Patterns and predictors of short-term death after emergency department discharge

Gelareh Z. Gabayan, Stephen F. Derose, Steven M. Asch, Sau Yiu, Elizabeth M. Lancaster, K. Trudy Poon, Jerome R. Hoffman, Benjamin C. Sun

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

Study objective: The emergency department (ED) is an inherently high-risk setting. Early death after an ED evaluation is a rare and devastating outcome; understanding it can potentially help improve patient care and outcomes. Using administrative data from an integrated health system, we describe characteristics and predictors of patients who experienced 7-day death after ED discharge. Methods: Administrative data from 12 hospitals were used to identify death after discharge in adults aged 18 year or older within 7 days of ED presentation from January 1, 2007, to December 31, 2008. Patients who were nonmembers of the health system, in hospice care, or treated at out-of-network EDs were excluded. Predictors of 7-day postdischarge death were identified with multivariable logistic regression. Results: The study cohort contained a total of 475,829 members, with 728,312 discharges from Kaiser Permanente Southern California EDs in 2007 and 2008. Death within 7 days of discharge occurred in 357 cases (0.05%). Increasing age, male sex, and number of preexisting comorbidities were associated with increased risk of death. The top 3 primary discharge diagnoses predictive of 7-day death after discharge included noninfectious lung disease (odds ratio [OR] 7.1; 95% confidence interval [CI] 2.9 to 17.4), renal disease (OR 5.6; 95% CI 2.2 to 14.2), and ischemic heart disease (OR 3.8; 95% CI 1.0 to 13.6). Conclusion: Our study suggests that 50 in 100,000 patients in the United States die within 7 days of discharge from an ED. To our knowledge, our study is the first to identify potentially "high-risk" discharge diagnoses in patients who experience a short-term death after discharge.

Original languageEnglish (US)
Pages (from-to)551-558.e2
JournalAnnals of emergency medicine
Volume58
Issue number6
DOIs
StatePublished - Dec 2011

ASJC Scopus subject areas

  • Emergency Medicine

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    Gabayan, G. Z., Derose, S. F., Asch, S. M., Yiu, S., Lancaster, E. M., Poon, K. T., Hoffman, J. R., & Sun, B. C. (2011). Patterns and predictors of short-term death after emergency department discharge. Annals of emergency medicine, 58(6), 551-558.e2. https://doi.org/10.1016/j.annemergmed.2011.07.001