The difference between the patients' initial and previously measured systolic blood pressure as predictor of mortality in older emergency department patients

Purpose To assess how often baseline systolic blood pressure (SBP) could be retrieved from the Electronic Health Record (EHR) in older Emergency Department (ED) patients. Second, to assess whether the difference between baseline SBP and initial SBP in the ED (Delta SBP) was associated with 30-day mortality. Methods A multicenter hypothesis-generating cohort study including patients >= 70 years. EHRs were searched for baseline SBPs. The association between Delta SBP and 30-day mortality was investigated. Results Baseline SBP was found in 220 out of 300 patients (73.3%; 95%CI 68.1-78.0%). In 72 patients with normal initial SBPs (133-166 mmHg) in the ED, fifteen (20.8%) had a negative Delta SBP with 20.0% mortality. A negative Delta SBP was associated with 30-day mortality (AHR 4.7; 1.7-12.7). Conclusion Baseline SBPs are often available in older ED patients. The Delta SBP has prognostic value and could be used as an extra variable to recognize hypotension in older ED patients. Future studies should clarify whether the Delta SBP improves risk stratification in the ED.Key summary pointsAim To investigate whether a baseline systolic blood pressure (SBP) in older Emergency Department (ED) patients of >= 70 years has prognostic value, when compared with the initial SBP at presentation in the ED (= Delta SBP). Findings A baseline SBP could be retrieved from the Electronic Health Record for most older ED patients (73.3%). A negative Delta SBP was associated with 30-day mortality. In 20% of the patients with a normal initial SBP in the ED, the Delta SBP was negative, with a high mortality rate. Message A baseline SBP value could be retrieved from the Electronic Health Record in most hospitalized ED patients >= 70 years. In addition, the 21% with a normal SBP at ED presentation had a negative Delta SBP and these patients had an increased risk for 30-day mortality. As a result, Delta SBP may contribute to improved risk stratification and may help to recognize hypotension in older patients.