A New Vital Sign in Determining the Triage Category in Emergency Department Presentations: End-Tidal Carbon Dioxide


Abstract views: 224 / PDF downloads: 111

Authors

DOI:

https://doi.org/10.58600/eurjther1819

Keywords:

Emergency triage, end-tidal carbon dioxide, triage category, vital sign, hospitalization

Abstract

Objective: To investigate whether patients’ end-tidal carbon dioxide (ETCO2) values ​​measured at the time of their presentation to the emergency department can be used together with vital signs in determining their triage categories and predicting hospitalization.

Material and method: This prospective, observational, cross-sectional study was conducted between May 1, 2023, and June 1, 2023, at the emergency department of a tertiary hospital. The study included patients aged >18 years who presented to the emergency department and were evaluated to have a triage category of level 2, 3, or 4 according to the five-step triage system. The patients’ vital signs were measured at the time of their presentation to the emergency department and the ETCO2 values ​​measured through a nasal cannula were statistically evaluated in terms of their relationship with triage categories and hospitalization indications.

Results: A total of 1,100 patients were included in the study. According to the triage category of the patients, the mean ETCO2 values for triage levels 2, 3, and 4 were 27.1±3.6, 30.6±3.1, and 35.4±3.5, respectively, indicating statistically significant differences (p<0.001). When the relationship of ETCO2 and vital signs with hospitalization indications evaluated at the emergency department was examined, the area under the receiver operating characteristic curve for ​​ ETCO2 was 0.733, which was statistically significant (p<0.001).

Conclusion: On completion of the study, it was concluded that the ETCO2 values ​​measured at the time of presentation to the emergency department can be a new vital sign that can be used to determine the triage categories of patients and identify those who require hospitalization.

Metrics

Metrics Loading ...

References

Klug M, Barash Y, Bechler S, et al. (2020) A gradient boosting machine learning model for predicting early mortality in the emergency department triage: devising a nine-point triage score. J Gen Intern Med. 35:220-227. https://doi.org/10.1007/s11606-019-05512-7

Aktaş YY, Alemdar DK (2017) Triage decision-making levels of healthcare professionals working in emergency departments. Eurasian J Emerg Med. 16(3): 92. https://doi.org/10.5152/eajem.2017.96168

Hinson JS, Martinez DA, Cabral S, et al. (2019) Triage performance in emergency medicine: a systematic review. Ann Emerg Med. 74(1):140-152. https://doi.org/10.1016/j.annemergmed.2018.09.022

Capraro GA, Balmaekers B, den Brinker AC, et al. (2022) Contactless vital signs acquisition using video photoplethysmography, motion analysis and passive infrared thermography devices during emergency department walk-in triage in pandemic conditions. J Emerg Med. 63(1):115-129. https://doi.org/10.1016/j.jemermed.2022.06.001

Downey CL, Tahir W, Randell R, Brown JM, Jayne DG (2017) Strengths and limitations of early warning scores: a systematic review and narrative synthesis. Int J Nurs Stud. 76:106-119. https://doi.org/10.1016/j.ijnurstu.2017.09.003

Brekke IJ, Puntervoll LH, Pedersen PB, Kellett J, Brabrand M (2019) The value of vital sign trends in predicting and monitoring clinical deterioration: A systematic review. PLoS One. 14(1):e0210875. https://doi.org/10.1371/journal.pone.0210875

García-Del-Valle S, Arnal-Velasco D, Molina-Mendoza R, Gómez-Arnau JI (2021) Update on early warning scores. Best Pract Res Clin Anaesthesiol. 35(1):105-113. https://doi.org/10.1016/j.bpa.2020.12.013

Ladde JG, Miller S, Chin K, Feffer C, Gulenay G, Kepple K, et al. (2023) End-tidal carbon dioxide measured at emergency department triage outperforms standard triage vital signs in predicting in-hospital mortality and intensive care unit admission. Acad Emerg Med. 00:1–10. https://doi.org/10.1111/acem.14703

Day DL, Terada KEF, Vondrus P, Watabayashi R, Severino R, Inn H, Ng K (2020) Correlation of Nasal Cannula End-Tidal Carbon Dioxide Concentration with Need for Critical Resources for Blunt Trauma Patients Triaged to Lower-Tier Trauma Activation. J Trauma Nurs. 27(2):88-95. https://doi.org/10.1097/jtn.0000000000000492

