Mortality after emergency department discharge: an analysis of 453599 cases.

OBJECTIVES

To quantify and analyze mortality in patients who die within 30 days of discharge home from a hospital emergency department (ED).

MATERIAL AND METHODS

All patients older than 14 years of age who were discharged home from the ED of a tertiary care hospital over a 5-year period were included. We collected age, sex, and other demographic variables, as well as the Charlson Comorbidity Index (CCI). The outcome variables of interest were 7-day and 30-day mortality and cause of death. Deaths were classified as expected and directly related to the emergency, expected but not directly related, unexpected and directly related, and unexpected and not directly related. A death was classified as an adverse event if it was directly related to a problem of diagnosis or management in the ED, underestimation of severity, or complications of a procedure.

RESULTS

Of 519312 patients attended in the ED, 453 599 were discharged home. Of those discharged, 148 died at home within 7 days (32.63 deaths/100 000 discharges) and 355 died within 30 days (78.48 deaths/100 000 discharges). One hundred thirteen deaths (31.8%) were expected and related to the emergency 24.91/100 000), 169 (47.6%) were expected but unrelated 37.26/100 000), 4 (1.1%) were unexpected and related 1.10/100000), and 69 (19.4%) were unexpected and unrelated 15.21/100000). Deaths were considered adverse events related to ED care in 24.2% of the cases. Underestimation of severity was responsible for the highest proportion (10.7%) of such deaths. The median age of patients who died was 83 years, and the median Charlson comorbidity index (CCI) was 6. The most common cause of death was a malignant tumor (23.0%), followed by congestive heart failure (20.2%) and atherosclerotic cardiovascular disease (13.2%). Unexpected deaths related to ED care were significantly related to a higher proportion of adverse events related to diagnosis (P = .001), management (P = .004), and underestimation of severity (P .001).

CONCLUSION

Early deaths after discharge home from a hospital ED occured in patients of advanced age with concomitant conditions. The main clinical settings were neoplastic and cardiovascular disease. Seven-day and 30-day mortality rates directly related to the emergency visit were low. Adverse events related to ED care played a role in about a quarter of the deaths after discharge.