Master of Science in Public Health, MScPH
Jeannett Kjær
The Pre-hospital Research Unit, Region of Southern Denmark
| Projekt styring | ||
| Projekt status | Closed | |
| Data indsamlingsdatoer | ||
| Start | 01.04.2021 | |
| Slut | 01.04.2024 | |
The association between high prehospital qSOFA score, triage at hospital admission and increased in-hospital mortality.
Short summary
High-risk prehospital patients may be difficult to identify because of time limits. Previous studies show high prehospital qSOFA scores are associated with increased mortality. The purposes of the project are to investigate: 1) The association of a high prehospital qSOFA score with an increased in-hospital mortality among patients, who are transported acutely by ambulance to an emergency department in the Region of Southern Denmark, and whether qSOFA is useful to detect increased in-hospital mortality. 2) How patients with high qSOFA scores are triaged with ADAPT at hospital admission. 3) Whether patients with a high qSOFA score, who are not triaged 'red' by the ADAPT triage system at the hospital, have increased in-hospital mortality compared to those who have a lower qSOFA score.
Rationale
High-risk prehospital patients can be difficult to identify because of time constraints in the emergency setting and as a result, these patients may receive reduced standard of care e.g. lack of objective assessments. Early detection of critically ill patients and subsequent initiation of treatment may contribute to decreased mortality. QSOFA (quick sequential organ failure assessment score) is a tool used for early detection of infected critically ill patients outside the intensive care units. Previous studies show that high prehospital qSOFA scores are associated with increased mortality in patients with suspected infection. One study determines an association between qSOFA and in-hospital mortality, hospitalizations, intensive care, and hospital stays in patients with and without infection. This association has not been investigated in a Danish context. We found it relevant to investigate mortality among patients with high prehospital qSOFA in Denmark based on patients in the Region of Southern Denmark. QSOFA score is a three-point scale where one point is given for each criterion met: 1) Systolic blood pressure ≤100mmHg, 2) Glasgow Coma score <15, 3) respiration rate ≥22 per minute. A high qSOFA score indicates a critical condition of the patient. Due to the simplicity of qSOFA, it is possible to use the tool in an out-of-hospital setting. All patients who arrive by ambulance to a hospital in the Region of Southern Denmark are triaged on admission. The triage system used in the Region of Southern Denmark is predominantly based on the ADAPT principles. Healthcare professionals assess the measure of vital parameters based on the ABCDE principle that include observation or measurement of respiration, oxygen saturation in the blood, heart rate, blood pressure, level of consciousness, and temperature. Following this assessment, patients are triaged with a color based on a prioritization of how quickly the patient should be attended by a physician. Patients who are triaged red should be seen immediately, orange urgent, yellow less urgent, green not urgent, and blue priority is given to patients with minor injuries. Some patients may not have a red triage according to the ADAPT triage system but still, have a qSOFA score of three. This means that patients with an expected high in-hospital mortality are not necessarily detected in the ADAPT system. We want to investigate whether patients with a high qSOFA score and orange, yellow, or green (i.e. low or intermediate) ADAPT score have a mortality rate similar to patients with a high qSOFA and a red (i.e. high) ADAPT score. Thus, can the qSOFA scoring system be used to identify seriously ill patients, who are not detected by the ADAPT system on arrival at an emergency department in the Region of Southern Denmark? To our knowledge, no studies have examined mortality in patients with a high qSOFA score AND high ADAPT score and compared to mortality in patients with a high qSOFA score and less critical ADAPT score. We expect that the study will be a relevant supplement to the existing research and the results will elucidate qSOFA scores' role in reducing mortality in the out-of-hospital and in-hospital emergency triage. The purpose of the project is to investigate: 1) The association of a high prehospital qSOFA score with an increased in-hospital mortality among patients, who are transported acutely by ambulance to an emergency department in the Region of Southern Denmark, and whether qSOFA is useful to detect increased in-hospital mortality. 2) How patients with high qSOFA scores are triaged with ADAPT at hospital admission. 3) Whether patients with a high qSOFA score, who are not triaged 'red' by the ADAPT triage system at the hospital, have increased in-hospital mortality compared to those who have a lower qSOFA score.
Description of the cohort
The population is prehospital patients, who have been transported acutely by ambulance to an emergency department in the Region of Southern Denmark from 2016 to 2020 (approximately 80,000 patients per year). The cohort is recruited from the Prehospital Patient Journal (PPJ).
Data and biological material
Our population will be triaged with the qSOFA tool based on information obtained from Prehospital Patient Journal (PPJ). Likewise, information needed for triage with ADAPT will be extracted from PPJ. Patients are triaged on the seriousness of their condition and how quickly they need to be attended by a physician. This is an assessment of the patient's vital parameters based on the ABCDE principle. Registry data is obtained from the Danish Civil Registration System. We will obtain information about the possible time of death to investigate whether the patients have passed away in connection with the prehospital incident or hospitalization. This information is used to calculate the mortality rate.