Focused abdominal ultrasound.

A focused point-of-care abdominal ultrasound is an examination performed at the patient's location and interpreted within the clinical context. This review gives an overview of this examination modality. The objective is to rapidly address predefined dichotomised questions about the presence of an abdominal aortic aneurysm, gallstones, cholecystitis, hydronephrosis, urinary retention, free intraperitoneal fluid, and small bowel obstruction. FAUS is a valuable tool for emergency physicians to promptly confirm various conditions upon the patients' arrival, thus reducing the time to diagnosis and in some cases eliminating the need for other imaging.

Education in Focused Assessment With Sonography for Trauma Using Immersive Virtual Reality: A Prospective, Interventional Cohort Study and Non-inferiority Analysis With a Historical Control.

OBJECTIVE: Focused assessment with sonography for trauma (FAST) is a valuable ultrasound procedure in emergency settings, and there is a need for evidence-based education in FAST to ensure competencies. Immersive virtual reality (IVR) is a progressive training modality gaining traction in the field of ultrasound training. IVR holds several economic and practical advantages to the common instructor-led FAST courses using screen-based simulation (SBS). METHODS: This prospective, interventional cohort study investigated whether training FAST using IVR unsupervised and out-of-hospital was non-inferior to a historical control group training at a 90 min SBS course in terms of developing FAST competencies in novices. Competencies were assessed in both groups using the same post-training simulation-based FAST test with validity evidence, and a non-inferiority margin of 2 points was chosen. RESULTS: A total of 27 medical students attended the IVR course, and 27 junior doctors attended the SBS course. The IVR group trained for a median time of 117 min and scored a mean 14.2 ± 2.0 points, compared with a mean 13.7 ± 2.5 points in the SBS group. As the lower bound of the 95% confidence interval at 13.6 was within the range of the non-inferiority margin (11.7-13.7 points), training FAST in IVR for a median of 117 min was found non-inferior to training at a 90 min SBS course. No significant correlation was found between time spent in IVR and test scores. CONCLUSION: Within the limitations of the use of a historical control group, the results suggest that IVR could be an alternative to SBS FAST training and suitable for unsupervised, out-of-hospital courses in basic FAST competencies.

Management of medical emergency patients in Danish emergency departments.

INTRODUCTION: In many emergency departments (ED), specialised teams are activated to take care of medical emergency patients (MEP). The aim of this study was to describe the organisation of the management of adult MEPs in Danish EDs. The study examined trigger team activation criteria, training and composition of trigger teams. METHODS: This was a cross-sectional descriptive study. A questionnaire was sent to the head of department and head nurse at each Danish ED. They recruited eligible personnel to answer the questionnaire. Data were obtained between 1 October and 15 December 2021. RESULTS: We included 23 hospitals and 19 responded (82.6%). Most EDs had a trigger call for MEP (89.5%). In 70.6% of the EDs, trigger calls for MEP were activated > 300 times annually. All EDs used red triage (Danish Emergency Process Triage) as activation criteria for MEP calls. Most respondents received simulation training (82.4%). All respondents felt adequately educated to manage MEP. The MEP trigger teams varied from three to 11 members with great variation with respect to team leaders. CONCLUSION: Management of MEP varies greatly in Danish Hospitals. A systematic approach to MEP management in line with management of trauma and stroke patients may potentially serve to improve the quality of care for and outcome of this patient group, but further research is needed. FUNDING: None. TRIAL REGISTRATION: Not relevant.

Impact of serial cardiopulmonary point-of-care ultrasound exams in patients with acute dyspnoea: a randomised, controlled trial.

