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Time patterns in mortality after an emergency medical admission; relationship to weekday or weekend admission

Published:August 18, 2016DOI:https://doi.org/10.1016/j.ejim.2016.08.010

      Highlights

      • The pattern of mortality for admissions can be represented by mathematical models
      • The pattern is identical for weekday and weekend admissions
      • Mortality is higher for weekend admissions at all time points
      • Case complexity and acuity are major determinants of survival

      Abstract

      Background

      The aim of this study was to detail the time profile and frequency distribution of mortality following an emergency admission and to compare these for weekday and weekend admissions.

      Methods

      We profiled in-hospital deaths following emergency medical admission between 2002 and 2014. We determined the frequency distribution, time pattern, causality and influence of day of admission on mortality out to 120 days. We utilized a multivariable regression model (logistic for in-hospital mortality and truncated Poisson for count data) to adjust for major predictor variables.

      Results

      There were 82,368 admissions in 44,628 patients with 4587 in-hospital deaths. The 30-day in-hospital mortality declined from 8.2% in 2002 to 3.7% in 2014. The mortality pattern showed an exponential decay over time; the time to death was best described by the three-parameter Weibull model. The calculated time to death for the 5th, 10th, 25th, 50th, 75th, and 90th centiles were 0.5, 1.2, 3.8, 11.1, 26.3 and 49.3 days. Acute Illness Severity Score, Chronic Disabling Disease Score, Charlson Co-Morbidity Index and Sepsis status were associated with mortality. The risk of death was initially high, lower by day 3, and showed a cumulative increase over time. The mortality pattern was very similar between a weekday or weekend admission; however, the risk of death was greater at all time points between 0 and 120 days for patients admitted at a weekend OR 1.08 (95% CI 1.01–1.15).

      Conclusion

      We have demonstrated the pattern of mortality following an emergency admission. The underlying pattern is similar between weekday and weekend admissions.

      Keywords

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