The association between abnormal vital sign groups and undesirable patient outcomes

Abstract

Introduction: To determine the association between both abnormal individual vital signs and abnormal vital sign groups in the emergency department, and undesirable patient outcomes: hospital admission, medical emergency team calls and death. Method: We undertook a prospective cohort study in a tertiary referral emergency department (February-May 2015). Vital signs were collected prospectively in the emergency department and undesirable outcomes from the medical records. The primary outcomes were undesirable outcomes for individual vital signs (multivariate logistic regression) and vital sign groups (univariate analyses). Results: Data from 1438 patients were analysed. Admission was associated with tachycardia, tachypnoea, fever, ≥1 abnormal vital sign on admission to the emergency department, ≥1 abnormal vital sign at any time in the emergency department, a persistently abnormal vital sign, and vital signs consistent with both sepsis (tachycardia/hypotension/abnormal temperature) and pneumonia (tachypnoea/fever) (p < 0.05). Medical emergency team calls were associated with tachycardia, tachypnoea, ≥1 abnormal vital sign on admission (odds ratio: 2.3, 95% confidence interval: 1.4-3.8), ≥2 abnormal vital signs at any time (odds ratio: 2.4, 95% confidence interval: 1.2-4.7), and a persistently abnormal vital sign (odds ratio: 2.7, 95% confidence interval: 1.6-4.6). Death was associated with Glasgow Coma Score ≤13 (odds ratio: 6.3, 95% confidence interval: 2.5-16.0), ≥1 abnormal vital sign on admission (odds ratio: 2.6, 95% confidence interval: 1.2-5.6), ≥2 abnormal vital signs at any time (odds ratio: 6.4, 95% confidence interval: 1.4-29.5), a persistently abnormal vital sign (odds ratio: 4.3, 95% confidence interval: 2.0-9.0), and vital signs consistent with pneumonia (odds ratio: 5.3, 95% confidence interval: 1.9-14.8). Conclusion: Abnormal vital sign groups are generally superior to individual vital signs in predicting undesirable outcomes. They could inform best practice management, emergency department disposition, and communication with the patient and family.

Routine investigations for patients with mental and behavioural disturbances

“…Variation in vital signs is common and evidence suggests that using groups or combinations of abnormal vital signs, together with clinician gestalt, is superior to one abnormal vital sign in isolation. 36 The single patient who was transferred to the medical department had an abnormal heart rate and diastolic blood pressure. Further research should aim to assess which abnormal vital signs or combinations of abnormal vital signs have clinical value to predict undesirable outcomes in MHCUs.…”

Early Diagnosis of Pulmonary Embolism Related to Clinical Presentation and Vital Signs in the Emergency Department at King Saud Medical City

“…Another cohort study was done at the tertiary referral emergency department to emphasize the association between abnormal vital signs and poor clinical outcomes and it showed that abnormal vital signs were predictors of unfavorable outcomes. They concluded that these abnormalities can guide the management plan and communication with the patients and their relatives [ 9 ]. While another study failed to formulate any evidence and highlighted the importance of more well-controlled studies in order to answer the research questions [ 10 ].…”

Alteração de sinais vitais e desfecho clínico de pacientes admitidos em unidade de emergência

“…Esses achados convergem para outra pesquisa que avaliou o conjunto de sinais vitais alterados e os desfechos dos pacientes em um serviço de emergência e observou que, na admissão, a maioria dos homens com idade igual ou superior a 60 anos tinha alteração da frequência cardíaca, respiratória e temperatura. 18 Ainda nesse estudo, os pacientes que foram a óbito apresentavam mais de dois sinais alterados durante a permanência na emergência. 18 Portanto, pesquisas reforçam a importância da vigilância rigorosa do conjunto de parâmetros fisiológicos em uma unidade de emergência.…”

“…18 Ainda nesse estudo, os pacientes que foram a óbito apresentavam mais de dois sinais alterados durante a permanência na emergência. 18 Portanto, pesquisas reforçam a importância da vigilância rigorosa do conjunto de parâmetros fisiológicos em uma unidade de emergência. 6,15,[18][19] Por fim, a realização da coleta de dados em uma única instituição por meio da análise retrospectiva de prontuários é uma limitação do estudo e tal fato deve ser considerado na generalização dos resultados.…”