Clinical characteristics, influencing factors and early warning indicators of 7-day all-cause mortality among patients in emergency rescue rooms
LI Kewei1, LI Na1, ZHU Lungang1, XIE Shuizhan2, GONG Xiaoling3, LIU Jining1
1. Mianyang Hospital Affiliated to Medical School of University of Electronic Science and Technology of China (Mianyang Central Hospital), Mianyang, Sichuan 621000, China; 2. Mianyang Municipal Hospital of Traditional Chinese Medicine, Mianyang, Sichuan 621000, China; 3. The Third People's Hospital of Mianyang City, Mianyang, Sichuan 621000, China
Abstract：Objective To explore the clinical characteristics, affecting factors and early warning indicators of 7-day all-cause death among patients in emergency rescue rooms in recent years so as to provide a basis for clinical practice. Methods We collected 2,480 patients admitted to emergency rescue rooms of tertiary medical institutions within the jurisdiction from January 2022 to December 2023, statistically analyzed the occurrence of all-cause death within 7 days, simultaneously explored the differences in clinical data between dead and surviving patients, and identified their influencing factors and early warning indicators. Results Seven hundred and sixty patients died from all causes within 7 days, with a 7-day all-cause mortality rate of 30.65%. In the distribution of causes of death, cardiovascular and cerebrovascular diseases and trauma were the main causes, accounting for 42.63% and 24.74% respectively. The dead patients' age, body temperature, white blood cell (WBC) count, prothrombin time (PT), bloodurea nitrogen (BUN), serum creatinine (Scr), blood glucose, alanine aminotransferase (ALT), aspartate aminotransferase (AST), British National Early Warning Score (NEWS), Acute Physiology and Chronic Health Evaluation (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score were (65.56±21.41) years old, (37.89±1.21) ℃, (12.21±2.21) ×109/L, (16.54±8.45)s, (9.89±4.60)mmol/L, (80.05±34.18)μmol/L, (13.10±4.12)mmol/L, (76.61±21.80)U/L, (72.26±18.84)U/L, (12.40±4.32)points, (27.45±9.84) points and (13.35±5.11) points respectively, which were significantly higher than those of the surviving patients (all P<0.05), but the dead patients' hemoglobin ((120.24±28.89)g/L) was significantly lower than that of the surviving patients (P<0.05). The results of multivariate logistic regression analysis showed that age, NEWS score, APACHE II score, and SOFA score were the factors influencing mortality among the patients in emergency rescue rooms (P<0.05). The areas under the receiver operating characteristic (ROC) curves predicted by NEWS score, APACHE II score, and SOFA score for patient death were 0.722, 0.789 and 0.742 respectively. There was no significant difference in the predictive values of the three scores for patient death (P>0.05). Conclusion In recent years, the leading causes of 7-day all-cause death among the patients in emergency rescuerooms are cardiovascular and cerebrovascular diseases and trauma. The factors influencing death include the patients' age, NEWS score, APACHE II score and SOFA score, of which NEWS score, APACHE II score and SOFA score have certain values in predicting patient death.
[1] Lal-Trehan EN, Carrasquer A, Del MV, et al. Prognostic value of myocardial injury and chronic kidney disease in an emergency unit[J]. Eur Heart J, 2021,33(44):221-224. [2] Fuks A, Liel-Cohen N, Blondheim D, et al. Global longitudinal strain and long-term outcome in patients presenting to the emergency department with suspected acute coronary syndrome[J]. Echocardiography, 2021,38(8):1254-1262. [3] Eniwumide JO,Akomolafe PO,Rasche C. While-U-Wait: a service-based solution for emergency room overcrowding[J]. Springer, 2022,33(8):269-294. [4] Singla R,Raghu B,Gupta A, et al. Risk factors for early mortality in patients with pulmonary tuberculosis admitted to the emergency room[J]. Pulmonology, 2021, 27(1):35-42. [5] Preciado SM, Sharp AL, Sun BC, et al. Evaluating sex disparities in the emergency department management of patients with suspected acute coronary syndrome[J]. Ann Emerg Med, 2021,77(4):416-424. [6] Jones S, Moulton C, Swift S, et al. Association between delays to patient admission from the emergency department and all-cause 30-day mortality[J]. Emerg Med J, 2022,39(3):168-173. [7] Freund Y,Chauvin A,Jimenez S,et al. Effect of a diagnostic strategy using an elevated and age-adjusted D-dimer threshold on thromboembolic events in emergency department patients with suspected pulmonary embolism: a randomized clinical trial[J]. JAMA, 2021,326(21):2141-2149. [8] Barash Y,Klang E,Soffer S,et al. Normal-range emergency department serum phosphorus levels and all-cause mortality[J]. Postgrad Med J, 2021,97(1144):83-88. [9] 胡明南,臧舒婷,任莹,等. 急诊就诊晚期肺癌的临床特征及患者死亡影响因素分析[J]. 实用癌症杂志,2021,36(6):966-968. [10] 管亚妹,安莹,马子凤.急诊重症监护病房患者院内死亡的相关因素分析[J].中国病案,2022,23(10):52-55. [11] Smith GB, Redfern OC, Pimentel MA, et al. The National Early Warning Score 2 (NEWS2) [J]. Clin Med (Lond), 2019,19(3):260-264. [12] Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system[J]. Crit Care Med, 1985,13(10):818-829. [13] Medlej K. Calculated decisions: sequential organ failure assessment (SOFA) score[J]. Emerg Med Pract, 2018,20(10):1-2. [14] Fabbian F, De Giorgi A,Ferro S,et al. Post-operative all-cause mortality in elderly patients undergoing abdominal emergency surgery: role of charlson comorbidity index[J]. Healthcare (Basel), 2021,9(7):805-807. [15] 申立波,付美娇,陈璟,等.急性心肌梗死合并心源性休克的临床特点和住院死亡影响因素分析[J].宁夏医科大学学报,2022,44(9):913-917 [16] 龚家辉,彭晓琳,赵丹,等. 深圳市南山区中小学生伤害发生情况及其影响因素分析[J]. 实用预防医学,2021,28(8):918-921. [17] 刘洪伟,史文宗,王耀辉,等. 某市综合三级甲等医院急诊抢救室患者滞留时间影响因素分析[J]. 中国急救复苏与灾害医学杂志,2021,16(1):72-75. [18] 邢雷,朱娜,高新梅,等. ICU患者病原菌及耐药情况与协同防控效果分析[J]. 实用预防医学,2023,30(7):857-860. [19] 李宝,苑建磊,高莹,等. 急诊外科创伤患者的死亡危险因素与急救措施[J]. 临床与病理杂志, 2021, 41(11):2594-2598.
2024, Vol. 31 
