Evidence map›Paper›PMID 28645946›Full record

ArticleBMJ open2017

Risk factors for admission at three urban emergency departments in England: a cross-sectional analysis of attendances over 1 month.

Sharif A Ismail, Ian Pope, Benjamin Bloom, Raquel Catalao, Emilie Green, Rebecca E Longbottom, Gwyneth Jansen, David McCoy, Tim Harris

Open access · goldAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.8field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 4 citations in OpenAlex.

  1. Validation of the Risk Instrument for Screening in the Community (International journal of environmental research and public health · 2023
    Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 1 country.

Sharif A IsmailBarts Health NHS Trust, London, UK.
Ian PopeHomerton University Hospital NHS Foundation Trust, London, UK.
Benjamin BloomEmergency Department, Royal London Hospital, London, UK.
Raquel CatalaoBarts Health NHS Trust, London, UK.
Emilie GreenBarts Health NHS Trust, London, UK.
Rebecca E LongbottomBarts Health NHS Trust, London, UK.
Gwyneth JansenQueen Mary University of London, London, UK.
David McCoyCentre for Primary Care and Public Health, Queen Mary University of London, London, UK.
Tim HarrisEmergency Department, Royal London Hospital, London, UK.
Barts Health NHS Trust · GBQueen Mary University of London · GBRoyal London Hospital · GBHomerton University Hospital NHS Foundation Trust · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo investigate factors associated with unscheduled admission following presentation to emergency departments (EDs) at three hospitals in England. DESIGN AND

settingCross-sectional analysis of attendance data for patients from three urban EDs in England: a large teaching hospital and major trauma centre (site 1) and two district general hospitals (sites 2 and 3). Variables included patient age, gender, ethnicity, deprivation score, arrival date and time, arrival by ambulance or otherwise, a variety of ED workload measures, inpatient bed occupancy rates and admission outcome. Coding inconsistencies in routine ED data used for this study meant that diagnosis could not be included. OUTCOME MEASURE: The primary outcome for the study was unscheduled admission.

participantsAll adults aged 16 and older attending the three inner London EDs in December 2013. Data on 19 734 unique patient attendances were gathered.

resultsOutcome data were available for 19 721 attendances (>99%), of whom 6263 (32%) were admitted to hospital. Site 1 was set as the baseline site for analysis of admission risk. Risk of admission was significantly greater at sites 2 and 3 (adjusted OR (AOR) relative to site 1 for site 2 was 1.89, 95% CI 1.74 to 2.05, p<0.001) and for patients of black or black British ethnicity (AOR 1.29, 1.16 to 1.44, p<0.001). Deprivation was strongly associated with admission. Analysis of departmental and hospital-wide workload pressures gave conflicting results, but proximity to the "4-hour target" (a rule that limits patient stays in EDs to 4 hours in the National Health Service in England) emerged as a strong driver for admission in this analysis (AOR 3.61, 95% CI 3.30 to 3.95, p<0.001).

conclusionThis study found statistically significant variations in odds of admission between hospital sites when adjusting for various patient demographic and presentation factors, suggesting important variations in ED-level and clinician-level behaviour relating to admission decisions. The 4-hour target is a strong driver for emergency admission.

Indexed as

AdolescentAdultAgedAged, 80 and overCross-Sectional StudiesEmergency Service, HospitalEnglandFemaleHospitalsHumansLogistic ModelsMaleMiddle AgedPatient Acceptance of Health CarePatient AdmissionReferral and ConsultationEmergency admissionEmergency departmentEmergency serviceUnscheduled admission

Identifiers

PMID28645946
PMCPMC5541436
OpenAlexW3022921046

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.