Abstract
Purpose
To examine the hospital- and patient-related factors associated with increased likelihood
of inpatient admission and extended hospitalization.
Methods
We applied multivariate logistic regression to a subset of ED hospital and patient
characteristics linearly extrapolated from the 2019 National Emergency Department
Sample database (n=626,508). Patient characteristics with 10 or fewer ED visits after
national extrapolation were not reported in the current study to maintain patient
confidentiality, in accordance with the HCUP Data Use Agreement. All selected ED visits
represented a primary diagnosis of CVD (ICD-10 codes 160-168). All reported hospital
and patient characteristics were subject to adjustment for covariates. P-values <
0.05 were considered statistically significant.
Main findings
Medicare beneficiaries report higher inpatient admission rates than uninsured OR 0.81
(0.73-0.91) and privately insured OR 0.86 (0.79-0.94) individuals. Black and Native-American
patients were 37% and 55% more likely to be hospitalized long (>75th percentile) (OR 1.37 [1.25-1.50], OR 1.55 [1.14-2.10]). Northeast emergency departments
reported an increased odds of admission compared to the Midwest OR (0.40-0.62), South
OR 0.79 (0.63-0.98) and West OR 0.52 (0.39-0.69). Patients with multiple comorbidities
(mCCI = 3+) were 226% more likely to have a longer stay OR 3.26 (3.09-3.45) than patients
presenting with zero or few comorbidities. Level I, II, and III trauma centers report
distinctly high odds of inpatient admission (OR 3.54 [2.84-4.42], OR 2.68 [2.14-3.35],
OR 1.51 [1.25-1.84]).
Principal conclusions
Likelihoods of inpatient admission and long hospital stays were observably stratified
through multiple, independently acting hospital and patient characteristics. Significant
associations were stratified by race/ethnicity, location, and clinical presentation,
among others. Attention to the factors reported here may serve well to mitigate emergency
department crowding and its sobering impact on United States healthcare systems and
patients.
Keywords
Abbreviations:
Cerebrovascular disease (CVD), Coronary artery disease (CAD), Do-not-resuscitate (DNR), Emergency department (ED), Healthcare Cost and Utilization Project (HCUP), International Classification of Diseases (ICD), Modified Charlson Comorbidity Index (mCCI), National Emergency Department Sample (NEDS), Odds ratio (OR)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 13, 2023
Accepted:
January 9,
2023
Received in revised form:
December 20,
2022
Received:
July 22,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.106983
Copyright
© 2023 Elsevier Inc. All rights reserved.
