Objectives: The aim of this study was to identify predictors of ICU transfer or death within 48 h obtainable within 4 h of admission in emergency department (ED) patients with suspected infection.
Patients and methods: This was a nested case-control study based on a prospective cohort of adult patients admitted to the ED at Aarhus University Hospital, in 2011, who had a blood culture drawn upon admission. Cases met the composite endpoint of ICU transfer or death within 4-48 h of admission. We identified up to three controls for each case, matched by age and admission month. We collected data on possible predictors from medical records. Univariate and multivariate logistic regressions were performed to identify predictors.
Results: A total of 1578 patients had a blood culture drawn in the ED. Among these, 61 (4%) patients were transferred to an ICU and 15 (1%) patients died within 4-48 h of admission. We could obtain complete data on 59 cases, which were matched to 165 controls. Significant predictors of ICU transfer or death within 4-48 h included temperature as a continuous variable, and neurologic (altered mental status), respiratory, and cardiovascular dysfunction.
Conclusion: Readily available clinical and laboratory variables at arrival in the ED can support identification of late deterioration leading to ICU transfer or death within 48 h of admission.