The TRIAGE-ProADM Score for an Early Risk Stratification of Medical Patients in the Emergency Department - Development Based on a Multi-National, Prospective, Observational Study.
The inflammatory biomarker pro-adrenomedullin (ProADM) provides additional prognostic information for the risk stratification of general medical emergency department (ED) patients. The aim of this analysis was to develop a triage algorithm for improved prognostication and later use in an interventio...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2016-01-01
|
| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5179054?pdf=render |
| _version_ | 1811270256863215616 |
|---|---|
| author | Alexander Kutz Pierre Hausfater Devendra Amin Adina Amin Pauline Canavaggio Gabrielle Sauvin Maguy Bernard Antoinette Conca Sebastian Haubitz Tristan Struja Andreas Huber Beat Mueller Philipp Schuetz TRIAGE study group |
| author_facet | Alexander Kutz Pierre Hausfater Devendra Amin Adina Amin Pauline Canavaggio Gabrielle Sauvin Maguy Bernard Antoinette Conca Sebastian Haubitz Tristan Struja Andreas Huber Beat Mueller Philipp Schuetz TRIAGE study group |
| author_sort | Alexander Kutz |
| collection | DOAJ |
| description | The inflammatory biomarker pro-adrenomedullin (ProADM) provides additional prognostic information for the risk stratification of general medical emergency department (ED) patients. The aim of this analysis was to develop a triage algorithm for improved prognostication and later use in an interventional trial.We used data from the multi-national, prospective, observational TRIAGE trial including consecutive medical ED patients from Switzerland, France and the United States. We investigated triage effects when adding ProADM at two established cut-offs to a five-level ED triage score with respect to adverse clinical outcome.Mortality in the 6586 ED patients showed a step-wise, 25-fold increase from 0.6% to 4.5% and 15.4%, respectively, at the two ProADM cut-offs (≤0.75nmol/L, >0.75-1.5nmol/L, >1.5nmol/L, p ANOVA <0.0001). Risk stratification by combining ProADM within cut-off groups and the triage score resulted in the identification of 1662 patients (25.2% of the population) at a very low risk of mortality (0.3%, n = 5) and 425 patients (6.5% of the population) at very high risk of mortality (19.3%, n = 82). Risk estimation by using ProADM and the triage score from a logistic regression model allowed for a more accurate risk estimation in the whole population with a classification of 3255 patients (49.4% of the population) in the low risk group (0.3% mortality, n = 9) and 1673 (25.4% of the population) in the high-risk group (15.1% mortality, n = 252).Within this large international multicenter study, a combined triage score based on ProADM and established triage scores allowed a more accurate mortality risk discrimination. The TRIAGE-ProADM score improved identification of both patients at the highest risk of mortality who may benefit from early therapeutic interventions (rule in), and low risk patients where deferred treatment without negatively affecting outcome may be possible (rule out). |
| first_indexed | 2024-04-12T21:58:40Z |
| format | Article |
| id | doaj.art-a083dd2a8b43412e8fb51490495a81b7 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-12T21:58:40Z |
| publishDate | 2016-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-a083dd2a8b43412e8fb51490495a81b72022-12-22T03:15:14ZengPublic Library of Science (PLoS)PLoS ONE1932-62032016-01-011112e016807610.1371/journal.pone.0168076The TRIAGE-ProADM Score for an Early Risk Stratification of Medical Patients in the Emergency Department - Development Based on a Multi-National, Prospective, Observational Study.Alexander KutzPierre HausfaterDevendra AminAdina AminPauline CanavaggioGabrielle SauvinMaguy BernardAntoinette ConcaSebastian HaubitzTristan StrujaAndreas HuberBeat MuellerPhilipp SchuetzTRIAGE study groupThe inflammatory biomarker pro-adrenomedullin (ProADM) provides additional prognostic information for the risk stratification of general medical emergency department (ED) patients. The aim of this analysis was to develop a triage algorithm for improved prognostication and later use in an interventional trial.We used data from the multi-national, prospective, observational TRIAGE trial including consecutive medical ED patients from Switzerland, France and the United States. We investigated triage effects when adding ProADM at two established cut-offs to a five-level ED triage score with respect to adverse clinical outcome.Mortality in the 6586 ED patients showed a step-wise, 25-fold increase from 0.6% to 4.5% and 15.4%, respectively, at the two ProADM cut-offs (≤0.75nmol/L, >0.75-1.5nmol/L, >1.5nmol/L, p ANOVA <0.0001). Risk stratification by combining ProADM within cut-off groups and the triage score resulted in the identification of 1662 patients (25.2% of the population) at a very