Factors associated with uncompleted emergency department care: a systematic review and meta-analysis

Uncompleted emergency department (ED) care is associated with an increased risk of adverse patient outcomes across diverse healthcare systems worldwide. This systematic review and meta-analysis aimed to identify factors associated with patients who leave the ED before completing their care and to explore potential strategies to address this issue. A systematic review and meta-analysis were conducted by searching six bibliographic databases: Embase, Web of Science Core Collection, Ovid MEDLINE All, Scopus, CINAHL and the Cochrane Library. Observational studies investigating factors associated with uncompleted ED care were included. Crude odds ratios (ORs) were calculated from the available event counts and total numbers of participants and were pooled using a random-effects Mantel-Haenszel model. For factors reported as mutually exclusive categories, category-specific estimates were analyzed separately. Sensitivity analyses were performed to evaluate the robustness of the findings and investigate potential sources of statistical heterogeneity. The results were presented using forest plots. Twelve studies met the inclusion criteria. The incidence of uncompleted ED care ranged from 0.76% to 13.12%. Pooled analyses indicated potential associations between uncompleted ED care and male sex, arrival without emergency medical services support, weekend presentation, and non-trauma presentations. Additional factors, including longer waiting times, younger age (≤ 64 years), lower emergency acuity (low-acuity and no-acuity), winter season, and presentation during off-peak hours (15:00–06:59), were also associated with increased odds of uncompleted ED care. However, these associations were accompanied by substantial statistical heterogeneity and should therefore be interpreted with caution. Uncompleted ED care appears to be associated with several patient- and system-level factors. However, the certainty of these associations varies, and several findings should be considered exploratory because of substantial heterogeneity and limited available evidence. Further research using standardized definitions and more comparable study designs is required to strengthen the evidence base before targeted interventions can be prioritized. CRD42025635833.