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Comment
. 2023 Dec 1;183(12):1378-1385.
doi: 10.1001/jamainternmed.2023.5961.

Overnight Stay in the Emergency Department and Mortality in Older Patients

Melanie Roussel  1 , Dorian Teissandier  2 , Youri Yordanov  3   4 , Frederic Balen  5 , Marc Noizet  6 , Karim Tazarourte  7 , Ben Bloom  8 , Pierre Catoire  2   4 , Laurence Berard  9 , Marine Cachanado  9 , Tabassome Simon  4   9 , Said Laribi  10 , Yonathan Freund  2   4 ; FHU IMPEC-IRU SFMU Collaborators; FHU IMPEC−IRU SFMU Collaborators
Collaborators, Affiliations
Comment

Overnight Stay in the Emergency Department and Mortality in Older Patients

Melanie Roussel et al. JAMA Intern Med. .

Abstract

Importance: Patients in the emergency department (ED) who are waiting for hospital admission on a wheeled cot may be subject to harm. However, mortality and morbidity among older patients who spend the night in the ED while waiting for a bed in a medical ward are unknown.

Objective: To assess whether older adults who spend a night in the ED waiting for admission to a hospital ward are at increased risk of in-hospital mortality.

Design, settings, and participants: This was a prospective cohort study of older patients (≥75 years) who visited the ED and were admitted to the hospital on December 12 to 14, 2022, at 97 EDs across France. Two groups were defined and compared: those who stayed in the ED from midnight until 8:00 am (ED group) and those who were admitted to a ward before midnight (ward group).

Main outcomes and measures: The primary end point was in-hospital mortality, truncated at 30 days. Secondary outcomes included in-hospital adverse events (ie, falls, infection, bleeding, myocardial infarction, stroke, thrombosis, bedsores, and dysnatremia) and hospital length of stay. A generalized linear-regression mixed model was used to compare end points between groups.

Results: The total sample comprised 1598 patients (median [IQR] age, 86 [80-90] years; 880 [55%] female and 718 [45%] male), with 707 (44%) in the ED group and 891 (56%) in the ward group. Patients who spent the night in the ED had a higher in-hospital mortality rate of 15.7% vs 11.1% (adjusted risk ratio [aRR], 1.39; 95% CI, 1.07-1.81). They also had a higher risk of adverse events compared with the ward group (aRR, 1.24; 95% CI, 1.04-1.49) and increased median length of stay (9 vs 8 days; rate ratio, 1.20; 95% CI, 1.11-1.31). In a prespecified subgroup analysis of patients who required assistance with the activities of daily living, spending the night in the ED was associated with a higher in-hospital mortality rate (aRR, 1.81; 95% CI, 1.25-2.61).

Conclusions and relevance: The findings of this prospective cohort study indicate that for older patients, waiting overnight in the ED for admission to a ward was associated with increased in-hospital mortality and morbidity, particularly in patients with limited autonomy. Older adults should be prioritized for admission to a ward.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Simon reported advisory board fees from Ablative Solutions, Air Liquide, Novartis, Sanofi, and Servier; educational event fees from AstraZeneca; and personal fees from 4Living Biotech DSMB, all outside the submitted work. Dr Laribi reported personal fees from Brahms outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Flow Diagram of Study Patients
ED indicates emergency department.
See this image and copyright information in PMC

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