Use of Tissue Oxygen Saturation Levels as a Vital Sign in the ED Triage

Sadiye Yolcu, Adem Kaya

J Clin Exp Invest 2019;10(2):em00723.

https://doi.org/10.5799/jcei/5832

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Abstract

Objectives: The utilization of vital signs as triage tools remains a mainstay ofemergency patients. The evolution of monitoring technologies, including the noninvasive tissue oxygen saturation devices has improved our ability to monitor the critically ill patients. The aim of the present study was to determine the tissue oxygen saturation (StO2) levels of the patients as a vital sign during emergency triage.
Methods: Approximately 30-35 patients present to our emergency department each day and the triage of these patients are performed by a nurse at admission time. A three level system (1: red, 2: yellow, 3: green) is used to determine the triage level of the patients presenting to our department. We examined 150 patients during five days. Age gender, triage levels and hospitalization status of the patients were noted. For the StO2 level measurement, an Inspectra device was placed to the right thenar muscle for 10 s and mean of the first, fifth and 10th second values were noted at the admission time.
Results: In our study 73 females (48.6%), 77 males (51.4%) totally 150 patients were included. We determined a significant difference between green and yellow (p=0.00), green and red (p=0.00), yellow and red (p=0.001) according to StO2 levels. We couldn’t find a significant difference between females and males in triage groups (p=0.13 for green, p=0.71 for yellow, p=0.86 for red). There was correlation between StO2 - triage level (p=0.00, r=0.609) and StO2-hospitalization status (p=0.00, r=0.449).
Conclusion: StO2 level measurement may be helpful in determining the triage level of the patients presenting to the ED.
Keywords: emergency, tissue oxygen saturation, triage

Keywords

emergency, tissue oxygen saturation, triage

References

  • Howard A, Brenner GD, Drexler J. Improving the Prompt Identification of the Emergency Severity Index Level 2 Patient in Triage: Rapid Triage and the Registered Nurse Greeter. J Emerg Nurs. 2014 Apr 15. doi: 10.1016/j.jen.2014.0009
  • Standards Committee Council, 1994. National Triage Scale. Emerg. Med. 6:145–146.
  • Beveridge R. CAEP issues The Canadian Triage and Acuity Scale: a new and critical element in health care reform. Canadian Association of Emergency Physician. J. Emerg. Med. 1998;16:507–511.
  • Doyle SL, Kingsnorth J, Guzzetta CE. Outcomes of implementing rapid triage in the pediatric emergency department. J Emerg Nurs. 2012;38(1):30-5.
  • Cooper RJ, Schriger DL, Flaherty HL. Effect of vital signs ontriage decisions. Ann Emerg Med. 2002;39(3):223-232.
  • Imhoff M, Lehner JH, Lohlein D. Noninvasive whole-body electrical bioimpedance cardiac output and invasive thermodilution cardiac output in high-risk surgical patients Crit Care Med 2000;28(8):2812–8.
  • Logemann F, Gras C, Mehler D, et al. Bilateral monitoring of cerebral oxygen saturation in aortic arch surgery. Anasthesiol Intensivmed Notfallmed Schmerzther 2001;36(6):388.
  • Fukui D, Urayama H, Tanaka K, et al. Use of near-infrared spectroscopic measurement at the buttocks during abdominal aortic surgery. Circ J 2002;66(12):1128–31.
  • de Letter JA, Sie HT, Thomas BM, et al. Near-infrared reflected spectroscopy and electroencephalography during carotid endarterectomy: In search of a new shunt criterion. Neurol Res 1998;20(suppl 1):S23–7
  • Calderon-Arnulphi M, Alaraj A, Slavin KV. Near infrared technology in neuroscience: past, present and future. Neurol Res 2009;31(6):605-14.
  • Crookes BA, Cohn SM, Bloch S, et al. Can near-infrared spectroscopy identify the severity of shock in trauma patients? J Trauma 2005;58(4):806-13.
  • Moore FA, Nelson T, McKinley BA, et al. Massive transfusion in trauma patients: tissue hemoglobin oxygen saturation predicts poor outcome. J Trauma 2008;64(4):1010-23.
  • Beilman GJ, Groehler KE, Lazaron V, et al. Near-infrared spectroscopy measurement of regional tissue oxyhemoglobin saturation during hemorrhagic shock. Shock 1999;12(3):196-200.
  • Cohn SM. Near-infrared spectroscopy: potential clinical benefits in surgery. J Am Coll Surg 2007;205:322.
  • Beilman GJ, Blondet JJ. Near-infrared spectroscopy-derived tissue oxygen saturation in battlefield injuries: a case series report. World J Emerg Surg 2009;4:25.
  • George ME, Beilman GJ, Mulier KE. Noninvasive tissue oxygen saturation measurements identify supply dependency. J Surg Res 2010;160:40.
  • Bazerbashi H, Merriman KW, Toale KM. Low tissue oxygen saturation at emergency center triage is predictive of intensive care unit admission. J Crit Care. 2014 Oct;29(5):775-9. doi: 10.1016/j.jcrc.2014.05.006. Epub 2014 May 27.
  • Cohn SM, Nathens AB, Moore FA. Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation. J Trauma 2007;62:44. Discussion.
  • Yolcu S, Erdur B. Use of tissue oxygenation (StO2) monitor in the ED. Am J Emerg Med. 2014. doi: 10.1016/j.ajem.2014.04.037.
  • Sagraves SG, Newell MA, Bard MR. Tissue oxygenation monitoring in the field: a new EMS vital sign. J Trauma. 2009 Sep;67(3):441-3.
  • Guyette FX, Gomez H, Suffoletto B. Prehospital dynamic tissue oxygen saturation response predicts in-hospital lifesaving interventions in trauma patients. J Trauma Acute Care Surg. 2012 Apr;72(4):930-5.
  • Shapiro NI, Arnold R, Sherwin R. Emergency Medicine Shock Research Network (EMShockNet). The association of near-infrared spectroscopy-derived tissue oxygenation measurements with sepsis syndromes, organ dysfunction and mortality in emergency department patients with sepsis. Crit Care. 2011;15(5):R223. doi: 10.1186/cc10463. Epub 2011 Sep
  • Beekley AC, Martin MJ, Nelson T. Continuous noninvasive tissue oximetry in the early evaluation of the combat casualty: a prospective study. J Trauma. 2010 Jul;69 Suppl 1:S14-25. doi: 10.1097/TA.0b013e3181e42326.9.

Citation

Yolcu S, Kaya A. Use of Tissue Oxygen Saturation Levels as a Vital Sign in the ED Triage. J Clin Exp Invest. 2019;10(2):em00723. https://doi.org/10.5799/jcei/5832