Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study
Abstract Background While there are clear national resuscitation room admission guidelines for major trauma patients, there are no comparable alarm criteria for critically ill nontrauma (CINT) patients in the emergency department (ED). The aim of this study was to define and validate specific trigge...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-11-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13049-021-00973-4 |
| _version_ | 1818402958276034560 |
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| author | Alexandros Rovas Efe Paracikoglu Mark Michael André Gries Janina Dziegielewski Hermann Pavenstädt Michael Bernhard Philipp Kümpers |
| author_facet | Alexandros Rovas Efe Paracikoglu Mark Michael André Gries Janina Dziegielewski Hermann Pavenstädt Michael Bernhard Philipp Kümpers |
| author_sort | Alexandros Rovas |
| collection | DOAJ |
| description | Abstract Background While there are clear national resuscitation room admission guidelines for major trauma patients, there are no comparable alarm criteria for critically ill nontrauma (CINT) patients in the emergency department (ED). The aim of this study was to define and validate specific trigger factor cut-offs for identification of CINT patients in need of a structured resuscitation management protocol. Methods All CINT patients at a German university hospital ED for whom structured resuscitation management would have been deemed desirable were prospectively enrolled over a 6-week period (derivation cohort, n = 108). The performance of different thresholds and/or combinations of trigger factors immediately available during triage were compared with the National Early Warning Score (NEWS) and Quick Sequential Organ Failure Assessment (qSOFA) score. Identified combinations were then tested in a retrospective sample of consecutive nontrauma patients presenting at the ED during a 4-week period (n = 996), and two large external datasets of CINT patients treated in two German university hospital EDs (validation cohorts 1 [n = 357] and 2 [n = 187]). Results The any-of-the-following trigger factor iteration with the best performance in the derivation cohort included: systolic blood pressure < 90 mmHg, oxygen saturation < 90%, and Glasgow Coma Scale score < 15 points. This set of triggers identified > 80% of patients in the derivation cohort and performed better than NEWS and qSOFA scores in the internal validation cohort (sensitivity = 98.5%, specificity = 98.6%). When applied to the external validation cohorts, need for advanced resuscitation measures and hospital mortality (6.7 vs. 28.6%, p < 0.0001 and 2.7 vs. 20.0%, p < 0.012) were significantly lower in trigger factor-negative patients. Conclusion Our simple, any-of-the-following decision rule can serve as an objective trigger for initiating resuscitation room management of CINT patients in the ED. |
| first_indexed | 2024-12-14T08:16:38Z |
| format | Article |
| id | doaj.art-e090176056ac40779310091e41442b29 |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-12-14T08:16:38Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-e090176056ac40779310091e41442b292022-12-21T23:09:55ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412021-11-012911910.1186/s13049-021-00973-4Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN studyAlexandros Rovas0Efe Paracikoglu1Mark Michael2André Gries3Janina Dziegielewski4Hermann Pavenstädt5Michael Bernhard6Philipp Kümpers7Department of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, Hypertension and Rheumatology, University Hospital MünsterDepartment of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, Hypertension and Rheumatology, University Hospital MünsterEmergency Department, University Hospital of Düsseldorf, Heinrich-Heine UniversityEmergency Department, University Hospital of LeipzigEmergency Department, University Hospital of Düsseldorf, Heinrich-Heine UniversityDepartment of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, Hypertension and Rheumatology, University Hospital MünsterEmergency Department, University Hospital of Düsseldorf, Heinrich-Heine UniversityDepartment of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, Hypertension and Rheumatology, University Hospital MünsterAbstract Background While there are clear national resuscitation room admission guidelines for major trauma patients, there are no comparable alarm criteria for critically ill nontrauma (CINT) patients in the emergency department (ED). The aim of this study was to define and validate specific trigger factor cut-offs for identification of CINT patients in need of a structured resuscitation management protocol. Methods All CINT patients at a German university hospital ED for whom structured resuscitation management would have been deemed desirable were prospectively enrolled over a 6-week period (derivation cohort, n = 108). The performance of different thresholds and/or combinations of trigger factors immediately available during triage were compared with the National Early Warning Score (NEWS) and Quick Sequential Organ Failure Assessment (qSOFA) score. Identified combinations were then tested in a retrospective sample of consecutive nontrauma patients presenting at the ED during a 4-week period (n = 996), and two large external datasets of CINT patients treated in two German university hospital EDs (validation cohorts 1 [n = 357] and 2 [n = 187]). Results The any-of-the-following trigger factor iteration with the best performance in the derivation cohort included: systolic blood pressure < 90 mmHg, oxygen saturation < 90%, and Glasgow Coma Scale score < 15 points. This set of triggers identified > 80% of patients in the derivation cohort and performed better than NEWS and qSOFA scores in the internal validation cohort (sensitivity = 98.5%, specificity = 98.6%). When applied to the external validation cohorts, need for advanced resuscitation measures and hospital mortality (6.7 vs. 28.6%, p < 0.0001 and 2.7 vs. 20.0%, p < 0.012) were significantly lower in trigger factor-negative patients. Conclusion Our simple, any-of-the-following decision rule can serve as an objective trigger for initiating resuscitation room management of CINT patients in the ED.https://doi.org/10.1186/s13049-021-00973-4Resuscitation roomConservative shock roomNontrauma patientsEmergency departmentTrigger factor |
| spellingShingle | Alexandros Rovas Efe Paracikoglu Mark Michael André Gries Janina Dziegielewski Hermann Pavenstädt Michael Bernhard Philipp Kümpers Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Resuscitation room Conservative shock room Nontrauma patients Emergency department Trigger factor |
| title | Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study |
| title_full | Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study |
| title_fullStr | Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study |
| title_full_unstemmed | Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study |
| title_short | Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study |
| title_sort | identification and validation of objective triggers for initiation of resuscitation management of acutely ill non trauma patients the initiate iron man study |
| topic | Resuscitation room Conservative shock room Nontrauma patients Emergency department Trigger factor |
| url | https://doi.org/10.1186/s13049-021-00973-4 |
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