The 'Unwell' clinical presentation- an opportunity for admission avoidance?

Area of Science:

• Emergency Medicine
• Clinical Outcomes Research
• Patient Triage

Background:

• The 'unwell' patient presentation is frequent in emergency departments (EDs).
• Understanding factors influencing outcomes for these patients is crucial for effective care.
• This presentation represents a broad spectrum of patient acuity.

Purpose of the Study:

• To investigate the characteristics and mortality factors of 'unwell' patients in the ED.
• To determine if the 'unwell' diagnosis predicts patient outcomes.
• To assess the heterogeneity within the 'unwell' patient group.

Main Methods:

• Retrospective analysis of emergency department admissions over six years.
• Logistic regression analysis to identify factors associated with mortality.
• Inclusion of 49,965 admissions, with 3650 (7.3%) diagnosed as 'unwell'.

Main Results:

• 'Unwell' presentations were associated with older age and longer hospital stays.
• Overall mortality for 'unwell' patients (4.2%) was not significantly different from other ED admissions (4.6%).
• Increased mortality was observed in respiratory patients (8.3%) and those aged 70 years or older (7.1%).

Conclusions:

• The 'unwell' diagnosis encompasses a heterogeneous patient population with varied clinical trajectories.
• Predictive models indicated that being diagnosed as 'unwell' might be associated with a better outcome.
• Targeted strategies to avoid admission based solely on an 'unwell' diagnosis are not supported by these findings.