The following is a summary of “Comparison of mortality in emergency department patients with immediate versus delayed hypotension,” published in the October 2023 issue of Emergency Medicine by Makonnen, et al.

Hypotension in the emergency department (ED) is linked to elevated mortality, but the relationship between the timing of hypotension and mortality was not well-explored. For a study, researchers sought to compare the mortality rates of patients presenting with hypotension to those developing hypotension during their ED stay.

A retrospective cohort study was conducted in a large academic medical center from January 2018 to December 2021. Inclusion criteria were age ≥ 18 years and at least one recorded systolic blood pressure (SBP) ≤ 90 in the ED. Patients were categorized by chief complaint into medical and trauma presentations. The primary outcome was in-hospital mortality. Further analysis explored the association between time, the first hypotensive SBP measurement, and mortality.

Of 212,085 adult ED patients, 4,053 (1.9%) had at least one hypotensive blood pressure measurement. The overall mortality rate was 0.8%, with a rate of 10.0% for hypotensive patients. No significant difference in mortality was observed between patients with hypotension on arrival, and those developing hypotension during their ED stay for both medical (RR 1.19 [95% CI:0.97–1.39]) and trauma (RR 0.6 [95% CI: 0.31–1.24]) presentations. However, a significant trend toward decreased mortality was noted every hour after arrival until the development of hypotension. Increased mortality was associated with an increasing number of hypotensive measurements.

While hypotension in the ED is strongly associated with elevated in-hospital mortality, the timing of hypotension onset (arrival or during ED stay) did not significantly impact mortality. It underscored the importance of continuous hemodynamic monitoring for ED patients.

Source: sciencedirect.com/science/article/abs/pii/S0735675723003340