title: Decreased general condition in the emergency department: high in-hospital mortality and a broad range of discharge diagnoses.
abstract: BACKGROUND
  Decreased general condition (DGC) is a frequent presenting complaint within the Adaptive Triage Process. DGC describes a nonspecific decline in health and well-being, and it is common among elderly patients in the emergency department (ED).
  
  
  OBJECTIVE
  The aim of this study was to compare the in-hospital mortality among patients presenting with DGC with that among patients in the corresponding triage category presenting with other complaints to an ED. The secondary aim was to describe the discharge diagnoses of patients presenting with DGC.
  
  
  METHODS
  All patients admitted to Södersjukhuset from the ED in 2008 were included. The difference in the in-hospital mortality rate was stratified for triage category at the ED, between patients with DGC (n=1182) and those with all other presenting complaints (n=20 775), and assessed with sex-adjusted and age-adjusted logistic regression models. Discharge diagnoses were assessed as the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10) in the medical discharge notes.
  
  
  RESULTS
  A total of 1182 patients with DGC at the ED were admitted for in-hospital care, and they had a four-fold risk of suffering an in-hospital death [odds ratio 4.74 (95% confidence interval 3.88-5.78)] compared with patients presenting with other presenting complaints. The most common discharge diagnoses were diseases of the circulatory system (14%), respiratory system (14%), and genitourinary system (10%).
  
  
  CONCLUSIONS
  Patients presenting with DGC to an ED often receive low triage priority, frequently require admission for in-hospital care, and, because of the three-fold increased risk of in-hospital death compared with others, belong to a high-risk group.
authors.affiliation: Departments of aClinical Science and Education bMedicine cSection of Emergency Medicine, Karolinska Institute, Stockholm, Sweden.
authors.forename: Therese
authors.initials: T
authors.lastname: Djärv
authors.forename: Maaret
authors.initials: M
authors.lastname: Castrén
authors.forename: Linda
authors.initials: L
authors.lastname: Mårtenson
authors.forename: Lisa
authors.initials: L
authors.lastname: Kurland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012307:Risk Factors; D014218:Triage / Q000379:methods / Q000706:statistics & numerical data; D055815:Young Adult