title: The Emergency Department presenting complaint as predictor of in-hospital fatality.
abstract: BACKGROUND
  The relationship between major discharge diagnoses and prediction of in-hospital death has been intensively studied. The relation between the presenting complaint at the Emergency Department (ED) and in-hospital fatality, however, is less well known.
  
  
  OBJECTIVE
  To investigate if presenting complaints add information regarding in-hospital fatality risk for nonsurgical ED patients.
  
  
  METHODS
  Investigating the relationship of in-hospital fatality rate and presenting complaint by comparing the presenting complaints, discharge diagnoses and in-hospital fatality for all nonsurgical patients visiting the ED during 1 year.
  
  
  RESULTS
  Of 12,995 nonsurgical admissions, 40% were treated as in-hospital patients. Among these, 328 in-hospital deaths occurred. Age was the most powerful predictor of death in hospitalized patients (P<0.0001). After adjustment for age, the female sex was found to be protective [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.92, P=0.007)]. Compared with the largest complaint group, chest pain with an in-hospital fatality rate of 2.5%, there was a significantly increased risk of dying among those with stroke-like symptoms (OR 2.04, 95% CI 1.35-3.08, P=0.0007), dyspnoea (OR 1.95, 95% CI 1.27-3.00, P=0.002) or general disability (OR 1.81, 95% CI 1.17-2.79, P=0.008).
  
  
  CONCLUSIONS
  The presenting complaint at the ED carries valuable information of the risk for in-hospital fatality in nonsurgical patients. This knowledge can be valuable in the prioritization between different patient groups in the process of initiating diagnostics and treatment procedures at the ED.
authors.affiliation: Department of Medicine, Uppsala University Hospital, Uppsala, Sweden. urban.safwenberg@medsci.uu.se
authors.forename: Urban
authors.initials: U
authors.lastname: Safwenberg
authors.forename: Andreas
authors.initials: A
authors.lastname: Terént
authors.forename: Lars
authors.initials: L
authors.lastname: Lind
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000175:diagnosis; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis