학술논문
The Association between Emergency Department Length of Stay and In-Hospital Mortality in Older Patients Using Machine Learning: An Observational Cohort Study
Document Type
article
Author
Lijuan Wu; Xuanhui Chen; Anna Khalemsky; Deyang Li; Taoufik Zoubeidi; Dominique Lauque; Mohammed Alsabri; Zoubir Boudi; Vijaya Arun Kumar; James Paxton; Dionyssios Tsilimingras; Lisa Kurland; David Schwartz; Said Hachimi-Idrissi; Carlos A. Camargo; Shan W. Liu; Gabriele Savioli; Geroge Intas; Kapil Dev Soni; Detajin Junhasavasdikul; Jose Javier Trujillano Cabello; Niels K. Rathlev; Karim Tazarourte; Anna Slagman; Michael Christ; Adam J. Singer; Eddy Lang; Giovanni Ricevuti; Xin Li; Huiying Liang; Shamai A. Grossman; Abdelouahab Bellou
Source
Journal of Clinical Medicine, Vol 12, Iss 14, p 4750 (2023)
Subject
Language
English
ISSN
2077-0383
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 ≥60 years) 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 ≤1 h (9.96%) vs. higher EDLOS 7 h