학술논문
Older Adult Patients in the Emergency Department: Which Patients should be Selected for a Different Approach?
Document Type
Article
Author
Larrea Aguirre, Nere; García Gutiérrez, Susana; Miro, Oscar; Aguiló, Sira; Jacob, Javier; Alquézar-Arbé, Aitor; Burillo, Guillermo; Fernandez, Cesáreo; Llorens, Pere; Roza Alonso, Cesar; Tavasci Lopez, Ivana; Cañete, Mónica; Ruiz Asensio, Pedro; Paderne Díaz, Beatriz; Pablos Pizarro, Teresa; del Rio Navarro, Rigoberto Jesús; Perelló Viola, Núria; Hernández-Castells, Lourdes; Cortés Soler, Alejandro; Sánchez Fernández-Linares, Elena
Source
Subject
*OLDER patients
*EMERGENCY medicine
*PATIENT reported outcome measures
*COMORBIDITY
*PATIENT readmissions
*FRAIL elderly
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Language
ISSN
2508-4798
Abstract
Background: While multidimensional and interdisciplinary assessment of older adult patients improves their short-term outcomes after evaluation in the emergency department (ED), this assessment is time-consuming and ill-suited for the busy environment. Thus, identifying patients who will benefit from this strategy is challenging. Therefore, this study aimed to identify older adult patients suitable for a different ED approach as well as independent variables associated with poor short-term clinical outcomes. Methods: We included all patients =65 years attending 52 EDs in Spain over 7 days. Sociodemographic, comorbidity, and baseline functional status data were collected. The outcomes were 30-day mortality, re-presentation, hospital readmission, and the composite of all outcomes. Results: During the study among 96,014 patients evaluated in the ED, we included 23,338 patients =65 years--mean age, 78.4±8.1 years; 12,626 (54.1%) women. During follow-up, 5,776 patients (24.75%) had poor outcomes after evaluation in the ED: 1,140 (4.88%) died, 4,640 (20.51) returned to the ED, and 1,739 (7.69%) were readmitted 30 days after discharge following the index visit. A model including male sex, age =75 years, arrival by ambulance, Charlson Comorbidity Index =3, and functional impairment had a C-index of 0.81 (95% confidence interval, 0.80-0.82) for 30-day mortality. Conclusion: Male sex, age =75 years, arrival by ambulance, functional impairment, or severe comorbidity are features of patients who could benefit from approaches in the ED different from the common triage to improve the poor short-term outcomes of this population. [ABSTRACT FROM AUTHOR]