Observational studyBMC emergency medicine2021
Validation of the modified Skåne emergency department assessment of patient load (mSEAL) model for emergency department crowding and comparison with international models; an observational study.
Observational study in BMC emergency medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 11 papers, 1 of them a synthesis that pooled 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.
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.
Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 10 citations in OpenAlex.
- Emergency department crowding in the modern era: a systematic review (2018-2025).Clinical and experimental emergency medicine · 2026Pooled it
- Correlations between monitor alarm workload and overall workload in Swedish emergency departments: a prospective multicenter cross-sectional study.BMC emergency medicine · 2026Article
- Article
- Predicting the Unpredictable: A Data-Driven Machine Learning Model for Emergency Department Waiting Room Surge Status.Mayo Clinic proceedings. Digital health · 2026Article
- Overcrowding Indicators in Emergency Departments Across Countries: Scoping Review.Interactive journal of medical research · 2026Review
- Multicentre cross-sectional study to assess nursing workload in Belgian emergency departments.Emergency medicine journal : EMJ · 2025Article
- Addition of the clinical frailty scale to triage tools and early warning scores improves mortality prognostication at 30 days: A prospective observational multicenter study.Journal of the American College of Emergency Physicians open · 2024Article
- Diagnosing an overcrowded emergency department from its Electronic Health Records.Scientific reports · 2024Article
- Emergency department overcrowding and its associated factors at HARME medical emergency center in Eastern Ethiopia.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2024Article
- Differentiating properties of occupancy rate and workload to estimate crowding: A Swedish national cross-sectional study.Journal of the American College of Emergency Physicians open · 2022Article
- Correction to: Validation of the modified Skåne emergency department assessment of patient load (mSEAL) model for emergency department crowding and comparison with international models; an observational study.BMC emergency medicine · 2021Article
Corrections and comments
- Erratum issued
Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundEmergency Department crowding is associated with increased morbidity and mortality but no measure of crowding has been validated in Sweden. We have previously derived and internally validated the Skåne Emergency Department Assessment of Patient Load (SEAL) score as a measure of crowding in Emergency Departments (ED) in a large regional healthcare system in Sweden. Due to differences in electronic health records (EHRs) between health care systems in Sweden, all variables in the original SEAL-score could not be measured reliably nationally. We aimed to derive and validate a modified SEAL (mSEAL) model and to compare it with established international measures of crowding.
methodsThis was an observational cross sectional study at four EDs in Sweden. All clinical staff assessed their workload (1-6 where 6 is the highest workload) at 5 timepoints each day. We used linear regression with stepwise backward elimination on the original SEAL dataset to derive and internally validate the mSEAL score against staff workload assessments. We externally validated the mSEAL at four hospitals and compared it with the National Emergency Department Overcrowding Score (NEDOCS), the simplified International Crowding Measure in Emergency Department (sICMED), and Occupancy Rate. Area under the receiver operating curve (AuROC) and coefficient of determination was used to compare crowding models. Crowding was defined as an average workload of 4.5 or higher.
resultsThe mSEAL score contains the variables Patient Hours and Time to physician and showed strong correlation with crowding in the derivation (r
conclusionsThe mSEAL model can measure crowding based on workload in Swedish EDs with good discriminatory capacity and has the potential to systematically evaluate crowding and help policymakers and researchers target its causes and effects. In Swedish EDs, Occupancy Rate and NEDOCS are good alternatives to measure crowding based on workload.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.