Emergency department patients with weakness or fatigue: Can physicians predict their outcomes at the front door? A prospective observational study.

<h4>Background</h4>Generalized weakness and fatigue are underexplored symptoms in emergency medicine. Triage tools often underestimate patients presenting to the emergency department (ED) with these nonspecific symptoms (Nemec et al., 2010). At the same time, physicians' disease sev...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Stefan M Herzog, Mirjam A Jenny, Christian H Nickel, Ricardo Nieves Ortega, Roland Bingisser
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2020
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/99ddf61edd8042ecaf58772d126f0be9
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:99ddf61edd8042ecaf58772d126f0be9
record_format	dspace
spelling	oai:doaj.org-article:99ddf61edd8042ecaf58772d126f0be92021-12-02T20:05:45ZEmergency department patients with weakness or fatigue: Can physicians predict their outcomes at the front door? A prospective observational study.1932-620310.1371/journal.pone.0239902https://doaj.org/article/99ddf61edd8042ecaf58772d126f0be92020-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0239902https://doaj.org/toc/1932-6203<h4>Background</h4>Generalized weakness and fatigue are underexplored symptoms in emergency medicine. Triage tools often underestimate patients presenting to the emergency department (ED) with these nonspecific symptoms (Nemec et al., 2010). At the same time, physicians' disease severity rating (DSR) on a scale from 0 (not sick at all) to 10 (extremely sick) predicts key outcomes in ED patients (Beglinger et al., 2015; Rohacek et al., 2015). Our goals were (1) to characterize ED patients with weakness and/or fatigue (W\|F); to explore (2) to what extent physicians' DSR at triage can predict five key outcomes in ED patients with W\|F; (3) how well DSR performs relative to two commonly used benchmark methods, the Emergency Severity Index (ESI) and the Charlson Comorbidity Index (CCI); (4) to what extent DSR provides predictive information beyond ESI, CCI, or their linear combination, i.e., whether ESI and CCI should be used alone or in combination with DSR; and (5) to what extent ESI, CCI, or their linear combination provide predictive information beyond DSR alone, i.e., whether DSR should be used alone or in combination with ESI and / or CCI.<h4>Methods</h4>Prospective observational study between 2013-2015 (analysis in 2018-2020, study team blinded to hypothesis) conducted at a single center. We study an all-comer cohort of 3,960 patients (48% female patients, median age = 51 years, 94% completed 1-year follow-up). We looked at two primary outcomes (acute morbidity (Bingisser et al., 2017; Weigel et al., 2017) and all-cause 1- year mortality) and three secondary outcomes (in-hospital mortality, hospitalization and transfer to ICU). We assessed the predictive power (i.e., resolution, measured as the Area under the ROC Curve, AUC) of the scores and, using logistic regression, their linear combinations.<h4>Findings</h4>Compared to patients without W\|F (n = 3,227), patients with W\|F (n = 733) showed higher prevalences for all five outcomes, reported more symptoms across both genders, and received higher DSRs (median = 4; interquartile range (IQR) = 3-6 vs. median = 3; IQR = 2-5). DSR predicted all five outcomes well above chance (i.e., AUCs > ~0.70), similarly well for both patients with and without W\|F, and as good as or better than ESI and CCI in patients with and without W\|F (except for 1-year mortality where CCI performs better). For acute morbidity, hospitalization, and transfer to ICU there is clear evidence that adding DSR to ESI and/or CCI improves predictions for both patient groups; for 1-year mortality and in-hospital mortality this holds for most, but not all comparisons. Adding ESI and/or CCI to DSR generally did not improve performance or even decreased it.<h4>Conclusions</h4>The use of physicians' disease severity rating has never been investigated in patients with generalized weakness and fatigue. We show that physicians' prediction of acute morbidity, mortality, hospitalization, and transfer to ICU through their DSR is also accurate in these patients. Across all patients, DSR is less predictive of acute morbidity for female than male patients, however. Future research should investigate how emergency physicians judge their patients' clinical state at triage and how this can be improved and used in simple decision aids.Stefan M HerzogMirjam A JennyChristian H NickelRicardo Nieves OrtegaRoland BingisserPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 15, Iss 11, p e0239902 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Stefan M Herzog Mirjam A Jenny Christian H Nickel Ricardo Nieves Ortega Roland Bingisser Emergency department patients with weakness or fatigue: Can physicians predict their outcomes at the front door? A prospective observational study.
