Open AccessInitial assessment in emergency departments by chief complaint and respiratory rate
Author(s) -
Soeno Shoko,
Hara Konan,
Fujimori Ryo,
Hashimoto Katsuhiko,
Shirakawa Toru,
Sonoo Tomohiro,
Nakamura Kensuke,
Goto Tadahiro
Publication year - 2021
Publication title -
journal of general and family medicine
Language(s) - English
Resource type - Journals
ISSN - 2189-7948
DOI - 10.1002/jgf2.423
Subject(s) - medicine , relative risk , odds ratio , emergency department , emergency medicine , logistic regression , mechanical ventilation , retrospective cohort study , cohort , confidence interval , psychiatry
Background Understanding heterogeneity of the respiratory rate (RR) as a risk stratification marker across chief complaints is important to reduce misinterpretation of the risk posed by outcome events and to build accurate risk stratification tools. This study was conducted to investigate the associations between RR and clinical outcomes according to the five most frequent chief complaints in an emergency department (ED): fever, shortness of breath, altered mental status, chest pain, and abdominal pain. Methods This retrospective cohort study examined ED data of all adult patients who visited the ED of a tertiary medical center during April 2018‐September 2019. The primary exposure was RR at the ED visit. Outcome measures were hospitalization and mechanical ventilation use. We used restrictive cubic spline and logistic regression models to assess the association of interest. Results Of 16 956 eligible ED patients, 4926 (29%) required hospitalization; 448 (3%) required mechanical ventilation. Overall, U‐shaped associations were found between RR and the risk of hospitalization (eg, using RR = 16 as the reference, the odds ratio [OR] of RR = 32, 6.57 [95% CI 5.87‐7.37]) and between RR and the risk of mechanical ventilation. This U‐shaped association was driven by patients' association with altered mental status (eg, OR of RR = 12, 2.63 [95% CI 1.25‐5.53]). For patients who have fever or shortness of breath, the risk of hospitalization increased monotonously with increased RR. Conclusions U‐shaped associations of RR with the risk of overall clinical outcomes were found. These associations varied across chief complaints.