Prevalence of organ failure and mortality among patients in the emergency department: a population-based cohort study

Abstract

ObjectivesThe aim was to describe population-based incidence and emergency department-based prevalence and 1-year all-cause mortality of patients with new organ failure present at arrival.DesignThis was a population-based cohort study of all citizens in four municipalities (population of 230 000 adults).SettingEmergency department at Odense University Hospital, Denmark.ParticipantsWe included all adult patients who arrived from 1 April 2012 to 31 March 2015.Primary and secondary outcome measuresOrgan failure was defined as a modified Sequential Organ Failure Assessment score≥2 within six possible organ systems: cerebral, circulatory, renal, respiratory, hepatic and coagulation.The primary outcome was prevalence of organ failure, and secondary outcomes were 0–7 days, 8–30 days and 31–365 days all-cause mortality.ResultsWe identified in total 175 278 contacts, of which 70 399 contacts were further evaluated for organ failure. Fifty-two per cent of these were women, median age 62 (IQR 42–77) years. The incidence of new organ failure was 1342/100 000 person-years, corresponding to 5.2% of all emergency department contacts.The 0–7-day, 8–30-day and 31–365-day mortality was 11.0% (95% CI: 10.2% to 11.8%), 5.6% (95% CI: 5.1% to 6.2%) and 13.2% (95% CI: 12.3% to 14.1%), respectively, if the patient had one or more new organ failures at first contact in the observation period, compared with 1.4% (95% CI: 1.3% to 1.6%), 1.2% (95% CI: 1.1% to 1.3%) and 5.2% (95% CI: 5.0% to 5.4%) for patients without. Seven-day mortality ranged from hepatic failure, 6.5% (95% CI: 4.9% to 8.6%), to cerebral failure, 33.8% (95% CI: 31.0% to 36.8%), the 8–30-day mortality ranged from cerebral failure, 3.9% (95% CI: 2.8% to 5.3%), to hepatic failure, 8.6% (95% CI: 6.6% to 10.8%) and 31–365-day mortality ranged from cerebral failure, 9.3% (95% CI: 7.6% to 11.2%), to renal failure, 18.2% (95% CI: 15.5% to 21.1%).ConclusionsThe study revealed an incidence of new organ failure at 1342/100 000 person-years and a prevalence of 5.2% of all emergency department contacts. One-year all-cause mortality was 29.8% among organ failure patients.

Level of vital and laboratory values on arrival, and increased risk of 7-day mortality among adult patients in the emergency department: a population-based cohort study

“…Baseline characteristics of all first-time contacts within the study period. Parts of the baseline characteristics were previously presented in another study21 …”

A retrospective study on end-of-life care in the emergency department of a tertiary hospital in Singapore

“…This is congruent with the concept of the 'trajectories of death' 11,12 as patients who have an expected trajectory towards death include those with chronic frailty, and/or organ failure. 13,14 Frailty was described by Lunney et al 12 as those with 'steadily progressive disability before dying from complications such as those associated with advanced frailty of old age, stroke, or dementia' . Yet, only a handful of patients had a previous extent of care plan documented or had ACP done before.…”

“…15 However, across the board, rates of goals-of-care discussions are low. 16,17 Many physicians treating patients with limited life expectancies 14 have identified the barriers they face for this discussion. Various articles describe patient factors such as lack of readiness, family factors such as denial as well as physician factors such as the fear of destroying hope and difficult prognostication.…”

Organ failure, aetiology and 7-day all-cause mortality among acute adult patients on arrival to an emergency department: a hospital-based cohort study

“…This cohort has previously been described [ 16 , 17 ]. Briefly, this is an observational population-based study at Odense University Hospital, Denmark, on all adult acute patients presenting at the ED from 1 April 2012 to 31 March 2015.…”

“…Renal failure: Creatinine>171 µmol/L and earlier creatinine <171 µmol/L or never previously registered [ 16 ].…”