Shock in the emergency department; a 12 year population based cohort study

BACKGROUND: The knowledge of the frequency and associated mortality of shock in the emergency department (ED) is limited. The aim of this study was to describe the incidence, all-cause mortality and factors associated with death among patients suffering shock in the ED.

METHODS: Population-based cohort study at an University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. All patients aged ≥18 years living in the hospital catchment area with a first time ED presentation with shock (n = 1646) defined as hypotension (systolic blood pressure (SBP) ≤100 mmHg)) and ≥1 organ failures. Outcomes were annual incidence per 100,000 person-years at risk (pyar), all-cause mortality at 0-7, and 8-90 days and risk factors associated with death.

RESULTS: We identified 1646 of 438,191 (0.4 %) ED patients with shock at arrival. Incidence of shock increased from 53.8 to 80.6 cases per 100,000 pyar. The 7-day, and 90-day mortality was 23.1 % (95 % CI: 21.1-25.1) and 40.7 % (95 % CI: 38.3-43.1), respectively. Independent predictors of 7-day mortality were: age (adjusted HR 1.03 (95 % CI: 1.03-1.04), and number of organ failures (≥3 organ failures; adjusted HR 3.13 95 % CI: 2.28-4.30). Age, comorbidity level and number of organ failure were associated with 90-day mortality.

CONCLUSION: Shock is a frequent and critical finding in the ED, carrying a 7- and, 90- day mortality of 23.1 and 40.7 %, respectively. Age and number of organ failures are independent prognostic factors for death within 7 days, whereas age, comorbidity and organ failures are of significance within 8-90 days.