Emergency Department Admission Research Articles

Abdominal cancer pain admission in emergency department vs. oncology emergency department

ABSTRACT Objective To investigate the rates of hospitalization, opioid prescription, supportive care, hospice referral, and 30-day all-cause mortality in patients with metastatic cancer and abdominal pain admitted to either the Emergency Department (ED) or the Oncology ED. Methods We conducted a retrospective cohort study of patients with metastatic cancer and abdominal pain admitted to the ED or Oncology ED at a tertiary medical center between June 2020 and May 2022. The MDClone ADAMS Platform, a healthcare data analytics environment, was used for data collection. Inverse probability weighting (IPW) based on propensity scoring was used to balance and compare characteristics of patient groups admitted to both ED settings. Results Weighted multivariable logistic regression found that metastatic cancer patients with abdominal pain complaints visiting the Oncology ED were 66% less likely to be admitted to the hospital (OR 0.34, 95% CI [0.16, 0.72], p-value = 0.005), and more likely to receive a supportive care consultation (OR 4.67, 95% CI [1.45, 15.05], p-value = 0.010), compared with the ED. Our study found that an Oncology ED, due to its expertise and immediate access to supportive care services due to their physical location within the same facility, enables prompt intervention for symptom management and psychosocial support, besides providing further oncology outpatient clinics follow-up for patients with metastatic cancer. Conclusions We believe that a developed oncology emergency care with specialized staff has the potential to reduce hospitalization rates.

Pediatric head trauma algorithm for head CT decision-making in the emergency department

BackgroundTraumatic brain injury is a common cause of admission in Emergency Department (ED) for pediatric patients. The aim of this study was to evaluate the application of the Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) algorithm in ED for head CT decision-making in pediatric patients. The secondary objective was to evaluate the impact of adherence to this protocol on ED crowding, length of stay, and boarding time.MethodsWe conducted a retrospective study including children aged ≤ 15 years who were admitted in a level 2 trauma center ED for mild TBI from 1 January 2016 to 31 December 2019. Collected data included amnesia, symptoms, demographics, outcomes, length of ED stay, the patient’s outcomes, including intracranial injuries (ICI) and injuries requiring neurosurgery.ResultsA total of 1372 children with mild TBI were included. More than half of the patients were male (59.8%) and ≥ 2 years of age (63.2%). Most of the trauma events (58%) were caused by home injury. Neurosurgical consultation (59.4%) was the most common intervention in the ED. Only 4.3% of patients required neuroimaging and 7 children had intracranial hemorrhage, with only 1 requiring immediate neurosurgical intervention. There were no re-admissions for bleeding. The adoption of this protocol had no negative impact on crowding, and a reduction of ED length of stay.ConclusionsThe adoption of the PECARNE algorithm led to fewer brain computed tomography scans with good clinical outcomes without increasing crowding.

Navigating the Crossroads: A 10-Year Population Study on Access to Care Among Patients With Brain Tumor.

Health care disparities are introduced at various points along the patient care continuum. This study explores disparities in initial health care access for patients with brain tumor (BT) in New York City (NYC) and New York State (NYS), comparing emergency department (ED) and elective admissions (EA). Using 2010-2020 data from the Statewide Planning and Research Cooperative System of NYS, patients were identified through relevant billing codes. Demographic, socioeconomic, and health care access variables were examined using univariate analysis and logistic mixed effects regression. The data were dichotomized by care location-NYC or NYS- and entry care site, ED vs EA. The cross-sectional study included 48 135 patients. Over the decade, there was a significant decrease in the percentage of patients with BT admitted through the ED (P < .001) without differences between the 2 cohorts. The NYC cohort (24 283 patients) had a higher proportion of younger, affluent individuals, racial/ethnic minorities, and publicly insured patients (P < .001). Male sex and older age were significantly associated with ED admissions in both cohorts (P < .05). Black, Hispanic/Latinx patients, and those with public health insurance were more likely to be admitted through ED (P < .001). Residing in census tracts within the lowest 3 quartiles was positively associated with ED admission in the NYC but not the NYS cohort (P < .001). Racial minorities with public insurance who reside in urban areas of low median household income are more likely to access BT care through ED rather than EA. Additional studies are needed to evaluate the impact of proximity to a hospital on access to care in rural areas. This study highlights the opportunities for policy and health care delivery changes to address current inequities.

