The Diagnostic Value of the First Clinical Impression of Patients Presenting to the Emergency Department (PREKEYDIA)

The Diagnostic Value of the First Clinical Impression of Patients Presenting to the Emergency Department

Finding a diagnosis for acutely ill patients places high demands on emergency medical personnel. While anamnesis and clinical examination provide initial indications and allow a tentative diagnosis, both laboratory chemistry and imaging tests are used to confirm (or exclude) the tentative diagnosis. The more precise and targeted the additional laboratory chemical or radiological diagnosis, the more quickly and economically the causal treatment of the emergency patient can be initiated.

One examination modality, which in addition to the medical history and clinical examination, could quickly provide information about the condition of the patient, their clinical picture and severity of illness, is the first clinical impression of the patient (so-called "first impression" or "end-of-bed view"). This describes the first sensory impression that the medical staff gathers from a patient. This includes visual (e.g., facial expression, gait, breathing), auditory (e.g., voice pitch, shortness of breath when speaking), and olfactory (e.g., smell of exhaled air, body odor) impressions. Clinical practice shows that a great deal of important additional information can be gathered through this first clinical impression, which, together with the history and clinical examination of the emergency patient, provides valuable clues to the underlying condition.

To date, however, only scattered data and study results exist in the medical literature on the value of the first clinical impression in the care of emergency patients. In the present prospective observational study, the study attempts to evaluate the predictive value of the first clinical impression in identifying a leading symptom and other important clinical parameters.

Study Overview

• Status: Completed
• Conditions: Emergencies
• Intervention / Treatment: Diagnostic test: Machine Learning Prediction

• Study Type: Observational
• Enrollment (Actual): 1506

Contacts and Locations

Study Locations

• Austria
  • Upper Austria
    • Linz, Upper Austria, Austria, 4021
      • Kepler University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Adults presenting to the emergency department.

Description

Inclusion Criteria:

• Patients presenting to the emergency department between 2019-09-01 and 2020-02-28.

Exclusion Criteria:

• None.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

6

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Shortness of breath	Diagnostic test: Machine Learning Prediction; Machine Learning Prediction
Extremity pathologies	Diagnostic test: Machine Learning Prediction; Machine Learning Prediction
Abdominal pain	Diagnostic test: Machine Learning Prediction; Machine Learning Prediction
Urological pathologies	Diagnostic test: Machine Learning Prediction; Machine Learning Prediction
Chest pain	Diagnostic test: Machine Learning Prediction; Machine Learning Prediction
Back pain	Diagnostic test: Machine Learning Prediction; Machine Learning Prediction

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
AUROC for Classification of Shortness of Breath	AUROC for Classification of Shortness of Breath	2019-09-01 to 2020-02-28
AUROC for Classification of Extremity Pathologies	AUROC for Classification of Extremity Pathologies	2019-09-01 to 2020-02-28
AUROC for Classification of Abdominal Pain	AUROC for Classification of Abdominal Pain	2019-09-01 to 2020-02-28
AUROC for Classification of Urological Pathologies	AUROC for Classification of Urological Pathologies	2019-09-01 to 2020-02-28
AUROC for Classification of Chest Pain	AUROC for Classification of Chest Pain	2019-09-01 to 2020-02-28
AUROC for Classification of Back Pain	AUROC for Classification of Back Pain	2019-09-01 to 2020-02-28

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
AUROC for Classification of Hospital Admission	AUROC for Classification of Hospital Admission	2019-09-01 to 2020-02-28
Confusion Matrix	Confusion Matrix Results: true positives, true negatives, false positive, false negatives and values calculated from these results.	2019-09-01 to 2020-02-28
Descriptive Statistics	Descriptive Statistics (e. g. age in years)	2019-09-01 to 2020-02-28

Collaborators and Investigators

• Sponsor: Kepler University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2019
• Primary Completion (Actual): February 28, 2020
• Study Completion (Actual): February 1, 2021

Study Registration Dates

• First Submitted: October 25, 2022
• First Submitted That Met QC Criteria: October 25, 2022
• First Posted (Actual): October 27, 2022

Study Record Updates

• Last Update Posted (Actual): October 31, 2022
• Last Update Submitted That Met QC Criteria: October 28, 2022
• Last Verified: October 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: PREKEYDIA

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No