Normal gait, albumin and d-dimer levels identify low risk emergency department patients: a prospective observational cohort study with 365-day 100% follow-up

Normal gait, albumin and d-dimer levels identify low risk emergency department patients: a prospective observational cohort study with 365-day 100% follow-up

Abstract Background If survival could be reliably predicted many patients could be safely managed outside of hospital in an ambulatory care setting. Aim Comparison of common laboratory findings, co-morbidities, mobility and vital signs as predictors of mortality of acutely ill emergency department (...

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Veröffentlicht in:QJM : An International Journal of Medicine 2020-02, Vol.113 (2), p.86-92
Hauptverfasser: Lyngholm, L, Nickel, C H, Kellett, J, Chang, S, Cooksley, T, Brabrand, M
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container_issue 2
container_start_page 86
container_title QJM : An International Journal of Medicine
container_volume 113
creator Lyngholm, L
Nickel, C H
Kellett, J
Chang, S
Cooksley, T
Brabrand, M
description Abstract Background If survival could be reliably predicted many patients could be safely managed outside of hospital in an ambulatory care setting. Aim Comparison of common laboratory findings, co-morbidities, mobility and vital signs as predictors of mortality of acutely ill emergency department (ED) attendees. Design Prospective observational study. Methods Secondary analysis of 1334 consenting acutely ill patients attending a Danish ED. Results 67 (5%) out of 1334 patients died within 100 days. After logistic regression seven predictors of 100 days mortality remained significant: an albumin level ≤34 gm/l, D-dimer level >0.51 mg/l, an Asadollahi score (based on admission laboratory data and age) ≥12, a platelet count
doi_str_mv 10.1093/qjmed/hcz226
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Aim Comparison of common laboratory findings, co-morbidities, mobility and vital signs as predictors of mortality of acutely ill emergency department (ED) attendees. Design Prospective observational study. Methods Secondary analysis of 1334 consenting acutely ill patients attending a Danish ED. Results 67 (5%) out of 1334 patients died within 100 days. After logistic regression seven predictors of 100 days mortality remained significant: an albumin level ≤34 gm/l, D-dimer level &gt;0.51 mg/l, an Asadollahi score (based on admission laboratory data and age) ≥12, a platelet count &lt;159 X 1000/ml, impaired mobility on presentation, a respiratory rate ≥30 bpm and a Charlson co-morbidity index ≥3. Only 5 of the 442 without any of these variables died within 365 days. Only one of the 517 patients with a stable independent gait and normal d-dimer and albumin levels died within 100 days, none died within 30 days of assessment and 12 died within 365 days. Of the remaining 817 patients 66 (8%) died within 100 days. Conclusion These findings suggest that normal gait, albumin and d-dimer levels are the most parsimonious way of identifying low risk ED patients.</description><identifier>ISSN: 1460-2725</identifier><identifier>EISSN: 1460-2393</identifier><identifier>DOI: 10.1093/qjmed/hcz226</identifier><identifier>PMID: 31504931</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><ispartof>QJM : An International Journal of Medicine, 2020-02, Vol.113 (2), p.86-92</ispartof><rights>The Author(s) 2019. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com 2019</rights><rights>The Author(s) 2019. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c361t-fb6d5bdb218aa57441fce5f5221a17c119dc66a3014abe8cf0251d570d8163f63</citedby><cites>FETCH-LOGICAL-c361t-fb6d5bdb218aa57441fce5f5221a17c119dc66a3014abe8cf0251d570d8163f63</cites><orcidid>0000-0002-3340-8251 ; 0000-0002-4741-9242</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31504931$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lyngholm, L</creatorcontrib><creatorcontrib>Nickel, C H</creatorcontrib><creatorcontrib>Kellett, J</creatorcontrib><creatorcontrib>Chang, S</creatorcontrib><creatorcontrib>Cooksley, T</creatorcontrib><creatorcontrib>Brabrand, M</creatorcontrib><title>Normal gait, albumin and d-dimer levels identify low risk emergency department patients: a prospective observational cohort study with 365-day 100% follow-up</title><title>QJM : An International Journal of Medicine</title><addtitle>QJM</addtitle><description>Abstract Background If survival could be reliably predicted many patients could be safely managed outside of hospital in an ambulatory care setting. Aim Comparison of common laboratory findings, co-morbidities, mobility and vital signs as predictors of mortality of acutely ill emergency department (ED) attendees. Design Prospective observational study. Methods Secondary analysis of 1334 consenting acutely ill patients attending a Danish ED. Results 67 (5%) out of 1334 patients died within 100 days. After logistic regression seven predictors of 100 days mortality remained significant: an albumin level ≤34 gm/l, D-dimer level &gt;0.51 mg/l, an Asadollahi score (based on admission laboratory data and age) ≥12, a platelet count &lt;159 X 1000/ml, impaired mobility on presentation, a respiratory rate ≥30 bpm and a Charlson co-morbidity index ≥3. Only 5 of the 442 without any of these variables died within 365 days. Only one of the 517 patients with a stable independent gait and normal d-dimer and albumin levels died within 100 days, none died within 30 days of assessment and 12 died within 365 days. 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Aim Comparison of common laboratory findings, co-morbidities, mobility and vital signs as predictors of mortality of acutely ill emergency department (ED) attendees. Design Prospective observational study. Methods Secondary analysis of 1334 consenting acutely ill patients attending a Danish ED. Results 67 (5%) out of 1334 patients died within 100 days. After logistic regression seven predictors of 100 days mortality remained significant: an albumin level ≤34 gm/l, D-dimer level &gt;0.51 mg/l, an Asadollahi score (based on admission laboratory data and age) ≥12, a platelet count &lt;159 X 1000/ml, impaired mobility on presentation, a respiratory rate ≥30 bpm and a Charlson co-morbidity index ≥3. Only 5 of the 442 without any of these variables died within 365 days. Only one of the 517 patients with a stable independent gait and normal d-dimer and albumin levels died within 100 days, none died within 30 days of assessment and 12 died within 365 days. 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title Normal gait, albumin and d-dimer levels identify low risk emergency department patients: a prospective observational cohort study with 365-day 100% follow-up
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