TY - JOUR
T1 - Patterns and predictors of short-term death after emergency department discharge
AU - Gabayan, Gelareh Z.
AU - Derose, Stephen F.
AU - Asch, Steven M.
AU - Yiu, Sau
AU - Lancaster, Elizabeth M.
AU - Poon, K. Trudy
AU - Hoffman, Jerome R.
AU - Sun, Benjamin C.
N1 - Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org ). The authors have stated that no such relationships exist. This research was supported by Kaiser Permanente Southern California and the UCLA Oppenheimer Foundation. During the initial phase of this project Dr. Gabayan received support from the Greater Los Angeles Veterans Affairs Department of Health Services Research and Development. Continued support was obtained from the Emergency Medicine Foundation Career Development Award ( 59668 : G. Gabayan). Dr. Sun received support from the UCLA Older Americans Independence Center, NIH/NIA grant P30-AG028748 , and the content does not necessarily represent the official views of the National Institute on Aging or the National Institutes of Health.
PY - 2011/12
Y1 - 2011/12
N2 - Study objective: The emergency department (ED) is an inherently high-risk setting. Early death after an ED evaluation is a rare and devastating outcome; understanding it can potentially help improve patient care and outcomes. Using administrative data from an integrated health system, we describe characteristics and predictors of patients who experienced 7-day death after ED discharge. Methods: Administrative data from 12 hospitals were used to identify death after discharge in adults aged 18 year or older within 7 days of ED presentation from January 1, 2007, to December 31, 2008. Patients who were nonmembers of the health system, in hospice care, or treated at out-of-network EDs were excluded. Predictors of 7-day postdischarge death were identified with multivariable logistic regression. Results: The study cohort contained a total of 475,829 members, with 728,312 discharges from Kaiser Permanente Southern California EDs in 2007 and 2008. Death within 7 days of discharge occurred in 357 cases (0.05%). Increasing age, male sex, and number of preexisting comorbidities were associated with increased risk of death. The top 3 primary discharge diagnoses predictive of 7-day death after discharge included noninfectious lung disease (odds ratio [OR] 7.1; 95% confidence interval [CI] 2.9 to 17.4), renal disease (OR 5.6; 95% CI 2.2 to 14.2), and ischemic heart disease (OR 3.8; 95% CI 1.0 to 13.6). Conclusion: Our study suggests that 50 in 100,000 patients in the United States die within 7 days of discharge from an ED. To our knowledge, our study is the first to identify potentially "high-risk" discharge diagnoses in patients who experience a short-term death after discharge.
AB - Study objective: The emergency department (ED) is an inherently high-risk setting. Early death after an ED evaluation is a rare and devastating outcome; understanding it can potentially help improve patient care and outcomes. Using administrative data from an integrated health system, we describe characteristics and predictors of patients who experienced 7-day death after ED discharge. Methods: Administrative data from 12 hospitals were used to identify death after discharge in adults aged 18 year or older within 7 days of ED presentation from January 1, 2007, to December 31, 2008. Patients who were nonmembers of the health system, in hospice care, or treated at out-of-network EDs were excluded. Predictors of 7-day postdischarge death were identified with multivariable logistic regression. Results: The study cohort contained a total of 475,829 members, with 728,312 discharges from Kaiser Permanente Southern California EDs in 2007 and 2008. Death within 7 days of discharge occurred in 357 cases (0.05%). Increasing age, male sex, and number of preexisting comorbidities were associated with increased risk of death. The top 3 primary discharge diagnoses predictive of 7-day death after discharge included noninfectious lung disease (odds ratio [OR] 7.1; 95% confidence interval [CI] 2.9 to 17.4), renal disease (OR 5.6; 95% CI 2.2 to 14.2), and ischemic heart disease (OR 3.8; 95% CI 1.0 to 13.6). Conclusion: Our study suggests that 50 in 100,000 patients in the United States die within 7 days of discharge from an ED. To our knowledge, our study is the first to identify potentially "high-risk" discharge diagnoses in patients who experience a short-term death after discharge.
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U2 - 10.1016/j.annemergmed.2011.07.001
DO - 10.1016/j.annemergmed.2011.07.001
M3 - Article
C2 - 21802775
AN - SCOPUS:81555203419
SN - 0196-0644
VL - 58
SP - 551-558.e2
JO - Journal of the American College of Emergency Physicians
JF - Journal of the American College of Emergency Physicians
IS - 6
ER -