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Biomarker-enhanced triage in respiratory infections: a proof-of-concept feasibility trial

Albrich, Werner C. and Rüegger, Kristina and Dusemund, Frank and Schuetz, Philipp and Arici, Birsen and Litke, Alexander and Blum, Claudine A. and Bossart, Rita and Regez, Katharina and Schild, Ursula and Guglielmetti, Merih and Conca, Antoinette and Schäfer, Petra and Schubert, Maria and de Geest, Sabina and Reutlinger, Barbara and Irani, Sarosh and Bürgi, Ulrich and Huber, Andreas and Müller, Beat. (2013) Biomarker-enhanced triage in respiratory infections: a proof-of-concept feasibility trial. European Respiratory Journal, 42 (4). pp. 1064-1075.

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Official URL: http://edoc.unibas.ch/dok/A6428644

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Abstract

Concerns about inadequate performance and complexity limit routine use of clinical risk scores in lower respiratory tract infections. Our aim was to study feasibility and effects of adding the biomarker proadrenomedullin (proADM) to the confusion, urea<7 mmol·L(-1), respiratory rate≥30 breaths·min(-1), blood pressure>90 mmHg (systolic) or ≤60 mmHg (diastolic), age≥65 years (CURB-65) score on triage decisions and length of stay. In a randomised controlled proof-of-concept intervention trial, triage and discharge decisions were made for adults with lower respiratory tract infection according to interprofessional assessment using medical and nursing risk scores either without (control group) or with (proADM group) knowledge of proADM values, measured on admission, and on days 3 and 6. An adjusted generalised linear model was calculated to investigate the effect of our intervention. On initial presentation the algorithms were overruled in 123 (39.3%) of the cases. Mean length of stay tended to be shorter in the proADM (n=154, 6.3 days) compared with the control group (n=159, 6.8 days; adjusted regression coefficient -0.19, 95% CI -0.41-0.04; p=0.1). This trend was robust in subgroup analyses and for overall length of stay within 90 days (7.2 versus 7.9 days; adjusted regression coefficient -0.18, 95% CI -0.40-0.05; p=0.13). There were no differences in adverse outcomes or readmission. Logistic obstacles and overruling are major challenges to implement biomarker-enhanced algorithms in clinical settings and need to be addressed to shorten length of stay.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Allgemeine innere Medizin AG > Argovia Professur für Medizin (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Allgemeine innere Medizin AG > Argovia Professur für Medizin (Müller)
UniBasel Contributors:Müller, Beat
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:European Respiratory Society
ISSN:0903-1936
e-ISSN:1399-3003
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:30 Nov 2017 12:45
Deposited On:02 Oct 2015 10:00

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