Observational studyPloS one2021
Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR).
Observational study in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
What it found
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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
22 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Emergency department crowding in the modern era: a systematic review (2018-2025).Clinical and experimental emergency medicine · 2026Pooled it
- Association between emergency department crowding and mortality: a nationwide analysis stratified by emergency department levels: a retrospective cohort study.BMC emergency medicine · 2026Article
- Factors associated with emergency department discharge among patients triaged as resuscitation (CTAS level 1): a retrospective cross-sectional study.BMC emergency medicine · 2026Article
- Incident and predictors of 30-day mortality in critically ill patients after admission to the emergency department in the central region of Thailand: a prospective observational study.BMC health services research · 2026Observational
- Evaluation of the implementation process of a new emergency triage system: West coast system for triage (WEST).PloS one · 2026Article
- Individual Patient Sociodemographic Characteristics Are Associated With Waiting Time to Physician Assessment in Seven Swedish Emergency Departments: An Observational 5-Year Cohort Study of Emergency Department Visits in the Stockholm Region.Journal of the American College of Emergency Physicians open · 2025Article
- Length of stay in the emergency department and its associated input-, throughput-, and output factors at two hospitals in Sweden.BMC emergency medicine · 2025Article
- Emergency Department Clinical Quality Registries: A Scoping Review.Healthcare (Basel, Switzerland) · 2025Review
- Incidence and risk factors for delayed intracranial hemorrhage after mild brain injury in anticoagulated patients: a multicenter retrospective study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Observational
- Forecasting Mortality Associated Emergency Department Crowding with LightGBM and Time Series Data.Journal of medical systems · 2025Article
- Serious conditions among conveyed and non-conveyed patients presenting with nonspecific chief complaints to the ambulance service.BMC emergency medicine · 2024Article
- 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
- Factors predictive of hospital admission for children via emergency departments in Australia and Sweden: an observational cross-sectional study.BMC health services research · 2024Observational
- Emergency department crowding increases 10-day mortality for non-critical patients: a retrospective observational study.Internal and emergency medicine · 2024Observational
- A Systematic Review of the Causes, Consequences, and Solutions of Emergency Department Overcrowding in Saudi Arabia.Cureus · 2023Review
- Age in addition to RETTS triage priority substantially improves 3-day mortality prediction in emergency department patients: a multi-center cohort study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2023Observational
- Socioeconomic status is associated with process times in the emergency department for patients with chest pain.Journal of the American College of Emergency Physicians open · 2023Article
- Stressed systems: Stroke unit bed occupancy and impact on reperfusion therapy in acute ischemic stroke.Frontiers in neurology · 2023Article
- Associated Factors of Under and Over-Triage Based on The Emergency Severity Index; a Retrospective Cross-Sectional Study.Archives of academic emergency medicine · 2023Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThere is evidence that emergency department (ED) crowding is associated with increased mortality, however large multicenter studies of high quality are scarce. In a prior study, we introduced a proxy-measure for crowding that was associated with increased mortality. The national registry SVAR enables us to study the association in a more heterogenous group of EDs with more recent data. The aim is to investigate the association between ED crowding and mortality.
methodsThis was an observational cohort study including visits from 14 EDs in Sweden 2015-2019. Crowding was defined as the mean ED-census divided with expected ED-census during the work-shift that the patient arrived. The crowding exposure was categorized in three groups: low, moderate and high. Hazard ratios (HR) for mortality within 7 and 30 days were estimated with a cox proportional hazards model. The model was adjusted for age, sex, triage priority, arrival hour, weekend, arrival mode and chief complaint. Subgroup analysis by county and for admitted patients by county were performed.
results2,440,392 visits from 1,142,631 unique patients were analysed. A significant association was found between crowding and 7-day mortality but not with 30-day mortality. Subgroup analysis also yielded mixed results with a clear association in only one of the three counties. The estimated HR (95% CI) for 30-day mortality for admitted patients in this county was 1.06 (1.01-1.12) in the moderate crowding category, and 1.11 (1.01-1.22) in the high category.
conclusionsThe association between crowding and mortality may not be universal. Factors that influence the association between crowding and mortality at different EDs are still unknown but a high hospital bed occupancy, impacting admitted patients may play a role.
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