Risk Factors Associated with 24-Hour Mortality in the Emergency Department: A Systematic Review
Keywords:
early mortality, emergency department, risk factors, systematic review, triageAbstract
The Emergency Department (ED) is the frontline of hospital care with a high risk of early mortality, particularly within the first 24 hours. Delayed recognition of critical conditions and variability in clinical assessment remain major challenges in reducing early deaths. This study aims to identify and synthesize risk factors associated with 24-hour mortality among patients in the ED. Methods: This study is a systematic review conducted in accordance with PRISMA guidelines using the PICO framework. Literature searches were performed in Scopus, PubMed, and Google Scholar databases from 2015 to 2025. Of 3,599 identified articles, 11 studies met the inclusion criteria and were analyzed qualitatively. Early mortality within 24 hours is influenced by multiple factors, including initial clinical conditions such as decreased consciousness, hypotension, hypoxia, and respiratory abnormalities; demographic factors such as advanced age; comorbidities, particularly cardiovascular and respiratory diseases; and healthcare system factors such as waiting time and ED length of stay. Additionally, clinical scoring systems (e.g., NEWS, qSOFA) and machine learning models demonstrated strong predictive performance for early mortality. Twenty-four-hour mortality in the ED is multifactorial, resulting from the interaction between patient clinical conditions and healthcare system factors. Reducing mortality requires an integrated approach, including improved triage accuracy, optimized early management, and enhanced ED service systems.
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