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Original Research

Open Access

Clinical factors of patients who die in an emergency department: the significance of early clinical data, especially for the elderly

  • Marina Serra1
  • Oriol Yuguero1,2,*,

1Faculty of Medicine, University of Lleida, 25198 Lleida, Spain

2ERLab, Research on Emergency Medicine, IRBLLEIDA, 25198 Lleida, Spain

DOI: 10.22514/sv.2024.083 Vol.20,Issue 7,July 2024 pp.53-59

Submitted: 04 December 2023 Accepted: 29 January 2024

Published: 08 July 2024

*Corresponding Author(s): Oriol Yuguero E-mail:


Numerous studies show that vital signs can act as predictors of death. We test these hypotheses with data from the summer of 2022, when Spanish emergency departments (EDs) were overwhelmed. The main objective of this study is to describe the clinical factors of patients who died in the emergency department. This study is a retrospective descriptive analysis of patients who attended an ED between January 2021 and September 2022, focusing on those who died during the same episode. Clinical, sociodemographic and management variables were evaluated. A comparison between the study years was performed. A bivariate analysis was conducted to examine the relationship between the cause of death, triage level, and survival. During the study period, 116,870 patients attended the ED, 317 (0.27%) of whom died during the same ED episode. Of the patients who died, 54.3% were men and 45.7% were women. 182 people died in 2021 and 135 in 2022. The primary cause of death is respiratory. The profile of a patient who dies in the emergency department is an elderly male (>80 years old) coming from their home with a triage level indicating a risk to life (urgent or emergent), presenting cardiovascular risk factors, and dying from a respiratory cause. Factors such as hypotension, tachypnea, hypoxia, elevated creatinine, and lactate levels, observed during the first minutes in the emergency department, significantly determine patient survival (p < 0.05). It can be asserted that clinical parameters can estimate patients’ immediate vital prognosis in the first hours of attending the emergency department, especially among elderly patients and those with a severe triage level (emergent/urgent). Creating a score for elderly patients with certain clinical parameters upon triage could help to provide better healthcare and reduce the delay in attending to them.


Mortality; Clinical signs; Emergency; Health management; Health systems

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Marina Serra,Oriol Yuguero. Clinical factors of patients who die in an emergency department: the significance of early clinical data, especially for the elderly. Signa Vitae. 2024. 20(7);53-59.


[1] Hollander J, Sharma R. The availablists: emergency care without the emergency department. NEJM Catalyst Innovations in Care Delivery. 2021; 6: 1–13.

[2] Ministerio de Sanidad y Consumo. Standards and recommendations. 2010. Available at: (Accessed: 01 September 2022).

[3] Julián-Jiménez A, Rubio-Díaz R, González del Castillo J, García-Lamberechts EJ, Huarte Sanz I, Navarro Bustos C, et al. Ability of qSOFA1-lactate to predict 30-day mortality in patients seen for infection in the emergency department. Spanish Journal of Chemotherapy. 2023; 36: 408–415. (In Spanish)

[4] Simbawa JH, Jawhari AA, Almutairi F, Almahmoudi A, Alshammrani B, Qashqari R, et al. The association between abnormal vital signs and mortality in the emergency department. Cureus. 2021; 13: e20454.

[5] Makonnen N, Layng T, Hartka T. Comparison of mortality in emergency department patients with immediate versus delayed hypotension. The American Journal of Emergency Medicine. 2023; 72: 1–6.

[6] Jones S, Moulton C, Swift S, Molyneux P, Black S, Mason N, et al. Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emergency Medicine Journal. 2022; 39: 168–173.

[7] Af Ugglas B, Lindmarker P, Ekelund U, Djärv T, Holzmann MJ. Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR). PLOS ONE. 2021; 16: e0247881.

[8] Jiménez J, Olaya FB, Cremidis OB, Cortés EA, Garrigós JBF, Prats MM. Clinical validation of the new version of the triage assistance program (web_e-PAT v3) of the Andorran triage model (MAT) and Spanish Triage System (SET). Reliability, usefulness and validity in the paediatric and adult population. Emergencias. 2006; 18: 207–214.

[9] Lu Y, Ren C, Wu C. In-hospital mortality prediction model for critically ill older adult patients transferred from the emergency department to the intensive care unit. Risk Management Healthcare Policy. 2023; 16: 2555–2563.

[10] Gunnarsdottir OS, Rafnsson V. Mortality of the users of a hospital emergency department. Emergency Medicine Journal. 2006; 23: 269–273.

[11] Martín-Rodríguez F, Ortega GJ, Castro Villamor MA, del Pozo Vegas C, Delgado Benito JF, Martín-Conty JL, et al. Development of a prehospital lactic acidosis score for early-mortality. A prospective, multicenter, ambulance-based, cohort study. The American Journal of Emergency Medicine. 2023; 65: 16–23.

[12] Wessman T, Ärnlöv J, Carlsson AC, Ekelund U, Wändell P, Melander O, et al. The association between length of stay in the emergency department and short-term mortality. Internal and Emergency Medicine. 2022; 17: 233–240.

[13] Ortiz SS, Huang Y, Rowe BH, Zheng B, Rosychuk RJ. Emergency department crowding negatively influences outcomes for adults presenting for chronic obstructive pulmonary disease. Canadian Journal of Emergency Medicine. 2023; 25: 411–420.

[14] Aguirre NL, Gutiérrez SG, Miro O, Aguiló S, Jacob J, Alquézar-Arbé A, et al. Older adult patients in the emergency department: which patients should be selected for a different approach? Annals of Geriatric Medicine and Research. 2024; 28: 9–19.

[15] Afonso-Argilés FJ, Comas Serrano M, Blázquez-Andión M, Castells Oliveres X, Cirera Lorenzo I, García Pérez D, et al. Factors associated with short-term mortality after emergency department care of residents living in aged care homes: findings from the multicenter Caregency study. Emergencias. 2022; 34: 437–443.

[16] Sakamoto JT, Liu N, Koh ZX, Guo D, Heldeweg MLA, Ng JCJ, et al. Integrating heart rate variability, vital signs, electrocardiogram, and troponin to triage chest pain patients in the ED. The American Journal of Emergency Medicine. 2018; 36: 185–192.

[17] Saberian SM, Chester DJ, Udobi KF, Childs EW, Danner OK, Sola R. A comparative analysis of hospital triage systems in the geriatric adult trauma patients: a quality improvement pilot study. The American Surgeon. 2023; 89: 2300–2305.

[18] Garcia-Pérez D, Robles-Perea L, Vena-Martínez A, Arnau A, Robles-Bernabeu G, Espaulella-Panicot J. 3D/3D+ as a tool for rapid geriatric assessment and adequacy of the care resource at discharge from the emergency department. Spanish journal of Geriatrics and Gerontology. 2022; 57: 212–219. (In Spanish)

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