BACKGROUND: Serial point-of-care ultrasound (PoCUS) can potentially improve acute patient care through treatment adjusted to the dynamic ultrasound findings. The objective was to investigate if treatment guided by monitoring patients with acute dyspnoea with serial cardiopulmonary PoCUS and usual care could reduce the severity of dyspnoea compared with usual care alone. METHODS: This was a randomised, controlled, blinded-outcome trial conducted in three EDs in Denmark between 9 October 2019 and 26 May 2021. Patients aged ≥18 years admitted with a primary complaint of dyspnoea were allocated 1:1 with block randomisation to usual care, which included a single cardiopulmonary PoCUS within 1 hour of arrival (control group) or usual care (including a PoCUS within 1 hour of arrival) plus two additional PoCUS performed at 2 hours interval from the initial PoCUS (serial ultrasound group). The primary outcome was a reduction of dyspnoea measured on a verbal dyspnoea scale (VDS) from 0 to 10 recorded at inclusion and after 2, 4 and 5 hours. RESULTS: There were 206 patients recruited, 102 in the serial ultrasound group and 104 in the control group, all of whom had complete follow-up. The mean difference in VDS between patients in the serial ultrasound and the control group was -1.09 (95% CI -1.51 to -0.66) and -1.66 (95% CI -2.09 to -1.23) after 4 and 5 hours, respectively. The effect was more pronounced in patients with a presumptive diagnosis of acute heart failure (AHF). A larger proportion of patients received diuretics in the serial ultrasound group. CONCLUSION: Therapy guided by serial cardiopulmonary PoCUS may, together with usual care, facilitate greater improvement in the severity of dyspnoea, especially in patients with AHF compared with usual care with a single PoCUS in the ED. Serial PoCUS should therefore be considered for routine use to aid the physician in stabilising the patient faster. TRIAL REGISTRATION NUMBER: NCT04091334.

Focused cardiac ultrasound in emergency medicine.

Focused cardiac ultrasound (FoCUS) is a point-of-care cardiac examination performed and interpreted by the emergency physician in the clinical context. This review summarises the current knowledge of FoCUS. The objective is to answer four predefined clinical questions: Are there any signs of pericardial effusion? Are there any signs of right ventricular dilatation? Are there any signs of reduced or hyperdynamic left ventricular function? Are there any signs of abnormal inferior vena cava? FoCUS is not a replacement for echocardiography but a useful tool in detecting cardiopulmonary pathology and haemodynamic abnormalities in the emergency setting.

Multiorgan ultrasonographic findings in patients with pulmonary embolism at diagnosis and clinical follow-up: a proof of concept study.

PURPOSE: The purpose of this descriptive feasibility study was to assess the clinical impact and feasibility of conducting a multiorgan ultrasound examination of patients with pulmonary embolism at both time of diagnosis and at clinical follow-up. METHODS: Hemodynamically stable patients with pulmonary embolism verified by CT pulmonary angiography or ventilation perfusion scintigraphy were eligible for inclusion. Enrolled patients underwent multiorgan ultrasound investigation encompassing echocardiography supplemented with focused lung and deep venous ultrasound emphasizing right ventricular strain, subpleural consolidations and presence of deep venous thrombi. Identical investigations were conducted at 3 months follow-up. The presence of ultrasonographic findings at diagnosis and follow-up was compared and the clinical impact of any remaining pathology or strain was described. RESULTS: Twenty-one patients were enrolled in the study of whom 20 survived to attend follow-up. Mean age was 62 ± 15 years and 48% were female. At diagnosis, the most prevalent ultrasonographic findings were subpleural consolidations in 11 patients and right ventricular dilation in eight. At follow-up, signs of right ventricular strain had resolved in all patients. However, in one patient, no resolution was seen in a subpleural consolidation observed at the time of pulmonary embolism diagnosis, resulting in referral to a chest CT. Additionally, one patient exhibited residual deep venous thrombotic material, leading to prolongation of anticoagulative treatment. CONCLUSION: In patients with pulmonary embolism, multiorgan ultrasound is feasible in follow-up and adequately powered studies should determine the clinical utility of such an approach.

Immersive Virtual Reality in Basic Point-of-Care Ultrasound Training: A Randomized Controlled Trial.

