Effect of Inter-Hospital Transfer on Mortality in Patients Admitted through the Emergency Department
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data Source
2.2. Selection of Study Patients
2.3. Data Analysis and Outcome
2.4. Statistical Analysis
3. Results
3.1. Study Population and Outcomes
3.2. Comparison of the Basic Characteristics According to Study Groups (Transfer Group vs. Non-Transfer Group) and Outcome (Survivor Group and Non-Survivor Group)
3.3. Multiple Logistic Regression Analysis for In-Hospital Mortality
3.4. Sub-Analyses Based on MEWS, ICU Admission, Onset Time, Diagnostic Classification
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Total N = 2,955,476 | Transfer Group N = 832,598 (28.2%) | Non-Transfer Group N = 2,122,878 (71.8%) | p-Value |
---|---|---|---|---|
Age (year ± SD) | 60.92 ± 18.5 | 62.84 ± 18.5 | 60.16 ± 18.4 | <0.001 |
Age (year), median (IQR) | 63 (48–76) | 66 (51–78) | 62 (48–75) | <0.001 |
Sex, male, n (%) | 1,574,549 (53.3) | 444,651 (53.4) | 1,129,898 (53.2) | 0.005 |
Insurance type—medical aid, n (%) | 257,892 (8.7) | 75,769 (9.1) | 182,123 (8.6) | <0.001 |
Disease type, injury (%) | 539,576 (18.3) | 131,775 (15.8) | 407,801 (19.2) | <0.001 |
KTAS, n (%) | <0.001 | |||
1 | 74,307 (2.5) | 25,984 (3.1) | 48,323 (2.3) | |
2 | 454,484 (15.4) | 155,089 (18.6) | 299,395 (14.1) | |
3 | 1,571,340 (53.2) | 477,616 (57.4) | 1,093,724 (51.5) | |
4 | 758,818 (25.7) | 152,424 (18.3) | 606,394 (28.6) | |
5 | 96,527 (3.3) | 21,485 (2.6) | 75,042 (3.5) | |
Classification of emergency medical center, n (%) | <0.001 | |||
Regional emergency medical center | 1,069,842 (36.2) | 378,002 (45.4) | 691,840 (32.6) | |
Local emergency medical center | 1,885,634 (63.8) | 454,596 (54.6) | 1,431,038 (67.4) | |
Modified Early Warning Score—SBP (mmHg), n (%) | <0.001 | |||
0 (101 ≤ SBP ≤ 199) | 2,504,048 (84.7) | 695,080 (83.5) | 1,808,968 (85.2) | |
1 (81 ≤ SBP ≤ 100) | 292,546 (9.9) | 92,783 (11.1) | 199,763 (9.4) | |
2 (71 ≤ SBP ≤ 80 or ≥200) | 118,115 (4.0) | 33,278 (4.0) | 84,837 (4.0) | |
3 (SBP < 70) | 40,767 (1.4) | 11,457 (1.4) | 29,310 (1.4) | |
Modified Early Warning Score—HR (rate/min), n (%) | <0.001 | |||
0 (51 ≤ HR ≤ 100) | 2,223,667 (75.2) | 629,128 (75.6) | 1,594,539 (75.1) | |
1 (41 ≤ HR ≤ 50 or 101 ≤ HR ≤ 110) | 324,285 (11.0) | 96,084 (11.5) | 228,201 (10.7) | |
2 (111 ≤ HR ≤ 129 or HR < 40) | 307,617 (10.4) | 81,172 (9.7) | 226,445 (10.7) | |
3 (HR ≥ 130) | 99,907 (3.4) | 26,214 (3.1) | 73,693 (3.5) | |
Modified Early Warning Score—RR (rate/min), n (%) | <0.001 | |||
0 (9 ≤ RR ≤ 14) | 47,861 (1.6) | 16,489 (2.0) | 31,372 (1.5) | |
1 (15 ≤ RR ≤ 20) | 2,417,676 (81.8) | 666,434 (80.0) | 1,751,242 (82.5) | |
