The ABCDE primary assessment in the emergency department in medically ill patients: an observational pilot study

Competency in the Airway Breathing Circulation Disability Exposure (ABCDE) approach is required for working in the emergency department. There is limited knowledge on how often and how completely the ABCDE approach is applied to medical patients. The objectives of this study were to assess the frequency with which the ABCDE approach was used in potentially unstable patients and to determine factors influencing the choice of whether or not to use the ABCDE approach.

This observational pilot study included 270 medical patients admitted to the emergency department and it was observed if and how completely the ABCDE approach was performed. We registered several factors possibly determining its use.

Of the 270 patients included, 206 were identified as possibly unstable patients based on their triage code. The ABCDE approach was used in a minority of these patients (33%). When the ABCDE approach was used, it was done rapidly (generally within 10 minutes) and highly completely (> 80% of needed items). The choice not to use the ABCDE approach was frequently based on a first clinical impression and/or vital signs obtained during triage. The ABCDE approach was used more often with a higher triage code.

We show that the emergency department staff are capable of performing the ABCDE approach rather completely (83%), but it was only used in the minority of potentially unstable patients. Important factors determining this choice were the vital signs on triage and a quick first impression. Whether this adequately selects patients in need for an ABCDE approach is not clear yet.