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Differences in Long-term Mortality for Different Emergency Department Presenting Complaints
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.
2008 (English)In: Academic Emergency Medicine, ISSN 1069-6563, Vol. 15, no 1, 9-16 p.Article in journal (Refereed) Published
Abstract [en]

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.
Keyword [en]
presenting complaint, emergency department, long-term mortality, risk prediction, standardized mortality ratio
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-96928DOI: 10.1111/j.1553-2712.2007.00004.xISI: 000253374100002PubMedID: 18211307OAI: oai:DiVA.org:uu-96928DiVA: diva2:171666
Available from: 2008-03-28 Created: 2008-03-28 Last updated: 2010-01-13Bibliographically 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.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 323
Medicine, Presenting complaint, Emergency Department, long-term mortality, Standardized Mortality Ratio, frequent attenders, Medicin
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
Available from: 2008-03-28 Created: 2008-03-28 Last updated: 2010-12-02Bibliographically approved

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