Factors associated with discharge home in older patients admitted to emergency department observation units: Looking for a predictive scale.

BACKGROUND: The selection of patients who are going to be admitted to an emergency department observation unit (EDOU) is essential for the good management of these units, intended fundamentally to avoid unnecessary hospitalization of patients. This is especially important when dealing with older pat...

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Autores: Montero-Pérez FJ, Bajo-Fernández I, González-Del Castillo J, Burillo-Putze G, Jacob J, Aguiló S, Piñera-Salmerón P, Alquezar-Arbé A, Fernández-Alonso C, Llorens P, Cho JH, Casado-Ramón B, Gayoso-Martín S, Sánchez-Sindín G, Fernández-Álvarez ME, Gallardo-Vizcaíno P, Romero-Carrete C, Llauger L, Vázquez-Rey V, Calle-Fernández S, Cañete M, Ruescas E, Fernández-Salgado F, Miró Ò
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p17633
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/17633
Access Level:acceso abierto
Palabra clave:discharge criteria
emergency department
geriatrics
observation Unit
older patients
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spelling Factors associated with discharge home in older patients admitted to emergency department observation units: Looking for a predictive scale.Montero-Pérez FJBajo-Fernández IGonzález-Del Castillo JBurillo-Putze GJacob JAguiló SPiñera-Salmerón PAlquezar-Arbé AFernández-Alonso CLlorens PCho JHCasado-Ramón BGayoso-Martín SSánchez-Sindín GFernández-Álvarez MEGallardo-Vizcaíno PRomero-Carrete CLlauger LVázquez-Rey VCalle-Fernández SCañete MRuescas EFernández-Salgado FMiró Òdischarge criteriaemergency departmentgeriatricsobservation Unitolder patientsBACKGROUND: The selection of patients who are going to be admitted to an emergency department observation unit (EDOU) is essential for the good management of these units, intended fundamentally to avoid unnecessary hospitalization of patients. This is especially important when dealing with older patients. It would be important to know what factors are associated with discharge home and to have a clinical predictive scale that appropriately selects older patients who are going to be admitted to an EDOU. METHODS: A retrospective cross-sectional study was conducted of all patients =65 years of age assisted in 48 Spanish Emergency Departments for 7 consecutive days and were admitted to the EDOU. Demographics-functional, vital signs data and initial laboratory results were analyzed to investigate its association with discharge home and develop and validate a prediction model for discharge home from EDOU. Multivariable logistic regression was performed to develop a prediction model, and a scoring system was created. RESULTS: Among 5457 patients admitted to the EDOU from the emergency room, 2508 (46%) patients were discharged home, and 2949 (54%) were admitted to the hospital. Five variables were strongly associated with discharge home: the absence of fever (adjusted OR: 3.61, 95% CI:1.53-8.54), Glasgow Coma Scale score of 15 points (2.80, 1.63-4.82), absence of tachypnea (2.51, 1.74-3.64) or leukocytosis (2.07, 1.70-2.52) and oxygen saturation >94% (2.00, 1.64-2.43). The final model achieved an area under the receiver operating characteristic curve of 0.648 (IC95% = 0.627-0.668) in the development cohort and 0.635 (0.614-0.656) in the validation cohort. CONCLUSIONS: There are factors associated with a greater probability of discharge home of older patients admitted to EDOUs. Prediction at the individual level remains elusive, as the best model obtained in this study did not have sufficient validity to be applied in the clinical setting.Wiley-Blackwell Publishing Ltd2025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fisabio.portalinvestigacion.com/publicaciones/17633Journal of Evaluation in Clinical PracticeISSN: 13652753ISSNe: 13561294reponame:r-FISABIO. Repositorio Institucional de Producción Científicainstname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)Inglésinfo:eu-repo/semantics/openAccessoai:fisabio.fundanetsuite.com:p176332026-06-11T12:45:17Z
dc.title.none.fl_str_mv Factors associated with discharge home in older patients admitted to emergency department observation units: Looking for a predictive scale.
title Factors associated with discharge home in older patients admitted to emergency department observation units: Looking for a predictive scale.
spellingShingle Factors associated with discharge home in older patients admitted to emergency department observation units: Looking for a predictive scale.
Montero-Pérez FJ
discharge criteria
emergency department
geriatrics
observation Unit
older patients
title_short Factors associated with discharge home in older patients admitted to emergency department observation units: Looking for a predictive scale.
title_full Factors associated with discharge home in older patients admitted to emergency department observation units: Looking for a predictive scale.
title_fullStr Factors associated with discharge home in older patients admitted to emergency department observation units: Looking for a predictive scale.
title_full_unstemmed Factors associated with discharge home in older patients admitted to emergency department observation units: Looking for a predictive scale.
title_sort Factors associated with discharge home in older patients admitted to emergency department observation units: Looking for a predictive scale.
dc.creator.none.fl_str_mv Montero-Pérez FJ
Bajo-Fernández I
González-Del Castillo J
Burillo-Putze G
Jacob J
Aguiló S
Piñera-Salmerón P
Alquezar-Arbé A
Fernández-Alonso C
Llorens P
Cho JH
Casado-Ramón B
Gayoso-Martín S
Sánchez-Sindín G
Fernández-Álvarez ME
Gallardo-Vizcaíno P
Romero-Carrete C
Llauger L
Vázquez-Rey V
Calle-Fernández S
Cañete M
Ruescas E
Fernández-Salgado F
Miró Ò
author Montero-Pérez FJ
author_facet Montero-Pérez FJ
Bajo-Fernández I
González-Del Castillo J
Burillo-Putze G
Jacob J
Aguiló S
Piñera-Salmerón P
Alquezar-Arbé A
Fernández-Alonso C
Llorens P
Cho JH
Casado-Ramón B
Gayoso-Martín S
Sánchez-Sindín G
Fernández-Álvarez ME
Gallardo-Vizcaíno P
Romero-Carrete C
Llauger L
Vázquez-Rey V
Calle-Fernández S
Cañete M
Ruescas E
Fernández-Salgado F
Miró Ò
author_role author
author2 Bajo-Fernández I
González-Del Castillo J
Burillo-Putze G
Jacob J
Aguiló S
Piñera-Salmerón P
Alquezar-Arbé A
Fernández-Alonso C
Llorens P
Cho JH
Casado-Ramón B
Gayoso-Martín S
Sánchez-Sindín G
Fernández-Álvarez ME
Gallardo-Vizcaíno P
Romero-Carrete C
Llauger L
Vázquez-Rey V
Calle-Fernández S
Cañete M
Ruescas E
Fernández-Salgado F
Miró Ò
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv discharge criteria
emergency department
geriatrics
observation Unit
older patients
topic discharge criteria
emergency department
geriatrics
observation Unit
older patients
description BACKGROUND: The selection of patients who are going to be admitted to an emergency department observation unit (EDOU) is essential for the good management of these units, intended fundamentally to avoid unnecessary hospitalization of patients. This is especially important when dealing with older patients. It would be important to know what factors are associated with discharge home and to have a clinical predictive scale that appropriately selects older patients who are going to be admitted to an EDOU. METHODS: A retrospective cross-sectional study was conducted of all patients =65 years of age assisted in 48 Spanish Emergency Departments for 7 consecutive days and were admitted to the EDOU. Demographics-functional, vital signs data and initial laboratory results were analyzed to investigate its association with discharge home and develop and validate a prediction model for discharge home from EDOU. Multivariable logistic regression was performed to develop a prediction model, and a scoring system was created. RESULTS: Among 5457 patients admitted to the EDOU from the emergency room, 2508 (46%) patients were discharged home, and 2949 (54%) were admitted to the hospital. Five variables were strongly associated with discharge home: the absence of fever (adjusted OR: 3.61, 95% CI:1.53-8.54), Glasgow Coma Scale score of 15 points (2.80, 1.63-4.82), absence of tachypnea (2.51, 1.74-3.64) or leukocytosis (2.07, 1.70-2.52) and oxygen saturation >94% (2.00, 1.64-2.43). The final model achieved an area under the receiver operating characteristic curve of 0.648 (IC95% = 0.627-0.668) in the development cohort and 0.635 (0.614-0.656) in the validation cohort. CONCLUSIONS: There are factors associated with a greater probability of discharge home of older patients admitted to EDOUs. Prediction at the individual level remains elusive, as the best model obtained in this study did not have sufficient validity to be applied in the clinical setting.
publishDate 2025
dc.date.none.fl_str_mv 2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fisabio.portalinvestigacion.com/publicaciones/17633
url https://fisabio.portalinvestigacion.com/publicaciones/17633
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Wiley-Blackwell Publishing Ltd
publisher.none.fl_str_mv Wiley-Blackwell Publishing Ltd
dc.source.none.fl_str_mv Journal of Evaluation in Clinical Practice
ISSN: 13652753
ISSNe: 13561294
reponame:r-FISABIO. Repositorio Institucional de Producción Científica
instname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
instname_str Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
reponame_str r-FISABIO. Repositorio Institucional de Producción Científica
collection r-FISABIO. Repositorio Institucional de Producción Científica
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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