NCT03892551

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

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

• Status: Completed
• Phase: —
• Study type: Observational
• Enrollment: 7,309 (actual)
• Sponsor: University Hospital, Basel, Switzerland · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

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.

Conditions

• Triage Risk Stratification

Interventions

Type	Name	Description
OTHER	Assessment of symptoms patients presenting when admitted to ED	Questionnaire with a predefined list of 35 symptoms
OTHER	Reason for patient presentation at ED	Exploratory interview assessing reason for patient presentation at ED
OTHER	physicians rating of severity of illness	numeric scale ranging from 0 (perfect condition) to 10 (extremely ill)
DIAGNOSTIC_TEST	Assessment of vital signs	Assessment of vital signs (heart rate, blood pressure, body temperature, respiration rate, peripheral capillary haemoglobin oxygen saturation)
OTHER	Clinical Frailty Scale	Assessment of frailty by Clinical Frailty Scale (CFS): assess patients' frailty level from 1, very fit, to 9, terminally ill
OTHER	Impaired mobility on presentation (IMOP)	Assessment of IMOP: defined as being unable to stand unaided or walk without help
OTHER	Assessment of suspected diagnosis and differential diagnoses	Assessment of treating physician's suspected diagnosis and differential diagnoses. Answers will be recorded in free text form.

Timeline

• Start date: 2019-03-18
• Primary completion: 2020-11-30
• Completion: 2020-11-30
• First posted: 2019-03-27
• Last updated: 2022-05-25

Locations

1 site across 1 country: Switzerland