Résumé
Introduction: Our main objective is to compare, in a French university hospital centre (CHU) and among patients hospitalized for medical etiologies from the emergency room (ER), the intra-hospital mortality rate between those who do not wait for lack of bed in ward and those who are waiting (boarding).
Method: Quasi-experimental, monocentric, observational, retrospective study by collecting data from computerized patient records. We applied a propensity score to adjust the judgment outcome to the variables measured in both groups, i.e.: 1) demographic (age and sex); 2) medical (triage level); 3) biological (leukocyte count, hemoglobinemia, natremia, kalemia, serum CRP, creatinemia); and 4) imaging (radiography, ultrasound, magnetic resonance imaging, CT scan).
Results: In 2017, the ER at the CHU admitted 60,062 adult patients. Of the 15,496 patients hospitalized after admission to the ER, 6,997 were for medical etiology, including 2,546 (36%) without waiting and 4,451 (64%) after waiting. When weighted, the intra-hospital mortality rate was higher in the boarding group: 7.8 vs. 6.3%; P < 0.05. Similarly, the median length of hospitalization was higher in the boarding group: 7.6 [4.7-12.0] vs. 7.1 d [4.3-11.5]; P < 0.01.
Discussion: Mortality rates and length of stay in hospital are higher in the patients studied who wait in the ER due to lack of bed in ward. Our results are consistent with the international literature. It is necessary to find solutions to reduce this excess mortality.