Publication:

Forty-eight-hour mortality in the emergency department: a record-based analysis of patterns and causes from a South Indian tertiary care centre

Background Early mortality within 48 hours of emergency department (ED) admission is a key indicator of acute care quality. Limited Indian data exist on its epidemiology, especially regarding contributory factors in both medico-legal (MLC) and non-medico-legal (non-MLC) deaths. To determine the 48-hour mortality rate in the ED, describe demographic and clinical profiles, identify the duration of ED stay prior to death, and evaluate causes and contributing factors to early mortality.

Methods This retrospective record-based study was conducted at a tertiary care center in South India over two years (January 2019–January 2021). All 132 patients who died within 48 hours of ED admission were included. Demographic and clinical parameters, cause of death, referral-to-death interval, and contributory factors (organizational, disease-related, human error) were analyzed descriptively and comparatively across MLC and non-MLC cases.

Results Out of 96,560 emergency department visits, 132 patients died within 48 hours of ED arrival, corresponding to a mortality rate of 1.37 per 1,000 ED visits. Most patients (58%) died within 6 hours of admission. Cardiac causes (51.5%) and sepsis (26.8%) were predominant in non-MLC deaths, while trauma (60%) was the leading cause in MLC. Over 60% of patients died within 1–6 hours of referral from other centers. Disease-related causes accounted for 65.7% of MLC and 41.2% of non-MLC deaths, followed by organizational delays and human errors.

Conclusion Early ED mortality is driven by both clinical severity and systemic delays. Stratified analysis of MLC and non-MLC cases reveals opportunities to strengthen prehospital referral systems, triage protocols, and resource allocation in emergency care.