Abstract 207: The Prevalence and Significance of Abnormal Vital Signs Prior to In-Hospital Cardiac Arrest

Abstract

Background: The association between vital sign abnormalities prior to cardiac arrest and outcome has not been previously reported. In this study we investigated the prevalence of abnormal vital signs prior to in-hospital cardiac arrest and the association with mortality Methods: We utilized the Get With the Guidelines - Resuscitation national registry to identify adult patients with an in-hospital cardiac arrest between 2007-2010. We included index events and excluded patients with missing data on vital signs within 1-4 hours prior to arrest. We evaluated the prevalence of abnormal vital signs classified as mild, moderate or severe (Table 1). We determined the association between the number of abnormal vital signs per patient and in-hospital mortality using multivariate logistic regression with adjustment for multiple potential confounders including patient demographics and co-morbid conditions. Results: A total of 9,560 patients were included. Median age was 71 (60 - 81) years, 42% were female and overall mortality was 77%. The prevalence of vital sign abnormalities is shown in Table 1. As illustrated in Figure 1 we found a step-wise increase in mortality with increasing number of abnormal vital signs that remained in multivariable analysis across all categories (Mild: adjusted OR 1.37 [CI: 1.27 - 1.48], Moderate: adjusted OR 1.53 [CI: 1.35 - 1.73] and Severe: adjusted OR 1.43 [CI: 1.21 - 1.70], all p-values < 0.0001). Conclusion: Abnormal vital signs are common within four hours before cardiac arrest on in-hospital wards. Our study demonstrates incremental increases in mortality with both increasing number of pre-arrest abnormal vital signs as well as increased severity.