Triage vital signs predict in-hospital mortality among emergency department patients with acute poisoning: a case control study

Abstract

Background: To document the relationship between triage vital signs and in-hospital mortality among emergency department (ED) patients with acute poisoning.

Methods: Poisoning patients who admitted to our emergency department during the study period were enrolled. Patient's demographic data were collected and odds ratios (OR) of triage vital signs to in-hospital mortality were assessed. Receiver operating characteristic curve was used to determine the proper cut-off value of vital signs that predict in-hospital mortality. Logistic regression analysis was performed to test the association of in-hospital mortality and vital signs after adjusting for different variables.

Results: 997 acute poisoning patients were enrolled, with 70 fatal cases (6.7%). A J-shaped relationship was found between triage vital signs and in-hospital mortality. ED triage vital signs exceed cut-off values independently predict in-hospital mortality after adjusting for variables were as follow: body temperature <36 or >37°C, p < 0.01, OR = 2.8; systolic blood pressure <100 or >150 mmHg, p < 0.01, OR: 2.5; heart rate <35 or >120 bpm, p < 0.01, OR: 3.1; respiratory rate <16 or >20 per minute, p = 0.38, OR: 1.4.

Conclusions: Triage vital signs could predict in-hospital mortality among ED patients with acute poisoning. A J-curve relationship was found between triage vital signs and in-hospital mortality. ED physicians should take note of the extreme initial vital signs in these patients.

Figure 1

Study protocol and patient grouping.^a Patients were excluded due to missing data, wrong registration or traumatic patients.

Figure 2

The odds ratio (OR) in different strata of initial vital signs at emergency department triage, including (A) systolic blood pressure, (B) body temperature, (C) heart rate, and (D) respiratory rate.

Figure 3

Receiver operating characteristic (ROC) curve for systolic blood pressure (SBP), body temperature (BT), heart rate (HR), and respiratory rate (RR). # Patients with paraquat intoxication were excluded in the figure B.