Factors Affecting Unpredictable Adverse Events after
Admission to the Emergency Department Observation Unit
1 Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Affiliation :
Ar-aishah Dadeh MD1, Preeyanuch Suwaluk MD1
Objective : To identify the predicting factors of unpredicted adverse event and in-hospital mortality after admission to the emergency
department observation unit (EDOU).
Materials and Methods : A retrospective study of all non-traumatic patients who were admitted to an emergency department based
observation unit between July 1, 2015 and June 30, 2016. The main outcome measurements were unpredicted adverse event and
the secondary outcome was in-hospital mortality.
Results : Of the 1,037 patients enrolled, 52 (5%) developed unpredicted adverse event. Predictors of unpredictable adverse event
included age older than 65 years (odds ratio [OR] 4.45, 95% con(cid:976)idence interval [CI] 2.15 to 9.20), the emergency department
(ED) qSOFA score more than two (OR 3.15, 95% CI 1.48 to 6.70), cirrhotic patients (OR 3.83; 95% CI 1.45 to 10.10), cardiovascular
patients (OR 6.28, 95% CI 3.18 to 12.41), initial body temperature at EDOU hotter than 38℃ (OR 2.40; 95% CI 1.12 to 5.11), and
initial pulse rate greater than 90/minute (OR 2.63, 95% CI 1.34 to 5.15). The hospital mortality at 3-day and 28-day of adverse
event group were 0.1% (p<0.001) and 1.3% (p<0.001), respectively.
Conclusion : In determining the appropriateness of patients selected for an EDOU: elderly patients, cirrhotic patients, cardiovascular
patients, and an ED qSOFA score more than 2, should be the qualifying criteria. Patients placed into the EDOU were more likely to
develop unpredictable adverse events if they had a fever and/or tachycardia in the EDOU.
Keywords : Adverse event, Observation unit, Emergency department
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