 
| Death rate (In-hospital mortality) | In-hospital mortality is defined as death occurring during presentation to the ED and hospital discharge | from day of presentation to the ED to day of hospital discharge (assessed within 365 days of the day of presentation to the ED) | 
| Number of institutionalisations | Institutionalisation is defined as no time spent at home during 365 days following presentation | within 365 days of the day of presentation to the ED | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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risk prediction, Electronic triage systems (ETS), undertriage, overtriage