Skip header and navigation

Refine By

5 records – page 1 of 1.

Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature125355
Source
Scand J Trauma Resusc Emerg Med. 2012;20:28
Publication Type
Article
Date
2012
Author
Charlotte Barfod
Marlene Mauson Pankoke Lauritzen
Jakob Klim Danker
György Sölétormos
Jakob Lundager Forberg
Peter Anthony Berlac
Freddy Lippert
Lars Hyldborg Lundstrøm
Kristian Antonsen
Kai Henrik Wiborg Lange
Author Affiliation
Department of Anaesthesia and Intensive Care, Hillerød Hospital, Denmark. cbar@hih.regionh.dk
Source
Scand J Trauma Resusc Emerg Med. 2012;20:28
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Denmark
Emergency Service, Hospital - statistics & numerical data
Female
Hospital Mortality
Humans
Intensive Care Units - statistics & numerical data
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Patient Admission - statistics & numerical data
Prognosis
Prospective Studies
Regression Analysis
Triage - methods - statistics & numerical data
Vital Signs
Young Adult
Abstract
Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT) system and the outcome measures; Admission to Intensive Care Unit (ICU) and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures.
The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT) and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, T(vitals), and presenting complaint, T(complaint). The more urgent of the two determines the final triage category, T(final). We retrieved 6279 unique adult patients admitted through the Emergency Department (ED) from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures.
The covariates, T(vitals), T(complaint) and T(final) were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO(2)), respiratory rate (RR), systolic blood pressure (BP) and Glasgow Coma Score (GCS). Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5%) and 'altered level of consciousness' (10.6%). More than half of the patients had a T(complaint) more urgent than T(vitals), the opposite was true in just 6% of the patients.
The HAPT system is valid in terms of predicting in-hospital mortality and ICU admission in the adult acute population. Abnormal vital signs are strongly associated with adverse outcome, while including the presenting complaint in the triage model may result in over-triage.
Notes
Cites: J Intern Med. 2004 May;255(5):579-8715078500
Cites: Am J Emerg Med. 1987 Jul;5(4):278-823593492
Cites: Emerg Med Australas. 2005 Jun;17(3):212-715953221
Cites: CJEM. 2008 Mar;10(2):151-7318371253
Cites: Rev Esp Salud Publica. 2008 May-Jun;82(3):251-918711640
Cites: Scand J Trauma Resusc Emerg Med. 2012;20:2922490233
Cites: Emerg Med J. 2010 Feb;27(2):86-9220156855
Cites: Resuscitation. 2010 Aug;81(8):932-720637974
Cites: J Emerg Med. 2011 Jun;40(6):623-818930373
Cites: Scand J Trauma Resusc Emerg Med. 2011;19:4221718476
Cites: Ugeskr Laeger. 2011 Oct 3;173(40):2490-321975184
Cites: J Emerg Med. 2010 Jan;38(1):70-918514465
PubMed ID
22490208 View in PubMed
Less detail

Elevated prostate specific antigen and reduced 10-year survival among a cohort of Danish men consecutively referred from primary care to an urological department during 2005-2006.

