Disability and morbidity among older patients in the emergency department: a Danish population-based cohort study

Tanderup, Anette; Lassen, Annmarie Touborg; Rosholm, Jens-Ulrik; Ryg, Jesper

doi:10.1136/bmjopen-2018-023803

Cited by 26 publications

(32 citation statements)

References 67 publications

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“…The increased mortality rates observed in the aged patients visiting the ED in our study were of similar magnitudes as shown before [6, 16]. In the here presented data, patients in the oldest age group and with the lowest triage priority had a 16 and 21-fold increased risk for 7 and 30-days mortality compared to patients in the youngest age group.…”

Section: Discussionsupporting

confidence: 90%

Age is associated with increased mortality in the RETTS-A triage scale

et al. 2019

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Background Triage is widely used in the emergency department (ED) in order to identify the patient’s level of urgency and often based on the patient’s chief complaint and vital signs. Age has been shown to be independently associated with short term mortality following an ED visit. However, the most commonly used ED triage tools do not include age as an independent core variable. The aim of this study was to investigate the relationship between age and 7- and 30-day mortality across the triage priority level groups according to Rapid Emergency Triage and Treatment System – Adult (RETTS-A), the most widely used triage tool in Sweden. Methods In this cohort, we included all adult patients visiting the ED at the Karolinska University Hospital, Sweden, from 1/1/2010 to 1/1/2015, n = 639,387. All patients were triaged according to the RETTS-A and subsequently separated into three age strata: 18–59, 60–79 and ≥ 80 years. Descriptive analyses and logistic regression was used. The primary outcome measures were 7- and 30-day mortality. Results We observed that age was associated with both 7 and 30-day mortality in each triage priority level group. Mortality was higher in older patients across all triage priority levels but the association with age was stronger in the lowest triage group ( p -value for interaction = < 0.001). Comparing patients ≥80 years with patients 18–59 years, older patients had a 16 and 7 fold higher risk for 7 day mortality in the lowest and highest triage priority groups, respectively. The corresponding numbers for 30-d mortality were a 21- and 8-foldincreased risk, respectively. Conclusion Compared to younger patients, patients above 60 years have an increased short term mortality across the RETTS-A triage priority level groups and this was most pronounced in the lowest triage level. The reason for our findings are unclear and data suggest a validation of RETTS-A in aged patients.

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Section: Discussionsupporting

confidence: 90%

Age is associated with increased mortality in the RETTS-A triage scale

et al. 2019

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“…Nevertheless, the incremental risk of death across DSC classes was comparable in the two studies. Moreover, short and long-term mortality rate figures in the AIDEA cohort compare well to those reported by Tanderup et al : in a Danish study on 3775 subjects aged 65+ years accessing the ED, 30-day and 1-year cumulative mortality increased progressively, from 2.2% to 10.6% and from 8% to 39%, respectively, with the number of geriatric conditions (from 0 to 4), identified on the basis of comprehensive geriatric assessment 27. The similarity between Tanderup’s and our estimates provides further, indirect support to the external validity of the DSC: the absolute mortality risk is indeed crucial, more than HR, to take appropriate decisions on treatment level.…”

Section: Discussionsupporting

confidence: 85%

“…Their clinical presentation is frequently characterised not by a single, well-defined disease, but rather by an entangled combination of age-related changes, comorbidity, functional and cognitive impairment, polypharmacy and social problems. As a consequence, the risk of wrong triage, incorrect diagnosis and treatment, prolonged ED stay and inappropriate destination is substantial 27. Worsening disability, institutionalisation or death shortly after the ED access may be ultimate consequences 28…”

