Patient disposition of admission or mortality versus treat-and-release from APAP toxicity-related presentation to the ED, 2006–2010
| Age 11 years and below (N=42 623) | Age 12–20 years (N=106 725) | Age 21–64 years (N=246 640) | Age 65 years and above (N=15 893) | |||||
|---|---|---|---|---|---|---|---|---|
| Admission (RRR, 95th CI) | Mortality (RRR, 95th CI) | Admission (RRR, 95th CI) | Mortality (RRR, 95th CI) | Admission (RRR, 95th CI) | Mortality (RRR, 95th CI) | Admission (RRR, 95th CI) | Mortality (RRR, 95th CI) | |
| Patient characteristics | ||||||||
| Age | 1.11** (1.03 to 1.19) | – | 1.09*** (1.06 to 1.11) | 1.49* (1.01 to 2.19) | 1.01*** (1.01 to 1.02) | 1.05*** (1.04 to 1.06) | 1.00 (0.99 to 1.01) | 1.09** (1.03 to 1.14) |
| Female sex | 1.01 (0.77 to 1.33) | – | 0.97 (0.89 to 1.06) | 1.94 (0.28 to 13.60) | 0.90*** (0.85 to 0.95) | 0.96 (0.76 to 1.22) | 1.24 (0.99 to 1.56) | 0.54 (0.25 to 1.15) |
| Payer (vs commercial insurance) | ||||||||
| Medicare | – | – | 0.54* (0.30 to 0.97) | OmittedA | 0.83** (0.75 to 0.92) | 0.87 (0.59 to 1.28) | 1.17 (0.49 to 2.78) | 0.12** (0.03 to 0.55) |
| Medicaid | 0.62** (0.45 to 0.86) | – | 0.97 (0.87 to 1.07) | 0.42 (0.09 to 1.85) | 1.02 (0.94 to 1.11) | 0.90 (0.64 to 1.27) | 0.64 (0.25 to 1.69) | 0.04** (0.01 to 0.28) |
| Other | 0.58* (0.37 to 0.92) | – | 0.86* (0.76 to 0.98) | 0.32 (0.07 to 1.46) | 0.90* (0.83 to 0.98) | 0.87 (0.62 to 1.22) | 0.31* (0.10 to 0.93) | OmittedA |
| Income quartile (vs lowest) | ||||||||
| 2nd quartile | 1.12 (0.79 to 1.59) | – | 1.13* (1.00 to 1.27) | 2.50 (0.21 to 29.40) | 1.05 (0.97 to 1.14) | 0.93 (0.67 to 1.28) | 0.84 (0.61 to 1.14) | 0.23* (0.07 to 0.74) |
| 3rd quartile | 0.75 (0.48 to 1.16) | – | 1.15* (1.02 to 1.29) | 13.40* (1.59 to 113.21) | 1.08 (0.98 to 1.20) | 1.21 (0.86 to 1.69) | 1.08 (0.75 to 1.54) | 1.03 (0.32 to 3.24) |
| 4th quartile | 0.90 (0.58 to 1.39) | – | 1.24** (1.07 to 1.43) | OmittedA | 1.26*** (1.13 to 1.41) | 1.20 (0.83 to 1.73) | 1.18 (0.83 to 1.69) | 1.76 (0.64 to 4.85) |
| Rural residence | 2.26* (1.19 to 4.30) | – | 1.30* (1.06 to 1.60) | 0.82 (0.18 to 3.78) | 1.24** (1.07 to 1.44) | 1.21 (0.72 to 2.03) | 1.36 (0.76 to 2.43) | 1.88 (0.44 to 7.97) |
| Hospital characteristics | ||||||||
| Rural location | 0.53 (0.26 to 1.12) | – | 0.79* (0.62 to 0.99) | 1.48 (0.15 to 14.19) | 0.67*** (0.56 to 0.80) | 0.42** (0.21 to 0.81) | 0.63 (0.35 to 1.14) | 1.27 (0.34 to 4.68) |
| Teaching facility | 3.13*** (2.17 to 4.50) | – | 1.55*** (1.35 to 1.79) | 5.08 (0.82 to 31.72) | 0.98* (0.86 to 1.12) | 1.04 (0.79 to 1.37) | 1.31* (1.03 to 1.68) | 1.58 (0.68 to 3.66) |
| Region (vs Northeast) | ||||||||
| Midwest | 0.72 (0.47 to 1.12) | – | 0.96 (0.81 to 1.14) | 1.18 (0.11 to 13.16) | 0.87 (0.72 to 1.04) | 0.59* (0.40 to 0.90) | 0.63* (0.44 to 0.90) | 0.48 (0.16 to 1.45) |
| South | 0.79 (0.51 to 1.22) | – | 0.85 (0.72 to 1.02) | 1.92 (0.17 to 21.10) | 0.86 (0.72 to 0.99) | 0.79 (0.55 to 1.14) | 0.85 (0.61 to 1.18) | 0.36* (0.14 to 0.92) |
| West | 0.65 (0.39 to 1.08) | – | 0.62*** (0.52 to 0.74) | 0.39 (0.01 to 12.73) | 0.51*** (0.43 to 0.59) | 0.52** (0.35 to 0.77) | 0.54** (0.38 to 0.77) | 0.26* (0.08 to 0.82) |
| Clinical characteristics | ||||||||
| Congestive heart failure | – | – | – | – | 1.48 (0.95 to 2.31) | 1.67 (0.80 to 3.49) | 3.36*** (2.01 to 5.63) | 1.64 (0.55 to 4.87) |
| Valvular disease | – | – | 3.94* (1.15 to 13.50) | OmittedA | 4.47*** (2.70 to 7.40) | 2.06 (0.60 to 7.01) | 3.64** (1.67 to 7.92) | 3.55 (0.51 to 24.58) |
| Pulmonary circulation disorders | – | – | – | – | 2.35* (1.03 to 5.40) | 8.50** (2.54 to 28.43) | 3.70 (0.39 to 35.40) | OmittedA |
| Peripheral vascular disorders | – | – | – | – | 3.15*** (1.55 to 6.37) | 2.64 (0.59 to 11.89) | 2.88** (1.32 to 6.28) | 5.77 (0.96 to 34.48) |
| Hypertension with complications | – | – | 2.46*** (1.53 to 3.96) | OmittedA | 2.27** (1.32 to 3.92) | 1.66 (0.59 to 4.68) | 5.74*** (2.32 to 14.21) | 0.66 (0.06 to 6.75) |
| Paralysis | – | – | 1.54 (0.31 to 7.54) | OmittedA | 3.28*** (1.90 to 5.65) | 11.47*** (4.84 to 27.23) | 1.75 (0.57 to 5.38) | 1.20 (0.14 to 10.13) |
| Other neurological disorders | 24.83*** (10.48 to 58.83) | – | 3.14*** (2.40 to 4.12) | 50.97***(10.75 to 241.71) | 2.19*** (1.95 to 2.47) | 2.21*** (1.55 to 3.15) | 1.97*** (1.40 to 2.78) | 1.48 (0.67 to 3.27) |
| Chronic pulmonary disease | 1.94 (0.95 to 3.96) | – | 2.35*** (1.93 to 2.86) | OmittedA | 2.01*** (1.78 to 2.28) | 1.29 (0.83 to 2.00) | 3.21*** (2.27 to 4.54) | 5.16** (1.75 to 15.25) |
| Diabetes with complications | – | – | 0.97 (0.58 to 1.64) | OmittedA | 4.52*** (2.55 to 8.01) | 3.57* (1.01 to 12.64) | 2.34 (0.62 to 8.88) | 16.60 (0.12 to 225.36) |
| Hypothyroidism | – | – | 1.04 (0.58 to 1.85) | OmittedA | 2.67*** (2.16 to 3.31) | 1.52 (0.77 to 2.99) | 2.15*** (1.43 to 3.24) | 2.17 (0.75 to 6.33) |
| Renal failure | – | – | 2.11 (0.24 to 18.52) | OmittedA | 2.39*** (1.51 to 3.80) | 3.16** (1.38 to 7.25) | 0.50 (0.22 to 1.12) | 1.06 (0.13 to 8.44) |
| Liver disease | – | – | 2.98* (1.03 to 8.64) | OmittedB | 12.13*** (5.98 to 24.60) | 47.89*** (21.53 to 106.52) | OmittedB | OmittedB |
| HIV/AIDS | – | – | – | – | 2.18 (0.82 to 5.83) | 6.86* (1.35 to 34.92) | – | – |
| Lymphoma | – | – | – | – | 1.43 (0.60 to 3.43) | 4.24 (0.69 to 25.95) | – | – |
| Metastatic cancer | – | – | – | – | 6.08*** (2.22 to 16.67) | 30.32*** (8.35 to 110.18) | 3.18 (0.78 to 13.04) | 1.76 (0.29 to 10.55) |
| Solid tumour | – | – | – | – | 1.97* (1.09 to 3.55) | 5.77** (2.13 to 15.59) | 2.41 (0.98 to 5.91 | 5.46 (0.94 to 31.63) |
| Rheumatoid arthritis/collagen vascular disease | – | – | 0.80 (0.21 to 3.07) | OmittedA | 2.66*** (1.89 to 3.76) | 2.28 (0.95 to 5.43) | 3.32* (1.24 to 8.90) | OmittedA |
