Can I Discharge This Adult Patient with Abnormal Vital Signs From the Emergency Department?

Abstract

Background: Vital signs are an essential component of the emergency department (ED) assessment. Vital sign abnormalities are associated with adverse events in the ED setting and may indicate a risk of poor outcomes after ED discharge.

Clinical question: What is the risk of adverse events among adult patients with abnormal vital signs at the time of ED discharge?

Evidence review: Studies retrieved included 6 retrospective studies with adult patients discharged from the ED. These studies evaluated adverse outcomes in adult patients discharged from the ED with abnormal vital signs. Hypotension at discharge was associated with the highest odds of adverse events after discharge. Tachycardia was also a key predictor of adverse events after discharge and may be easily missed by ED clinicians.

Conclusion: Based on the available evidence, the specific vital sign abnormality and the number of total abnormalities influence the risk of adverse outcomes after discharge. Vital sign abnormalities at the time of discharge also increase the risk of ED revisit. The most common abnormal vital sign at the time of discharge is tachycardia.

Keywords: Abnormal; Adverse outcome; Fever; Hypotension; Hypoxemia; Tachycardia; Tachypnea; Vital signs.