Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR)

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 enable...

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Veröffentlicht in:PloS one 2021-03, Vol.16 (3), p.e0247881-e0247881
Hauptverfasser: Af Ugglas, Björn, Lindmarker, Per, Ekelund, Ulf, Djärv, Therese, Holzmann, Martin J
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Lindmarker, Per
Ekelund, Ulf
Djärv, Therese
Holzmann, Martin J
description 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. 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. 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. 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.
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subjects Adverse events
Anestesi och intensivvård
Anesthesiology and Intensive Care
Biology and Life Sciences
Censuses
Clinical Medicine
Cohort analysis
Complaints
Crowding
Drafting software
Editing
Emergency medical care
Emergency medical services
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Health risks
Hospital size
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Hälsovetenskap
Influence
Klinisk medicin
Mathematical analysis
Medical and Health Sciences
Medicin och hälsovetenskap
Medicine
Medicine and Health Sciences
Methodology
Mortality
Patients
People and places
Research and Analysis Methods
Risk factors
Social aspects
Supervision
Survival analysis
title Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR)
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