The PRIEST Study: Pandemic Respiratory Infection Emergency System Triage

Summary: The aim of this study is to find the most accurate triage method (the way of deciding the order of treatment of patients) for predicting severe illness among patients attending the emergency department with suspected respiratory infection (infection in the lungs) during a pandemic (when a disease has spread across many countries). The study will be observational and will not change patient care. Participating hospitals and ambulance trusts will use whatever triage method is most suitable for them, based on national and local guidance. The study will include all adults and children with suspected respiratory infection who attend the emergency department of a participating hospital, call 111 or 999 services or are dealt with by a 999 ambulance from a participating ambulance trust. Outcomes will be assessed based on the triage method used. Patients who die or require respiratory (lung), cardiovascular (heart and blood vessels) or renal (kidney) support will be considered as having an adverse outcome. In addition, if the pandemic leads to hospital resources being overwhelmed, meaning that patients with respiratory, cardiovascular or renal conditions are unable to access support, they will be considered to have had an adverse outcome. If patients survive to 30 days without requiring respiratory, cardiovascular or renal support they will be defined as having no adverse outcome. [COVID-19 amendment 23/03/2020] Description: We aim to optimise the triage of people using the emergency care system (111 and 99calls, ambulance conveyance, or hospital emergency department) with suspected respiratory infections during a pandemic and identify the most accurate triage method for predicting severe illness among patients attending the emergency department with suspected respiratory infection. Our specific objectives during the pandemic are: 1. To undertake continuous monitoring of the performance of the emergency care triage method (or methods) used for suspected respiratory infections during a pandemic 2. To identify clinical characteristics and routine tests associated with under-triage (false negative assessent) or over-triage (false positive assessment) during a pandemic 3. To determine the discriminant value of alternative triage methods for predicting severe illness in patients presenting with suspected respiratory infection during a pandemic 4. To inform policy makers and practitioners during a pandemic of the study's emerging findings. Our specific objectives after the pandemic are: 1. To determine the discriminant value of emergency department triage methods for predicting severe illness in patients presenting with suspected pandemic respiratory infection 2. To determine the discriminant value of presenting clinical characteristics and routine tests for identifying severe illness 3. To determine the independent predictive value of presenting clinical characteristics and routine tests for severe illness 4. To develop new triage methods based upon presenting clinical characteristics alone or presenting clinical characteristics, electrocardiogram (ECG), chest X-ray and routine blood test results, depending upon the data available and the predictive value of variables evaluated in objective 3