Emergency department crowding is associated with 28-day mortality in community-acquired pneumonia patients.
OBJECTIVE
Although emergency department (ED) crowding has been shown to be associated with delayed antibiotics treatment in community-acquired pneumonia (CAP) patients, association between ED crowding with mortality has not been investigated. We hypothesized emergency department crowding is associated with 28-day mortality in CAP patients.


METHODS
A retrospective observational study using prospective database was performed on CAP patients who visited a single, urban, tertiary care hospital ED between April 1, 2008 and September 30, 2009. Main outcomes were 28-day mortality and timeliness of antibiotic therapy (within 2, 4, 6, and 8 h of arrival). ED crowding was measured by Emergency Department Occupancy (EDO) rate. A multivariate logistic regression was performed to determine the association of 28-day mortality with EDO rate after adjusting for factors such as time-to-first-antibiotic-dose (TFAD), pneumonia severity index and laboratory markers.


RESULTS
477 cases were enrolled during the study period. 28-day mortality rate was 4.8%. EDO rate ranged from 37.2% to 162.8%, and median was 97.7% (IQR: 80.2%-116.3%). When categorized into tertiles by EDO rate, high crowding condition (EDO rate >109.3%) was significantly associated with a higher 28-day mortality (adjusted OR = 9.48, 95% CI 1.53-58.90). However, TFAD was not associated with 28-day mortality. ED crowding was not associated with delay of TFAD at various time intervals (2, 4, 6, and 8 h).


CONCLUSIONS
ED crowding measured by EDO rate was associated with higher 28-day mortality in CAP patients after adjusting TFAD, pneumonia severity index (PSI), and laboratory markers, although there was no association between ED crowding and TFAD.
Department of Emergency Medicine, Seoul National University Bundang Hospital, Sungnam, Republic of Korea.
Sion
S
Jo
Kyuseok
K
Kim
Jae Hyuk
JH
Lee
Joong Eui
JE
Rhee
Yu Jin
YJ
Kim
Gil Joon
GJ
Suh
Young Ho
YH
Jin
D000368:Aged; D001509:Bed Occupancy; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality*; D003441:Crowding; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors