PMID- 37278782
OWN - NLM
STAT- MEDLINE
DCOM- 20230608
LR  - 20230701
IS  - 1936-9018 (Electronic)
IS  - 1936-900X (Print)
IS  - 1936-900X (Linking)
VI  - 24
IP  - 3
DP  - 2023 May 5
TI  - National Trends in Vital Sign Abnormalities at Arrival to the Emergency 
      Department.
PG  - 401-404
LID - 10.5811/westjem.58990 [doi]
AB  - INTRODUCTION: Recent reports suggest rising intensity of emergency department 
      (ED) billing practices, sparking concerns that this may represent up-coding. 
      However, it may reflect increasing severity and complexity of care in the ED 
      population. We hypothesize that this in part may be reflected in more severe 
      manifestations of illness as indicated by vital sign abnormalities. METHODS: 
      Using 18 years of data from the National Hospital Ambulatory Medical Care Survey, 
      we conducted a retrospective secondary analysis of adults (>18 years). We 
      assessed standard vital signs using weighted descriptive statistics (heart rate, 
      oxygen saturation, temperature, and systolic blood pressure [SBP]), as well as 
      hypotension and tachycardia. Finally, we evaluated for differing effects 
      stratifying by subpopulations of interest, including age (<65 vs >/=65), payer 
      type, arrival by ambulance, and high-risk diagnoses. RESULTS: In total there were 
      418,849 observations representing 1,745,368,303 ED visits. We found only minimal 
      variations in vital signs over the study period: heart rate (median 85, 
      interquartile range [IQR] 74-97); oxygen saturation (median 98, IQR 97-99); 
      temperature (median 98.1, IQR 97.6-98.6); and SBP (median 134, IQR 120-149). 
      Similar results were found among the subpopulations tested. The proportion of 
      visits with hypotension decreased (first/last year difference 0.5% [95% CI 
      0.2%-0.7%]) while there was no difference in the proportion of patients with 
      tachycardia. CONCLUSIONS: Arrival vital signs in the ED have largely remained 
      unchanged or improved over the most recent 18 years of nationally representative 
      data, even for key subpopulations. Greater intensity in ED billing practices is 
      not explained by changes in arrival vital signs.
FAU - Salhi, Rama A
AU  - Salhi RA
AD  - Department of Emergency Medicine, Massachusetts General Hospital, Boston, 
      Massachusetts.
FAU - Greenwood-Ericksen, Margaret
AU  - Greenwood-Ericksen M
AD  - Department of Emergency Medicine, University of New Mexico, Albuquerque, New 
      Mexico.
AD  - Department of Psychiatry and Behavioral Sciences, University of New Mexico, 
      Albuquerque, New Mexico.
FAU - Kocher, Keith E
AU  - Kocher KE
AD  - Department of Emergency Medicine, University of Michigan, Ann Arbor, Missouri.
LA  - eng
PT  - Journal Article
DEP - 20230505
PL  - United States
TA  - West J Emerg Med
JT  - The western journal of emergency medicine
JID - 101476450
SB  - IM
MH  - Adult
MH  - Humans
MH  - Retrospective Studies
MH  - *Emergency Service, Hospital
MH  - Vital Signs
MH  - Tachycardia/diagnosis
MH  - *Hypotension/diagnosis
PMC - PMC10284526
COIS- Conflicts of Interest: By the WestJEM article submission agreement, all authors 
      are required to disclose all affiliations, funding sources and financial or 
      management relationships that could be perceived as potential sources of bias. No 
      author has professional or financial relationships with any companies that are 
      relevant to this study. There are no conflicts of interest or sources of funding 
      to declare.
EDAT- 2023/06/06 13:09
MHDA- 2023/06/08 06:42
PMCR- 2023/05/01
CRDT- 2023/06/06 11:06
PHST- 2022/09/23 00:00 [received]
PHST- 2023/02/17 00:00 [accepted]
PHST- 2023/06/08 06:42 [medline]
PHST- 2023/06/06 13:09 [pubmed]
PHST- 2023/06/06 11:06 [entrez]
PHST- 2023/05/01 00:00 [pmc-release]
AID - westjem.58990 [pii]
AID - wjem-24-401 [pii]
AID - 10.5811/westjem.58990 [doi]
PST - epublish
SO  - West J Emerg Med. 2023 May 5;24(3):401-404. doi: 10.5811/westjem.58990.