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Emergency department crowding associated with increased 30‐day mortality: a cohort study in Stockholm Region, Sweden, 2012 to 2016

OBJECTIVES: Emergency department (ED) crowding is a major problem across the world. Studies investigating the association between crowding and mortality are many, but the quality is inconsistent and there are very few large, high‐quality multicenter studies that are properly designed to deal with co...

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Autores principales: af Ugglas, Björn, Djärv, Therese, Ljungman, Petter L.S., Holzmann, Martin J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771779/
https://www.ncbi.nlm.nih.gov/pubmed/33392538
http://dx.doi.org/10.1002/emp2.12243
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author af Ugglas, Björn
Djärv, Therese
Ljungman, Petter L.S.
Holzmann, Martin J.
author_facet af Ugglas, Björn
Djärv, Therese
Ljungman, Petter L.S.
Holzmann, Martin J.
author_sort af Ugglas, Björn
collection PubMed
description OBJECTIVES: Emergency department (ED) crowding is a major problem across the world. Studies investigating the association between crowding and mortality are many, but the quality is inconsistent and there are very few large, high‐quality multicenter studies that are properly designed to deal with confounding due to case mix. The aim of this study is to investigate the association between ED crowding and 30‐day mortality. METHODS: We conducted an observational cohort study at all 7 EDs in Stockholm Region, Sweden 2012–2016. The crowding exposure was defined as the mean hourly ED census during the shift that the exposed patient arrived, divided with the expected ED census for this shift. The expected ED census was estimated using a separate linear model for each hospital with year and shift as predictors. The exposure was categorized in 3 groups: reference (lowest 75% of observations), moderate (75%–95% of observations), and high (highest 5% of observations). Hazard ratios (HR) for all‐cause mortality within 30 days were estimated with a Cox proportional hazards model. The model was adjusted for age, sex, triage priority, arrival hour, weekend, arrival mode, chief complaint, number of prior hospital admissions, and comorbidities. RESULTS: 884,228 patients who visited the ED 2,252,656 times were included in the analysis. The estimated HR (95% confidence interval) for death within 30‐days was 1.00 (0.97–1.03) in crowding category 75%‐95% and 1.08 (1.03–1.14) in the 95%‐100% category. CONCLUSIONS: In a large cohort study including 7 EDs in Stockholm Region, Sweden we identified a significant association between high levels of ED crowding and increased 30‐day mortality.
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spelling pubmed-77717792020-12-31 Emergency department crowding associated with increased 30‐day mortality: a cohort study in Stockholm Region, Sweden, 2012 to 2016 af Ugglas, Björn Djärv, Therese Ljungman, Petter L.S. Holzmann, Martin J. J Am Coll Emerg Physicians Open Health Policy OBJECTIVES: Emergency department (ED) crowding is a major problem across the world. Studies investigating the association between crowding and mortality are many, but the quality is inconsistent and there are very few large, high‐quality multicenter studies that are properly designed to deal with confounding due to case mix. The aim of this study is to investigate the association between ED crowding and 30‐day mortality. METHODS: We conducted an observational cohort study at all 7 EDs in Stockholm Region, Sweden 2012–2016. The crowding exposure was defined as the mean hourly ED census during the shift that the exposed patient arrived, divided with the expected ED census for this shift. The expected ED census was estimated using a separate linear model for each hospital with year and shift as predictors. The exposure was categorized in 3 groups: reference (lowest 75% of observations), moderate (75%–95% of observations), and high (highest 5% of observations). Hazard ratios (HR) for all‐cause mortality within 30 days were estimated with a Cox proportional hazards model. The model was adjusted for age, sex, triage priority, arrival hour, weekend, arrival mode, chief complaint, number of prior hospital admissions, and comorbidities. RESULTS: 884,228 patients who visited the ED 2,252,656 times were included in the analysis. The estimated HR (95% confidence interval) for death within 30‐days was 1.00 (0.97–1.03) in crowding category 75%‐95% and 1.08 (1.03–1.14) in the 95%‐100% category. CONCLUSIONS: In a large cohort study including 7 EDs in Stockholm Region, Sweden we identified a significant association between high levels of ED crowding and increased 30‐day mortality. John Wiley and Sons Inc. 2020-09-12 /pmc/articles/PMC7771779/ /pubmed/33392538 http://dx.doi.org/10.1002/emp2.12243 Text en © 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Health Policy
af Ugglas, Björn
Djärv, Therese
Ljungman, Petter L.S.
Holzmann, Martin J.
Emergency department crowding associated with increased 30‐day mortality: a cohort study in Stockholm Region, Sweden, 2012 to 2016
title Emergency department crowding associated with increased 30‐day mortality: a cohort study in Stockholm Region, Sweden, 2012 to 2016
title_full Emergency department crowding associated with increased 30‐day mortality: a cohort study in Stockholm Region, Sweden, 2012 to 2016
title_fullStr Emergency department crowding associated with increased 30‐day mortality: a cohort study in Stockholm Region, Sweden, 2012 to 2016
title_full_unstemmed Emergency department crowding associated with increased 30‐day mortality: a cohort study in Stockholm Region, Sweden, 2012 to 2016
title_short Emergency department crowding associated with increased 30‐day mortality: a cohort study in Stockholm Region, Sweden, 2012 to 2016
title_sort emergency department crowding associated with increased 30‐day mortality: a cohort study in stockholm region, sweden, 2012 to 2016
topic Health Policy
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771779/
https://www.ncbi.nlm.nih.gov/pubmed/33392538
http://dx.doi.org/10.1002/emp2.12243
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