Overnight Stay in the Emergency Department and Mortality in Older Patients
Authors: Melanie Roussel, Dorian Teissandier, Youri Yordanov, Frederic Balen, Marc Noizet, Karim Tazarourte, Ben Bloom, Pierre Catoire, Laurence Berard, Marine Cachanado, Tabassome Simon, Said Laribi, Yonathan Freund; FHU IMPEC-IRU SFMU Collaborators
Published in: Journal of the American Medical Association Internal Medicine, 2023 (Available on 2024-11-06)
Conclusions and Relevance:
- Older patients waiting overnight in the ED for ward admission had increased in-hospital mortality and morbidity rates, especially those with limited autonomy.
- This study suggests the importance of prioritizing older adults for quicker admission to hospital wards.
Objective:
- To investigate if older adults (≥75 years) who spend a night in the ED waiting for hospital ward admission have increased risks of in-hospital mortality.
Design, Settings, and Participants:
- Prospective cohort study conducted on December 12 to 14, 2022, involving 97 EDs across France.
- Participants were older patients (≥75 years) admitted to the hospital.
- Two groups were compared: those who stayed in the ED overnight (ED group) and those admitted to a ward before midnight (ward group).
Main Outcomes and Measures:
- Primary endpoint: In-hospital mortality within 30 days.
- Secondary outcomes: In-hospital adverse events (falls, infections, bleeding, myocardial infarction, stroke, thrombosis, bedsores, dysnatremia) and hospital length of stay.
Results:
- Total of 1598 patients (median age 86; 55% female, 45% male).
- 707 (44%) in the ED group and 891 (56%) in the ward group.
- In-hospital mortality: Higher in the ED group (15.7%) compared to the ward group (11.1%), with an adjusted risk ratio (aRR) of 1.39.
- Increased risk of adverse events in the ED group (aRR, 1.24).
- Longer median hospital stay for the ED group (9 days) vs. the ward group (8 days).
- In patients requiring assistance with daily activities, overnight ED stay was associated with a higher mortality rate (aRR, 1.81).