Journal Article

The TRIAGE-ProADM Score for an Early Risk Stratification of Medical Patients in the Emergency Department - Development Based on a Multi-National, Prospective, Observational Study

Haubitz, Sebastian, Struja, Tristan, Schuetz, Philipp, Canavaggio, Pauline, Kutz, Alexander, Amin, Adina, Sauvin, Gabrielle, Bernard, Maguy, Amin, Devendra, Mueller, Beat, Conca, Antoinette, Huber, Andreas, Hausfater, Pierre

2016

Overview

The inflammatory biomarker pro-adrenomedullin (ProADM) provides additional prognostic information for the risk stratification of general medical emergency department (ED) patients. The aim of this analysis was to develop a triage algorithm for improved prognostication and later use in an interventional trial. We used data from the multi-national, prospective, observational TRIAGE trial including consecutive medical ED patients from Switzerland, France and the United States. We investigated triage effects when adding ProADM at two established cut-offs to a five-level ED triage score with respect to adverse clinical outcome. Mortality in the 6586 ED patients showed a step-wise, 25-fold increase from 0.6% to 4.5% and 15.4%, respectively, at the two ProADM cut-offs (≤0.75nmol/L, >0.75-1.5nmol/L, >1.5nmol/L, p ANOVA <0.0001). Risk stratification by combining ProADM within cut-off groups and the triage score resulted in the identification of 1662 patients (25.2% of the population) at a very low risk of mortality (0.3%, n = 5) and 425 patients (6.5% of the population) at very high risk of mortality (19.3%, n = 82). Risk estimation by using ProADM and the triage score from a logistic regression model allowed for a more accurate risk estimation in the whole population with a classification of 3255 patients (49.4% of the population) in the low risk group (0.3% mortality, n = 9) and 1673 (25.4% of the population) in the high-risk group (15.1% mortality, n = 252). Within this large international multicenter study, a combined triage score based on ProADM and established triage scores allowed a more accurate mortality risk discrimination. The TRIAGE-ProADM score improved identification of both patients at the highest risk of mortality who may benefit from early therapeutic interventions (rule in), and low risk patients where deferred treatment without negatively affecting outcome may be possible (rule out).

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adrenomedullin / Adrenomedullin - blood / Aged / Aged, 80 and over / Analysis / Biology and Life Sciences / Biomarkers / Biomarkers - blood / Cardiovascular Diseases - blood / Cardiovascular Diseases - diagnosis / Clinical outcomes / Emergency medical care / Emergency medical services / Emergency Service, Hospital / Emergency services / Female / Gastrointestinal Diseases - blood / Gastrointestinal Diseases - diagnosis / Health aspects / Health risk assessment / Health risks / Heart attacks / Heart failure / Hospital patients / Hospitals / Human health and pathology / Humans / Infection - blood / Infection - diagnosis / Inflammation / International Agencies / Laboratories / Life Sciences / Male / Medicine / Medicine and Health Sciences / Middle Aged / Mortality / Mortality risk / Nervous System Diseases - blood / Nervous System Diseases - diagnosis / Observational studies / Patients / People and Places / Physical Sciences / Pneumonia / Prognosis / Prospective Studies / Regression analysis / Regression models / Research and Analysis Methods / Risk / Risk Assessment / Risk groups / Severity of Illness Index / Studies / Systematic review / Therapeutic applications / Triage (Medicine) / Triage - methods / Variance analysis