title: Hyponatraemia in Emergency Medical Admissions-Outcomes and Costs.
abstract: Healthcare systems in the developed world are struggling with the demand of emergency room presentations; the study of the factors driving such demand is of fundamental importance. From a database of all emergency medical admissions (66,933 episodes in 36,271 patients) to St James' Hospital, Dublin, Ireland, over 12 years (2002 to 2013) we have explored the impact of hyponatraemia on outcomes (30 days in-hospital mortality, length of stay (LOS) and costs). Identified variables, including Acute Illness Severity, Charlson Co-Morbidity and Chronic Disabling Disease that proved predictive univariately were entered into a multivariable logistic regression model to predict the bivariate of 30 days in-hospital survival. A zero truncated Poisson regression model assessed LOS and episode costs and the incidence rate ratios were calculated. Hyponatraemia was present in 22.7% of episodes and 20.3% of patients. The 30 days in-hospital mortality rate for hyponatraemic patients was higher (15.9% vs. 6.9% p < 0.001) and the LOS longer (6.3 (95% CI 2.9, 12.2) vs. 4.0 (95% CI 1.5, 8.2) p < 0.001). Both parameters worsened with the severity of the initial sodium level. Hospital costs increased non-linearly with the severity of initial hyponatraemia. Hyponatraemia remained an independent predictor of 30 days in-hospital mortality, length of stay and costs in the multi-variable model.
authors.affiliation: Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland. drrichardconway@gmail.com.
authors.forename: Richard
authors.initials: R
authors.lastname: Conway
authors.affiliation: Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland. declangbyrne@me.com.
authors.forename: Declan
authors.initials: D
authors.lastname: Byrne
authors.affiliation: Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland. doriordan@stjames.ie.
authors.forename: Deirdre
authors.initials: D
authors.lastname: O'Riordan
authors.affiliation: Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland. bernardsilke@physicians.ie.
authors.forename: Bernard
authors.initials: B
authors.lastname: Silke
keywords: emergency admission; hyponatraemia; length of stay; mortality