Characteristics and outcomes of patients with emergency department revisits within 72 hours and subsequent admission to the intensive care unit

Objective: This study aimed to investigate the characteristics and outcomes of patients with emergency department (ED) revisits within 72 hours and subsequent admission to the intensive care unit (ICU). Materials and Methods: The medical records of all adult patients revisiting the ED of a single tertiary referral medical center with ICU admissions between January 2012 and September 2014 were reviewed in terms of patient characteristics, clinical manifestations, diagnoses, triage according to the Taiwan Triage and Acuity Scale, causes of revisits, and mortality. Results: The majority of the 51 patients reviewed were male (64.7%). Their mean age was 62.9 +/- 14.9 years. Most patients visited the ED during the evening shift (51%) and were categorized into triage Level III (76.5%) during their first ED visit. The causes of revisits were doctor-related (21/51, 41.1%), illness-related (18/51, 35.3%), and patient-related (12/51, 23.5%). Disease categories included the neurological (23.5%), digestive (23.5%), and cardiovascular systems (21.6%). Abdominal pain and vertigo/dizziness were the two most common initial manifestations. The mortality rate was 27.5%. Malignancy and hepatic diseases were the two most common underlying medical conditions for nonsurvivors. In addition, patients initially presenting to the ED with lower triage scores (III & IV) had a higher mortality rate than those with higher scores (I & II). Conclusion: Most of the patients who revisited the ED within 72 hours and were subsequently admitted to the ICU visited the ED during the evening shift and were categorized into triage Level III on their first visit. The most common chief complaint at the first visit was abdominal pain. The most common cause of revisits with ICU admission was doctor-related, while the most common underlying disease was hypertension. Significantly higher mortality was observed after ED revisits in patients with lower triage scores with underlying malignancy and liver cirrhosis. Copyright (C) 2016, Buddhist Compassion Relief Tzu Chi Foundation. Published by Elsevier Taiwan LLC.