Nontraumatic Out-of-Hospital Hypotension Predicts Inhospital Mortality

Alan E. Jones, Ian G. Stiell, Lisa P. Nesbitt, Daniel W. Spaite, Nael Hasan, Brian A. Watts, Jeffrey Kline

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Study objective: Out-of-hospital hypotension may signify need for intensive resuscitation and rapid diagnosis on emergency department (ED) arrival. We hypothesized that nontraumatic out-of-hospital hypotension confers risk of inhospital mortality. Methods: This was a multicenter study of ambulance-transported, nontrauma, noncardiopulmonary resuscitation patients conducted at 2 venues: (1) a cross-sectional risk assessment study of high-priority medical transports at a US metropolitan county; and (2) a Canadian prospective multicenter cohort study of patients with respiratory distress. Data at both venues were extracted from prospectively recorded, standardized run sheets by either a physician or a paramedic. Data extraction and analysis at each venue were conducted independently. Exposures to hypotension were defined as age older than 17 years old, systolic blood pressure less than 100 mm Hg during transport, and 1 or more of 10 predefined symptoms of circulatory insufficiency. Nonexposures to hypotension had the same definition as exposures, except the systolic blood pressure had to be more than 100 mm Hg during the entire out-of-hospital transport. The main outcome variable was inhospital mortality. Results: At venue 1, of 3,128 transports, 395 (13%) exposures and 395 nonexposures were identified. Inhospital mortality of exposures was 26% versus 8% for nonexposures (adjusted odds ratio [OR] 4.6; 95% confidence interval [CI] 2.0 to 5.9). At venue 2, of 7,679 transports, 532 exposures (7%) and 7,147 nonexposures were identified. Out-of-hospital exposure to hypotension conferred a mortality rate of 32% versus 11% for nonexposures (OR 3.0; 95% CI 2.4 to 3.7), representing a sensitivity of 18% and a specificity of 95%. Conclusion: The inhospital mortality rate after out-of-hospital, nontraumatic hypotension is high and reproducible. Future research should focus on ED clinical protocols to ensure appropriate resuscitation and investigation of etiology of out-of-hospital hypotension.

Original languageEnglish (US)
Pages (from-to)106-113
Number of pages8
JournalAnnals of Emergency Medicine
Volume43
Issue number1
DOIs
StatePublished - Jan 2004
Externally publishedYes

Fingerprint

Hospital Mortality
Hypotension
Resuscitation
Blood Pressure
Multicenter Studies
Hospital Emergency Service
Odds Ratio
Confidence Intervals
Allied Health Personnel
Ambulances
Mortality
Clinical Protocols
Cohort Studies
Physicians

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Jones, A. E., Stiell, I. G., Nesbitt, L. P., Spaite, D. W., Hasan, N., Watts, B. A., & Kline, J. (2004). Nontraumatic Out-of-Hospital Hypotension Predicts Inhospital Mortality. Annals of Emergency Medicine, 43(1), 106-113. https://doi.org/10.1016/j.annemergmed.2003.08.008

Nontraumatic Out-of-Hospital Hypotension Predicts Inhospital Mortality. / Jones, Alan E.; Stiell, Ian G.; Nesbitt, Lisa P.; Spaite, Daniel W.; Hasan, Nael; Watts, Brian A.; Kline, Jeffrey.

In: Annals of Emergency Medicine, Vol. 43, No. 1, 01.2004, p. 106-113.

Research output: Contribution to journalArticle

Jones, AE, Stiell, IG, Nesbitt, LP, Spaite, DW, Hasan, N, Watts, BA & Kline, J 2004, 'Nontraumatic Out-of-Hospital Hypotension Predicts Inhospital Mortality', Annals of Emergency Medicine, vol. 43, no. 1, pp. 106-113. https://doi.org/10.1016/j.annemergmed.2003.08.008
Jones, Alan E. ; Stiell, Ian G. ; Nesbitt, Lisa P. ; Spaite, Daniel W. ; Hasan, Nael ; Watts, Brian A. ; Kline, Jeffrey. / Nontraumatic Out-of-Hospital Hypotension Predicts Inhospital Mortality. In: Annals of Emergency Medicine. 2004 ; Vol. 43, No. 1. pp. 106-113.
@article{828b01b623fc48efae15b36173355265,
title = "Nontraumatic Out-of-Hospital Hypotension Predicts Inhospital Mortality",
abstract = "Study objective: Out-of-hospital hypotension may signify need for intensive resuscitation and rapid diagnosis on emergency department (ED) arrival. We hypothesized that nontraumatic out-of-hospital hypotension confers risk of inhospital mortality. Methods: This was a multicenter study of ambulance-transported, nontrauma, noncardiopulmonary resuscitation patients conducted at 2 venues: (1) a cross-sectional risk assessment study of high-priority medical transports at a US metropolitan county; and (2) a Canadian prospective multicenter cohort study of patients with respiratory distress. Data at both venues were extracted from prospectively recorded, standardized run sheets by either a physician or a paramedic. Data extraction and analysis at each venue were conducted independently. Exposures to hypotension were defined as age older than 17 years old, systolic blood pressure less than 100 mm Hg during transport, and 1 or more of 10 predefined symptoms of circulatory insufficiency. Nonexposures to hypotension had the same definition as exposures, except the systolic blood pressure had to be more than 100 mm Hg during the entire out-of-hospital transport. The main outcome variable was inhospital mortality. Results: At venue 1, of 3,128 transports, 395 (13{\%}) exposures and 395 nonexposures were identified. Inhospital mortality of exposures was 26{\%} versus 8{\%} for nonexposures (adjusted odds ratio [OR] 4.6; 95{\%} confidence interval [CI] 2.0 to 5.9). At venue 2, of 7,679 transports, 532 exposures (7{\%}) and 7,147 nonexposures were identified. Out-of-hospital exposure to hypotension conferred a mortality rate of 32{\%} versus 11{\%} for nonexposures (OR 3.0; 95{\%} CI 2.4 to 3.7), representing a sensitivity of 18{\%} and a specificity of 95{\%}. Conclusion: The inhospital mortality rate after out-of-hospital, nontraumatic hypotension is high and reproducible. Future research should focus on ED clinical protocols to ensure appropriate resuscitation and investigation of etiology of out-of-hospital hypotension.",
author = "Jones, {Alan E.} and Stiell, {Ian G.} and Nesbitt, {Lisa P.} and Spaite, {Daniel W.} and Nael Hasan and Watts, {Brian A.} and Jeffrey Kline",
year = "2004",
month = "1",
doi = "10.1016/j.annemergmed.2003.08.008",
language = "English (US)",
volume = "43",
pages = "106--113",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Nontraumatic Out-of-Hospital Hypotension Predicts Inhospital Mortality

