Journal of Clinical Medicine (Jul 2023)
The Association between Emergency Department Length of Stay and In-Hospital Mortality in Older Patients Using Machine Learning: An Observational Cohort Study
- Lijuan Wu,
- Xuanhui Chen,
- Anna Khalemsky,
- Deyang Li,
- Taoufik Zoubeidi,
- Dominique Lauque,
- Mohammed Alsabri,
- Zoubir Boudi,
- Vijaya Arun Kumar,
- James Paxton,
- Dionyssios Tsilimingras,
- Lisa Kurland,
- David Schwartz,
- Said Hachimi-Idrissi,
- Carlos A. Camargo,
- Shan W. Liu,
- Gabriele Savioli,
- Geroge Intas,
- Kapil Dev Soni,
- Detajin Junhasavasdikul,
- Jose Javier Trujillano Cabello,
- Niels K. Rathlev,
- Karim Tazarourte,
- Anna Slagman,
- Michael Christ,
- Adam J. Singer,
- Eddy Lang,
- Giovanni Ricevuti,
- Xin Li,
- Huiying Liang,
- Shamai A. Grossman,
- Abdelouahab Bellou
Affiliations
- Lijuan Wu
- 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
- Xuanhui Chen
- Medical Big Data Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Anna Khalemsky
- Management Department, Hadassah Academic College, Jerusalem 91010, Israel
- Deyang Li
- 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
- Taoufik Zoubeidi
- Department of Statistics, College of Business and Economics, UAE University, Al Ain 1555, United Arab Emirates
- Dominique Lauque
- Department of Emergency of Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Boston, MA 02115, USA
- Mohammed Alsabri
- Department of Emergency of Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Boston, MA 02115, USA
- Zoubir Boudi
- Department of Emergency Medicine, Dr Sulaiman Alhabib Hospital, Dubai 2542, United Arab Emirates
- Vijaya Arun Kumar
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
- James Paxton
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Dionyssios Tsilimingras
- Department of Family Medicine & Public Health Sciences, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Lisa Kurland
- Department of Medical Sciences, Örebro University, 70182 Örebro, Sweden
- David Schwartz
- Information Systems Department, Graduate School of Business Administration, Bar-Ilan University, Ramat-Gan 529002, Israel
- Said Hachimi-Idrissi
- Global Network on Emergency Medicine, Brookline, MA 02446, USA
- Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Shan W. Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Gabriele Savioli
- Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
- Geroge Intas
- Department of Critical Care, General Hospital of Nikaia Agios Panteleimon, 18454 Athens, Greece
- Kapil Dev Soni
- Jai Prakash Narayan Apex Trauma Center, Ring Road, New Delhi 110029, India
- Detajin Junhasavasdikul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Jose Javier Trujillano Cabello
- Intensive Care Unit, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
- Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School, Baystate, Springfield, MA 01199, USA
- Karim Tazarourte
- Department of Health Quality, University Hospital, Hospices Civils, 69002 Lyon, France
- Anna Slagman
- Division of Emergency and Acute Medicine, Campus Virchow Klinikum and Charité Campus Mitte, Charité Universitätsmedizin, 10117 Berlin, Germany
- Michael Christ
- Department of Emergency Medicine, 6000 Lucerne, Switzerland
- Adam J. Singer
- Department of Emergency Medicine, Renaissance Scholl of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
- Eddy Lang
- Department of Emergency Medicine, Emergency Medicine Cumming School of Medicine, University of Calgary, Alberta Health Services, Calgary, AB T2N 1N4, Canada
- Giovanni Ricevuti
- Emergency Medicine, School of Pharmacy, University of Pavia, 27100 Pavia, Italy
- Xin Li
- Department of Emergency Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Huiying Liang
- Medical Big Data Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Shamai A. Grossman
- Department of Emergency of Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Boston, MA 02115, USA
- Abdelouahab Bellou
- 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
- DOI
- https://doi.org/10.3390/jcm12144750
- Journal volume & issue
-
Vol. 12,
no. 14
p. 4750
Abstract
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 (p ≤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.
Keywords
- emergency department
- in-hospital mortality
- length of stay
- boarding time
- machine learning
- older adults