title: Physiological status during emergency department care: relationship with inhospital death after clinical deterioration.
abstract: OBJECTIVE
  To examine the relationship between patient physiological status in the emergency department (ED) and inhospital mortality after rapid response team (RRT) or cardiac arrest team (CAT) activations within 72 hours of emergency admission to medical or surgical wards.
  
  
  METHODS
  A multisite, retrospective, cohort study of 660 randomly selected (220 patients per site) adult medical or surgical patients who were admitted from the ED during 2012 and who had had an RRT or CAT activation within 72 hours of admission, at three hospitals in Melbourne, Australia.
  
  
  METHODS
  Inhospital mortality.
  
  
  RESULTS
  There were 825 RRT activations (for 634 patients) and 42 CAT activations (for 35 patients). The median time to the first RRT or CAT activation was 18.8 hours and was significantly shorter in patients who died in hospital (14.6 v 20.6 hours, P=0.036). Compared with survivors, patients who died were more likely to have at least one observation meeting RRT criteria during their ED stay (45.9% v 34.8%; P=0.029): tachypnoea (21.1% v 13.4%, P=0.039), hypotension (20.2% v 11.8%, P=0.018), hypoxaemia (8.3% v 3.1%, P=0.001) and altered conscious state (6.2% v 1.3%, P=0.001) were more common in patients who died. The risk-adjusted odds ratio (OR) for inhospital death was highest for patients with an altered conscious state during their ED stay (OR, 4.633; 95% CI, 1.365-15.728; P=0.014).
  
  
  CONCLUSIONS
  In patients who needed an RRT or CAT activation within the first 72 hours of emergency admission to medical or surgical wards, there was a strong association between physiological derangement during ED care and inhospital death.
authors.affiliation: Deakin University, Melbourne, VIC, Australia. julie.considine@deakin.edu.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Considine
authors.affiliation: Austin Health, Melbourne, VIC, Australia.
authors.forename: Daryl
authors.initials: D
authors.lastname: Jones
authors.affiliation: Austin Health, Melbourne, VIC, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Pilcher
authors.affiliation: Deakin University, Melbourne, VIC, Australia.
authors.forename: Judy
authors.initials: J
authors.lastname: Currey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006304:Health Status; D006323:Heart Arrest / Q000628:therapy*; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies