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

[Capacity in Danish intensive care units. A national survey of capacity, cancellations and transfers of critically ill patients].

https://arctichealth.org/en/permalink/ahliterature165038
Source
Ugeskr Laeger. 2007 Feb 19;169(8):712-6
Publication Type
Article
Date
Feb-19-2007
Author
Anne Lippert
Kurt Espersen
Kristian Antonsen
Henning Joensen
Tina E Waldau
Kim Michael Larsen
Author Affiliation
a.lippert@dadlnet.dk
Source
Ugeskr Laeger. 2007 Feb 19;169(8):712-6
Date
Feb-19-2007
Language
Danish
Publication Type
Article
Keywords
Adult
Appointments and Schedules
Bed Occupancy - statistics & numerical data
Denmark
Hospital Bed Capacity - statistics & numerical data
Humans
Intensive Care Units - standards - statistics & numerical data
Patient Admission - statistics & numerical data
Patient Transfer - statistics & numerical data
Questionnaires
Risk factors
Surgical Procedures, Elective - standards - statistics & numerical data
Abstract
A shortage of intensive care beds and fully-booked intensive care units has a range of undesirable consequences for patients and personnel, eg. transfer to other intensive care units, cancellation of operations, tighter visitation criteria and an increase in the work-load. The problem is illustrated in a national survey.
The survey was undertaken in 3 parts and comprised all 50 adult intensive care units in Denmark. Part 1 was a questionnaire encompassing demographic data, the number of open intensive care beds and how often under or over capacity was experienced in the department. Parts 2 and 3 consisted of a daily registry of the capacity and occupancy rate in the intensive care departments for two weeks along with a contemporary registry of the number of admittances, transfers and cancellations of operations.
In Denmark only 2% of all somatic beds are intensive care beds. Under capacity, defined as a 100% occupancy rate, was experienced weekly or monthly in 80% of all intensive care units in Denmark. Occupancy rate was high, a medium of 78%, highest in level III intensive care units with an 88% occupancy rate. The numbers for transfers were equivalent to 800-1000 patient transfers per year. The number of cancelled operations was equivalent to 2000 per year.
This survey documents that there is a problem with the capacity in Danish intensive care units. Establishing more intensive care beds in selected departments, ensuring personnel for the beds already established and establishing intermediate care beds could relieve the shortage of beds.
Notes
Comment In: Ugeskr Laeger. 2007 May 7;169(19):1811; author reply 181117542086
PubMed ID
17313924 View in PubMed
Less detail

[Capacity problems in Danish intensive care units?].

https://arctichealth.org/en/permalink/ahliterature165039
Source
Ugeskr Laeger. 2007 Feb 19;169(8):710-2
Publication Type
Article
Date
Feb-19-2007
Author
Kurt Espersen
Kristian Antonsen
Henning Joensen
Author Affiliation
Rigshospitalet, Abdominalcentret, Intensiv Terapi Klinik 4131, København Ø. kurt.espersen@rh.hosp.dk
Source
Ugeskr Laeger. 2007 Feb 19;169(8):710-2
Date
Feb-19-2007
Language
Danish
Publication Type
Article
Keywords
Denmark
Europe
Hospital Bed Capacity - economics - statistics & numerical data
Hospital Units - organization & administration
Humans
Intensive Care - economics - organization & administration - statistics & numerical data
Intensive Care Units - economics - organization & administration - statistics & numerical data
United States
Abstract
There are documented capacity problems in Danish ICUs. The indications for intensive care have increased in the last decade without any increase in the number of ICU beds. The result is massive pressure on many ICUs and many negative consequences in relation to healthcare, healthcare economics and patient comfort. Possible solutions: 1) an increase in the number of ICU beds, 2) re-organization of Danish ICUs into larger units and 3) creation of "step-down"-units. Intensive care is a costly area in the healthcare system, where there must be distinct guidelines for visitation and use of expensive medicine and advanced technology.
Notes
Comment In: Ugeskr Laeger. 2007 May 7;169(19):1811; author reply 181117542086
Comment In: Ugeskr Laeger. 2007 Jun 4;169(23):2235; author reply 223717607852
PubMed ID
17313923 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

Serious adverse events in a hospital using early warning score - what went wrong?

https://arctichealth.org/en/permalink/ahliterature267975
Source
Resuscitation. 2014 Dec;85(12):1699-703
Publication Type
Article
Date
Dec-2014
Author
John Asger Petersen
Rebecca Mackel
Kristian Antonsen
Lars S Rasmussen
Source
Resuscitation. 2014 Dec;85(12):1699-703
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Denmark - epidemiology
Early Diagnosis
Female
Follow-Up Studies
Heart Arrest - diagnosis - mortality
Hospital Mortality - trends
Humans
Intensive Care Units
Male
Middle Aged
Monitoring, Physiologic - methods
Prospective Studies
Risk Assessment - methods
Abstract
To evaluate the performance of a new early warning score (EWS) system by reviewing all serious adverse events in our hospital over a 6-month time period.
All incidents of unexpected death (UD), cardiac arrest (CA) and unanticipated intensive care unit admission(UICU) of adult patients on general wards were reviewed to see if the escalation protocol that is part of the EWS system was followed in the 24h preceding the event, and if not where in the chain of events failure occurred.
We found 77 UICU and 67 cases of the combined outcome (CO) of CA and UD. At least two full sets of EWS were recorded in 87, 94 and 75% of UICU, CA and UD. Patients were monitored according to the escalation protocol in 13, 31 and 13% of UICU, CA and UD. Nurses escalated care and contacted physicians in 64% and 60% of events of UICU and the corresponding proportions for CO were 58% and 55%. On call physicians provided adequate care in 49% of cases of UICU and 29% of cases of the CO. Senior staff was involved according to protocol in 53% and 36% of cases of UICU and CO, respectively.
Poor compliance with the escalation protocol was commonly found when serious adverse events occurred but level of care provided by physicians was also a problem in a hospital with implemented early warning system. This information may prove useful in improving performance of EWS systems.
PubMed ID
25238741 View in PubMed
Less detail