Section: Discussionmentioning

confidence: 99%

Real-time utilisation of administrative data in the ED to identify older patients at risk: development and validation of the Dynamic Silver Code

et al. 2019

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ObjectiveIdentification of older patients at risk, among those accessing the emergency department (ED), may support clinical decision-making. To this purpose, we developed and validated the Dynamic Silver Code (DSC), a score based on real-time linkage of administrative data.Design and settingThe ‘Silver Code National Project (SCNP)’, a non-concurrent cohort study, was used for retrospective development and internal validation of the DSC. External validation was obtained in the ‘Anziani in DEA (AIDEA)’ concurrent cohort study, where the DSC was generated by the software routinely used in the ED.ParticipantsThe SCNP contained 281 321 records of 180 079 residents aged 75+ years from Tuscany and Lazio, Italy, admitted via the ED to Internal Medicine or Geriatrics units. The AIDEA study enrolled 4425 subjects aged 75+ years (5217 records) accessing two EDs in the area of Florence, Italy.InterventionsNone.Outcome measuresPrimary outcome: 1-year mortality. Secondary outcomes: 7 and 30-day mortality and 1-year recurrent ED visits.ResultsAdvancing age, male gender, previous hospital admission, discharge diagnosis, time from discharge and polypharmacy predicted 1-year mortality and contributed to the DSC in the development subsample of the SCNP cohort. Based on score quartiles, participants were classified into low, medium, high and very high-risk classes. In the SCNP validation sample, mortality increased progressively from 144 to 367 per 1000 person-years, across DSC classes, with HR (95% CI) of 1.92 (1.85 to 1.99), 2.71 (2.61 to 2.81) and 5.40 (5.21 to 5.59) in class II, III and IV, respectively versus class I (p<0.001). Findings were similar in AIDEA, where the DSC predicted also recurrent ED visits in 1 year. In both databases, the DSC predicted 7 and 30-day mortality.ConclusionsThe DSC, based on administrative data available in real time, predicts prognosis of older patients and might improve their management in the ED.

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“…12 In the emergency department (ED), older adults commonly visit with severe illnesses, which have a high mortality rate and are at risk for the functional impairment after discharge. [13][14][15] Furthermore, an avoidable hospitalization due to dehydration costed approximately 1.14 billion USD in a year with higher charges when admitted from ED. 16 Detecting HD in these patients is crucial.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors of hypertonic dehydration among older patients admitted to the emergency department: A prospective cross‐sectional study

Buaprasert

Piyapaisarn

Vanichkulbodee

et al. 2021

Geriatrics Gerontology Int

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The prevalence of hypertonic dehydration (HD) among community-dwelling and hospitalized populations has been evaluated. However, to our knowledge, no study had previously focused on older patients admitted to the emergency department (ED). The present study aimed to evaluate the prevalence, risk factors and short-term outcomes of HD among Thai older patients admitted to the ED.Methods: This was a prospective cross-sectional study at one urban ED in Thailand. Patients aged ≥65 years who were admitted to the ED were enrolled into the study. Data including clinical hydration status, Charlson Comorbidity Index (CCI) score, activities of daily living score, current use of medications, laboratory examination results and serum osmolarity level were collected. HD was defined as a serum osmolarity level of >300 mOsm/kg. The short-term outcomes were a 30-day ED revisit, hospital readmission and mortality rates.Results: In total, 80 (21.6%) of 370 patients presented with HD. A CCI score of ≥5 was found associated with HD among older patients (adjusted odds ratio: 1.82; 95% confidence interval: 1.03-3.21). The ED revisit rates were 18.1% in the dehydrated group and 10.9% in the non-dehydrated group. The hospital readmission rates were 8.3% in the dehydrated group and 10.6% in the non-dehydrated group. Furthermore, the 30-day mortality rates were 6.9% and 5.3% in the dehydrated and non-dehydrated groups, respectively.Conclusions: One-fifth of older patients admitted to the ED presented with HD. A CCI score of ≥5 was considered a risk factor of HD. Moreover, further studies should focus on the long-term outcomes of HD and risk reduction.

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Disability and morbidity among older patients in the emergency department: a Danish population-based cohort study

Cited by 26 publications

References 67 publications

Age is associated with increased mortality in the RETTS-A triage scale

Age is associated with increased mortality in the RETTS-A triage scale

Real-time utilisation of administrative data in the ED to identify older patients at risk: development and validation of the Dynamic Silver Code

Prevalence and risk factors of hypertonic dehydration among older patients admitted to the emergency department: A prospective cross‐sectional study

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