Triage vital signs predict in-hospital mortality among emergency department patients with acute poisoning: a case control study

Yu, Jiun Hao; Weng, Yi Ming; Chen, Kuan Fu; Chen, Shou Yen; Lin, Chih Chuan

doi:10.1186/1472-6963-12-262

Cited by 31 publications

(34 citation statements)

References 18 publications

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“…The present study showed that there was statistically significant difference between the discharged and died patients as regards blood pressure, incidence of shock, heart rate, respiratory rate and body temperature where hypotension, shock, bradycardia, bradypnea and fever observed more in died patients than discharged patients. This was similar to the results observed by Lee et al (2008) and Yu et al (2012) who mentioned that there were significant differences in heart rate, systolic blood pressure, respiratory rate and body temperature between survivors and non-survivors. Also, this was in agreement with Lee et al (2013) study in which there was significant association between the mortality and decrease in respiratory rate.…”

Section: Discussionsupporting

confidence: 91%

Predictive Value of Triage Vital Signs and Conscious Level for Outcome Evaluation in Acutely Organophosphate Poisoned Patients

Moussa

Mohamed

Hilal

et al. 2018

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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Triage in Emergency departments requires emergency doctors to make rapid decisions based on their knowledge and experiences. Triage of patients is critical to patient safety, yet no clear information exists by the utility of initial vital signs and conscious level in identifying critically ill acutely organophosphate (OP) poisoned patients. The objective of this study is to determine the relationship between triage vital signs and conscious level in predicting outcome of acutely organophosphate poisoned patients. A retrospective and prospective study was carried out on 200 patients of acute OP poisoning admitted to the Poison Control Center (PCC), Ain Shams University Hospitals. Information including vital signs and Glasgow coma scale (GCS) on admission after obtaining the permission of the director of PCC and the regional ethics committee was collected from the sheets and computerized data base of the patients, an informed written consent has been obtained from each patient or from his/her caregiver for inclusion in the prospective part of the study. The results were revised, coded and organized for statistical analysis. The study results revealed 180 (90%) patients discharged and 20 (10%) patients died. The study also showed that 8% of patients had fever, 9.5% had tachycardia, 1.5% had bradycardia, 5% had hypotension, 2% had hypertension, 2.5% had tachypnea and 3.5% showed bradypnea. Also 89% of patients had GCS > 8, while 11% of patients had GCS ≤ 8. The study showed statistically significant difference between discharged and died patients as regards heart rate, blood pressure, respiratory rate, body temperature and GCS. It could be concluded that heart rate, respiratory rate and coma scale can serve as easily measurable tools for outcome prediction in acutely OP poisoned patients. From the previous results, our study recommends to use these parameters to help emergency physicians to quickly detect poisoned patients with poor outcomes.

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Section: Discussionsupporting

confidence: 91%

Predictive Value of Triage Vital Signs and Conscious Level for Outcome Evaluation in Acutely Organophosphate Poisoned Patients

Moussa

Mohamed

Hilal

et al. 2018

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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“…Again, the absence of a central point of entry and of a triage system for new patients may have contributed to inconsistencies in measurements or documentation. As vital signs are important markers of the severity of illness and have been shown to be reliable predictors of death following trauma and acute poisoning in low- and middle-income countries, these should be measured and documented in every patient 18 , 19 …”

Section: Discussionmentioning

confidence: 99%

An observational study of adults seeking emergency care in Cambodia

Yan

Mahadevan

Yore

et al. 2014

Bull. World Health Organ.

