Has Admission Blood Pressure Any Prognostic Value in Patients With Subarachnoid Hemorrhage: An Emergency Department Experience

Duran, Latif; Balcı, Kemal; Katı, Celal; Akdemir, Hızır Ufuk; Kocabıcak, Ersoy; Doğruel, Canan

doi:10.1111/jch.12177

Cited by 11 publications

(11 citation statements)

References 18 publications

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“…This is consistent with previous literature that has found low blood pressure to be associated with poor outcomes. 34–36 This finding suggests that in an ED setting, patients with reduced systolic blood pressure warrant further scrutiny before discharge. We also found that an elevated pulse rate greater than 90 beats/min was associated with the outcome.…”

Section: Discussionmentioning

confidence: 97%

Poor Outcomes After Emergency Department Discharge of the Elderly: A Case-Control Study

Gabayan

Gould²,

Weiss

et al. 2016

Annals of Emergency Medicine

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Study objective The emergency department (ED) is an inherently high-risk setting. Our objective is to identify the factors associated with the combined poor outcome of either death or an ICU admission shortly after ED discharge in older adults. Methods We conducted chart review of 600 ED visit records among adults older than 65 years that resulted in discharge from any of 13 hospitals within an integrated health system in 2009 to 2010. We randomly chose 300 patients who experienced the combined outcome within 7 days of discharge and matched case patients to controls who did not experience the outcome. Two emergency physicians blinded to the outcome reviewed the records and identified whether a number of characteristics were present. Predictors of the outcome were identified with conditional logistic regression. Results Of 1,442,594 ED visits to Kaiser Permanente Southern California in 2009 to 2010, 300 unique cases and 300 unique control records were randomly abstracted. Characteristics associated with the combined poor outcome included cognitive impairment (adjusted odds ratio [AOR] 2.10; 95% confidence interval [CI] 1.19 to 3.56), disposition plan change (AOR 2.71; 95% CI 1.50 to 4.89), systolic blood pressure less than 120 mm Hg (AOR 1.48; 95% CI 1.00 to 2.20), and pulse rate greater than 90 beats/min (AOR 1.66; 95% CI 1.02 to 2.71). Conclusion We found that older patients discharged from the ED with a change in disposition from “admit” to “discharge,” cognitive impairment, systolic blood pressure less than 120 mm Hg, and pulse rate greater than 90 beats/ min were at increased risk of death or ICU admission shortly after discharge. Increased awareness of these high-risk characteristics may improve ED disposition decisionmaking.

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Section: Discussionmentioning

confidence: 97%

Poor Outcomes After Emergency Department Discharge of the Elderly: A Case-Control Study

Gabayan

Gould²,

Weiss

et al. 2016

Annals of Emergency Medicine

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“…While both high blood pressure 25–27 and low blood pressure 28–30 have been associated with poor outcomes, we found patients with systolic blood pressure ≤ 97 mmHg to have at least twice the odds of experiencing an admission after discharge‥ We also found that for the standard cut off ranges, a systolic blood pressure < 90 bpm has close to 3.5 times the odds of admission after discharge, the highest odds of all vital signs. This finding is consistent with clinical judgement.…”

Section: Discussionmentioning

confidence: 52%

Emergency Department Vital Signs and Outcomes After Discharge

Gabayan

Gould

Weiss

et al. 2017

Academic Emergency Medicine

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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.

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“…In patients with spontaneous intracerebral hemorrhage, many studies evaluating the relationship between BPs in ED and outcomes have been carried out, and higher BPs seem to predict worse outcomes. However, only a few studies have looked into the relationship in SAH patients, despite the fact that SAH patients frequently present to the ED with extremely HBP . The results of the aforementioned studies are inconclusive; HBPs in SAH patients were predictive of either better or worse outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…However, only a few studies have looked into the relationship in SAH patients, despite the fact that SAH patients frequently present to the ED with extremely HBP . The results of the aforementioned studies are inconclusive; HBPs in SAH patients were predictive of either better or worse outcomes. Moreover, little effort has been made to delineate a cut‐off BP value that might predict poor outcomes in SAH patients.…”