This study was aimed at comparing the learning efficacy of a traditional instructor-led lesson with that of a completely virtual, self-directed lesson in immersive virtual reality (IVR) in teaching basic point-of-care ultrasound (PoCUS) skills. We conducted a blinded, non-inferiority, parallel-group, randomized controlled trial in which final-year medical students were randomized to an instructor-led (n = 53) or IVR (n = 51) lesson. Participants' learning efficacy was evaluated by blinded assessors, who rated each participant's performance using the Objective Structured Assessment of Ultrasound Skills (OSAUS) assessment tool.The mean total scores for participants were 11.0 points (95% confidence interval: 9.8-12.2) for the instructor-led lesson and 10.3 points (95% confidence interval: 9.0-11.5) for the IVR lesson. No significant differences were observed between the groups with respect to total score (p = 0.36) or subgroup objectives of the OSAUS score (p = 0.34 for familiarity, p = 0.45 for image optimization, p = 0.96 for systematic approach and p = 0.07 for interpretation). Maintenance costs for both courses were estimated at 400 euros each. Startup costs for the instructor-led course were estimated 16 times higher than those for the IVR course. The learning efficacy of an instructor-led lesson on basic US did not differ significantly from that of a self-directed lesson in IVR, as assessed using the OSAUS. The results suggest that IVR could be an equivalent alternative to instructor-led lessons in future basic US courses, but further research is warranted to clarify the role of IVR in PoCUS courses.

Focused lung ultrasound to predict respiratory failure in patients with symptoms of COVID-19: a multicentre prospective cohort study.

Background: In this study we aimed to assess if a focused lung ultrasound examination predicts the need for mechanical ventilation, admission to an intensive care unit, high-flow oxygen treatment, death from COVID-19 within 30 days and 30-day all-cause mortality in patients with clinical suspicion of COVID-19 or PCR-verified SARS-CoV-2 infection. Methods: A multicentre prospective cohort trial was performed. Film clips from focused lung ultrasound examinations were recorded and rated by blinded observers using different scoring systems. A prediction model was built and used to test relationship between lung ultrasound scores and clinical outcomes. Diagnostic performance of scoring systems was analysed. Results: A total of 3889 film clips of 398 patients were analysed. Patients who had any of the outcomes of interest had a significantly higher ultrasound score than those who did not. Multivariable logistic regression analyses showed that lung ultrasound predicts mechanical ventilation (relative risk 2.44, 95% CI 1.32-5.52), admission to intensive care (relative risk 2.55, 95% CI 1.41-54.59) and high-flow oxygen treatment (relative risk 1.95, 95% CI 1.5-2.53) but not survival when adjusting for sex, age and relevant comorbidity. There was no diagnostic difference in area under the receiver operating characteristic curve between a scoring system using only anterolateral thorax zones and a scoring system that also included dorsal zones. Conclusion: Focused lung ultrasound in patients with clinical suspicion of COVID-19 predicts respiratory failure requiring mechanical ventilation, admission to intensive care units and the need for high-flow oxygen treatment. Thus, focused lung ultrasound may be used to risk stratify patients with COVID-19 symptoms.

Ultra-low dose computed tomography of the chest in an emergency setting: A prospective agreement study.

