Short summary

It is a multicenter study performed in Denmark at the ED's. The aim is to clarify whether a termografic picture taken immediately after arrival to the ED, better can predict 30-day mortality than the observations usually used.

Rationale

The increased admission of acute patients in the ED's means that the healthcare professionals are increasingly depending on being able to sort the patients correctly in relation to who needs to be seen first. This is done by using the triage system as well and based on patients' symptoms and the intuition of the healthcare professionals. Despite this, there are patients who fall in between the fingers of the staff, where it is too late discovered that the patient is worse than expected. In addition, it is time-consuming to make repetitive vital parameter measurements on the patient. Healthcare professionals need a method to find the sickest patients entering the door of the ED based on information that can be provided immediately and ideally without the need to involve the staff.

Our research group has for several years been working with thermographic pictures from a heat-sensitive camera. This makes it possible to make an automated and quick overall assessment. The idea is based on clinical experience in Africa where it has been shown that patients who arrive at the hospital with a cold nose have a higher risk of dying than a patient with a hot nose. This is due to a physiological response in the diseased body in an attempt to maintain homeostasis. The body gathers the blood circulation around the vital organs and "sacrifices" the blood circulation in minor parts of the body, including the skin.

Through two small prospective studies, we have shown that there is a connection between the blood circulation in the skin and the patient's prognosis. We show a correlation between thermographic pictures taken 30 minutes after the patient has arrived at the emergency department and mortality within 30 days. Our measurements thus compare the temperature difference between the core temperature and the temperature at the tip of the nose with the mortality.

Our two smaller studies even show us that the temperature difference is as good a marker of death within 30 days as abnormal vital parameters and assessment by an experienced physician, provided that the patients do not receive oxygen supplementation via the nose, because the oxygen cools the nose more down than the natural reaction.

Since we have performed the two studies, we have, in collaboration with the Maersk McKinney Møller Institute at the University of Southern Denmark, developed an app. An app designed for smartphones with a connected thermographic camera, which automatically can take, analyze and report the temperature gradient in a picture in a few seconds. By using this app, it makes it possible to take a picture immediately after the patient has entered the ED. However, since our previous studies were performed after the patient has been in the ED for at least 30 minutes, we do not know if a picture taken at the door can be used to predict outcome. This is what we want to investigate in our new study.

Our aim in this study is therefore: to clarify whether a thermographic picture taken immediately after arrival to the ED, better can predict 30-day mortality than the observations usually used.

Description of the cohort

All medical patients who are 18 years or older who are admitted to the emergency department will be invited to participate in the study.

Data and biological material

From the patients medical record:

Gender, age, medical history, vital parameters: respiratory rate, heart rate, oxygen saturation, blood pressure, temperature.

From the LPR- and CPR register:

status after 30 days: re-admission, possibly death and hospitalization in intensive care.

Collaborating researchers and departments

Department of Emergency Medicine, Southwestern Jutland Hospital, Esbjerg

Department of Emergency Medicine, Kolding Hospital

Department of Emergency Medicine, Odense University Hospital

Department of Emergency Medicine, Aabenraa Hospital

Department of Emergency Medicine, Svendborg Hospital