Accuracy in identification of pre-eclampsia patients at emergency department triage: A quantitative descriptive study

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing Pub Date : 2025-02-03 DOI:10.1016/j.ienj.2025.101583

Lisa Wolf , Angelique Russell , Deena Brecher , Claire Simon

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引用次数: 0

Abstract

Introduction

To describe the accuracy of triage decision-making in a sample of US emergency departments regarding the identification of preeclampsia in both pregnant and postpartum patients.

Methods

A quantitative correlative retrospective approach using a large data set to verify the impact of accurate identification of the high-risk preeclamptic patient at triage. Data were extracted from a dataset of de-identified ED records. All female-identified patients presenting to the study sites from January 1, 2022-September 30, 2023, were included. Accurate triage of patients was modeled using logistic regression to identify significance and strength of associations between ESI classification and patient disposition outcomes in high-risk patients with the specific emergency department diagnosis of preeclampsia.

Results

The final sample included over 1.3 million patients whose record contained an ICD-10 code describing suspected perinatal preeclampsia in 25 sites across four U.S. states. The percentage of high-risk perinatal presentations at triage ranged from 17.7% to 23.3% across sites; the percentage of those patients with a final (confirmed) diagnosis of preeclampsia comprised 881 patients of 243,872 high-risk presentations. Of the 881 patients with preeclampsia, 80.1% (711) were under triaged. Women in the preeclampsia cohort were 66% more likely to be in a maternal care desert and 59% were Hispanic or non-white.

Conclusions

While high risk pregnancy and postpartum presentations are 18.5% of the obstetric population presenting to emergency departments, they are under triaged 50% of the time; when a very high risk, low volume presentation such as preeclampsia is present, those patients are under triaged 80% of the time. Given the documented inadequacy of education related to obstetric emergencies, and growing maternal care deserts, these findings suggest a concerning situation for patients seeking pregnancy-related care in emergency departments.

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鉴别子痫前期患者在急诊科分诊的准确性：一项定量描述性研究

简介：描述美国急诊科样本中鉴别妊娠和产后先兆子痫患者分诊决策的准确性。方法采用定量相关的回顾性方法，利用大量数据验证在分诊时准确识别高危子痫前期患者的影响。数据是从去识别ED记录的数据集中提取的。所有在2022年1月1日至2023年9月30日期间就诊的女性患者均被纳入研究。采用logistic回归模型对患者进行准确分诊，以确定ESI分类与特定急诊科诊断为子痫前期的高危患者的患者处置结果之间的相关性的显著性和强度。结果最终样本包括超过130万患者，这些患者的记录包含ICD-10代码，描述了美国四个州25个地点的疑似围产期先兆子痫。高危围产儿分诊的百分比从17.7%到23.3%不等；最终确诊子痫前期的患者占243,872例高危患者的881例。在881例先兆子痫患者中，80.1%（711例）未分诊。在子痫前期队列中，66%的女性更有可能处于产妇护理沙漠中，59%的女性是西班牙裔或非白人。结论高危妊娠和产后就诊的产科人口占急诊人口的18.5%，但其中50%的时间未经过分类；当一个非常高的风险，小容量的表现，如先兆子痫，这些患者80%的时间都是经过分类的。鉴于文献记载的与产科急诊有关的教育不足，以及产妇护理需求的增加，这些发现表明，在急诊室寻求与妊娠有关的护理的患者的情况令人担忧。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Emergency Nursing NURSING-

CiteScore

3.20

自引率

11.10%

发文量

期刊介绍： International Emergency Nursing is a peer-reviewed journal devoted to nurses and other professionals involved in emergency care. It aims to promote excellence through dissemination of high quality research findings, specialist knowledge and discussion of professional issues that reflect the diversity of this field. With an international readership and authorship, it provides a platform for practitioners worldwide to communicate and enhance the evidence-base of emergency care. The journal publishes a broad range of papers, from personal reflection to primary research findings, created by first-time through to reputable authors from a number of disciplines. It brings together research from practice, education, theory, and operational management, relevant to all levels of staff working in emergency care settings worldwide.