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

TL;DR

High blood pressure alone does not increase the risk of in-hospital death for patients meeting medical emergency team criteria.

Contribution

The study reveals that hypertension as a MET criterion is not significantly linked to in-hospital mortality.

Findings

4282 out of 15,734 admissions met MET criteria, with a positive likelihood ratio of 3.05 for in-hospital mortality.

Respiratory rate ≤7 had the highest positive likelihood ratio (9.83) for mortality, while systolic pressure ≥200 mmHg had a non-significant LR of 1.26.

Hypertension as a MET criterion was not significantly associated with in-hospital mortality.

Abstract

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.

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.

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 ≥ 200 mmHg (LR + 1.26, 95% CI 0.86 to 1.69).

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.