Triage - Symptoms and Other Predictors in an All-comer Emergency Department Population

Study Overview
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Brief Summary
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This study is to evaluate a tool capable of improved risk prediction regarding the 30-day mortality. The primary objective of this study is hospitalization, ICU-admission and mortality in correlation with abuse of elderly and caregiver burden.

Detailed Description
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Most emergency departments (EDs) perform an initial risk stratification of patients, called triage. Triage defines the process of systematically grouping patients according to their treatment priority on the base of algorithms in an environment with scarce health care resources. 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. All of these systems have their shortcomings, especially in nonspecific ED presentations and in older patients. The primary objective of this study is hospitalization, ICU-admission and mortality in correlation with abuse of elderly and caregiver burden. In this national single centre, prospective, consecutive, observational all-comers study patients entering the ED undergo triage and will be verbally informed about the study. After triage, patients are transferred to the treatment unit. Patients in need of immediate therapy, such as analgesia, will receive therapy before start of the interview. Patients will then be approached by a member of the study personnel and will be first asked which symptoms are you experiencing at the moment?. The question will be repeated 3 times, Answers will be recorded by ticking boxes in the CRF for a predefined list of 37 symptoms. Second, patients will be asked which of the symptoms you reported is most important to you?. Patients of 65 years and older will be asked an additional questionnaire by the study team: Patients will be asked about their current living situation; living at home independently, living at home with help by family members or professional services, and living in a retirement or nursing home. 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 V)

Conditions
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Triage Risk Stratification

Intervention / Treatment
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* Diagnostic Test: Assessment of vital signs
* Diagnostic Test: Assessment of impaired mobility on presentation (IMOP)
* Diagnostic Test: Assessment of level of consciousness by AVPUC scale
* Diagnostic Test: Assessment of symptoms patients presenting when admitted to ED
* Diagnostic Test: Assessment of current living situation in patients of 65 years and older
* Diagnostic Test: Assessment of elder abuse (EA)
* Diagnostic Test: Assessment of caregiver burden:


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients presenting to the ED of the University Hospital Basel over a timecourse of 9 weeks from 25.04.2022 to 30.05.2022 Exclusion Criteria: Obstetric, ophthalmologic, and paediatric patients will not be included 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 of the University Hospital Basel.<br> | Diagnostic Test: Assessment of vital signs<br>* heart rate, blood pressure, body temperature, respiration rate, peripheral capillary haemoglobin oxygen saturation)<br>Diagnostic Test: Assessment of impaired mobility on presentation (IMOP)<br>* Assessment of IMOP: defined as being unable to stand unaided or walk without help<br>Diagnostic Test: Assessment of level of consciousness by AVPUC scale<br>* Assessment of level of consciousness by AVPUC scale (alert, new confusion, verbal, pain, unresponsive, new confusion)<br>Diagnostic Test: Assessment of symptoms patients presenting when admitted to ED<br>* Questionnaire with a predefined list of 37 symptoms<br>Diagnostic Test: Assessment of current living situation in patients of 65 years and older<br>* Questionnaire to assess living situation (living at home independently, living at home with help by family members or professional services, and living in a retirement or nursing home)<br>Diagnostic Test: Assessment of elder abuse (EA)<br>* The ED Senior AID tool is a questionnaire with 15 questions to identify elder abuse<br>Diagnostic Test: Assessment of caregiver burden:<br>* The caregiver will be asked 4 questions about caregiver burden: do you feel emotionally burdened by caring for your relative?, is caring for your relative a physical strain for you?, has the care of the relative negatively affected the relationship with someone close (family, care recipient)?, is caring for your relative a financial burden for you?.<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 | at baseline (= 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 | at baseline (= 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) | 
| 1-year mortality | 1-year mortality is defined as death within 1 year of the day of presentation to the ED | within 1 year 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 1 year 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, 30-day mortality