Written by Clay Smith
Spoon Feed
Emergency physician (EP) advancing age was associated with higher 7-day patient mortality. This is a call to keep current with the literature, clinical skills, and best practices.
Read Less, Learn More, SAVE LIVES – Our tagline may be more true than we thought…
This was a retrospective study of 2,629,464 Medicare patients 65-89 years of age, seen by 32,570 EPs, that compared 7-day mortality rates, stratified by age of the treating EP, while adjusting for potential confounders that could impact mortality. Disturbingly, they found that adjusted mortality rates went up as EP age went up: <40 years, 1.33%; 40-49, 1.36%; 50-59, 1.40%; ≥60, 1.43%. Differences, compared to <40 years old, were all statistically significant. Assuming this association is true, comparing a physician <40 to ≥60, this means 1 additional death for every 909 patients.
I really didn’t want this study to be true. For each confounder I thought of, the authors addressed it, except that older EPs tended to work in smaller, rural EDs than younger docs: 19.6% ≥60 years worked in small hospitals (<100 beds) vs 9.3% <40 years old. Authors did not adjust for this.
How will this change my practice?
This study makes me concerned. However, we still don’t know why this association exists. A plausible reason discussed was the difficulty of staying current with the latest literature and guidelines. Our tagline: Read Less, Learn More, Save Lives may be more true than I realized when I wrote it. Others can help you keep up too: EM:RAP EMA, ERcast, Journal Watch, EMCrit, and more. Whether you read JournalFeed or something else, as you advance in years of practice, you have to keep up. We’re honored you choose JournalFeed to help you save lives!
Source
Association Between Emergency Physician’s Age and Mortality of Medicare Patients Aged 65 to 89 Years After Emergency Department Visit. Ann Emerg Med. 2023 Sep;82(3):301-312. doi: 10.1016/j.annemergmed.2023.02.010. Epub 2023 Mar 23.
I would also wonder what the rates of unnecessary testing that resulted in complications in mortality or morbidity from less experienced physicians. I think being “up to date” is not anywhere as relevant as the inevitable “cutting corners” that comes with age & experience- seeing the 99999th chest pain vs the 10th.
In the end I think what makes the best ER doc is humility hard work & thick skin.
Raw mortality figures are misleading because you not asking whether it was more appropriate to let someone die with dignity in the ED rather than simply passing the patient, and the decision, onto to an inpatient unit to die later which ultimately contributes to boarding of patients in the ED. Medicine is both an art and a science. The art is knowing when to apply the science. Experience helps to make the decision when less is more.
This is an important potential confounder that’s very hard to measure. But this could have played a role.