Objectives: To identify the occurrence of adverse events in stroke patients presenting to the emergency department of a tertiary university facility, and to disclose the categories of adverse events associated with death.
Methods: This matched case–control study enrolled 468 patients admitted with stroke to the emergency department from March 1996 to September 1999. The cases comprised 234 consecutive deaths and the controls 234 discharged patients, matched for primary diagnosis and admission period. Adverse events, detected by chart review, were classified according to the degree of severity, immediate causes, and professional category. The association with death was analysed by conditional logistic regression.
Results: Adverse events totaled 1218 and occurred in 295 patients: 932 events (76.5%) in 170 cases and 286 (23.5%) in 125 controls. Major adverse events equaled 54.1% of all events (659 episodes): 538 events in 143 cases and 121 in 65 controls. Diagnostic or therapeutic procedures and nursing activities accounted for 55.2% of events. Nursing (38.4%) and medical (31%) adverse events represented the most common related professional categories. A significant association with death was found for major adverse events, medical adverse events, and nosocomial infections, with adjusted odds ratio estimates of 3.74 [95% confidence interval (CI) 1.64–8.54], 3.71 (95% CI 1.61–8.53), and 3.22 (95% CI 1.21–8.59), respectively.
Conclusion: Adverse events, mostly severe, predominated among deceased patients, resulting mainly from diagnostic or therapeutic procedures and nursing activities. In spite of limitations concerning the observational retrospective nature of this study, we found that severe adverse events, medical adverse events, and nosocomial infections were significantly associated with death in stroke patients.
Departments of aMedical Emergency Medicine
bOtolaryngology, Hospital das Clínicas
cDepartment of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
Correspondence and requests for reprints to Renata Daud Gallotti, MD, PhD, Alameda Itu, 1420 apt 101, São Paulo, SP, Brazil CEP: 01421-001
Tel: +55 11 3085 7783; fax: +55 11 3069 6336;
Presented at the 37th Annual Society of Epidemiologic Research (SER) Meeting. Salt Lake City, Utah, USA, 15–18 June 2004.
Presented at the VIth Brazilian Congress of Epidemiology. Recife, Pernambuco, Brazil, 19–23 June 2004.