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ObjectiveTo describe the characteristics and chief complaints of adults seeking emergency care at two Cambodian provincial referral hospitals.MethodsAdults aged 18 years or older who presented without an appointment at two public referral hospitals were enrolled in an observational study. Clinical and demographic data were collected and factors associated with hospital admission were identified. Patients were followed up 48 hours and 14 days after presentation.FindingsIn total, 1295 hospital presentations were documented. We were able to follow up 85% (1098) of patients at 48 hours and 77% (993) at 14 days. The patients’ mean age was 42 years and 64% (823) were females. Most arrived by motorbike (722) or taxi or tuk-tuk (312). Most common chief complaints were abdominal pain (36%; 468), respiratory problems (15%; 196) and headache (13%; 174). Of the 1050 patients with recorded vital signs, 280 had abnormal values, excluding temperature, on arrival. Performed diagnostic tests were recorded for 539 patients: 1.2% (15) of patients had electrocardiography and 14% (175) had diagnostic imaging. Subsequently, 783 (60%) patients were admitted and 166 of these underwent surgery. Significant predictors of admission included symptom onset within 3 days before presentation, abnormal vital signs and fever. By 14-day follow-up, 3.9% (39/993) of patients had died and 19% (192/993) remained functionally impaired.ConclusionIn emergency admissions in two public hospitals in Cambodia, there is high admission-to-death ratio and limited application of diagnostic techniques. We identified ways to improve procedures, including better documentation of vital signs and increased use of diagnostic techniques.

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“…[25][26][27] However, very few studies have looked as triage parameters as the outcome predictors for poisoning cases in emergency or these were done for single agents. [28][29][30] Our study shows significant difference in triage findings (SPO2, AVPU scale and MAP) for mortality and no mortality groups (fig 1). Similar findings were noted for triage parameters like body temperature <36 or >37°C, p <0.01, systolic blood pressure <100 or >150 mmHg, p<0.01, heart rate <35 or >120 bpm, respiratory rate <16 or >20 per minute to predict mortality of acute poisoning cases in emergency.…”

mentioning

confidence: 99%

“…Similar findings were noted for triage parameters like body temperature <36 or >37°C, p <0.01, systolic blood pressure <100 or >150 mmHg, p<0.01, heart rate <35 or >120 bpm, respiratory rate <16 or >20 per minute to predict mortality of acute poisoning cases in emergency. 30 This highlights the need for a systematic triage especially in our country where there are resource constraints.…”

mentioning

confidence: 99%

Trend and outcome of acute poisoning case: an experience from emergency department of eastern Nepal

Bhandari

Gupta

2017

Int J Community Med Public Health

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Background: Poisoning is common in Nepal. The objective of the study was to describe the profile of poisoning cases presenting to the emergency of a medical university in eastern Nepal. The specific focus was on to describe the presentation, demographics, delay to care and describe the triage parameters at presentation. Methods: An observational study was done. The secondary data from case files of all poisoning patients starting February 2012 to March 2013 were analyzed after retrieving them from Hospital record. Results: Poisoning constituted 3.89% of total emergency visits. Mean age was 24 years with female: male 1.32. Median time delay to presentation from the incident was 4 hours. Mortality rate was 5.1%, intubation rate 6.3%. Agricultural products ingestion (763/1399) was the commonest modality. The triage vitals were noted as median 110 mm of Hg (Q25, Q75 100, 120) for systolic blood pressure, median 87 mm of Hg (Q25, Q75 73, 93) for mean arterial pressure and median 97 (Q25, Q75 94, 98) for SPO2 by pulse oximetry. The level of consciousness was noted as alert (87.6%), response to verbal stimuli (3.7%), response to pain stimuli (7.1) and unconscious (1.6%). Comparison between mortality and no mortality groups showed significant difference for mean arterial pressure (n 1399, p<0.001, Kruskal Wallis Test), SPO2 (n 1399, p<0.001, Kruskal Wallis Test) and state of consciousness (n 1399, p<0.001, Chi Square test). Conclusions: Agricultural products are commonest, drugs and unknown poisons are significant. A large proportion is still unknown poisoning. Triage parameters can help to identify patients in risk of high mortality.

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Triage vital signs predict in-hospital mortality among emergency department patients with acute poisoning: a case control study

Cited by 31 publications

References 18 publications

Predictive Value of Triage Vital Signs and Conscious Level for Outcome Evaluation in Acutely Organophosphate Poisoned Patients

Predictive Value of Triage Vital Signs and Conscious Level for Outcome Evaluation in Acutely Organophosphate Poisoned Patients

An observational study of adults seeking emergency care in Cambodia

Trend and outcome of acute poisoning case: an experience from emergency department of eastern Nepal

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