Prior emergency medical services utilization is a risk factor for in-hospital death among patients with substance misuse: a retrospective cohort study.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968543 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-227X (Electronic) Linking ISSN: 1471227X NLM ISO Abbreviation: BMC Emerg Med Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Substance-Related Disorders* ; Hospital Mortality* ; Emergency Medical Services*/statistics & numerical data; Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Adult ; Risk Factors ; Wisconsin/epidemiology ; Length of Stay/statistics & numerical data ; Aged

Background: Substance misuse poses a significant public health challenge, characterized by premature morbidity and mortality, and heightened healthcare utilization. While studies have demonstrated that previous hospitalizations and emergency department visits are associated with increased mortality in patients with substance misuse, it is unknown whether prior utilization of emergency medical service (EMS) is similarly associated with poor outcomes among this population. The objective of this study is to determine the association between EMS utilization in the 30 days before a hospitalization or emergency department visit and in-hospital outcomes among patients with substance misuse.
Methods: We conducted a retrospective analysis of adult emergency department visits and hospitalizations (referred to as a hospital encounter) between 2017 and 2021 within the Substance Misuse Data Commons, which maintains electronic health records from substance misuse patients seen at two University of Wisconsin hospitals, linked with state agency, claims, and socioeconomic datasets. Using regression models, we examined the association between EMS use and the outcomes of in-hospital death, hospital length of stay, intensive care unit (ICU) admission, and critical illness events, defined by invasive mechanical ventilation or vasoactive drug administration. Models were adjusted for age, comorbidities, initial severity of illness, substance misuse type, and socioeconomic status.
Results: Among 19,402 encounters, individuals with substance misuse who had at least one EMS incident within 30 days of a hospital encounter experienced a higher likelihood of in-hospital mortality (OR 1.52, 95% CI [1.05 - 2.14]) compared to those without prior EMS use, after adjusting for confounders. Using EMS in the 30 days prior to an encounter was associated with a small increase in hospital length of stay but was not associated with ICU admission or critical illness events.
Conclusions: Individuals with substance misuse who have used EMS in the month preceding a hospital encounter are at an increased risk of in-hospital mortality. Enhanced monitoring of EMS users in this population could improve overall patient outcomes.
(© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

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K01HL148390 United States HL NHLBI NIH HHS; R01DA051464-S1 United States DA NIDA NIH HHS; R01 DA051464 United States DA NIDA NIH HHS; K01 HL148390 United States HL NHLBI NIH HHS; 5T32HL144909-04 United States HL NHLBI NIH HHS

Keywords: Critical Illness; Data Linkage; Emergency Medical Services; Emergency Services Utilization; Facilities and Services Utilization; Health Services; Hospital Mortality; Substance-Related Disorders

Date Created: 20240709 Date Completed: 20240709 Latest Revision: 20240712

20240712

PMC11234660

10.1186/s12873-024-01025-7

38982351