Data from: Routine blood tests are associated with short term mortality and can improve emergency department triage: a cohort study of >12,000 patients

Background: Prioritization of acutely ill patients in the Emergency Department remains a challenge. We aimed to evaluate whether routine blood tests can predict mortality in unselected patients in an emergency department and to compare risk prediction with a formalized triage algorithm.

Methods: A prospective observational cohort study of 12,661 consecutive admissions to the Emergency Department of Nordsjælland University Hospital during two separate periods in 2010 (primary cohort, n = 6279) and 2013 (validation cohort, n = 6383). Patients were triaged in five categories by a formalized triage algorithm. All patients with a full routine biochemical screening (albumin, creatinine, c-reactive protein, haemoglobin, lactate dehydrogenase, leukocyte count, potassium, and sodium) taken at triage were included. Information about vital status was collected from the Danish Central Office of Civil registration.

Multiple logistic regressions were used to predict 30-day mortality. Validation was performed by applying the regression models on the 2013 validation cohort.

Results: Thirty-day mortality was 5.3%. The routine blood tests had a significantly stronger discriminative value on 30-day mortality compared to the formalized triage (AUC 88.1 [85.7;90.5] vs. 63.4 [59.1;67.5], p < 0.01). Risk stratification by routine blood tests was able to identify a larger number of low risk patients (n = 2100, 30-day mortality 0.1% [95% CI 0.0;0.3%]) compared to formalized triage (n = 1591, 2.8% [95% CI 2.0;3.6%]), p < 0.01.

Conclusions: Routine blood tests were strongly associated with 30-day mortality in acutely ill patients and discriminatory ability was significantly higher than with a formalized triage algorithm. Thus routine blood tests allowed an improved risk stratification of patients presenting in an emergency department.

背景：急诊科急危重症患者的优先级分诊仍为临床实践难题。本研究旨在评估常规血液检验能否预测急诊科未筛选患者的死亡率，并将其风险预测效能与标准化分诊算法进行对比。

方法：本研究为前瞻性观察性队列研究，纳入北西兰大学医院（Nordsjælland University Hospital）急诊科2010年（主要队列，n=6279）及2013年（验证队列，n=6383）两个独立时段内连续收治的12661例急诊就诊患者。所有患者均通过标准化分诊算法分为5个分诊类别，且纳入在分诊时完成全套常规生化筛查（白蛋白、肌酐、C反应蛋白、血红蛋白、乳酸脱氢酶、白细胞计数、钾离子及钠离子）的患者。患者的生命状态信息从丹麦中央民事登记办公室获取。

采用多因素logistic回归模型预测患者30天死亡率，并将该回归模型应用于2013年验证队列以完成模型验证。

结果：本研究队列的30天总体死亡率为5.3%。相较于标准化分诊算法，常规血液检验对30天死亡率的判别效能显著更高（受试者工作特征曲线下面积[AUC] 88.1 [95%CI: 85.7~90.5] vs 63.4 [95%CI: 59.1~67.5]，p<0.01）。通过常规血液检验进行风险分层，可识别出更多低危患者（共2100例，30天死亡率0.1% [95%CI: 0.0~0.3%]）；而标准化分诊算法仅识别出1591例低危患者，其30天死亡率为2.8% [95%CI: 2.0~3.6%]，组间差异具有统计学意义（p<0.01）。

结论：急诊急危重症患者的常规血液检验结果与30天死亡率显著相关，且其判别效能显著优于标准化分诊算法。因此，常规血液检验可实现对急诊科就诊患者更精准的风险分层。