Differences in Long-term Mortality for Different Emergency Department Presenting Complaints
2008 (English)In: Academic Emergency Medicine, ISSN 1069-6563, Vol. 15, no 1, 9-16 p.Article in journal (Refereed) Published
OBJECTIVES: To characterize long-term mortality based on previous emergency department (ED) presenting complaints. METHODS: The authors followed, for 10 years, all of the 12,667 nonsurgical patients visiting an ED during 1995/1996. Differences in standardized mortality ratio (SMR) depending on presenting complaints were then investigated. RESULTS: During follow-up, 5,324 deaths occurred (mortality rate 6.6 per 100 person-years at risk), giving a SMR of 1.33 (95% CI = 1.30 to 1.37, p < 0.001) when compared with the expected mortality in the catchment area. Different presenting complaints were associated with different long-term mortality rates, independent of age and gender (p < 0.0001). The subjects with seizures had the highest SMR (2.62, 95% CI = 2.13 to 3.22) followed by intoxications (2.51, 95% CI = 2.11 to 2.98), asthmalike symptoms (1.84, 95% CI = 1.65 to 2.06), and hyperglycemia (1.67, 95% CI = 1.42 to 1.95). The largest complaint group, chest pain, had a 20% higher mortality rate than the background population (95% CI = 1.13 to 1.26). Patients with a discharge diagnosis of myocardial infarction, but without chest pain as the presenting complaint, had an increased long-term mortality (hazard ratio [HR] 1.70, 95% CI = 1.15 to 2.42) compared to the group with chest pain. In contrast, stroke patients without strokelike symptoms had a reduced mortality (HR 0.74, 95% CI = 0.65 to 0.84) compared to patients with strokelike symptoms. CONCLUSIONS: Long-term age- and gender-adjusted mortality is the highest with seizures out of 33 presenting complaints and differs markedly between different ED admission complaints. Furthermore, depending on the admission complaint, long-term mortality differs within the same discharge diagnosis. Hence, the presenting complaint adds unique information to the discharge diagnosis regarding long-term mortality in nonsurgical patients.
Place, publisher, year, edition, pages
2008. Vol. 15, no 1, 9-16 p.
presenting complaint, emergency department, long-term mortality, risk prediction, standardized mortality ratio
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-96928DOI: 10.1111/j.1553-2712.2007.00004.xISI: 000253374100002PubMedID: 18211307OAI: oai:DiVA.org:uu-96928DiVA: diva2:171666