Clinical trial NCT03892551: Triage - Symptoms and Other Predictors in an All-comer Emergency Department Population; (EKBB 236/13)
Official title: Triage - Symptoms and Other Predictors in an All-comer Emergency Department Population (EMERGE IV)
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Triage Risk Stratification
Keywords: risk prediction
Electronic triage systems (ETS)
undertriage
overtriage
Lead sponsor: University Hospital, Basel, Switzerland
Sponsor class: OTHER
First posted: 2019-03-27
Enrollment: 7309
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Patients presenting to the ED of the University Hospital Basel over a time-course of 9 weeks from 25.03.2019 to 27.05.2019.

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.

Eligibility criteria: 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.

Primary outcomes:
measure: 30-day mortality
timeFrame: within 30 days of the day of presentation to the ED
Secondary outcomes:
measure: Number of hospitalizations
timeFrame: day of presentation to the ED
measure: Number of ICU-admissions
timeFrame: day of presentation to the ED
measure: Death rate (In-hospital mortality)
timeFrame: from day of presentation to the ED to day of hospital discharge (assessed within 365 days of the day of presentation to the ED)
measure: Number of institutionalisations
timeFrame: within 365 days of the day of presentation to the ED
Other outcomes:
Locations:
city: Basel
country: Switzerland
facility: Department of Emergency Medicine, University Hospital Basel
Study officials:
affiliation: Department of Emergency Medicine, University Hospital Basel
name: Roland Bingisser, Prof. Dr.
role: PRINCIPAL_INVESTIGATOR
References:
citation: Rueegg M, Nissen SK, Brabrand M, Kaeppeli T, Dreher T, Carpenter CR, Bingisser R, Nickel CH. The clinical frailty scale predicts 1-year mortality in emergency department patients aged 65 years and older. Acad Emerg Med. 2022 May;29(5):572-580. doi: 10.1111/acem.14460. Epub 2022 Apr 23.
citation: Kaeppeli T, Rueegg M, Dreher-Hummel T, Brabrand M, Kabell-Nissen S, Carpenter CR, Bingisser R, Nickel CH. Validation of the Clinical Frailty Scale for Prediction of Thirty-Day Mortality in the Emergency Department. Ann Emerg Med. 2020 Sep;76(3):291-300. doi: 10.1016/j.annemergmed.2020.03.028. Epub 2020 Apr 24.