Death within 8 days after discharge home form the emergency department

Background

The association of clinical evaluation at the emergency department and death within 8 days after discharge home has previously been studied retrospectively. This is a prospective study on the association of non-causative diagnosis with death within 8 days after discharge.

Methods

The primary data was computer files from the emergency department including personal identification number, gender, age, and discharge diagnosis. Information on death was obtained, by record linkage, from nation wide cause-of-death registry. The hazard ratio and 95% confidence intervals (CI) was computed where non-causative discharge diagnosis versus causative diagnosis was introduced as a dichotomous variable, adjusted for gender and age.

Results

Eleven percent of those who died within 8 days after discharge home had non-causative diagnosis as compared to 20 percent of all discharged users of the emergency department. The mortality per 100,000 within 8 days was 208.5. In the analysis of deaths within 8 days the hazard ratio was higher for men than women and increasing age was significantly associated with high mortality. The adjusted hazard ratio for non-causative diagnosis was 0.44 (95% CI 0.20 to 0.96) as compared to causative diagnosis.

Conclusion

In this register based study mortality within 8 days was considerably higher than in two previous studies from US, perhaps indicating a successful follow-up by the record linkage. Non-causative discharge diagnoses seem to be protecting against early death after discharge from the emergency department. However, death shortly after discharge of those with non-causative diagnosis indicate misjudgement of patients' condition at the time of discharge.