Key summary points
To investigate whether a baseline systolic blood pressure (SBP) in older Emergency Department (ED) patients of ≥ 70 years has prognostic value, when compared with the initial SBP at presentation in the ED (= ΔSBP).
AbstractSection FindingsA baseline SBP could be retrieved from the Electronic Health Record for most older ED patients (73.3%). A negative ΔSBP was associated with 30-day mortality. In 20% of the patients with a normal initial SBP in the ED, the ΔSBP was negative, with a high mortality rate.
AbstractSection MessageA baseline SBP value could be retrieved from the Electronic Health Record in most hospitalized ED patients ≥ 70 years. In addition, the 21% with a normal SBP at ED presentation had a negative ΔSBP and these patients had an increased risk for 30-day mortality. As a result, ΔSBP may contribute to improved risk stratification and may help to recognize hypotension in older patients.
Abstract
Purpose
To assess how often baseline systolic blood pressure (SBP) could be retrieved from the Electronic Health Record (EHR) in older Emergency Department (ED) patients. Second, to assess whether the difference between baseline SBP and initial SBP in the ED (ΔSBP) was associated with 30-day mortality.
Methods
A multicenter hypothesis-generating cohort study including patients ≥ 70 years. EHRs were searched for baseline SBPs. The association between ΔSBP and 30-day mortality was investigated.
Results
Baseline SBP was found in 220 out of 300 patients (73.3%; 95%CI 68.1–78.0%). In 72 patients with normal initial SBPs (133–166 mmHg) in the ED, fifteen (20.8%) had a negative ΔSBP with 20.0% mortality. A negative ΔSBP was associated with 30-day mortality (AHR 4.7; 1.7–12.7).
Conclusion
Baseline SBPs are often available in older ED patients. The ΔSBP has prognostic value and could be used as an extra variable to recognize hypotension in older ED patients. Future studies should clarify whether the ΔSBP improves risk stratification in the ED.
Availability of data and material
Data are available upon reasonable request.
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BC and BDG devised and designed the study, contributed to the analyses, and edited the manuscript. IvI and IvD collected and analyzed data, and wrote the manuscript. EDJ, WR and LAAM-E edited the manuscript. BdG takes full responsibility for the study. All authors have read and approved the manuscript.
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The medical ethical committee of Máxima MC reviewed the research proposal and concluded that the anonymized data were not subject to the Dutch Research on Humans Subjects Act (in Dutch "WMO") and waived the need for informed consent. The study was approved with registration number (N20.052).
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Candel, B.G.J., van Ingen, I.B., van Doormalen, I.P.H. et al. The difference between the patients' initial and previously measured systolic blood pressure as predictor of mortality in older emergency department patients. Eur Geriatr Med 13, 359–365 (2022). https://doi.org/10.1007/s41999-021-00588-z
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DOI: https://doi.org/10.1007/s41999-021-00588-z