Ultra-low dose computed tomography (ULD-CT) assessed by non-radiologists in a medical Emergency Department (ED) has not been examined in previous studies. To (i) investigate intragroup agreement among attending physicians caring for ED patients (i.e., radiologists, senior- and junior clinicians) and medical students for the detection of acute lung conditions on ULD-CT and supine chest X-ray (sCXR), and (ii) evaluate the accuracy of interpretation compared to the reference standard. In this prospective study, non-traumatic patients presenting to the ED, who received an sCXR were included. Between February and July 2019, 91 patients who underwent 93 consecutive examinations were enrolled. Subsequently, a ULD-CT and non-contrast CT were performed. The ULD-CT and sCXR were assessed by 3 radiologists, 3 senior clinicians, 3 junior clinicians, and 3 medical students for pneumonia, pneumothorax, pleural effusion, and pulmonary edema. The non-contrast CT, assessed by a chest radiologist, was used as the reference standard. The results of the assessments were compared within each group (intragroup agreement) and with the reference standard (accuracy) using kappa statistics. Accuracy and intragroup agreement improved for pneumothorax on ULD-CT compared with the sCXR for all groups. Accuracy and intragroup agreement improved for pneumonia on ULD-CT when assessed by radiologists and for pleural effusion when assessed by medical students. In patients with acute lung conditions ULD-CT offers improvement in the detection of pneumonia by radiologists and the detection of pneumothorax by radiologists as well as non-radiologists compared to sCXR. Therefore, ULD-CT may be considered as an alternative first-line imaging modality to sCXR for non-traumatic patients who present to EDs.

Diagnostic accuracy of ultra-low-dose chest computed tomography in an emergency department.

BACKGROUND: This study examined whether ultra-low-dose chest computed tomography (ULD-CT) could improve detection of acute chest conditions. PURPOSE: To determine (i) whether diagnostic accuracy of ULD-CT is superior to supine chest X-ray (sCXR) for acute chest conditions and (ii) the feasibility of ULD-CT in an emergency department. MATERIAL AND METHODS: From 1 February to 31 July 2019, 91 non-traumatic patients from the Emergency Department were prospectively enrolled in the study if they received an sCXR. An ULD-CT and a non-contrast chest CT (NCCT) scan were then performed. Three radiologists assessed the sCXR and ULD-CT examinations for cardiogenic pulmonary edema, pneumonia, pneumothorax, and pleural effusion. Resources and effort were compared for sCXR and ULD-CT to evaluate feasibility. Diagnostic accuracy was calculated for sCXR and ULD-CT using NCCT as the reference standard. RESULTS: The mean effective dose of ULD-CT was 0.05±0.01 mSv. For pleural effusion and cardiogenic pulmonary edema, no difference in diagnostic accuracy between ULD-CT and sCXR was observed. For pneumonia and pneumothorax, sensitivities were 100% (95% confidence interval [CI] 69-100) and 50% (95% CI 7-93) for ULD-CT and 60% (95% CI 26-88) and 0% (95% CI 0-0) for sCXR, respectively. Median examination time was 10 min for ULD-CT vs. 5 min for sCXR (P<0.001). For ULD-CT 1-2 more staff members were needed compared to sCXR (P<0.001). ULD-CT was rated more challenging to perform than sCXR (P<0.001). CONCLUSION: ULD-CT seems equal or better in detecting acute chest conditions compared to sCXR. However, ULD-CT examinations demand more effort and resources.

Diagnostic accuracy of focused deep venous, lung, cardiac and multiorgan ultrasound in suspected pulmonary embolism: a systematic review and meta-analysis.

