Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis

Area of Science:

• Emergency Medicine
• Critical Care Medicine
• Health Services Research

Background:

• The relationship between emergency department length of stay (EDLOS) and in-hospital mortality (IHM) requires further clarification.
• Understanding this association is crucial for optimizing patient flow and outcomes in emergency care settings.

Purpose of the Study:

• To systematically review and meta-analyze existing literature to determine the association between EDLOS and IHM.
• To identify specific EDLOS thresholds that correlate with increased in-hospital mortality.

Main Methods:

• A comprehensive search of multiple electronic databases (PubMed, Medline, Embase, Web of Science, etc.) was conducted.
• Included studies reported on the association between EDLOS and IHM.
• A meta-analysis was performed on data from 33 selected studies involving over 1.7 million ED patients.

Main Results:

• A significant association between EDLOS exceeding 24 hours and increased IHM was found in intensive care unit (ICU)-admitted patients (OR = 1.396).
• Conversely, a short EDLOS was associated with increased IHM in non-ICU-admitted patients (OR = 0.583).
• No significant associations were detected for other EDLOS cut-offs.

Conclusions:

• Both prolonged EDLOS (>24 hours) for ICU admissions and very short EDLOS for non-ICU admissions are associated with increased in-hospital mortality.
• Healthcare systems should focus on minimizing long ED stays and providing special attention to patients with short EDLOS.
• Further research may be needed to elucidate the mechanisms behind these associations.