Mortality, admission rates and outpatient use among frequent users of emergency departments: a systematic review
Why this work is in the frame
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Bibliographic record
Abstract
OBJECTIVE: This systematic review examines whether frequent emergency department (ED) users experience higher mortality, hospital admissions and outpatient visits than non-frequent ED users. DESIGN: We published an a priori study protocol in PROSPERO. Our search strategy combined terms for 'frequent users' and 'emergency department'. At least two independent reviewers screened, selected, assessed quality and extracted data. Third-party adjudication resolved conflicts. Results were synthesised based on median effect sizes. DATA SOURCES: We searched seven electronic databases with no limits and performed an extensive grey literature search. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included observational analytical studies that focused on adult patients, had a comparison group of non-frequent ED users and reported deaths, admissions and/or outpatient outcomes. RESULTS: The search strategy identified 4004 citations; 374 were screened by full text and 31 cohort and cross-sectional studies were included. Authors used many different definitions to describe frequent users; the overall quality of the included studies was moderate. Across seven studies examining mortality, frequent users had a median 2.2-fold increased odds of mortality compared with non-frequent users. Twenty-eight studies assessing hospital admissions found a median increased odds of admissions per visit at 1.16 and of admissions per patient at 2.58. Ten studies reported outpatient visits with a median 2.65-fold increased risk of having at least one outpatient encounter post-ED visit. CONCLUSIONS: Frequent ED users appear to experience higher mortality, hospital admissions and outpatient visits compared with non-frequent users, and may benefit from targeted interventions. Standardised definitions to facilitate comparable research are urgently needed. REVIEW REGISTRATION NUMBER: PROSPERO (CRD42013005855).
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it