2 (21 ≤ RR ≤ 29 or RR < 9) | 429,021 (14.5) | 133,162 (16.0) | 295,859 (13.9) | |
3 (RR ≥ 30) | 60,918 (2.1) | 16,513 (2.0) | 44,405 (2.1) | |
Modified Early Warning Score—Temperature, T (°C), n (%) | ||||
0 (35 ≤ T ≤ 38.4) | 2,753,402 (93.2) | 796,036 (95.6) | 1,957,366 (92.2) | |
2 (T ≥ 38.5 or T < 35) | 202,074 (6.8) | 36,562 (4.4) | 165,512 (7.8) | |
Modified Early Warning Score—AVPU score, n (%) | <0.001 | |||
Alert (A) | 2,696,346 (91.2) | 736,775 (88.5) | 1,959,571 (92.3) | |
Reacting to voice (V) | 131,688 (4.5) | 47,981 (5.8) | 83,707 (3.9) | |
Reacting to Pain (P) | 99,390 (3.4) | 38,293 (4.6) | 61,097 (2.9) | |
Unresponsive (U) | 28,052 (0.9) | 9549 (1.1) | 18,503 (0.9) | |
Onset time (Interval from onset of symptom to admission at ED) (hour), median (IQR), n (%) | 10 (2–48) | 22 (5–72) | 7 (2–38) | <0.001 |
Onset time (Interval from onset of symptom to admission at ED) (hour, IQR) | <0.001 | |||
Onset time ≤ 2 | 814,951 (27.6) | 96,015 (11.5) | 718,936 (33.9) | |
2 < onset time ≤ 10 | 693,418 (23.5) | 232,577 (27.9) | 460,841 (21.7) | |
10 < onset time ≤ 48 | 753,402 (25.5) | 243,565 (29.3) | 509,837 (24.0) | |
48 < onset time | 693,705 (23.5) | 260,441 (31.3) | 433,264 (20.4) | |
ED LOS (hour), median (IQR), n (%) | 4.17 (2.40–7.73) | 4.5 (2.6–8.4) | 4.0 (2.4–7.5) | <0.001 |
Hospital day (day), median (IQR), n (%) | 6 (3–13) | 7 (3–15) | 5 (2–12) | <0.001 |
ICU admission N, (%) | 512,723 (17.3) | 191,768 (23.0) | 320,955 (15.1) | <0.001 |
In-hospital mortality N, (%) | 159,513 (5.4) | 57,219 (6.9) | 102,294 (4.8) | <0.001 |
Variable | Total N = 2,955,476 | Survivor Group N = 2,795,963 (94.6) | Non-Survivor Group N = 159,513 (5.4) | p-Value |
---|---|---|---|---|
Age (year ± SD) | 62.98 ± 17.8 | 60.34 ± 18.5 | 71.09 ± 14.1 | <0.001 |
Age (year), median (IQR) | 63 (48–76) | 62 (48–76) | 74 (62–81) | |
Sex, male, n (%) | 1,574,549 (53.3) | 1,478,706 (52.9) | 95,843 (60.1) | <0.001 |
Insurance type—medical aid, n (%) | 257,892 (8.7) | 239,608 (8.6) | 18,284 (11.5) | <0.001 |
Disease type, injury, n (%) | 539,576 (18.3) | 527,411 (18.9) | 12,165 (7.6) | <0.001 |
KTAS, n (%) | <0.001 | |||
1 | 74,307 (2.5) | 51,078 (1.8) | 23,229 (14.6) | |
2 | 454,484 (15.4) | 409,693 (14.7) | 44,791 (28.1) | |
3 | 1,571,340 (53.2) | 1,500,353 (53.7) | 70,987 (44.5) | |
4 | 758,818 (25.7) | 741,630 (26.5) | 17,188 (10.8) | |
5 | 96,527 (3.3) | 93,209 (3.3) | 3318 (2.1) | |
Classification of emergency medical center, n (%) | <0.001 | |||
Regional emergency medical center | 1,069,842 (36.2) | 1,009,838 (36.1) | 60,004 (37.6) | |
Local emergency medical center | 1,885,634 (63.8) | 1,786,125 (63.9) | 99,509 (62.4) | |
Onset time (Interval from onset of symptom to admission at ED) (hour), median (IQR) | 10 (2–48) | 10 (2–48) | 9 (2–48) | |
