Etiology of Shock in the Emergency Department: A 12-Year Population-Based Cohort Study

Overview

Journal Shock

Date 2016 Dec 17

PMID 27984523

Citations 11

Authors

Jon Gitz Holler

Helene Kildegaard Jensen

Daniel Pilsgaard Henriksen

Lars Melholt Rasmussen

Soren Mikkelsen

Court Pedersen

Annmarie Touborg Lassen

Affiliations

Soon will be listed here.

Abstract

Introduction: The knowledge of the etiology and associated mortality of undifferentiated shock in the emergency department (ED) is limited. We aimed to describe the etiology-based proportions and incidence rates (IR) of shock, as well as the associated mortality in the ED.

Methods: Population-based cohort study at a University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. Patients aged ≥18 years living in the ED-catchment area (N = 225,000) with a first-time ED presentation with shock (n = 1,553) defined as hypotension (systolic blood pressure ≤100 mm Hg) and ≥1 organ failures were included. Discharge diagnoses defined the etiology and were grouped as follows: distributive septic shock (SS), distributive non-septic shock (NS), cardiogenic shock (CS), hypovolemic shock (HS), obstructive shock (OS), and other conditions (OC). Outcomes were etiology-based characteristics, annual IR per 100,000 person-years at risk (95% confidence intervals [CIs]), mortality at 0 to 7-, and 0 to 90 days (95% CIs) and hazard rates (HR) at 0 to 7, 8 to 90 days (95% CIs). Poisson and Cox regression models were used for analyses.

Results: Among 1,553 shock patients: 423 (27.2%) had SS, 363 (23.4%) NS, 217 (14.0%) CS, 479 (30.8%) HS, 14 (0.9%) OS, and 57 (3.7%) OC. The corresponding IRs were 16.2/100,000 (95% CI: 14.8-17.9), 13.9/100,000 (95% CI: 12.6-15.4), 8.3/100,000 (95% CI: 7.3-9.5), 18.4/100,000 (95% CI: 16.8-20.1), 0.5/100,000 (95% CI: 0.3-0.9), and 2.2/100,000 (95% CI: 1.7-2.8). SS IR increased from 8.4 to 28.5/100,000 during the period 2000 to 2011. Accordingly, the 7-, and 90-day mortalities of SS, NS, CS, and HS were 30.3% (95% CI: 25.9-34.7) and 56.2% (95% CI: 50.7-61.5), 12.7% (95% CI: 9.2-16.1) and 22.6% (95% CI: 18.1-27.7), 34.6% (95% CI: 28.2-40.9) and 52.3% (95% CI: 44.6-59.8), 19.2% (95% CI: 15.7-22.7), and 36.8% (95% CI: 33.3-43.3). SS (HR = 1.46 [95% CI: 1.03-2.07]), and CS (HR = 2.15 [95% CI: 1.47-3.13]) were independent predictors of death within 0 to 7 days, whereas SS was a predictor within 8 to 90 days (HR = 1.66 [95% CI: 1.14-2.42]).

Conclusion: HS and SS are frequent etiological characteristics followed by NS and CS, whereas OS is a rare condition. We confirm the increasing trend of SS, as previously reported. Seven-day mortality ranged from 12.7% to 34.6%, while 90-day mortality ranged from 22.6% to 56.2%. The underlying etiology was an independent predictor of mortality.

Citing Articles

The Outcomes of the Initial Misclassification of Undifferentiated Hypotension in the Emergency Department: A Prospective Observational Study.

Lin J, Chen W, Ong H, Hung C, Chang W, Huang C J Clin Med. 2024; 13(17).

PMID: 39274504 PMC: 11396653. DOI: 10.3390/jcm13175293.

[Distributive shock].

Bocklein M, Beck M, Shmygalev S Anaesthesiologie. 2023; 72(8):608-618.

PMID: 37493826 DOI: 10.1007/s00101-023-01304-1.

Principles of Hypotensive Shock: A Video Introduction to Pathophysiology and Treatment Strategies.

MacDonald B, MacDonald N, Garcia J, Zhang X, Papanagnou D J Educ Teach Emerg Med. 2023; 7(1):L1-L10.

PMID: 37483400 PMC: 10358873. DOI: 10.21980/J8MS84.

Early Recognition and Risk Stratification in Cardiogenic Shock: Well Begun Is Half Done.

Polyzogopoulou E, Bezati S, Karamasis G, Boultadakis A, Parissis J J Clin Med. 2023; 12(7).

PMID: 37048727 PMC: 10095596. DOI: 10.3390/jcm12072643.

Prediction of septic and hypovolemic shock in intensive care unit patients using machine learning.

Pessoa S, Oliveira B, Santos W, Oliveira A, Camargo M, Matos D Rev Bras Ter Intensiva. 2023; 34(4):477-483.

PMID: 36888828 PMC: 9986996. DOI: 10.5935/0103-507X.20220280-pt.

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