AU - Jones, Alan E.

AU - Stiell, Ian G.

AU - Nesbitt, Lisa P.

AU - Spaite, Daniel W.

AU - Hasan, Nael

AU - Watts, Brian A.

AU - Kline, Jeffrey

PY - 2004/1

Y1 - 2004/1

N2 - Study objective: Out-of-hospital hypotension may signify need for intensive resuscitation and rapid diagnosis on emergency department (ED) arrival. We hypothesized that nontraumatic out-of-hospital hypotension confers risk of inhospital mortality. Methods: This was a multicenter study of ambulance-transported, nontrauma, noncardiopulmonary resuscitation patients conducted at 2 venues: (1) a cross-sectional risk assessment study of high-priority medical transports at a US metropolitan county; and (2) a Canadian prospective multicenter cohort study of patients with respiratory distress. Data at both venues were extracted from prospectively recorded, standardized run sheets by either a physician or a paramedic. Data extraction and analysis at each venue were conducted independently. Exposures to hypotension were defined as age older than 17 years old, systolic blood pressure less than 100 mm Hg during transport, and 1 or more of 10 predefined symptoms of circulatory insufficiency. Nonexposures to hypotension had the same definition as exposures, except the systolic blood pressure had to be more than 100 mm Hg during the entire out-of-hospital transport. The main outcome variable was inhospital mortality. Results: At venue 1, of 3,128 transports, 395 (13%) exposures and 395 nonexposures were identified. Inhospital mortality of exposures was 26% versus 8% for nonexposures (adjusted odds ratio [OR] 4.6; 95% confidence interval [CI] 2.0 to 5.9). At venue 2, of 7,679 transports, 532 exposures (7%) and 7,147 nonexposures were identified. Out-of-hospital exposure to hypotension conferred a mortality rate of 32% versus 11% for nonexposures (OR 3.0; 95% CI 2.4 to 3.7), representing a sensitivity of 18% and a specificity of 95%. Conclusion: The inhospital mortality rate after out-of-hospital, nontraumatic hypotension is high and reproducible. Future research should focus on ED clinical protocols to ensure appropriate resuscitation and investigation of etiology of out-of-hospital hypotension.

AB - Study objective: Out-of-hospital hypotension may signify need for intensive resuscitation and rapid diagnosis on emergency department (ED) arrival. We hypothesized that nontraumatic out-of-hospital hypotension confers risk of inhospital mortality. Methods: This was a multicenter study of ambulance-transported, nontrauma, noncardiopulmonary resuscitation patients conducted at 2 venues: (1) a cross-sectional risk assessment study of high-priority medical transports at a US metropolitan county; and (2) a Canadian prospective multicenter cohort study of patients with respiratory distress. Data at both venues were extracted from prospectively recorded, standardized run sheets by either a physician or a paramedic. Data extraction and analysis at each venue were conducted independently. Exposures to hypotension were defined as age older than 17 years old, systolic blood pressure less than 100 mm Hg during transport, and 1 or more of 10 predefined symptoms of circulatory insufficiency. Nonexposures to hypotension had the same definition as exposures, except the systolic blood pressure had to be more than 100 mm Hg during the entire out-of-hospital transport. The main outcome variable was inhospital mortality. Results: At venue 1, of 3,128 transports, 395 (13%) exposures and 395 nonexposures were identified. Inhospital mortality of exposures was 26% versus 8% for nonexposures (adjusted odds ratio [OR] 4.6; 95% confidence interval [CI] 2.0 to 5.9). At venue 2, of 7,679 transports, 532 exposures (7%) and 7,147 nonexposures were identified. Out-of-hospital exposure to hypotension conferred a mortality rate of 32% versus 11% for nonexposures (OR 3.0; 95% CI 2.4 to 3.7), representing a sensitivity of 18% and a specificity of 95%. Conclusion: The inhospital mortality rate after out-of-hospital, nontraumatic hypotension is high and reproducible. Future research should focus on ED clinical protocols to ensure appropriate resuscitation and investigation of etiology of out-of-hospital hypotension.

UR - http://www.scopus.com/inward/record.url?scp=0347359323&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0347359323&partnerID=8YFLogxK

U2 - 10.1016/j.annemergmed.2003.08.008

DO - 10.1016/j.annemergmed.2003.08.008

M3 - Article

C2 - 14707949

AN - SCOPUS:0347359323

VL - 43

SP - 106

EP - 113

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 1

ER -