2178 Relative hypotension: the mortality effect of below-baseline systolic pressure in older people receiving emergency care

Conclusion 5136 (16%) of 32548 ED attendances were linkable with recent discharge vital signs. Relative hypotension exceeding 7mmHg was associated with increased 30-day mortality (HR: 1.98; 95%CI: 1.66-2.35). The adjusted risk tool (AUC: 0.69; sensitivity: 0.61; specificity: 0.68) estimated each 1mmHg relative hypotension to increase 30-day mortality by 2% (OR: 1.02; 95%CI: 1.02-1.02). 30-day mortality prediction was marginally better with NEWS2 alone (AUC: 0.73; sensitivity: 0.59; specificity: 0.78) and NEWS2 + relative systolic (AUC: 0.74; sensitivity: 0.62; specificity: 0.75). Comparing ED vital signs with recent discharge observations was feasible for 16% individuals. The association of relative hypotension exceeding 7mmHg with 30-day mortality was externally validated. Indeed, any relative hypotension appeared to increase risk, but model characteristics were poor. These findings are limited to the context of older people with recent hospital admissions.
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: RCEM Rod Little Prize Papers Source Type: research