Association of Age, Systolic Blood Pressure, and Heart Rate with Adult Morbidity and Mortality after Urgent Care Visits.
BACKGROUND
Little data exists to help urgent care (UC) clinicians predict morbidity and mortality risk. Age, systolic blood pressure (SBP), and heart rate (HR) are easily obtainable and have been used in other settings to predict short-term risk of deterioration. We hypothesized that there is a relationship between advancing age, SBP, HR, and short-term health outcomes in the UC setting.


METHODS
We collected retrospective data from 28 UC clinics and 22 hospitals in the Intermountain Healthcare system between years 2008-2013. Adult patients (≥18 years) were included if they had a unique UC visit and HR or SBP data. Three endpoints following UC visit were assessed: emergency department (ED) visit within three days, hospitalization within three days, and death within seven days. We analyzed associations between age, SBP, HR and endpoints using local regression with a binomial likelihood. Five age groups were chosen from previously published national surveys. Vital sign (VS) distributions were determined for each age group, and the central tendency was compared against previously published norms (90-120mmHg for SBP and 60-100bpm for HR.).


RESULTS
A total of 1,720,207 encounters (714,339 unique patients) met the inclusion criteria; 51,446 encounters (2.99%) had ED visit within three days; 12,397 (0.72%) experienced hospitalization within three days; 302 (0.02%) died within seven days of UC visit. Heart rate and SBP combined with advanced age predicted the probability of ED visit (p<0.0001) and hospitalization (p<0.0001) following UC visit. Significant associations between advancing age and death (p<0.0001), and VS and death (p<0.0001) were observed. Odds ratios of risk were highest for elderly patients with lower SBP or higher HR. Observed distributions of SBP were higher than published normal ranges for all age groups.


CONCLUSIONS
Among adults seeking care in the UC, associations between HR and SBP and likelihood of ED visits and hospitalization were more pronounced with advancing age. Death following UC visit had a more limited association with advancing age or the VS evaluated. Rapidly increasing risk below SBP of 100-110 mmHg in older patients suggests that accepted normal ranges for SBP may need to be redefined for patients treated in the UC clinic.
Intermountain Healthcare, Intermountain Instacare, Salt Lake City, Utah.
James
J
Hart
Intermountain Healthcare, Intermountain Medical Center, Department of Emergency Medicine, Salt Lake City, Utah; Intermountain Healthcare, Quality and Patient Safety, Salt Lake City, Utah.
Michael
M
Woodruff
Intermountain Healthcare, Community Benefit, Salt Lake City, Utah.
Elizabeth
E
Joy
Intermountain Healthcare, Quality and Patient Safety, Salt Lake City, Utah.
Joseph
J
Dalto
Intermountain Healthcare, Office of Research, Salt Lake City, Utah.
Gregory
G
Snow
Intermountain Healthcare, Office of Research, Salt Lake City, Utah; Intermountain Healthcare, Institute for Healthcare Leadership, Salt Lake City, Utah; Intermountain Healthcare, Intermountain Medical Center, Department of Medicine, Salt Lake City, Utah; University of Utah School of Medicine, Department of Pediatrics, Salt Lake City, Utah.
Rajendu
R
Srivastava
Intermountain Healthcare, Office of Research, Salt Lake City, Utah.
Brad
B
Isaacson
Intermountain Healthcare, Intermountain Medical Center, Department of Emergency Medicine, Salt Lake City, Utah; Intermountain Healthcare, Institute for Healthcare Leadership, Salt Lake City, Utah.
Todd
T
Allen
D000328:Adult; D000368:Aged; D000375:Aging; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006339:Heart Rate; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data*; D009026:Mortality; D010820:Physicians; D012189:Retrospective Studies; D012307:Risk Factors