| Objectives:To determine the trend in emergency patients mortality of a tertiary general hospital during the past decade. Study the clinical features, epidemiological characteristics, first-aid awareness, death time of ED deaths and condition change of ED, and find the factors that have influence on ED mortality.Methods:In a retrospective chart review of ED records, we collected records of all cases of ED deaths at three years (2004,2009 and 2014), fill the charts according to the records by trained staffs. The statistics of ED visiting patients, deaths, facilities and staffs came from ED annual report. A database was funded based on computer. Statistical analysis was done with SPSS software, version 22.0.Results:1092 of the total 1127 ED deaths at above three years (2004,2009 and 2014) were incorporated in the study, and 36 cases were excluded because of records deficiency, the lost rate was 3.2%.1. ED treatments. During the past decade, ED visits increased greatly (from 57,131 in 2004 to 78,822 in 2014, increased by 38%). ED deaths also increased from 192 to 579. ED mortality increased during the past decade (from 0.7%,in 2004, to 0.9% in 2009, to 1.2% in 2014; p<0.0001). Although those died before arrival were excluded, the rising trend didn’t change.2. Clinical features and epidemiological characteristics. The average age and sex distribution did not change, the average age was 62, and the male/female ratio was 1.36:1. Patients between the ages of 40 and 64 were the most. Adults under 40 years old (18-39) increased (from 7.5% in 2004, to 10.6% in 2009, to 14.4% in 2014; p<0.05). Cardiovascular and cerebrovascular diseases, sudden death were the main cause of ED deaths. The ratio of cerebrovascular diseases decreased (from 20.6% in 2004, to 13.6% in 2009, to 10.9% in 2014; p<0.05), while the ratio of sudden death and poisoning increased (from 12.2% in 2004, to 12.5% in 2009, to 21.1% in 2014; p<0.001). The ratio of trauma and tumor didn’t show significant changes.3. First-aid awareness. Average time from attack to ED didn’t change significantly, which was 70.5h. We see no changes in use of ambulance, only 29% of the patients were sent to ED by ambulance. We noted significant increases in non-compliant patients or family (from 18.3% in 2004, to 25.6% in 2009, to 38.3% in 2014; p<0.0001) and decreases in compliant patients or family (from 61.1% in 2004, to 60.2% in 2009, to 42.8% in 2014; p<0.0001), no changes in the ratio of those abandoning therapy.4. Death time. There were no changes in shifts and holiday distribution, but the average boarding time increased from 22.4h in 2004 to 53.3h in 2014 (p<0.05).5. ED conditions. Both the ED facilities and staffs improved during the past decade.Conclusions:1. During the past decade, although ED facilities and staffs have shown some improvement, ED mortality is in an increasing tendency.2. ED deaths have the youth oriented tendency, more attention should be paid to the ED youth patients. Cardiovascular and cerebrovascular diseases are still the main cause of ED deaths, sudden death also increased.3. First-aid awareness of ED patients didn’t improve, high-risk patients should enhance the application of emergency medical system.4. The increase in ED mortality may be related to the decrease in compliance of ED patients and increase in ED boarding time. Governments, medical institutions, news media and the public should collaborate closely, and correct the deficiencies in medical system to facilitate emergency medical progress. |
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