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The difference between the patients' initial and previously measured systolic blood pressure as predictor of mortality in older emergency department patients

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Key summary points

AbstractSection Aim

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 Findings

A 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 Message

A 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.

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Availability of data and material

Data are available upon reasonable request.

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Funding

No funding.

Author information

Author notes

  1. Iris B. van Ingen and Iris P. H. van Doormalen contributed equally.

Authors and Affiliations

  1. Department of Emergency Medicine, Máxima Medical Center, De Run 4600, 5504DB, Veldhoven, The Netherlands

    Bart G. J. Candel, Iris P. H. van Doormalen & Lisette A. A. Mignot-Evers

  2. Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands

    Bart G. J. Candel, Iris B. van Ingen, Wouter Raven & Bas de Groot

  3. Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands

    Lisette A. A. Mignot-Evers

  4. Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands

    Evert de Jonge

Authors
  1. Bart G. J. Candel
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  2. Iris B. van Ingen
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  3. Iris P. H. van Doormalen
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  4. Wouter Raven
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  5. Lisette A. A. Mignot-Evers
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  6. Evert de Jonge
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  7. Bas de Groot
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Contributions

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.

Corresponding author

Correspondence to Bart G. J. Candel.

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Conflict of interest

All authors declare no conflicts of interest.

Ethics approval

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).

Informed consent

Due to the retrospective design, informed consent was not required.

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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

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