Are unplanned readmissions to Emergency Departments predicted by discharge with abnormal vital signs

<b>Background:</b><b> </b>Vital signs are usually blood pressure, heart rate, respiration rate and temperature. They are used to monitor patient conditions. Changes in vital signs can assist inidentifying deterioration. Afferent monitoring systems can be paired with efferent systems to ensure an appropriate response to abnormal vital signs. Emergency departments do not generally use Early warning score charts, but they might help predict readmissions.<b>Objective:</b><b> </b>To investigate the association between abnormal vital signs and adult hospital re-presentations.<b>Methods:</b><b> </b>An integrative review using a systematic search of the databases Cochrane, EBSCO Host, Embase, Medline, and CINAHL. No time frame was used. Inclusion criteria were case-control and cohort studies that looked at hospital re-presentations in adults 18 years or older with unstable or stable vital signs on discharge. Risk of bias was assessed through seven domains using the Robins E tool. A deductive approach through thematic analysis explored four questions that were developed before carrying out the systematic search.<b>Results:</b><b> </b>Five studies, all based in the USA, were included, with 182,035 participants. All studies used retrospective electronic health records and data. The mean age combined is 64.9. Four of the studies had more than 50% of woman participants. Two studies were found tobe of high quality, two were reviewed as low quality with a high risk of confounding bias, and one was deemed to have some concerns about missing data. All five studies defined vitalsigns, with one study excluding respiration rate. Four studies found that abnormal vital signs on discharge increased the risk of readmission or death. The same four studies determined that two or more abnormal vital signs increase the risk of re-presentations or death. In threestudies, heart rate and blood pressure were the most significant predictors of re-presentation or death.<b>Conclusion:</b><b> </b>Abnormal vital signs on discharge can predict re-presentations or readmissions.The more abnormal vital signs a patient has on discharge, the increased likelihood of re-presentations or death. Abnormal heart rate and blood pressure were more likely to predict readmissions than respiration rate and temperature.