Emergency department length of stay of hospitalized patients and short-term outcomes (EDEN-18 Study)
Objectives. To estimate the probability of adverse events based on the length of emergency department (ED) stay prior to hospitalization in patients aged > 65 treated in Spanish EDs. Method. All patients aged >= 65 years treated in 52 Spanish EDs during a 1-week period and included in the EDEN...
| Autores: | , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2025 |
| País: | España |
| Institución: | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| Repositorio: | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| OAI Identifier: | oai:iibsantpau.fundanetsuite.com:p20774 |
| Acceso en línea: | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=20774 |
| Access Level: | acceso abierto |
| Palabra clave: | Geriatrics Severity Mortality Hospitalization Emergency department Quality Length of emergency department stay |
| Sumario: | Objectives. To estimate the probability of adverse events based on the length of emergency department (ED) stay prior to hospitalization in patients aged > 65 treated in Spanish EDs. Method. All patients aged >= 65 years treated in 52 Spanish EDs during a 1-week period and included in the EDEN (Emergency Department and Elder Needs) Registry who were hospitalized and had available data on the length of ED stay were included in the study. Adverse events considered were in-hospital mortality and prolonged hospitalization (> 7 days) in patients discharged alive. Non-linear models using restricted cubic splines were applied to estimate the probability of adverse events as a function of the length of ED stay, and crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) were calculated, adjusting for 13 demographic, baseline health, and vital sign variables. First-order interactions with covariates were also examined. Results. A total of 6,333 patients were included. The length of ED stay ranged from 0 to 240 hours prior to hospital admission (median, 6 hours; and 12.6%, 3.5%, 1.5%, and 0.2% of patients remained in the ED for more than 1, 2, 3, and 7 days, respectively). A total of 683 patients (10.8%) died during hospitalization, and among survivors, 2,734 (46.9%) experienced prolonged hospitalization. Compared with patients with a 12-hour ED stay (reference), those with stays of 6 and 3 hours had adjusted ORs for in-hospital mortality of 1.11 (1.01-1.22) and 1.22 (1.03-1.44), and for prolonged hospitalization of 0.89 (0.84-0.95) and 0.83 (0.75-0.93), respectively. For ED stays of 1, 2, 3, and 7 days, the adjusted ORs for in-hospital mortality were 1.00 (0.94-1.06), 1.18 (0.97-1.43), 1.39 (0.98-1.97), and 2.70 (1.02-7.13), and for prolonged hospitalization, 1.14 (1.09-1.19), 1.39 (1.17-1.62), 1.66 (1.25-2.21), and 3.53 (1.60-7.76), respectively. Patients with functional limitation and hypotension showed a stronger association between the length of ED stay and in-hospital mortality, while those aged < 80 years and without prior falls showed a stronger association between the length of ED stay and prolonged hospitalization. Conclusions. Both short and long ED stays in patients who are subsequently hospitalized were associated with increased in-hospital mortality. However, shorter stays were associated with a lower likelihood of prolonged hospitalization, whereas longer stays were associated with a higher likelihood of prolonged hospitalization. These associations may be significantly stronger in certain patient subgroups. |
|---|