OBJECTIVE: To determine the diagnostic accuracy of point-of-care ultrasound in suspected pulmonary embolism. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, Embase, CINAHL and Cochrane library were searched on 2 July 2020 with no restrictions on the date of publication. Subject headings or subheadings combined with text words for the concepts of pulmonary embolism, ultrasound and diagnosis were used. ELIGIBILITY CRITERIA AND DATA ANALYSIS: Eligible studies reported sensitivity and specificity of deep venous, lung, cardiac or multiorgan ultrasound in patients with suspected pulmonary embolism, using an adequate reference-test. Prospective, cross-sectional and retrospective studies were considered for eligibility. No restrictions were made on language. Studies were excluded if a control group consisted of healthy volunteers or if transesophageal or endobronchial ultrasound was used. Risk of bias was assessed using quality assessment of diagnostic accuracy studies-2. Meta-analysis of sensitivity and specificity was performed by construction of hierarchical summary receiver operator curves. I2 was used to assess the study heterogeneity. MAIN OUTCOME MEASURES: The primary outcome was overall sensitivity and specificity of reported ultrasound signs, stratified by organ approach (deep venous, lung, cardiac and multiorgan). Secondary outcomes were stratum-specific sensitivity and specificity within subgroups defined by pretest probability of pulmonary embolism. RESULTS: 6378 references were identified, and 70 studies included. The study population comprised 9664 patients with a prevalence of pulmonary embolism of 39.9% (3852/9664). Risk of bias in at least one domain was found in 98.6% (69/70) of included studies. Most frequently, 72.8% (51/70) of studies reported >24 hours between ultrasound examination and reference test or did not disclose time interval at all. Level of heterogeneity ranged from 0% to 100%. Most notable ultrasound signs were bilateral compression of femoral and popliteal veins (22 studies; 4708 patients; sensitivity 43.7% (36.3% to 51.4%); specificity 96.7% (95.4% to 97.6%)), presence of at least one hypoechoic pleural-based lesion (19 studies; 2134 patients; sensitivity 81.4% (73.2% to 87.5%); specificity 87.4% (80.9% to 91.9%)), D-sign (13 studies; 1579 patients; sensitivity 29.7% (24.6% to 35.4%); specificity 96.2% (93.1% to 98.0%)), visible right ventricular thrombus (5 studies; 995 patients; sensitivity 4.7% (2.7% to 8.1%); specificity 100% (99.0% to 100%)) and McConnell's sign (11 studies; 1480 patients; sensitivity 29.1% (20.0% to 40.1%); specificity 98.6% (96.7% to 99.4%)). CONCLUSION: Several ultrasound signs exhibit a high specificity for pulmonary embolism, suggesting that implementation of ultrasound in the initial assessment of patients with suspected pulmonary embolism may improve the selection of patients for radiation imaging. PROSPERO REGISTRATION NUMBER: CRD42020184313.

Diagnostic Accuracy of a Bespoke Multiorgan Ultrasound Approach in Suspected Pulmonary Embolism.

Purpose The aims of this study were to prospectively assess the diagnostic accuracy of a bespoke multiorgan point-of-care ultrasound approach for suspected pulmonary embolism and evaluate if this model allows reduced referral to further radiation diagnostics while maintaining safety standards. Materials and Methods Patients with suspected pulmonary embolism referred for CT pulmonary angiography or ventilation/perfusion scintigraphy were included as a convenience sample. All patients were subject to blinded ultrasound investigation with cardiac, lung, and deep venous ultrasound. The sensitivity and specificity of applied ultrasound signs and the hypothetical reduction in the need for further diagnostic workup were calculated. Results 75 patients were prospectively enrolled. The Wells score was below 2 in 48 patients, between 2 and 6 in 24 patients, and above 6 in 3 patients. The prevalence of pulmonary embolism was 28%. The most notable ultrasound signs were presence of a deep venous thrombus, at least two hypoechoic pleural-based lesions, the D-sign, the 60/60-sign, and a visible right ventricular thrombus which all had a specificity of 100%. Additionally, a multiorgan ultrasound investigation with no findings compatible with pulmonary embolism yielded a sensitivity of 95.2% (95%CI: 76.2-99.9). CT or scintigraphy could be safely avoided in 70% of cases (95%CI: 63.0-83.1%). Conclusion The findings of our study suggest that implementation of a multiorgan ultrasound assessment in patients with suspected pulmonary embolism may safely reduce the need for CT or scintigraphy by confirming or dismissing the suspicion.

Improved diagnostics of infectious diseases in emergency departments: a protocol of a multifaceted multicentre diagnostic study.

