title: Adverse events and death in stroke patients admitted to the emergency department of a tertiary university hospital.
abstract: OBJECTIVE
  To identify the occurrence of adverse events in stroke patients presenting to the emergency department of a tertiary university facility, and to disclose the categories of adverse events associated with death.
  
  
  METHODS
  This matched case-control study enrolled 468 patients admitted with stroke to the emergency department from March 1996 to September 1999. The cases comprised 234 consecutive deaths and the controls 234 discharged patients, matched for primary diagnosis and admission period. Adverse events, detected by chart review, were classified according to the degree of severity, immediate causes, and professional category. The association with death was analysed by conditional logistic regression.
  
  
  RESULTS
  Adverse events totaled 1218 and occurred in 295 patients: 932 events (76.5%) in 170 cases and 286 (23.5%) in 125 controls. Major adverse events equaled 54.1% of all events (659 episodes): 538 events in 143 cases and 121 in 65 controls. Diagnostic or therapeutic procedures and nursing activities accounted for 55.2% of events. Nursing (38.4%) and medical (31%) adverse events represented the most common related professional categories. A significant association with death was found for major adverse events, medical adverse events, and nosocomial infections, with adjusted odds ratio estimates of 3.74 [95% confidence interval (CI) 1.64-8.54], 3.71 (95% CI 1.61-8.53), and 3.22 (95% CI 1.21-8.59), respectively.
  
  
  CONCLUSIONS
  Adverse events, mostly severe, predominated among deceased patients, resulting mainly from diagnostic or therapeutic procedures and nursing activities. In spite of limitations concerning the observational retrospective nature of this study, we found that severe adverse events, medical adverse events, and nosocomial infections were significantly associated with death in stroke patients.
authors.affiliation: Department of Medical Emergency Medicine, School of Medicine, University of São Paulo, São Paulo, SP, Brazil. renatagallotti@terra.com.br
authors.forename: Renata
authors.initials: R
authors.lastname: Daud-Gallotti
authors.forename: Hillegonda Maria
authors.initials: HM
authors.lastname: Dutilh Novaes
authors.forename: Maria Cecília
authors.initials: MC
authors.lastname: Lorenzi
authors.forename: José
authors.initials: J
authors.lastname: Eluf-Neto
authors.forename: Mirna
authors.initials: M
authors.lastname: Namie Okamura
authors.forename: Irineu
authors.initials: I
authors.lastname: Tadeu Velasco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D002423:Cause of Death; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality*