The Association between Emergency Department Length of Stay and In-Hospital Mortality in Older Patients Using Machine Learning: An Observational Cohort Study

The association between emergency department (ED) length of stay (EDLOS) with in-hospital mortality (IHM) in older patients remains unclear. This retrospective study aims to delineate the relationship between EDLOS and IHM in elderly patients. From the ED patients (n = 383,586) who visited an urban...

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Detalles Bibliográficos
Autores: Wu, Lijuan, Chen, Xuanhui, Khalemsky, Anna, Li, Deyang, Zoubeidi, Taoufik, Lauque, Dominique, Alsabri, Mohammed, Boudi, Zoubir, Kumar, Vijaya Arun, Paxton, James H., Tsilimingras, Dionyssios, Kurland, Lisa, Schwartz, David G., Hachimi-Idrissi, Said, Camargo, Carlos A., Liu, Shan W., Savioli, Gabriele, Intas, Geroge, Soni, Kapil Dev, Junhasavasdikul, Detajin, Trujillano Cabello, Javier, Rathlev, Niels K., Tazarourte, Karim, Slagman, Anna, Christ, Michael, Singer, Adam J., Lang, Eddy, Ricevuti, Giovanni, Li, Xin, Liang, Huiying, Grossman, Shamai A., Bellou, Abdelouahab
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:10459.1/464303
Acceso en línea:https://doi.org/10.3390/jcm12144750
https://hdl.handle.net/10459.1/464303
Access Level:acceso abierto
Palabra clave:Emergency department
In-hospital mortality
Length of stay
Boarding time
Machine learning
Older adults
Descripción
Sumario:The association between emergency department (ED) length of stay (EDLOS) with in-hospital mortality (IHM) in older patients remains unclear. This retrospective study aims to delineate the relationship between EDLOS and IHM in elderly patients. From the ED patients (n = 383,586) who visited an urban academic tertiary care medical center from January 2010 to December 2016, 78,478 older patients (age ≥60 years) were identified and stratified into three age subgroups: 60-74 (early elderly), 75-89 (late elderly), and ≥90 years (longevous elderly). We applied multiple machine learning approaches to identify the risk correlation trends between EDLOS and IHM, as well as boarding time (BT) and IHM. The incidence of IHM increased with age: 60-74 (2.7%), 75-89 (4.5%), and ≥90 years (6.3%). The best area under the receiver operating characteristic curve was obtained by Light Gradient Boosting Machine model for age groups 60-74, 75-89, and ≥90 years, which were 0.892 (95% CI, 0.870-0.916), 0.886 (95% CI, 0.861-0.911), and 0.838 (95% CI, 0.782-0.887), respectively. Our study showed that EDLOS and BT were statistically correlated with IHM (p < 0.001), and a significantly higher risk of IHM was found in low EDLOS and high BT. The flagged rate of quality assurance issues was higher in lower EDLOS ≤1 h (9.96%) vs. higher EDLOS 7 h <t≤ 8 h (1.84%). Special attention should be given to patients admitted after a short stay in the ED and a long BT, and new concepts of ED care processes including specific areas and teams dedicated to older patients care could be proposed to policymakers.

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