ArticleScandinavian journal of trauma, resuscitation and emergency medicine2021
Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study.
Article in Scandinavian journal of trauma, resuscitation and emergency medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 21 citations in OpenAlex.
- Evaluation of the Sensitivity and Specificity of the Modified Moenchengladbach Resuscitation Team Activation (MJournal of clinical medicine · 2026Article
- Acidosis as a promising early indicator of mortality among point-of-care parameters and vital signs in non-traumatic critically ill patients.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Observational
- [Initial diagnosis and treatment of shock].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2024Article
- Resuscitation room management of patients with non-traumatic critical illness in the emergency department (OBSERvE-DUS-study).BMC emergency medicine · 2023Article
- [Management of critically ill nontrauma patients in a nonuniversity emergency department].Notfall & rettungsmedizin · 2022Article
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWhile there are clear national resuscitation room admission guidelines for major trauma patients, there are no comparable alarm criteria for critically ill nontrauma (CINT) patients in the emergency department (ED). The aim of this study was to define and validate specific trigger factor cut-offs for identification of CINT patients in need of a structured resuscitation management protocol.
methodsAll CINT patients at a German university hospital ED for whom structured resuscitation management would have been deemed desirable were prospectively enrolled over a 6-week period (derivation cohort, n = 108). The performance of different thresholds and/or combinations of trigger factors immediately available during triage were compared with the National Early Warning Score (NEWS) and Quick Sequential Organ Failure Assessment (qSOFA) score. Identified combinations were then tested in a retrospective sample of consecutive nontrauma patients presenting at the ED during a 4-week period (n = 996), and two large external datasets of CINT patients treated in two German university hospital EDs (validation cohorts 1 [n = 357] and 2 [n = 187]).
resultsThe any-of-the-following trigger factor iteration with the best performance in the derivation cohort included: systolic blood pressure < 90 mmHg, oxygen saturation < 90%, and Glasgow Coma Scale score < 15 points. This set of triggers identified > 80% of patients in the derivation cohort and performed better than NEWS and qSOFA scores in the internal validation cohort (sensitivity = 98.5%, specificity = 98.6%). When applied to the external validation cohorts, need for advanced resuscitation measures and hospital mortality (6.7 vs. 28.6%, p < 0.0001 and 2.7 vs. 20.0%, p < 0.012) were significantly lower in trigger factor-negative patients.
conclusionOur simple, any-of-the-following decision rule can serve as an objective trigger for initiating resuscitation room management of CINT patients in the ED.
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