[Borderline between emergencies and hospitalization in the analysis of hospital mortality]

The analysis of hospital mortality rate as a measure of care quality is usually restricted to death occurred at hospital wards, and no consideration is given to deaths occurred at the Emergency Department. Therefore, the information from a fundamental hospital area goes without analysis.

The following characteristics of decreased individuals at the Emergency Department (n = 79) and hospital wards (n = 280) in the Costa del Sol Hospital (Marbella, Málaga, Spain) during 1997 were compared: age, sex, main diagnosis at admission, main diagnosis specificity, and number of secondary diagnoses. A reevaluation of hospital mortality rates was made after data from ED deaths had been added.

The addition of deaths occurred at the ED meant a relevant increase in hospital mortality rates: 57% for heart failure, 30% for stroke, and 25% for myocardial infarction. Twenty percent of deaths at the ED had non-specific diagnosis versus 5% at wards (p < 0.0001; 95%CI: 6.03; 24.15). Deaths at the ED had 2.9 +/- 1.3 secondary diagnoses versus 4.9 +/- 2.0 in deaths at hospital wards (p < 0.0001; 95%CI: 1.6; 2.4).

Deaths at the ED make up a relevant proportion of the total deaths and should be incorporated to the hospital mortality analysis. Deficiencies in the collection of clinical information were observed in this ED. Therefore, adjustments for severity--an essential issue for comparing mortality rates between centers--might be precluded.