Monday October 23, 2006
Hypotension in ED and Sudden Unexpected In-hospital Mortality !

Interesting study published this month in 'chest' though not sure how it impacts the overall management as editorial in the same issue asked: "But despite the strength of the observational data in this study, there is still one all-important question that will require additional research and remains as-of-yet unanswered: "now what should you DO?".

Nontrauma Emergency Department patients (age above 17) were divided into 2 groups:

• "Exposures" who had any systolic BP less than 100 mm Hg in the ED ( n = 887)
• "Non-exposures" all had SBP more than or equal to 100 mm Hg in the ED (n = 3903)

Deaths were classified as sudden and unexpected by independent observers (using explicit criteria - available in article).

'Exposures' were more likely to die in the hospital compared with nonexposures as well as 'Exposures' were more likely to have sudden and unexpected death compared with nonexposures (2% vs 0.2%). Exposure to hypotension was as an independent predictor of in-hospital mortality. Study concluded that patients exposed to hypotension (even single reading of less than 100 mm Hg) had a significantly increased risk of death during hospitalization, despite been stabalized later in ED or hospital.

As asked in the discussion of this study by authors and being an intensivist, here is the million dollar question?: "Do they need to get admit to higher level of care such as an ICUs?".


Reference: click to get abstract

Emergency Department Hypotension Predicts Sudden Unexpected In-hospital Mortality Chest. 2006;130:941-946.