急診出院一週內死亡個案

Death Within 1 Week After ED Discharge

In a large study, 1 in 2000 adult patients died within 7 days after ED discharge. Predictors of death included increasing age, noninfectious lung disease, and renal disease.

To determine the rate and predictors of death within 7 days after emergency department (ED) evaluation in adults, researchers studied data from the Kaiser Permanente system in Southern California and government databases.
During 2007 through 2008, there were 728,312 discharges of 475,829 patients and 357 deaths. The rate of death within 7 days of ED discharge was 0.05%. The major risk factor for death was older age: patients aged 80 had nearly 11 times the odds of death relative to those aged 18–39. Comorbid diseases that were strong predictors of death included noninfectious lung disease (odds ratio 7.1), renal disease (OR, 5.6), ischemic heart disease (OR, 3.8), neoplasm (OR, 3.7), and diseases of the blood (OR, 3.6).

Comment: Although the overall 0.05% rate of death within 7 days of discharge seems high, many deaths occurred in older patients and those with severe chronic disease. For example, by our calculations, 0.46% of patients aged 80 died versus 0.01% of those aged 18–39, and 0.4% of those with renal disease died versus none of those with pregnancy and childbirth-related problems. These unsurprising findings suggest that early and assured follow-up is important in high-risk groups, especially patients older than 80.

— Daniel J. Pallin, MD, MPH
Published in Journal Watch Emergency Medicine December 22, 2011

Citation(s): Gabayan GZ et al. Patterns and predictors of short-term death after emergency department discharge. Ann Emerg Med 2011 Dec; 58:551.