Older Adult Patients in the Emergency Department: Which Patients should be Selected for a Different Approach?

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 fro...

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Detalles Bibliográficos
Autores: Aguirre, NL, Gutiérrez, SG, Miro, O, Aguiló, S, Jacob, J, Alquézar-Arbé, A, Burillo, G, Fernandez, C, Llorens, P, Alanso, CR, Lopez, IT, Cañete, M, Asensio, PR, Díaz, BP, Pizarro, TP, Navarro, RJD, Viola, NP, Hernández-Castells, L, Soler, AC, Fernández-Linares, ES, Serrano, JAS, Ezponda, P, Lorenzo, AM, Liarte, JVO, Ramón, SS, Aranda, AR, Martín-Sánchez, FJ, del Castillo, JG
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p19158
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/19158
Access Level:acceso abierto
Palabra clave:Emergencies
Geriatrics
Frail elderly
Triage
Descripción
Sumario: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.

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