Dataset Information

Emergency department use by pregnant women in Ontario: a retrospective population-based cohort study.

ABSTRACT:

Background

Peripregnancy emergency department use may be common, but data specific to health care systems like that in Canada are lacking. As prior research was limited to livebirths, omitting pregnancies ending in miscarriage or induced abortion, the current study quantified and characterized emergency department use among women in Ontario with a recognized pregnancy.

Methods

This retrospective population-based cohort study included all recognized pregnancies among Ontario residents aged 10-55 years with an estimated date of conception between Apr. 1, 2002, and Mar. 31, 2017. We defined peripregnancy emergency department use as any emergency department visit during pregnancy or within 42 days after pregnancy. We used modified Poisson regression with a robust error variance to generate relative risks (RRs) and 95% confidence intervals (CIs) for the outcome of any peripregnancy emergency department use in association with maternal age, parity, residential income quintile, location of residence, immigrant status, antenatal care provider and number of comorbidities within 120 days before the clinical start of the pregnancy (expressed as total number of Aggregated Diagnosis Groups [ADGs] obtained with the Johns Hopkins Adjusted Clinical Group System). All RRs, except for number of comorbidities, were further adjusted for number of ADGs.

Results

Peripregnancy emergency department use occurred in 1 075 991 (39.4%) of 2 728 236 recognized pregnancies, including 35.8% of livebirths, 47.3% of stillbirths, 73.7% of miscarriages and 84.8% of threatened abortions. A peripregnancy emergency department visit was more likely among women who were less than 25 years of age (adjusted RR 1.16, 95% CI 1.16-1.17), were nulliparous (adjusted RR 1.13, 95% CI 1.13-1.13), resided in the lowest income quintile area (adjusted RR 1.16, 95% CI 1.15-1.16) or in a rural area (adjusted RR 1.50, 95% CI 1.50-1.51), were Canadian-born (adjusted RR 1.22, 95% CI 1.22-1.23), were not seen by an obstetrician (adjusted RR 1.66, 95% CI 1.54-1.80) or had a greater number of ADGs. Emergency department use peaked in the first trimester and in the first week postpartum. Compared to women residing in urban areas, those residing in rural areas had an odds ratio (OR) of 3.44 (95% CI 3.39-3.49) for 3 or more emergency department visits. Women with 3-4 (OR 1.99, 95% CI 1.97-2.01), 5-6 (OR 3.55, 95% CI 3.49-3.61), or 7 or more (OR 7.59, 95% CI 7.39-7.78) prepregnancy comorbidities were more likely to have 3 or more peripregnancy emergency department visits than were those with 2 or fewer comorbidities.

Interpretation

Peripregnancy emergency department use occurred in nearly 40% of pregnancies, notably in the first trimester and early in the postpartum period. Efforts are needed to streamline rapid access to ambulatory obstetric care during these peak periods, when women are susceptible to miscarriage or a complication after a livebirth.

SUBMITTER: Varner CE

PROVIDER: S-EPMC7207029 | biostudies-literature | 2020 Apr-Jun

REPOSITORIES: biostudies-literature

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Publications

Emergency department use by pregnant women in Ontario: a retrospective population-based cohort study.

Varner Catherine E CE Park Alison L AL Little Darby D Ray Joel G JG

CMAJ open 20200428 2

<h4>Background</h4>Peripregnancy emergency department use may be common, but data specific to health care systems like that in Canada are lacking. As prior research was limited to livebirths, omitting pregnancies ending in miscarriage or induced abortion, the current study quantified and characterized emergency department use among women in Ontario with a recognized pregnancy.<h4>Methods</h4>This retrospective population-based cohort study included all recognized pregnancies among Ontario reside ...[more]

PMID: 32345709

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Project description:BackgroundPatients with cancer frequently require emergency medical care during treatment. The objective of this study was to characterize emergency department visits made by patients with cancer receiving chemotherapy and to describe associated outcomes.MethodsThis retrospective cohort study used population-based administrative data from Ontario, Canada. Patients aged 18 years and older, with a cancer diagnosis, and who received chemotherapy in the 30 days before being seen in an emergency department between 2013 and 2017 were included. Emergency department discharge diagnosis codes were categorized to identify the most frequent emergency department diagnoses. We examined the proportion of patients admitted to hospital and 30-day mortality. We used logistic regression to identify predictors of hospital admission.ResultsWe identified 218 459 emergency department visits made by 87 555 patients. The median number of emergency department visits per patient was 2 (interquartile range 1-3). Hematological, gastrointestinal, breast and lung cancer were the most common malignancies represented. The most common emergency department diagnoses were infection or fever (57 036 [26.1%]) and gastrointestinal diagnoses (26 456 [12.2%]). Of all visits, 77 978 (35.7%) resulted in admission to hospital. Thirty-day mortality after an emergency department visit was 9.8%. There was an increased odds of admission among patients who previously received palliative consultation, patients with bone or soft tissue or hematological malignancies, and patients with infection, gastrointestinal, pulmonary, cardiac, weakness or genitourinary and nephrology diagnoses.InterpretationPatients with cancer frequently used the emergency department during chemotherapy, and 1 in 4 emergency department visits were for infection or fever. These results highlight opportunities to optimize care for certain patients being actively treated for cancer, particularly around infectious complaints.

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Dataset Information

Emergency department use by pregnant women in Ontario: a retrospective population-based cohort study.

Background

Methods

Results

Interpretation

Publications

Emergency department use by pregnant women in Ontario: a retrospective population-based cohort study.

Similar Datasets

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