Meeting medical emergency response criteria for hypertension is not associated with an increased likelihood of in-hospital mortality in a tertiary referral center

Jin Nuo Joan Tsang; Stephen Bacchi; Christopher D Ovenden; Rudy Goh; Joshua G Kovoor; Aashray K Gupta; Yong Min Le; Antoinette Lam; Brandon Stretton; Minh-Son To; Richard Woodman; Arduino A Mangoni; James Malycha

doi:10.1016/j.resplu.2024.100679

Meeting medical emergency response criteria for hypertension is not associated with an increased likelihood of in-hospital mortality in a tertiary referral center

Resusc Plus. 2024 Jun 5:19:100679. doi: 10.1016/j.resplu.2024.100679. eCollection 2024 Sep.

Authors

Jin Nuo Joan Tsang¹, Stephen Bacchi^{2

3}, Christopher D Ovenden^{2

3}, Rudy Goh^{2

3}, Joshua G Kovoor^{3

4}, Aashray K Gupta^{2

5}, Yong Min Le^{2

3}, Antoinette Lam^{1

2}, Brandon Stretton^{1

2}, Minh-Son To¹, Richard Woodman¹, Arduino A Mangoni^{1

6}, James Malycha^{2

3

4}

Affiliations

¹ College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia.
² University of Adelaide, Adelaide SA 5005, Australia.
³ Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide SA 5000, Australia.
⁴ Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville SA 5011, Australia.
⁵ Gold Coast University Hospital, Southport QLD 4215, Australia.
⁶ Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park SA 5042, Australia.

Abstract

Backgrounds: Rapid response team or medical emergency team (MET) calls are typically activated by significant alterations of vital signs in inpatients. However, the clinical significance of a specific criterion, blood pressure elevations, is uncertain.

Objectives: The aim of this study was to evaluate the likelihood ratios associated with MET-activating vital signs, particularly in-patient hypertension, for predicting in-hospital mortality among general medicine inpatients who met MET criteria at any point during admission in a South Australian metropolitan teaching hospital.

Results: Among the 15,734 admissions over a two-year period, 4282 (27.2%) met any MET criteria, with a positive likelihood ratio of 3.05 (95% CI 2.93 to 3.18) for in-hospital mortality. Individual MET criteria were significantly associated with in-hospital mortality, with the highest positive likelihood ratio for respiratory rate ≤ 7 breaths per minute (9.83, 95% CI 6.90 to 13.62), barring systolic pressure $\geq$ 200 mmHg (LR + 1.26, 95% CI 0.86 to 1.69).

Conclusions: Our results show that meeting the MET criteria for hypertension, unlike other criteria, was not significant associated with in-hospital mortality. This observation warrants further research in other patient cohorts to determine whether blood pressure elevations should be routinely included in MET criteria.

Keywords: Hospital medicine; Hypertension; Medical emergency response; Vital signs.