Characteristics, management and outcome of critically ill general medical patients in the Emergency Department: An observational study. (January 2021)

• Record Type: Journal Article
• Authors: Engebretsen, Stine; Bogstrand, Stig Tore; Jacobsen, Dag; Rimstad, Rune
• Is Part Of: International emergency nursing. Volume 54(2021)
• Publication Date: 2021-01
• Subjects: Emergency Service, Hospital -- Critical Care -- Internal medicine -- Patient Care Management -- Hospital Rapid Response Team; Emergency nursing -- Periodicals; 616.025
• DOI: 10.1016/j.ienj.2020.100939
• Languages: English
• ISSNs: 1755-599X

Abstract

Highlights: Triage 1 patients were relatively young and with few comorbidities. Almost half had National Early Warning Score 2 lower than 7, and a large proportion were diagnosed with acute poisoning. Young age, male gender and higher National Early Warning Score 2, were factors associated with ICU admittance. ED length of stay was short, especially if admitted to ICU, potentially due to management by a multidisciplinary team. Abstract: Background: Critically ill general medical patients are an increasing group in the Emergency Department (ED). This register-based cohort study aimed to examine these patients' characteristics, ED management and outcome, and investigate factors associated with ICU admission. Methods: The study comprised all adult medical triage 1 patients treated by a specialized multidisciplinary team in 2015 and 2016. Univariate and multivariate analysis were used. Results: 1294 patients were included. Mean age was 59 years, 56% (n = 725) were male, mean National Early Warning Score 2 (NEWS2) was 7, intensive care unit (ICU) admission was 56.8% (n = 735) and mortality rate was 16.8% (n = 217). Median ED length of stay (LOS) was 1.6 h, 1.2 h if admitted to ICU. The most frequent discharge diagnosis was acute poisoning (24.0%, n = 308). Younger age, male gender, arriving at nighttime weekdays, higher NEWS2 at arrival, critical care interventions or medications in the ED was associated with ICU admission. Conclusion: More than half of the patients were admitted to ICU, and the mortality rate was 16.8%. A large proportion was diagnosed with acute poisoning. Younger age, higher NEWS and critical care in ED were associated with ICU admission. The short ED LOS suggests that management by a multidisciplinary team is beneficial.