Overnight stay in Spanish emergency departments and mortality in older patients.
Intern Emerg Med
; 19(6): 1653-1665, 2024 Sep.
Article
in En
| MEDLINE
| ID: mdl-38900240
ABSTRACT
To assess whether older adults who spend a night in emergency departments (ED) awaiting admission are at increased risk of mortality. This was a retrospective review of a multipurpose cohort that recruited all patients ≥ 75 years who visited ED and were admitted to hospital on April 1 to 7, 2019, at 52 EDs across Spain. Study groups were patients staying in ED from midnight until 800 a.m. (ED group) and patients admitted to a ward before midnight (ward group). The primary endpoint was in-hospital mortality, truncated at 30 days, and secondary outcomes assessed length of stay for the index episode. The sample comprised 3,243 patients (median [IQR] age, 85 [81-90] years; 53% women), with 1,096 (34%) in the ED group and 2,147 (66%) in the ward group. In-hospital mortality for patients spending the night in the ED the ED group was 10.7% and 9.5% for patients transferred to a ward bed before midnight the ward group (adjusted OR 1.12, 95%CI 0.80-1.58). Sensitivity analyses rendered similar results (ORs ranged 1.06-1.13). Interaction was only detected for academic/non-academic hospitals (p < 0.001), with increased mortality risk for the latter (1.01, 0.33-3.09 vs 2.86, 1.30-6.28). There were no differences in prolonged hospitalization (> 7 days), with adjusted OR of 1.16 (0.94-1.43) and 1.15 (0.94-1.42) depending on whether time spent in the ED was or was not taken into consideration. No increased risk of in-hospital mortality or prolonged hospitalization was found in older patients waiting overnight in the ED for admission. Nonetheless, all estimations suggest a potential harmful effect of staying overnight, especially if a proper bedroom and hospitalist ward bed and hospitalized care are not provided.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Hospital Mortality
/
Emergency Service, Hospital
/
Length of Stay
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Country/Region as subject:
Europa
Language:
En
Journal:
Intern Emerg Med
Journal subject:
MEDICINA DE EMERGENCIA
/
MEDICINA INTERNA
Year:
2024
Document type:
Article
Affiliation country:
Country of publication: