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Observational Study
. 2022 Oct;71(10):774-783.
doi: 10.1007/s00101-021-00962-3. Epub 2021 Apr 30.

Early in-hospital course of critically ill nontrauma patients in a resuscitation room of a German emergency department (OBSERvE2 study)

C Grahl  1 , T Hartwig  1 , L Weidhase  2 , S Laudi  3 , S Petros  2 , A Gries  1 , M Bernhard  4
Affiliations
Observational Study

Early in-hospital course of critically ill nontrauma patients in a resuscitation room of a German emergency department (OBSERvE2 study)

C Grahl et al. Anaesthesiologie. 2022 Oct.

Abstract
in English, German

Background: Management of critically ill nontrauma (CINT) patients in the resuscitation room of the emergency department (ED) is very challenging. Detailed data describing the patient characteristics and management of this population are lacking. This observational study describes the epidemiology, management and outcome in CINT ED patients in the resuscitation room.

Methods: This prospective, single center observational study included all adult patients who were consecutively admitted to the ED resuscitation room during 2 periods of 1 year (September 2014-August 2015 vs. September 2017- August 2018). Patient characteristics, out-of-hospital/in-hospital treatment, admission-related conditions, time intervals for diagnostics and interventions and outcome were recorded using a self-developed questionnaire.

Results: A total of 34,303 patients in the first and 35,039 patients in the second study period were admitted to the ED, of whom 532 and 457 patients, respectively, were admitted to the nontrauma resuscitation room due to acute life-threatening conditions. The patient characteristics did not differ significantly between the study periods (male: 58% vs. 59%, age: 68 ± 17 years vs. 65 ± 17 years). Time intervals for diagnostic and therapeutic interventions were similar. The CINT patients during the second study period were treated faster compared to the first study period (end of ED management: 53 ± 33 min vs. 41 ± 24 min, p < 0.0001). The 30-day all-cause mortality was comparable (34.0% vs. 36.3%).

Conclusion: Observation of critically ill patient management in the ED resuscitation room showed reliable results between both study periods. Structured ED management guidelines for CINT patients may provide comparable results at one institution.

Zusammenfassung: HINTERGRUND: Das Management von nichttraumatologischen kritisch kranken Patienten im Schockraum einer Zentralen Notaufnahme (ZNA) ist sehr anspruchsvoll. Es fehlen detaillierte Daten, welche die Patientencharakteristika und das Management dieser Population beschreiben. Ziel der Beobachtungsstudie war es, die Epidemiologie, das Management und das Behandlungsergebnis bei nichttraumatologisch kritisch kranken Patienten im Schockraum zu beschreiben.

Methoden: Diese monozentrische prospektive Beobachtungsstudie schloss alle erwachsenen Patienten ein, die während zweier 1‑Jahres-Perioden (September 2014 bis August 2015 vs. September 2017 bis August 2018) konsekutiv im Schockraum der ZNA aufgenommen wurden. Patientencharakteristika, prähospitale und innerklinische Maßnahmen, Aufnahmezustand, Zeitintervalle für Diagnostik und Interventionen sowie das Behandlungsergebnis wurden mittels eines selbst entwickelten Fragebogens erfasst.

Ergebnisse: Insgesamt wurden 34.303 Patienten im ersten und 35.039 Patienten im zweiten Studienzeitraum in die ZNA aufgenommen, von denen 532 bzw. 457 Patienten aufgrund akut lebensbedrohlicher Zustände in den nichttraumatologischen Schockraum aufgenommen wurden. Die Patientencharakteristika unterschieden sich nicht signifikant zwischen den Studienzeiträumen (männlich: 58 % vs. 59 %, Alter: 68 ± 17 Jahre vs. 65 ± 17 Jahre). Die Zeitintervalle für diagnostische und therapeutische Interventionen waren ähnlich. Nichttraumatologische Patienten im zweiten Studienzeitraum wurden im Vergleich zum ersten Studienzeitraum schneller behandelt (Ende des Schockraummanagements: 53 ± 33 vs. 41 ± 24 min; p < 0,0001). Die 30-Tage-Gesamtmortalität war vergleichbar (34,0 vs. 36,3 %).

Schlussfolgerung: Die Beobachtung des Managements kritisch kranker nichttraumatologischer Schockraumpatienten zeigt reliabel Ergebnisse im Vergleich beider Studienzeiträumen. Strukturierte Richtlinien zum Management kritisch kranker nichttraumatologischer Schockraumpatienten können vergleichbare Ergebnisse in einer Institution liefern.

Keywords: Clinical pathway; Emergency department; Mortality; Nontraumatic critically ill patients; Shock room.

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Conflict of interest statement

C. Grahl, T. Hartwig, L. Weidhase, S. Laudi, S. Petros, A. Gries and M. Bernhard declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Out-of-hospital EMS and in-hospital resuscitation room interventions (n = 532 vs. n = 457). ACCD automated external chest compression devices; EMS emergency medical services. The data from the first study period were obtained from the same ED and previously published [1]
Fig. 2
Fig. 2
Time intervals between resuscitation room admission to medical interventions in minutes. Results were illustrated as interquartile ranges and mean ± standard deviation for the first (black) and second (gray) study period. RR resuscitation room, ED emergency department. The data from the first study period were obtained from the same ED and previously published [1]
Fig. 3
Fig. 3
Diagnoses at hospital discharge or death for all patients (n = 532 vs. n = 457) including situations with (black) and without (gray) cardiac arrest. Numbers are per disease category. The data from the first study period were obtained from the same ED and previously published [1]
See this image and copyright information in PMC

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