According to the most recent data from the CDC, more than 136 million people visit the emergency room each year in the United States. Studies indicate that about 40 million of these visits were injury-related, and almost 12% resulted in patients being admitted to the hospital.

To address this research gap, Hemal K. Kanzaria, MD, MSc, and colleagues published a study in Health Affairs that analyzed data from the National Hospital Ambulatory Medical Care Survey. The data included almost 368,000 ED visits that occurred throughout the country between 1997 and 2011. “Our goal was to determine trends in ED mortality,” says Dr. Kanzaria. “We also explored possible reasons underlying these trends.”

Decreasing Mortality

Results of the study showed that there was a nearly 50% reduction in U.S. ED mortality rates for adults over the 15-year study period. ED mortality rates fell from 1.48 per 1,000 U.S. adults in 1997 to 0.77 per 1,000 U.S. adults in 2011. When compared with ED patients who survived their visit, those who died were more likely to be older, male and white, and more severely ill or injured when they presented to the ED. In about two-thirds of ED visits which resulted in death, patients were in cardiac arrest or were unconscious or dead upon their arrival. In the remaining patients who died, the most common presenting symptoms included shortness of breath, injury, and chest pain.

“It’s important to note that our study was descriptive in nature and is hypothesis-generating,” explains Dr. Kanzaria. “Our finding of a nearly 50% reduction was thought-provoking but also highlights how rare deaths are in the ED overall.”

Possible Explanations

The trends observed in the study likely have many causes, according to Dr. Kanzaria. “Some of the possible explanations may be related to advances in palliative, pre-hospital, and emergency care,” he says. “Several recent changes across society and healthcare may also contribute to our findings, including greater use of home hospice care and palliative care services. It’s also possible that improvements in emergency medical services and public health might help explain the results.”

While the findings are encouraging, Dr. Kanzaria cautions that it is still reasonable to think that more patients are simply dying in other healthcare settings. “There have been significant gains in the emergency management of many time-sensitive conditions, including heart attack, stroke, trauma, and sepsis,” he says. “That said, we need more research to determine if our results are explained by such improvements or if they could be explained by patients dying in other healthcare settings or by patients surviving but remaining in poor condition. Our hope is that future studies will look more deeply into these issues so that we can develop strategies to further improve patient outcomes.”

Hemal K. Kanzaria, MD, MSc, has indicated to Physician’s Weekly that he is a consultant for RAND Health and Castlight Health.



Kanzaria HK, Probst MC, Hsia RY. Emergency department death rates dropped by nearly 50 percent, 1997-2011. Health Aff. 2016;35:1303-1308. Available at:

Kanzaria HK, Brook RH, Probst MA, Harris D, Berry SH, Hoffman JR. Emergency physician perceptions of shared decision-making. Acad Emerg Med. 2015;22:399-405.

Kanzaria HK, Hoffman JR, Probst MA, Caloyeras JP, Berry SH, Brook RH. Emergency physician perceptions of medically unnecessary advanced diagnostic imaging. Acad Emerg Med. 2015;22:390-398.