The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest.

ABSTRACT: 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 1-4h before cardiac arrest, and to evaluate the association between these vital sign abnormalities and in-hospital mortality.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 ? 100 min(-1), respiratory rate (RR) ? 10 or >20 min(-1) and systolic blood pressure (SBP) ? 90 mm Hg) and severely abnormal (HR ? 50 or ? 130 min(-1), RR ? 8 or ? 30 min(-1) and SBP ? 80 mm Hg). We evaluated the association between the number of abnormal vital signs and in-hospital mortality using a multivariable logistic regression model.7851 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 1-4h 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)).Abnormal vital signs are prevalent 1-4h 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.

SUBMITTER: Andersen LW 

PROVIDER: S-EPMC4715919 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature