Mikko Kivipuro1, Joonas Tirkkonen2, Timo Kontula3, Juuso Solin4, Jari Kalliomäki5, Satu-Liisa Pauniaho6, Heini Huhtala7, Arvi Yli-Hankala8, Sanna Hoppu9. 1. Medical School, University of Tampere and Department of Anaesthesia, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland. Electronic address: kivipuro.mikko.m@student.uta.fi. 2. Department of Intensive Care Medicine and Department of Emergency, Anaesthesia and Pain Medicine, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland. Electronic address: tirkkonen.joonas.o@student.uta.fi. 3. Department of Emergency Medicine, Jyväskylä Central Hospital, Keskussairaalantie 19, FI-40620 Jyväskylä, Finland. Electronic address: timo.kontula@ksshp.fi. 4. Medical School, University of Tampere and Department of Anaesthesia, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland. Electronic address: solin.juuso.O@student.uta.fi. 5. Department of Intensive Care Medicine, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland. Electronic address: jari.kalliomaki@pshp.fi. 6. Department of Emergency Medicine, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland. Electronic address: satu-liisa.pauniaho@pshp.fi. 7. Biostatistics, Faculty of Social Sciences, University of Tampere, FI-33014, Finland. Electronic address: Heini.Huhtala@staff.uta.fi. 8. Department of Emergency, Anaesthesia and Pain Medicine, Tampere University Hospital, PO Box 2000, FI-33521, Finland; Faculty of Medicine and Life Sciences, University of Tampere, FI-33014 Tampereen yliopisto, Tampere, Finland. Electronic address: arvi.yli-hankala@staff.uta.fi. 9. Department of Intensive Care Medicine and Department of Emergency, Anaesthesia and Pain Medicine, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland. Electronic address: sanna.hoppu@pshp.fi.
Abstract
OBJECTIVES: We investigated the national early warning scores (NEWSs) and related outcomes of patients in a tertiary referral center's multidisciplinary emergency department (ED). Patients were further categorized into three groups: triaged directly to intensive care unit (EDICU), triaged to general ward with later ICU admission (EDwardICU) and triaged to general ward (EDward). NEWSs and subsequent outcomes among these sub groups were compared. METHODS: We conducted a prospective one-month cohort study in Tampere University Hospital's ED, Finland. ED-NEWSs were obtained for all adult patients without treatment limitations, and control (ward) NEWSs were further obtained for the EDwardICU and EDward patients. RESULTS: Cohort consisted of 1,354 patients with a median ED-NEWS of 2, and higher ED-NEWS was associated with in-hospital mortality (OR 1.26, 95% CI 1.11-1.42; AUROC 0.75, 0.64‒0.86, p < 0.001) and 30-day mortality (OR 1.27, 1.17-1.39; AUROC 0.78, 0.71‒0.84, p < 0.001) irrespective of age and comorbidity. There were 64 patients in EDICU group, 12 patients in EDwardICU group and 1,278 patients in EDward group with median ED-NEWSs of 7, 3 and 2 (p < 0.001), respectively. After the first 24 h in wards, median NEWSs of the EDwardICU patients had substantially increased as compared with EDward patients (6 vs. 2, p < 0.001). There were no statistical differences in last NEWS before ICU admission between the EDICU and EDwardICU patients (7 vs. 8, p = 0.534), or in ICU severity-of-illness scores or patient outcomes. CONCLUSIONS: ED-NEWS is independently associated with in-hospital and 30-day mortality with acceptable discrimination capability. Direct and late ICU admissions occurred with comparable NEWSs at admission.
OBJECTIVES: We investigated the national early warning scores (NEWSs) and related outcomes of patients in a tertiary referral center's multidisciplinary emergency department (ED). Patients were further categorized into three groups: triaged directly to intensive care unit (EDICU), triaged to general ward with later ICU admission (EDwardICU) and triaged to general ward (EDward). NEWSs and subsequent outcomes among these sub groups were compared. METHODS: We conducted a prospective one-month cohort study in Tampere University Hospital's ED, Finland. ED-NEWSs were obtained for all adult patients without treatment limitations, and control (ward) NEWSs were further obtained for the EDwardICU and EDward patients. RESULTS: Cohort consisted of 1,354 patients with a median ED-NEWS of 2, and higher ED-NEWS was associated with in-hospital mortality (OR 1.26, 95% CI 1.11-1.42; AUROC 0.75, 0.64‒0.86, p < 0.001) and 30-day mortality (OR 1.27, 1.17-1.39; AUROC 0.78, 0.71‒0.84, p < 0.001) irrespective of age and comorbidity. There were 64 patients in EDICU group, 12 patients in EDwardICU group and 1,278 patients in EDward group with median ED-NEWSs of 7, 3 and 2 (p < 0.001), respectively. After the first 24 h in wards, median NEWSs of the EDwardICU patients had substantially increased as compared with EDward patients (6 vs. 2, p < 0.001). There were no statistical differences in last NEWS before ICU admission between the EDICU and EDwardICU patients (7 vs. 8, p = 0.534), or in ICU severity-of-illness scores or patient outcomes. CONCLUSIONS: ED-NEWS is independently associated with in-hospital and 30-day mortality with acceptable discrimination capability. Direct and late ICU admissions occurred with comparable NEWSs at admission.
Authors: Francisco Martín-Rodríguez; Raúl López-Izquierdo; Carlos Del Pozo Vegas; Juan F Delgado-Benito; Carmen Del Pozo Pérez; Virginia Carbajosa Rodríguez; Agustín Mayo Iscar; José Luis Martín-Conty; Carlos Escudero Cuadrillero; Miguel A Castro-Villamor Journal: Emerg Med Int Date: 2019-07-01 Impact factor: 1.112
Authors: Vincent M Quinten; Matijs van Meurs; Tycho J Olgers; Judith M Vonk; Jack J M Ligtenberg; Jan C Ter Maaten Journal: Scand J Trauma Resusc Emerg Med Date: 2018-07-13 Impact factor: 2.953
Authors: Kirsi Kemp; Janne Alakare; Veli-Pekka Harjola; Timo Strandberg; Jukka Tolonen; Lasse Lehtonen; Maaret Castrén Journal: BMC Emerg Med Date: 2020-10-28
Authors: Francisco Martín-Rodríguez; José L Martín-Conty; Ancor Sanz-García; Virginia Carbajosa Rodríguez; Guillermo Ortega Rabbione; Irene Cebrían Ruíz; José R Oliva Ramos; Enrique Castro Portillo; Begoña Polonio-López; Rodrigo Enríquez de Salamanca Gambarra; Marta Gómez-Escolar Pérez; Raúl López-Izquierdo Journal: J Pers Med Date: 2021-03-02