National Early Warning Score and D-dimer to Identify Medical Patients At Low Risk of 30-day Mortality

Large increases in emergency admissions are raising concerns about whether all admissions are necessary. If there was a fast and reliable system that could be used to determine the risk of all medical patients, many low-risk patients could be safely returned to primary care or outpatient follow-up clinics.

The investigators wish to determine, if the combination of the National Early Warning Score and plasma D-dimer levels can be used to identify patients at low risk of mortality within 30 days in an unselected group of medical patients presenting to a Danish Emergency Department.

This is a prospective observational study that will be performed on adult medical patients referred to the Emergency Department of a Danish hospital to be assessed for possible admission. The study will be performed in the Emergency Department of Hospital of South West Jutland in the region of Southern Denmark.

• D-dimer test (Diagnostic test): D-dimer test

Primary outcomes

• 30-days mortality [30 days]: mortality within 30 days after assessment will be determined for all patients using data extracted from the Danish Civil Registration System patients using data extracted from the Danish Civil Registration System

Secondary outcomes

• Hospital length of stay (LOS) [30 days]: length of stay will be calculated from the time of the patients' arrival at the hospital to the moment of the discharge for all patients using data extracted from the Danish National Patient Registry
• Readmissions within 30 days [30 days]: readmissions within 30 days after primary assessment will be determined for all patients using data extracted from the Danish National Patient Registry

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Admission to the Emergency Department of Hospital of South West Jutland
* Requirement of any blood test
* Age 18 years
* Informed consent given

Exclusion Criteria:

* Age 18 years
* Informed consent not given

• Nickel CH, Kuster T, Keil C, Messmer AS, Geigy N, Bingisser R. Risk stratification using D-dimers in patients presenting to the emergency department with nonspecific complaints. Eur J Intern Med. 2016 Jun;31:20-4. doi: 10.1016/j.ejim.2016.03.006. Epub 2016 Apr 1. PMID 27053291
• Nickel CH, Kellett J, Cooksley T, Bingisser R, Henriksen DP, Brabrand M. Combined use of the National Early Warning Score and D-dimer levels to predict 30-day and 365-day mortality in medical patients. Resuscitation. 2016 Sep;106:49-52. doi: 10.1016/j.resuscitation.2016.06.012. Epub 2016 Jun 20. PMID 27339095
• Results publication: Nickel CH, Kellett J, Nieves Ortega R, Lyngholm L, Wasingya-Kasereka L, Brabrand M. Mobility Identifies Acutely Ill Patients at Low Risk of In-Hospital Mortality: A Prospective Multicenter Study. Chest. 2019 Aug;156(2):316-322. doi: 10.1016/j.chest.2019.04.001. Epub 2019 Apr 11. PMID 30981722

• Mikkel Brabrand, MD, PhD, Principal investigator, Esbjerg Hospital - University Hospital of Southern Denmark