Etiology of Shock in the Emergency Department; A 12 Year Population Based Cohort Study

Jon Gitz Holler, Helene Kildegaard Jensen, Daniel Pilsgaard Henriksen, Lars Melholt Rasmussen, Søren Mikkelsen, Court Pedersen, Annmarie Touborg Lassen

    Abstract

    INTRODUCTION: The knowledge of the etiology and associated mortality of undifferentiated shock in the emergency department (ED) is limited. We aimed to describe the etiology based proportions and incidence rates (IR) of shock, as well as the associated mortality in the ED.

    METHODS: Population-based cohort study at an University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. Patients aged ≥18 years living in the ED-catchment area (N = 225,000) with a first time ED presentation with shock (n = 1,646) defined as hypotension (systolic blood pressure ≤100 mmHg)) and ≥1 organ failures were included. Discharge diagnoses defined the etiology and were grouped as; distributive septic shock (SS), distributive non-septic shock (NS)), cardiogenic shock (CS), hypovolemic shock (HS), obstructive shock (OS) and other conditions (OC). Outcomes were etiology-based characteristics, annual IR per 100,000 person-years at risk (95% CIs), mortality at 0-7-, and 0-90 days (95% CIs) and hazard rates (HR) at 0-7, 8-90 days (95% CIs). Poisson and Cox regression models were used for analyses.

    RESULTS: Among 1,646 shock patients: 434 (26.4%) had SS, 384 (23.3%) NS, 237 (14.4%) CS, 515 (31.3%) HS, 15 (0.9%) OS and 61 (3.7%) OC. The corresponding IR's were: 16.7/100,000 (11.7-23.6), 14.7/100,000 (12.7-17.1), 9.1/100,000 (6.5-12.8), 19.8/100,000 (15.0-26.0), 0.6/100,000 (0.3-10.5) and 2.3/100,000 (1.8-3.0). SS IR increased from 8.9-28.5/100,000 during the period 2000-2011. Accordingly, the 7-, and 90-day mortalities of SS, NS, CS, and HS were: 28.9% (95% CI: 24.3-34.1) and 53.4% (95% CI: 48.0-58.8), 12.1% (95% CI: 8.8-16.4) and 23.3% (95% CI: 18.8-28.6), 32.0% (95% CI: 25.5-39.2) and 50.2% (95% CI: 42.8-57.6), 20.4% (95% CI: 16.6-24.7) and 37.6% (95% CI: 32.8-42.5). SS (HR = 1.56 (95% CI, 1.11-2.20)), and CS (HR = 2.03 (95% CI, 1.40-2.93)) were independent predictors of death within 0-7 days, whereas SS was a predictor within 8-90 days (HR = 1.71 (95% CI: 1.19-2.46)).

    CONCLUSION: HS and SS are frequent etiological characteristics followed by NS and CS, whereas OS is a rare condition. We confirm the increasing trend of SS, as previously reported. 7-day mortality ranged from 12% to 32% while 90-day mortality ranged from 23% to 54%. The underlying etiology was an independent predictor of mortality.

    OriginalsprogEngelsk
    TidsskriftShock
    ISSN1073-2322
    DOI
    StatusUdgivet - 14 dec. 2016

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