https://arctichealth.org/en/permalink/ahliterature281339
Source
Scand J Clin Lab Invest. 2017 Feb;77(1):27-35
Publication Type
Article
Date
Feb-2017
Author
Thore Hillig
Torben Kjær Nielsen
Steen Ingemann Hansen
Ann-Britt Nygaard
György Sölétormos
Source
Scand J Clin Lab Invest. 2017 Feb;77(1):27-35
Date
Feb-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Biological Assay
Biomarkers, Tumor - blood
Cross-Sectional Studies
Denmark
Humans
Male
Middle Aged
Neoplasm Grading
Primary Health Care
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood - diagnosis - mortality - pathology
Registries
Retrospective Studies
Sensitivity and specificity
Survival Analysis
Abstract
It remains unclear whether total prostate specific antigen (tPSA) or complex PSA (cPSA) has the best diagnostic performance. Additionally, the utility of percentage free PSA (%fPSA) is still debated. Our objectives were to compare the diagnostic performances of tPSA, cPSA, and %fPSA among patients referred from GP to an Urological Specialist and to investigate prognostic factors and survival in the cohort. A total of 1261 consecutive male patients without previously known prostate cancer (PCa) were referred to the same Department of Urology during June 2005 to August 2006. Some 299 patients were diagnosed with PCa and 962 patients were found without PCa. Among the PCa patients, the median age, tPSA, cPSA, and %fPSA levels were 70.8 years, 13.4?µg/L, 10.8?µg/L, and 12.6%. For patients without PCa the results were 67.5 years, 2.5?µg/L, 1.9?µg/L, and 24.9%. The sensitivity, specificity, PVpos, PVneg, and efficiency of tPSA and cPSA were overlapping (p?>?.05). In the tPSA interval >4?µg/L -?=20?µg/L, %fPSA excluded PCa with a PVneg of 72.4%; 38.5% of PCa patients had a tPSA concentration >20?µg/L at the time of referral and these patients had a reduced 10-year survival as compared to patients with tPSA concentrations =20?µg/L. In conclusion, tPSA and cPSA showed similar diagnostic performances. %fPSA provided additional diagnostic information at tPSA concentrations >4?µg -?=20?µg/L. The high percentage of patients with tPSA concentrations >20?µg/L indicate delayed use of tPSA resulting in advanced disease at presentation and reduced patient survival.
PubMed ID
27762145 View in PubMed
Less detail

The formation and design of the 'Acute Admission Database'- a database including a prospective, observational cohort of 6279 patients triaged in the emergency department in a larger Danish hospital.

https://arctichealth.org/en/permalink/ahliterature125354
Source
Scand J Trauma Resusc Emerg Med. 2012;20:29
Publication Type
Article
Date
2012
Author
Charlotte Barfod
Marlene Mauson Pankoke Lauritzen
Jakob Klim Danker
György Sölétormos
Peter Anthony Berlac
Freddy Lippert
Lars Hyldborg Lundstrøm
Kristian Antonsen
Kai Henrik Wiborg Lange
Author Affiliation
Department of Anaesthesia and Intensive Care, Hillerød Hospital, Hillerød, Denmark. cbar@hih.regionh.dk
Source
Scand J Trauma Resusc Emerg Med. 2012;20:29
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Databases, Factual
Denmark
Emergency Service, Hospital - statistics & numerical data
Female
Hospital Mortality
Humans
Intensive Care Units - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Middle Aged
Outcome Assessment (Health Care)
Patient Admission - statistics & numerical data
Patient Discharge - statistics & numerical data
Prospective Studies
Severity of Illness Index
Triage - statistics & numerical data
Abstract
Management and care of the acutely ill patient has improved over the last years due to introduction of systematic assessment and accelerated treatment protocols. We have, however, sparse knowledge of the association between patient status at admission to hospital and patient outcome. A likely explanation is the difficulty in retrieving all relevant information from one database. The objective of this article was 1) to describe the formation and design of the 'Acute Admission Database', and 2) to characterize the cohort included.
All adult patients triaged at the Emergency Department at Hillerød Hospital and admitted either to the observationary unit or to a general ward in-hospital were prospectively included during a period of 22 weeks. The triage system used was a Danish adaptation of the Swedish triage system, ADAPT. Data from 3 different data sources was merged using a unique identifier, the Central Personal Registry number; 1) Data from patient admission; time and date, vital signs, presenting complaint and triage category, 2) Blood sample results taken at admission, including a venous acid-base status, and 3) Outcome measures, e.g. length of stay, admission to Intensive Care Unit, and mortality within 7 and 28 days after admission.
In primary triage, patients were categorized as red (4.4%), orange (25.2%), yellow (38.7%) and green (31.7%). Abnormal vital signs were present at admission in 25% of the patients, most often temperature (10.5%), saturation of peripheral oxygen (9.2%), Glasgow Coma Score (6.6%) and respiratory rate (4.8%). A venous acid-base status was obtained in 43% of all patients. The majority (78%) had a pH within the normal range (7.35-7.45), 15% had acidosis (pH 7.45). Median length of stay was 2 days (range 1-123). The proportion of patients admitted to Intensive Care Unit was 1.6% (95% CI 1.2-2.0), 1.8% (95% CI 1.5-2.2) died within 7 days, and 4.2% (95% CI 3.7-4.7) died within 28 days after admission.
Despite challenges of data registration, we succeeded in creating a database of adequate size and data quality. Future studies will focus on the association between patient status at admission and patient outcome, e.g. admission to Intensive Care Unit or in-hospital mortality.
Notes
Cites: J Am Coll Surg. 2000 Jun;190(6):656-6410873000
Cites: Emerg Med J. 2001 Sep;18(5):340-211559602
Cites: Am J Emerg Med. 2002 Jan;20(1):26-911781908
Cites: Ann Emerg Med. 1997 Apr;29(4):479-839095008
Cites: CJEM. 2008 Mar;10(2):151-7318371253
Cites: Resuscitation. 2004 Aug;62(2):137-4115294398
Cites: N C Med J. 2010 Jan-Feb;71(1):15-2520369667
Cites: Scand J Trauma Resusc Emerg Med. 2011;19:3721668987
Cites: Scand J Trauma Resusc Emerg Med. 2011;19:4221718476
Cites: Ugeskr Laeger. 2011 Oct 3;173(40):2490-321975184
Cites: J Trauma. 2009 Apr;66(4):1040-419359912
PubMed ID
22490233 View in PubMed
Less detail

