143 Vital Signs as Predictors of Rapid Response Team Activations Within Twelve Hours of Admission From the Emergency Department

Abstract

Rapid-response teams (RRTs) are interdisciplinary groups created to rapidly assess and treat patients with unexpected clinical deterioration in non-intensive care unit (ICU) beds. It has been suggested that emergency department (ED) disposition should take into consideration vital signs (VS) at the time of hospital admission. We aimed to predict which patients will have RRT activation within 12 hours of admission based on their ED VS. We conducted a case-control study of patients presenting from January 2009 to December 2013 to a tertiary ED who subsequently had RRT activation within 12 hours of admission. The records of patients 18 years and older admitted to a non-ICU setting were reviewed to obtain VS at the time of ED departure. Each of the 474 RRT activation cases was matched to a control by age, sex, and ED diagnosis. Controls presented to the ED during the same time period, were admitted, but did not have RRT activation. VS were evaluated using cut points (lowest 10%, middle 80% and highest 10%) based on the distribution of VS for all 948 patients and were compared between cases and controls using conditional logistic regression. Vital signs have a bimodal distribution, where the lowest and the highest extremes are concerning. Cutoff comparison between cases and controls is shown in Table 1. Patients with RRT activations were more likely to have a heart rate > 111 bpm (OR 2.76; CI 1.65-4.60), have a sBP 157 mmHg (OR 1.82; 1.19-2.80), have a respiratory rate >24 (OR 4.15; CI 2.44-7.07) and have an oxygen saturation <93% (OR 2.29; CI 1.43-3.67) at the time of ED departure. After matching for age, sex, and ED diagnosis, abnormal VS at the time of ED departure are predictive of RRT activation within 12 hours of admission. However, an ideal set of VS cut points to trigger a change in ED disposition remain unclear.