Wu Lijuan, Chen Xuanhui, Khalemsky Anna, Li Deyang, Zoubeidi Taoufik, Lauque Dominique, Alsabri Mohammed, Boudi Zoubir, Kumar Vijaya Arun, Paxton James, Tsilimingras Dionyssios, Kurland Lisa, Schwartz David, Hachimi-Idrissi Said, Camargo Carlos A, Liu Shan W, Savioli Gabriele, Intas Geroge, Soni Kapil Dev, Junhasavasdikul Detajin, Cabello Jose Javier Trujillano, Rathlev Niels K, Tazarourte Karim, Slagman Anna, Christ Michael, Singer Adam J, Lang Eddy, Ricevuti Giovanni, Li Xin, Liang Huiying, Grossman Shamai A, Bellou Abdelouahab
Institute of Sciences in Emergency Medicine, Department of Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China.
Medical Research Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China.
J Clin Med. 2023 Jul 18;12(14):4750. doi: 10.3390/jcm12144750.
The association between emergency department (ED) length of stay (EDLOS) with in-hospital mortality (IHM) in older patients remains unclear. This retrospective study aims to delineate the relationship between EDLOS and IHM in elderly patients. From the ED patients (n = 383,586) who visited an urban academic tertiary care medical center from January 2010 to December 2016, 78,478 older patients (age ≥60 years) were identified and stratified into three age subgroups: 60-74 (early elderly), 75-89 (late elderly), and ≥90 years (longevous elderly). We applied multiple machine learning approaches to identify the risk correlation trends between EDLOS and IHM, as well as boarding time (BT) and IHM. The incidence of IHM increased with age: 60-74 (2.7%), 75-89 (4.5%), and ≥90 years (6.3%). The best area under the receiver operating characteristic curve was obtained by Light Gradient Boosting Machine model for age groups 60-74, 75-89, and ≥90 years, which were 0.892 (95% CI, 0.870-0.916), 0.886 (95% CI, 0.861-0.911), and 0.838 (95% CI, 0.782-0.887), respectively. Our study showed that EDLOS and BT were statistically correlated with IHM ( < 0.001), and a significantly higher risk of IHM was found in low EDLOS and high BT. The flagged rate of quality assurance issues was higher in lower EDLOS ≤1 h (9.96%) vs. higher EDLOS 7 h <t≤ 8 h (1.84%). Special attention should be given to patients admitted after a short stay in the ED and a long BT, and new concepts of ED care processes including specific areas and teams dedicated to older patients care could be proposed to policymakers.
老年患者急诊科（ED）留观时间（EDLOS）与院内死亡率（IHM）之间的关联尚不清楚。这项回顾性研究旨在明确老年患者EDLOS与IHM之间的关系。从2010年1月至2016年12月就诊于一家城市学术型三级医疗中心的ED患者（n = 383,586）中，识别出78,478名老年患者（年龄≥60岁），并将其分为三个年龄亚组：60 - 74岁（老年早期）、75 - 89岁（老年晚期）和≥90岁（长寿老年）。我们应用多种机器学习方法来识别EDLOS与IHM之间以及等待时间（BT）与IHM之间的风险关联趋势。IHM的发生率随年龄增长而增加：60 - 74岁（2.7%）、75 - 89岁（4.5%）和≥90岁（6.3%）。对于60 - 74岁、75 - 89岁和≥90岁年龄组，通过轻量级梯度提升机模型获得的受试者操作特征曲线下的最佳面积分别为0.892（95%CI，0.870 - 0.916）、0.886（95%CI，0.861 - 0.911）和0.838（95%CI，0.782 - 0.887）。我们的研究表明，EDLOS和BT与IHM在统计学上相关（<0.001），并且在EDLOS低和BT高的情况下发现IHM风险显著更高。质量保证问题的标记率在EDLOS≤1小时较低时（9.96%）高于EDLOS 7小时<t≤8小时较高时（1.84%）。对于在ED短期留观后且BT较长的入院患者应给予特别关注，并且可以向政策制定者提出包括专门针对老年患者护理的特定区域和团队在内的ED护理流程新概念。
