• Boier TygesenGitteG0000-0002-3891-7960Department of Emergency Medicine, Horsens Regional Hospital, Horsens, Denmark.Research Centre for Emergency Medicine, Aarhus University, Aarhus, Denmark., Hans Kirkegaard, Nikolaj Raaber, Trøllund RaskMetteM0000-0002-0460-9484The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark., and Marianne Lisby.
• Department of Emergency Medicine, Horsens Regional Hospital, Horsens, Denmark.
• Acta Anaesthesiol Scand. 2021 Feb 1; 65 (2): 266-275.

AimThe study aim was to determine relevance and applicability of generic predictors of clinical deterioration in emergency departments based on consensus among clinicians.MethodsThirty-three predictors of clinical deterioration identified from literature were assessed in a modified two-stage Delphi-process. Sixty-eight clinicians (physicians and nurses) participated in the first round and 48 in the second round; all treating hospitalized patients in Danish emergency departments, some with pre-hospital experience. The panel rated the predictors for relevance (relevant marker of clinical deterioration) and applicability (change in clinical presentation over time, generic in nature and possible to detect bedside). They rated their level of agreement on a 9-point Likert scale and were also invited to propose additional generic predictors between the rounds. New predictors suggested by more than one clinician were included in the second round along with non-consensus predictors from the first round. Final decisions of non-consensus predictors after second round were made by a research group and an impartial physician.ResultsThe Delphi-process resulted in 19 clinically relevant and applicable predictors based on vital signs and parameters (respiratory rate, saturation, dyspnoea, systolic blood pressure, pulse rate, abnormal electrocardiogram, altered mental state and temperature), biochemical tests (serum c-reactive protein, serum bicarbonate, serum lactate, serum pH, serum potassium, glucose, leucocyte counts and serum haemoglobin), objective clinical observations (skin conditions) and subjective clinical observations (pain reported as new or escalating, and relatives' concerns).ConclusionThe Delphi-process led to consensus of 19 potential predictors of clinical deterioration widely accepted as relevant and applicable in emergency departments.© 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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