open access

Vol 9, No 1 (2024)
Research paper
Published online: 2023-09-08
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How long to provide special care after emergency department admission in three most common non-traumatic diseases?

Wawrzyniec Mantorski1, Piotr Feusette2, Andrzej Tukiendorf3, Edyta Wolny-Rokicka4
DOI: 10.5603/demj.96069
·
Disaster Emerg Med J 2024;9(1):1-7.
Affiliations
  1. Specialistic Hospital in Rybnik, Poland
  2. University Clinical Hospital in Opole, Poland
  3. Opole University, Opole, Poland
  4. Multidisciplinary Hospital in Zgorzelec, Poland

open access

Vol 9, No 1 (2024)
ORIGINAL ARTICLES
Published online: 2023-09-08

Abstract

INTRODUCTION: The first hours after the admission of patients, and proper medical care is administered in the emergency department [ED], are of decisive importance in protecting them from unexpected death. Medical staff and researchers are not consistent in the period to follow up on deaths after admission to the emergency department and they analyze arbitrarily different time intervals without any justification for the chosen period. In this study, we will conduct an epidemiological data analysis to determine the range of the most dangerous (elevated) risk (hazard) of death for patients within one month of observation from an ED admission using modern survival modeling and software. MATERIAL AND METHODS: Epidemiological data analysis of the three most common non-traumatic diseases (neoplasms, circulatory, and endocrine) was carried out in this study. Using the 2016–2019 sample of 14,904 first-visit ED patients at the Multi-Specialistic Hospital in Gorzów Wielkopolski, Poland, we determined the range of the most dangerous (elevated) risk (hazard) of death within one month of observation, based on a Royston–Parmar (RP) regression with spline functions (assuming non-constant hazard over time). RESULTS: The results show that in the three most common non-traumatic diseases (neoplasms, circulatory, and endocrine) for the first 72 hours, patients should be under special supervision of medical personnel to avoid an excess of unexpected deaths. Moreover, within a month from ED admission, the hazard ratio [HR] of death was almost half as high [HR = 1.47, 95% confidence interval (CI) = 1.07 to 2.02] in diagnosed circulatory patients and over twice as high (HR = 2.25, 95% CI = 1.58 to 3.20) in neoplastic diseases as compared to reference endocrine patients. Moreover, the estimated RP hazards (probabilities of death) increased until the third day after admission, reaching 1.0% (95% CI = 0.8% to 1.4%) of endocrine patients, 1.5% (95% CI = 1.3% to 1.6%) of circulatory patients, and 2.2% (95% CI = 1.8% to 2.6%) for neoplasms, and then dropped radically with the time of observation. CONCLUSIONS: In view of the care of patients in the three most non-traumatic clinical diagnoses (endocrine diseases, circulatory diseases, and neoplasms), special attention should be paid to the first three days after admission to the ED (after this time, in the first month of observation, the risk of death of these patients decreases significantly).

Abstract

INTRODUCTION: The first hours after the admission of patients, and proper medical care is administered in the emergency department [ED], are of decisive importance in protecting them from unexpected death. Medical staff and researchers are not consistent in the period to follow up on deaths after admission to the emergency department and they analyze arbitrarily different time intervals without any justification for the chosen period. In this study, we will conduct an epidemiological data analysis to determine the range of the most dangerous (elevated) risk (hazard) of death for patients within one month of observation from an ED admission using modern survival modeling and software. MATERIAL AND METHODS: Epidemiological data analysis of the three most common non-traumatic diseases (neoplasms, circulatory, and endocrine) was carried out in this study. Using the 2016–2019 sample of 14,904 first-visit ED patients at the Multi-Specialistic Hospital in Gorzów Wielkopolski, Poland, we determined the range of the most dangerous (elevated) risk (hazard) of death within one month of observation, based on a Royston–Parmar (RP) regression with spline functions (assuming non-constant hazard over time). RESULTS: The results show that in the three most common non-traumatic diseases (neoplasms, circulatory, and endocrine) for the first 72 hours, patients should be under special supervision of medical personnel to avoid an excess of unexpected deaths. Moreover, within a month from ED admission, the hazard ratio [HR] of death was almost half as high [HR = 1.47, 95% confidence interval (CI) = 1.07 to 2.02] in diagnosed circulatory patients and over twice as high (HR = 2.25, 95% CI = 1.58 to 3.20) in neoplastic diseases as compared to reference endocrine patients. Moreover, the estimated RP hazards (probabilities of death) increased until the third day after admission, reaching 1.0% (95% CI = 0.8% to 1.4%) of endocrine patients, 1.5% (95% CI = 1.3% to 1.6%) of circulatory patients, and 2.2% (95% CI = 1.8% to 2.6%) for neoplasms, and then dropped radically with the time of observation. CONCLUSIONS: In view of the care of patients in the three most non-traumatic clinical diagnoses (endocrine diseases, circulatory diseases, and neoplasms), special attention should be paid to the first three days after admission to the ED (after this time, in the first month of observation, the risk of death of these patients decreases significantly).

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Keywords

emergency department; non-traumatic diseases; death; Royston–Parmar model

About this article
Title

How long to provide special care after emergency department admission in three most common non-traumatic diseases?

Journal

Disaster and Emergency Medicine Journal

Issue

Vol 9, No 1 (2024)

Article type

Research paper

Pages

1-7

Published online

2023-09-08

Page views

128

Article views/downloads

135

DOI

10.5603/demj.96069

Bibliographic record

Disaster Emerg Med J 2024;9(1):1-7.

Keywords

emergency department
non-traumatic diseases
death
Royston–Parmar model

Authors

Wawrzyniec Mantorski
Piotr Feusette
Andrzej Tukiendorf
Edyta Wolny-Rokicka

References (19)
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