Association of Presenting Complaint at Triage with 72-h Mortality and Intensive Care Admission

Introduction: Triage is a critical process in prioritizing patients based on acuity to ensure timely care. Patients arrive at the emergency department (ED) with complaints, not diagnoses. High-risk patients are identified based on history, vital signs, mechanism of injury in trauma, and clinical fin...

Full description

Saved in:
Bibliographic Details
Main Authors: Niraj Rauniyar, Ankit Kumar Sahu, Bharath Gopinath, Akshay Kumar, Nayer Jamshed, Meera Ekka, Prakash Ranjan Mishra, Sanjeev Bhoi, Tej Prakash Sinha, Gaurav Rajwanshi
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2025-04-01
Series:Journal of Emergencies, Trauma and Shock
Subjects:
Online Access:https://journals.lww.com/10.4103/jets.jets_127_24
Tags: Add Tag
No Tags, Be the first to tag this record!
_version_ 1839639490565505024
author Niraj Rauniyar
Ankit Kumar Sahu
Bharath Gopinath
Akshay Kumar
Nayer Jamshed
Meera Ekka
Prakash Ranjan Mishra
Sanjeev Bhoi
Tej Prakash Sinha
Gaurav Rajwanshi
author_facet Niraj Rauniyar
Ankit Kumar Sahu
Bharath Gopinath
Akshay Kumar
Nayer Jamshed
Meera Ekka
Prakash Ranjan Mishra
Sanjeev Bhoi
Tej Prakash Sinha
Gaurav Rajwanshi
author_sort Niraj Rauniyar
collection DOAJ
description Introduction: Triage is a critical process in prioritizing patients based on acuity to ensure timely care. Patients arrive at the emergency department (ED) with complaints, not diagnoses. High-risk patients are identified based on history, vital signs, mechanism of injury in trauma, and clinical findings. Chief complaints in the ED may suggest acuity independent of other clinical parameters. The objective of this study was to identify high-risk chief complaints associated with intensive care unit (ICU) admission or mortality within 72 h of ED presentation. We also characterized the chief complaints by frequency and evaluated the accuracy of the All India Institute of Medical Sciences Triage Protocol (ATP) in conjunction with high-risk complaints for predicting mortality. Methods: This prospective observational study was conducted at AIIMS, New Delhi, from March 2021 to October 2023, including 1225 patients. Inclusion criteria covered all patients older than 16 years presenting to the ED, excluding cardiac arrest cases, pregnancy-related complications, and individuals declared dead on arrival. Data were collected using predesigned proformas. Univariate and multivariate logistic regression analyses identified high-risk chief complaints. Results: Of the 1754 patients screened, 1225 were included in the analysis. Thirty-four complaints were identified, with six deemed high risk. Specific complaints such as shortness of breath (odds ratio [OR] 43.691, 95% confidence interval [CI] 20.033–95.291, P = 0.001), altered mental status (OR: 6.243, 95% CI: 3.282–11.876, P < 0.001), hematemesis (OR: 3.88, 95% CI: 2.019–7.454, P < 0.001), fall from height (OR: 3.875, 95% CI: 1.874–8.014, P < 0.001), weakness of one side (OR: 3.159, 95% CI: 1.656–6.024, P < 0.001), and chest pain (OR: 1.784, 95% CI: 1.22–3.209, P = 0.043) were significantly associated with adverse outcomes (mortality or ICU admission) at 72 h, even after adjusting for age, gender, and comorbidities. Incorporating high-risk complaints into the ATP triage system increased predictive value (OR 3.12 vs. 7.14). Conclusion: Our findings highlight specific chief complaints as valuable indicators for the early identification of patients at risk of 72-h mortality or ICU admission in the ED. Early identification of high-risk patients can enhance early resuscitation, timely referral to higher-level care, and improve patient outcomes.
format Article
id doaj-art-a8a55d68168b4f4582b38aeea6adf700
institution Matheson Library
issn 0974-2700
0974-519X
language English
publishDate 2025-04-01
publisher Wolters Kluwer Medknow Publications
record_format Article
series Journal of Emergencies, Trauma and Shock