Section: Discussionmentioning

confidence: 99%

“…It has been repeatedly reported that the higher the BP in the emergency department (ED), the worse the outcomes of patients with spontaneous intracerebral hemorrhage . By contrast, the relationship between BP measured in the ED and outcomes has been studied less frequently in patients with aneurysmal subarachnoid hemorrhage (SAH) . It may be beneficial for emergency physicians if earlier prognostication of SAH patients was possible using BP values measured in the ED.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between systolic blood pressures measured in emergency department and outcomes in patients with subarachnoid hemorrhage

Inamasu

Oheda

Ito

et al. 2014

Acute Medicine & Surgery

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Aim: High blood pressure is observed frequently in patients with subarachnoid hemorrhage who present to the emergency department. Although extremely high blood pressure is known to predict poor outcomes in patients with spontaneous intracerebral hemorrhage, the relationship between high blood pressure and outcomes has been studied less frequently in patients with subarachnoid hemorrhage.Methods: A retrospective study was carried out to evaluate whether high blood pressure observed in the emergency department was predictive of poor outcomes in patients with subarachnoid hemorrhage. Three-hundred and twelve subarachnoid hemorrhage patients who were admitted to our institution were quadrichotomized based on their initial systolic blood pressure: <140 mmHg (n = 60), 140-184 mmHg (n = 144), 185-219 mmHg (n = 64), and ≥220 mmHg (n = 44). Demographics including subarachnoid hemorrhage severity (World Federation of Neurosurgical Societies grade) and outcome variables evaluated with the modified Rankin scale 30 days after admission were compared among the four blood pressure groups. Furthermore, an effort was made to delineate a threshold value of systolic blood pressure predictive of outcomes by receiver operating characteristic curve analysis. Results:The frequency of grade V subarachnoid hemorrhage in the ≥220 mmHg group (55%) was significantly higher than in the other three blood pressure groups. The frequency of patients scoring 5-6 on the modified Rankin scale in the ≥220 mmHg group (54%) was significantly higher than in the other three blood pressure groups. The cut-off systolic blood pressure value predicting poor outcomes (modified Rankin scale 5-6) determined by receiver operating characteristic curve analysis was 189 mmHg. Conclusions:The higher proportion of grade V patients may be responsible for the worse outcomes in the group with systolic blood pressure ≥220 mmHg. Initial systolic blood pressure ≥220 mmHg may be a crude indicator of poor outcomes in patients with subarachnoid hemorrhage.Key words: Emergency department, high blood pressure, outcomes, predictability, subarachnoid hemorrhage INTRODUCTION H IGH BLOOD PRESSURE (HBP) is observed frequently in patients with hemorrhagic stroke.1,2 It has been repeatedly reported that the higher the BP in the emergency department (ED), the worse the outcomes of patients with spontaneous intracerebral hemorrhage.3-6 By contrast, the relationship between BP measured in the ED and outcomes has been studied less frequently in patients with aneurysmal subarachnoid hemorrhage (SAH). 7,8 It may be beneficial for emergency physicians if earlier prognostication of SAH patients was possible using BP values measured in the ED. For that purpose, the relationship between: (i) systolic BPs (SBPs) in the ED and severity of SAH; and (ii) SBPs in the ED and outcomes, was investigated in this study. Furthermore, an effort was made to delineate a threshold value of SBP predictive of poor outcomes with receiver operating characteristic (ROC) curve analysis. METHODS PatientsT HIS WAS ...

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Has Admission Blood Pressure Any Prognostic Value in Patients With Subarachnoid Hemorrhage: An Emergency Department Experience

Cited by 11 publications

References 18 publications

Poor Outcomes After Emergency Department Discharge of the Elderly: A Case-Control Study

Poor Outcomes After Emergency Department Discharge of the Elderly: A Case-Control Study

Emergency Department Vital Signs and Outcomes After Discharge

Relationship between systolic blood pressures measured in emergency department and outcomes in patients with subarachnoid hemorrhage

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