The formation and design of the TRIAGE study--baseline data on 6005 consecutive patients admitted to hospital from the emergency department.

https://arctichealth.org/en/permalink/ahliterature274638
Source
Scand J Trauma Resusc Emerg Med. 2015;23:106
Publication Type
Article
Date
2015
Author
Louis Lind Plesner
Anne Kristine Servais Iversen
Sandra Langkjær
Ture Lange Nielsen
Rebecca Østervig
Peder Emil Warming
Idrees Ahmad Salam
Michael Kristensen
Morten Schou
Jesper Eugen-Olsen
Jakob Lundager Forberg
Lars Køber
Lars S Rasmussen
György Sölétormos
Bente Klarlund Pedersen
Kasper Iversen
Source
Scand J Trauma Resusc Emerg Med. 2015;23:106
Date
2015
Language
English
Publication Type
Article
Keywords
Biomarkers - blood
Comorbidity
Crowding
Denmark
Diagnostic Tests, Routine
Emergency Service, Hospital - organization & administration
Female
Humans
Length of Stay - statistics & numerical data
Male
Patient Admission - statistics & numerical data
Prospective Studies
Research Design
Risk assessment
Severity of Illness Index
Triage - organization & administration
Vital Signs
Abstract
Patient crowding in emergency departments (ED) is a common challenge and associated with worsened outcome for the patients. Previous studies on biomarkers in the ED setting has focused on identification of high risk patients, and and the ability to use biomarkers to identify low-risk patients has only been sparsely examined. The broader aims of the TRIAGE study are to develop methods to identify low-risk patients appropriate for early ED discharge by combining information from a wide range of new inflammatory biomarkers and vital signs, the present baseline article aims to describe the formation of the TRIAGE database and characteristize the included patients.
We included consecutive patients = 17 years admitted to hospital after triage staging in the ED. Blood samples for a biobank were collected and plasma stored in a freezer (-80 °C). Triage was done by a trained nurse using the Danish Emergency Proces Triage (DEPT) which categorizes patients as green (not urgent), yellow (urgent), orange (emergent) or red (rescusitation). Presenting complaints, admission diagnoses, comorbidities, length of stay, and 'events' during admission (any of 20 predefined definitive treatments that necessitates in-hospital care), vital signs and routine laboratory tests taken in the ED were aslo included in the database.
Between September 5(th) 2013 and December 6(th) 2013, 6005 patients were included in the database and the biobank (94.1 % of all admissions). Of these, 1978 (32.9 %) were categorized as green, 2386 (39.7 %) yellow, 1616 (26.9 %) orange and 25 (0.4 %) red. Median age was 62 years (IQR 46-76), 49.8 % were male and median length of stay was 1 day (IQR 0-4). No events were found in 2658 (44.2 %) and 158 (2.6 %) were admitted to intensive or intermediate-intensive care unit and 219 (3.6 %) died within 30 days. A higher triage acuity level was associated with numerous events, including acute surgery, endovascular intervention, i.v. treatment, cardiac arrest, stroke, admission to intensive care, hospital transfer, and mortality within 30 days (p
Notes
Cites: Intensive Care Med. 1995 Sep;21(9):770-68847434
Cites: Ann Surg. 2015 Jun;261(6):1114-2325243545
Cites: Dis Colon Rectum. 2004 Mar;47(3):271-7; discussion 277-814991487
Cites: Emerg Med J. 2006 Feb;23(2):154-516439754
Cites: Med J Aust. 2006 Mar 6;184(5):208-1216515429
Cites: QJM. 2006 Nov;99(11):771-8117046859
Cites: QJM. 2010 Jan;103(1):23-3219846579
Cites: Lancet. 2010 Jan 9;375(9709):132-4020031199
Cites: BMJ. 2012;344:e290422550349
Cites: J Intern Med. 2013 Feb;273(2):205-1623140269
Cites: J Crit Care. 2013 Oct;28(5):541-823566734
Cites: Int J Cardiol. 2013 Sep 30;168(2):818-2423117016
Cites: Med J Aust. 2013 Oct 21;199(8):543-724138380
Cites: Clin Chem. 2013 Nov;59(11):1621-923842203
Cites: BMJ Qual Saf. 2014 Jan;23(1):47-5523904507
Cites: J Nurs Scholarsh. 2014 Mar;46(2):106-1524354886
Cites: BMC Med. 2014;12:8024884642
Cites: Medicare Medicaid Res Rev. 2014;4(1). pii: mmrr.004.01.b01. doi: 10.5600/mmrr.004.01.b0124926414
Cites: Health Aff (Millwood). 2014 Jul;33(7):1236-4425006151
Cites: J Intern Med. 2015 May;277(5):562-7225143177
Cites: Med Care. 1981 Aug;19(8):855-717196975
PubMed ID
26626588 View in PubMed
Less detail