Severity Indices of Diquat Poisoning for Triage and Prognosis in Acute Diquat Poisoning: A Multicenter Prospective Cohort Study.

Severity Indices of Diquat Poisoning for Triage and Prognosis in Acute Diquat Poisoning: A Multicenter Prospective Cohort Study.

Evaluation of patients with decreased general condition and comparing HOTEL, WPS, and REMS for mortality prediction

The emergency department (ED) plays a crucial role in evaluating patients with decreased general condition (DGC). Prompt diagnosis and precise risk stratification enhances clinical care outcomes. This study aimed to reveal which scoring system is better for predicting mortality in patients with DGC. This single-center prospective study was conducted between 1 March 2021 and 1 June 2021 in a tertiary university hospital’s ED. All patients presented with DGC were included. The scores assessed upon ED admission for patients include the Hypotension, Oxygen saturation, low Temperature, ECG changes, and Loss of independence, abbreviated as HOTEL score, Rapid Emergency Medicine Score (REMS), and the Worthing Physiological Scoring (WPS). The study aimed to compare the scoring systems to identify which is the best mortality predictor. Independent risk factors for 30-day mortality were analyzed using binary logistic regression and ROC curves to assess the effectiveness of HOTEL, REMS, and WPS scores in predicting mortality. The study was conducted with 137 DGC patients. The median age of patients presented to the ED with DGC was 77 (66.5–87), and 50.4% were male. 52.6% of patients died within one month. Analysis of mortality risk factors revealed that gender, age, day of admission, visit type, home oxygen, urinary catheter use, and speech status were not independent risk factors. For one-month mortality prediction, AUCs were: HOTEL 0.644 (cut-off 1), REMS 0.635 (cut-off 8), WPS 0.547 (cut-off 5). For mechanical ventilation: HOTEL 0.689 (10), REMS 0.790 (10), WPS 0.777 (4). For ICU admission: HOTEL 0.697 (2), REMS 0.770 (9), WPS 0.728 (4). Both the HOTEL and REMS scoring systems have moderate prognostic value in predicting mortality in patients with a DGC. The REMS, and WPS scores are also more helpful in determining the need for intensive care unit admission and mechanical ventilation.

A global perspective of epidemiological trends in oncological emergencies.

Oncologic emergencies are a critical interface between oncology and acute-care medicine. As global cancer trends evolve and healthcare disparities persist, this review seeks to address the pressing need to understand the epidemiology, predictors of outcomes, and care strategies for oncological emergencies across diverse healthcare contexts. The limited data available in this field underscores the vast knowledge gaps and the potential for significant scientific discovery. North American research networks have highlighted the variability in emergency department admissions and identified key determinants of outcomes, including functional status and disease staging. European studies have revealed that emergency presentations are frequently linked to advanced disease, whereas data from Asia and Oceania suggest that tumor burden and ethnicity significantly influence emergency care. In resource-limited regions, infection-related malignancies and inadequate healthcare infrastructure exacerbate challenges in managing oncologic emergencies. Despite these regional differences, consistent predictors of clinical outcomes, such as performance status and disease stage, have emerged as universal themes. This review highlights the need for targeted research and innovative interventions to bridge gaps in knowledge and care delivery. Region-specific strategies based on local epidemiological insights can improve patient outcomes and promote equity in oncological emergency management worldwide.

The impact of a voluntary alcohol and other drug diversion program on reoffending, imprisonment, and health.

