unanticipated death after discharge from the ED

FEAR IS HEALTHY (usually):

--nice study (see reference), oldie but a goodie, worth a read (click the link)
--retrospective cohort of ED patients who were discharged to home, >= 10 yrs old

--387,334 ED visits among 186,859 individuals

KEY POINTS:

--Reviewed 117 patients who died within 7 days of discharge (30.2 deaths per 100,000 ED discharges) 

l       58 (50%) were unexpected but related to the ED visit

l       35 (60%) of these had a possible error.

--Four themes repeatedly emerged:

l       atypical presentation of an unusual problem

l       chronic disease with decompensation

l       abnormal vital signs, (in 48/58 unexpected & 29/35 possible error cases)

l       mental disability or psychiatric problem or substance abuse that may have made it less likely that the patient would return for worsening symptoms

--Tachycardia present in most of the unexpected death cases (in 48/58 unexpected & 25 of 35 possible error cases)

10-SECOND TAKEAWAY:

--of the four common themes seen in people who die unexpectedly after ED discharge, the one you have the best chance of looking out for is abnormal vital signs, particularly tachycardia

--think twice before sending home the tachycardic patient, particularly if unexplained. doesn't mean its not the right thing to do, but probably healthy to let your brain work it over one last time.


Reference(s): Sklar DP, et al. Unanticipated Death After Discharge Home From the Emergency Department. Ann Emerg Med. 2007;49:735-745., picture