Analysis of Demographic Characteristics and Predisposing Factors of a Young Cases aged 18-45 years who died in the Emergency Service: Results of a Retrospective Cross-sectional Study

Abstract

Background: The emergency department (ED) is unique in cases of death. However, ED outcomes for young age deaths have not been widely reported in literatures. We aimed to examine the young adult deaths of an academic ED and its precursor. Materials and Methods: The study includes a retrospective cross-sectional analysis of 256 consecutive deaths of young adults aged 18-45 years who applied to ED between 2018-2023. Chi-Square Tests were used to analyze the relationship between variables, Mann Whitney U test was used for bivariate data analysis, Kruskal Wallis H test was used for more than two data analysis. Statistically, p>0.05 was considered significant. Results: 66.4% (n=170) of the cases were male, 33.6% (n=87) were female, mean age was 30.84 (18-45) and mean cardiopulmonary resuscitation (CPR) time was 41.48 (0-240) minutes. It was found that 82.8% (n=212) of the cases were admitted by ambulance. 12:01-18:00 hours were the most intense admission interval with 39.8% (n=102). It was determined that there was no significant relationship between the time of arrival in the ED and the cause of death (p>0.05), When the causes of death are trauma 21.1% (n=54), organ failure10.5% (n=27), and cardiac7% (n=18) causes, are aligned respectively. The most common complaints of the cases to the ED were trauma 18.4% (n=47), shortness of breath 18%(n=46) and sudden loss of consciousness 9.4% (n=24) and unconsciousness 9.4% (n=24). Conclusions: Our research has multiple results. The primary result is that trauma, cardiac and other medical causes came first place in young deaths, respectively. It is important to develop institutional policies to increase the surviv-al rate for preventable young deaths.

Acil Serviste 18-45 Yaş Vefat Eden Genç Vakaların Demografik Karakteristikleri ve Hazırlayıcı Faktörlerin Analizi: Retrospektif Kesitsel Bir Araştırmanın Sonuçları

Abstract

Amaç: Acil servis (AS), ölüm vakaları konusunda benzersizdir. Bununla birlikte, genç yaş ölüm vakaları ile ilgili AS sonuçları yaygın olarak bildirilmemiştir. Bu çalışma, bir akademik AS’in genç ölüm nedenlerini ve hazırlayıcı faktörleri incelemeyi amaçladık. Materyal ve metot: Çalışma 2018-2023 tarihleri arasında, AS’e başvuran 18-45 yaşarası ardışık 256 genç erişkin ölüm vakasının geriye dönük kesitsel incelenmesini içermektedir. Değişkenler arasındaki ilişkiyi incelemek amacıyla Chi-Square Tests, iki değişkenli verileri analizi için Mann Whitney U testi kullanılırken, ikiden fazla veri analizi için Kruskal Wallis H testi kullanılmıştır. İstatistiksel olarak p>0,05 anlamlı kabul edilmiştir. Bulgular: Vakaların %66,4(n=170) erkek, %33,6(n=87)si kadın, yaş ortalaması 30,84 (18-45) ve ortalama kardiyo-pulmoner resusitasyon (KPR) süresi 41,48(0-240) dakika olarak tespit edilmiştir. Vakaların %82,8(n=212) ile en sık ambulansla başvuru yaptığı, zaman dilimi olarak %39,8(n=102) ile 12:01-18:00 saatleri olduğu tespit edilmiştir. AS’e geliş zamanı ile ölüm nedeni arasındaki ilişki incelendiğinde istatistiksel olarak anlamlı bir ilişki olmadığı (p>0,05) ve tüm vakaların %55,3(n=141)‘i AS’e geldiğinde arrest durumunda olmadığı tespit edilmiştir. Ölüm nedenlerine göre incelendiğinde ise %21,1(n=54) ile travma birinci sırada, %10,5(n=27) ile organ yetersizliğine bağlı ölümler ikinci sırada ve %7(n=18) ile üçüncü sırada kardiyak sebepler gelmektedir. Vakaların AS’e en sık başvuru şikayeti sırasıyla travma %18,4(n=47), nefes darlığı %18(n=46) ve ani bilinç kaybı %9,4(n=24) ile şuur bozukluğu %9,4(n=24) olduğu görülmüştür. Sonuç: Araştırmamız birden fazla sonucu bulunmaktadır. Şikayet göre travma, organlara sistemlerine kalple ilgili nedenler, tüm tanılara göre ise medikal nedenler genç ölümlerde birinci sırada geldiği tespit edilmiştir. Önlenebilir genç ölümler için sağ kalım oranını arttırmak amacıyla kurumsal politikalar geliştirmek önemlidir.

