Cause of Emergency Department Mortality; a Case-control Study
Archives of Academic Emergency Medicine,
Vol. 2 No. 1 (2014),
1 February 2014
,
Page 30-35
https://doi.org/10.22037/aaem.v2i1.19
Abstract
Introduction: Based on previous studies, cardiovascular diseases, traffic accidents, traumas and cancers are the most important etiology of mortalities in emergency departments (ED). However, contradictory findings have been reported in relation to mortality in emergency departments. Therefore, the present study was undertaken to evaluate the role of clinical factors in mortality among patients referring to an emergency department in a third-level hospital in Tehran, Iran. Methods: In the present case-control study, all the patients over 18 years of age were evaluated, referring to the ED of Imam Hossein Hospital, Tehran, Iran, from the beginning of 2009 to the end of 2010. The patients died in the ED were placed in the case group and those discharged or hospitalized in other hospital wards in the control group. Demographic data, background diseases, and the final diagnoses were recorded. Chi-squared test, multivariate logistic regression, and Pearson’s correlation coefficient were used to evaluate the relationship between the variables mentioned above and patient mortality. Results: 2907 patients (969 (59.9% male) in the case and 1938 (62.2% male) in the control groups) were evaluated. Cardiovascular diseases (39.2%), severe traumas (18.5%), and cerebrovascular accidents (17.7%) were the most frequent etiology of patient mortality in ED. Multivariate regression analysis showed that presentation with cardiovascular complaints (OR=7.3; 95% CI: 3.5-16.1; p<0.001), a history of hypertension (OR=5.4; 95% CI: 1.2-12.3; p<0.001), severe trauma (OR=4.6; 95% CI: 2.0-13.2; p<0.001), age over 60 (OR=3.8; 95% CI: 1.8-7.8; p<0.01) and a final diagnosis of renal disease (OR=3.4; 95% CI: 2.1-6.4; p<0.001) were factors that increased the odds of mortality in patients referring to the ED. Multivariate regression analysis in patients over 60 years showed that sepsis was an independent factor increasing the risk of death (OR=2.9; 95% CI: 1.3-5.9; p=0.009). A patient’s risk of death increases with an increase in the number of risk factors in that patient (r2=0.96; p=0.02). Conclusion: It appears the odds of mortality in patients referring to ED with cardiovascular complaints, a history of hypertensive, severe trauma, age over 60 and a final diagnosis of renal disease are higher versus other patients. In addition, the patients’ odds of death increase with an increase in the number of risk factors. Such an increase is more noticeable at age over 60.- Emergency department
- etiology
- mortality
- risk factor
How to Cite
References
Ly N, McCaig LF. National Hospital Ambulatory Medical Care Survey: 2000 outpatient department summary. Adv Data. 2002 (327):1-7.
Olsen JC, Buenefe ML, Falco WD. Death in the emergency department. Ann Emerg Med. 1998;31(6):758-65.
Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States, 1989 to 1998. Circulation. 2001; 104(18):2158-63.
Wall M, Huang J, Oswald J, McCullen D. Factors associated with reporting multiple causes of death. BMC Med Res Methodol. 2005;5(1):4-17.
Jarman B, Gault S, Alves B, et al. Explaining differences in English hospital death rates using routinely collected data. BMJ. 1999;318(7197):1515-20.
Nelson P. Death in the Emergency Department :The Forgotten Tragedy. J Pain Symptom Manage. 2011;41(1):215-9.
Halm EA, Chassin MR. Why do hospital death rates vary? N Engl J Med. 2001;345(9):692-4.
Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52(2):126-36.
Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW. Mortality in Emergency Department Sepsis (MEDS) score: A prospectively derived and validated clinical prediction rule. Crit Care Med. 2003;31(3):670-5.
Baker M, Clancy M. Can mortality rates for patients who die within the emergency department, within 30 days of discharge from the emergency department, or within 30 days of admission from the emergency department be easily measured? Emerg Med J. 2006;23(8):601-3.
Cameron PA, Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrow-ding. Med J Aust. 2006;184(5):213-6.
Caterino JM, Kulchycki LK, Fischer CM, Wolfe RE, Shapiro NI. Risk factors for death in elderly emergency department patients with suspected infection. J Am Geriatr Soc. 2009;57 (7):1184-90.
Salazar A, Bardés I, Juan A, Olona N, Sabido M, Corbella X. High mortality rates from medical problems of frequent emergency department users at a university hospital tertiary care centre. Eur J Emerg Med. 2005;12(1):2-5.
van Dam RM, Li T, Spiegelman D, Franco OH, Hu FB. Combined impact of lifestyle factors on mortality: prospective cohort study in US women. BMJ. 2008;337:a1440.
De Vivo MJ, Stuart Krause J, Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil. 1999;80(11):1411-9.
Melanie W, Jinzhou H, John O, Diane MC. Factors asso-ciated with reporting multiple causes of death. BMC Med Res Methodol. 2005; 5: 4:4-17.
Cannon CP, Gibson CM, Lambrew CT, et al. Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA. 2000;283(22):2941-7.
Frankel FM, Duong N, Shil AB. Association of Hypertension With Mortality. Am J Hypertens. 2010;23(5):452-3.
Gombojav B, Yi S-W, Sull JW, Nam CM, Ohrr H. Combined effects of cognitive impairment and hypertension on total mortality in elderly people: the Kangwha Cohort study. Gerontology. 2011;57(6):490-6.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. The Lancet. 2005;365(9455):217-23.
Lawes CM, Hoorn SV, Rodgers A. Global burden of blood-pressure-related disease, 2001. The Lancet. 2008;371(9623): 1513-8.
World Health Organization. A global brief on hypertension. Silent killer, global public health crisis. World Health Organ-ization. Geneva: World Health Organization; 2013.
Gabayan GZ, Derose SF, Asch SM, et al. Patterns and Pred-ictors of Short-Term Death After Emergency Department Disc-harge. Ann Emerg Med. 2011;58(6):551-8.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296-305.
Ma K, Greene E, Raij L. Cardiovascular risk factors in chronic renal failure and hemodialysis populations. Am J Kidney Dis. 1992;19(6):505-11.
Muntner P, He J, Hamm L, Loria C, Whelton PK. Renal insufficiency and subsequent death resulting from cardiovasc-ular disease in the United States. J Am Soc Nephrol. 2002;13(3):745-53.
Sarnak MJ, Levey AS, Schoolwerth AC, et al. Kidney disease as a risk factor for development of cardiovascular disease. Circulation. 2003;108(17):2154-69.
McCullough PA, Wolyn R, Rocher LL, Levin RN, O’Neill WW. Acute renal failure after coronary intervention: inciden-ce, risk factors, and relationship to mortality. Am J Med. 1997; 103(5):368-75.
Collins AJ, Foley RN, Herzog C, et al. US Renal Data System 2010 Annual Data Report. Am J Kidney Dis. 2011;57(1):1-9.
Foley RN, Collins AJ. End-stage renal disease in the United States: an update from the United States Renal Data System. J Am Soc Nephrol. 2007;18(10):2644-8.
Goodman WG, Goldin J, Kuizon BD, et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med. 2000;342(20):1478-83.
Hosseini M, Carpenter R, Mohammad K. Growth of child-ren in Iran. Ann Hum Biol. 1998;25(3):249-61.
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