spelling doaj-art-a8a55d68168b4f4582b38aeea6adf7002025-07-04T08:43:37ZengWolters Kluwer Medknow PublicationsJournal of Emergencies, Trauma and Shock0974-27000974-519X2025-04-01182626810.4103/jets.jets_127_24Association of Presenting Complaint at Triage with 72-h Mortality and Intensive Care AdmissionNiraj RauniyarAnkit Kumar SahuBharath GopinathAkshay KumarNayer JamshedMeera EkkaPrakash Ranjan MishraSanjeev BhoiTej Prakash SinhaGaurav RajwanshiIntroduction: Triage is a critical process in prioritizing patients based on acuity to ensure timely care. Patients arrive at the emergency department (ED) with complaints, not diagnoses. High-risk patients are identified based on history, vital signs, mechanism of injury in trauma, and clinical findings. Chief complaints in the ED may suggest acuity independent of other clinical parameters. The objective of this study was to identify high-risk chief complaints associated with intensive care unit (ICU) admission or mortality within 72 h of ED presentation. We also characterized the chief complaints by frequency and evaluated the accuracy of the All India Institute of Medical Sciences Triage Protocol (ATP) in conjunction with high-risk complaints for predicting mortality. Methods: This prospective observational study was conducted at AIIMS, New Delhi, from March 2021 to October 2023, including 1225 patients. Inclusion criteria covered all patients older than 16 years presenting to the ED, excluding cardiac arrest cases, pregnancy-related complications, and individuals declared dead on arrival. Data were collected using predesigned proformas. Univariate and multivariate logistic regression analyses identified high-risk chief complaints. Results: Of the 1754 patients screened, 1225 were included in the analysis. Thirty-four complaints were identified, with six deemed high risk. Specific complaints such as shortness of breath (odds ratio [OR] 43.691, 95% confidence interval [CI] 20.033–95.291, P = 0.001), altered mental status (OR: 6.243, 95% CI: 3.282–11.876, P < 0.001), hematemesis (OR: 3.88, 95% CI: 2.019–7.454, P < 0.001), fall from height (OR: 3.875, 95% CI: 1.874–8.014, P < 0.001), weakness of one side (OR: 3.159, 95% CI: 1.656–6.024, P < 0.001), and chest pain (OR: 1.784, 95% CI: 1.22–3.209, P = 0.043) were significantly associated with adverse outcomes (mortality or ICU admission) at 72 h, even after adjusting for age, gender, and comorbidities. Incorporating high-risk complaints into the ATP triage system increased predictive value (OR 3.12 vs. 7.14). Conclusion: Our findings highlight specific chief complaints as valuable indicators for the early identification of patients at risk of 72-h mortality or ICU admission in the ED. Early identification of high-risk patients can enhance early resuscitation, timely referral to higher-level care, and improve patient outcomes.https://journals.lww.com/10.4103/jets.jets_127_24chief complaintemergency departmenttriage
spellingShingle Niraj Rauniyar
Ankit Kumar Sahu
Bharath Gopinath
Akshay Kumar
Nayer Jamshed
Meera Ekka
Prakash Ranjan Mishra
Sanjeev Bhoi
Tej Prakash Sinha
Gaurav Rajwanshi
Association of Presenting Complaint at Triage with 72-h Mortality and Intensive Care Admission
Journal of Emergencies, Trauma and Shock
chief complaint
emergency department
triage
title Association of Presenting Complaint at Triage with 72-h Mortality and Intensive Care Admission
title_full Association of Presenting Complaint at Triage with 72-h Mortality and Intensive Care Admission
title_fullStr Association of Presenting Complaint at Triage with 72-h Mortality and Intensive Care Admission
title_full_unstemmed Association of Presenting Complaint at Triage with 72-h Mortality and Intensive Care Admission
title_short Association of Presenting Complaint at Triage with 72-h Mortality and Intensive Care Admission
title_sort association of presenting complaint at triage with 72 h mortality and intensive care admission
topic chief complaint
emergency department
triage
url https://journals.lww.com/10.4103/jets.jets_127_24
work_keys_str_mv AT nirajrauniyar associationofpresentingcomplaintattriagewith72hmortalityandintensivecareadmission
AT ankitkumarsahu associationofpresentingcomplaintattriagewith72hmortalityandintensivecareadmission
AT bharathgopinath associationofpresentingcomplaintattriagewith72hmortalityandintensivecareadmission
AT akshaykumar associationofpresentingcomplaintattriagewith72hmortalityandintensivecareadmission
AT nayerjamshed associationofpresentingcomplaintattriagewith72hmortalityandintensivecareadmission
AT meeraekka associationofpresentingcomplaintattriagewith72hmortalityandintensivecareadmission
AT prakashranjanmishra associationofpresentingcomplaintattriagewith72hmortalityandintensivecareadmission
AT sanjeevbhoi associationofpresentingcomplaintattriagewith72hmortalityandintensivecareadmission
AT tejprakashsinha associationofpresentingcomplaintattriagewith72hmortalityandintensivecareadmission
AT gauravrajwanshi associationofpresentingcomplaintattriagewith72hmortalityandintensivecareadmission