The impact of a voluntary alcohol and other drug diversion program on reoffending, imprisonment, and health.

Predictive factors at emergency department admission for a complicated course of acute pancreatitis.

Acute pancreatitis (AP) is a condition frequently encountered by emergency department (ED) physicians, presenting with a spectrum of severity ranging from a mild, uncomplicated form to a severe, potentially fatal one. This study aimed to identify ED admission parameters that could predict a complicated disease course in patients with AP. Patients consecutively diagnosed with AP between 2010 and 2018 were included in the study and categorized into complicated and uncomplicated AP groups based on disease progression. Various clinical and laboratory characteristics at ED admission were compared between the two groups, and independent risk factors for complicated AP were identified. Complicated AP was de-fined as the development of any of the following during hospitalization: death, severe disease, necrosis, late peripancreatic or vascular complications, and pancreatic/peripancreatic or major extrapancreatic infections. Of the 511 patients included in the study, 74 (14.5%) were classified into the complicated AP group. At ED admission, recurrent AP, alcoholic etiology, pleural effusion, systemic inflammatory response syndrome, and calcium levels were identified as independent risk factors for complicated AP. The area under the curve for the combination of these five predictors for complicated AP was 0.857 (95% confidence interval: 0.810-0.904), significantly higher than that of existing scoring systems. Using five simple parameters, the development of complicated AP was successfully predicted. These parameters should be considered in the development of new scoring systems to identify patients at risk for clinically severe outcomes in AP.

Outpatient Versus Inpatient Total Joint Arthroplasty: Do Medically and Socially Complex Patients Require More Resources but Achieve Similar Outcomes?

Outpatient Versus Inpatient Total Joint Arthroplasty: Do Medically and Socially Complex Patients Require More Resources but Achieve Similar Outcomes?

Social Risk at Individual vs Neighborhood Levels and Health Care Use in Medicaid Enrollees

Health-related social risks are increasingly recognized as important contributors to health. Compared with individual screening, neighborhood measures are potentially a lower cost, scalable strategy for identifying social risk. To inform health resource planning and social risk screening strategies by comparing self-reported vs neighborhood-level social risk with inpatient, emergency department (ED), and outpatient care. A cross-sectional analysis of self-reported social risks measured during Medicaid enrollment and neighborhood-level social risk in relation to health care use was conducted. Members of Kaiser Permanente Northern California, a large integrated health care delivery system, who completed the Medicaid Integrated Outcomes Questionnaire from January 1, 2018, to February 29, 2020, were included. Analysis took place from January 8 to November 29, 2024. Neighborhood-level social risk (living in the least-resourced Neighborhood Deprivation Index quartile) and self-reported social risk (indicating a need or wanting help with finances, food, housing, or transportation domains). Hospital and ED admissions, primary care, specialty care, mental health, and social work visits in the year prior to questionnaire completion. Multivariable negative binomial regression models were analyzed for each type of health care use, controlling for demographic characteristics and several health conditions (eg, asthma, hypertension, and chronic pain). Among 13 527 respondents (8631 [63.8%] female; 5289 [39.1%] aged 25-44 years; 2846 [21.0%] Asian, 1986 [14.7%] Black or African American, 3040 [22.5%] Hispanic, 4602 [34.0%] White, and 1053 [7.8%] other race or ethnicity), 33.8% in the most-resourced neighborhood reported at least 1 social risk vs 40.1% in the least-resourced quartile (P < .001). Individual- and neighborhood-level measures were each associated with ED visits (marginal effect estimate for both measures: 0.23; 95% CI, 0.17-0.29). Neither measure was associated with hospital admissions. Individual risk was associated with greater use of all outpatient services (ranging from primary care visit marginal effect estimate: 0.22; 95% CI, 0.13-0.31 to mental health visit marginal effect estimate: 1.21; 95% CI, 0.67-1.75). Neighborhood-level risk was not associated with most outpatient visits and was negatively associated with mental health visits. In this cross-sectional study, associations were found for hospital and ED use but not outpatient visits, especially mental health visits. These findings suggest that individual social risk screening appears to provide distinct information compared with neighborhood social risk.

