Abstract
BackgroundTo document the relationship between triage vital signs and in-hospital mortality among emergency department (ED) patients with acute poisoning.MethodsPoisoning patients who admitted to our emergency department during the study period were enrolled. Patient’s demographic data were collected and odds ratios (OR) of triage vital signs to in-hospital mortality were assessed. Receiver operating characteristic curve was used to determine the proper cut-off value of vital signs that predict in-hospital mortality. Logistic regression analysis was performed to test the association of in-hospital mortality and vital signs after adjusting for different variables.Results997 acute poisoning patients were enrolled, with 70 fatal cases (6.7%). A J-shaped relationship was found between triage vital signs and in-hospital mortality. ED triage vital signs exceed cut-off values independently predict in-hospital mortality after adjusting for variables were as follow: body temperature <36 or >37°C, p < 0.01, OR = 2.8; systolic blood pressure <100 or >150 mmHg, p < 0.01, OR: 2.5; heart rate <35 or >120 bpm, p < 0.01, OR: 3.1; respiratory rate <16 or >20 per minute, p = 0.38, OR: 1.4.ConclusionsTriage vital signs could predict in-hospital mortality among ED patients with acute poisoning. A J-curve relationship was found between triage vital signs and in-hospital mortality. ED physicians should take note of the extreme initial vital signs in these patients.
Highlights
To document the relationship between triage vital signs and in-hospital mortality among emergency department (ED) patients with acute poisoning
No significant difference in the mean age, triage respiratory rate, triage blood pressure, suicide attempts, psychiatric medical histories, and length of hospital stay were found between the groups
Logistic regression analysis was performed and the ED triage vital signs exceeding cut-off values independently predicted in-hospital mortality after adjusting for variables (BT 37°C, odds ratios (OR) 3.2, 95% confidence interval (95%CI) 1.4 – 7.1, p < 0.01; systolic blood pressure (SBP) 150 mmHg, OR 2.2, 95%CI 1.0 – 4.5, p = 0.04; heart rate (HR) 120 bpm, OR 2.7, 95%CI 1.2 – 6.0, p = 0.01; respiratory rate (RR) 20 per minute, OR 2.4, 95%CI 1.0 – 5.1, p = 0.03)
Summary
To document the relationship between triage vital signs and in-hospital mortality among emergency department (ED) patients with acute poisoning. In the modern practice of medical toxicology, vital signs play an important role in diagnosis since they are the key components of toxic syndromes. Their role in assessing severity of poisoned patients is still lack of evidence. Most of the previous research focused on the relationship between a single specific poison and its prognostic factors, such as tachycardia in glyphosatesurfactant intoxication or low body temperature in paraquat intoxication These reports are of little use when you face patients with mixed drug poisoning or unknown poison [1,2].
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