• Òscar Miró, Sira Aguiló, Aitor Alquézar-Arbé, Cesáreo Fernández, Guillermo Burillo, MartínezSergio GuzmánSGEmergency Department, Hospital Doctor Balmis, Alicante, Spain., María Esther Martínez Larrull, Andrea B Bravo Periago, Claudia Lorena Amarilla Molinas, Carolina Rangel Falcón, Paz Balado Dacosta, Rudiger Carlos Chávez Flores, CalzadaJorge NavarroJNEmergency Department, Hospital Universitario Miguel Servet, Saragossa, Spain., Eva María Fragero Blesa, Manuel Ángel Palomero Martín, Ángela Cobos Requena, Lidia Fuentes, Isabel Lobo Cortizo, Pablo González Garcinuño, María Bóveda García, Del VallePedro RivasPREmergency Department, Hospital Virgen Rocío, Seville, Spain., Raquel Benavent Campos, JiménezVerónica CastroVCEmergency Department, Hospital Universitario de Burgos, Burgos, Spain., Vanesa Abad Cuñado, Olga Trejo Gutiérrez, María Del Mar Sousa Reviriego, Melanie Roussel, Del CastilloJuan GonzálezJGEmergency Department, Hospital Clínico San Carlos, IDISSC, Complutense University, Madrid, Spain., and SIESTA research network members.
• Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain. OMIRO@CLINIC.CAT.
• Intern Emerg Med. 2024 Sep 1; 19 (6): 165316651653-1665.

AbstractTo assess whether older adults who spend a night in emergency departments (ED) awaiting admission are at increased risk of mortality. This was a retrospective review of a multipurpose cohort that recruited all patients ≥ 75 years who visited ED and were admitted to hospital on April 1 to 7, 2019, at 52 EDs across Spain. Study groups were: patients staying in ED from midnight until 8:00 a.m. (ED group) and patients admitted to a ward before midnight (ward group). The primary endpoint was in-hospital mortality, truncated at 30 days, and secondary outcomes assessed length of stay for the index episode. The sample comprised 3,243 patients (median [IQR] age, 85 [81-90] years; 53% women), with 1,096 (34%) in the ED group and 2,147 (66%) in the ward group. In-hospital mortality for patients spending the night in the ED the ED group was 10.7% and 9.5% for patients transferred to a ward bed before midnight the ward group (adjusted OR: 1.12, 95%CI: 0.80-1.58). Sensitivity analyses rendered similar results (ORs ranged 1.06-1.13). Interaction was only detected for academic/non-academic hospitals (p < 0.001), with increased mortality risk for the latter (1.01, 0.33-3.09 vs 2.86, 1.30-6.28). There were no differences in prolonged hospitalization (> 7 days), with adjusted OR of 1.16 (0.94-1.43) and 1.15 (0.94-1.42) depending on whether time spent in the ED was or was not taken into consideration. No increased risk of in-hospital mortality or prolonged hospitalization was found in older patients waiting overnight in the ED for admission. Nonetheless, all estimations suggest a potential harmful effect of staying overnight, especially if a proper bedroom and hospitalist ward bed and hospitalized care are not provided.© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

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