Emergency Department Vital Signs and Outcomes After Discharge

Abstract

Objective Vital signs are critical markers of illness severity in the Emergency Department (ED). Providers need to understand the abnormal vital signs in older adults that are problematic. We hypothesized that in patients age ≥ 65 years discharged from the ED, there are abnormal vital signs that are associated with an admission to an inpatient bed within 7 days of discharge. Methods We conducted a retrospective cohort study using data from a regional integrated health system of members age ≥ 65 years during the years 2009–2010. We used univariate contingency tables to assess the relationship between hospital admission within 7 days of discharge and vital sign (including systolic blood pressure, heart rate, body temperature, and pulse oximetry (Sp02) values measured closest to discharge) using standard thresholds for abnormal and thresholds derived from the study data‥ Results Of 104,025 ED discharges, 4,638 (4.5%) were followed by inpatient admission within 7-days. Vital signs had a greater odds of admission beyond a single cut-off. The vital signs with at least twice the odds of admission were systolic blood pressure ≤ 97 mmHg (OR 2.02, 95% CI 1.57–2.60), heart rate ≥ 101 bpm (OR 2.00 95% CI 1.75–2.29), body temperature ≥99.2 degrees Fahrenheit (OR 2.14, 95% CI 1.90–2.41), and pulse oximetry ≤ 92 Sp02 (OR 2.04, 95% CI 1.55–2.68). Patients with two vital sign abnormalities per the analysis had the highest odds of admission. A majority of patients discharged with abnormal vital signs per the analysis were not admitted within 7 days of ED discharge. Conclusion While we found a majority of patients discharged with abnormal vital signs as defined by the analysis, not to be admitted after discharge, we identified vital signs associated with at least twice the odds of admission.

Current concepts of perioperative monitoring in high-risk surgical patients: a review

“…All vital signs should be recorded as well as all signs of bleedings, dehydration and hypoperfusion (diuresis, core temperature, fluid and blood spillage from drainages, mucosal appearance, jugular veins filling or capillary refill) and particular emphasis should be addressed to detect early signs of sepsis [6, 7, 18]. Specific vital sign abnormalities in elderly patients such as systolic blood pressure < 97 mmHg, heart rate > 101 beats per minute, hyperthermia or hypothermia < 36 °C, pulse oximetry < 92 SpO 2 are consistently associated with adverse patient outcomes [9, 21, 43].…”

Advances in Non-Invasive Blood Pressure Monitoring

“…Blood pressure monitoring will be a vital part of care for virtually every one of the five million plus patients admitted annually to Intensive Care Units (ICUs) in the US [ 2 , 3 ]. Similarly, blood pressure monitoring will be a required part of care for virtually every one of the 130 million plus patients admitted annually to emergency departments (EDs) across the US [ 4 , 5 ].…”

Association of Vital Signs and Process Outcomes in Emergency Department Patients

“…Previous studies support this traditional teaching. In discharged elderly patients, specific vital sign abnormalities (systolic blood pressure [SBP] < 97 millimeters of mercury [mmHg], heart rate > 101 beats per minute, body temperature > 37.3° C, and pulse oximetry < 92 SpO 2 ) were associated with twice the odds of admission within seven days of emergency department (ED) discharge, with the greatest odds found in patients with two or more abnormal vital signs 1. Other studies focused on admitted patients, with mixed findings.…”