Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
JAMA Netw Open. 2022 Nov 1;5(11):e2240399. doi: 10.1001/jamanetworkopen.2022.40399.
There are more than 140 million annual visits to emergency departments (EDs) in the US. The role of EDs in providing care at or near the end of life is not well characterized.
To determine the frequency of death in the ED or within 1 month of an ED visit in an all-age, all-payer national database.
DESIGN, SETTING, AND PARTICIPANTS: The retrospective cohort study used patient-level data from the nationally representative Optum clinical electronic health record data set for 2010 to 2020. Data were analyzed from January to March 2022.
Age, Charlson Comorbidity Index (CCI), and year of ED encounter.
The primary outcome was death in the ED, overall and stratified by age, CCI, or year. A key secondary outcome was death within 1 month of an ED encounter. We extrapolated to make national estimates using US Census and Nationwide Emergency Department Sample data.
Among a total of 104 113 518 individual patients with 96 239 939 ED encounters, 205 372 ED deaths were identified in Optum, for whom median (IQR) age was 72 (53 to >80) years, 114 582 (55.8%) were male, and 152 672 (74.3%) were White. ED death affected 0.20% of overall patients and accounted for 0.21% of ED encounters. An additional 603 273 patients died within 1 month of an ED encounter. Extrapolated nationally, ED deaths accounted for 11.3% of total deaths from 2010 to 2019, and 33.2% of all decedents nationally visited the ED within 1 month of their death. The proportion of total national deaths occurring in the ED decreased by 0.27% annually (P for trend = .003) but the proportion who died within 1 month of an ED visit increased by 1.2% annually (P for trend < .001). Compared with all ED encounters, patients with visits resulting in death were older, more likely to be White, male, and not Hispanic, and had higher CCI. Among ED encounters for patients aged older than 80 years, nearly 1 in 12 died within 1 month.
This retrospective cohort study found deaths during or shortly after ED care were common, especially among patients who are older and with chronic comorbidities. EDs must identify patients for whom end-of-life care is necessary or preferred and be equipped to deliver this care excellently.
美国每年有超过 1.4 亿人次到急诊科就诊。急诊科在提供临终关怀方面的作用尚未得到充分描述。
在一个全国性的、所有年龄段和付费方式的数据库中，确定急诊科死亡或急诊科就诊后 1 个月内死亡的频率。
设计、地点和参与者：这项回顾性队列研究使用了来自全国代表性的 Optum 临床电子健康记录数据集的患者水平数据，时间范围为 2010 年至 2020 年。数据分析于 2022 年 1 月至 3 月进行。
年龄、Charlson 合并症指数（CCI）和急诊科就诊年份。
主要结局是急诊科死亡，总体情况以及按年龄、CCI 或年份分层的情况。一个关键的次要结局是急诊科就诊后 1 个月内死亡。我们使用美国人口普查和全国急诊科样本数据进行外推，以得出全国估计值。
在总共 104113518 名患者中，有 96239939 人次在急诊科就诊，在 Optum 中发现了 205372 例急诊科死亡，其中中位数（IQR）年龄为 72（53 至＞80）岁，114582 例（55.8%）为男性，152672 例（74.3%）为白人。急诊科死亡影响了 0.20%的患者总数，并占急诊科就诊的 0.21%。另有 603273 名患者在急诊科就诊后 1 个月内死亡。全国范围内推算，急诊科死亡占 2010 年至 2019 年总死亡人数的 11.3%，全国 33.2%的死亡者在去世前 1 个月内曾到急诊科就诊。每年在急诊科死亡的总人数比例下降 0.27%（趋势 P 值=0.003），但在急诊科就诊后 1 个月内死亡的人数比例每年增加 1.2%（趋势 P 值＜0.001）。与所有急诊科就诊相比，导致死亡的就诊患者年龄更大，更可能是白人、男性，且不是西班牙裔，CCI 更高。在年龄大于 80 岁的急诊科就诊患者中，近 12 人中就有 1 人在 1 个月内死亡。
这项回顾性队列研究发现，在急诊科接受治疗期间或治疗后不久死亡的情况很常见，尤其是在年龄较大且患有慢性合并症的患者中。急诊科必须识别出需要或偏好临终关怀的患者，并具备出色地提供这种护理的能力。