Mapping of HLA- DQ haplotypes in a group of Danish patients with celiac disease.

https://arctichealth.org/en/permalink/ahliterature272035
Source
Scand J Clin Lab Invest. 2015 Oct;75(6):519-22
Publication Type
Article
Date
Oct-2015
Author
Flemming Lund
Mette N Hermansen
Merete F Pedersen
Thore Hillig
Henrik Toft-Hansen
György Sölétormos
Source
Scand J Clin Lab Invest. 2015 Oct;75(6):519-22
Date
Oct-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Celiac Disease - genetics
Cohort Studies
Denmark
Gene Frequency
Genetic Predisposition to Disease
HLA-DQ Antigens - genetics
Haplotypes
Humans
Polymorphism, Single Nucleotide
Abstract
A cost-effective identification of HLA- DQ risk haplotypes using the single nucleotide polymorphism (SNP) technique has recently been applied in the diagnosis of celiac disease (CD) in four European populations. The objective of the study was to map risk HLA- DQ haplotypes in a group of Danish CD patients using the SNP technique.
Cohort A: Among 65 patients with gastrointestinal symptoms we compared the HLA- DQ2 and HLA- DQ8 risk haplotypes obtained by the SNP technique (method 1) with results based on a sequence specific primer amplification technique (method 2) and a technique used in an assay from BioDiagene (method 3). Cohort B: 128 patients with histologically verified CD were tested for CD risk haplotypes (method 1). Patients with negative results were further tested for sub-haplotypes of HLA- DQ2 (methods 2 and 3).
Cohort A: The three applied methods provided the same HLA- DQ2 and HLA- DQ8 results among 61 patients. Four patients were negative for the HLA- DQ2 and HLA- DQ8 haplotypes (method 1) but were positive for the HLA- DQ2.5-trans and HLA- DQ2.2 haplotypes (methods 2 and 3). Cohort B: A total of 120 patients were positive for the HLA- DQ2.5-cis and HLA- DQ8 haplotypes (method 1). The remaining seven patients were positive for HLA- DQ2.5-trans or HLA- DQ2.2 haplotypes (methods 2 and 3). One patient was negative with all three HLA methods.
The HLA- DQ risk haplotypes were detected in 93.8% of the CD patients using the SNP technique (method 1). The sensitivity increased to 99.2% by combining methods 1 - 3.
PubMed ID
26083606 View in PubMed
Less detail