title: Profile of Patients Hospitalized through the Emergency Room to the Medicine Ward and their Short-term Outcome at a Tertiary Care Hospital in Delhi.
abstract: BACKGROUND
  With an increasing number of sicker patients, limited hospital beds, and an emphasis on day care, the profile of patients hospitalized to medicine wards has undergone a radical re-definition. The increasing share of patients hospitalized through the emergency department for acute care to medicine wards has left little space for hospitalization through the outpatient department (OPD). There are some global data available on the profile of patients presenting to the emergency rooms (ERs) and their subsequent outcome. Data from developing countries, especially India, in this regard are lacking.
  
  
  METHODS
  This cross-sectional study included all patients hospitalized to the medicine ward through the medical emergency services, provided by the Department of Medicine, each Wednesday and every sixth Sunday for the entire year (a total of 62 days), from November 2010 through October 2011, and followed their outcome up to seven days after hospitalization.
  
  
  RESULTS
  Of the 3,618 cases presenting to medicine emergency on these days, 1,547 (42.3%) were advised admission. Nine hundred sixty-seven reported to the medicine wards. One hundred eleven (7.73%) expired within 24 hours; others absconded, were lost in transit, did not consent to participation, or were discharged. During the next seven days, 452 (46.7%) recovered sufficiently and were discharged to go home. Two hundred thirty (23.8%) left the hospital without informing the medical staff. Fourteen (1.4%) patients were transferred to other departments. One hundred thirty-seven (8.8%) patients died during the next six days of hospitalization. After Multivariate Logistic Regression analysis, abnormal Glasgow Coma Scale (GCS) score, high systolic blood pressure (BP), age, increased total leucocyte count, increased globulin, low bicarbonate in arterial blood, low Mini Mental Status Examination (MMSE) score, and a raised urea >40 mg/dL were found to be associated significantly with mortality.
  
  
  CONCLUSIONS
  Of the 1,547 patients who needed urgent hospitalization, 248 (16%) died within the first week, one-half of them within the first 24 hours. An advanced age, abnormal GCS score, low MMSE score, increased systolic BP, leukocytosis, acidosis, and uremia were found to be associated with a fatal outcome. Therefore, nearly one-half of the patients who would have a fatal short-term outcome were likely to do so within the first 24 hours, making the first day of presentation "the golden day" period.
authors.affiliation: 1Department of Medicine,University College of Medical Sciences,University of Delhi,New Delhi,India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Choudhary
authors.affiliation: 1Department of Medicine,University College of Medical Sciences,University of Delhi,New Delhi,India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Goel
authors.affiliation: 1Department of Medicine,University College of Medical Sciences,University of Delhi,New Delhi,India.
authors.forename: Sonal
authors.initials: S
authors.lastname: Pruthi
authors.affiliation: 2Neurosurgery,University College of Medical Sciences,University of Delhi,New Delhi,India.
authors.forename: Sarathi
authors.initials: S
authors.lastname: Kalra
authors.affiliation: 1Department of Medicine,University College of Medical Sciences,University of Delhi,New Delhi,India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: 1Department of Medicine,University College of Medical Sciences,University of Delhi,New Delhi,India.
authors.forename: Om Prakash
authors.initials: OP
authors.lastname: Kalra
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D063128:Tertiary Health Care / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: ADL Activities of Daily Living; BP blood pressure; CVA cerebrovascular accident; ER mergency room; GCS Glasgow Coma Scale; LAMA left against medical advice; MMSE Mini Mental Status Examination; OPD outpatient department; emergency department; hospitalization; short-term outcome