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

NCT ID: NCT03892551

Last Updated: 2022-05-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

7309 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-03-18

Study Completion Date

2020-11-30

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.

Conditions

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Triage Risk Stratification

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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patients admitted to emergency ward

all patients admitted to the emergency ward and awaiting triage are observed

Assessment of symptoms patients presenting when admitted to ED

Intervention Type OTHER

Questionnaire with a predefined list of 35 symptoms

Reason for patient presentation at ED

Intervention Type OTHER

Exploratory interview assessing reason for patient presentation at ED

physicians rating of severity of illness

Intervention Type OTHER

numeric scale ranging from 0 (perfect condition) to 10 (extremely ill)

Assessment of vital signs

Intervention Type DIAGNOSTIC_TEST

Assessment of vital signs (heart rate, blood pressure, body temperature, respiration rate, peripheral capillary haemoglobin oxygen saturation)

Clinical Frailty Scale

Intervention Type OTHER

Assessment of frailty by Clinical Frailty Scale (CFS): assess patients' frailty level from 1, very fit, to 9, terminally ill

Impaired mobility on presentation (IMOP)

Intervention Type OTHER

Assessment of IMOP: defined as being unable to stand unaided or walk without help

Assessment of suspected diagnosis and differential diagnoses

Intervention Type OTHER

Assessment of treating physician's suspected diagnosis and differential diagnoses. Answers will be recorded in free text form.

Interventions

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Assessment of symptoms patients presenting when admitted to ED

Questionnaire with a predefined list of 35 symptoms

Intervention Type OTHER

Reason for patient presentation at ED

Exploratory interview assessing reason for patient presentation at ED

Intervention Type OTHER

physicians rating of severity of illness

numeric scale ranging from 0 (perfect condition) to 10 (extremely ill)

Intervention Type OTHER

Assessment of vital signs

Assessment of vital signs (heart rate, blood pressure, body temperature, respiration rate, peripheral capillary haemoglobin oxygen saturation)

Intervention Type DIAGNOSTIC_TEST

Clinical Frailty Scale

Assessment of frailty by Clinical Frailty Scale (CFS): assess patients' frailty level from 1, very fit, to 9, terminally ill

Intervention Type OTHER

Impaired mobility on presentation (IMOP)

Assessment of IMOP: defined as being unable to stand unaided or walk without help

Intervention Type 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.

Intervention Type OTHER

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.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Basel, Switzerland

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Roland Bingisser, Prof. Dr.

Role: PRINCIPAL_INVESTIGATOR

Department of Emergency Medicine, University Hospital Basel

Locations

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Department of Emergency Medicine, University Hospital Basel

Basel, , Switzerland

Site Status

Countries

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Switzerland

References

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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.

Reference Type DERIVED
PMID: 35138670 (View on PubMed)

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.

Reference Type DERIVED
PMID: 32336486 (View on PubMed)

Other Identifiers

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PB_2019_00008; me19Bingisser

Identifier Type: -

Identifier Source: org_study_id

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