Quantification of chronic diseases presenting in the Emergency Department and their disposition outcomes: A hospital-based cross-sectional study in north India

A knowledge of the extent and distribution of chronic comorbidity plays an essential role in providing appropriate care, and allocating health resources to the patients admitted to the emergency department. We performed a cross-sectional study to quantify the chronic diseases presenting in the Emergency Department of PGIMER, Chandigarh (India). Out of 205 patients, 133 (64.9%) had pre-existing comorbidity. Common were chronic kidney disease (29, 14.1%), chronic liver disease (23, 11.2%), diabetes mellitus (21, 10.2%), malignancy (20, 9.8%), cardiac diseases (17, 8.3%), and chronic obstructive pulmonary disease (9, 4.4%). The median Charlson comorbidity index score was 2 (range, 0–9). In-hospital mortality was 43 (21%) and was predicted by older age (median, 60 v. 50 years; p-value, 0.017). Deaths with previous stroke (66.6%), chronic obstructive pulmonary disease (55.6%), and diabetes (28.6%) were higher than cardiac (2.3%) and renal (6.9%) comorbidity. Increasing comorbidity requires a shift in existing models of emergency care.

1. World Health Organization . The global health observatory. Global health estimates: life expectancy and leading causes of death and disability. Geneva: World Health Organization, 2019, Available at:
https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates. Accessed May 3, 2021.
Google Scholar2. World Health Organization . Preventing chronic diseases : a vital investment : wHO global report. Geneva: World Health Organization, 2005, Available at: https://apps.who.int/iris/handle/10665/43314. Accessed May 3, 2021.
Google Scholar3. GBD 2019 Diseases and Injuries Collaborators . Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet 2020; 396: 1204–1222. Erratum in: Lancet 2020;396(10262):1562.
Google Scholar | Crossref | Medline4. Pandey, SK, Sharma, V. World diabetes day 2018: battling the emerging epidemic of diabetic retinopathy. Indian J Ophthalmol 2018; 66: 1652–1653.
Google Scholar | Crossref | Medline5. Agarwal, SK, Srivastava, RK. Chronic kidney disease in India: challenges and solutions. Nephron Clin Pract 2009; 111: c197–c203. discussion c203.
Google Scholar | Crossref | Medline6. Mukherjee, PS, Vishnubhatla, S, Amarapurkar, DN, et al. Etiology and mode of presentation of chronic liver diseases in India: a multi centric study. PLoS One 2017; 12: e0187033.
Google Scholar | Crossref | Medline7. Institute for Health Metrics and Evaluation (IHME). GBD 2019 Cause and Risk Summary: Accessed [May 3,2021]. Seattle, USA: IHME, University of Washington, 2020.
Google Scholar8. Donnan, PT, Leese, GP, Morris, AD. Diabetes audit and research in tayside, Scotland/medicine monitoring unit collaboration. Hospitalizations for people with type 1 and type 2 diabetes compared with the nondiabetic population of tayside, Scotland: a retrospective cohort study of resource use. Diabetes Care 2000; 23: 1774–1779.
Google Scholar | Crossref | Medline | ISI9. De Berardis, G, D’Ettorre, A, Graziano, G, et al. ; DADA (diabetes administrative data analysis) study group. The burden of hospitalization related to diabetes mellitus: a population-based study. Nutr Metab Cardiovasc Dis 2012; 22: 605–612.
Google Scholar | Crossref | Medline10. Carral, F, Olveira, G, Salas, J, et al. Care resource utilization and direct costs incurred by people with diabetes in a spanish hospital. Diabetes Res Clin Pract 2002; 56: 27–34.
Google Scholar | Crossref | Medline11. Mayor S. Emergency admissions for diabetes increase more quickly in deprived areas of England. BMJ 2017; 356 : j214.
Google Scholar | Crossref12. Olson, JC . Acute-on-chronic and decompensated chronic liver failure: definitions, epidemiology, and prognostication. Crit Care Clin 2016; 32: 301–309.
Google Scholar | Crossref | Medline13. Mokdad, AA, Lopez, AD, Shahraz, S, et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med 2014; 12: 145.
Google Scholar | Crossref | Medline | ISI14. Yeatts, KB, Lippmann, SJ, Waller, AE, et al. Population-based burden of COPD-related visits in the ED: return ED visits, hospital admissions, and comorbidity risks. Chest 2013; 144: 784–793.
Google Scholar | Crossref | Medline15. Charlson, M, Szatrowski, T, Peterson, J, et al. Validation of a combined comorbidity index. J Clin Epidemiol 1994; 47: 1245–1251.
Google Scholar | Crossref | Medline | ISI16. Melady, D, Perry, A. Ten best practices for the older patient in the emergency department. Clin Geriatr Med 2018; 34: 313–326.
Google Scholar | Crossref | Medline17. Rosenberg, M, Rosenberg, L. The geriatric emergency department. Emerg Med Clin North Am 2016; 34: 629–648.
Google Scholar | Crossref | Medline18. Varughese, S, John, GT, Alexander, S, et al. Pre-tertiary hospital care of patients with chronic kidney disease in India. Indian J Med Res 2007; 126: 28–33.
Google Scholar | Medline | ISI19. Lovasik, BP, Zhang, R, Hockenberry, JM, et al. Emergency department Use and hospital admissions Among patients With End-stage renal disease in the United States. JAMA Intern Med 2016; 176: 1563–1565.
Google Scholar | Crossref | Medline20. Pannu, AK, Saroch, A, Singla, V, et al. Clinical spectrum, etiology and outcome of infectious disease emergencies in adult diabetic patients in northern India. Diabetes Metab Syndr 2020; 14: 921–925.
Google Scholar | Crossref | Medline

Comments (0)

No login
gif