294 Emergency Department Patients Who Smoke Have Higher Admission Rates Than Non-Smokers

Abstract

Smoking is a known risk factor for poor health outcomes. We hypothesized smoking would result in an increased admission rate from the emergency department (ED). Our goal was to determine the magnitude of the difference in admission rates from the ED for smokers versus nonsmokers. Design retrospective cohort. Setting: Suburban community teaching hospital with annual visits of 90,000. Population: Consecutive ED patients from 40 to 70 years of age for the period 6-1-18 to 4-9-19. While the adverse effects from cigarette use and the age at which adverse health outcomes first appear varies, we a priori chose to examine the age group > 40 years of age. We also excluded patients greater than 70 years because other comorbidities may play a larger role. Trauma patients were also excluded as their smoking status is unlikely to influence the admission decision. Protocol: We obtained the current smoking and admission status from the electronic medical record. We calculated the admission rates for smokers and non-smokers and the relative change along with the 95% confidence interval (CI). Of the 28,894 patients who met our exclusion criteria, 18% were smokers. The average age of smokers and nonsmokers was 56 years. Females comprised 50% of the total patients. The percent of smokers in females and males was 15% and 22% respectively. The admission rate for smokers and nonsmokers was 61% and 45% respectively a relative increase of 37% (95% CI: 34% to 41%, p < 0.0001). We found a marked increase in admission rates in smokers compared to nonsmokers. To our knowledge this is the first report of an association between smoking and admission rates of ED patients who smoke. Modifiable lifestyle choices such as smoking should be addressed when counseling ED patients who smoke.