Baldi E, Caputo ML, Klersy C, Benvenuti C, Contri E, Palo A, et al. (2022) End-tidal carbon dioxide (ETCO2) at intubation and its increase after 10 minutes resuscitation predicts survival with good neurological outcome in out-of-hospital cardiac arrest patients. Resuscitation. 181:197-207. https://doi.org/10.1016/j.resuscitation.2022.09.015

Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, et al. (2013) CPR Quality Summit Investigators, the American Heart Association Emergency Cardiovascular Care Committee, and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation. 128(4):417-35. https://doi.org/10.1161/cir.0b013e31829d8654

Bulger N, Harrington B, Krieger J, Latimer A, Arbabi S, Counts CR, et al. (2021) Prehospital end-tidal carbon dioxide predicts hemorrhagic shock upon emergency department arrival. J Trauma Acute Care Surg. 91(3):457-464. https://doi.org/10.1097/ta.0000000000003312

Wilson BR, Bruno J, Duckwitz M, Akers N, Jeanmonod D, Jeanmonod R. (2021) Prehospital end-tidal CO2 as an early marker for transfusion requirement in trauma patients. Am J Emerg Med. 45:254-257. https://doi.org/10.1016/j.ajem.2020.08.056

Koch E, Lovett S, Nghiem T, Riggs RA, Rech MA (2019) Shock index in the emergency department: utility and limitations. Open Access Emerg Med. 11:179-199. https://doi.org/10.2147/oaem.s178358

Sapra A, Malik A, Bhandari P (2022) Vital sign assessment. In StatPearls [Internet]. StatPearls Publishing.

Zimmermann PG (2001) The case for a universal, valid, reliable 5-tier triage acuity scale for US emergency departments. J Emerg Nurs. 27(3):246-54. https://doi.org/10.1067/men.2001.115284

Wilson BR, Bruno J, Duckwitz M, Akers N, Jeanmonod D, Jeanmonod R (2021) Prehospital end-tidal CO2 as an early marker for transfusion requirement in trauma patients. Am J Emerg Med. 45:254-257. https://doi.org/10.1016/j.ajem.2020.08.056

Willis RG, Cunningham KW, Troia PA, Gutierrez AS, Christmas AB, Brintzenhoff R, et al. (2022) Prehospital End-Tidal CO2: A Superior Marker for Mortality Risk in the Acutely Injured Patient. Am Surg. 88(8):2011-2016. https://doi.org/10.1177/00031348211023401

Weiss SJ, Guerrero A, Root-Bowman C, Ernst A, Krumperman K, Femling J, et al. (2019) Sepsis alerts in EMS and the results of pre-hospital ETCO2. Am J Emerg Med. 37(8):1505-1509. https://doi.org/10.1016/j.ajem.2018.11.009

Kotak AH (2019) Capnography's Ability to Improve Patient Health Outcomes in the Prehospital Setting. NCUR.

Duyan M, Vural N (2023) Diagnostic value of end-tidal carbon dioxide in the differential diagnosis of unstable angina and non-cardiac chest pain. Am J Emerg Med. 63:69-73. https://doi.org/10.1016/j.ajem.2022.10.026

Kellett J, Sebat F (2017) Make vital signs great again - A call for action. Eur J Intern Med. 45:13-19. https://doi.org/10.1016/j.ejim.2017.09.018

Hong W, Earnest A, Sultana P, Koh Z, Shahidah N, Ong ME (2013) How accurate are vital signs in predicting clinical outcomes in critically ill emergency department patients. Eur J Emerg Med. 20(1):27-32. https://doi.org/10.1097/mej.0b013e32834fdcf3

Ljunggren M, Castrén M, Nordberg M, Kurland L (2016) The association between vital signs and mortality in a retrospective cohort study of an unselected emergency department population. Scand J Trauma Resusc Emerg Med. 24:21. https://doi.org/10.1186/s13049-016-0213-8

Tsai CL, Lu TC, Fang CC, Wang CH, Lin JY, Chen WJ, et al. (2022) Development and Validation of a Novel Triage Tool for Predicting Cardiac Arrest in the Emergency Department. West J Emerg Med. 23(2):258-267. https://doi.org/10.5811/westjem.2021.8.53063

Downloads

Published

2023-09-24

How to Cite

Tortum, F., Gur, A., Calbay, A., Turalioglu, O., & Tekin, E. (2023). A New Vital Sign in Determining the Triage Category in Emergency Department Presentations: End-Tidal Carbon Dioxide. European Journal of Therapeutics, 29(4), 689–697. https://doi.org/10.58600/eurjther1819

Issue

Section

Original Articles

Categories