The chief complaint poor general condition represents a risk
Therese Djärv, Maaret Castrén & Lisa Kurland
CONCLUSION
Patients presenting with poor general condition have a high mortality rate, both overall and in each corresponding triage category, which exceeds that of the average for other patients presenting to the ED with a factor of 3‐14.Patients presenting with poor general condition as chief complaint represent a so far unrecognized high risk group in EDs. INTRODUCTION
Decreased general condition (DGC) is a common, although unspecific chief complaint .
There is no stringent definition of DGC.
Aim: to measure in‐hospital mortality and discharge diagnosis among patients with DGC METHOD
All patients admitted to Södersjukhuset, Sweden from the ED during 2008 were included. Patients with DGC (n=909) and patients with all other chief complaints (n= 20 775) were used as a reference group.
In‐hospital mortality rate was stratified for ED triage category and assessed with sex and age adjusted logistic regression models. Discharge diagnosis were assessed according to ICD‐10 . Figure. Odds Ratio for suffering an in‐hospital death stratified for triage priority (highest red‐ lowest green) between patients with poor general condition as chief complaints compared to all other chief complaints at Södersjukhuset Emergency Department, Sweden
RESULTS
909 patients with DGC were admitted to in‐hospital care and they received less often (than controls) the two highest triage categories (red, 3% and 11%, as well as orange 14% and 29%, respectively) (p‐
values <0.01). Further, they had at least a tripled risk of suffering an in‐hospital death, overall odds ratio 3.56 (3.02‐4.63 95% CI) (Figure). The discharge diagnoses with the highest mortality rates were related to neoplasms, infections and the circulatory system (Table).
Table. Top three discharge diagnosis according to ICD‐10 with the highest mortality rates . Top three high‐mortality discharge diagnosis
Neoplams (C00‐D48)
83 (9)
30 (36)
Certain infections and parasitic diseases (A00‐B99)
74 (8)
19 (26)
Diseases of circulatory system (I00‐I99)
128 (14) 25 (20)
The study was published as: Djarv, T., et al., Decreased general condition in the emergency
department: high in-hospital mortality and a broad range of discharge diagnoses. Eur J
Emerg Med, 2015. 22(4): p. 241-6.
Therese Djärv
MD PhD
[email protected]
Karolinska Institutet