title: Optimised patient transfer using an innovative multidisciplinary assessment in Kanton Aargau (OPTIMA I): an observational survey in lower respiratory tract infections.
abstract: BACKGROUND
  Current medical scores have limited efficiency and safety profiles to enable assignment to the most appropriate treatment site in patients with lower respiratory tract infections (LRTIs). We describe our current triage practice and assess the potential of a combination of CURB65 with proadrenomedullin (ProADM) levels for triage decisions.
  
  
  METHODS
  Consecutive patients with LRTIs presenting to our emergency department were prospectively followed and retrospectively classified according to CURB65 and ProADM levels (CURB65-A). Low medical risk patients were further subgrouped according to biopsychosocial and functional risks. We compared the proportion of patients virtually allocated to triage sites with actual triage decisions and assessed the added impact of ProADM in a subgroup.
  
  
  RESULTS
  Overall, 93% of 146 patients were hospitalised. Among the 138 patients with available CURB65-A, 17.4% had a low medical risk indicating possible treatment in an outpatient or non-acute medical setting; 34.1% had an intermediate medical risk (short-hospitalisation); and 48.6% had a high medical risk (hospitalisation). Fewer patients were in a low CURB65-A class (I) than a low CURB65 class (0,1) (17.4% vs. 46.3%, p <0.001). Mean length of hospitalisation was 9.8 days including 3.6 days after reaching medical stability. In 60.3% of patients, hospitalisation was prolonged after medical stability mainly for medical reasons.
  
  
  CONCLUSIONS
  Current rates of hospitalisation are high in patients with LRTI and length of stay frequently extended beyond time of medical stabilization. The lower proportion of patients reclassified as low risk by adding ProADM to the CURB65 score might improve confidence in the triage algorithm.
authors.affiliation: Medical University Department of the University of Basel, Kantonsspital Aarau, Tellstrasse, CH. werner.albrich@ksa.ch
authors.forename: W C
authors.initials: WC
authors.lastname: Albrich
authors.forename: K
authors.initials: K
authors.lastname: Rüegger
authors.forename: F
authors.initials: F
authors.lastname: Dusemund
authors.forename: R
authors.initials: R
authors.lastname: Bossart
authors.forename: K
authors.initials: K
authors.lastname: Regez
authors.forename: U
authors.initials: U
authors.lastname: Schild
authors.forename: A
authors.initials: A
authors.lastname: Conca
authors.forename: P
authors.initials: P
authors.lastname: Schuetz
authors.forename: T
authors.initials: T
authors.lastname: Sigrist
authors.forename: A
authors.initials: A
authors.lastname: Huber
authors.forename: B
authors.initials: B
authors.lastname: Reutlinger
authors.forename: B
authors.initials: B
authors.lastname: Müller
mesh_terms: D000203:Activities of Daily Living; D053607:Adrenomedullin / Q000097:blood*; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D003221:Confusion; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D057184:Practice Patterns, Nurses'; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D056152:Respiratory Rate; D012141:Respiratory Tract Infections / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D012720:Severity of Illness Index; D013557:Switzerland; D013997:Time Factors; D014218:Triage / Q000379:methods*; D014508:Urea
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin; D014508:Urea