description	<h4>Background</h4>Generalized weakness and fatigue are underexplored symptoms in emergency medicine. Triage tools often underestimate patients presenting to the emergency department (ED) with these nonspecific symptoms (Nemec et al., 2010). At the same time, physicians' disease severity rating (DSR) on a scale from 0 (not sick at all) to 10 (extremely sick) predicts key outcomes in ED patients (Beglinger et al., 2015; Rohacek et al., 2015). Our goals were (1) to characterize ED patients with weakness and/or fatigue (W\|F); to explore (2) to what extent physicians' DSR at triage can predict five key outcomes in ED patients with W\|F; (3) how well DSR performs relative to two commonly used benchmark methods, the Emergency Severity Index (ESI) and the Charlson Comorbidity Index (CCI); (4) to what extent DSR provides predictive information beyond ESI, CCI, or their linear combination, i.e., whether ESI and CCI should be used alone or in combination with DSR; and (5) to what extent ESI, CCI, or their linear combination provide predictive information beyond DSR alone, i.e., whether DSR should be used alone or in combination with ESI and / or CCI.<h4>Methods</h4>Prospective observational study between 2013-2015 (analysis in 2018-2020, study team blinded to hypothesis) conducted at a single center. We study an all-comer cohort of 3,960 patients (48% female patients, median age = 51 years, 94% completed 1-year follow-up). We looked at two primary outcomes (acute morbidity (Bingisser et al., 2017; Weigel et al., 2017) and all-cause 1- year mortality) and three secondary outcomes (in-hospital mortality, hospitalization and transfer to ICU). We assessed the predictive power (i.e., resolution, measured as the Area under the ROC Curve, AUC) of the scores and, using logistic regression, their linear combinations.<h4>Findings</h4>Compared to patients without W\|F (n = 3,227), patients with W\|F (n = 733) showed higher prevalences for all five outcomes, reported more symptoms across both genders, and received higher DSRs (median = 4; interquartile range (IQR) = 3-6 vs. median = 3; IQR = 2-5). DSR predicted all five outcomes well above chance (i.e., AUCs > ~0.70), similarly well for both patients with and without W\|F, and as good as or better than ESI and CCI in patients with and without W\|F (except for 1-year mortality where CCI performs better). For acute morbidity, hospitalization, and transfer to ICU there is clear evidence that adding DSR to ESI and/or CCI improves predictions for both patient groups; for 1-year mortality and in-hospital mortality this holds for most, but not all comparisons. Adding ESI and/or CCI to DSR generally did not improve performance or even decreased it.<h4>Conclusions</h4>The use of physicians' disease severity rating has never been investigated in patients with generalized weakness and fatigue. We show that physicians' prediction of acute morbidity, mortality, hospitalization, and transfer to ICU through their DSR is also accurate in these patients. Across all patients, DSR is less predictive of acute morbidity for female than male patients, however. Future research should investigate how emergency physicians judge their patients' clinical state at triage and how this can be improved and used in simple decision aids.
format	article
author	Stefan M Herzog Mirjam A Jenny Christian H Nickel Ricardo Nieves Ortega Roland Bingisser
author_facet	Stefan M Herzog Mirjam A Jenny Christian H Nickel Ricardo Nieves Ortega Roland Bingisser
author_sort	Stefan M Herzog
title	Emergency department patients with weakness or fatigue: Can physicians predict their outcomes at the front door? A prospective observational study.
title_short	Emergency department patients with weakness or fatigue: Can physicians predict their outcomes at the front door? A prospective observational study.
title_full	Emergency department patients with weakness or fatigue: Can physicians predict their outcomes at the front door? A prospective observational study.
title_fullStr	Emergency department patients with weakness or fatigue: Can physicians predict their outcomes at the front door? A prospective observational study.
title_full_unstemmed	Emergency department patients with weakness or fatigue: Can physicians predict their outcomes at the front door? A prospective observational study.
title_sort	emergency department patients with weakness or fatigue: can physicians predict their outcomes at the front door? a prospective observational study.
publisher	Public Library of Science (PLoS)
publishDate	2020
url	https://doaj.org/article/99ddf61edd8042ecaf58772d126f0be9
work_keys_str_mv	AT stefanmherzog emergencydepartmentpatientswithweaknessorfatiguecanphysicianspredicttheiroutcomesatthefrontdooraprospectiveobservationalstudy AT mirjamajenny emergencydepartmentpatientswithweaknessorfatiguecanphysicianspredicttheiroutcomesatthefrontdooraprospectiveobservationalstudy AT christianhnickel emergencydepartmentpatientswithweaknessorfatiguecanphysicianspredicttheiroutcomesatthefrontdooraprospectiveobservationalstudy AT ricardonievesortega emergencydepartmentpatientswithweaknessorfatiguecanphysicianspredicttheiroutcomesatthefrontdooraprospectiveobservationalstudy AT rolandbingisser emergencydepartmentpatientswithweaknessorfatiguecanphysicianspredicttheiroutcomesatthefrontdooraprospectiveobservationalstudy
_version_	1718375439808856064

Emergency department patients with weakness or fatigue: Can physicians predict their outcomes at the front door? A prospective observational study.

Ejemplares similares