The Emergency Department presenting complaint as predictor of in-hospital fatality

Eur J Emerg Med. 2007 Dec;14(6):324-31. doi: 10.1097/MEJ.0b013e32827b14dd.


Background: The relationship between major discharge diagnoses and prediction of in-hospital death has been intensively studied. The relation between the presenting complaint at the Emergency Department (ED) and in-hospital fatality, however, is less well known.

Objective: To investigate if presenting complaints add information regarding in-hospital fatality risk for nonsurgical ED patients.

Methods: Investigating the relationship of in-hospital fatality rate and presenting complaint by comparing the presenting complaints, discharge diagnoses and in-hospital fatality for all nonsurgical patients visiting the ED during 1 year.

Results: Of 12,995 nonsurgical admissions, 40% were treated as in-hospital patients. Among these, 328 in-hospital deaths occurred. Age was the most powerful predictor of death in hospitalized patients (P<0.0001). After adjustment for age, the female sex was found to be protective [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.92, P=0.007)]. Compared with the largest complaint group, chest pain with an in-hospital fatality rate of 2.5%, there was a significantly increased risk of dying among those with stroke-like symptoms (OR 2.04, 95% CI 1.35-3.08, P=0.0007), dyspnoea (OR 1.95, 95% CI 1.27-3.00, P=0.002) or general disability (OR 1.81, 95% CI 1.17-2.79, P=0.008).

Conclusions: The presenting complaint at the ED carries valuable information of the risk for in-hospital fatality in nonsurgical patients. This knowledge can be valuable in the prioritization between different patient groups in the process of initiating diagnostics and treatment procedures at the ED.

MeSH terms

  • Acute Disease
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Chest Pain / diagnosis
  • Diagnosis, Differential
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Health Status Indicators
  • Hospital Mortality*
  • Humans
  • Male
  • Middle Aged
  • Patient Discharge
  • Prospective Studies
  • Risk Assessment*
  • Risk Factors
  • Stroke / diagnosis