Table 1 Does assessment of certain vital signs and chief complaints in emergency department triage of adults have an impact on 30-day or in-hospital mortality?

Goodacre S et al

2006 [23]

United Kingdom

Observational

Cohort

Retrospective

database review

Emergency medical admissions, life threatening category A emergency calls

N = 5 583

Female: 2 350 (42.3%)

Male: 3 233 (57.7%)

Mean age 63.4 years

Inclusion criteria: Any case where caller report chest pain, unconsciousness, not breathing and patient admitted to hospital or died in emergency department (ED)

Setting: variables recorded on ambulance arrival

Mortality in hospital during the stay

Age, Glascow Coma Scale (GCS) and oxygen saturation independent predictors of mortality in multivariate analysis, blood pressure is not useful

Glascow Coma Scale (GCS): OR 2.10 (95% CI 1.86-2.38) p < 0.001

Age: OR 1.74 (95% CI 1.52-1.98) p < 0.001

Saturation: OR 1.36 (95% CI 1.13-1.64) p = 0.001

Rapid Acute Physiology Score (RAPS - blood pressure, pulse, GCS, RR, saturation and temp) in only 3 624 (64.9%). Missing in 35.1%

Rapid Emergency Medicine Score (REMS - Blood pressure, pulse, GCS, RR) in only 2 215 (39,7%). Missing in 60.3%.

New Score (GCS, saturation, age) in 2 743 (49.1%). Missing in 50.9%

Moderate

Acceptable external validity

Good/acceptable internal validity

Age, GCS and saturation independent predictors of mortality.

Blood pressure is not a useful predictor

Olsson T et al

2004 [22]

Sweden

Observational cohort

Prospective

Nonsurgical emergency department (ED) patients

n = 11 751

Female: 51.6%

Male: 48.4%

Mean age 61.9 (SD ± 20.7)

Inclusion criteria: Patients consecutively admitted to the emergency department (ED) over 12 months.

Exclusion criteria: Patients with cardiac arrest that could not be resuscitated, patients with more than one parameter missing.

Setting: 1 200 bed University hospital ED in Sweden

Mortality in hospital, within 48 hours

In-hospital mortality 2.4%, mortality within 48 hours 1.0%.

Predictors for mortality: Saturation OR: 1.70 (95% CI: 1.36-2.11) p < 0.0001

Respiratory frequency OR: 1.93 (95% CI: 1.37-2.72) p < 0.0002

Pulse frequency OR 1.67 (95% CI 1.36-2.07) p < 0.0002

Coma OR: 1.68 (95% CI: 1.38-2.06) p < 0.0001

Age OR: 1.34 (95% CI: 1.10-1.63) p < 0.004

Moderate

Good internal validity

Han JH et al 2007

[25]

USA

Singapore

Observational cohort

Retrospective database review

Comparison patients ≥/≤ 75 years

Suspected acute coronary syndrome (ACS)

n = 10 126

Female: 5 635

Male: 4 491

Mean age = ?

11.4% ≥75 years

Inclusion criteria: ≥ age 18, suspected ACS verified by electrocardiogram (ECG), cardiac biomarkers, dyspnoea, light-headedness, dizziness and weakness.

Exklusion criteria: Inter-hospital transfer, if missing data concerning gender, age or clinical presentation

Setting: 8 emergency departments (ED) (USA), 1 ED (Singapore)

Mortality in-hospital/within 30 days

2.7% in-hospital mortality for patients age ≥75 years, higher 30 day mortality (Adjusted OR: 2.6, 95% CI: 1.6-4.3)

Missing data for ECG, symptoms or gender in 1 810 (15.2%)

Low

Convenience sample-selection bias

Confounders, such as co-morbidity not described

Acceptable intern validity

Arboix A et al

1996

[24]

Spain

Observational cohort

Stroke

n = 986

Female: 468

Male: 518

Mean age = ?

Inclusion criteria: First-ever stroke, admitted to hospital.

Setting: Department of neurology, university hospital

Mortality in-hospital

Overall mortality 16.3%.

Age OR: 1.05 (95% CI: 1.03-1.07), previous or concomitant Pathologic conditions OR: 1.83 (95% CI: 1.19-2.82)

Deteriorated level of Consciousness OR: 11.70 (95% CI: 7.70-17.77)

Vomiting OR: 2.18 (95% CI: 1.20-3.94)

Cranial nerve palsy OR: 2.61 (95% CI: 1.34-5.09)

Seizures OR: 5.18 (95% CI: 1.70-15.77) and

Limb weakness OR: 3.79 (95% CI: 1.96-7.32) were independent prognostic factors of in-hospital mortality

Not stated

Moderate