The Association between Emergency Department Length of Stay and In-Hospital Mortality in Older Patients Using Machine Learning: An Observational Cohort Study
Issued Date
2023-07-01
Resource Type
eISSN
20770383
Scopus ID
2-s2.0-85166332423
Journal Title
Journal of Clinical Medicine
Volume
12
Issue
14
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Clinical Medicine Vol.12 No.14 (2023)
Suggested Citation
Wu L., Chen X., Khalemsky A., Li D., Zoubeidi T., Lauque D., Alsabri M., Boudi Z., Kumar V.A., Paxton J., Tsilimingras D., Kurland L., Schwartz D., Hachimi-Idrissi S., Camargo C.A., Liu S.W., Savioli G., Intas G., Soni K.D., Junhasavasdikul D., Cabello J.J.T., Rathlev N.K., Tazarourte K., Slagman A., Christ M., Singer A.J., Lang E., Ricevuti G., Li X., Liang H., Grossman S.A., Bellou A. The Association between Emergency Department Length of Stay and In-Hospital Mortality in Older Patients Using Machine Learning: An Observational Cohort Study. Journal of Clinical Medicine Vol.12 No.14 (2023). doi:10.3390/jcm12144750 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/88268
Title
The Association between Emergency Department Length of Stay and In-Hospital Mortality in Older Patients Using Machine Learning: An Observational Cohort Study
Author(s)
Wu L.
Chen X.
Khalemsky A.
Li D.
Zoubeidi T.
Lauque D.
Alsabri M.
Boudi Z.
Kumar V.A.
Paxton J.
Tsilimingras D.
Kurland L.
Schwartz D.
Hachimi-Idrissi S.
Camargo C.A.
Liu S.W.
Savioli G.
Intas G.
Soni K.D.
Junhasavasdikul D.
Cabello J.J.T.
Rathlev N.K.
Tazarourte K.
Slagman A.
Christ M.
Singer A.J.
Lang E.
Ricevuti G.
Li X.
Liang H.
Grossman S.A.
Bellou A.
Chen X.
Khalemsky A.
Li D.
Zoubeidi T.
Lauque D.
Alsabri M.
Boudi Z.
Kumar V.A.
Paxton J.
Tsilimingras D.
Kurland L.
Schwartz D.
Hachimi-Idrissi S.
Camargo C.A.
Liu S.W.
Savioli G.
Intas G.
Soni K.D.
Junhasavasdikul D.
Cabello J.J.T.
Rathlev N.K.
Tazarourte K.
Slagman A.
Christ M.
Singer A.J.
Lang E.
Ricevuti G.
Li X.
Liang H.
Grossman S.A.
Bellou A.
Author's Affiliation
Hadassah Academic College
Renaissance School of Medicine at Stony Brook University
Guangdong Provincial People’s Hospital of Southern Medical University
Athens General Hospital
Universitair Ziekenhuis Gent
Université Toulouse III - Paul Sabatier
Fondazione IRCCS Policlinico San Matteo
Charité – Universitätsmedizin Berlin
Wayne State University School of Medicine
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Università degli Studi di Pavia
CHU de Lyon
Hospital Universitari Arnau de Vilanova de Lleida
All India Institute of Medical Sciences, New Delhi
United Arab Emirates University
Örebro Universitet
Brookdale University Hospital and Medical Center
Bar-Ilan University
Harvard Medical School
University of Massachusetts Chan Medical School
Cumming School of Medicine
Dr. Suliman Alhabib Hospital
Global Network on Emergency Medicine
Renaissance School of Medicine at Stony Brook University
Guangdong Provincial People’s Hospital of Southern Medical University
Athens General Hospital
Universitair Ziekenhuis Gent
Université Toulouse III - Paul Sabatier
Fondazione IRCCS Policlinico San Matteo
Charité – Universitätsmedizin Berlin
Wayne State University School of Medicine
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Università degli Studi di Pavia
CHU de Lyon
Hospital Universitari Arnau de Vilanova de Lleida
All India Institute of Medical Sciences, New Delhi
United Arab Emirates University
Örebro Universitet
Brookdale University Hospital and Medical Center
Bar-Ilan University
Harvard Medical School
University of Massachusetts Chan Medical School
Cumming School of Medicine
Dr. Suliman Alhabib Hospital
Global Network on Emergency Medicine
Other Contributor(s)
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.