title: Characteristics and predictors of mortality among frequent users of an Emergency Department in Switzerland.
abstract: OBJECTIVE
  Frequent Emergency Department (ED) users have an elevated mortality, yet little is known about risk factors. Our aim was to characterize deceased frequent ED users and determine predictors of mortality.
  
  
  METHODS
  This is a post-hoc analysis of all-cause mortality among frequent ED users participating in a randomized clinical trial on case management at the Lausanne University Hospital (Switzerland). We enrolled 250 frequent ED users (5+ visits/past year) in a 12-month randomized clinical trial; those with an estimated survival of fewer than 18 months were excluded. The primary outcome was 12-month all-cause mortality. We performed descriptive statistics to compare the baseline characteristics of living and deceased participants, and examined predictors of all-cause mortality using logistic regressions, including age adjustment.
  
  
  RESULTS
  Twenty of the 250 (8%) frequent users died during the 12-month follow-up. Seven (35%) deaths were because of cardiac causes and six (30%) were because of cancer. The median age at death was 71 years. Deceased participants were older and more likely to report any somatic determinant, chronic illness, and medical comorbidity. Age (odds ratio 1.07, 95% confidence interval 1.04-1.11) and medical comorbidity (odds ratio 4.76, 95% confidence interval 1.86-12.15) were statistically significant predictors of mortality.
  
  
  CONCLUSIONS
  Despite excluding those with an estimated survival of fewer than 18 months, 8% of frequent ED users died during the study. Age and medical comorbidity were significant predictors of mortality. Interventions, such as case management, should target older frequent ED users and those with multiple medical conditions, and future research should explore their potential impact on mortality.
authors.affiliation: Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center.
authors.forename: Judith L
authors.initials: JL
authors.lastname: Griffin
authors.affiliation: Department of Ambulatory Care and Community Medicine.
authors.forename: Marie
authors.initials: M
authors.lastname: Yersin
authors.affiliation: Life Course and Social Inequality Research Center, Faculty of Social and Political Sciences.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Baggio
authors.affiliation: Department of Community Medicine and Public Health, Institute of Higher Education and Research in Healthcare.|Center for the Understanding of Social Processes, University of Neuchâtel, Neuchâtel, Switzerland.
authors.forename: Katia
authors.initials: K
authors.lastname: Iglesias
authors.affiliation: Department of Community Medicine and Public Health, Institute of Higher Education and Research in Healthcare.
authors.forename: Venetia-Sofia
authors.initials: VS
authors.lastname: Velonaki
authors.affiliation: IEMS - Health Economics and Management Platform, University of Lausanne.|Institute of Social and Preventive Medicine.|Health Technology Assessment Unit.
authors.forename: Karine
authors.initials: K
authors.lastname: Moschetti
authors.affiliation: Institute of Social and Preventive Medicine.
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.affiliation: Health Technology Assessment Unit.
authors.forename: Jean-Blaise
authors.initials: JB
authors.lastname: Wasserfallen
authors.affiliation: Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center.
authors.forename: Francis
authors.initials: F
authors.lastname: Vu
authors.affiliation: Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center.
authors.forename: Corine
authors.initials: C
authors.lastname: Ansermet
authors.affiliation: Emergency Department.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hugli
authors.affiliation: Alcohol Treatment Center, Lausanne University Hospital, Lausanne.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Daeppen
authors.affiliation: Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bodenmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D000069342:Medical Overuse / Q000706:statistics & numerical data*; D008875:Middle Aged; D009026:Mortality; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013557:Switzerland; D035862:Vulnerable Populations / Q000706:statistics & numerical data