The John Doe syndrome: Diagnosis and outcome of patients unidentified at the time of emergency department admission
The American Journal of Emergency Medicine(1992)
Abstract
Patients unidentified at the time of admission to urban emergency departments are a group about whom little is known. To determine the medical diagnoses and outcomes of these “John” and “Mary Does”, we reviewed emergency department charts for these patients admitted from January 1 to December 31, 1988. During this period there were 344 initially unidentifiable patients, for 0.44% of all visits. Age was 36.9 ± 15.6 years (mean ± SD); 71% were male. All patients had one or more of the following diagnoses, with mortality highest for cardiopulmonary arrest (n = 42, mortality = 100%), followed by major trauma (163, 68%), drug overdose (27, 41%), miscellaneous medical conditions (11, 18%), neuropsychiatric disorders (59, 12%), acute alcohol intoxication (62, 0%), and seizures (13, 0%). Overall mortality was 47%. Identification was made prior to hospital discharge in 92% of cases. In this group, the most cummon sources of information were the patient (38%), family (19%), or documents eventually found on the person or in belongings (4%). Survivors were much more likely to be identified than those who died (99% versus 84%, P < .0001). These observations describe a John Doe syndrome in patients whose identity is obscured by critical illness, the effects of drugs or alcohol, or neuropsychiatric disease. Economic privation is a major underlying risk factor.
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Key words
Trauma,alcohol intoxication,seizures
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