Monitored patient in emergency room with storm clouds and a ray of hope

Decoding Deterioration: Can Vital Signs Predict Hospital Outcomes?

Mira Elwood in Health & Wellness December 2025 • 4 min read.

"New research identifies key risk factors to help emergency departments better predict which patients are at high risk for deterioration after admission."

Emergency departments (EDs) are fast-paced environments where quick decisions are critical. Identifying patients at high risk for adverse outcomes is a major challenge, especially when individuals present with abnormal vital signs but aren't showing obvious signs of shock. Knowing who is most likely to deteriorate after admission can significantly improve care.

Traditionally, markedly abnormal vital signs and elevated lactate levels have been used to assess risk. However, many patients fall into a gray area where the need for intervention isn't immediately clear. A new study published in the Western Journal of Emergency Medicine sought to identify independent predictors of in-hospital adverse outcomes in ED patients presenting with abnormal vital signs or lactate levels, but who were not in shock.

This article breaks down the key findings of this research, highlighting which factors are most predictive of deterioration and what this means for improving patient management in the ED and beyond.

Unveiling the Predictors: What the Study Found

Monitored patient in emergency room with storm clouds and a ray of hope

Researchers conducted a prospective observational study involving patients presenting to the ED with at least one of the following:

The study excluded patients with conditions that could skew vital signs (like isolated atrial tachycardia, active seizures, intoxication, or simple trauma) and those already in shock. The primary outcome was deterioration, defined as the development of acute renal failure (doubling of baseline creatinine), the need for non-elective intubation, vasopressor requirement, or mortality during their hospital stay.

Heart rate ≥130 beats/min
Respiratory rate ≥24 breaths/min
Shock index ≥1
Systolic blood pressure <90 mmHg
Lactate level ≥4 mmol/L

Of the 532 patients included in the final analysis, approximately 10% experienced deterioration after hospital admission. The study identified four independent predictors of in-hospital deterioration:

What This Means for Emergency Care

This study underscores that patients exhibiting abnormal vital signs or elevated lactate levels, even without overt shock, are at significant risk for deterioration after hospitalization. By identifying key predictors such as elevated lactate, advanced age, low bicarbonate, and high heart rate, ED clinicians can better risk stratify patients and make more informed decisions about resource allocation and level of care.

While this research provides valuable insights, it's important to remember that it has limitations. The reliance on chart abstraction could introduce misclassification bias, and the composite outcome of deterioration might mask nuances in individual endpoints like renal failure versus mortality. Also, the exclusion of certain patient populations may limit the generalizability of the findings.

Future studies should explore the potential of newer medical devices and biomarkers to improve risk stratification further, ultimately leading to better patient outcomes and more efficient use of healthcare resources. By paying close attention to these key indicators, healthcare providers can work proactively to mitigate risks and provide the best possible care for their patients.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.5811/westjem.2015.9.27348, Alternate LINK

Title: Derivation And Validation Of Predictive Factors For Clinical Deterioration After Admission In Emergency Department Patients Presenting With Abnormal Vital Signs Without Shock

Subject: General Medicine

Journal: Western Journal of Emergency Medicine

Publisher: Western Journal of Emergency Medicine

Authors: Daniel Henning, Kimie Oedorf, Danielle Day, Colby Redfield, Colin Huguenel, Jonathan Roberts, Leon Sanchez, Richard Wolfe, Nathan Shapiro

Published: 2015-12-17

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Everything You Need To Know

1

What specific factors can help predict if a patient's condition will worsen after being admitted to the hospital?

The research pinpointed four key indicators: elevated Lactate levels, advanced age, low Bicarbonate levels, and a high Heart Rate. The presence of these factors, even without obvious signs of shock, suggests a higher likelihood of a patient's condition worsening after they are admitted to the hospital.

2

In this context, what does 'deterioration' specifically mean in terms of a patient's health status?

Deterioration, in the context of this study, is defined as the development of acute renal failure indicated by a doubling of baseline Creatinine, the necessity for non-elective Intubation, the need for Vasopressor intervention to maintain blood pressure, or, in the most severe cases, mortality occurring during the patient's hospital stay.

3

What specific vital signs and lab results were considered when evaluating patients for potential deterioration?

The vital signs considered were a Heart Rate at or above 130 beats per minute, a Respiratory Rate at or above 24 breaths per minute, a Shock Index equal to or greater than 1, and a Systolic Blood Pressure below 90 mmHg. Additionally, a Lactate Level at or above 4 mmol/L was also considered as a key indicator.

4

How can Emergency Departments use this information to improve the care they provide to patients?

Emergency Departments can use the findings to improve patient care by identifying at-risk individuals early on. Recognizing predictors like elevated Lactate, advanced age, low Bicarbonate, and high Heart Rate allows for better risk stratification. This, in turn, enables clinicians to make more informed decisions about allocating resources and determining the appropriate level of care for each patient, potentially preventing adverse outcomes.

5

What aspects of patient deterioration were not addressed, and what further research could be conducted?

While the study identified key predictors of deterioration, it didn't focus on specific interventions or treatment protocols. Future research could explore how targeted interventions based on these predictors (Elevated Lactate, advanced age, low Bicarbonate levels, and a high Heart Rate) might improve patient outcomes. Additionally, further investigation into the underlying mechanisms connecting these predictors to deterioration could lead to more effective preventative strategies.