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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?

From: Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence

Author Year, reference Country Study design Patient characteristics Sample Female/age Male/age Inclusion criteria Type of emergency department Primary outcome Outcome Frequency RR (relative risk), OR (odds ratio) P-value, 95% CI (confidence interval) Missing data (%) Study quality and relevance Comments
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