ObjectiveTo identify the demographic patterns of mortality, the time spent before death in the emergency department (ED), and the causes of fatal outcomes.MethodsWe performed a 5-year (01/01/2011 to 01/01/2016) retrospective analysis of all non-traumatic deaths in the ED of the UMHAT – Pleven. To extract the necessary information, we used the registers in the ED until the patients’ death.ResultsAmong 156,848 patients in the study period, 381 died and the mortality rate was 2.4/100000. The male:female ratio was 1.48:1. The 71–80 years age group was the most affected. The mean (SD) age of patients who died in the ED was 69.9 ± 8.4 years. Most non-traumatic deaths (222 cases) were due to cardiovascular disease. Most patients (70.9%) died within 2.3 h after arrival. The factors contributing to mortality included poverty, transporting the patient to hospital too late, and a lack of developed care centres for terminally ill patients.ConclusionMost patients die within approximately 2 h after arrival at the ED. The main cause of death is acute myocardial infarction. Pulmonary embolism remains unrecognized in most patients (69%). Oncological pathology is among the main causes (7.4%) of mortality.

Summary We performed a retrospective evaluation of the criteria for suspected pulmonary embolism (PE) and requests for computed tomography angiography (CTA) by the emergency room (ER) teams. Simultaneously, we tried to find irregularities in their work. Then we designed new behavioral protocols, and yearly we evaluated the effect on the workload of the computed tomography (CT) unit of the Roentgenology and Radiology at the University Hospital – Pleven and the total impact on the behavior of the teams in cases of suspected for PE. The data from before and after the intervention was evaluated. After the implementation of the protocols, matching the criteria of PE rule-out criteria (PERC), the number of D-dimer testing, echocardiography, and computed tomography pulmonary angiographies (CTPA) was significantly higher. We found that the number of patients urgently transported for primary thrombectomy had increased, and the reduction of PE mortality in the Emergency Unit proves the safety of our intervention. Overall, the intervention in the attitude of the ER teams has a significant positive effect on the management of patients with suspected PE.

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