Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea
Abstract Background Prolonged emergency department length of stay (EDLOS) in critically ill patients leads to increased mortality. This nationwide study investigated patient and hospital characteristics associated with prolonged EDLOS and in-hospital mortality in adult patients admitted from the eme...
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | BMC Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12873-022-00745-y |
| _version_ | 1811215843648864256 |
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| author | Kyung-Shin Lee Hye Sook Min Jae Young Moon Daesung Lim Younghwan Kim Eunsil Ko You Sun Kim Joohae Kim Jeehye Lee Ho Kyung Sung |
| author_facet | Kyung-Shin Lee Hye Sook Min Jae Young Moon Daesung Lim Younghwan Kim Eunsil Ko You Sun Kim Joohae Kim Jeehye Lee Ho Kyung Sung |
| author_sort | Kyung-Shin Lee |
| collection | DOAJ |
| description | Abstract Background Prolonged emergency department length of stay (EDLOS) in critically ill patients leads to increased mortality. This nationwide study investigated patient and hospital characteristics associated with prolonged EDLOS and in-hospital mortality in adult patients admitted from the emergency department (ED) to the intensive care unit (ICU). Methods We conducted a retrospective cohort study using data from the National Emergency Department Information System. Prolonged EDLOS was defined as an EDLOS of ≥ 6 h. We constructed multivariate logistic regression models of patient and hospital variables as predictors of prolonged EDLOS and in-hospital mortality. Results Between 2016 and 2019, 657,622 adult patients were admitted to the ICU from the ED, representing 2.4% of all ED presentations. The median EDLOS of the overall study population was 3.3 h (interquartile range, 1.9–6.1 h) and 25.3% of patients had a prolonged EDLOS. Patient characteristics associated with prolonged EDLOS included night-time ED presentation and Charlson comorbidity index (CCI) score of 1 or higher. Hospital characteristics associated with prolonged EDLOS included a greater number of staffed beds and a higher ED level. Prolonged EDLOS was associated with in-hospital mortality after adjustment for selected confounders (adjusted odds ratio: 1.18, 95% confidence interval: 1.16–1.20). Patient characteristics associated with in-hospital mortality included age ≥ 65 years, transferred-in, artificially ventilated in the ED, assignment of initial triage to more urgency, and CCI score of 1 or higher. Hospital characteristics associated with in-hospital mortality included a lesser number of staffed beds and a lower ED level. Conclusions In this nationwide study, 25.3% of adult patients admitted to the ICU from the ED had a prolonged EDLOS, which in turn was significantly associated with an increased in-hospital mortality risk. Hospital characteristics, including the number of staffed beds and the ED level, were associated with prolonged EDLOS and in-hospital mortality. |
| first_indexed | 2024-04-12T06:30:20Z |
| format | Article |
| id | doaj.art-80e256079e27466b879156b8ddfce318 |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-04-12T06:30:20Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-80e256079e27466b879156b8ddfce3182022-12-22T03:44:02ZengBMCBMC Emergency Medicine1471-227X2022-11-0122111210.1186/s12873-022-00745-yPatient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in KoreaKyung-Shin Lee0Hye Sook Min1Jae Young Moon2Daesung Lim3Younghwan Kim4Eunsil Ko5You Sun Kim6Joohae Kim7Jeehye Lee8Ho Kyung Sung9Public Health Research Institute, National Medical CenterPublic Health Research Institute, National Medical CenterDepartment of Internal Medicine, Chungnam National University School of MedicineDepartment of Emergency Medicine, Seoul Medical CenterDepartment of Trauma Surgery, National Medical CenterNational Emergency Medical Center, National Medical CenterDepartment of Pediatrics, National Medical CenterDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical CenterNational Emergency Medical Center, National Medical CenterPublic Health Research Institute, National Medical CenterAbstract Background Prolonged emergency department length of stay (EDLOS) in critically ill patients leads to increased mortality. This nationwide study investigated patient and hospital characteristics associated with prolonged EDLOS and in-hospital mortality in adult patients admitted from the emergency department (ED) to the intensive care unit (ICU). Methods We conducted a retrospective cohort study using data from the National Emergency Department Information System. Prolonged EDLOS was defined as an EDLOS of ≥ 6 h. We constructed multivariate logistic regression models of patient and hospital variables as predictors of prolonged EDLOS and in-hospital mortality. Results Between 2016 and 2019, 657,622 adult patients were admitted to the ICU from the ED, representing 2.4% of all ED presentations. The median EDLOS of the overall study population was 3.3 h (interquartile range, 1.9–6.1 h) and 25.3% of patients had a prolonged EDLOS. Patient characteristics associated with prolonged EDLOS included night-time ED presentation and Charlson comorbidity index (CCI) score of 1 or higher. Hospital characteristics associated with prolonged EDLOS included a greater number of staffed beds and a higher ED level. Prolonged EDLOS was associated with in-hospital mortality after adjustment for selected confounders (adjusted odds ratio: 1.18, 95% confidence interval: 1.16–1.20). Patient characteristics associated with in-hospital mortality included age ≥ 65 years, transferred-in, artificially ventilated in the ED, assignment of initial triage to more urgency, and CCI score of 1 or higher. Hospital characteristics associated with in-hospital mortality included a lesser number of staffed beds and a lower ED level. Conclusions In this nationwide study, 25.3% of adult patients admitted to the ICU from the ED had a prolonged EDLOS, which in turn was significantly associated with an increased in-hospital mortality risk. Hospital characteristics, including the number of staffed beds and the ED level, were associated with prolonged EDLOS and in-hospital mortality.https://doi.org/10.1186/s12873-022-00745-yEmergency departmentCritical careIntensive care unitLength of stayIn-hospital mortality |
| spellingShingle | Kyung-Shin Lee Hye Sook Min Jae Young Moon Daesung Lim Younghwan Kim Eunsil Ko You Sun Kim Joohae Kim Jeehye Lee Ho Kyung Sung Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea BMC Emergency Medicine Emergency department Critical care Intensive care unit Length of stay In-hospital mortality |
| title | Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea |
| title_full | Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea |
| title_fullStr | Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea |
| title_full_unstemmed | Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea |
| title_short | Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea |
| title_sort | patient and hospital characteristics predict prolonged emergency department length of stay and in hospital mortality a nationwide analysis in korea |
| topic | Emergency department Critical care Intensive care unit Length of stay In-hospital mortality |
| url | https://doi.org/10.1186/s12873-022-00745-y |
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