Profiling Bispebjerg Acute Cohort: Database Formation, Acute Contact Characteristics of a Metropolitan Hospital, and Comparisons to Urban and Rural Hospitals in Denmark

Abstract

Purpose To present a metropolitan cohort, Bispebjerg acute cohort (BAC), and compare patient characteristics and outcomes with patients from urban and rural hospitals in Denmark. Patients and Methods We linked data from seven Danish nationwide registries and included all acute contacts to non-psychiatric hospitals in the years 2016–2018. Acute hospital contacts to Bispebjerg and Frederiksberg Hospital constituted BAC, representing a solely metropolitan/urban catchment area. Patient characteristics and outcomes were compared to the rest of Denmark in an urban cohort (UrC) and a rural cohort (RuC), stratified by visit and hospitalization contact types. Results We identified 4,063,420 acute hospital contacts in Denmark and BAC constituted 8.4% (n=343,200) of them. BAC had a higher proportion of visits (65.1%) compared with UrC (52.1%) and RuC (45.3%). Patients in BAC more often lived alone (visits: BAC: 34.8%, UrC: 30.6%, RuC: 29.2%; hospitalizations: BAC: 50.8%, UrC: 36.7%, RuC: 37.2%) and had temporary CPR number (visits: BAC: 4.4%, UrC: 1.9%, RuC: 1.6%; hospitalizations: BAC: 1.5%, UrC: 0.9%, RuC: 0.8%). Visit patients in BAC were younger (BAC: 36, UrC: 42, RuC: 45 years, median), more often students (BAC: 18.0%, UrC: 14.0%, RuC: 12.5%), and had more contacts due to infectious diseases (BAC: 19.8%, UrC: 14.1%, RuC: 6.2%) but less due to injuries (BAC: 40.0%, UrC: 43.8%, RuC: 60.7%). Hospitalized patients in BAC had higher median age (BAC: 64, UrC: 61, RuC: 64 years) and fewer were in employment than in UrC (BAC: 26.1%, UrC: 32.1%, RuC: 28.1%). BAC Hospitalizations had a lower death rate within 30 days than in RuC (BAC: 3.0% [2.9–3.1%], UrC: 3.1% [3.0–3.1%], RuC: 3.4% [3.3–3.4%]), but a higher readmission-rate (BAC: 20.5% [20.3–20.8%], UrC: 17.3% [17.2–17.4%], RuC: 17.5% [17.5–17.6%]). Conclusion Significant differences between BAC, urban, and rural cohorts may be explained by differences in healthcare structure and sociodemographics of the catchment areas.

More emergency patients presenting with chest pain

“…A recent study investigated all acute somatic hospital contacts in Denmark in the period 2016–2018. Amongst others, the study found 25.4–28.1% of hospitalizations had an non-specific diagnosis, either R “symptoms and signs” or Z “other factors” [ 26 ]. In the current study, among patients calling the emergency number with chest pain, the combined non-specific R and Z diagnoses, accounted for nearly half (47%) of the patients.…”

Predicting Short-Term Mortality in Older Patients Discharged from Acute Hospitalizations Lasting Less Than 24 Hours

“…To consider the entire length of the patients’ hospital stay, we combined sequential Danish National Patient Registry (DNPR) contacts within ≤4 hours, considering contacts with both somatic and psychiatric departments and all types of inpatient/outpatient and acute/elective contacts. 4 We only included contacts with at least one acute and one inpatient contact. Thereby, patients with a contact with the ED without outright hospitalization were not included.…”

“…Since four-digit ICD-10 grouping has been shown to be an inadequate way of categorizing diseases, we conducted our own clinically meaningful grouping of discharge diagnoses for our population ( Supplementary Materials; Table S1 ). 4 , 21 , 22 We selected 14 laboratory blood tests to represent a standard ED package, and reference values were drawn directly from the respective laboratories. Initial screening of the frequency of these tests was done: tests missing for >10% of the population were handled as categorical variables with up to four levels: “missing”, “below normal”, “normal”, and “above normal.” Otherwise, the tests were handled as continuous.…”

Disparities in Emergency Care Among Patients with Mental Illness

“…43 In 2020, in Denmark, the median length of stay at the hospital was four hours (IQR, 1;23) among patients with any unplanned (emergency) hospital contact including both injuries and diseases. 44 This finding is supported by other authors, 45 meaning than less than 25% of patients with an unplanned hospital contact will need a hospital stay lasting more than 24 hours. This indicates that most patients will have critical diseases ruled out or will be diagnosed with less urgent diseases not requiring hospital admission, advanced care or critical care.…”

“…61,62 A corner stone in the recommendations was reducing the number of emergency hospitals receiving emergency patients around the clock from more than 44 to 21. 45,59,60 Also, in the same period, the increasing evidence regarding the association between higher patient volumes and better outcome of emergency care in, e.g., trauma, 63, 64 myocardial infarction 65,66 and stroke [67][68][69] , created a need to reorganise and centralise the treatment of selected time-dependent diseases in even fewer specialised centres. This resulted in the selection of four Danish trauma centres, four centres offering acute coronary interventions and six (later ten) stroke centres.…”