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Increased long-term mortality in patients with repeated visits to the emergency department
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
2010 (English)In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 17, no 5, p. 274-279Article in journal (Refereed) Published
Abstract [en]

Background Revisits to the emergency department (ED) are common. It is not clear whether the number of revisits, the time between revisits or the reason for the revisits are associated with increased mortality.

Methods During 1 year, the number of visits, the reason for the visit and the time between visits were recorded in 15 607 nonsurgical ED patients and related to 1-year and 5-year mortality.

Results Five-year mortality was dependent on the number of revisits in an inverse U-shaped manner. When compared with one-time visitors, patients with three visits showed an increased 5-year mortality (hazard ratio 1.85, 95% confidence interval 1.58-2.16, P < 0.0001), whereas in patients with four or five visits mortality decreased. Patients with six or more visits had a 5-year mortality not different from one-time visitors. The impact of the number of visits was, however, dependent on the presenting complaint (P < 0.0001). Furthermore, the time between two adjacent visits influenced long-term mortality in an inverse U-shaped manner. In patients not admitted to the ward, a revisit after 2-3 days was associated with increased mortality (hazard ratio 1.89, 95% confidence interval 1.06-3.35, P = 0.03). In patients revisiting the ED with the same adjacent presenting complaint, mortality differed depending on the complaint (P < 0.0001).

Conclusion In nonsurgical patients revisiting the ED, long-term mortality was dependent on both the number of revisits, as well as the time between two visits in an inverse U-shaped manner. This indicates a possibility of detecting the transition level between appropriate medical utilization and inappropriate frequent ED use.

Place, publisher, year, edition, pages
2010. Vol. 17, no 5, p. 274-279
Keyword [en]
emergency department, emergency department utilization, frequent attenders, frequent emergency department users, long-term mortality, revisit
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-96930DOI: 10.1097/MEJ.0b013e3283104106ISI: 000282107800008OAI: oai:DiVA.org:uu-96930DiVA, id: diva2:171668
Available from: 2008-03-28 Created: 2008-03-28 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Presenting complaint and mortality in non-surgical emergency medicine patients
Open this publication in new window or tab >>Presenting complaint and mortality in non-surgical emergency medicine patients
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In 1995 and 2000 a total of 29 886 non surgical ED visits at Uppsala University Hospital were registered. Presenting complaint, admittance to a ward, length of stay, in-hospital mortality, discharge diagnoses, 30-day and long-term mortality were registered. The presenting complaints were sorted into 33 presenting complaint groups (PCGs).

For different PCGs there was different in-hospital fatality rate. Compared to the largest PCG, chest pain, the gender and age adjusted OR was 2.12 (95% CI 1.01 – 4.44) for the miscellaneous complaint group and 2.04 (95 % CI 1.35 – 3.08) for the stroke–like symptom group. Within a given PCG the in-hospital mortality could vary depending on discharge diagnoses. By relating PCG and long term mortality to the expected mortality in the population, the Standardized Mortality Ratio (SMR) could be calculated. The SMR was found to be highest in seizure 2.62 (95 % CI 2.13 – 3.22), intoxication 2.51 (95% CI 2.11-2.98) and symptoms of asthma 1.8 (1.65 – 2.06). For the same discharge diagnoses the long term mortality could differ considerably depending on PCG at ED arrival (p<0.001).

Between 1995 and 2000 there was a 30 % increase in ED visits at the non surgical ED. PCGs representing lesser severe conditions had increased. Demographic changes could account for 45 % of the increment and the remaining increase could be ascribed to change in visiting pattern.

In the 2000 cohort 41.0 % of all visits were performed by re-visitors. The number of revisits and five-year mortality had an inversed u-shaped relationship were patients with three re-visits within the same year had an increased mortality compared to patients with more or less visits.

Conclusion: It is possible to define presenting complaint groups (PCGs) that are robust and consistent over time and useful as a tool for epidemiological studies in the ED.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. p. 57
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 323
Keyword
Medicine, Presenting complaint, Emergency Department, long-term mortality, Standardized Mortality Ratio, frequent attenders, Medicin
Identifiers
urn:nbn:se:uu:diva-8583 (URN)978-91-554-7136-1 (ISBN)
Public defence
2008-04-18, Enghoffsalen, entrance 50,, Akademiska sjukhuset, Uppsala, 09:15
Opponent
Supervisors
Available from: 2008-03-28 Created: 2008-03-28 Last updated: 2010-12-02Bibliographically approved

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