title: The association between crowding and mortality in admitted pediatric patients from mixed adult-pediatric emergency departments in Korea.
abstract: OBJECTIVE
  We aimed to investigate the effect of crowding on the hospital mortality of pediatric patients from adult-pediatric mixed emergency departments (EDs).
  
  
  METHODS
  We used the National Emergency Department Information System database, which included demographic, clinical, diagnostic, and procedural information with all emergency patients visiting to 116 EDs from Korea since 2004. We enrolled EDs with mean length of stay of more than 6 hours. Study period was from January 2006 to December 2008. Pediatric patients younger than 15 years admitted from these EDs were study targets. We calculated the mean patient volume (mean number of patients in the ED) over 8-hour shift for each hospital. When the volume reached the highest quartile, the period was considered as crowded. Patients who came during the overcrowded period were defined as the crowded group. We performed a Kaplan-Meier analysis, and hazard ratio and 95% confidence intervals (95% CIs) were calculated using a Cox proportional hazards regression model.
  
  
  RESULTS
  A total of 34 EDs and 125,031 admitted pediatric patients were included; 74,152 (59.3%) were male, and the mean age was 3.84 (95% CI, 3.82-3.86) years; 35,924 (28.7%) were determined as the crowded group. The 30-day mortality rates were 0.4% and 0.3% (P = 0.063) for the crowded group and for the noncrowded group, respectively. The hazard ratio for hospital mortality of the crowded group was 1.230 (95% CI, 1.019-1.558).
  
  
  CONCLUSIONS
  The ED crowding was associated with increased hazard for hospital mortality for pediatric patients in mixed EDs.
authors: Department of Emergency Medicine, Seoguipo Medical Center, Cheju, South Korea.
authors: Won Chul
authors: WC
authors: Cha
authors: Sang Do
authors: SD
authors: Shin
authors: Jin Sung
authors: JS
authors: Cho
authors: Kyoung Jun
authors: KJ
authors: Song
authors: Adam J
authors: AJ
authors: Singer
authors: Young Ho
authors: YH
authors: Kwak
mesh_terms: D000328:Adult; D002055:Burnout, Professional; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003441:Crowding; D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010343:Patient Admission; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D056910:Republic of Korea / Q000453:epidemiology; D014218:Triage