The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest

Abstract

BackgroundPatients suffering in-hospital cardiac arrest often show signs of physiological deterioration before the event. The purpose of this study was to determine the prevalence of abnormal vital signs 1–4h before cardiac arrest, and to evaluate the association between these vital sign abnormalities and in-hospital mortality. MethodsWe included adults from the Get With the Guidelines®– Resuscitation registry with an in-hospital cardiac arrest. We used two a priori definitions for vital signs: abnormal (heart rate (HR)≤60 or ≥100min−1, respiratory rate (RR)≤10 or >20min−1 and systolic blood pressure (SBP)≤90mmHg) and severely abnormal (HR≤50 or ≥130min−1, RR≤8 or ≥30min−1 and SBP≤80mmHg). We evaluated the association between the number of abnormal vital signs and in-hospital mortality using a multivariable logistic regression model. Results7851 patients were included. Individual vital signs were associated with in-hospital mortality. The majority of patients (59.4%) had at least one abnormal vital sign 1–4h before the arrest and 13.4% had at least one severely abnormal sign. We found a step-wise increase in mortality with increasing number of abnormal vital signs within the abnormal (odds ratio (OR) 1.53 (CI: 1.42–1.64) and severely abnormal groups (OR 1.62 (CI: 1.38–1.90)). This remained in multivariable analysis (abnormal: OR 1.38 (CI: 1.28–1.48), and severely abnormal: OR 1.40 (CI: 1.18–1.65)). ConclusionAbnormal vital signs are prevalent 1–4h before in-hospital cardiac arrest on hospital wards. In-hospital mortality increases with increasing number of pre-arrest abnormal vital signs as well as increased severity of vital sign derangements.