The Association Between Abnormal Vital Signs and Mortality in the Emergency Department

Simbawa, Jood H; Jawhari, Abdulkarim A.; Almutairi, Fay; Almahmoudi, Ahlam; Alshammrani, Bashair; Qashqari, Raneem; Alattas, Ibtihal

doi:10.7759/cureus.20454

Cited by 4 publications

(9 citation statements)

References 27 publications

(61 reference statements)

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“…Tringali et al’s study reported that DBP values below 70 mmHg were associated with increased all-cause mortality in patients aged 45 years or older who encountered outpatient care [ 17 ]. Most studies used DBP ≤ 60 mmHg to indicate an impending serious adverse event; however, at this low level, it may be significantly late to detect the abnormality, which may lead to delayed treatment [ 4 , 5 , 17 ]. A previous study explored the predictors of poor outcomes in geriatric patients with acute abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with unfavorable outcomes in patients with acute abdominal pain visiting the emergency department

Dadeh

2022

BMC Emerg Med

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Background Unfavorable outcomes occur in patients with acute abdominal pain who visit the emergency department (ED). We aimed to determine the factors associated with unfavorable outcomes in patients with acute abdominal pain visiting the ED. Methods This retrospective cohort study was conducted from July 1, 2015 to June 30, 2016. The inclusion criterion was patients aged older than 18 years who presented to the ED with acute abdominal pain. Significant factors associated with unfavorable outcomes were examined using univariate and multivariate logistic regression analyses. Results A total of 951 patients were included in the study. Multivariate logistic regression analysis showed that the ED length of stay (EDLOS) > 4 h (adjusted odds ratio (AOR) 2.62, 95% confidence interval [CI]: 1.33–5.14; p = 0.005), diastolic blood pressure (DBP) < 80 mmHg (AOR 3.31, 95% CI: 1.71–6.4; p ≤ 0.001), respiratory rate ≥ 24 breaths/min (AOR 2.03, 95% CI: 1.07–3.86; p ≤ 0.031), right lower quadrant (RLQ) tenderness (AOR 3.72, 95% CI: 1.89–7.32; p ≤ 0.001), abdominal distension (AOR 2.91, 95% CI: 1.29–6.57; p = 0.010), hypoactive bowel sounds (AOR 2.89, 95% CI: 1.09–7.67; p = 0.033), presence of specific abdominal signs (AOR 2.07, 95% CI: 1.1–3.88; p = 0.024), white blood cell count ≥ 12,000 cells/mm3 (AOR 2.37, 95% CI: 1.22–4.6; p = 0.011), and absolute neutrophil count (ANC) > 75% (AOR 2.83, 95% CI: 1.39–5.75; p = 0.004) were revealed as significant factors associated with unfavorable outcomes. Conclusions The present study revealed that the significant clinical signs associated with the occurrence of unfavorable outcomes were DBP < 80 mmHg, tachypnea (≥ 24 breaths/min), RLQ tenderness, abdominal distension, hypoactive bowel sounds, and presence of specific abdominal signs. Moreover, the associated laboratory results identified in this study were leukocytosis and ANC > 75%. Additionally, patients with abdominal pain visiting the ED who had an EDLOS longer than 4 h were associated with unfavorable outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Vital signs are commonly used among triage systems, along with risk scoring tools in the ED [ 4 ]. The type and number of abnormal vital signs are strong predictors for in-hospital mortality and admission to the intensive care unit (ICU) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with unfavorable outcomes in patients with acute abdominal pain visiting the emergency department

Dadeh

2022

BMC Emerg Med

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“…The statistically signi cant factors (i.e., clinical signs) that were associated with the occurrence of an unfavorable outcome after the multivariate logistic regression analysis were DBP < 80 mmHg, tachypnea [4,5,18]. Previous research explored the predictors of a poor outcome in geriatric patients with acute abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

“…Vital signs are commonly used among triage systems along with risk scoring tools in the ED [4]. The type and number of abnormal vital signs were strong predictors for in-hospital mortality and admission to the intensive care unit (ICU) [5].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with an unfavorable outcome in patients visiting the emergency department with acute abdominal pain

