• Ups. J. Med. Sci. · Jan 2022

    Observational Study

    Admission of patients with chest pain and/or breathlessness from the emergency department in relation to risk assessment and copeptin levels - an observational study.

    • Lee Ti Davidson, Emilia Gauffin, Preben Henanger, Maciej Wajda, Daniel Wilhelms, Bertil Ekman, Hans J Arnqvist, Martin Schilling, and Simona I Chisalita.
    • Department of Emergency Medicine in Linköping, Local Health Care Services in Central Östergötland, Region Östergötland & Department of Biomedical and Clinical Sciences, Linköping University, Sweden.
    • Ups. J. Med. Sci. 2022 Jan 1; 127.

    BackgroundOne of the most critical decisions that emergency department (ED) physicians make is the discharge versus admission of patients. We aimed to study the association of the decision in the ED to admit patients with chest pain and/or breathlessness to a ward with risk assessment using the Rapid Emergency Triage and Treatment System (RETTS), the National Early Warning Score (NEWS), and plasma levels of the biomarkers copeptin, midregional proadrenomedulin (MR-proADM), and midregional proatrial natriuretic peptide (MR-proANP).MethodsPatients presenting at the ED with chest pain and/or breathlessness with less than one week onset were enrolled. Patients were triaged according to RETTS. NEWS was calculated from the vital signs retrospectively.ResultsThree hundred and thirty-four patients (167 males), mean age 63.8 ± 16.8 years, were included. Of which, 210 (62.8%) patients complained of chest pain, 65 (19.5%) of breathlessness, and 59 (17.7%) of both. Of these, 176 (52.7%) patients were admitted to a ward, and 158 (47.3%) patients were discharged from the ED. In binary logistic models, age, gender, vital signs (O2 saturation and heart rate), NEWS class, and copeptin were associated with admission to a ward from the ED. In receiver-operating-characteristics (ROC) analysis, copeptin had an incremental predictive value compared to NEWS alone (P = 0.002).ConclusionsEmergency physicians' decisions to admit patients with chest pain and/or breathlessness from the ED to a ward are related to age, O2 saturation, heart rate, NEWS category, and copeptin. As an independent predictive marker for admission, early analysis of copeptin might be beneficial when improving patient pathways at the ED.© 2022 The Author(s). Published by Upsala Medical Society.

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