107 Patterns and Disparities in the Triage of Pediatric Burns

Abstract Introduction The American Burn Association (ABA) verifies pediatric burns centers to maintain the highest quality in the care of burned children. However, children may be triaged to other facilities. To date, there are no population health level studies exploring factors that determine which burned children are treated at pediatric verified burn centers. Further, there is a need to define characteristics of those most at risk for under-referral. We hypothesize that factors including race, distance to the burn center, social deprivation index (SDI), and insurance status will impact treatment at verified pediatric burn centers. Methods A state’s health care information database was queried from 2010-2019 extracting all pediatric emergency department (ED) and inpatient admissions. Individual patients were linked between ED and inpatient encounters. The distance between the burn center and patient’s home was calculated by using the geographic coordinates of the patient’s and facility’s zip codes. Facilities were categorized as pediatric verified burn centers, non-verified burn centers, or non-burn centers using information from the ABA. The primary outcome was admission to a verified pediatric burn center which was modeled with multivariable logistic regression. Study variables included race, social deprivation index (SDI), insurance status, and travel distance. The model was adjusted for age, TBSA, non-accidental trauma, and inhalation injury. Results There were 108,541 ED visits of which 10,099 (9.3%) were admitted or transferred. Of patients admitted from an ED, 45.48 % were admitted to pediatric verified centers, 32.39% were admitted to non-verified burn centers, and 22.12% were admitted to non-burn centers. 5.95% were transferred from initial ED to a different facility. Of all admitted transfers, 42.62% occurred to verified centers compared to 31.05% to non-verified centers and 26.33% to non burn centers. SDI (aOR 0.99, 95% CI 0.99-0.99, p = 0.002) and public health insurance status (aOR 0.50, CI 0.41- 0.59, p&amp;lt; 0.001) were significantly associated with admission to verified centers. Conclusions Children living in areas with higher SDI or with public health insurance were less likely to be admitted to a verified pediatric burn center from the ED. The data suggests a significant economic disparity in access to specialized burn care. Future interventions can be targeted to address the link between childhood poverty and poorer access to quality burn care. Applicability of Research to Practice Understanding referral patterns in pediatric burn patients is crucial for shaping local and statewide efforts to improve access to specialized, high-quality care for all children with burns. Identifying barriers to referral can guide revisions to referral guidelines and enhance the effectiveness of American Burn Association educational initiatives, ultimately ensuring more equitable access to pediatric-specific burn care. Funding for the Study Institutional Pediatrics Residency Research Grant - January 2024

Costs and Benefits of the Melbourne Mobile Stroke Unit Compared With Standard Ambulance: Causal Analysis Using Observational Linked Data.

Evidence of the cost implications and health outcomes associated with the use of mobile stroke units (MSU) is required to support their utilization. We aimed to evaluate the causal effect of the use of an MSU compared with a standard ambulance on hospitalization costs and 90- to 180-day health outcomes. Causal effect estimation was performed using patient-level data from a cohort of patients with stroke in 2018 identified from the Australian Stroke Clinical Registry (Victoria) and Melbourne MSU. These data were linked to Ambulance Victoria and government-held administrative data sets. In total, linked data from 8657 patients were available. Propensity score matching was used to define comparator groups within a target trial framework. Costs included emergency department and hospital admission costs in the first 180 days after stroke. Multivariable regression analyses of the matched data were used to compare costs and outcomes (mortality and modified Rankin Scale) between MSU and standard ambulance groups. The target trial sample included 96 patients transported by the MSU (intervention) and 198 patients transported by standard ambulance services (control). Of these, the mean age was 76 years and 157 (53%) were men. A greater proportion of patients received mechanical thrombectomy in the intervention group than the control group (40% versus 23%; P<0.001). The adjusted hospital costs were $17 949 greater in the intervention group than the control group (95% CI, $4682-$31 214; P=0.01). Patients in intervention group doubled the odds of achieving nondisability (modified Rankin Scale scores of 0-1, adjusted odds ratio of 2.11 [95% CI, 1.07-4.18]) and halved the mortality rate (adjusted hazard ratio, 0.53 [95% CI, 0.32-0.86]) within 90 to 180 days poststroke compared with the control group. There are important cost implications and improved outcomes from using the MSU that are likely related to increased provision of reperfusion therapy.