BACKGROUND: The major obstacle in prescribing an appropriate and targeted antibiotic treatment is insufficient knowledge concerning whether the patient has a bacterial infection, where the focus of infection is and which bacteria are the agents of the infection. A prerequisite for the appropriate use of antibiotics is timely access to accurate diagnostics such as point-of-care (POC) testing.The study aims to evaluate diagnostic tools and working methods that support a prompt and accurate diagnosis of hospitalised patients suspected of an acute infection. We will focus on the most common acute infections: community-acquired pneumonia (CAP) and acute pyelonephritis (APN). The objectives are to investigate (1) patient characteristics and treatment trajectory of the different acute infections, (2) diagnostic and prognostic accuracy of infection markers, (3) diagnostic accuracy of POC urine flow cytometry on diagnosing and excluding bacteriuria, (4) how effective the addition of POC analysis of sputum to the diagnostic set-up for CAP is on antibiotic prescriptions, (5) diagnostic accuracy of POC ultrasound and ultralow dose (ULD) computerized tomography (CT) on diagnosing CAP, (6) diagnostic accuracy of specialist ultrasound on diagnosing APN, (7) diagnostic accuracy of POC ultrasound in diagnosing hydronephrosis in patients suspected of APN. METHODS AND ANALYSIS: It is a multifaceted multicentre diagnostic study, including 1000 adults admitted with suspicion of an acute infection. Participants will, within the first 24 hours of admission, undergo additional diagnostic tests including infection markers, POC urine flow cytometry, POC analysis of sputum, POC and specialist ultrasound, and ULDCT. The primary reference standard is an assigned diagnosis determined by a panel of experts. ETHICS, DISSEMINATION AND REGISTRATION: Approved by Regional Committees on Health Research Ethics for Southern Denmark, Danish Data Protection Agency and clinicaltrials.gov. Results will be presented in peer-reviewed journals, and positive, negative and inconclusive results will be published. TRIAL REGISTRATION NUMBERS: NCT04661085, NCT04681963, NCT04667195, NCT04652167, NCT04686318, NCT04686292, NCT04651712, NCT04645030, NCT04651244.

Teaching ultrasound-guided peripheral venous catheter placement through immersive virtual reality: An explorative pilot study.

INTRODUCTION: Immersive virtual reality (IVR)-based training is gaining ground as an educational tool in healthcare. When combined with well-established educational methods, IVR can potentially increase competency and autonomy in ultrasound (US)-guided peripheral venous cannulation.The aim of this study was to examine the impact of adding IVR training to a course in US-guided peripheral venous cannulation. METHODS: Medical students (n = 19) from the University of Southern Denmark with no former standardized US education were recruited to voluntarily participate in a pilot study, designed as a randomized controlled trial. The primary outcome was the proportion of successful peripheral venous cannulations on a phantom. Secondary outcomes included the proportion of surface punctures on the phantom and procedure time. Participants received e-learning on the basic US before randomization to either IVR (n = 10) or no further training (n = 9). The additional IVR training comprised 10 virtual scenarios for US-guided peripheral venous catheter (PVC) placement. Students were subsequently evaluated in peripheral venous cannulation by a blinded assessor. RESULTS: The proportion of successful peripheral venous cannulations was significantly higher in the IVR group (P ≤ .001). The proportions of successful cannulations were significantly higher in the IVR group compared to the control group for the 1st and 2nd PVC (P = .011, P = .023), but not for the 3rd PVC (P = .087). Similar results were found for the proportion of surface punctures (1st: P ≤ .001, 2nd: P = .001, and 3rd: P = .114). No significant differences in procedure times were found between the groups. CONCLUSION: This pilot study showed that adding an IVR-based training simulation to an existing e-learning curriculum significantly increased the learning efficacy of US-guided PVC placement for medical students.

[Point-of-care ultrasound in emergency departments in Denmark].

Point-of-are ultrasound (PoCUS) has become an integrated part of initial diagnostics and procedural guidance after establishing emergency departments and a speciality in emergency medicine in Denmark. Focused PoCUS is a fast examination, which is done and interpreted bedside to answer clinical, predefined dichotomous questions. Emergency physicians have an obligate course in PoCUS as part of their training and must be certified to get speciality recognition. In this review we argue, that the future of PoCUS is continuing the development of the education and training in PoCUS and in further research.