Dadeh

2022

Preprint

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Background Unfavorable outcome occurs in patients who visit the emergency department (ED) with acute abdominal pain. We aimed to determine the factors associated with unfavorable outcome in ED patients who presented with acute abdominal pain. Methods A retrospective cohort study was conducted from July 1, 2015 to June 30, 2016. The inclusion criteria were patients aged older than 18 years who presented to the emergency department (ED) with acute abdominal pain. The patients were divided into either the favorable outcome group or unfavorable outcome group. The two groups were compared in terms of baseline characteristics, triage category, physical examination findings, duration of symptoms, laboratory and imaging results, final diagnosis, treatment in the ED, emergency department length of stay (EDLOS), and ED disposition, morbidity, and mortality. The significant associated factors for an unfavorable outcome were examined using univariate and multivariate analyses by logistic regression. Results A total of 951 patients were included in the study. The multivariate logistic regression analysis showed EDLOS > 4 hours (adjusted odd ratio (AOR) 2.62, 95% CI: 1.33–5.14, p = 0.005), diastolic blood pressure (DBP) < 80 mmHg (AOR 3.31, 95% CI: 1.71–6.4, p ≤ 0.001), respiratory rate ≥ 24 breaths/min (AOR 2.03, 95% CI: 1.07–3.86, p ≤ 0.031), right lower quadrant (RLQ) tenderness (AOR 3.72, 95% CI: 1.89–7.32, p ≤ 0.001), abdominal distension (AOR 2.91, 95% CI: 1.29–6.57, p = 0.010), hypoactive bowel sounds (AOR 2.89, 95% CI: 1.09–7.67, p = 0.033), presence of specific abdominal signs (AOR 2.07, 95% CI: 1.1–3.88, p = 0.024), leukocytosis ≥ 12,000 cells/mm3 (AOR 2.37, 95% CI: 1.22–4.6, p = 0.011), and absolute neutrophil count (ANC) > 75% (AOR 2.83, 95% CI: 1.39–5.75, p = 0.004) were revealed as significant factors associated with unfavorable outcome. Significant variables associated with in-hospital mortality in the unfavorable outcome group were presence of shock (p ≤ 0.001), mechanical ventilation used (p = 0.008), emergency surgery required (p = 0.007), and occurrence of in-hospital cardiac arrest (p = 0.002). Emergency surgical procedures performed were appendectomy (58.5%, 38 patients), exploratory laparotomy (29.2%, 19 patients), laparoscopy (7.7%, 5 patients), and cholecystectomy (4.6%, 3 patients). Three patients died after admission and one patient died at the ED. Conclusions The present study revealed that the significant clinical signs associated with the occurrence of unfavorable outcome were DBP < 80 mmHg, tachypnea (≥ 24 breaths/minute), RLQ tenderness, abdominal distension, hypoactive bowel sounds, and presence of specific abdominal signs. Moreover, associated laboratory results identified from this study were leukocytosis and ANC > 75%. Finally, ED patients with abdominal pain who had EDLOS longer than 4 hours were associated with unfavorable outcome.

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“…Disease-related characteristics included reason for visiting, and route of visit, emergency symptoms applicable, visitor's level of consciousness, systolic blood pressure at arrival, diastolic blood using pressure at arrival, pulse rate at arrival, respiration at arrival and body temperature at arrival. The classification of vital signs was performed according to Simbawa et al (2021). Emergency symptoms were classified according to the Enforcement Rules of the Emergency Medical Services Act in Korea (Ministry of Health and Welfare, 2022).…”

Section: Disease-related Variablesmentioning

confidence: 99%

Incidence of overtriage and undertriage and associated factors: A cross‐sectional study using a secondary data analysis

Jung,

2023

Journal of Advanced Nursing

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BackgroundImproving triage accuracy for accurate patient identification and appropriate resource allocation is essential. Little is known about the trend of triage accuracy, and factors associated with mistriage vary from study to study.AimTo identify incidence and risk factors of mistriage, such as overtriage and undertriage.DesignThis is a cross‐sectional study.MethodsThe data came from the National Emergency Department Information System database in 2016–2020. All patients 15 years and older visiting emergency departments in Korea were assessed for eligibility, and 20,641,411 emergency patients' data were used. Multivariable logistic regressions were conducted to confirm the associated factors with overtriage and undertriage compared to expected triage. Demographic characteristics, disease‐related signs and triage‐related factors were independent variables.ResultsExpected triage decreased from 96.8% in 2016 to 95.7% in 2020. Overtriage (0.5%–0.7%) and undertriage (2.4%–3.3%) increased. The occupation that performed triage the most (over 85%) was nurses. Associated factors with overtriage were demographic characteristics (40–64 age group, female), disease‐related signs (known disease, direct visit) and triage‐related factors (regional emergency medical centre). Risk factors to undertriage were disease‐related signs (systolic/diastolic blood pressure and pulse rates within normal range).ConclusionsWhile the acuity degree remained within the recommended range, the accuracy of triage decreased, and there was a gradual increase in mistriaged cases. Nurses have performed most of the triage and played a key role in expected triage. Associated factors with overtriage were demographic characteristics, disease‐related signs and triage‐related factors and risk factors to undertriage were disease‐related signs.Patient or public contributionNo patient or public contribution.Implications for the professionNurses should be aware of what factors are associated with mistriage and why the factors cause mistriage to improve the triage accuracy because they are responsible for the majority of the triage assessments.

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The Association Between Abnormal Vital Signs and Mortality in the Emergency Department

Cited by 4 publications

References 27 publications

Factors associated with unfavorable outcomes in patients with acute abdominal pain visiting the emergency department

Factors associated with unfavorable outcomes in patients with acute abdominal pain visiting the emergency department

Factors associated with an unfavorable outcome in patients visiting the emergency department with acute abdominal pain

Incidence of overtriage and undertriage and associated factors: A cross‐sectional study using a secondary data analysis

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