Association of Race and Ethnicity With Healthcare Utilization for Inflammatory Bowel Disease in the United States: A Retrospective Cohort Study.

Advances in medical and surgical therapy have improved the outlook for those affected with Crohn's disease and ulcerative colitis; however, it is unclear whether Americans from marginalized racial and ethnic backgrounds have adequate and equitable access to care for inflammatory bowel disease (IBD). We evaluated the association between race and ethnicity and healthcare utilization in patients diagnosed with inflammatory bowel disease. This study identified children and adults diagnosed with IBD in 2 national data sets from 2016 to 2017. We modeled the association between healthcare utilization and racial and ethnic subpopulations across different age groups using generalized estimating equations adjusted by disease and socioeconomic factors. Among working-age adults, Black Americans had higher emergency department admission, hospitalization, and steroid use than White patients; however, these differences were attenuated after adjusting for socioeconomic factors. Asian and Hispanic Americans were less likely to receive outpatient gastroenterological care and medical therapy even after adjustment. Emergency department use was more likely among elderly Black patients. Hispanic children had increased healthcare utilization for IBD compared with White children, although these results did not meet statistical significance. Healthcare utilization for long-term management of IBD is lower in historically marginalized racial and ethnic groups compared with White Americans. Further research is needed to identify and address modifiable patient, clinician, and healthcare system barriers to achieve health equity in the management of IBD.

Performance of the PATHOS score in predicting in-hospital mortality in patients aged 65 years and older admitted to the intensive care unit from the emergency department

Purpose: The aim of this study was to investigate the performance of the platelets, age, troponin, heart rate, oxygenation, and systolic blood pressure (PATHOS) score in predicting in-hospital mortality among patients aged 65 years and older admitted to the intensive care unit (ICU) from the emergency department (ED). Materials and Methods: This single-center, retrospective observational study included patients aged 65 years and older who presented to the ED and were admitted to the ICU between 2018 and 2024. The PATHOS score was calculated using routine vital signs and blood parameters obtained at ED admission. The patients were divided into two groups: survivors and non-survivors. The predictive power of the PATHOS score for in-hospital mortality was evaluated by comparing these groups. Results: The study included a total of 1,131 patients. The number of survivors was 889 (78.6%), while that of non-survivors was 242 (21.4%). Multivariate logistic regression analysis revealed that the PATHOS score (odds ratio [OR]: 3.80, 95% confidence interval [CI]: 3.07–4.70, p

The Factors That Affect Operating Room Start Time for Pediatric Femoral Shaft Fractures.

