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עברית
Paul S. Mueller, MD, MPH, FACP, reviewing
Risk for death was 40% higher in older adults who stayed in the ED overnight before admission to the hospital.
Hospital staffing and bed shortages can result in prolonged emergency department (ED) stays for patients who are awaiting admission, but prolonged ED stays have been associated with adverse outcomes. In this prospective study from 97 French EDs, researchers compared two groups of older adults (age, ≥75; mean age, 86). The ED group consisted of 700 patients who stayed in the ED from midnight to 8 a.m. and subsequently were admitted; the ward group consisted of 900 patients who were admitted before midnight.
The ED group had significantly higher risks for in-hospital death (16% vs. 11%; adjusted risk ratio, 1.4) and adverse events (aRR, 1.2). Hospital stays were longer for the ED group (9 vs. 8 days). Among patients who required assistance with activities of daily living, those in the ED group had even higher risk for in-hospital death (aRR, 1.8). Key adverse events that occurred more commonly in the ED group were falls and nosocomial infections.
CITATIONS
Roussel M et al. Overnight stay in the emergency department and mortality in older adults. JAMA Intern Med 2023 Nov 6; [e-pub]. (https://doi.org/10.1001/jamainternmed.2023.5961. opens in new tab)
COMMENT
Despite statistical adjustment for baselined differences between groups, confounding is possible in this study; however, the results are plausible. Patients in the ED who wait overnight for admission often do so on cots in a noisy and lighted environment, resulting in sleep deprivation and stress. Furthermore, monitoring and care in a crowded ED might differ from that in a hospital ward with a fixed staff-to-patient ratio. The authors recommend that older adults be prioritized for admission.