Chief Complaints, Underlying Diagnoses, and Mortality in Adult, Non-trauma Emergency Department Visits: A Population-based, Multicenter Cohort Study
Introduction: Knowledge about the relationship between symptoms, diagnoses, and mortality in emergency department (ED) patients is essential for the emergency physician to optimize treatment, monitoring, and flow. In this study, we investigated the association between symptoms and discharge diagnose...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2022-10-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/5f0497zg |
| _version_ | 1811218598899744768 |
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| author | Michael Dan Arvig Christian Backer Mogensen Helene Skjøt-Arkil Isik Somuncu Johansen Flemming Schønning Rosenvinge Annmarie Touborg Lassen |
| author_facet | Michael Dan Arvig Christian Backer Mogensen Helene Skjøt-Arkil Isik Somuncu Johansen Flemming Schønning Rosenvinge Annmarie Touborg Lassen |
| author_sort | Michael Dan Arvig |
| collection | DOAJ |
| description | Introduction: Knowledge about the relationship between symptoms, diagnoses, and mortality in emergency department (ED) patients is essential for the emergency physician to optimize treatment, monitoring, and flow. In this study, we investigated the association between symptoms and discharge diagnoses; symptoms and mortality; and we then analyzed whether the association between symptoms and mortality was influenced by other risk factors. Methods: This was a population-based, multicenter cohort study of all non-trauma ED patients ≥18 years who presented at a hospital in the Region of Southern Denmark between January 1, 2016–March 20, 2018. We used multivariable logistic regression to examine the association between symptoms and mortality adjusted for other risk factors. Results: We included 223,612 ED visits with a median patient age of 63 and even distribution of females and males. The frequency of the chief complaints at presentation were as follows: non-specific symptoms (19%); abdominal pain (16%); dyspnea (12%); fever (8%); chest pain (8%); and neurologic complaints (7%). Discharge diagnoses were symptom-based (24%), observational (hospital visit for observation or examination, 17%), circulatory (12%), or respiratory (12%). The overall 30-day mortality was 3.5%, with 1.7% dead within 0–7 days and 1.8% within 8–30 days. The presenting symptom was associated with mortality at 0–7 days but not with mortality at 8–30 days. Patients whose charts were missing documentation of symptoms (adjusted odds ratio [aOR] 3.5) and dyspneic patients (aOR 2.4) had the highest mortality at 0–7 days across patients with different primary symptoms. Patients ≥80 years and patients with a higher degree of comorbidity had increased mortality from 0–7 days to 8–30 days (aOR from 24.0 to 42.7 and 1.9 to 2.8, respectively). Conclusion: Short-term mortality was more strongly associated with patient-related factors than with the primary presenting symptom at arrival to the hospital. |
| first_indexed | 2024-04-12T07:12:12Z |
| format | Article |
| id | doaj.art-e6cadc25be354643a4b3fb6fe537a4f6 |
| institution | Directory Open Access Journal |
| issn | 1936-9018 |
| language | English |
| last_indexed | 2024-04-12T07:12:12Z |
| publishDate | 2022-10-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-e6cadc25be354643a4b3fb6fe537a4f62022-12-22T03:42:37ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-90182022-10-0123610.5811/westjem.2022.9.56332wjem-23-855Chief Complaints, Underlying Diagnoses, and Mortality in Adult, Non-trauma Emergency Department Visits: A Population-based, Multicenter Cohort StudyMichael Dan Arvig0Christian Backer Mogensen1Helene Skjøt-Arkil2Isik Somuncu Johansen3Flemming Schønning Rosenvinge4Annmarie Touborg Lassen5University of Southern Denmark, Department of Clinical Research, Odense, DenmarkUniversity Hospital of Southern Denmark, Department of Emergency Medicine, Aabenraa, DenmarkUniversity Hospital of Southern Denmark, Department of Emergency Medicine, Aabenraa, DenmarkUniversity of Southern Denmark, Odense University, Hospital, Open Patient data Explorative Network (OPEN), Odense, DenmarkOdense University Hospital, Department of Clinical Microbiology, Odense, DenmarkUniversity of Southern Denmark, Department of Clinical Research, Odense, DenmarkIntroduction: Knowledge about the relationship between symptoms, diagnoses, and mortality in emergency department (ED) patients is essential for the emergency physician to optimize treatment, monitoring, and flow. In this study, we investigated the association between symptoms and discharge diagnoses; symptoms and mortality; and we then analyzed whether the association between symptoms and mortality was influenced by other risk factors. Methods: This was a population-based, multicenter cohort study of all non-trauma ED patients ≥18 years who presented at a hospital in the Region of Southern Denmark between January 1, 2016–March 20, 2018. We used multivariable logistic regression to examine the association between symptoms and mortality adjusted for other risk factors. Results: We included 223,612 ED visits with a median patient age of 63 and even distribution of females and males. The frequency of the chief complaints at presentation were as follows: non-specific symptoms (19%); abdominal pain (16%); dyspnea (12%); fever (8%); chest pain (8%); and neurologic complaints (7%). Discharge diagnoses were symptom-based (24%), observational (hospital visit for observation or examination, 17%), circulatory (12%), or respiratory (12%). The overall 30-day mortality was 3.5%, with 1.7% dead within 0–7 days and 1.8% within 8–30 days. The presenting symptom was associated with mortality at 0–7 days but not with mortality at 8–30 days. Patients whose charts were missing documentation of symptoms (adjusted odds ratio [aOR] 3.5) and dyspneic patients (aOR 2.4) had the highest mortality at 0–7 days across patients with different primary symptoms. Patients ≥80 years and patients with a higher degree of comorbidity had increased mortality from 0–7 days to 8–30 days (aOR from 24.0 to 42.7 and 1.9 to 2.8, respectively). Conclusion: Short-term mortality was more strongly associated with patient-related factors than with the primary presenting symptom at arrival to the hospital.https://escholarship.org/uc/item/5f0497zg |
| spellingShingle | Michael Dan Arvig Christian Backer Mogensen Helene Skjøt-Arkil Isik Somuncu Johansen Flemming Schønning Rosenvinge Annmarie Touborg Lassen Chief Complaints, Underlying Diagnoses, and Mortality in Adult, Non-trauma Emergency Department Visits: A Population-based, Multicenter Cohort Study Western Journal of Emergency Medicine |
| title | Chief Complaints, Underlying Diagnoses, and Mortality in Adult, Non-trauma Emergency Department Visits: A Population-based, Multicenter Cohort Study |
| title_full | Chief Complaints, Underlying Diagnoses, and Mortality in Adult, Non-trauma Emergency Department Visits: A Population-based, Multicenter Cohort Study |
| title_fullStr | Chief Complaints, Underlying Diagnoses, and Mortality in Adult, Non-trauma Emergency Department Visits: A Population-based, Multicenter Cohort Study |
| title_full_unstemmed | Chief Complaints, Underlying Diagnoses, and Mortality in Adult, Non-trauma Emergency Department Visits: A Population-based, Multicenter Cohort Study |
| title_short | Chief Complaints, Underlying Diagnoses, and Mortality in Adult, Non-trauma Emergency Department Visits: A Population-based, Multicenter Cohort Study |
| title_sort | chief complaints underlying diagnoses and mortality in adult non trauma emergency department visits a population based multicenter cohort study |
| url | https://escholarship.org/uc/item/5f0497zg |
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