Overnight stay in Spanish emergency departments and mortality in older patients
Por:
Miró, O, Aguiló, S, Alquézar-Arbé, A, Fernández, C, Burillo, G, Martínez, SG, Larrull, MEM, Periago, ABB, Molinas, CLA, Falcón, CR, Dacosta, PB, Flores, RCC, Calzada, JN, Blesa, EMF, Martín, MAP, Requena, AC, Fuentes, L, Cortizo, IL, Garcinuño, PG, García, MB, Del Valle, PR, Campos, RB, Jiménez, VC, Cuñado, VA, Gutiérrez, OT, Reviriego, MDS, Roussel, M, del Castillo, JG
Publicada:
20 jun 2024
Ahead of Print:
1 jun 2024
Resumen:
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 8:00 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.
Filiaciones:
Miró, O:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Barcelona, Catalonia, Spain
Aguiló, S:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Barcelona, Catalonia, Spain
Alquézar-Arbé, A:
Hosp Santa Creu I St Pau, Emergency Dept, Barcelona, Catalonia, Spain
Fernández, C:
Univ Complutense Madrid, Hosp Clin San Carlos, Emergency Dept, IDISSC, Madrid, Spain
Burillo, G:
Univ La Laguna, Hosp Univ Canarias, Emergency Dept, Tenerife, Canary Island, Spain
Martínez, SG:
Hosp Doctor Balmis, Emergency Dept, Alicante, Spain
Larrull, MEM:
Hosp Univ Gregorio Maranon, Emergency Dept, Madrid, Spain
Periago, ABB:
Univ Complutense Madrid, Hosp Clin San Carlos, Emergency Dept, IDISSC, Madrid, Spain
Molinas, CLA:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Barcelona, Catalonia, Spain
Falcón, CR:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Barcelona, Catalonia, Spain
Dacosta, PB:
Hosp Alvarolvaro Cunqueiro Vigo, Emergency Dept, Vigo, Spain
Flores, RCC:
Complejo Asistencial Univ Leon, Emergency Dept, Leon, Spain
Calzada, JN:
Hosp Univ Miguel Servet, Emergency Dept, Zaragoza, Spain
Blesa, EMF:
Hosp Reg Univ Malaga, Emergency Dept, Malaga, Spain
Martín, MAP:
Hosp Univ Salamanca, Emergency Dept, Salamanca, Spain
Requena, AC:
Hosp Univ Reina Sofia Cordoba, Emergency Dept, Cordoba, Spain
Fuentes, L:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Spain
Cortizo, IL:
Hosp Univ Cent Asturias, Emergency Dept, Oviedo, Spain
Garcinuño, PG:
Hosp Univ Rio Hortega, Emergency Dept, Valladolid, Spain
García, MB:
Hosp Univ & Politecn La Fe Valencia, Emergency Dept, Valencia, Spain
Del Valle, PR:
Hosp Virgen Rocio, Emergency Dept, Seville, Spain
Campos, RB:
Hosp Univ Clin Univ Valencia, Emergency Dept, Valencia, Spain
Jiménez, VC:
Hosp Univ Burgos, Emergency Dept, Burgos, Spain
Cuñado, VA:
Hosp Univ Severo Ochoa, Emergency Dept, Madrid, Spain
Gutiérrez, OT:
Hosp Santa Creu I St Pau, Emergency Dept, Barcelona, Catalonia, Spain
Reviriego, MDS:
Hosp Nuestra Senora del Prado, Emergency Dept, Talavera De La Reina, Toledo, Spain
Roussel, M:
Ctr Hosp Univ Rouen, Dept Neurol, Rouen, France
del Castillo, JG:
Univ Complutense Madrid, Hosp Clin San Carlos, Emergency Dept, IDISSC, Madrid, Spain
Green Submitted
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