low risk of mortality (0.3%, n = 5) and 425 patients (6.5% of the population) at very high risk of mortality (19.3%, n = 82). Risk estimation by using ProADM and the triage score from a logistic regression model allowed for a more accurate risk estimation in the whole population with a classification of 3255 patients (49.4% of the population) in the low risk group (0.3% mortality, n = 9) and 1673 (25.4% of the population) in the high-risk group (15.1% mortality, n = 252).Within this large international multicenter study, a combined triage score based on ProADM and established triage scores allowed a more accurate mortality risk discrimination. The TRIAGE-ProADM score improved identification of both patients at the highest risk of mortality who may benefit from early therapeutic interventions (rule in), and low risk patients where deferred treatment without negatively affecting outcome may be possible (rule out).http://europepmc.org/articles/PMC5179054?pdf=render |
| spellingShingle | Alexander Kutz Pierre Hausfater Devendra Amin Adina Amin Pauline Canavaggio Gabrielle Sauvin Maguy Bernard Antoinette Conca Sebastian Haubitz Tristan Struja Andreas Huber Beat Mueller Philipp Schuetz TRIAGE study group The TRIAGE-ProADM Score for an Early Risk Stratification of Medical Patients in the Emergency Department - Development Based on a Multi-National, Prospective, Observational Study. PLoS ONE |
| title | The TRIAGE-ProADM Score for an Early Risk Stratification of Medical Patients in the Emergency Department - Development Based on a Multi-National, Prospective, Observational Study. |
| title_full | The TRIAGE-ProADM Score for an Early Risk Stratification of Medical Patients in the Emergency Department - Development Based on a Multi-National, Prospective, Observational Study. |
| title_fullStr | The TRIAGE-ProADM Score for an Early Risk Stratification of Medical Patients in the Emergency Department - Development Based on a Multi-National, Prospective, Observational Study. |
| title_full_unstemmed | The TRIAGE-ProADM Score for an Early Risk Stratification of Medical Patients in the Emergency Department - Development Based on a Multi-National, Prospective, Observational Study. |
| title_short | The TRIAGE-ProADM Score for an Early Risk Stratification of Medical Patients in the Emergency Department - Development Based on a Multi-National, Prospective, Observational Study. |
| title_sort | triage proadm score for an early risk stratification of medical patients in the emergency department development based on a multi national prospective observational study |
| url | http://europepmc.org/articles/PMC5179054?pdf=render |
| work_keys_str_mv | AT alexanderkutz thetriageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT pierrehausfater thetriageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT devendraamin thetriageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT adinaamin thetriageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT paulinecanavaggio thetriageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT gabriellesauvin thetriageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT maguybernard thetriageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT antoinetteconca thetriageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT sebastianhaubitz thetriageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT tristanstruja thetriageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT andreashuber thetriageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT beatmueller thetriageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT philippschuetz thetriageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT triagestudygroup thetriageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT alexanderkutz triageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT pierrehausfater triageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT devendraamin triageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT adinaamin triageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT paulinecanavaggio triageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT gabriellesauvin triageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT maguybernard triageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT antoinetteconca triageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT sebastianhaubitz triageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT tristanstruja triageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT andreashuber triageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT beatmueller triageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT philippschuetz triageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy AT triagestudygroup triageproadmscoreforanearlyriskstratificationofmedicalpatientsintheemergencydepartmentdevelopmentbasedonamultinationalprospectiveobservationalstudy |