The triage decision in pulmonary edema

Abstract

The authors studied the clinical courses of 216 prospectively selected patients with cardiogenic pulmonary edema presenting to an emergency ward (EW) to identity which patients should be triaged to the intensive care unit (ICU). The first four hours were considered the EW or pre-triage phase of hospitalization. During the EW phase, 108 patients remained stable; 33 of them developed cardiopulmonary complications over the next two days. Logistic regression identified four significant independent features that distinguished these 33 patients from the remaining patients: four-hour diuresis <1 L, history of prior pulmonary edema, T-wave abnormalities, and jugular venous distention. A model containing the four variables predicted hospital complications with a sensitivity of 81% and a specificity of 65%. In comparison, the sensitivity of physicians in admitting to the ICU patients who would go on to have complications was 70%, with a specificity of 63%. In a model containing a term for the physicians’ actual triage decision, all four independent predictors remained significant, producing an overall sensitivity of 81% and an overall specificity of 69%.