title: Outcome of hypotensive ward patients who re-deteriorate after initial stabilization by the Medical Emergency Team.
abstract: OBJECTIVE
  We evaluated the outcome of hypotensive ward patients who re-deteriorated after initial stabilization by the Medical Emergency Team (MET) in our hospital, due to limited data in this regard.
  
  
  METHODS
  One thousand one hundred seventy-nine MET calls in 32184 ward patients from January 2009 to August 2011 were evaluated. Four hundred ten hypotensive patients met study criteria and were divided into: (1)"Immediate Transfers (IT), n = 136":admitted by MET to intensive care unit (ICU) immediately; (2)"Re-deteriorated Transfers (RDT) n = 72":initially stabilized and signed off by MET, but later re-deteriorated within 48-hours and admitted to ICU; (3)"Ward Patients (WP) n = 202": remained stable on ward after treatment.
  
  
  RESULTS
  The RDT and IT had similar APACHE II scores (20.2 ± 5.1 vs. 19.8 ± 4.8; P=.57], but RDT showed hemodynamic stabilization with initial MET resuscitation. Patients who re-deteriorated were younger, took longer for eventual ICU transfer, had higher initial lactic acid and delayed normalization as compared to IT (P < .04). The re-deterioration predominantly occurred within 8-hours of MET evaluation. RDT had higher 28-day mortality than IT and WP; 42% vs. 27% vs. 7% respectively (P < .03). RDT also had a higher rate of endotracheal intubation and worse ICU mortality (P < .01).
  
  
  CONCLUSIONS
  Hypotensive ward patients who re-deteriorate after initial stabilization have higher mortality. METs should consider implementing at least an 8-hour follow-up in patients who are deemed stable to remain on the wards after hypotensive episodes.
authors.affiliation: John D. Dingell VA Medical Center, Detroit, MI, USA; King Faisal Specialist Hospital and Research Center, Jeddah Saudi Arabia. Electronic address: dr.imrankhalid@yahoo.com.
authors.forename: Imran
authors.initials: I
authors.lastname: Khalid
authors.affiliation: King Faisal Specialist Hospital and Research Center, Jeddah Saudi Arabia.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Qabajah
authors.affiliation: John D. Dingell VA Medical Center, Detroit, MI, USA.
authors.forename: Wasfy J
authors.initials: WJ
authors.lastname: Hamad
authors.affiliation: King Faisal Specialist Hospital and Research Center, Jeddah Saudi Arabia.
authors.forename: Tabindeh Jabeen
authors.initials: TJ
authors.lastname: Khalid
authors.affiliation: Henry Ford Health System, Detroit, MI, USA.
authors.forename: Bruno
authors.initials: B
authors.lastname: Digiovine
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006801:Humans; D007022:Hypotension / Q000503:physiopathology* / Q000628:therapy*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012151:Resuscitation; D012189:Retrospective Studies
keywords: Hypotension; Intensive care unit transfer; Medical emergency team; Mortality; Ward patients