Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study

Abstract Background While there are clear national resuscitation room admission guidelines for major trauma patients, there are no comparable alarm criteria for critically ill nontrauma (CINT) patients in the emergency department (ED). The aim of this study was to define and validate specific trigge...

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Autores principales:	Alexandros Rovas, Efe Paracikoglu, Mark Michael, André Gries, Janina Dziegielewski, Hermann Pavenstädt, Michael Bernhard, Philipp Kümpers
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Resuscitation room Conservative shock room Nontrauma patients Emergency department Trigger factor Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/e090176056ac40779310091e41442b29
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spelling	oai:doaj.org-article:e090176056ac40779310091e41442b292021-11-14T12:16:38ZIdentification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study10.1186/s13049-021-00973-41757-7241https://doaj.org/article/e090176056ac40779310091e41442b292021-11-01T00:00:00Zhttps://doi.org/10.1186/s13049-021-00973-4https://doaj.org/toc/1757-7241Abstract Background While there are clear national resuscitation room admission guidelines for major trauma patients, there are no comparable alarm criteria for critically ill nontrauma (CINT) patients in the emergency department (ED). The aim of this study was to define and validate specific trigger factor cut-offs for identification of CINT patients in need of a structured resuscitation management protocol. Methods All CINT patients at a German university hospital ED for whom structured resuscitation management would have been deemed desirable were prospectively enrolled over a 6-week period (derivation cohort, n = 108). The performance of different thresholds and/or combinations of trigger factors immediately available during triage were compared with the National Early Warning Score (NEWS) and Quick Sequential Organ Failure Assessment (qSOFA) score. Identified combinations were then tested in a retrospective sample of consecutive nontrauma patients presenting at the ED during a 4-week period (n = 996), and two large external datasets of CINT patients treated in two German university hospital EDs (validation cohorts 1 [n = 357] and 2 [n = 187]). Results The any-of-the-following trigger factor iteration with the best performance in the derivation cohort included: systolic blood pressure < 90 mmHg, oxygen saturation < 90%, and Glasgow Coma Scale score < 15 points. This set of triggers identified > 80% of patients in the derivation cohort and performed better than NEWS and qSOFA scores in the internal validation cohort (sensitivity = 98.5%, specificity = 98.6%). When applied to the external validation cohorts, need for advanced resuscitation measures and hospital mortality (6.7 vs. 28.6%, p < 0.0001 and 2.7 vs. 20.0%, p < 0.012) were significantly lower in trigger factor-negative patients. Conclusion Our simple, any-of-the-following decision rule can serve as an objective trigger for initiating resuscitation room management of CINT patients in the ED.Alexandros RovasEfe ParacikogluMark MichaelAndré GriesJanina DziegielewskiHermann PavenstädtMichael BernhardPhilipp KümpersBMCarticleResuscitation roomConservative shock roomNontrauma patientsEmergency departmentTrigger factorMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENScandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol 29, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Resuscitation room Conservative shock room Nontrauma patients Emergency department Trigger factor Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Resuscitation room Conservative shock room Nontrauma patients Emergency department Trigger factor Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Alexandros Rovas Efe Paracikoglu Mark Michael André Gries Janina Dziegielewski Hermann Pavenstädt Michael Bernhard Philipp Kümpers Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study
description	Abstract Background While there are clear national resuscitation room admission guidelines for major trauma patients, there are no comparable alarm criteria for critically ill nontrauma (CINT) patients in the emergency department (ED). The aim of this study was to define and validate specific trigger factor cut-offs for identification of CINT patients in need of a structured resuscitation management protocol. Methods All CINT patients at a German university hospital ED for whom structured resuscitation management would have been deemed desirable were prospectively enrolled over a 6-week period (derivation cohort, n = 108). The performance of different thresholds and/or combinations of trigger factors immediately available during triage were compared with the National Early Warning Score (NEWS) and Quick Sequential Organ Failure Assessment (qSOFA) score. Identified combinations were then tested in a retrospective sample of consecutive nontrauma patients presenting at the ED during a 4-week period (n = 996), and two large external datasets of CINT patients treated in two German university hospital EDs (validation cohorts 1 [n = 357] and 2 [n = 187]). Results The any-of-the-following trigger factor iteration with the best performance in the derivation cohort included: systolic blood pressure < 90 mmHg, oxygen saturation < 90%, and Glasgow Coma Scale score < 15 points. This set of triggers identified > 80% of patients in the derivation cohort and performed better than NEWS and qSOFA scores in the internal validation cohort (sensitivity = 98.5%, specificity = 98.6%). When applied to the external validation cohorts, need for advanced resuscitation measures and hospital mortality (6.7 vs. 28.6%, p < 0.0001 and 2.7 vs. 20.0%, p < 0.012) were significantly lower in trigger factor-negative patients. Conclusion Our simple, any-of-the-following decision rule can serve as an objective trigger for initiating resuscitation room management of CINT patients in the ED.
format	article
author	Alexandros Rovas Efe Paracikoglu Mark Michael André Gries Janina Dziegielewski Hermann Pavenstädt Michael Bernhard Philipp Kümpers
author_facet	Alexandros Rovas Efe Paracikoglu Mark Michael André Gries Janina Dziegielewski Hermann Pavenstädt Michael Bernhard Philipp Kümpers
author_sort	Alexandros Rovas
title	Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study
title_short	Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study
title_full	Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study
title_fullStr	Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study
title_full_unstemmed	Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study
title_sort	identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the initiate iron man study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/e090176056ac40779310091e41442b29
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Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study

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