Presenting Diagnosis Predicts Critical Care Need and Death Among Home Health Care Patients Admitted Through the Emergency Department: A Retrospective Cross-Sectional Study of 928 Admissions
Mustafa Orman, Erdinç Yavuz, Nur Şimşek YurtBackground:
Home health care patients are frail and dependent, but which of their presentations are followed by the most intensive hospital care is unknown.
Objective:
To examine whether the diagnostic category recorded at emergency department (ED) presentation is associated with critical care admission, length of stay and death beyond age and triage acuity.
Methods:
Retrospective episode-based cohort study of every admission from the ED at a Turkish hospital among patients registered with its home health care unit, 1 June 2023 to 31 May 2024; target population: admitted episodes. Working diagnoses were grouped into 7 ICD-10 categories. Logistic and gamma regression with patient-clustered errors were fitted sequentially; death by Firth penalised regression.
Results:
There were 928 admission episodes among 697 patients; 158 patients (22.7%) accounted for 389 episodes (41.9%). Respiratory presentations were commonest (185, 19.9%). Critical care admitted 326 episodes (35.1%); median stay was 7 days; 39 patients (4.2%) died. Adding diagnostic category to age, sex, arrival, season and triage raised discrimination from 0.739 to 0.811. Respiratory presentation was associated with critical care admission (adjusted odds ratio 5.44, 95% CI 2.98-9.93) and 60% longer stay (1.60, 1.23-2.09) across 5 sensitivity analyses. The cardiovascular association (10.85, 5.16-22.82) reflected coronary care routeing, falling to 2.06 (0.79-5.36) when coronary care was excluded. Age was unassociated. With all categories modelled together none was associated with death; only red triage (3.08, 1.61-5.90).
Conclusion:
Among admitted episodes, respiratory presentation was associated with critical care admission and longer stay, independently of age and triage; these associations are hypothesis-generating.