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Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR)
OBJECTIVES: There is evidence that emergency department (ED) crowding is associated with increased mortality, however large multicenter studies of high quality are scarce. In a prior study, we introduced a proxy-measure for crowding that was associated with increased mortality. The national registry...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946203/ https://www.ncbi.nlm.nih.gov/pubmed/33690653 http://dx.doi.org/10.1371/journal.pone.0247881 |
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author | af Ugglas, Björn Lindmarker, Per Ekelund, Ulf Djärv, Therese Holzmann, Martin J. |
author_facet | af Ugglas, Björn Lindmarker, Per Ekelund, Ulf Djärv, Therese Holzmann, Martin J. |
author_sort | af Ugglas, Björn |
collection | PubMed |
description | OBJECTIVES: There is evidence that emergency department (ED) crowding is associated with increased mortality, however large multicenter studies of high quality are scarce. In a prior study, we introduced a proxy-measure for crowding that was associated with increased mortality. The national registry SVAR enables us to study the association in a more heterogenous group of EDs with more recent data. The aim is to investigate the association between ED crowding and mortality. METHODS: This was an observational cohort study including visits from 14 EDs in Sweden 2015–2019. Crowding was defined as the mean ED-census divided with expected ED-census during the work-shift that the patient arrived. The crowding exposure was categorized in three groups: low, moderate and high. Hazard ratios (HR) for mortality within 7 and 30 days were estimated with a cox proportional hazards model. The model was adjusted for age, sex, triage priority, arrival hour, weekend, arrival mode and chief complaint. Subgroup analysis by county and for admitted patients by county were performed. RESULTS: 2,440,392 visits from 1,142,631 unique patients were analysed. A significant association was found between crowding and 7-day mortality but not with 30-day mortality. Subgroup analysis also yielded mixed results with a clear association in only one of the three counties. The estimated HR (95% CI) for 30-day mortality for admitted patients in this county was 1.06 (1.01–1.12) in the moderate crowding category, and 1.11 (1.01–1.22) in the high category. CONCLUSIONS: The association between crowding and mortality may not be universal. Factors that influence the association between crowding and mortality at different EDs are still unknown but a high hospital bed occupancy, impacting admitted patients may play a role. |
format | Online Article Text |
id | pubmed-7946203 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-79462032021-03-19 Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR) af Ugglas, Björn Lindmarker, Per Ekelund, Ulf Djärv, Therese Holzmann, Martin J. PLoS One Research Article OBJECTIVES: There is evidence that emergency department (ED) crowding is associated with increased mortality, however large multicenter studies of high quality are scarce. In a prior study, we introduced a proxy-measure for crowding that was associated with increased mortality. The national registry SVAR enables us to study the association in a more heterogenous group of EDs with more recent data. The aim is to investigate the association between ED crowding and mortality. METHODS: This was an observational cohort study including visits from 14 EDs in Sweden 2015–2019. Crowding was defined as the mean ED-census divided with expected ED-census during the work-shift that the patient arrived. The crowding exposure was categorized in three groups: low, moderate and high. Hazard ratios (HR) for mortality within 7 and 30 days were estimated with a cox proportional hazards model. The model was adjusted for age, sex, triage priority, arrival hour, weekend, arrival mode and chief complaint. Subgroup analysis by county and for admitted patients by county were performed. RESULTS: 2,440,392 visits from 1,142,631 unique patients were analysed. A significant association was found between crowding and 7-day mortality but not with 30-day mortality. Subgroup analysis also yielded mixed results with a clear association in only one of the three counties. The estimated HR (95% CI) for 30-day mortality for admitted patients in this county was 1.06 (1.01–1.12) in the moderate crowding category, and 1.11 (1.01–1.22) in the high category. CONCLUSIONS: The association between crowding and mortality may not be universal. Factors that influence the association between crowding and mortality at different EDs are still unknown but a high hospital bed occupancy, impacting admitted patients may play a role. Public Library of Science 2021-03-10 /pmc/articles/PMC7946203/ /pubmed/33690653 http://dx.doi.org/10.1371/journal.pone.0247881 Text en © 2021 af Ugglas et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article af Ugglas, Björn Lindmarker, Per Ekelund, Ulf Djärv, Therese Holzmann, Martin J. Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR) |
title | Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR) |
title_full | Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR) |
title_fullStr | Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR) |
title_full_unstemmed | Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR) |
title_short | Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR) |
title_sort | emergency department crowding and mortality in 14 swedish emergency departments, a cohort study leveraging the swedish emergency registry (svar) |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946203/ https://www.ncbi.nlm.nih.gov/pubmed/33690653 http://dx.doi.org/10.1371/journal.pone.0247881 |
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