Presenting Diagnosis Predicts Critical Care Need and Death Among Home Health Care Patients Admitted Through the Emergency Department: A Retrospective Cross-Sectional Study of 928 Admissions

Abstract

Home health care patients are frail and dependent, but which of their presentations are followed by the most intensive hospital care is unknown. To examine whether the diagnostic category recorded at emergency department (ED) presentation is associated with critical care admission, length of stay and death beyond age and triage acuity. Retrospective episode-based cohort study of every admission from the ED at a Turkish hospital among patients registered with its home health care unit, 1 June 2023 to 31 May 2024; target population: admitted episodes. Working diagnoses were grouped into 7 ICD-10 categories. Logistic and gamma regression with patient-clustered errors were fitted sequentially; death by Firth penalised regression. There were 928 admission episodes among 697 patients; 158 patients (22.7%) accounted for 389 episodes (41.9%). Respiratory presentations were commonest (185, 19.9%). Critical care admitted 326 episodes (35.1%); median stay was 7 days; 39 patients (4.2%) died. Adding diagnostic category to age, sex, arrival, season and triage raised discrimination from 0.739 to 0.811. Respiratory presentation was associated with critical care admission (adjusted odds ratio 5.44, 95% CI 2.98-9.93) and 60% longer stay (1.60, 1.23-2.09) across 5 sensitivity analyses. The cardiovascular association (10.85, 5.16-22.82) reflected coronary care routeing, falling to 2.06 (0.79-5.36) when coronary care was excluded. Age was unassociated. With all categories modelled together none was associated with death; only red triage (3.08, 1.61-5.90). Among admitted episodes, respiratory presentation was associated with critical care admission and longer stay, independently of age and triage; these associations are hypothesis-generating.