Unexpected emergency department death: incidence, causes, and relationship to presentation and time in the department.

STUDY OBJECTIVE

To determine the incidence and causes of unexpected death in emergency department patients and its relationship to initial ED presentation. To determine if length of ED stay is directly related to unexpected death.

DESIGN

Retrospective chart review of all patients dying in the study ED during a three-year period. Patients receiving CPR on admission or who had "do not resuscitate" orders were classified as expected deaths. Vital signs, level of consciousness, length of time in the ED, and cause of death were recorded for all unexpected deaths.

SETTING

Five hundred sixty-six-bed medical center with an ED volume of 45,000 patients per year.

PARTICIPANTS

Four hundred eleven patients were pronounced dead from 1987 to 1989, and 403 (98%) charts were available.

RESULTS

Fifty-seven (14%) patients met the unexpected death criteria. Abnormal vital signs or altered level of consciousness was observed in 56 (98%) patients on presentation. Medical causes accounted for 42 (74%) of the unexpected deaths. Five (9%) surgical and ten (18%) trauma-related deaths were identified. The yearly incidence of unexpected death was 4.9 (per 10,000 ED visits) in 1987 and 4.1 in both 1988 and 1989. Average length of time in the ED before unexpected death increased during the study period (1987, 91 minutes; 1988, 110 minutes; 1989, 116 minutes).

CONCLUSION

Unexpected ED death was uncommon, usually nontraumatic, and occurred in patients with evidence of significant illness. Although average length of stay in the ED increased, there was no increase in the incidence of unexpected ED death. If lengths of ED stay continue to increase, this situation will require further study.