Predictors of emergency department death for patients presenting with ruptured abdominal aortic aneurysms

Matthew Mell, Rachael A. Callcut, Fritz Bech, M. Kit Delgado, Kristan Staudenmayer, David A. Spain, Tina Hernandez-Boussard

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Ruptured abdominal aortic aneurysm (rAAA) is a critically time-sensitive condition with outcomes dependent on rapid diagnosis and definitive treatment. Emergency department (ED) death reflects the hemodynamic stability of the patient upon arrival and the ability to mobilize resources before hemodynamic stability is lost. The goals of this study were to determine the incidence and predictors of ED death for patients presenting to EDs with rAAAs. Data for patients presenting with International Classification of Disease, 9th Revision, Clinical Modification codes for rAAA from 2006 to 2008 were extracted from discharge data using the Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project, and Agency for Healthcare Research and Quality. The NEDS is the largest stratified weighted sample of US hospital-based ED visits with links to inpatient files. We compared those transferred to those admitted and treated. Sample weights were applied to produce nationally representative estimates. Patient and hospital factors associated with transfer were identified using multivariate logistic regression. These factors were then analyzed for a relationship with ED deaths. A total of 18,363 patients were evaluated for rAAAs. Of these, 7% (1201) died in the ED, 6% (1160) were admitted and died without a procedure, 42% (7731) were admitted and died after repair, and 41% (7479) were admitted, treated, and survived. Transfers accounted for 4% (793) of all ED visits for rAAAs. ED death was more likely for patients seen in nonmetropolitan hospitals (12.7%) vs metropolitan nonteaching (7.0%) or metropolitan teaching hospitals (4.5%; P < .0001). Compared with other regions, the West had a higher ED mortality rate (9.6% vs 5.1%-6.9%; P = .0038). On multivariate analysis, ED death was associated with hospital groups exhibiting both high and low transfer rates. ED death remains a significant cause for mortality for rAAAs and varies by hospital type, rural/urban location, and geographic region. Both delays in ED arrival and delays in providing definitive care may contribute to increased ED death rates, suggesting that improved regional systems of care may improve survival after rAAA.

Original languageEnglish (US)
Pages (from-to)651-655
Number of pages5
JournalJournal of Vascular Surgery
Volume56
Issue number3
DOIs
StatePublished - Sep 1 2012
Externally publishedYes

Fingerprint

Aortic Rupture
Abdominal Aortic Aneurysm
Hospital Emergency Service
Urban Hospitals
Mortality
Hemodynamics
Rural Hospitals
Geographic Locations
Health Services Research
International Classification of Diseases
Teaching Hospitals
Health Care Costs

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Mell, M., Callcut, R. A., Bech, F., Delgado, M. K., Staudenmayer, K., Spain, D. A., & Hernandez-Boussard, T. (2012). Predictors of emergency department death for patients presenting with ruptured abdominal aortic aneurysms. Journal of Vascular Surgery, 56(3), 651-655. https://doi.org/10.1016/j.jvs.2012.02.025

Predictors of emergency department death for patients presenting with ruptured abdominal aortic aneurysms. / Mell, Matthew; Callcut, Rachael A.; Bech, Fritz; Delgado, M. Kit; Staudenmayer, Kristan; Spain, David A.; Hernandez-Boussard, Tina.

In: Journal of Vascular Surgery, Vol. 56, No. 3, 01.09.2012, p. 651-655.

Research output: Contribution to journalArticle

Mell, M, Callcut, RA, Bech, F, Delgado, MK, Staudenmayer, K, Spain, DA & Hernandez-Boussard, T 2012, 'Predictors of emergency department death for patients presenting with ruptured abdominal aortic aneurysms', Journal of Vascular Surgery, vol. 56, no. 3, pp. 651-655. https://doi.org/10.1016/j.jvs.2012.02.025
Mell, Matthew ; Callcut, Rachael A. ; Bech, Fritz ; Delgado, M. Kit ; Staudenmayer, Kristan ; Spain, David A. ; Hernandez-Boussard, Tina. / Predictors of emergency department death for patients presenting with ruptured abdominal aortic aneurysms. In: Journal of Vascular Surgery. 2012 ; Vol. 56, No. 3. pp. 651-655.
@article{259ddc17053a46f09f68085472b1c143,
title = "Predictors of emergency department death for patients presenting with ruptured abdominal aortic aneurysms",
abstract = "Ruptured abdominal aortic aneurysm (rAAA) is a critically time-sensitive condition with outcomes dependent on rapid diagnosis and definitive treatment. Emergency department (ED) death reflects the hemodynamic stability of the patient upon arrival and the ability to mobilize resources before hemodynamic stability is lost. The goals of this study were to determine the incidence and predictors of ED death for patients presenting to EDs with rAAAs. Data for patients presenting with International Classification of Disease, 9th Revision, Clinical Modification codes for rAAA from 2006 to 2008 were extracted from discharge data using the Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project, and Agency for Healthcare Research and Quality. The NEDS is the largest stratified weighted sample of US hospital-based ED visits with links to inpatient files. We compared those transferred to those admitted and treated. Sample weights were applied to produce nationally representative estimates. Patient and hospital factors associated with transfer were identified using multivariate logistic regression. These factors were then analyzed for a relationship with ED deaths. A total of 18,363 patients were evaluated for rAAAs. Of these, 7{\%} (1201) died in the ED, 6{\%} (1160) were admitted and died without a procedure, 42{\%} (7731) were admitted and died after repair, and 41{\%} (7479) were admitted, treated, and survived. Transfers accounted for 4{\%} (793) of all ED visits for rAAAs. ED death was more likely for patients seen in nonmetropolitan hospitals (12.7{\%}) vs metropolitan nonteaching (7.0{\%}) or metropolitan teaching hospitals (4.5{\%}; P < .0001). Compared with other regions, the West had a higher ED mortality rate (9.6{\%} vs 5.1{\%}-6.9{\%}; P = .0038). On multivariate analysis, ED death was associated with hospital groups exhibiting both high and low transfer rates. ED death remains a significant cause for mortality for rAAAs and varies by hospital type, rural/urban location, and geographic region. Both delays in ED arrival and delays in providing definitive care may contribute to increased ED death rates, suggesting that improved regional systems of care may improve survival after rAAA.",
author = "Matthew Mell and Callcut, {Rachael A.} and Fritz Bech and Delgado, {M. Kit} and Kristan Staudenmayer and Spain, {David A.} and Tina Hernandez-Boussard",
year = "2012",
month = "9",
day = "1",
doi = "10.1016/j.jvs.2012.02.025",
language = "English (US)",
volume = "56",
pages = "651--655",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Predictors of emergency department death for patients presenting with ruptured abdominal aortic aneurysms

