Comparison of Standardized Mortality Ratios in seven Dutch EDs based on presenting complaints.

IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE
Wouter Raven, Bart G J Candel, Nabila Wali, Menno I Gaakeer, Ewoud Ter Avest, Ozcan Sir, Heleen Lameijer, Roger A P A Hessels, Resi Reijnen, Christian H Nickel, Evert de Jonge, Erik van Zwet, Bas de Groot
{"title":"Comparison of Standardized Mortality Ratios in seven Dutch EDs based on presenting complaints.","authors":"Wouter Raven, Bart G J Candel, Nabila Wali, Menno I Gaakeer, Ewoud Ter Avest, Ozcan Sir, Heleen Lameijer, Roger A P A Hessels, Resi Reijnen, Christian H Nickel, Evert de Jonge, Erik van Zwet, Bas de Groot","doi":"10.1186/s12873-025-01200-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Comparison of emergency departments (EDs) becomes more important, but differences are difficult to interpret because of the heterogeneity of the ED population regarding reason for ED presentation. The aim of this study was two-fold: First to compare patient characteristics (including diagnoses) across 7 EDs. Secondly, to compare Standardized Mortality Ratios (SMRs) across 7 EDs and in subgroups of ED patients categorized by presenting complaints (PCs).</p><p><strong>Methods: </strong>Observational multicenter study including all consecutive visits of 7 Dutch (two tertiary care centre and 5 teaching hospitals) EDs. Patient characteristics, including PCs as part of triage systems, and SMRs (observed divided by expected in-hospital mortality) per ED and for the most common PCs (PC-SMRs) were compared across EDs and presented as funnel plots. The expected mortality was calculated with a prediction model, which was developed using multivariable logistic regression in the overall population and for PCs separately. Demographics, disease severity, diagnoses, proxies for comorbidity and complexity, and PCs (overall population only) were incorporated as covariates.</p><p><strong>Results: </strong>We included 693,289 ED visits from January 1, 2017 to June 31, 2023, with a median age of 56 years, of which 47.9% were women and 1.9% died. Patient characteristics varied markedly among EDs. Expected mortality was similar in prediction models with or without diagnoses as covariate. SMRs differed across EDs, ranging from 0.80 to 1.44. All EDs had SMRs within the 95%-Confidence Intervals of the funnel plot apart from one ED, which had an higher than expected SMR. However, PC-SMRs showed more variation and more EDs had SMRs falling outside the funnel, either higher or lower than expected. The ranking of SMRs across EDs was PC-dependent and differences across EDs are present only for specific PC-SMRs, such as in \"dyspnea\" and \"feeling unwell\".</p><p><strong>Conclusion: </strong>In summary, patient characteristics and mortality varied largely across Dutch EDs, and expected mortality across EDs is well assessed in PC subgroups without adjustment for final diagnoses. Differences in SMRs across EDs are PC-dependent. Future studies should investigate reasons of the differences in PC-SMRs across EDs and whether PC-targeted quality improvement programs can improve outcomes.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"49"},"PeriodicalIF":2.3000,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951612/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12873-025-01200-4","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Comparison of emergency departments (EDs) becomes more important, but differences are difficult to interpret because of the heterogeneity of the ED population regarding reason for ED presentation. The aim of this study was two-fold: First to compare patient characteristics (including diagnoses) across 7 EDs. Secondly, to compare Standardized Mortality Ratios (SMRs) across 7 EDs and in subgroups of ED patients categorized by presenting complaints (PCs).

Methods: Observational multicenter study including all consecutive visits of 7 Dutch (two tertiary care centre and 5 teaching hospitals) EDs. Patient characteristics, including PCs as part of triage systems, and SMRs (observed divided by expected in-hospital mortality) per ED and for the most common PCs (PC-SMRs) were compared across EDs and presented as funnel plots. The expected mortality was calculated with a prediction model, which was developed using multivariable logistic regression in the overall population and for PCs separately. Demographics, disease severity, diagnoses, proxies for comorbidity and complexity, and PCs (overall population only) were incorporated as covariates.

Results: We included 693,289 ED visits from January 1, 2017 to June 31, 2023, with a median age of 56 years, of which 47.9% were women and 1.9% died. Patient characteristics varied markedly among EDs. Expected mortality was similar in prediction models with or without diagnoses as covariate. SMRs differed across EDs, ranging from 0.80 to 1.44. All EDs had SMRs within the 95%-Confidence Intervals of the funnel plot apart from one ED, which had an higher than expected SMR. However, PC-SMRs showed more variation and more EDs had SMRs falling outside the funnel, either higher or lower than expected. The ranking of SMRs across EDs was PC-dependent and differences across EDs are present only for specific PC-SMRs, such as in "dyspnea" and "feeling unwell".

Conclusion: In summary, patient characteristics and mortality varied largely across Dutch EDs, and expected mortality across EDs is well assessed in PC subgroups without adjustment for final diagnoses. Differences in SMRs across EDs are PC-dependent. Future studies should investigate reasons of the differences in PC-SMRs across EDs and whether PC-targeted quality improvement programs can improve outcomes.

荷兰7个急诊科的标准化死亡率比较
背景:急诊科(ED)的比较变得越来越重要,但由于急诊科人群在急诊科表现原因上的异质性,差异很难解释。本研究的目的有两个:首先比较7种急诊科的患者特征(包括诊断)。其次,比较7种急诊科和按主诉分类的急诊科亚组的标准化死亡率(SMRs)。方法:观察性多中心研究,包括7个荷兰急诊科(2个三级保健中心和5个教学医院)的所有连续就诊。患者特征,包括作为分诊系统一部分的pc,以及每个急诊科的smr(观察结果除以预期住院死亡率)和最常见的pc (pc - smr)在急诊科之间进行比较,并以漏斗图的形式呈现。使用预测模型计算预期死亡率,该模型分别在总体和pc中使用多变量逻辑回归开发。人口统计学、疾病严重程度、诊断、合并症和复杂性的替代指标以及pc(仅限总体人口)被纳入协变量。结果:我们纳入了2017年1月1日至2023年6月31日的693,289例ED就诊,中位年龄为56岁,其中47.9%为女性,1.9%死亡。不同急诊科的患者特征差异显著。在有或没有诊断作为协变量的预测模型中,预期死亡率相似。不同ed的smr差异在0.80到1.44之间。除了一个ED的SMR高于预期外,所有ED的SMR都在漏斗图的95%置信区间内。然而,pc - smr表现出更多的变化,更多的ed的smr落在漏斗之外,或高于或低于预期。各急诊科的smr排名与个人电脑有关,各急诊科的差异仅存在于特定的个人电脑- smr,如“呼吸困难”和“感觉不适”。结论:总之,荷兰急诊科的患者特征和死亡率差异很大,在PC亚组中,急诊科的预期死亡率得到了很好的评估,而不需要对最终诊断进行调整。不同ed之间的smr差异与个人电脑有关。未来的研究应该调查不同急诊科患者pc - smr差异的原因,以及针对pc的质量改进计划是否能改善结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
BMC Emergency Medicine
BMC Emergency Medicine Medicine-Emergency Medicine
CiteScore
3.50
自引率
8.00%
发文量
178
审稿时长
29 weeks
期刊介绍: BMC Emergency Medicine is an open access, peer-reviewed journal that considers articles on all urgent and emergency aspects of medicine, in both practice and basic research. In addition, the journal covers aspects of disaster medicine and medicine in special locations, such as conflict areas and military medicine, together with articles concerning healthcare services in the emergency departments.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信