Factors Associated with Survival in Non-Trauma Subjects Treated in the "Shock Room" in a Tertiary Medical Center

Emergency department shock rooms provide immediate care for critically ill patients requiring life-saving interventions. Rapid diagnosis and treatment are crucial determinants of survival, yet factors predicting outcomes in this population remain poorly understood. This study evaluated factors associated with survival among patients hospitalized after shock room treatment in a tertiary medical center.

In this retrospective cohort study, medical records of patients treated in the emergency department shock room of a tertiary referral center were reviewed. Patients were categorized according to hospital survival. Variables analyzed included age, sex, comorbidities, etiology of the acute event, vital signs at admission and discharge from the SR (including blood pressure, heart rate, respiratory rate, body temperature, and oxygen saturation), out-of-hospital mechanical ventilation, and laboratory values including creatinine, hemoglobin, lactate, electrolytes, and coagulation parameters.

A total of 101 patients treated over 24 consecutive months were included. The cohort comprised 50 men and 51 women with a mean age of 68±20 years (range 18-100). The mean shock room stay was 4.69±4.3 hours. Sixteen patients (16%) arrived following out-of-hospital resuscitation and were invasively ventilated. Overall, 60 patients (60%) died during hospitalization. Approximately half of all admissions were related to respiratory system morbidity. Mortality was significantly higher among patients aged >65 years than among those aged ≤65 years (75% vs 34%, p=0.046). Oncological disease as a comorbidity was significantly more prevalent in deceased patients (38% vs 10%, p=0.001). Admission creatinine was higher in deceased patients (1.5 vs 0.9 mg/dL, p=0.004) and hemoglobin was lower (11.9 vs 12.9 g/dL, p=0.044). Respiratory rate was significantly higher (18 vs 12 breaths/min, p=0.002) and diastolic blood pressure lower (67.5 vs 79.0 mmHg, p=0.011) in patients who died. Diastolic blood pressure remained significantly lower at shock room discharge in deceased patients (p=0.010). Shock room stay duration (≤4 vs >4 hours) was not significantly associated with mortality (OR 0.66, p=0.320).

Age over 65, elevated creatinine, low hemoglobin, high respiratory rate, and low diastolic blood pressure at admission were associated with in-hospital mortality. Persistent diastolic hypotension at shock room discharge was a novel finding. Shock room stay duration was not independently associated with mortality. These findings are exploratory and prospective validation in larger cohorts is needed.