title: Patterns and predictors of short-term death after emergency department discharge.
abstract: OBJECTIVE
  The emergency department (ED) is an inherently high-risk setting. Early death after an ED evaluation is a rare and devastating outcome; understanding it can potentially help improve patient care and outcomes. Using administrative data from an integrated health system, we describe characteristics and predictors of patients who experienced 7-day death after ED discharge.
  
  
  METHODS
  Administrative data from 12 hospitals were used to identify death after discharge in adults aged 18 year or older within 7 days of ED presentation from January 1, 2007, to December 31, 2008. Patients who were nonmembers of the health system, in hospice care, or treated at out-of-network EDs were excluded. Predictors of 7-day postdischarge death were identified with multivariable logistic regression.
  
  
  RESULTS
  The study cohort contained a total of 475,829 members, with 728,312 discharges from Kaiser Permanente Southern California EDs in 2007 and 2008. Death within 7 days of discharge occurred in 357 cases (0.05%). Increasing age, male sex, and number of preexisting comorbidities were associated with increased risk of death. The top 3 primary discharge diagnoses predictive of 7-day death after discharge included noninfectious lung disease (odds ratio [OR] 7.1; 95% confidence interval [CI] 2.9 to 17.4), renal disease (OR 5.6; 95% CI 2.2 to 14.2), and ischemic heart disease (OR 3.8; 95% CI 1.0 to 13.6).
  
  
  CONCLUSIONS
  Our study suggests that 50 in 100,000 patients in the United States die within 7 days of discharge from an ED. To our knowledge, our study is the first to identify potentially "high-risk" discharge diagnoses in patients who experience a short-term death after discharge.
authors.affiliation: Department of Medicine, University of California Los Angeles, USA. gelareh@gabayan.com
authors.forename: Gelareh Z
authors.initials: GZ
authors.lastname: Gabayan
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Derose
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Sau
authors.initials: S
authors.lastname: Yiu
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Lancaster
authors.forename: K Trudy
authors.initials: KT
authors.lastname: Poon
authors.forename: Jerome R
authors.initials: JR
authors.lastname: Hoffman
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality; D016015:Logistic Models; D008171:Lung Diseases / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009026:Mortality; D017202:Myocardial Ischemia / Q000401:mortality; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult