Death after discharge from the emergency department

To determine the rate and cause of death of patients who were evaluated in the emergency department and discharged and how the cause of death related to the ED visit.

Retrospective chart review of medical examiner cases from July 1, 1990, to June 30, 1991.

Urban county served by 13 hospital EDs with 383,416 visits in 1991. Eighty-five percent of these patients were discharged.

Medical examiner cases of patients who had been evaluated and released from an ED within 8 days prior to death.

Forty-two of the 2,665 medical examiner cases met inclusion criteria. Death was classified as expected or unexpected based on the patient's clinical status at the time of discharge, and directly related or not directly related to the ED visit, based on review of all records and the cause of death as listed on the death certificate. Six deaths (14%) were considered expected and directly related. Three deaths (7%) were considered expected and not directly related. Twenty-four deaths (57%) were considered unexpected and not directly related. Nine deaths (21%) were considered unexpected and directly related; the most common cause was ruptured aortic aneurysm, occurring in three of these nine cases. The death rate was 13 per 100,000 discharged patients.

Death after discharge from the ED is uncommon. The most common cause of unexpected, directly related death is ruptured aortic aneurysm.