Keywords

• Acil Servis
• genç ölümler
• kardiyak arrest

References

1. 1. Ravindran R, Kwok CS, Wong CW, Siller-Matula JM, Parwani P, et al. Cardiac arrest and related mortality in emergency departments in the United States: Analysis of the nation-wide emergency department sample. Resuscitation, 2020;157:166-173.
2. 2. Gulacti U, Lok U, Aydin İ, Gurger M, Hatipoglu HS, Polat H. Outcomes of In-Hospital Cardiopulmonary Resuscitation Af-ter Introduction Of Medical Emergency Team. Kuwait Medi-cal Journal 2016; 48 (2):127-131.
3. 3. Gulacti U, Lok U. Influences of “do-not-resuscitate order” prohibition on CPR outcomes. Turkish Journal of Emergency Medicine 2016;16:47-52.
4. 4. Kempster K, Howell S, Bernard S, Smith K, Cameron P, Finn J, Stub D, Morley P, Bray J. Out-of-hospital cardiac arrest outcomes in emergency departments. Resuscitation. 2021 ;166:21-30. doi: 10.1016/j.resuscitation.2021.07.003.
5. 5. Evren G, Gulen M, Avci A. efficiency of the critical care uni-tusage in the emergency department. Int J Health Sci Res. 2018;8(3): 30-8.
6. 6. Olsen JC, Buenefe ML, Falco WD. Death in the emergency department. Ann Emerg Med. 1998;31(6):758-65. doi: 10.1016/s0196-0644(98)70236-7.
7. 7. Kornegay, JG, Daya MR. Emergency department cardiac arrests: Who, when, and why? Insights from Sweden. Re-suscitation, 2022;175:44-45.
8. 8. Kayser RG, Ornato JP, Peberdy MA; American Heart Associ-ation National Registry of Cardiopulmonary Resuscitation. Cardiac arrest in the Emergency Department: a report from the National Registry of Cardiopulmonary Resuscitation. Re-suscitation. 2008;78(2):151-60. doi: 10.1016/j.resuscitation.2008.03.007.

9. 9. Valderrama, AL, Fang J, Merritt RK, Hong Y. Cardiac arrest patients in the emergency department—National Hospital Ambulatory Medical Care Survey, 2001–2007. Resuscitation, 2011;82(10):1298-1301.
10. 10. Kimblad H, Marklund J, Riva G, Rawshani A, Lauridsen KG, Djärv T. Adult cardiac arrest in the emergency department–A Swedish cohort study. Resuscitation, 2022;175, 105-112.
11. 11. Chan GK. Trajectories of approaching death in the emer-gency department: clinician narratives of patient transitions to the end of life. J Pain Symptom Manage. 2011;42(6):864-81. doi: 10.1016/j.jpainsymman.2011.02.023.
12. 12. Mir T, Qureshi WT, Uddin M, Soubani A, Saydain G, Rab T, Kakouros N. Predictors and outcomes of cardiac arrest in the emergency department and in-patient settings in the United States (2016-2018). Resuscitation. 2022;170:100-106. doi: 10.1016/j.resuscitation.2021.11.009.
13. 13. Keirns CC, Carr BG. From the emergency department to vital statistics: cause of death uncertain. Acad Emerg Med. 2008;15(8):768-75. doi:10.1111/j.1553-2712.2008.00193.x.
14. 14. Ekere AU, Yellowe BE, Umune S. Mortality patterns in the accident and emergency department of an urban hospital in Nigeria. Niger J Clin Pract. 2005;8(1):14-8. PMID: 16392450.
15. 15. Tirkkonen J, Hellevuo H, Olkkola KT, Hoppu S. Aetiology of in-hospital cardiac arrest on general wards. Resuscitation. 2016;107:19-24. doi:10.1016/j.resuscitation.2016.07.007.
16. 16. Vanbrabant P, Dhondt E, Sabbe M. What do we know about patients dying in the emergency department? Resuscita-tion. 2004;60(2):163-70. doi:0.1016/j.resuscitation.2003.08.012.
17. 17. Yang TH, Chen KF, Gao SY, Lin CC. Risk factors associated with peri-intubation cardiac arrest in the emergency de-partment. Am J Emerg Med. 2022;58:229-234. doi: 10.1016/j.ajem.2022.06.013.
18. 18. April MD, Arana A, Reynolds JC, Carlson JN, Davis WT, Schauer SG, Oliver JJ, Summers SM, Long B, Walls RM, Brown CA 3rd; NEAR Investigators. Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study. Resuscitation. 202;162:403-411. doi: 10.1016/j.resuscitation.2021.02.039.
19. 19. Warwick JW, Davenport DL, Bettis A, Bernard AC. Associa-tion of Prehospital Step 1 Vital Sign Criteria and Vital Sign Decline with Increased Emergency Department and Hospital Death. J Am Coll Surg. 2021;232(4):572-579. doi: 10.1016/j.jamcollsurg.2020.12.009.
20. 20. Cha WC, Lee EJ, Hwang SS. The duration of cardiopulmonary resuscitation in emergency departments after out-of-hospital cardiac arrest is associated with the outcome: A na-tionwide observational study. Resuscitation. 2015;96:323-7. doi: 10.1016/j.resuscitation.2015.05.005. Epub 2015 May 15. PMID: 25986336.
21. 21. Swan D, Baumstark L. Does Every Minute Really Count? Road Time as an Indicator for the Economic Value of Emer-gency Medical Services. Value Health. 2022;25(3):400-408. doi: 10.1016/j.jval.2021.09.009.
22. 22. Dyson K, Brown SP, May S, Sayre M, Colella M, Daya MR, et al. Community lessons to understand resuscitation excel-lence (culture): Association between emergency medical services (EMS) culture and outcome after out-of-hospital cardiac arrest. .Resuscitation. 2020;156:202-209. doi: 10.1016/j.resuscitation.2020.09.020.
23. 23. Embong H, Md Isa SA, Harunarashid H, Abd Samat AH. Fac-tors associated with prolonged cardiopulmonary resuscita-tion attempts in out-of-hospital cardiac arrest patients pre-senting to the emergency department. Australas Emerg Care. 2021;24(2):84-88. doi: 10.1016/j.auec.2020.08.001.
24. 24. Moore K. Trauma mortality: understanding mortality distri-bution to improve outcomes. J Emerg Nurs. 2014 Jul;40(4):405-6. doi: 10.1016/j.jen.2014.04.006.
25. 25. Borta T, Gulacti U, Lok U, Aydın İ, Cebe İH, Arslan E. Patients who Die Within Emergency Department: A Descriptive Study. M J E-Med. 2017;2(2): 1-6