PhD defence R. (Romy) Schuttevaer

Dissertation in short:

Acute internal medicine is a relatively new subspecialty of internal medicine that is involved with early management of adult patients who present to the emergency department
(ED) with urgent medical conditions. Our aim was to advance the developing field of acute internal medicine by identifying mortality risk in patients with infection and by laboratory testing

In chapter 1, we provide a general introduction to the studies we performed. We explain why acute internal medicine originated as a subspecialty and how it is represented nowadays
in the ED. Also, we discuss how mortality risk is currently identified and whether there are potentials for improvement – during triage, clinical assessment (primary and secondary survey), and additional diagnostic testing. Subsequently, we describe the challenges encountered in managing patients with infection, which is a substantial part of the ED presentations for internal medicine. Also, we mention the opportunities for improving recognition of mortality risk by laboratory testing.

We conclude this chapter with stating the research questions answered in the thesis: 

1. Can we improve recognition of mortality risk in patients presenting to the ED with infection?
   a. What is the association between body temperature and outcome?
   b. What is the predictive performance of comorbidity versus vital signs?
2. Can we improve antibiotic therapy in the ED?
   a. What is the association between appropriate antibiotic therapy and mortality?
   b. What is the association between antibiotic guideline adherence and outcome?
3. Can we improve identification of mortality risk by laboratory testing in the ED?
   a. What is the predictive performance of a ‘laboratory point-of-care testing’-model?
   b. What is the association between D-dimer and mortality?