The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Lars Wiuff Andersen
  • Won Young Kim
  • ,
  • Maureen Chase
  • ,
  • Katherine M Berg
  • ,
  • Sharri J Mortensen
  • ,
  • Ari Moskowitz
  • ,
  • Victor Novack
  • ,
  • Michael N Cocchi
  • ,
  • Michael W Donnino
  • ,
  • American Heart Association's Get With the Guidelines(®) – Resuscitation Investigators

BACKGROUND: Patients suffering in-hospital cardiac arrest often show signs of physiological deterioration before the event. The purpose of this study was to determine the prevalence of abnormal vital signs 1-4h before cardiac arrest, and to evaluate the association between these vital sign abnormalities and in-hospital mortality.

METHODS: We included adults from the Get With the Guidelines(®)- Resuscitation registry with an in-hospital cardiac arrest. We used two a priori definitions for vital signs: abnormal (heart rate (HR)≤60 or ≥100min(-1), respiratory rate (RR)≤10 or >20min(-1) and systolic blood pressure (SBP)≤90mmHg) and severely abnormal (HR≤50 or ≥130min(-1), RR≤8 or ≥30min(-1) and SBP≤80mmHg). We evaluated the association between the number of abnormal vital signs and in-hospital mortality using a multivariable logistic regression model.

RESULTS: 7851 patients were included. Individual vital signs were associated with in-hospital mortality. The majority of patients (59.4%) had at least one abnormal vital sign 1-4h before the arrest and 13.4% had at least one severely abnormal sign. We found a step-wise increase in mortality with increasing number of abnormal vital signs within the abnormal (odds ratio (OR) 1.53 (CI: 1.42-1.64) and severely abnormal groups (OR 1.62 (CI: 1.38-1.90)). This remained in multivariable analysis (abnormal: OR 1.38 (CI: 1.28-1.48), and severely abnormal: OR 1.40 (CI: 1.18-1.65)).

CONCLUSION: Abnormal vital signs are prevalent 1-4h before in-hospital cardiac arrest on hospital wards. In-hospital mortality increases with increasing number of pre-arrest abnormal vital signs as well as increased severity of vital sign derangements.

OriginalsprogEngelsk
TidsskriftJournal of Critical Care
Vol/bind98
Sider (fra-til)112-7
Antal sider6
ISSN0883-9441
DOI
StatusUdgivet - jan. 2016

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