Key result
Emergency department respiratory rate predicted the need for ICU or intermediate care transfer within 24 hours of admission (OR 2.79 per 10-point change; 95% CI 1.41 to 5.51).
Why the study?
Do vital sign abnormalities (specifically tachypnea) in the emergency department predict clinical deterioration and transfer to a higher level of care within 24 hours of admission in adults?
Case-Control (n=320)
Do vital sign abnormalities (specifically tachypnea) in the emergency department predict clinical deterioration and transfer to a higher level of care within 24 hours of admission in adults?
Odds Ratio: 2.79 (95% CI 1.41–5.51)
Emergency department respiratory rate preceding floor transfer is a significant predictor of the need for ICU or intermediate care transfer within the first 24 hours of admission.
ED respiratory rate was associated with early transfer risk; hypothesis-generating for vital sign–based triage pending prospective validation.
OBJECTIVES: The authors hypothesized that vital sign abnormalities detected in the emergency department (ED) can be used to forecast clinical deterioration occurring within 24 hours of hospital admission. METHODS: This was a retrospective case-control study performed after implementation of a hospitalwide rapid response team (RRT) system. Inclusion criteria for study patients consisted of age > or = 18 years, admission to the general floor though the ED, and RRT activation and subsequent transfer to a higher level of care in the first 24 hours. Control patients were > or =18 years, were admitted to the floor though the ED, never required RRT or transfer to a higher level of care, and were matched to cases by risk of mortality. Multilevel logistic regression was used to model the odds of an adverse outcome as a function of race and sex, respiratory rate (RR), heart rate (HR), and systolic (sBP) and diastolic blood pressure (dBP) at time of transfer from the ED. RESULTS: A total of 74 cases and 246 controls were used. RR (odds ratio [OR] = 2.79 per 10-point change, 95% confidence interval [CI] = 1.41 to 5.51) and to a lesser extent dBP (OR = 0.81, 95% CI = 0.67 to 0.97) contributed significantly to the odds of intensive care unit (ICU) or intermediate care transfer within 24 hours of admission; HR (OR = 1.15, 95% CI = 0.98 to 1.37) did not. CONCLUSIONS: Emergency department RR preceding floor transfer appears to have a significant relationship to the need for ICU or intermediate care transfer in the first 24 hours of hospital admission.
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Farley et al. (2010) conducted a case-control in Clinical deterioration within 24 hours of hospital admission (n=320). Respiratory rate (RR) was evaluated on Intensive care unit (ICU) or intermediate care transfer within 24 hours of admission (OR 2.79, 95% CI 1.41 to 5.51). Emergency department respiratory rate predicted the need for ICU or intermediate care transfer within 24 hours of admission (OR 2.79 per 10-point change; 95% CI 1.41 to 5.51).
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