Key result
Among adults seeking urgent care, heart rate and systolic blood pressure combined with advanced age significantly predicted the probability of subsequent emergency department visits and hospitalization (p<0.0001).
Cross-Sectional (n=714,339)
Yes
In the urgent care setting, accepted normal ranges for systolic blood pressure may need to be redefined for older adults, as values below 100-110 mmHg are associated with a rapidly increasing risk of short-term morbidity and mortality.
May support vital sign-age triage in urgent care; hypothesis-generating and needs prospective validation before practice change.
INTRODUCTION: 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. CONCLUSION: 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.
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Hart et al. (2016) conducted a cross-sectional in Urgent care visits (n=714,339). Abnormal heart rate and systolic blood pressure vs. Normal heart rate and systolic blood pressure was evaluated on Emergency department visit within 3 days, hospitalization within 3 days, and death within 7 days (p=<0.0001). Among adults seeking urgent care, heart rate and systolic blood pressure combined with advanced age significantly predicted the probability of subsequent emergency department visits and hospitalization (p<0.0001).
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