Lung ultrasound as a prognostic tool in emergency patients clinically suspected of COVID-19.

INTRODUCTION: Tools to quickly triage and evaluate patients with suspected COVID-19 in an emergency department (ED) can improve patient care and reduce risk of overcrowding. The aim of this study was to evaluate if lung ultrasound (LUS) may provide valuable prognostic information in adult patients suspected of COVID-19. METHODS: A prospective cohort study of adult patients in an ED was conducted. LUS was performed within one hour of the patients' arrival; COVID-19 was defined by a respiratory syndrome coronavirus 2 RNA positive test. The primary outcome was the proportion of patients suspected of COVID-19 and normal LUS with critical outcomes during follow-up, defined as one or more of the following: need of non-invasive ventilation (NIV), invasive mechanical ventilation, intensive care unit (ICU) stay or death. Follow-up was 14 days. RESULTS: A total of 83 patients were included between 9 March and 12 April 2020. In all, 47 (57%; 95% confidence interval (CI): 45.3-67.5%) had a normal LUS, 46 (98%; 95% CI: 88.7-99.9%) of whom had no critical outcomes. A total of 36 (43%; 95% CI: 32.5-54.7%) had an abnormal LUS, eight of whom (22%; 95% CI: 10.1-39.2%) had critical outcomes. Nine (11%; 95%: CI 5.1-19.6%) had one or more critical outcomes: three on NIV, five in ICUs, four on invasive mechanical ventilation and two died. Among the 12 patients (14%; 95% CI: 7.7-23.9%) tested positive for COVID-19, 11 (92%; 95% CI: 61.5-99.8%) had an abnormal LUS. CONCLUSIONS: Among adult ED patients suspected of COVID-19, a normal LUS is associated with a low risk of critical outcomes. LUS might be considered for routine use as a prognostic tool in patients suspected of COVID-19. FUNDING: none. TRIAL REGISTRATION: not relevant.

Trigger team activation in the emergency department at a tertiary university hospital.

INTRODUCTION The aim of this study was to describe the diversity in the incidence, diagnosis and prognosis of patients met by the trigger teams for trauma, STEMI, stroke and medical emergency patients (MEP). METHODS This was a single-centre, retrospective cohort study of all patients admitted to Odense University Hospital (OUH) from November 2012 to September 2015 with trauma, STEMI, stroke or MEP trigger team activation on arrival. OUH is a tertiary referral centre for patients with severe trauma, STEMI (directly referred to the catheterisation laboratory), stroke and MEP. RESULTS A total of 8,075 trigger team activations were recorded, a median of eight calls per day (range: 1-18), covering 16.7% trauma calls, 28.3% STEMI calls, 19.7% stroke calls and 35.3% MEP calls. This corresponds to 160/100,000 person years (py) trauma calls, 65/100,000 py STEMI calls, 73/100,000 py stroke calls and 339/100,000 py MEP calls. Seven-day mortality was 10% (95% confidence interval (CI): 9-12%) for patients with trauma calls, 6% (95% CI: 5-7%) for STEMI calls, 3% (95% CI: 3-4%) for stroke calls and 16% (95% CI: 15-17%) for MEP calls. Patients from trauma, STEMI and stroke calls were discharged with a diagnosis within 3-5 International Classification of Diseases (version 10) main coding areas, whereas patients from MEP calls had discharge diagnoses within 13 main coding areas. CONCLUSION Patients with MEP calls are more frequent, have a more diverse aetiology and a higher mortality than patients in the other trigger teams. A need exists for further guidelines and research regarding MEP with a view to reducing the high mortality rate among MEP in the future. FUNDING Annmarie Lassen was funded by an unrestricted grant from the philanthropic fund the Tryg Foundation given to the University of Southern Denmark. TRIAL REGISTRATION The study was approved by the Danish Health Authority (Record no. 3-3013-1385/1) and the Danish Data Protection Agency (Record no. 2013-41-2435).