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Association between persistent tachycardia and tachypnea and in-hospital mortality among non-hypotensive emergency department patients admitted to the hospital

View Article: PubMed Central - PubMed

ABSTRACT

Objective: Vital sign trends are used in clinical practice to assess treatment response and aid in disposition, yet quantitative data to support this practice are lacking. This study aimed to determine the prognostic value of vital sign normalization.

Methods: Secondary analysis of a prospective cohort of adult emergency department (ED) patients admitted a single urban tertiary care hospital. A random sample of 182 days was chosen, and a manual review of all admissions was undertaken. Persistent tachycardia or tachypnea was defined as failure to decrease to a normal value in the ED. Elevated upon admission was defined as an abnormal value at the last set of vital signs documented. The primary outcome was in-hospital mortality.

Results: 4,878 patients were enrolled and 4.5 (±3.8) sets of vital signs were checked per patient. 1,770 patients were tachycardic and 1,499 were tachypneic. Among tachycardic patients, 941 (53%) were persistently tachycardic and 1,074 (61%) were tachycardic upon admission. Among tachypneic patients 639 (42%) were persistently tachypneic and 768 (51%) were tachypneic upon admission. Mortality was higher in patients persistently tachycardic (5.7% vs. 3.1%, P=0.008) or tachycardic upon admission (5.5% vs. 3.0%, P=0.014). Similar results were found in tachypneic patients (8.3% vs. 4.5%, P=0.003; 7.8% vs. 4.4%, P=0.006).

Conclusion: Persistent tachycardia and tachypnea are associated with an increased risk of mortality in ED patients admitted to the hospital. Further study is necessary to determine if improved recognition or earlier interventions can affect outcomes.

No MeSH data available.


Relative mortality associated with the persistence of tachycardia and/or tachypnea in patients with both measures abnormal at emergency department triage (P=0.08). Note that persistent tachypnea tends to carry a worse prognosis than persistent tachycardia.
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f2-ceem-16-144: Relative mortality associated with the persistence of tachycardia and/or tachypnea in patients with both measures abnormal at emergency department triage (P=0.08). Note that persistent tachypnea tends to carry a worse prognosis than persistent tachycardia.

Mentions: Finally, we attempted to determine whether persistent tachypnea and tachycardia were independently associated with increased risk of mortality, or whether they were different metrics that identified the same group of patients. Eight hundred and fourteen patients demonstrated both initial tachycardia and tachypnea. Normalization of these two parameters in the ED were independent of each other by chi-square testing (P<0.001). Mortality was highest in patients who had persistence of both tachycardia and tachypnea throughout their ED stay at 8.1%, and was lowest among patients who normalized both (3.9%) as illustrated in Fig. 2. However, these results did not reach statistical significance in the stratified analysis (P=0.08).


Association between persistent tachycardia and tachypnea and in-hospital mortality among non-hypotensive emergency department patients admitted to the hospital
Relative mortality associated with the persistence of tachycardia and/or tachypnea in patients with both measures abnormal at emergency department triage (P=0.08). Note that persistent tachypnea tends to carry a worse prognosis than persistent tachycardia.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5385508&req=5

f2-ceem-16-144: Relative mortality associated with the persistence of tachycardia and/or tachypnea in patients with both measures abnormal at emergency department triage (P=0.08). Note that persistent tachypnea tends to carry a worse prognosis than persistent tachycardia.
Mentions: Finally, we attempted to determine whether persistent tachypnea and tachycardia were independently associated with increased risk of mortality, or whether they were different metrics that identified the same group of patients. Eight hundred and fourteen patients demonstrated both initial tachycardia and tachypnea. Normalization of these two parameters in the ED were independent of each other by chi-square testing (P<0.001). Mortality was highest in patients who had persistence of both tachycardia and tachypnea throughout their ED stay at 8.1%, and was lowest among patients who normalized both (3.9%) as illustrated in Fig. 2. However, these results did not reach statistical significance in the stratified analysis (P=0.08).

View Article: PubMed Central - PubMed

ABSTRACT

Objective: Vital sign trends are used in clinical practice to assess treatment response and aid in disposition, yet quantitative data to support this practice are lacking. This study aimed to determine the prognostic value of vital sign normalization.

Methods: Secondary analysis of a prospective cohort of adult emergency department (ED) patients admitted a single urban tertiary care hospital. A random sample of 182 days was chosen, and a manual review of all admissions was undertaken. Persistent tachycardia or tachypnea was defined as failure to decrease to a normal value in the ED. Elevated upon admission was defined as an abnormal value at the last set of vital signs documented. The primary outcome was in-hospital mortality.

Results: 4,878 patients were enrolled and 4.5 (&plusmn;3.8) sets of vital signs were checked per patient. 1,770 patients were tachycardic and 1,499 were tachypneic. Among tachycardic patients, 941 (53%) were persistently tachycardic and 1,074 (61%) were tachycardic upon admission. Among tachypneic patients 639 (42%) were persistently tachypneic and 768 (51%) were tachypneic upon admission. Mortality was higher in patients persistently tachycardic (5.7% vs. 3.1%, P=0.008) or tachycardic upon admission (5.5% vs. 3.0%, P=0.014). Similar results were found in tachypneic patients (8.3% vs. 4.5%, P=0.003; 7.8% vs. 4.4%, P=0.006).

Conclusion: Persistent tachycardia and tachypnea are associated with an increased risk of mortality in ED patients admitted to the hospital. Further study is necessary to determine if improved recognition or earlier interventions can affect outcomes.

No MeSH data available.