The operating room start time (ORST) for pediatric femoral fractures is a health-care quality metric used for hospital rankings and accreditation. Factors affecting ORST remain unclear. This study aimed to evaluate the demographic and clinical factors associated with gold-standard (early) ORST (<18 hours) versus delayed ORST (≥18 hours) for pediatric femoral fractures. A retrospective review was conducted of 216 pediatric patients with a femoral shaft fracture admitted to the emergency department (ED) at a pediatric Level-I trauma hospital from 2021 to 2023. Patient demographic and clinical data were analyzed to identify significant factors associated with ORST. Immediate postoperative outcomes were compared across ORST groups. In multivariable models, race, ED admission time, comorbidities, and surgery type affected ORST (p < 0.05). Compared with White patients, patients of other racial or ethnic groups, including Hispanic, Black, Asian, and multiracial patients, had 2.4 times higher odds of delayed ORST. Compared with midnight to 6 a.m. ED admissions, the odds of delayed ORST were 6.6 times higher for ED admissions between 6 a.m. and noon and 9.2 times higher for ED admissions between noon and 6 p.m. Patients with comorbidities were 4.7 times more likely to experience delayed surgery compared with healthy patients. Patients who underwent open reduction and internal fixation (ORIF) were 2.5 times as likely as patients who underwent closed reduction (CR) with a spica cast to have delayed ORST. Delayed ORST was associated with longer hospital stay (median, 71 hours) compared with early ORST (median, 41 hours), but not with immediate complications. ED admission time, race, method of transfer, comorbidities, and procedure type were associated with ORST for pediatric femoral fractures. Longer ORST led to a disproportionately longer hospital stay. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Short-Term Gains, Enduring Potential: An Integrated SDOH-Focused Care Model Delivers Cost Savings and Patient-Reported Benefits.

High-need, high-cost (HNHC) adults require comprehensive strategies that address both clinical and social determinants of health (SDOH). This retrospective, propensity score-matched study (n = 526) evaluated a care model integrating monthly SDOH screenings, medication oversight, and real-time admission-discharge-transfer alerts in four urban primary care clinics. Compared to usual care, the intervention significantly reduced acute utilization within 60 days: emergency department (ED) visits decreased by 0.17 (P < 0.001) and hospital admissions declined by 0.12 (P < 0.001). Gross per-participant costs fell from $6,019 to $2,422 (a $3,597 reduction); after accounting for intervention expenses, net savings reached $3,222 (P < 0.001), yielding an estimated 6.9:1 return on investment. Patient-reported outcomes also demonstrated significant gains: EQ-5D-5L scores increased by 0.082 (P < 0.001) in the intervention cohort, exceeding the threshold for clinically meaningful change, while Net Promoter Scores rose by 8.8 points (P < 0.001). Subgroup analyses revealed slightly smaller quality-of-life gains among non-White cohorts, highlighting the need for culturally tailored approaches to advance equity. These findings align with prior Population Health Management research showing that integrated care models can reduce costs and enhance patient satisfaction. Overall, this multifaceted model effectively curbs avoidable ED visits and admissions, generates short-term cost savings, and boosts patient satisfaction-key outcomes under value-based care contracts. Future research should investigate longer-term outcomes and refine equity-focused strategies to ensure sustained and inclusive benefits.

The burden of ethanol-positive patients in emergency departments: a clinical evaluation

Aims: Alcohol-related emergency department (ED) admissions pose a significant burden on healthcare systems. This study aims to evaluate the demographic, clinical, and biochemical characteristics of ethanol-positive patients and analyze the impact of blood ethanol levels on the emergency department. Methods: This retrospective study included 769 patients who presented to a tertiary care ED between November 1, 2023, and April 30, 2024, with a blood ethanol level &gt;50 mg/dL. Patients were categorized into two groups (&lt;200 mg/dL and &gt;200 mg/dL), and their demographic data, admission reasons, biochemical parameters, and brain computed tomography (CT) findings were compared. Results: The mean age of the study population was 38.24 ± 13.81 years, and 80% were male. Patients in the &gt;200 mg/dL group were significantly older than those in the &lt;200 mg/dL group. Trauma was the leading cause of ED admission (90% of cases), with falls being more common in the &gt;200 mg/dL group (19.9% vs. 8.4%, p&lt;0.001) and assaults being more frequent in the &lt;200 mg/dL group (25.5% vs. 18.2%, p&lt;0.001). Biochemical analysis showed significant elevations in AST, amylase, and lipase levels in the &gt;200 mg/dL group. Brain CT scans were performed in 54.4% of patients, with no significant differences in intracranial pathology between groups (p=0.427). Conclusion: Alcohol-related ED visits contribute to both clinical and operational challenges. Patients with ethanol levels &gt;200 mg/dL were more advanced in age and had higher rates of trauma-related admissions, particularly falls. Despite increased brain CT utilization in this group, no significant difference was found in intracranial pathology rates. These findings highlight the need for more selective imaging strategies. Additionally, targeted interventions such as alcohol screening protocols, specialized sobering units, and staff training programs are essential to reducing the burden of alcohol-related ED visits and improving patient care.

