Abstract
Background
Emergency patients are frequently assigned non-specific diagnoses. Non-specific diagnoses describe observations or symptoms and are found in chapters R and Z of the International Classification of Diseases, 10th edition (ICD-10). Patients with such diagnoses have relatively low mortality, but due to patient volume, the absolute number of deaths is substantial. However, information on cause of short-term mortality is limited.
Objectives
To investigate whether death could be expected for ambulance patients brought to the emergency department (ED) following a 1-1-2 call, released with a non-specific ICD-10 diagnosis within 24 hours, and who subsequently died within 30 days.
Methods
Retrospective medical record review of adult 1-1-2 emergency ambulance patients brought to an ED in the North Denmark Region during 2017-2021. Patients were divided into three categories; unexpected death, expected death (terminal illness), and miscellaneous. Charlson Comorbity Index (CCI) was assessed.
Results
We included 492 patients. Mortality was distributed as follows: Unexpected death 59.2% (N=291), expected death (terminal illness) 25.8% (N=127), and miscellaneous 15.0% (N=74). Patients who died unexpectedly were old (median age of 82 years) had CCI 1-2 (58.1%), 43.0% used ≥5 daily prescription drugs, and they were severely acutely ill upon arrival (24.7% with red triage, 60.1% died within 24 hours).
Conclusion
More than half of ambulance patients released within 24 hours from the ED with non-specific diagnoses, and who subsequently died within 30 days, died unexpectedly. One fourth died from a preexisting terminal illness. Patients dying unexpectedly were old, treated with polypharmacy, and often life-threateningly sick at arrival.
Emergency patients are frequently assigned non-specific diagnoses. Non-specific diagnoses describe observations or symptoms and are found in chapters R and Z of the International Classification of Diseases, 10th edition (ICD-10). Patients with such diagnoses have relatively low mortality, but due to patient volume, the absolute number of deaths is substantial. However, information on cause of short-term mortality is limited.
Objectives
To investigate whether death could be expected for ambulance patients brought to the emergency department (ED) following a 1-1-2 call, released with a non-specific ICD-10 diagnosis within 24 hours, and who subsequently died within 30 days.
Methods
Retrospective medical record review of adult 1-1-2 emergency ambulance patients brought to an ED in the North Denmark Region during 2017-2021. Patients were divided into three categories; unexpected death, expected death (terminal illness), and miscellaneous. Charlson Comorbity Index (CCI) was assessed.
Results
We included 492 patients. Mortality was distributed as follows: Unexpected death 59.2% (N=291), expected death (terminal illness) 25.8% (N=127), and miscellaneous 15.0% (N=74). Patients who died unexpectedly were old (median age of 82 years) had CCI 1-2 (58.1%), 43.0% used ≥5 daily prescription drugs, and they were severely acutely ill upon arrival (24.7% with red triage, 60.1% died within 24 hours).
Conclusion
More than half of ambulance patients released within 24 hours from the ED with non-specific diagnoses, and who subsequently died within 30 days, died unexpectedly. One fourth died from a preexisting terminal illness. Patients dying unexpectedly were old, treated with polypharmacy, and often life-threateningly sick at arrival.
| Original language | English |
|---|---|
| Journal | The Journal of Emergency Medicine |
| ISSN | 0736-4679 |
| DOIs | |
| Publication status | E-pub ahead of print - 14 Dec 2023 |