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Characteristics and predictors of mortality among frequent users of an Emergency Department in Switzerland

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Title: Characteristics and predictors of mortality among frequent users of an Emergency Department in Switzerland
Authors: Griffin, Judith L., Yersin, Marie, Baggio, Stéphanie, Iglesias, Katia, Velonaki, Venetia-Sofia, Moschetti, Karine, Burnand, Bernard, Wasserfallen, Jean-Blaise, Vu, Francis, Ansermet, Corine, Hugli, Olivier, Daeppen, Jean-Bernard, Bodenmann, Patrick
Source: European Journal of Emergency Medicine, Vol. 25, No 2 (2018) pp. 140-146
Publisher Information: Ovid Technologies (Wolters Kluwer Health), 2018.
Publication Year: 2018
Subject Terms: Aged, 80 and over, Male, Patient Acceptance of Health Care / statistics & numerical data, Medical Overuse, Middle Aged, Patient Acceptance of Health Care, 16. Peace & justice, Severity of Illness Index, Vulnerable Populations, 3. Good health, Patient Admission / statistics & numerical data, 03 medical and health sciences, Patient Admission, 0302 clinical medicine, Emergency Service, Hospital / statistics & numerical data, Humans, Vulnerable Populations / statistics & numerical data, Female, Mortality, Medical Overuse / statistics & numerical data, Emergency Service, Hospital, Switzerland, Aged
Description: Objectives Frequent Emergency Department (ED) users have an elevated mortality, yet little is known about risk factors. Our aim was to characterize deceased frequent ED users and determine predictors of mortality. Methods This is a post-hoc analysis of all-cause mortality among frequent ED users participating in a randomized clinical trial on case management at the Lausanne University Hospital (Switzerland). We enrolled 250 frequent ED users (5+ visits/past year) in a 12-month randomized clinical trial; those with an estimated survival of fewer than 18 months were excluded. The primary outcome was 12-month all-cause mortality. We performed descriptive statistics to compare the baseline characteristics of living and deceased participants, and examined predictors of all-cause mortality using logistic regressions, including age adjustment. Results Twenty of the 250 (8%) frequent users died during the 12-month follow-up. Seven (35%) deaths were because of cardiac causes and six (30%) were because of cancer. The median age at death was 71 years. Deceased participants were older and more likely to report any somatic determinant, chronic illness, and medical comorbidity. Age (odds ratio 1.07, 95% confidence interval 1.04–1.11) and medical comorbidity (odds ratio 4.76, 95% confidence interval 1.86–12.15) were statistically significant predictors of mortality. Conclusion Despite excluding those with an estimated survival of fewer than 18 months, 8% of frequent ED users died during the study. Age and medical comorbidity were significant predictors of mortality. Interventions, such as case management, should target older frequent ED users and those with multiple medical conditions, and future research should explore their potential impact on mortality.
Document Type: Article
Language: English
ISSN: 0969-9546
DOI: 10.1097/mej.0000000000000425
Access URL: https://pubmed.ncbi.nlm.nih.gov/27749377
https://serval.unil.ch/en/notice/serval:BIB_E65181B3F680
https://www.ncbi.nlm.nih.gov/pubmed/27749377
https://archive-ouverte.unige.ch/unige:157700
Accession Number: edsair.doi.dedup.....3c060171a13c71ec8c5ec5d7b002a0d8
Database: OpenAIRE
Description
Abstract:Objectives Frequent Emergency Department (ED) users have an elevated mortality, yet little is known about risk factors. Our aim was to characterize deceased frequent ED users and determine predictors of mortality. Methods This is a post-hoc analysis of all-cause mortality among frequent ED users participating in a randomized clinical trial on case management at the Lausanne University Hospital (Switzerland). We enrolled 250 frequent ED users (5+ visits/past year) in a 12-month randomized clinical trial; those with an estimated survival of fewer than 18 months were excluded. The primary outcome was 12-month all-cause mortality. We performed descriptive statistics to compare the baseline characteristics of living and deceased participants, and examined predictors of all-cause mortality using logistic regressions, including age adjustment. Results Twenty of the 250 (8%) frequent users died during the 12-month follow-up. Seven (35%) deaths were because of cardiac causes and six (30%) were because of cancer. The median age at death was 71 years. Deceased participants were older and more likely to report any somatic determinant, chronic illness, and medical comorbidity. Age (odds ratio 1.07, 95% confidence interval 1.04–1.11) and medical comorbidity (odds ratio 4.76, 95% confidence interval 1.86–12.15) were statistically significant predictors of mortality. Conclusion Despite excluding those with an estimated survival of fewer than 18 months, 8% of frequent ED users died during the study. Age and medical comorbidity were significant predictors of mortality. Interventions, such as case management, should target older frequent ED users and those with multiple medical conditions, and future research should explore their potential impact on mortality.
ISSN:09699546
DOI:10.1097/mej.0000000000000425