Teresa Betsy, Subhi Mohammed, Boyle Adrian, Kark Wayne
Emergency Medicine, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, GBR.
General Practice, Staploe Medical Centre, Cambridge, GBR.
Cureus. 2024 Mar 13;16(3):e56083. doi: 10.7759/cureus.56083. eCollection 2024 Mar.
Early identification of patients at higher risk of death and hospital admission is an important problem in Emergency Departments (ED). Most triage scales were developed before current electronic healthcare records were developed. The implementation of a national Emergency Care Data Set (ECDS) allows for the standardised recording of presenting complaints and the use of Electronic Patient Records (EPR) offers the potential for automated triage. The mortality risk and need for hospital admission associated with the different presenting complaints in a standardised national data set has not been previously reported. This study aimed to quantify the risks of death and hospitalisation from presenting complaints. This would be valuable in developing automated triage tools and decision support software.
We conducted an observational retrospective cohort study on patients who visited a single ED in 2021. The presenting complaints related to subsequent attendances were excluded. This patient list was then manually matched with a routinely collected list of deaths. All deaths that occurred within 30 days of attendance were included.
Data was collected from 84,999 patients, of which 1,159 people died within 30 days of attendance. The mortality rate was the highest in cardiac arrest [32 (78.1%)], cardiac arrest due to trauma [2(50%)] and respiratory arrest [3(50%)]. Drowsy [17(12%)], hypothermia [3(13%)] and cyanosis [1(10%)] were also high-risk categories. Chest pain [34(0.6%)] was not a high-risk presenting complaint.
The initial presenting complaint in ECDS may be useful to identify people at higher and lower risk of death. This information is useful for building automated triage models.
早期识别死亡和住院风险较高的患者是急诊科的一个重要问题。大多数分诊量表是在当前电子健康记录出现之前制定的。国家急诊护理数据集（ECDS）的实施允许对就诊主诉进行标准化记录，而电子病历（EPR）的使用为自动分诊提供了可能性。此前尚未有关于标准化国家数据集中不同就诊主诉相关的死亡风险和住院需求的报道。本研究旨在量化就诊主诉导致的死亡和住院风险。这对于开发自动分诊工具和决策支持软件将具有重要价值。
我们对2021年就诊于单一急诊科的患者进行了一项观察性回顾性队列研究。排除与后续就诊相关的就诊主诉。然后将该患者名单与常规收集的死亡名单进行人工匹配。纳入所有在就诊后30天内发生的死亡病例。
收集了84999名患者的数据，其中1159人在就诊后30天内死亡。心脏骤停[32例（78.1%）]、创伤性心脏骤停[2例（50%）]和呼吸骤停[3例（50%）]的死亡率最高。嗜睡[17例（12%）]、体温过低[3例（13%）]和发绀[1例（10%）]也是高风险类别。胸痛[34例（0.6%）]并非高风险就诊主诉。
ECDS中的初始就诊主诉可能有助于识别死亡风险较高和较低的人群。该信息对于构建自动分诊模型很有用。
