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Predictors of critical care admission in emergency department patients triaged as low to moderate urgency

Considine, Julie, Thomas, Shane A. and Potter, Robyn 2009, Predictors of critical care admission in emergency department patients triaged as low to moderate urgency, Journal of advanced nursing, vol. 65, no. 4, pp. 818-827, doi: 10.1111/j.1365-2648.2008.04938.x.

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Title Predictors of critical care admission in emergency department patients triaged as low to moderate urgency
Author(s) Considine, JulieORCID iD for Considine, Julie orcid.org/0000-0003-3801-2456
Thomas, Shane A.
Potter, Robyn
Journal name Journal of advanced nursing
Volume number 65
Issue number 4
Start page 818
End page 827
Total pages 10
Publisher Wiley Interscience
Place of publication New York, N.Y.
Publication date 2009
ISSN 0309-2402
1365-2648
Keyword(s) admission
critical care
emergency department
nursing
patients
predictors
triage
urgency
Summary Aim. This paper is a report of a study to identify predictors of critical care admission in emergency department patients triaged as low to moderate urgency that may be apparent early in the emergency department episode of care.

Background. Observations of clinical practice show that a number of emergency department patients triaged as low to moderate urgency require critical care admission, raising questions about the relationship between illness severity and physiological status early in the emergency department episode of care.

Methods. A retrospective case control design was used. All participants were aged over 18 years, triaged to Australasian Triage Scale categories 3, 4 or 5, and attended emergency department between 1 July 2004 and 30 June 2005. Cases were admitted to intensive care unit or coronary care unit and controls were admitted to general medical or surgical units. Cases (n = 193) and controls (n = 193) were matched by age, gender, emergency department discharge diagnosis and triage category.

Results. Critical care admission associated with: (i) a presenting complaint of nausea, vomiting and diarrhoea (OR = 3·40, 95%CI:1·22–9·47, P = 0·019), (ii) heart rate abnormalities at triage (OR = 2·10, 95%CI:1·19–3·71, P = 0·011), (iii) temperature abnormalities at triage (OR = 2·87 95%CI:1·05–7·89, P = 0·041), (iv) respiratory rate at first nursing assessment (OR = 1·66, 95%CI:1·05–2·06, P = 0·31) or (v) heart rate abnormalities at first nursing assessment (OR = 1·57, 95%CI = 1·04−2·39, P = 0·033).

Conclusion. Derangements in temperature, respiratory rate and heart appear to increase risk of critical care admission. Further work using a prospective approach is needed to establish which physiological parameters have the highest predictive validity, the level(s) of physiological abnormality with highest clinical utility, and the optimal timing for collection of physiological data.
Notes Published Online: 18 Feb 2009
Language eng
DOI 10.1111/j.1365-2648.2008.04938.x
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
HERDC collection year 2009
Copyright notice ©2009, Blackwell Publishing
Persistent URL http://hdl.handle.net/10536/DRO/DU:30016541

Document type: Journal Article
Collection: School of Nursing and Midwifery
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Created: Wed, 24 Jun 2009, 17:00:21 EST by Julie Considine

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