Simple Clinical Assessment in ED Best for Predicting Mortality
THURSDAY, Oct. 18, 2018 -- A simple clinical assessment seems to be superior to the formalized Danish Emergency Process Triage (DEPT) system for predicting mortality in patients presenting to the emergency department, according to a study published online Oct. 16 in the Emergency Medicine Journal.
Anne Kristine Servais Iversen, M.D., from Rigshospitalet in Copenhagen, Denmark, and colleagues conducted a prospective cohort study involving patient visits to the emergency department (minor injury visits were excluded). Nurses performed the DEPT, while phlebotomists performed a quick non-systematic clinical assessment based on patient appearance (Eyeball triage). Patients were categorized as green (not urgent, reference), yellow, orange, or red by both triage methods.
DEPT was performed for 98.5 percent of the 6,383 patient visits, and Eyeball triage was performed for 100 percent of patient visits; data were included for patients with both triage assessments. The researchers found that with exception of patients classified in the yellow DEPT group, the hazard ratio for death increased with higher level of triage category for both triage types. For patients classified as yellow, the hazard ratio for 48-hour mortality was 0.9 for DEPT versus 4.2 for Eyeball triage. For orange and red patients, the corresponding hazard ratios were 2.2 and 17.1 and 30.9 and 128.7. For 30-day mortality, the corresponding hazard ratios were 1.7 and 2.4 for yellow patients; 2.6 and 7.6 for orange patients; and 19.1 and 27.1 for red patients. Poor agreement was seen between the systems (κ, 0.05), and Eyeball triage was the superior discriminator.
"We believe the findings from our study indicate that we need new initiatives in order to evaluate triage and optimize initial patient stratification," the authors write.
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Posted: October 2018
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