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The Emergency Department presenting complaint as predictor of in-hospital fatality
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
2007 (English)In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 14, no 6, 324-331 p.Article in journal (Refereed) Published
Abstract [en]

Background: The relationship between major discharge diagnoses and prediction of in-hospital death has been intensively studied. The relation between the presenting complaint at the Emergency Department (ED) and in-hospital fatality, however, is less well known.

Objective: To investigate if presenting complaints add information regarding in-hospital fatality risk for nonsurgical ED patients.

Methods: Investigating the relationship of in-hospital fatality rate and presenting complaint by comparing the presenting complaints, discharge diagnoses and in-hospital fatality for all nonsurgical patients visiting the ED during 1 year.

Results: Of 12 995 nonsurgical admissions, 40% were treated as in-hospital patients. Among these, 328 in-hospital deaths occurred. Age was the most powerful predictor of death in hospitalized patients (P<0.0001). After adjustment for age, the female sex was found to be protective [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.92, P=0.007)]. Compared with the largest complaint group, chest pain with an in-hospital fatality rate of 2.5%, there was a significantly increased risk of dying among those with stroke-like symptoms (OR 2.04, 95% CI 1.35-3.08, P=0.0007), dyspnoea (OR 1.95, 95% CI 1.27-3.00, P=0.002) or general disability (OR 1.81, 95% CI 1.17-2.79, P=0.008).

Conclusions: The presenting complaint at the ED carries valuable information of the risk for in-hospital fatality in nonsurgical patients. This knowledge can be valuable in the prioritization between different patient groups in the process of initiating diagnostics and treatment procedures at the ED.

Place, publisher, year, edition, pages
2007. Vol. 14, no 6, 324-331 p.
Keyword [en]
emergency department, in-hospital fatality rate, nonsurgical patients, presenting complaint, risk prediction
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-96927DOI: 10.1097/MEJ.0b013e32827b14ddISI: 000251115200003PubMedID: 17968197OAI: oai:DiVA.org:uu-96927DiVA: diva2:171665
Available from: 2008-03-28 Created: 2008-03-28 Last updated: 2011-01-14Bibliographically approved
In thesis
1. Presenting complaint and mortality in non-surgical emergency medicine patients
Open this publication in new window or tab >>Presenting complaint and mortality in non-surgical emergency medicine patients
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In 1995 and 2000 a total of 29 886 non surgical ED visits at Uppsala University Hospital were registered. Presenting complaint, admittance to a ward, length of stay, in-hospital mortality, discharge diagnoses, 30-day and long-term mortality were registered. The presenting complaints were sorted into 33 presenting complaint groups (PCGs).

For different PCGs there was different in-hospital fatality rate. Compared to the largest PCG, chest pain, the gender and age adjusted OR was 2.12 (95% CI 1.01 – 4.44) for the miscellaneous complaint group and 2.04 (95 % CI 1.35 – 3.08) for the stroke–like symptom group. Within a given PCG the in-hospital mortality could vary depending on discharge diagnoses. By relating PCG and long term mortality to the expected mortality in the population, the Standardized Mortality Ratio (SMR) could be calculated. The SMR was found to be highest in seizure 2.62 (95 % CI 2.13 – 3.22), intoxication 2.51 (95% CI 2.11-2.98) and symptoms of asthma 1.8 (1.65 – 2.06). For the same discharge diagnoses the long term mortality could differ considerably depending on PCG at ED arrival (p<0.001).

Between 1995 and 2000 there was a 30 % increase in ED visits at the non surgical ED. PCGs representing lesser severe conditions had increased. Demographic changes could account for 45 % of the increment and the remaining increase could be ascribed to change in visiting pattern.

In the 2000 cohort 41.0 % of all visits were performed by re-visitors. The number of revisits and five-year mortality had an inversed u-shaped relationship were patients with three re-visits within the same year had an increased mortality compared to patients with more or less visits.

Conclusion: It is possible to define presenting complaint groups (PCGs) that are robust and consistent over time and useful as a tool for epidemiological studies in the ED.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 57 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 323
Keyword
Medicine, Presenting complaint, Emergency Department, long-term mortality, Standardized Mortality Ratio, frequent attenders, Medicin
Identifiers
urn:nbn:se:uu:diva-8583 (URN)978-91-554-7136-1 (ISBN)
Public defence
2008-04-18, Enghoffsalen, entrance 50,, Akademiska sjukhuset, Uppsala, 09:15
Opponent
Supervisors
Available from: 2008-03-28 Created: 2008-03-28 Last updated: 2010-12-02Bibliographically approved

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Terént, AndreasLind, Lars

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