scholarly journals Pre-hospital suPAR, lactate and CRP measurements for decision-making: a prospective, observational study of patients presenting non-specific complaints

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Milla Jousi ◽  
Marja Mäkinen ◽  
Johanna Kaartinen ◽  
Leena Meriläinen ◽  
Maaret Castrén
Keyword(s):  
Decision Making ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Point Of Care ◽  
Vital Signs ◽  
Hospital Setting ◽  
Medical Systems ◽  
Urokinase Plasminogen Activator Receptor ◽  
Support Tool ◽  
Chief Complaints

Abstract Background In the pre-hospital setting, non-urgent patients with non-specific chief complaints pose assessment challenges for the emergency medical systems (EMS). Severely ill patients should be identified among these patients, and unnecessary transport to the emergency department (ED) should be avoided. Unnecessary admissions burden EDs, deplete EMS resources and can even be harmful to patients, especially elderly patients. Therefore, tools for facilitating pre-hospital decision-making are needed. They could be based on vital signs or point-of-care laboratory biomarkers. In this study, we examined whether the biomarker soluble urokinase plasminogen activator receptor (suPAR), either alone or combined with C-reactive protein (CRP) and/or lactate, could predict discharge from the ED and act as a pre-hospital support tool for non-conveyance decision-making. Methods This was a prospective, observational study of adult patients with normal or near-normal vital signs transported by an EMS to an ED with a code referring to deteriorated general condition. The levels of suPAR, CRP and lactate in the patients’ pre-hospital blood samples were analysed. The values of hospitalized patients were compared to those of discharged patients to determine whether these biomarkers could predict direct discharge from the ED. Results A total of 109 patients (median age: 81 years) were included in the study. Of those, 52% were hospitalized and 48% were discharged from the ED. No statistically significant association was found between suPAR and the ED discharge vs hospitalization outcome (OR: 1.04, 95% CI 0.97–1.13, AUROC: 0.58, 95% CI 0.47–0.69). Adding CRP (AUROC: 0.64, 95% CI 0.54–0.75) or lactate (AUROC: 0.60, 95% CI 0.49–0.71) to the regression models did not improve their diagnostic accuracy. None of the patients with a suPAR value of less than 2 ng/ml were admitted to hospital, while 64% of the patients with a suPAR value of more than 6 ng/ml were hospitalized. Conclusion Pre-hospital suPAR measurements alone or combined with CRP and/or lactate measurements could not predict the ED discharge or hospital admission of 109 non-urgent EMS patients with non-specific chief complaints and normal or near-normal vital signs.

scholarly journals Soluble urokinase plasminogen activator receptor and lactate as prognostic biomarkers in patients presenting with non-specific chief complaints in the pre-hospital setting – the PRIUS-study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Robert Ivic ◽  
Jouni Nurmi ◽  
Lisa Kurland ◽  
Veronica Vicente ◽  
Veronica Lindström ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Vital Signs ◽  
Hospital Setting ◽  
Positive Likelihood Ratio ◽  
Urokinase Plasminogen Activator ◽  
Urokinase Plasminogen Activator Receptor ◽  
Chief Complaints ◽  
Observational Cohort ◽  
Plasminogen Activator Receptor ◽  
National Emergency

Abstract Background Emergency Medical Services (EMS) are faced daily with patients presenting with non-specific chief complaints (NSC). Patients presenting with NSCs often have normal vital signs. It has previously been established that NSCs may have a serious underlying condition that has yet to be identified. The aim of the current study was to determine if soluble urokinase plasminogen activator receptor (suPAR) and lactate could be used to identify serious conditions among patients presenting with NSCs to the EMS. The secondary aim was to describe the prognostic value for mortality in the group. Method A blinded prospective observational cohort study was conducted of patients brought to the ED by ambulance after calling the national emergency number 112 and who were assessed as having NSC by the EMS. Biomarkers were measured during index EMS assessment before transportation to the ED. Patients were followed via EMS and hospital electronic health records. Descriptive and logistic regression analyses were used. Results A total of 414 patients were included, with a median age of 82 years. A serious condition was present in 15.2% of the patients. Elevated suPAR above 3 ng/ml had a positive likelihood ratio (LR+) of 1.17 and a positive predictive value (PPV) of 17.3% as being predictive of a prevalent serious condition. Elevated suPAR above 9 ng/ml had LR+ 4.67 and a PPV of 16.7% as being predictive of 30-day mortality. Lactate was not significantly predictive. Conclusion Pre-hospital suPAR and lactate cannot differentiate serious conditions in need of urgent treatment and assessment in the ED among patients presenting with non-specific chief complaints. suPAR has shown to be predictive of 30-day mortality, which could add some value to the clinical assessment. Trial registration NCT03089359. Registered 20 March 2017, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03089359.

