2023-06-08 14:05:00
The number had caused a lot of reaction in the heart of winter: 150 patients would have died “unexpectedly” in the emergency room in December and January, for lack of being able to be taken care of early enough. This estimate from the Samu Urgences de France union was the result of simple feedback in certain regions. A more than limited methodology but which testifies to a very real problem, illustrated by a French study presented this Thursday at the annual congress of emergency physicians. Having to wait overnight would increase the risk of dying in the elderly by almost 50%, according to these results.
This study, awaiting validation for publication in a scientific journal, was conducted for two days in mid-December in 97 emergency departments spread across France. We were then in the midst of a “triple epidemic” of Covid, influenza and RSV infections, overloading hospitals.
A study of patients over the age of 75
1,598 patients aged over 75 were followed, in two groups. 707 of them spent at least an entire night on a stretcher in the emergency room, referring to the famous expression “no bed night”. The other 891 were able to get a hospital bed before midnight on the day of their arrival. In other words, they did not wait a whole night in an uncomfortable environment (hard mattress, noise, etc.)
The results are eloquent: the mortality rate is 15.7% in the “stretcher” group (111 deaths out of 707 patients) and “only” 11.1% in the more rapidly treated group (99 out of 891) . After adjustment according to comorbidities, degree of autonomy, average age or reason for admission to hospital, we find a risk of dying almost 50% higher in the event of prolonged waiting. The confidence interval is quite wide, but the result remains statistically significant.
To put it another way, “for 25 patients who spent a night on a stretcher, one of them could have stayed alive if he had not spent that night in these conditions”, illustrates Yonathan Freund, emergency doctor at the Pitié-Salpêtrière (Paris) and lead author of the study. Patients who had to wait in the emergency room from evening to morning also have a longer hospital stay (once they have been taken care of) and more complications (infections, falls, etc.).
How to explain it? Spending a whole night on a stretcher probably goes hand in hand with less good care, aggravating the condition of the patients. Yonathan Freund draws up several possible and very concrete implications: “delay in administering medication, less frequent care, uncomfortable situation, degraded cognitive state, etc. “.
The emergency doctor said he was “surprised” by the extent of the excess mortality, especially if we restrict ourselves to the elderly with very little autonomy (difficulty performing activities of daily living alone, cognitive disorders, etc.). In this subgroup, the risk of dying is more than doubled when waiting overnight in the emergency room.
“Unclog” emergencies by the end of 2024, really?
Like any study, this one has several limitations, which call for caution. For example, the severity status for each patient may not have been filled in correctly. Be that as it may, it is in line with previous work which has also resulted in increased mortality in the event of late treatment. But these analyzes already published “had sometimes been carried out on a single hospital service and retrospectively”, indicates Yonathan Freund.
The new French study is called “cohort”. In each hospital, a scientist was appointed upstream to follow each elderly patient admitted to the emergency room and then record all the medical information concerning him.
Of course, there would be no additional deaths if no patient had to wait a long time in the emergency room. On April 17, Emmanuel Macron promised to “unclog” them by the end of 2024. Tenable? Many doctors find it hard to believe. “That would mean reopening all the beds closed for lack of staff, reopening beds downstream of the emergency services and making working conditions more attractive, especially night guards”, reacted in the wake of Patrick Pelloux. , head of the Association of Emergency Physicians of France.
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