Adverse events and death in patients with community-acquired pneumonia in the emergency department of a major university hospital in Brazil

Introduction

Adverse events (AEs), defined as unintended injuries due to medical care, have been related to patient death. Urgent care is an important AE risk factor.

Objectives

This paired case–control study aimed to identify the occurrence of AEs in patients with community-acquired pneumonia (CAP) attending a medical Emergency Department (ED) of a Brazilian major university hospital, disclosing the AEs categories associated with death.

Methods

We investigated 202 patients admitted for CAP from March 1996 to September 1999. The cases comprised 101 consecutive deaths and the controls 101 discharged patients matched for primary diagnosis and admission period. AEs, detected by chart review, were classified regarding: severity degree (major and minor), immediate cause, and professional category. The association with death was analyzed by multivariate conditional regression including variables related to demographic features, severity on admission and care characteristics.

Results

A total of 603 AEs were identified in 202 patients: 456 events (75.6%) in 85 cases and 147 (24.4%) in 55 controls. Two hundred and twenty-four major AEs were detected: 201 events in 65 cases and 23 in 10 controls. Diagnostic procedures and nursing activities accounted for 43.1% of all events. Nursing (43.8%) and medical (36.5%) AEs were the main professional categories of AEs detected in both groups. The occurrence of at least one AE was associated with a higher risk of death, with adjusted odds ratio (OR) estimates of 2.99 (95% confidence interval [CI] = 1.09–8.17; P = 0.033). A stronger association with death was found regarding major AEs (OR 6.05; 95% CI = 2.19–16.68; P = 0.001). Medical AEs and administrative AEs were also associated with death, with adjusted OR estimates of 3.74 (95% CI = 1.40–10.00; P = 0.009) and 2.97 (95% CI = 1.12–7.90; P = 0.029), respectively.

Conclusions

In summary, AEs predominated among the deceased patients admitted with CAP. Diagnostic and therapeutic procedures and nursing activities corresponded to the main AE immediate causes. Regarding the professional involved, AEs related to nurses and physicians predominated. The occurrence of AEs was associated with a higher risk of death in CAP patients admitted to a tertiary ED.