The characteristics and prognostic predictors of unplanned hospital admission within 72 hours after ED discharge

• Published in: The American journal of emergency medicine 2013-10, Vol.31 (10), p.1490-1494
• Main Authors: Cheng, Shih-Yu, MD, Wang, Hui-Ting, MD, Lee, Chi-Wei, MD, Tsai, Tsung-Cheng, MD, Hung, Chi-Wei, MD, Wu, Kuan-Han, MD
• Format: Article
• Language: English
• Subjects: Age Factors; Diabetes; Emergency; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Female; Hospital Mortality; Hospitalization; Hospitalization - statistics & numerical data; Humans; Infections; Leukemia; Liver diseases; Male; Medical errors; Middle Aged; Mortality; Neurology; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Population; Prognosis; Retrospective Studies; Surgery; Teaching hospitals; Tumors
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2013.08.004

Abstract Objectives The aims of this study were (1) to identify the characteristics of patients who return to the emergency department (ED) within 72 hours and are admitted to the hospital and (2) to identify the characteristics and predictors of in-hospital mortality subgroup. Methods This study was conducted in a tertiary teaching hospital to identify characteristics of adult nontraumatic revisit-admission patients from January 1 to December 31, 2011. Demographic data, cause of revisit, and the underlying diseases as well as the in-hospital complications were reviewed. Results Of the 72 188 ED discharged patients, 690 revisit-admission patients were enrolled. The top 3 disease classifications were infection (38.7%), neurology (11.3%), and gastroenterology (11.2%). The etiology of the revisit included recurrent symptoms (72%), disease complications (15.8%), and inadequate diagnosis (12.1%). A total of 150 patients (21.7%) had complications, including receiving operation (17.2%), intensive care unit admission (4.2%), and cardiovascular conditions (2.5%). Forty-nine patients (7.1%) died during hospitalization owing to sepsis (57.1%), malignancy (34.7%), cardiogenic diseases (4.1%), and cerebrovascular conditions (4.1%). The nonsurvival group was older (64.1 ± 15.3 vs 55.7 ± 17.8; P < .001), had more patients with a diagnosis of moderate to severe liver disease (18.4% vs 4.8%; P < .001), malignancy (69.3% vs 20.1%; P < .001), and metastatic solid tumor (38.8% vs 6.2%; P < .001). Conclusions Age and diagnosis with malignancy, metastatic tumors, or moderate-to-severe liver disease were predictors of in-hospital mortality among 72-hour revisit-admission patients.