Diagnosis and mortality of emergency department patients in the North Denmark region

Abstract

BackgroundEmergency departments handle a large proportion of acute patients. In 2007, it was recommended centralizing the Danish healthcare system and establishing emergency departments as the main common entrance for emergency patients. Since this reorganization, few studies describing the emergency patient population in this new setting have been carried out and none describing diagnoses and mortality. Hence, we aimed to investigate diagnoses and 1- and 30-day mortality of patients in the emergency departments in the North Denmark Region during 2014–2016.MethodsPopulation-based historic cohort study in the North Denmark Region (580,000 inhabitants) of patients with contact to emergency departments during 2014–2016. The study included patients who were referred by general practitioners (daytime and out-of-hours), by emergency medical services or who were self-referred.Primary diagnoses (ICD-10) were retrieved from the regional Patient Administrative System. For non-specific diagnoses (ICD-10 chapter ‘Symptoms and signs’ and ‘Other factors’), we searched the same hospital stay for a specific diagnosis and used this, if one was given. We performed descriptive analysis reporting distribution and frequency of diagnoses. Moreover, 1- and 30-day mortality rate estimates were performed using the Kaplan-Meier estimator.ResultsWe included 290,590 patient contacts corresponding to 166 ED visits per 1000 inhabitants per year. The three most frequent ICD-10 chapters used were ‘Injuries and poisoning’ (38.3% n = 111,274), ‘Symptoms and signs’ (16.1% n = 46,852) and ‘Other factors’ (14.52% n = 42,195). Mortality at day 30 (95% confidence intervals) for these chapters were 0.86% (0.81–0.92), 3.95% (3.78–4.13) and 2.84% (2.69–3.00), respectively.The highest 30-day mortality were within chapters ‘Neoplasms’ (14.22% (12.07–16.72)), ‘Endocrine diseases’ (8.95% (8.21–9.75)) and ‘Respiratory diseases’ (8.44% (8.02–8.88)).ConclusionsPatients in contact with the emergency department receive a wide range of diagnoses within all chapters of ICD-10, and one third of the diagnoses given are non-specific. Within the non-specific chapters, we found a 30-day mortality, surpassing several of the more organ specific ICD-10 chapters.Trial registrationObservational study - no trial registration was performed.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3361-x) contains supplementary material, which is available to authorized users.

Non-specific diagnoses are frequent in patients hospitalized after calling 112 and their mortality is high – a register-based Danish cohort study

“…Several studies found that non-specific diagnoses represent a considerable part among acute patients: among patients taken to hospital by ambulance after calling 112 [3], among acute medical admissions [9,10] and among all patients with contact to emergency departments [11].…”

Acute care pathways for patients calling the out-of-hours services

“…Emergency calls to EMS display a diurnal pattern with the highest number of call occurring during daytime [23] and differences in proportion of certain diseases and admission rates between daytime and OOH in primary care have also been reported [33][34][35]. Nevertheless, Vest-Hansen et al [36] reported circulatory disease (19.3%), other factors (16.9%), infections (15.5%), symptoms and signs (11.8%) and injury and poisoning (6.3%) as the top five ICD-10 chapters used in acute admissions to a medical ward (not including surgical specialties, which explains the lower proportion of injuries and poisoning) and a study on emergency department contacts found injuries and poisoning (38.3%), symptoms and signs (16.1%), other factors (14.5%), circulatory diseases (5.7%) and respiratory diseases (5.4%) as the most frequent chapters [37]. These studies did not investigate whether the patients arrived at hospital after calling EMS or OOH-PC.…”

Patient experience of severe acute dyspnoea and relief during treatment in ambulances: a prospective observational study

“…Acute dyspnoea is a distressing symptom with a sensation of difficult, laboured and uncomfortable breathing [1,2]. It is the symptom of numerous acute as well as chronic diseases, and it is a frequent symptom seen among patients in the emergency departments as well as in the ambulances [3,4]. A study of emergency medical service patients from the United States of America showed that in 2002-2006, one in eight of the patients had respiratory distress, when excluding traumatic injury and cardiac arrest [5].…”