scholarly journals Prospective observational study of point-of-care creatinine in trauma

2016 ◽  
Vol 1 (1) ◽  
pp. e000014 ◽  
Author(s):  
Anthony J Carden ◽  
Edgardo S Salcedo ◽  
Nam K Tran ◽  
Eric Gross ◽  
Jennifer Mattice ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Point Of Care

scholarly journals Prospective, observational study comparing automated and visual point-of-care urinalysis in general practice

BMJ Open ◽  
2016 ◽  
Vol 6 (8) ◽  
pp. e011230 ◽  
Author(s):  
Sanne van Delft ◽  
Annelijn Goedhart ◽  
Mark Spigt ◽  
Bart van Pinxteren ◽  
Niek de Wit ◽  
...  
Keyword(s):  
General Practice ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Point Of Care

scholarly journals The performance of the EMS triage (RETTS-p) and the agreement between the field assessment and final hospital diagnosis: a prospective observational study among children < 16 years

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Carl Magnusson ◽  
Johan Herlitz ◽  
Thomas Karlsson ◽  
Maria Jiménez-Herrera ◽  
Christer Axelsson
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Hospital Setting ◽  
Risk Of Death ◽  
Computerised Decision Support System ◽  
Field Assessment ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Life Threatening ◽  
Triage Level

Abstract Background The rapid triage and treatment system for paediatrics (RETTS-p) has been used by the emergency medical services (EMS) in the west of Sweden since 2014. The performance of the RETTS-p in the pre-hospital setting and the agreement between the EMS nurse’s field assessment and the hospital diagnosis is unknown. The aim of this study was to evaluate the performance of the RETTS-p in the EMS and the agreement between the EMS field assessment and the hospital diagnosis. Methods A prospective observational study was conducted among 454 patients < 16 years of age who were assessed and transported to the PED. Two instruments were used for comparison: 1) Classification of an emergent patient according to predefined criteria as compared to the RETTS-p and 2) Agreement between the EMS nurse’s field assessment and the hospital diagnosis. Results Among all children, 11% were identified as having vital signs associated with an increased risk of death and 7% were diagnosed in hospital with a potentially life-threatening condition. Of the children triaged with RETTS-p (85.9%), 149 of 390 children (38.2%) were triaged to RETTS-p red or orange (life-threatening, potentially life-threatening), of which 40 (26.8%) children were classified as emergent. The hospitalised children were triaged with the highest frequency to level yellow (can wait; 41.5%). In children with RETTS-p red or orange, the sensitivity for a defined emergent patient was 66.7%, with a corresponding specificity of 67.0%. The EMS field assessment was in agreement with the final hospital diagnosis in 80% of the cases. Conclusions The RETTS-p sensitivity in this study is considered moderate. Two thirds of the children triaged to life threatening or potentially life threatening were later identified as non-emergent. Of those, one in six was discharged from the PED without any intervention. Further, one third of the children were under triaged, the majority were found in the yellow triage level (can wait). The highest proportion of hospitalised patients was found in the yellow triage level. Our result is in agreement with previous studies using other triage instruments. A computerised decision support system might help the EMS triage to increase sensitivity and specificity.

scholarly journals Can point-of-care ultrasound predict spinal hypotension during caesarean section? A prospective observational study

Anaesthesia ◽  
2017 ◽  
Vol 73 (1) ◽  
pp. 15-22 ◽  
Author(s):  
L. Zieleskiewicz ◽  
A. Noel ◽  
G. Duclos ◽  
M. Haddam ◽  
A. Delmas ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Spinal Hypotension
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