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The Prevalence and Significance of Abnormal Vital Signs Prior to In-Hospital Cardiac Arrest.
Resuscitation. 2015 Sep 8;
Authors: Andersen LW, Kim WY, Chase M, Berg K, Mortensen SJ, Moskowitz A, Novack V, Cocchi MN, Donnino MW, American Heart Association's Get With The Guidelines® - Resuscitation Investigators
Abstract
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 1-4hours before cardiac arrest, and to evaluate the association between these vital sign abnormalities and in-hospital mortality.</abstract> 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) ≤ 90mm Hg) and severely abnormal (HR ≤ 50 or ≥ 130min(-1), RR ≤ 8 or ≥ 30min(-1) and SBP ≤80mm Hg). We evaluated the association between the number of abnormal vital signs and in-hospital mortality using a multivariable logistic regression model.
RESULTS: 7,851 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 1-4hours 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 1-4hours 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.
PMID: 26362486 [PubMed - as supplied by publisher]