AU - Mell, Matthew

AU - Callcut, Rachael A.

AU - Bech, Fritz

AU - Delgado, M. Kit

AU - Staudenmayer, Kristan

AU - Spain, David A.

AU - Hernandez-Boussard, Tina

PY - 2012/9/1

Y1 - 2012/9/1

N2 - Ruptured abdominal aortic aneurysm (rAAA) is a critically time-sensitive condition with outcomes dependent on rapid diagnosis and definitive treatment. Emergency department (ED) death reflects the hemodynamic stability of the patient upon arrival and the ability to mobilize resources before hemodynamic stability is lost. The goals of this study were to determine the incidence and predictors of ED death for patients presenting to EDs with rAAAs. Data for patients presenting with International Classification of Disease, 9th Revision, Clinical Modification codes for rAAA from 2006 to 2008 were extracted from discharge data using the Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project, and Agency for Healthcare Research and Quality. The NEDS is the largest stratified weighted sample of US hospital-based ED visits with links to inpatient files. We compared those transferred to those admitted and treated. Sample weights were applied to produce nationally representative estimates. Patient and hospital factors associated with transfer were identified using multivariate logistic regression. These factors were then analyzed for a relationship with ED deaths. A total of 18,363 patients were evaluated for rAAAs. Of these, 7% (1201) died in the ED, 6% (1160) were admitted and died without a procedure, 42% (7731) were admitted and died after repair, and 41% (7479) were admitted, treated, and survived. Transfers accounted for 4% (793) of all ED visits for rAAAs. ED death was more likely for patients seen in nonmetropolitan hospitals (12.7%) vs metropolitan nonteaching (7.0%) or metropolitan teaching hospitals (4.5%; P < .0001). Compared with other regions, the West had a higher ED mortality rate (9.6% vs 5.1%-6.9%; P = .0038). On multivariate analysis, ED death was associated with hospital groups exhibiting both high and low transfer rates. ED death remains a significant cause for mortality for rAAAs and varies by hospital type, rural/urban location, and geographic region. Both delays in ED arrival and delays in providing definitive care may contribute to increased ED death rates, suggesting that improved regional systems of care may improve survival after rAAA.

AB - Ruptured abdominal aortic aneurysm (rAAA) is a critically time-sensitive condition with outcomes dependent on rapid diagnosis and definitive treatment. Emergency department (ED) death reflects the hemodynamic stability of the patient upon arrival and the ability to mobilize resources before hemodynamic stability is lost. The goals of this study were to determine the incidence and predictors of ED death for patients presenting to EDs with rAAAs. Data for patients presenting with International Classification of Disease, 9th Revision, Clinical Modification codes for rAAA from 2006 to 2008 were extracted from discharge data using the Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project, and Agency for Healthcare Research and Quality. The NEDS is the largest stratified weighted sample of US hospital-based ED visits with links to inpatient files. We compared those transferred to those admitted and treated. Sample weights were applied to produce nationally representative estimates. Patient and hospital factors associated with transfer were identified using multivariate logistic regression. These factors were then analyzed for a relationship with ED deaths. A total of 18,363 patients were evaluated for rAAAs. Of these, 7% (1201) died in the ED, 6% (1160) were admitted and died without a procedure, 42% (7731) were admitted and died after repair, and 41% (7479) were admitted, treated, and survived. Transfers accounted for 4% (793) of all ED visits for rAAAs. ED death was more likely for patients seen in nonmetropolitan hospitals (12.7%) vs metropolitan nonteaching (7.0%) or metropolitan teaching hospitals (4.5%; P < .0001). Compared with other regions, the West had a higher ED mortality rate (9.6% vs 5.1%-6.9%; P = .0038). On multivariate analysis, ED death was associated with hospital groups exhibiting both high and low transfer rates. ED death remains a significant cause for mortality for rAAAs and varies by hospital type, rural/urban location, and geographic region. Both delays in ED arrival and delays in providing definitive care may contribute to increased ED death rates, suggesting that improved regional systems of care may improve survival after rAAA.

UR - http://www.scopus.com/inward/record.url?scp=84865203894&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84865203894&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2012.02.025

DO - 10.1016/j.jvs.2012.02.025

M3 - Article

C2 - 22560234

AN - SCOPUS:84865203894

VL - 56

SP - 651

EP - 655

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 3

ER -