Characteristics and predictors of mortality among frequent users of an Emergency Department in Switzerland.

Autor:	Griffin JL; Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center., Yersin M; Department of Ambulatory Care and Community Medicine., Baggio S; Life Course and Social Inequality Research Center, Faculty of Social and Political Sciences., Iglesias K; Department of Community Medicine and Public Health, Institute of Higher Education and Research in Healthcare.; Center for the Understanding of Social Processes, University of Neuchâtel, Neuchâtel, Switzerland., Velonaki VS; Department of Community Medicine and Public Health, Institute of Higher Education and Research in Healthcare., Moschetti K; IEMS - Health Economics and Management Platform, University of Lausanne.; Institute of Social and Preventive Medicine.; Health Technology Assessment Unit., Burnand B; Institute of Social and Preventive Medicine., Wasserfallen JB; Health Technology Assessment Unit., Vu F; Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center., Ansermet C; Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center., Hugli O; Emergency Department., Daeppen JB; Alcohol Treatment Center, Lausanne University Hospital, Lausanne., Bodenmann P; Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center.
Jazyk:	angličtina
Zdroj:	European journal of emergency medicine : official journal of the European Society for Emergency Medicine [Eur J Emerg Med] 2018 Apr; Vol. 25 (2), pp. 140-146.
DOI:	10.1097/MEJ.0000000000000425
Abstrakt:	Objectives: Frequent Emergency Department (ED) users have an elevated mortality, yet little is known about risk factors. Our aim was to characterize deceased frequent ED users and determine predictors of mortality. Methods: This is a post-hoc analysis of all-cause mortality among frequent ED users participating in a randomized clinical trial on case management at the Lausanne University Hospital (Switzerland). We enrolled 250 frequent ED users (5+ visits/past year) in a 12-month randomized clinical trial; those with an estimated survival of fewer than 18 months were excluded. The primary outcome was 12-month all-cause mortality. We performed descriptive statistics to compare the baseline characteristics of living and deceased participants, and examined predictors of all-cause mortality using logistic regressions, including age adjustment. Results: Twenty of the 250 (8%) frequent users died during the 12-month follow-up. Seven (35%) deaths were because of cardiac causes and six (30%) were because of cancer. The median age at death was 71 years. Deceased participants were older and more likely to report any somatic determinant, chronic illness, and medical comorbidity. Age (odds ratio 1.07, 95% confidence interval 1.04-1.11) and medical comorbidity (odds ratio 4.76, 95% confidence interval 1.86-12.15) were statistically significant predictors of mortality. Conclusion: Despite excluding those with an estimated survival of fewer than 18 months, 8% of frequent ED users died during the study. Age and medical comorbidity were significant predictors of mortality. Interventions, such as case management, should target older frequent ED users and those with multiple medical conditions, and future research should explore their potential impact on mortality.
Databáze:	MEDLINE
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