The European Journal of Public Health Advance Access originally published online on June 10, 2008
The European Journal of Public Health 2008 18(5):522-526; doi:10.1093/eurpub/ckn045
Mortality |
Death within 8 days after discharge to home from the emergency department
Oddny S. Gunnarsdottir1 and Vilhjalmur Rafnsson2
1 Office of Education, Research and Development, Landspitali University Hospital, Reykjavik, Iceland
2 Department of Preventive Medicine, University of Iceland, Reykjavik, Iceland
Correspondence: Vilhjalmur Rafnsson, Department of Preventive Medicine, University of Iceland, Neshagi 16, IS - 107 Reykjavik, Iceland, tel: +354 525 5213, fax: +354 562 2013, e-mail: vilraf{at}hi.is
Received October 23, 2007 , accepted April 29, 2008
Background: Deaths within 8 days after discharge have, in previous studies, been evaluated retrospectively based on review of hospital records and the cause of death. The aim of the study was to evaluate the association of death within 8 days after discharge to home from the emergency department with a non-causative diagnosis in a prospective cohort study. Methods: The records from the emergency department were filed by personal identification number and included information on gender, age, admission, discharge and diagnosis. The cause of death was obtained from a nation-wide registry by record linkage. Mortality per 100 000 within 8 days and the hazard ratio and 95% confidence intervals (CIs) were calculated for all causes of death in a time-dependent analysis. Results: A non-causative diagnosis had been given to 11% of those who died within 8 days after discharge home. The mortality per 100 000 within 8 days was 208.5, within 15 days 347.4 and within 30 days 648.6. In the analysis of deaths within 8 days, the hazard ratio was higher for men than women and increasing age was significantly associated with high mortality. The hazard ratio for non-causative diagnosis was 0.44 (95% CI 0.20–0.96) as compared to causative diagnosis, adjusted for gender and age. Conclusion: The mortality rate within 8 days of discharge found in the present study is considerably higher than findings in previous studies. Death shortly after discharge of patients with non-causative diagnosis may indicate a misjudgement of the patients’ condition at the time of discharge.
Keywords: mortality, non-causative diagnosis, prospective, record linkage