Recurrent themes reported by Sklar et al:
(1) atypical presentation of an unusual problem
(2) chronic disease with end-stage decompensation
(3) presence of abnormal vital signs (see below)
(4) mental disability, psychiatric problem and/or substance abuse (unwilling to return for worsening symptoms)
Abnormal vital signs included:
(1) pulse > 99 OR < 60 beats per minute
(2) systolic blood pressure > 179 OR < 90 mm Hg
(3) diastolic blood pressure > 109 mm Hg
(4) respiratory rate > 24 OR < 12 breaths per minute
(5) body temperature > 37.9°C (100.2°F) OR < 35°C (95°F)
(6) oxygen saturation < 90%
Additional factors might include:
(1) The patient was physically unable to return for worsening condition.
(2) There was progression of a condition not detected in the ED (like subarachnoid hemorrhage).
(3) The patient did not want to stay.
(4) The healthcare provider was inexperienced or made an error.
