title: Shock in the emergency department; a 12 year population based cohort study.
abstract: BACKGROUND
  The knowledge of the frequency and associated mortality of shock in the emergency department (ED) is limited. The aim of this study was to describe the incidence, all-cause mortality and factors associated with death among patients suffering shock in the ED.
  
  
  METHODS
  Population-based cohort study at an University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. All patients aged ≥18 years living in the hospital catchment area with a first time ED presentation with shock (n = 1646) defined as hypotension (systolic blood pressure (SBP) ≤100 mmHg)) and ≥1 organ failures. Outcomes were annual incidence per 100,000 person-years at risk (pyar), all-cause mortality at 0-7, and 8-90 days and risk factors associated with death.
  
  
  RESULTS
  We identified 1646 of 438,191 (0.4 %) ED patients with shock at arrival. Incidence of shock increased from 53.8 to 80.6 cases per 100,000 pyar. The 7-day, and 90-day mortality was 23.1 % (95 % CI: 21.1-25.1) and 40.7 % (95 % CI: 38.3-43.1), respectively. Independent predictors of 7-day mortality were: age (adjusted HR 1.03 (95 % CI: 1.03-1.04), and number of organ failures (≥3 organ failures; adjusted HR 3.13 95 % CI: 2.28-4.30). Age, comorbidity level and number of organ failure were associated with 90-day mortality.
  
  
  CONCLUSIONS
  Shock is a frequent and critical finding in the ED, carrying a 7- and, 90- day mortality of 23.1 and 40.7 %, respectively. Age and number of organ failures are independent prognostic factors for death within 7 days, whereas age, comorbidity and organ failures are of significance within 8-90 days.
authors.affiliation: Department of Emergency Medicine, Odense University Hospital, Sdr Boulevard 29, Entrance 130, 1. Floor 5000, Odense C, Denmark. Jon.Gitz.Holler@dadlnet.dk.
authors.forename: Jon Gitz
authors.initials: JG
authors.lastname: Holler
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark.
authors.forename: Daniel Pilsgaard
authors.initials: DP
authors.lastname: Henriksen
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital, Odense C, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Mikkelsen
authors.affiliation: Centre for Individualized Medicine in Arterial Diseases (CIMA) Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark.
authors.forename: Lars Melholt
authors.initials: LM
authors.lastname: Rasmussen
authors.affiliation: Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark.
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
authors.affiliation: Department of Emergency Medicine, Odense University Hospital, Sdr Boulevard 29, Entrance 130, 1. Floor 5000, Odense C, Denmark.
authors.forename: Annmarie Touborg
authors.initials: AT
authors.lastname: Lassen
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005544:Forecasting; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012769:Shock / Q000453:epidemiology* / Q000628:therapy
keywords: Epidemiology; Incidence; Mortality; Shock