title: The John Doe syndrome: diagnosis and outcome of patients unidentified at the time of emergency department admission.
abstract: Patients unidentified at the time of admission to urban emergency departments are a group about whom little is known. To determine the medical diagnoses and outcomes of these "John" and "Mary Does", we reviewed emergency department charts for these patients admitted from January 1 to December 31, 1988. During this period there were 344 initially unidentifiable patients, for 0.44% of all visits. Age was 36.9 +/- 15.6 years (mean +/- SD); 71% were male. All patients had one or more of the following diagnoses, with mortality highest for cardiopulmonary arrest (n = 42, mortality = 100%), followed by major trauma (163, 68%), drug overdose (27, 41%), miscellaneous medical conditions (11, 18%), neuropsychiatric disorders (59, 12%), acute alcohol intoxication (62, 0%), and seizures (13, 0%). Overall mortality was 47%. Identification was made prior to hospital discharge in 92% of cases. In this group, the most common sources of information were the patient (38%), family (19%), or documents eventually found on the person or in belongings (4%). Survivors were much more likely to be identified than those who died (99% versus 84%, P less than .0001). These observations describe a John Doe syndrome in patients whose identity is obscured by critical illness, the effects of drugs or alcohol, or neuropsychiatric disease. Economic privation is a major underlying risk factor.
authors.affiliation: Department of Emergency Medicine, Wayne State University Medical School, Detroit, MI.
authors.forename: P J
authors.initials: PJ
authors.lastname: Claps
authors.forename: W A
authors.initials: WA
authors.lastname: Berk
mesh_terms: D003933:Diagnosis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008824:Michigan; D009026:Mortality; D010343:Patient Admission; D010355:Patient Identification Systems; D010361:Patients / Q000145:classification*; D016896:Treatment Outcome