Emergency department hypotension predicts suddden unexpected in-hospital mortality: A prospective cohort study

Alan E. Jones, Vasilios Yiannibas, Charles Johnson, Jeffrey Kline

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Objective: The prevalence and prognostic significance of nontraumatic hypotension measured in the emergency department (ED) have not been studied. We hypothesized that ED hypotension confers risk of in-hospital mortality. Design: Prospective cohort study. Setting: Large urban ED with 115,000 visits per year. Participants: Nontrauma ED patients aged > 17 years admitted to the hospital were prospectively identified on a random sample of 24-h blocks during 2004 to 2005. "Exposures" had any systolic BP (SBP) <100 mm Hg in the ED; "nonexposures" all had SBP ≥ 100 mm Hg in the ED. Deaths were classified as sudden and unexpected by independent observers using explicit criteria. Outcome measures: Mortality rates were compared with confidence intervals (CIs), Kaplan-Meier survival curves, and multivariate logistic regression. Results: A total of 4,790 patients were enrolled during the study period, with 887 patients (19%) in the exposure group. Exposures were more likely to die in the hospital compared with nonexposures (8% vs 3%; 95% CI for difference of 5%, 4 to 8%). Exposures were more likely to have sudden and unexpected death compared with nonexposures (2% vs 0.2%, 95% CI for difference of 1.8%, 1 to 3%). Kaplan-Meier estimates showed increased mortality in the exposure group at all time points (log-rank test, p <0.001). Multivariate logistic regression revealed exposure to hypotension as an independent predictor of in-hospital mortality (odds ratio, 2.0; 95% CI, 1.3 to 2.8). Conclusion: Nontraumatic hypotension was documented in 19% of a random sample of ED patients admitted to the hospital. Patients exposed to hypotension had a significantly increased risk of death during hospitalization.

Original languageEnglish (US)
Pages (from-to)941-946
Number of pages6
JournalChest
Volume130
Issue number4
DOIs
StatePublished - Oct 2006
Externally publishedYes

Fingerprint

Hospital Mortality
Hypotension
Hospital Emergency Service
Cohort Studies
Prospective Studies
Confidence Intervals
Kaplan-Meier Estimate
Logistic Models
Mortality
Sudden Death
Hospitalization
Odds Ratio
Outcome Assessment (Health Care)

Keywords

  • BP
  • Emergency department
  • Hypotension
  • Mortality
  • Risk stratification
  • Shock

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Emergency department hypotension predicts suddden unexpected in-hospital mortality : A prospective cohort study. / Jones, Alan E.; Yiannibas, Vasilios; Johnson, Charles; Kline, Jeffrey.

In: Chest, Vol. 130, No. 4, 10.2006, p. 941-946.

Research output: Contribution to journalArticle

Jones, Alan E. ; Yiannibas, Vasilios ; Johnson, Charles ; Kline, Jeffrey. / Emergency department hypotension predicts suddden unexpected in-hospital mortality : A prospective cohort study. In: Chest. 2006 ; Vol. 130, No. 4. pp. 941-946.
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T1 - Emergency department hypotension predicts suddden unexpected in-hospital mortality

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AU - Yiannibas, Vasilios

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N2 - Objective: The prevalence and prognostic significance of nontraumatic hypotension measured in the emergency department (ED) have not been studied. We hypothesized that ED hypotension confers risk of in-hospital mortality. Design: Prospective cohort study. Setting: Large urban ED with 115,000 visits per year. Participants: Nontrauma ED patients aged > 17 years admitted to the hospital were prospectively identified on a random sample of 24-h blocks during 2004 to 2005. "Exposures" had any systolic BP (SBP) <100 mm Hg in the ED; "nonexposures" all had SBP ≥ 100 mm Hg in the ED. Deaths were classified as sudden and unexpected by independent observers using explicit criteria. Outcome measures: Mortality rates were compared with confidence intervals (CIs), Kaplan-Meier survival curves, and multivariate logistic regression. Results: A total of 4,790 patients were enrolled during the study period, with 887 patients (19%) in the exposure group. Exposures were more likely to die in the hospital compared with nonexposures (8% vs 3%; 95% CI for difference of 5%, 4 to 8%). Exposures were more likely to have sudden and unexpected death compared with nonexposures (2% vs 0.2%, 95% CI for difference of 1.8%, 1 to 3%). Kaplan-Meier estimates showed increased mortality in the exposure group at all time points (log-rank test, p <0.001). Multivariate logistic regression revealed exposure to hypotension as an independent predictor of in-hospital mortality (odds ratio, 2.0; 95% CI, 1.3 to 2.8). Conclusion: Nontraumatic hypotension was documented in 19% of a random sample of ED patients admitted to the hospital. Patients exposed to hypotension had a significantly increased risk of death during hospitalization.

AB - Objective: The prevalence and prognostic significance of nontraumatic hypotension measured in the emergency department (ED) have not been studied. We hypothesized that ED hypotension confers risk of in-hospital mortality. Design: Prospective cohort study. Setting: Large urban ED with 115,000 visits per year. Participants: Nontrauma ED patients aged > 17 years admitted to the hospital were prospectively identified on a random sample of 24-h blocks during 2004 to 2005. "Exposures" had any systolic BP (SBP) <100 mm Hg in the ED; "nonexposures" all had SBP ≥ 100 mm Hg in the ED. Deaths were classified as sudden and unexpected by independent observers using explicit criteria. Outcome measures: Mortality rates were compared with confidence intervals (CIs), Kaplan-Meier survival curves, and multivariate logistic regression. Results: A total of 4,790 patients were enrolled during the study period, with 887 patients (19%) in the exposure group. Exposures were more likely to die in the hospital compared with nonexposures (8% vs 3%; 95% CI for difference of 5%, 4 to 8%). Exposures were more likely to have sudden and unexpected death compared with nonexposures (2% vs 0.2%, 95% CI for difference of 1.8%, 1 to 3%). Kaplan-Meier estimates showed increased mortality in the exposure group at all time points (log-rank test, p <0.001). Multivariate logistic regression revealed exposure to hypotension as an independent predictor of in-hospital mortality (odds ratio, 2.0; 95% CI, 1.3 to 2.8). Conclusion: Nontraumatic hypotension was documented in 19% of a random sample of ED patients admitted to the hospital. Patients exposed to hypotension had a significantly increased risk of death during hospitalization.

KW - BP

KW - Emergency department

KW - Hypotension

KW - Mortality

KW - Risk stratification

KW - Shock

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