The Value of the First Clinical Impression as Assessed by 18 Observations in Patients Presenting to the Emergency Department
The first clinical impression of emergency patients conveys a myriad of information that has been incompletely elucidated. In this prospective, observational study, the value of the first clinical impression, assessed by 18 observations, to predict the need for timely medical attention, the need for...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/2/724 |
| _version_ | 1797440523997282304 |
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| author | Thomas Tschoellitsch Stefan Krummenacker Martin W. Dünser Roland Stöger Jens Meier |
| author_facet | Thomas Tschoellitsch Stefan Krummenacker Martin W. Dünser Roland Stöger Jens Meier |
| author_sort | Thomas Tschoellitsch |
| collection | DOAJ |
| description | The first clinical impression of emergency patients conveys a myriad of information that has been incompletely elucidated. In this prospective, observational study, the value of the first clinical impression, assessed by 18 observations, to predict the need for timely medical attention, the need for hospital admission, and in-hospital mortality in 1506 adult patients presenting to the triage desk of an emergency department was determined. Machine learning models were used for statistical analysis. The first clinical impression could predict the need for timely medical attention [area under the receiver operating characteristic curve (AUC ROC), 0.73; <i>p =</i> 0.01] and hospital admission (AUC ROC, 0.8; <i>p =</i> 0.004), but not in-hospital mortality (AUC ROC, 0.72; <i>p =</i> 0.13). The five most important features informing the prediction models were age, ability to walk, admission by emergency medical services, lying on a stretcher, breathing pattern, and bringing a suitcase. The inability to walk at triage presentation was highly predictive of both the need for timely medical attention (<i>p <</i> 0.001) and the need for hospital admission (<i>p <</i> 0.001). In conclusion, the first clinical impression of emergency patients presenting to the triage desk can predict the need for timely medical attention and hospital admission. Important components of the first clinical impression were identified. |
| first_indexed | 2024-03-09T12:09:24Z |
| format | Article |
| id | doaj.art-2dcac59d7be94355aef6488dee62aca5 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T12:09:24Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-2dcac59d7be94355aef6488dee62aca52023-11-30T22:53:58ZengMDPI AGJournal of Clinical Medicine2077-03832023-01-0112272410.3390/jcm12020724The Value of the First Clinical Impression as Assessed by 18 Observations in Patients Presenting to the Emergency DepartmentThomas Tschoellitsch0Stefan Krummenacker1Martin W. Dünser2Roland Stöger3Jens Meier4Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital, Johannes Kepler University Linz, 4020 Linz, AustriaKepler University Hospital, Johannes Kepler University Linz, 4020 Linz, AustriaDepartment of Anesthesiology and Critical Care Medicine, Kepler University Hospital, Johannes Kepler University Linz, 4020 Linz, AustriaPraxis für Allgemein- und Familienmedizin, 4262 Leopoldschlag, AustriaDepartment of Anesthesiology and Critical Care Medicine, Kepler University Hospital, Johannes Kepler University Linz, 4020 Linz, AustriaThe first clinical impression of emergency patients conveys a myriad of information that has been incompletely elucidated. In this prospective, observational study, the value of the first clinical impression, assessed by 18 observations, to predict the need for timely medical attention, the need for hospital admission, and in-hospital mortality in 1506 adult patients presenting to the triage desk of an emergency department was determined. Machine learning models were used for statistical analysis. The first clinical impression could predict the need for timely medical attention [area under the receiver operating characteristic curve (AUC ROC), 0.73; <i>p =</i> 0.01] and hospital admission (AUC ROC, 0.8; <i>p =</i> 0.004), but not in-hospital mortality (AUC ROC, 0.72; <i>p =</i> 0.13). The five most important features informing the prediction models were age, ability to walk, admission by emergency medical services, lying on a stretcher, breathing pattern, and bringing a suitcase. The inability to walk at triage presentation was highly predictive of both the need for timely medical attention (<i>p <</i> 0.001) and the need for hospital admission (<i>p <</i> 0.001). In conclusion, the first clinical impression of emergency patients presenting to the triage desk can predict the need for timely medical attention and hospital admission. Important components of the first clinical impression were identified.https://www.mdpi.com/2077-0383/12/2/724first clinical impressionpredictiontriageemergency medicineemergency departmenturgency |
| spellingShingle | Thomas Tschoellitsch Stefan Krummenacker Martin W. Dünser Roland Stöger Jens Meier The Value of the First Clinical Impression as Assessed by 18 Observations in Patients Presenting to the Emergency Department Journal of Clinical Medicine first clinical impression prediction triage emergency medicine emergency department urgency |
| title | The Value of the First Clinical Impression as Assessed by 18 Observations in Patients Presenting to the Emergency Department |
| title_full | The Value of the First Clinical Impression as Assessed by 18 Observations in Patients Presenting to the Emergency Department |
| title_fullStr | The Value of the First Clinical Impression as Assessed by 18 Observations in Patients Presenting to the Emergency Department |
| title_full_unstemmed | The Value of the First Clinical Impression as Assessed by 18 Observations in Patients Presenting to the Emergency Department |
| title_short | The Value of the First Clinical Impression as Assessed by 18 Observations in Patients Presenting to the Emergency Department |
| title_sort | value of the first clinical impression as assessed by 18 observations in patients presenting to the emergency department |
| topic | first clinical impression prediction triage emergency medicine emergency department urgency |
| url | https://www.mdpi.com/2077-0383/12/2/724 |
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