Common laboratory tests predict imminent medical emergency team calls, intensive care unit admission or death in emergency department patients

Loekito, Elsa; Bailey, James M.; Bellomo, Rinaldo; Hart, Graeme K; Hegarty, Colin; Davey, Peter; Bain, Christopher; Pilcher, David; Schneider, Hans‐Gerhard

doi:10.1111/1742-6723.12040

Cited by 19 publications

(20 citation statements)

References 34 publications

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“…One drawback to our current approach is that whilst many, if not all, non-elective admissions to 27 The same authors have also shown good discrimination in detecting to imminent ICU admission and imminent death, using the same technique. 28 These findings provide optimism that an LDT-EWS might be predictive of outcome even when a full set of biochemistry and haematology tests is not available for use in the calculation of an LDT-EWS value. This hypothesis clearly needs further testing.…”

Section: -6mentioning

confidence: 88%

Development and validation of a decision tree early warning score based on routine laboratory test results for the discrimination of hospital mortality in emergency medical admissions

et al. 2013

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Section: -6mentioning

confidence: 88%

Development and validation of a decision tree early warning score based on routine laboratory test results for the discrimination of hospital mortality in emergency medical admissions

et al. 2013

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“…Loekito and colleagues have published a retrospective observational study in this issue of Emergency Medicine Australasia that takes some initial steps towards facing this challenge. 1 Their study is the first of its kind. There are studies looking at selected groups of patients, or 'track and trigger' early warning systems largely based on physiological parameters or ICU-derived scoring systems, [2][3][4] but none that focus solely on laboratory tests in undifferentiated ED patients.…”

Section: -Neils Bohrmentioning

confidence: 99%

“…The sickest of the sick need emergency physicians when they arrive and then intensivists during their admission. Despite our best efforts, medical emergency team (MET) calls, intensive care unit (ICU) admissions and deaths still occur soon after admission to the ED . Perhaps if high‐risk patients could be reliably identified, then ICU review could occur earlier, end‐of‐life issues might be addressed urgently and timelier interventions instituted.…”

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confidence: 99%

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Nostradamus in a tube of blood?

Nickson

2013

Emerg Medicine Australasia

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See also pp. 132-139'Prediction is difficult, especially about the future.' -Neils BohrIn emergency medicine, we play a high-stakes game with a dealer who likes to shuffle the deadly disorders imperceptibly among the common benign disorders. We are the poker players of modern medicine; hold or fold, risks and probabilities are our game. We agonise over which of our patients might die, who can go home and who should stay in hospital.Yet merely admitting patients to hospital does not keep them out of harm's way. Patients still need to be treated by the right people, in the right place, at the right time. The sickest of the sick need emergency physicians when they arrive and then intensivists during their admission. Despite our best efforts, medical emergency team (MET) calls, intensive care unit (ICU) admissions and deaths still occur soon after admission to the ED.1 Perhaps if high-risk patients could be reliably identified, then ICU review could occur earlier, end-of-life issues might be addressed urgently and timelier interventions instituted. We might even be able to avert these imminent adverse events.Loekito and colleagues have published a retrospective observational study in this issue of Emergency Medicine Australasia that takes some initial steps towards facing this challenge.1 Their study is the first of its kind. There are studies looking at selected groups of patients, or 'track and trigger' early warning systems largely based on physiological parameters or ICU-derived scoring systems, 2-4 but none that focus solely on laboratory tests in undifferentiated ED patients.Let us delve into the mechanics of this study. It assesses the ability of common laboratory measurements from undifferentiated ED patients to predict who imminently required a MET call, needed ICU admission or died. The common laboratory measurements used were those derived from the full blood count, urea, electrolytes and creatinine, liver function tests and blood gases. The authors scoured the database records of more than 70 000 patients at the Austin Hospital in Melbourne, Australia, who were admitted between 2000 and 2006. They determined which of these patients had MET calls (within 24 h), ICU admission or who died (on the same or next calendar day). They obtained over 2.5 million individual laboratory measurements taken from these patients. These were analysed in subgroups (called 'batches') of the 30 laboratory variables measured. Univariate logistic regression identified the nine laboratory variables that had the greatest individual predictive power of death (haemoglobin, haematocrit, bicarbonate, pH, bilirubin, albumin, urea, creatine and white cell count), which, for pragmatic reasons, were the ones chosen to be analysed further as predictors of MET calls and ICU admissions.In combination, through multivariate logistic regression, these nine laboratory variables were found to be an excellent predictor of death (area under the receiver operating characteristic curve [AUC-ROC] = 0.90), a good predictor of ICU admission (AUC-ROC = ...

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“…The accessibility, turnaround time, reliability, and predictive ability of laboratory test results are crucial to the performance of emergency departments (EDs) in hospitals [ 1 – 4 ], and to the safety and quality of care provided by emergency physicians (EPs) [ 5 , 6 ]. Due to the specific nature of emergency medicine, EPs must rapidly investigate the state and stability of a patient’s health in order to make informed decisions and implement medical interventions that can make the difference between life and death.…”

Section: Introductionmentioning

confidence: 99%

Improving performance in the ED through laboratory information exchange systems

et al. 2018

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BackgroundThe accessibility of laboratory test results is crucial to the performance of emergency departments and to the safety of patients. This study aims to develop a better understanding of which laboratory information exchange (LIE) systems emergency care physicians (ECPs) are using to consult their patients’ laboratory test results and which benefits they derive from such use.MethodsA survey of 163 (36%) ECPs in Quebec was conducted in collaboration with the Quebec’s Department of Health and Social Services. Descriptive statistics, chi-square tests, cluster analyses, and ANOVAs were conducted.ResultsThe great majority of respondents indicated that they use several LIE systems including interoperable electronic health record (iEHR) systems, laboratory results viewers (LRVs), and emergency department information systems (EDIS) to consult their patients’ laboratory results. Three distinct profiles of LIE users were observed. The extent of LIE usage was found to be primarily determined by the functional design differences between LIE systems available in the EDs. Our findings also indicate that the more widespread LIE usage, the higher the perceived benefits. More specifically, physicians who make extensive use of iEHR systems and LRVs obtain the widest range of benefits in terms of efficiency, quality, and safety of emergency care.ConclusionsExtensive use of LIE systems allows ECPs to better determine and monitor the health status of their patients, verify their diagnostic assumptions, and apply evidence-based practices in laboratory medicine. But for such benefits to be possible, ECPs must be provided with LIE systems that produce accurate, up-to-date, complete, and easy-to-interpret information.

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Common laboratory tests predict imminent medical emergency team calls, intensive care unit admission or death in emergency department patients

Abstract: Commonly performed laboratory tests can help predict imminent MET calls, ICU admission or death in ED patients. Prospective investigations of the clinical utility of such predictions appear desirable.

Cited by 19 publications

References 34 publications

Development and validation of a decision tree early warning score based on routine laboratory test results for the discrimination of hospital mortality in emergency medical admissions

Development and validation of a decision tree early warning score based on routine laboratory test results for the discrimination of hospital mortality in emergency medical admissions

Nostradamus in a tube of blood?

Improving performance in the ED through laboratory information exchange systems

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