The use of baclofen to reduce alcohol-attributable hospitalizations and emergency department admissions.

The use of baclofen to reduce alcohol-attributable hospitalizations and emergency department admissions.

The Prognostic Role of Serum Procalcitonin for Adult Patients with Acute Diarrhea in the Emergency Department.

Background. Acute diarrhea is one of the leading causes of Emergency Department (ED) access. The search for the causative pathogen cannot be routinely performed since conventional methods, like stool cultures, are time-consuming, requiring days for growth and delaying diagnosis and the start of therapy. In this large sample retrospective study, we evaluated the prognostic role of serum procalcitonin (PCT) for adult patients with acute diarrhea in the ED. Methods. In a retrospective, mono-centric study, we enrolled all patients visiting our ED complaining of acute diarrhea and then hospitalized over five years. Final diagnosis of an infective (including bacterial) diarrhea, any other infection, and a bloodstream infection (BSI) was collected by clinical records, according to the International Disease Classification 10th edition. Procalcitonin determination was obtained upon request of the ED physician at the admission visit based on patient evaluation and clinical judgment. Results. Of a total of 1910 patients, early PCT values (cut-off of 0.5 ng/mL) did not show a significant predictive value for infective diarrhea (OR 0.554 [0.395-0.778]), nor for bacterial diarrhea (OR 0.596 [0.405-0.875]). Conversely, PCT levels at ED admission showed a significant predictive value for a final diagnosis of any infection (OR 1.793 [1.362-2.362]) and, above all, of bloodstream infection (BSI) (OR 6.694 [4.869-9.202]). Conclusions. Our data suggest that in ED, where the complexity and heterogeneity of patients are very high, indiscriminate PCT-guided management of patients with diarrhea is not indicated. Conversely, in patients with diarrhea but also clinical suspicion of BSI, PCT determination remains a useful instrument, possibly improving clinical management.

Socioeconomic disparities in health-related quality of life and healthcare use in the last year of life of patients with advanced cancer: longitudinal results from the eQuiPe study

PurposeTo examine socioeconomic disparities in health-related quality of life (HRQoL) and healthcare use during the last year of life of patients with advanced cancer.MethodsData was used from a prospective, longitudinal, multicenter, observational study of patients with advanced cancer in forty Dutch hospitals (eQuiPe). Adult patients with stage IV cancer completed 3-monthly questionnaires until death. Socioeconomic position (SEP) was defined as estimated income on street-level. Mixed-effects regression analysis was used to identify associated factors.ResultsA total of 639 patients were included, 14% with a lower SEP, 59% medium SEP and 28% higher SEP. Patients with a lower SEP were more often lower educated (40% vs. 18%, p < 0.001) and less often reported to have a partner (61% vs. 90%, p < 0.001) than those with a higher SEP. In the last year of life, patients with lower SEP were more likely to experience disease-related financial difficulties than those with higher SEP (28% vs. 12%, p = 0.001; β 8.2, 95%CI 2.9–13.3). No significant associations were found between SEP and HRQoL, hospital admissions or emergency department admissions. Although, patients with lower SEP had more frequent (≥ 5 per month) interactions with healthcare professionals than patients with higher SEP in the last year of life (OR 1.9, 95%CI 1.0–3.5).ConclusionSome socioeconomic disparities are present during the last year of life of patients with advanced cancer. It is important for clinicians to be aware of the greater financial impact and higher healthcare utilization in patients with a lower SEP to ensure equitable end-of-life care.