A combination of clinical parameters and blood-gas analysis identifies patients at risk of transfer to intensive care upon arrival to the Emergency Department

• Published in: European journal of emergency medicine Vol. 23; no. 4; p. 305
• Main Authors: Bjørn, Maria, Simonsen, Jakúp W, Mogensen, Christian B
• Format: Journal Article
• Language: English
• Published: England 01.08.2016
• Subjects: Aged; Blood Gas Analysis - statistics & numerical data; Blood Pressure; Body Temperature; Case-Control Studies; Emergency Service, Hospital - statistics & numerical data; Female; Glasgow Coma Scale; Heart Rate; Humans; Intensive Care Units - statistics & numerical data; Male; Middle Aged; Patient Transfer - statistics & numerical data; Respiratory Rate; Risk Factors; Triage; Vital Signs
• ISSN: 1473-5695
• DOI: 10.1097/MEJ.0000000000000269

Identifying patients at risk of transfer to the ICU upon arrival to the Emergency Department (ED) might direct early therapy and optimize transfers. However, among the many ED patients, it is difficult to pinpoint the few who insidiously deteriorate to an ICU-requiring level. The aim of this study was to identify predictors in background information, vital values and blood-gas analysis for transfer to ICU 3-36 h after arrival among nontrauma ED patients. A case-control study of 10 007 acute adult patients admitted to ED within 1 year was carried out. The case group consisted of all ICU transfers 3-36 h after arrival who underwent blood-gas analysis and a similar control group not transferred to the ICU. Blood pressure, respiratory frequency, pulse rate, peripheral oxygen saturation and temperature, triage, height, weight, Glasgow Coma Score, drugs, alcohol, tobacco, age, sex, Charlson score and blood-gas results were analysed. A total of 49 medical and 33 surgical patients were transferred to the ICU. For medical cases, 2.3 and surgical cases 3.7 controls were included. For medical patients, low systolic blood pressure [odds ratio (OR) 14.4], elevated heart rate (OR 3.9), severe acidosis (OR 5.1) and hypercapnia (OR 8.4) and for surgical patients age 60-79 years (OR 6.3), low diastolic blood pressure (OR 2.7) and severe acidosis (OR 15.3) were associated significantly with later transfer to the ICU. The predictors identified could be used as part of ED triage to identify high-risk patients for ICU. These findings should be examined in a well-designed prospective cohort study.