The association between presenting complaints and clinical outcomes in emergency department patients of different age categories

Abstract

Background and importance Although aging societies in Western Europe use presenting complaints (PCs) in emergency departments (EDs) triage systems to determine the urgency and severity of the care demand, it is unclear whether their prognostic value is age-dependent.Objective To assess the frequency and association of PCs with hospitalization and mortality across age categories.Methods An observational multicenter study using all consecutive visits of three EDs in the Netherlands Emergency department Evaluation Database. Patients were stratified by age category (0-18; 19-50; 51-65; 66-80; >80 years), in which the association between PCs and case-mix adjusted hospitalization and mortality was studied using multivariable logistic regression analysis (adjusting for demographics, hospital, disease severity, comorbidity and other PCs) ResultsWe included 172 104 ED-visits. The most frequent PCs were 'extremity problems' [range across age categories (13.5-40.8%)], 'feeling unwell' (9.5-23.4%), 'abdominal pain' (6.0-13.9%), 'dyspnea' (4.5-13.3%) and 'chest pain' (0.6-10.7%). For most PCs, the observed and the case-mix-adjusted odds for hospitalization and mortality increased the higher the age category. The most common PCs with the highest adjusted odds ratios (AORs, 95% CI) for hospitalization were 'diarrhea and vomiting ' [2.30 (2.02-2.62)] and 'feeling unwell ' [1.60 (1.48-1.73)]. Low hospitalization risk was found for 'chest pain ' [0.58 (0.53-0.63)] and 'palpitations' [0.64 (0.58-0.71)]. Conclusions Frequency of PCs in ED patients varies with age, but the same PCs occur in all age categories. For most PCs, (case-mix adjusted) hospitalization and mortality vary across age categories. 'Chest pain' and 'palpitations, ' usually triaged 'very urgent', carry a low risk for hospitalization and mortality.

Elderly patients with non-specific complaints at the emergency department have a high risk for admission and 30-days mortality

“…Chest pain as chief complaint will be prioritized higher at the ED compared to NSC. This study is in line with earlier studies and shows that patients with NSC have a higher admission rate and mortality rate than patients presenting with chest pain at the ED [ 36 ]. In addition, patients with NSC have a longer LOS at the ED, a high admission rate and the highest number of bed-days once admitted.…”

Comparison of emergency department workloads before and during the COVID-19 pandemic as assessed using relative value units

“…The workload varies depending on the patient. 1,2 Thus, the actual workload performed by an emergency physician (EP) may not match the number of patients they see.…”

“…However, the ED is an environment where many patients with various medical complaints and needs are seen every day. The workload varies depending on the patient [ 1 , 2 ]. Thus, the actual workload performed by an emergency physician (EP) may not match the number of patients they see.…”

Use TRIPOD when validating clinical prediction models

“…For example, an NTS score of U3 may be triggered for ‘humane reasons’ if the patient is stable, but is in pain, or simply feeling unwell. Alhough such complaints can be related to mortality,5 they may also be unrelated to one’s risk of death or admission but trigger appropriate responses to relieve physical or mental suffering. Relieving suffering should be a core task for any ED, but it challenges our conception of urgency.…”