| Coagulopathy | – | – | 21.75*** (7.70 to 61.42) | 178.62*** (10.96 to 291.11) | 16.06*** (9.70 to 26.57) | 72.42*** (39.91 to 131.40) | OmittedB | OmittedB |
| Obesity | – | – | 6.29*** (3.95 to 10.01) | OmittedA | 4.96*** (3.32 to 6.27) | 5.55*** (3.08 to 10.02) | 5.43** (1.68 to 17.54) | 0.10 (0.01 to 1.37) |
| Weight loss | – | – | – | – | 20.51*** (7.35 to 57.18) | 25.74*** (7.64 to 86.71) | 19.01** (2.50 to 144.65) | 283.59*** (17.45 to 468.08) |
| Fluid and electrolyte disorders | 20.75*** (9.22 to 46.70) | – | 6.78*** (5.70 to 8.07) | 8.91** (2.48 to 31.96) | 7.97*** (7.09 to 8.96) | 28.45*** (21.84 to 37.07) | 9.77*** (6.85 to 13.92) | 56.28*** (22.19 to 142.71) |
| Blood loss or deficiency anaemia | 13.27** (2.65 to 66.38) | – | 4.17*** (2.83 to 6.15) | OmittedA | 4.46*** (3.64 to 5.46) | 3.34*** (2.22 to 5.04) | 2.64*** (1.72 to 4.04) | 0.15 (0.01 to 4.35) |
| Alcohol abuse | – | – | 2.32*** (1.94 to 2.77) | 1.16 (0.09 to 14.53) | 2.53*** (2.33 to 2.75) | 1.75*** (1.34 to 2.29) | 2.96*** (1.76 to 4.95) | 3.27 (0.71 to 15.09) |
| Drug abuse | – | – | 2.02*** (1.77 to 2.30) | 3.02 (0.59 to 15.37) | 2.37*** (2.17 to 2.59) | 1.58** (1.17 to 2.13) | 1.71 (0.96 to 3.04) | 0.59 (0.06 to 5.44) |
| Psychoses | – | – | 5.13*** (4.48 to 5.89) | 4.46 (0.91 to 21.85) | 4.44*** (4.00 to 4.93) | 1.42 (1.00 to 2.03) | 6.41*** (3.88 to 10.57) | 6.46 (0.84 to 49.84) |
| Depression | – | – | 1.71*** (1.55 to 1.88) | 3.46 (0.94 to 12.70) | 1.75*** (1.62 to 1.89) | 1.10 (0.82 to 1.48) | 1.95*** (1.44 to 2.64) | 1.88 (0.79 to 4.49) |
| Intentional self-harm | – | – | 3.40*** (3.07 to 3.77) | OmittedB | 3.03*** (2.81 to 3.26) | 1.69*** (1.30 to 2.21) | 4.89*** (3.59 to 6.64) | 8.57*** (3.97 to 18.49) |
| Calendar year | ||||||||
| 2007 (vs 2006) | 0.78 (0.48 to 1.28) | – | 0.92 (0.80 to 1.06) | 0.95 (0.17 to 5.34) | 0.99 (0.88 to to 1.11) | 1.01 (0.69 to 1.49) | 1.29 (0.92 to 1.81) | 1.97 (0.39 to 9.87) |
| 2008 (vs 2006) | 0.79 (0.49 to 1.26) | – | 0.79** (0.68 to 0.92) | 0.65 (0.07 to 5.73) | 0.82** (0.72 to 0.94) | 0.82 (0.56 to 1.21) | 0.94 (0.67 to 1.32) | 3.13 (0.96 to 10.19) |
| 2009 (vs 2006) | 0.67 (0.40 to 1.11) | – | 0.84* (0.72 to 0.98) | 0.30 (0.03 to 3.17) | 0.87 (0.77 to 1.00) | 0.58* (0.38 to 0.88) | 0.79 (0.55 to 1.13) | 2.23 (0.65 to 7.64) |
| 2010 (vs 2006) | 0.74 (0.45 to 1.22) | – | 0.88 (0.74 to 1.03) | 0.56 (0.06 to 5.18) | 0.83** (0.73 to 0.95) | 0.78 (0.53 to 1.13) | 1.03 (0.74 to 1.45) | 2.57 (0.72 to 9.18) |
OmittedA, variable omitted due to near-perfect association with survival (ie, OR<0.01).
OmittedB, variable omitted due to near-perfect association with mortality (ie, RRR>10 000).
***Statistically significant at p<0.001.
**Statistically significant at p<0.01.
*Statistically significant at p<0.05.
–, Variable omitted due to small sample size (n≤0.1%); APAP, acetaminophen; ED, emergency department; RRR, relative risk ratio.