End-tidal carbon dioxide measured at emergency department triage outperforms standard triage vital signs in predicting in-hospital mortality and intensive care unit admission.

Autor: Ladde JG; Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA., Miller S; Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA., Chin K; Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA., Feffer C; Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA., Gulenay G; Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA., Kepple K; Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA., Hunter C; Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA., Thundiyil JG; Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA., Papa L; Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA.
Jazyk: angličtina
Zdroj: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine [Acad Emerg Med] 2023 Aug; Vol. 30 (8), pp. 832-841. Date of Electronic Publication: 2023 Mar 20.
DOI: 10.1111/acem.14703
Abstrakt: Objectives: This study assessed the ability of end-tidal carbon dioxide (ETCO 2 ) in predicting in-hospital mortality and intensive care unit (ICU) admission compared to standard vital signs at ED triage as well as comparing to measures of metabolic acidosis.
Methods: This prospective study enrolled adult patients presenting to the ED of a tertiary care Level I trauma center over 30 months. Patients had standard vital signs measured along with exhaled ETCO 2 at triage. Outcome measures included in-hospital mortality; ICU admission; and correlations with lactate, sodium bicarbonate (HCO 3 ), and anion gap.
Results: There were 1136 patients enrolled and 1091 patients with outcome data available. There were 26 (2.4%) patients who did not survive to hospital discharge. Mean ETCO 2 levels were 34 (33-34) in survivors and 22 (18-26) nonsurvivors (p < 0.001). The area under the curve (AUC) for predicting in-hospital mortality for ETCO 2 was 0.82 (0.72-0.91). In comparison the AUC for temperature was 0.55 (0.42-0.68), respiratory rate (RR) 0.59 (0.46-0.73), systolic blood pressure (SBP) 0.77 (0.67-0.86), diastolic blood pressure (DBP) 0.70 (0.59-0.81), heart rate (HR) 0.76 (0.66-0.85), and oxygen saturation (SpO 2 ) 0.53 (0.40-0.67). There were 64 (6%) patients admitted to the ICU, and the ETCO 2 AUC for predicting ICU admission was 0.75 (0.67-0.80). In comparison the AUC for temperature was 0.51, RR 0.56, SBP 0.64, DBP 0.63, HR 0.66, and SpO 2 0.53. Correlations between expired ETCO 2 and serum lactate, anion gap, and HCO 3 were rho = -0.25 (p < 0.001), rho = -0.20 (p < 0.001), and rho = 0.330 (p < 0.001), respectively.
Conclusions: ETCO 2 was a better predictor of in-hospital mortality and ICU admission than the standard vital signs at ED triage. ETCO 2 correlated significantly with measures of metabolic acidosis.
(© 2023 Society for Academic Emergency Medicine.)
Databáze: MEDLINE
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