'Eyeballing' patients may find sickest ones more effectively than formal assessment

When assessing patients, simply eyeballing them may prove more effective than using a formal structured algorithm to prioritize those who need urgent medical care most, a study published in Emergency Medicine Journal found.

The study found a basic clinical assessment may better predict patients most at risk of dying, even when healthcare professionals with relatively little emergency care experience are assessing them, such as phlebotomists and medical students.

The researchers compared triage decisions nurses, phlebotomists and medical students made when prioritizing more than 6,000 patients at one emergency department over a three-month period.

The nurses used an established algorithm to decide which patients were the sickest, while the phlebotomists and medical students made their decisions by only looking at each patient.

The two approaches, which categorized need from minor injuries and conditions to most urgent, were compared for their ability to assess the likelihood of death within 30 days. The researchers also analyzed any links between triage method and death within 48 hours, and how often both methods reached the same decisions for the same patients. 

Overall, 6,290 patients were assessed using both methods. It was uncommon for both methods to come to the same decisions for the same patients. When the researchers compared the ability to assess the likelihood of death within 48 hours and 30 days, simply eyeballing the patient was more accurate than structured triage.

In an accompanying editorial,  Ellen Weber, MD, professor emeritus of emergency medicine at the University of California in San Francisco, cautions that the study was carried out in only one emergency care department, and with a triage system that is not widely used across the globe.

But "the study should make us rethink our current process and the evidence behind it," Dr. Weber said.

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