stop reading now if you want…
This was an
electronic medical record review of 30,278 adults treated and released
from the University of Alberta ED in 2016.
identified those that had elevated BP’s at triage and
cross-referenced them with multiple data bases to see if they developed
cardiovascular events by 2 years. (Databases
included hospital EDIS, Pyxis, Pharmaceutical Information Network,
administrative data holdings, National Ambulatory Care Reporting systems,
outpatient billing claims etc.)
Of the 30,278
that were treated and released, about half had elevated BP’s at triage.
70% had no prior history of hypertension and eventually about a quarter of those
subsequently received a diagnosis of chronic hypertension.
adjusting for confounders, high BP at triage was not associated with
adverse cardiovascular outcomes within 2 years of the ED visit.
to believe this is true… but there are many methodologic limitations.
mesmerized by the huge number of patients… this does not guarantee quality. Nor
do large numbers reduce bias.
concerned about a potential “garbage in & garbage out” phenomenon.
The veracity of this study is predicated on the quality of the information in
many large databases. (For example, a large database in the USA shows the rate of virgin births
a lot of other issues; retrospective design, residual confounding, use of
triage BP’s, lack of follow up, possible non-differential misclassification, etc.
elevated BP’s in the ED important?
I still say
no, but not necessarily due to this study. Heck, at least hypertension is better than hypotension.
FA, Youngson E, Rowe B. Elevated Blood Pressures are Common in the Emergency
Department but Are they Important? A Retrospective Cohrt Study of 30,278
Adults. Ann Emerg Med. 2021;77:425-432. [link