Elderly 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...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2024 |
| País: | España |
| Institución: | Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL) |
| Repositorio: | r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante |
| OAI Identifier: | oai:isabial.fundanetsuite.com:p9986 |
| Acceso en línea: | https://isabial.portalinvestigacion.com/publicaciones9986 https://www.e-agmr.org/journal/view.php?doi=10.4235/agmr.23.0121 |
| Access Level: | acceso abierto |
| Palabra clave: | Emergencies Frail Older adult Geriatrics Triage |
| 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 d. 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 [SD 8.1] years, 12,626 (54.1%) women). During follow-up, 5,776 (24.75) patients 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 d after discharge following the index visit. A model including male sex, age =75 years, arrival by ambulance, Charlson Cormorbidity Index =3, and functional impairment had a C-index of 0.81 (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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