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Objectives

Generic triage risk assessments are widely used in the emergency department ED, but have not been validated for prediction of short-term risk among patients with acute heart failure HF. Our objective was to evaluate the Canadian Triage Acuity Scale CTAS for prediction of early death among HF patients.

Methods

We included patients presenting with HF to an ED in Ontario from Apr 2003 to Mar 2007. We used the National Ambulatory Care Reporting System and vital statistics databases to examine care and outcomes.

Results

Among 68,380 patients 76±12 years, 49.4% men, early mortality was stratified with death rates of 9.9%, 1.9%, 0.9%, and 0.5% at 1-day, and 17.2%, 5.9%, 3.8%, and 2.5% at 7-days, for CTAS 1, 2, 3, and 4–5, respectively. Compared to lower acuity CTAS 4–5 patients, adjusted odds ratios aOR for 1-day death were 1.32 95%CI; 0.93–1.88; p = 0.12 for CTAS 3, 2.41 95%CI; 1.71–3.40; p<0.001 for CTAS 2, and highest for CTAS 1: 9.06 95%CI; 6.28–13.06; p<0.001. Predictors of triage-critical CTAS 1 status included oxygen saturation <90% aOR 5.92, 95%CI; 3.09–11.81; p<0.001, respiratory rate >24 breaths-minute aOR 1.96, 95%CI; 1.05–3.67; p = 0.034, and arrival by paramedic aOR 3.52, 95%CI; 1.70–8.02; p = 0.001. While age-sex-adjusted CTAS score provided good discrimination for ED c-statistic = 0.817 and 1-day c-statistic = 0.724 death, mortality prediction was improved further after accounting for cardiac and non-cardiac co-morbidities c-statistics 0.882 and 0.810, respectively; both p<0.001.

Conclusions

A semi-quantitative triage acuity scale assigned at ED presentation and based largely on respiratory factors predicted emergent death among HF patients.



Autor: Harriette G. C. Van Spall, Clare Atzema, Michael J. Schull, Gary E. Newton, Susanna Mak, Alice Chong, Jack V. Tu, Thérèse A. St

Fuente: http://plos.srce.hr/



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