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 JunhasavasdikulJose 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

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

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 (Formula presented.)) 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 < 0.001), and a significantly higher risk of IHM was found in low EDLOS and high BT. The flagged rate of quality assurance issues was higher in lower EDLOS (Formula presented.) h (9.96%) vs. higher EDLOS 7 h (Formula presented.) 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.

Original languageEnglish
Article number4750
JournalJournal of Clinical Medicine
Volume12
Issue number14
DOIs
StatePublished - 18 Jul 2023

Bibliographical note

Publisher Copyright:
© 2023 by the authors.

Keywords

  • boarding time
  • emergency department
  • in-hospital mortality
  • length of stay
  • machine learning
  • older adults

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