title: Emergency department tachypnea predicts transfer to a higher level of care in the first 24 hours after ED admission.
abstract: OBJECTIVE
  The authors hypothesized that vital sign abnormalities detected in the emergency department (ED) can be used to forecast clinical deterioration occurring within 24 hours of hospital admission.
  
  
  METHODS
  This was a retrospective case-control study performed after implementation of a hospitalwide rapid response team (RRT) system. Inclusion criteria for study patients consisted of age > or = 18 years, admission to the general floor though the ED, and RRT activation and subsequent transfer to a higher level of care in the first 24 hours. Control patients were > or =18 years, were admitted to the floor though the ED, never required RRT or transfer to a higher level of care, and were matched to cases by risk of mortality. Multilevel logistic regression was used to model the odds of an adverse outcome as a function of race and sex, respiratory rate (RR), heart rate (HR), and systolic (sBP) and diastolic blood pressure (dBP) at time of transfer from the ED.
  
  
  RESULTS
  A total of 74 cases and 246 controls were used. RR (odds ratio [OR] = 2.79 per 10-point change, 95% confidence interval [CI] = 1.41 to 5.51) and to a lesser extent dBP (OR = 0.81, 95% CI = 0.67 to 0.97) contributed significantly to the odds of intensive care unit (ICU) or intermediate care transfer within 24 hours of admission; HR (OR = 1.15, 95% CI = 0.98 to 1.37) did not.
  
  
  CONCLUSIONS
  Emergency department RR preceding floor transfer appears to have a significant relationship to the need for ICU or intermediate care transfer in the first 24 hours of hospital admission.
authors.affiliation: Christiana Care Health System, Newark, DE, USA. hfarley@christianacare.org
authors.forename: Heather
authors.initials: H
authors.lastname: Farley
authors.forename: Marc T
authors.initials: MT
authors.lastname: Zubrow
authors.forename: Jonna
authors.initials: J
authors.lastname: Gies
authors.forename: Paul
authors.initials: P
authors.lastname: Kolm
authors.forename: Susan
authors.initials: S
authors.lastname: Mascioli
authors.forename: Donna D
authors.initials: DD
authors.lastname: Mahoney
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003691:Delaware / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010360:Patient Transfer; D011237:Predictive Value of Tests; D056152:Respiratory Rate; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors