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. 2016 Jun 30:24:87.
doi: 10.1186/s13049-016-0280-x.

Shock in the emergency department; a 12 year population based cohort study

Jon Gitz Holler  1 , Daniel Pilsgaard Henriksen  2 , Søren Mikkelsen  3 , Lars Melholt Rasmussen  4 , Court Pedersen  5 , Annmarie Touborg Lassen  6
Affiliations

Shock in the emergency department; a 12 year population based cohort study

Jon Gitz Holler et al. Scand J Trauma Resusc Emerg Med. .

Erratum in

Abstract

Background: The knowledge of the frequency and associated mortality of shock in the emergency department (ED) is limited. The aim of this study was to describe the incidence, all-cause mortality and factors associated with death among patients suffering shock in the ED.

Methods: Population-based cohort study at an University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. All patients aged ≥18 years living in the hospital catchment area with a first time ED presentation with shock (n = 1646) defined as hypotension (systolic blood pressure (SBP) ≤100 mmHg)) and ≥1 organ failures. Outcomes were annual incidence per 100,000 person-years at risk (pyar), all-cause mortality at 0-7, and 8-90 days and risk factors associated with death.

Results: We identified 1646 of 438,191 (0.4 %) ED patients with shock at arrival. Incidence of shock increased from 53.8 to 80.6 cases per 100,000 pyar. The 7-day, and 90-day mortality was 23.1 % (95 % CI: 21.1-25.1) and 40.7 % (95 % CI: 38.3-43.1), respectively. Independent predictors of 7-day mortality were: age (adjusted HR 1.03 (95 % CI: 1.03-1.04), and number of organ failures (≥3 organ failures; adjusted HR 3.13 95 % CI: 2.28-4.30). Age, comorbidity level and number of organ failure were associated with 90-day mortality.

Conclusion: Shock is a frequent and critical finding in the ED, carrying a 7- and, 90- day mortality of 23.1 and 40.7 %, respectively. Age and number of organ failures are independent prognostic factors for death within 7 days, whereas age, comorbidity and organ failures are of significance within 8-90 days.

Keywords: Epidemiology; Incidence; Mortality; Shock.

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Figures

Fig. 1
Fig. 1
Flow chart of patients recruited to the study
Fig. 2
Fig. 2
Annual incidence rate during 2000–2011. The crude annual incidence rates of shock from 2000 to 2011 and the standardized incidence rate to the population of the EDs cathment area in 2000 (using direct standardization on sex and ten-year age bands). Bars indicate the 95 % confidence interval based on a Poisson distribution
Fig. 3
Fig. 3
Estimated incidence rates stratified by sex and age group from 2000 to 2011. Incidence rates estimated on the basis of a Poisson model adjusting for sex, age group, interaction between sex and age group, and calendar years. The table is showing the corresponding estimated incidence rate ratios with 95 % confidence intervals (95 % CI)
Fig. 4
Fig. 4
Kaplan-Meier curves illustrating overall 90-day survival according to age (a), Charlson comorbidity index (b), organ failures (c) and systolic blood pressure levels (d). Below the curves are listed the number at risk at corresponding intervals in survival time
See this image and copyright information in PMC

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