Overnight stay in Spanish emergency departments and mortality in older patients

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...

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Published in:	Internal and emergency medicine Vol. 19; no. 6; pp. 1653 - 1665
Main Authors:	Miró, Òscar, Aguiló, Sira, Alquézar-Arbé, Aitor, Fernández, Cesáreo, Burillo, Guillermo, Martínez, Sergio Guzmán, Larrull, María Esther Martínez, Periago, Andrea B. Bravo, Molinas, Claudia Lorena Amarilla, Falcón, Carolina Rangel, Dacosta, Paz Balado, Flores, Rudiger Carlos Chávez, Calzada, Jorge Navarro, Blesa, Eva María Fragero, Martín, Manuel Ángel Palomero, Requena, Ángela Cobos, Fuentes, Lidia, Cortizo, Isabel Lobo, Garcinuño, Pablo González, García, María Bóveda, Del Valle, Pedro Rivas, Campos, Raquel Benavent, Jiménez, Verónica Castro, Cuñado, Vanesa Abad, Gutiérrez, Olga Trejo, del Mar Sousa Reviriego, María, Roussel, Melanie, del Castillo, Juan González
Format:	Journal Article
Language:	English
Published:	Cham Springer International Publishing 01-09-2024 Springer Nature B.V
Subjects:	Emergency medical care Im - Original Internal Medicine Medicine Medicine & Public Health Mortality Patients Sensitivity analysis Prolonged hospitalization Overnight Emergency department Mortality Outcomes Older
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1828-0447 1970-9366 1970-9366
DOI:	10.1007/s11739-024-03660-1