Mellgren Emil, Järhult Susann J, Lind Lars, Muntlin Åsa
Department of Pre-hospital Care and Emergency Medicine, Uppsala University Hospital.
Department of Medical Sciences/Clinical Epidemiology, Uppsala University.
Eur J Emerg Med. 2025 Aug 4. doi: 10.1097/MEJ.0000000000001268.
Crowded emergency departments (EDs) and long waiting times may lead to delayed care for acute conditions and increased mortality in patients leaving without being seen by a physician (LWBS).
The aim of this study was to characterize patients LWBS from the ED at a Swedish university hospital and report their mortality.
DESIGN, SETTING, AND PARTICIPANTS: A cohort study was conducted. Data from electronic medical records of patients LWBS (exposure) were compared with those who stayed through completion of treatment. Data were gathered from 151 228 patients making 363 308 visits to the Uppsala University Hospital ED from 1 January 2010 to 30 June 2017.
Short- and long-term mortality of patients LWBS were studied using Cox regression analysis. Sex, age, triage level, arrival mode, length of stay, presenting complaint, crowding, and time of day were assessed as regards effect on the probability of LWBS and as covariates in the mortality analysis.
In our dataset, 9058 patient visits to the ED (2.5% of all ED visits) ended in LWBS. These patients were younger than average and had lower triage levels. No significant difference was found between males and females. The highest rates were seen in patients presenting with a psychiatric disorder (12.8%), victims of physical assault (11.7%), or alcohol/drug withdrawal (9.9%). The likelihood of LWBS was highest in the evening and lowest in the early morning. Short-term mortality at 28 days was not significantly affected by LWBS, but a 34% lower long-term mortality risk was seen for patients LWBS (hazard ratio 0.66, 95% confidence interval 0.45-0.95, P = 0.028) in median follow-up of 3.5 years.
Patients LWBS were younger, had lower triage levels, and more frequently presented with psychiatric or substance use-related complaints. They had lower short- and long-term mortality compared with those who completed treatment. This observation does not imply a causal relationship but highlights differences in patient characteristics.
急诊科拥挤以及候诊时间过长可能导致急性病患者的治疗延误，并增加未经医生诊治即离开（LWBS）患者的死亡率。
本研究旨在描述瑞典一家大学医院急诊科LWBS患者的特征，并报告其死亡率。
设计、地点与参与者：进行了一项队列研究。将LWBS患者（暴露组）的电子病历数据与完成治疗的患者的数据进行比较。数据收集自2010年1月1日至2017年6月30日期间前往乌普萨拉大学医院急诊科就诊363308次的151228例患者。
采用Cox回归分析研究LWBS患者的短期和长期死亡率。评估性别、年龄、分诊级别、到达方式、住院时间、主诉、拥挤程度和就诊时间对LWBS可能性的影响以及作为死亡率分析中的协变量。
在我们的数据集中，9058例患者的急诊科就诊（占所有急诊科就诊的2.5%）以LWBS告终。这些患者比平均年龄年轻，分诊级别较低。男性和女性之间未发现显著差异。精神疾病患者（12.8%）、身体攻击受害者（11.7%）或酒精/药物戒断患者（9.9%）的LWBS发生率最高。LWBS的可能性在晚上最高，在清晨最低。LWBS对28天的短期死亡率没有显著影响，但在中位随访3.5年时，LWBS患者的长期死亡风险降低了34%（风险比0.66，95%置信区间0.45 - 0.95，P = 0.028）。
LWBS患者更年轻，分诊级别较低，更频繁地出现与精神疾病或物质使用相关的主诉。与完成治疗的患者相比，他们的短期和长期死亡率较低。这一观察结果并不意味着存在因果关系，但突出了患者特征的差异。
