Emil Mellgren, Susann J Järhult, Lars Lind, Åsa Muntlin
{"title":"未见内科医生而离开急诊科患者的特征和死亡率：一项队列研究。","authors":"Emil Mellgren, Susann J Järhult, Lars Lind, Åsa Muntlin","doi":"10.1097/MEJ.0000000000001268","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and importance: </strong>Crowded emergency departments (EDs) and long waiting times may lead to delayed care for acute conditions and increased mortality in patients leaving without being seen by a physician (LWBS).</p><p><strong>Objectives: </strong>The aim of this study was to characterize patients LWBS from the ED at a Swedish university hospital and report their mortality.</p><p><strong>Design, setting, and participants: </strong>A cohort study was conducted. Data from electronic medical records of patients LWBS (exposure) were compared with those who stayed through completion of treatment. Data were gathered from 151 228 patients making 363 308 visits to the Uppsala University Hospital ED from 1 January 2010 to 30 June 2017.</p><p><strong>Outcome measures and analysis: </strong>Short- and long-term mortality of patients LWBS were studied using Cox regression analysis. Sex, age, triage level, arrival mode, length of stay, presenting complaint, crowding, and time of day were assessed as regards effect on the probability of LWBS and as covariates in the mortality analysis.</p><p><strong>Results: </strong>In our dataset, 9058 patient visits to the ED (2.5% of all ED visits) ended in LWBS. These patients were younger than average and had lower triage levels. No significant difference was found between males and females. The highest rates were seen in patients presenting with a psychiatric disorder (12.8%), victims of physical assault (11.7%), or alcohol/drug withdrawal (9.9%). The likelihood of LWBS was highest in the evening and lowest in the early morning. Short-term mortality at 28 days was not significantly affected by LWBS, but a 34% lower long-term mortality risk was seen for patients LWBS (hazard ratio 0.66, 95% confidence interval 0.45-0.95, P = 0.028) in median follow-up of 3.5 years.</p><p><strong>Conclusion: </strong>Patients LWBS were younger, had lower triage levels, and more frequently presented with psychiatric or substance use-related complaints. They had lower short- and long-term mortality compared with those who completed treatment. This observation does not imply a causal relationship but highlights differences in patient characteristics.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.2000,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Characteristics and mortality of patients leaving the emergency department without being seen by a physician: a cohort study.\",\"authors\":\"Emil Mellgren, Susann J Järhult, Lars Lind, Åsa Muntlin\",\"doi\":\"10.1097/MEJ.0000000000001268\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and importance: </strong>Crowded emergency departments (EDs) and long waiting times may lead to delayed care for acute conditions and increased mortality in patients leaving without being seen by a physician (LWBS).</p><p><strong>Objectives: </strong>The aim of this study was to characterize patients LWBS from the ED at a Swedish university hospital and report their mortality.</p><p><strong>Design, setting, and participants: </strong>A cohort study was conducted. Data from electronic medical records of patients LWBS (exposure) were compared with those who stayed through completion of treatment. Data were gathered from 151 228 patients making 363 308 visits to the Uppsala University Hospital ED from 1 January 2010 to 30 June 2017.</p><p><strong>Outcome measures and analysis: </strong>Short- and long-term mortality of patients LWBS were studied using Cox regression analysis. Sex, age, triage level, arrival mode, length of stay, presenting complaint, crowding, and time of day were assessed as regards effect on the probability of LWBS and as covariates in the mortality analysis.</p><p><strong>Results: </strong>In our dataset, 9058 patient visits to the ED (2.5% of all ED visits) ended in LWBS. These patients were younger than average and had lower triage levels. No significant difference was found between males and females. The highest rates were seen in patients presenting with a psychiatric disorder (12.8%), victims of physical assault (11.7%), or alcohol/drug withdrawal (9.9%). The likelihood of LWBS was highest in the evening and lowest in the early morning. Short-term mortality at 28 days was not significantly affected by LWBS, but a 34% lower long-term mortality risk was seen for patients LWBS (hazard ratio 0.66, 95% confidence interval 0.45-0.95, P = 0.028) in median follow-up of 3.5 years.</p><p><strong>Conclusion: </strong>Patients LWBS were younger, had lower triage levels, and more frequently presented with psychiatric or substance use-related complaints. They had lower short- and long-term mortality compared with those who completed treatment. This observation does not imply a causal relationship but highlights differences in patient characteristics.</p>\",\"PeriodicalId\":11893,\"journal\":{\"name\":\"European Journal of Emergency Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.2000,\"publicationDate\":\"2025-08-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Emergency Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/MEJ.0000000000001268\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MEJ.0000000000001268","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
Characteristics and mortality of patients leaving the emergency department without being seen by a physician: a cohort study.
Background and importance: Crowded emergency departments (EDs) and long waiting times may lead to delayed care for acute conditions and increased mortality in patients leaving without being seen by a physician (LWBS).
Objectives: The aim of this study was to characterize patients LWBS from the ED at a Swedish university hospital and report their mortality.
Design, setting, and participants: A cohort study was conducted. Data from electronic medical records of patients LWBS (exposure) were compared with those who stayed through completion of treatment. Data were gathered from 151 228 patients making 363 308 visits to the Uppsala University Hospital ED from 1 January 2010 to 30 June 2017.
Outcome measures and analysis: Short- and long-term mortality of patients LWBS were studied using Cox regression analysis. Sex, age, triage level, arrival mode, length of stay, presenting complaint, crowding, and time of day were assessed as regards effect on the probability of LWBS and as covariates in the mortality analysis.
Results: In our dataset, 9058 patient visits to the ED (2.5% of all ED visits) ended in LWBS. These patients were younger than average and had lower triage levels. No significant difference was found between males and females. The highest rates were seen in patients presenting with a psychiatric disorder (12.8%), victims of physical assault (11.7%), or alcohol/drug withdrawal (9.9%). The likelihood of LWBS was highest in the evening and lowest in the early morning. Short-term mortality at 28 days was not significantly affected by LWBS, but a 34% lower long-term mortality risk was seen for patients LWBS (hazard ratio 0.66, 95% confidence interval 0.45-0.95, P = 0.028) in median follow-up of 3.5 years.
Conclusion: Patients LWBS were younger, had lower triage levels, and more frequently presented with psychiatric or substance use-related complaints. They had lower short- and long-term mortality compared with those who completed treatment. This observation does not imply a causal relationship but highlights differences in patient characteristics.
期刊介绍：
The European Journal of Emergency Medicine is the official journal of the European Society for Emergency Medicine. It is devoted to serving the European emergency medicine community and to promoting European standards of training, diagnosis and care in this rapidly growing field.
Published bimonthly, the Journal offers original papers on all aspects of acute injury and sudden illness, including: emergency medicine, anaesthesiology, cardiology, disaster medicine, intensive care, internal medicine, orthopaedics, paediatrics, toxicology and trauma care. It addresses issues on the organization of emergency services in hospitals and in the community and examines postgraduate training from European and global perspectives. The Journal also publishes papers focusing on the different models of emergency healthcare delivery in Europe and beyond. With a multidisciplinary approach, the European Journal of Emergency Medicine publishes scientific research, topical reviews, news of meetings and events of interest to the emergency medicine community.
Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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