• Heather Farley, Marc T Zubrow, Jonna Gies, Paul Kolm, Susan Mascioli, Donna D Mahoney, and William S Weintraub.
• Christiana Care Health System, Newark, DE, USA. hfarley@christianacare.org
• Acad Emerg Med. 2010 Jul 1;17(7):718-22.

ObjectivesThe authors hypothesized that vital sign abnormalities detected in the emergency department (ED) can be used to forecast clinical deterioration occurring within 24 hours of hospital admission.MethodsThis was a retrospective case-control study performed after implementation of a hospitalwide rapid response team (RRT) system. Inclusion criteria for study patients consisted of age > or = 18 years, admission to the general floor though the ED, and RRT activation and subsequent transfer to a higher level of care in the first 24 hours. Control patients were > or =18 years, were admitted to the floor though the ED, never required RRT or transfer to a higher level of care, and were matched to cases by risk of mortality. Multilevel logistic regression was used to model the odds of an adverse outcome as a function of race and sex, respiratory rate (RR), heart rate (HR), and systolic (sBP) and diastolic blood pressure (dBP) at time of transfer from the ED.ResultsA total of 74 cases and 246 controls were used. RR (odds ratio [OR] = 2.79 per 10-point change, 95% confidence interval [CI] = 1.41 to 5.51) and to a lesser extent dBP (OR = 0.81, 95% CI = 0.67 to 0.97) contributed significantly to the odds of intensive care unit (ICU) or intermediate care transfer within 24 hours of admission; HR (OR = 1.15, 95% CI = 0.98 to 1.37) did not.ConclusionsEmergency department RR preceding floor transfer appears to have a significant relationship to the need for ICU or intermediate care transfer in the first 24 hours of hospital admission.2010 by the Society for Academic Emergency Medicine

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