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August 22, 2026BMC Health Services ResearchOpen Access

Emergency department crowding during a 360-day period: associations with patient dropouts and early mortality in a high-volume tertiary emergency department

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Authors

SDSlobodan DželebdžićBDBosiljka DjikanovicAMAleksandar Medarevic

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Overview

Retrospective study reveals crowding increases patient dropouts without altering early mortality in emergency care, suggesting operational metrics need pairing with clinical acuity tools.

Key Points

  • To evaluate emergency department crowding using the National Emergency Department Overcrowding Score and determine its associations with patients leaving without being seen and early 24-hour mortality.
  • Conducted a single-center retrospective analysis across 360 days (8,640 one-hour intervals) analyzing 178,679 emergency department visits at a tertiary emergency department in Serbia.
  • Calculated hourly National Emergency Department Overcrowding Score (NEDOCS) values and recorded waiting times, leave-without-being-seen (LWBS) events, and mortality within 24 hours of registration or admission.
  • Utilized Generalized Additive Models to evaluate non-linear relationships and Spearman's correlation to evaluate associations between crowding categories and clinical outcomes.
  • Across 178,679 visits, 8.3% resulted in inpatient hospital admission, 3.0% left without being seen (LWBS), and total early mortality within 24 hours was 0.43%.
  • Crowding peaked between 08:00–10:00 (p < 0.001) and showed a significant non-linear association with LWBS rates, increasing up to a NEDOCS value of ~129 before declining (Spearman correlation p < 0.001).
  • NEDOCS crowding categories exhibited no statistically significant association with early 24-hour mortality measures.

Cite This Study

Dželebdžić et al. (2026) studied this question.

synapsesocial.com/papers/6a895ffeca7ade938187eebehttps://doi.org/10.1186/s12913-026-14987-0
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Daily, weekly, and monthly dynamics of crowding in emergency department of university clinical centre Serbia: a one-year analysis of NEDOCS score2026
  2. 2Association between emergency department crowding and mortality: a nationwide analysis stratified by emergency department levels: a retrospective cohort study2026 · 1 citations
  3. 3Measuring Overcrowding in a Large Academic Tertiary Care Pediatric Emergency Department2024 · 5 citations
  4. 4Increases in Emergency Department Occupancy Are Associated With Adverse 30‐day Outcomes2014 · 100 citations
  5. 5Development and validation of a multivariable predictive model for Emergency Department Overcrowding based on the National Emergency Department Overcrowding Study (NEDOCS) score2024