Onset time (Interval from onset of symptom to admission at ED) (hour, IQR) | <0.001 | |||
Onset time ≤ 2 | 814,951 (27.6) | 768,352 (27.5) | 46,599 (29.2) | |
2 < onset time ≤ 10 | 693,418 (23.5) | 656,960 (23.5) | 36,458 (22.9) | |
10 < onset time ≤ 48 | 753,402 (25.5) | 716,178 (25.6) | 37,224 (23.3) | |
48 < onset time | 693,705 (23.5) | 654,473 (23.4) | 39,232 (24.6) | |
ED LOS (hour), median (IQR) | 4.17 (2.40–7.73) | 4.13 (2.40–7.65) | 4.75 (2.66–9.27) | <0.001 |
Hospital day (day), median (IQR) | 6 (3–13) | 6 (3–12) | 8 (2–20) | <0.001 |
ICU admission, n (%) | 512,723 (17.3) | 439,224 (15.7) | 73,499 (46.1) | <0.001 |
Inter-hospital transfer, n (%) | <0.001 | |||
Yes | 832,598 (28.2) | 775,379 (27.7) | 57,219 (35.9) | |
No | 2,122,878 (71.8) | 2,020,584 (72.3) | 102,294 (64.1) |
Variable | Unadjusted | Adjusted | ||||
---|---|---|---|---|---|---|
OR | 95%CI | p-Value | OR | 95%CI | p-Value | |
Age(year) | 1.039 | 1.038–1.039 | <0.001 | 1.034 | 1.033–1.034 | <0.001 |
Sex, male | 1.341 | 1.327–1.355 | <0.001 | 1.442 | 1.426–1.458 | <0.001 |
Insurance type-medical aid | 1.381 | 1.359–1.403 | <0.001 | 1.074 | 1.055–1.092 | <0.001 |
Disease type, n (%) | ||||||
Medical | 2.816 | 2.764–2.869 | <0.001 | 1.912 | 1.874–1.952 | <0.001 |
injury | 1.00 | - | - | |||
ICU admission | 4.585 | 4.538–4.633 | <0.001 | 2.154 | 2.128–2.181 | <0.001 |
Onset time (Interval from onset of symptom to admission at ED) (hour, IQR) | ||||||
Onset time ≤ 2 | 1.012 | 0.998–1.026 | 0.098 | 0.684 | 0.673–0.696 | <0.001 |
2 < onset time ≤ 10 | 0.926 | 0.912–0.939 | <0.001 | 0.753 | 0.723–0.747 | <0.001 |
10 < onset time ≤ 48 | 0.867 | 0.855–0.880 | <0.001 | 0.816 | 0.803–0.828 | <0.001 |
48 < onset time | 1.00 | - | - | |||
Inter-hospital transfer | ||||||
Yes | 1.458 | 1.442–1.473 | <0.001 | 1.114 | 1.101–1.128 | <0.001 |
No | 1.00 | - | - |
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Song, J.-J.; Lee, S.-J.; Song, J.-H.; Lee, S.-W.; Kim, S.-J.; Han, K.-S. Effect of Inter-Hospital Transfer on Mortality in Patients Admitted through the Emergency Department. J. Clin. Med. 2024, 13, 4944. https://doi.org/10.3390/jcm13164944
Song J-J, Lee S-J, Song J-H, Lee S-W, Kim S-J, Han K-S. Effect of Inter-Hospital Transfer on Mortality in Patients Admitted through the Emergency Department. Journal of Clinical Medicine. 2024; 13(16):4944. https://doi.org/10.3390/jcm13164944
Chicago/Turabian StyleSong, Jei-Joon, Si-Jin Lee, Ju-Hyun Song, Sung-Woo Lee, Su-Jin Kim, and Kap-Su Han. 2024. "Effect of Inter-Hospital Transfer on Mortality in Patients Admitted through the Emergency Department" Journal of Clinical Medicine 13, no. 16: 4944. https://doi.org/10.3390/jcm13164944