Death within eight days after discharge from the emergency department

Background/Purpose: Death within short time after discharge of the patient from the emergency department (ED) is an alarming outcome. The aim was to evaluate the association of death within eight days after discharge with non-causative diagnosis at discharge. Methods: The source of data was computer records on patients 18 years or older who were discharged from the ED during 2002-2008, comprising 227 097 visits. Vital status was ascertained for all by record linkage of personal identifier with death registry. The follow-up started on date of each discharge and ended on date of death or at end of the eight day. The patients with non-causative diagnosis (International Classification of Diseases: Symptoms, sign, abnormal findings, and ill-defined causes, R00-R99) were compared with those with other diagnosis at discharge and hazard ratio (HR) and 95% confidence interval (CI) calculated. Results: Non-causative diagnoses had been given to 14% of those died within 8 days after discharge. The crude mortality per 100 000 within 8 days was 68.7. Analysing death within 8 days, the HR was higher for men than women and increasing age was significantly associated with high mortality. The HR within 8 days for non-causative diagnosis was 0.82 (95%CI 0.65-1.04) as compared with causative diagnosis, adjusted for gender and age. Conclusions: Death shortly after discharge of patients with non-causative diagnosis may indicate a misjudgement of the patients' condition at the time of discharge. The association of non-causative diagnosis at discharge with early death can be used to evaluate the performance of the EDs.