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Karamercan MA, Dündar DZ, Slagman A, Ergin M, Janssens KAC, Fabbri A, Bjornsen LP, Somodi S, Adam VN, Polyzogopoulou E, Demir HA, Laribi S. Epidemiology of geriatric patients presenting to emergency departments in Europe: EGERS study. Eur J Emerg Med 2023; 30:117-124. [PMID: 36719188 DOI: 10.1097/mej.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND IMPORTANCE Patients aged 65 and above constitute a large and growing part of emergency department (ED) visits in western countries. OBJECTIVE The primary aim of this European prospective study was to determine the epidemiologic characteristics of elderly patients presenting to EDs across Europe. Our secondary objective was to determine the hospitalization rate, characteristics, and in-hospital mortality rates of geriatric patients presenting to EDs. DESIGN SETTING AND PARTICIPANTS An observational prospective cohort study over seven consecutive days between 19 October and 30 November 2020, in 36 EDs from nine European countries. Patients aged 65 years and older presenting to EDs with any complaint during a period of seven consecutive days were included. OUTCOME MEASURES Data were collected on demographics, the major presenting complaint, the presenting vital signs, comorbidities, usual medication, and outcomes after the ED, including disposition, in-hospital outcome, and the final hospital diagnosis. The patients were stratified into three groups: old (65-74 years), older (75-84 years), and oldest age (>85 years). MAIN RESULTS A total of 5767 patients were included in the study. The median age of the patients was 77 (interquartile range: 71-84) years. The majority presented with a non-traumatic complaint (81%) and about 90% of the patients had at least one comorbid disease and were on chronic medication. An ED visit resulted in subsequent hospital admission in 51% of cases, with 9% of patients admitted to an intensive care unit. Overall in-hospital mortality was 8%, and ED mortality was 1%. Older age was associated with a higher female proportion, comorbidities, need for home care service, history of previous falls, admission rates, length of ED, and hospital stay. CONCLUSION The characteristics of ED elderly patients and their subsequent hospital stay are reported in this prospective study.
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Affiliation(s)
- Mehmet A Karamercan
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara
| | - Defne Z Dündar
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara
| | - Ana Slagman
- Division of Emergency and Acute Medicine, Campus Virchow Klinikum and Charité Campus Mitte, Charite Universitatmedizin, Berlin, Germany
| | - Mehmet Ergin
- Department of Emergency Medicine, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | | | - Andrea Fabbri
- Dipartimento Emergenza, Azienda USL della Romagna, Forli, Italy
| | - Lars P Bjornsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sándor Somodi
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Visnja N Adam
- Department of Anesthesiology, Resuscitation and Intensive Care, Clinical Hospital Sveti Duh, Zagreb, Croatia
| | - Effie Polyzogopoulou
- Emergency Medicine Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Hüseyin A Demir
- Department of Emergency Medicine, Sanliurfa Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
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Simon NR, Jauslin AS, Bingisser R, Nickel CH. Emergency presentations of older patients living with frailty: Presenting symptoms compared with non-frail patients. Am J Emerg Med 2022; 59:111-117. [PMID: 35834872 DOI: 10.1016/j.ajem.2022.06.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Symptoms may differ between frail and non-frail patients presenting to Emergency Departments (ED). However, the association between frailty status and type of presenting symptoms has not been investigated. We aimed to systematically analyse presenting symptoms in frail and non-frail older emergency patients and hypothesized that frailty may be associated with nonspecific complaints (NSC), such as generalised weakness. METHODS Secondary analysis of a prospective, single centre, observational all-comer cohort study conducted in the ED of a Swiss tertiary care hospital. All presentations of patients aged 65 years and older were analysed. At triage, presenting symptoms and frailty were systematically assessed using a questionnaire. Patients with a Clinical Frailty Scale (CFS) > 4 were considered frail. Presenting symptoms, stratified by frailty status, were analysed. The association between frailty and generalised weakness was tested by logistic regression. RESULTS Overall, 2'416 presentations of patients 65 years and older were analysed. Mean age was 78.9 (SD 8.4) years, 1'228 (50.8%) patients were female, and 885 (36.6%) patients were frail (CFS > 4). Generalised weakness, dyspnea, localised weakness, speech disorder, loss of consciousness and gait disturbance were recorded more often in frail patients, whereas chest pain was reported more often by non-frail patients. Generalised weakness was reported as presenting symptom in 166 (18.8%) frail patients and in 153 (10.0%) non-frail patients. Frailty was associated with generalised weakness after adjusting for age, gender and elevated National Early Warning Score 2 (NEWS) ≥ 3 (OR 1.19, CI 1.10-1.29, p < 0.001). CONCLUSION Presenting symptoms differ in frail and non-frail patients. Frailty is associated with generalised weakness at ED presentation.
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Affiliation(s)
- N R Simon
- Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland.
| | - A S Jauslin
- Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland.
| | - R Bingisser
- Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland.
| | - C H Nickel
- Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland.
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Raven W, van den Hoven EMP, Gaakeer MI, Ter Avest E, Sir O, Lameijer H, Hessels RAPA, Reijnen R, van Zwet E, de Jonge E, Nickel CH, de Groot B. The association between presenting complaints and clinical outcomes in emergency department patients of different age categories. Eur J Emerg Med 2022; 29:33-41. [PMID: 34406137 DOI: 10.1097/mej.0000000000000860] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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). RESULTS We 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.
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Affiliation(s)
- Wouter Raven
- Department of Emergency Medicine, Leiden University Medical Centre, Leiden
| | | | | | - Ewoud Ter Avest
- Department of Emergency Medicine, University Medical Centre Groningen, Groningen
| | - Ozcan Sir
- Department of Emergency Medicine, Radboud University Medical Centre, Nijmegen
| | - Heleen Lameijer
- Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden
| | | | - Resi Reijnen
- Department of Emergency Medicine, Haaglanden Medical Centre, The Hague
| | - Erik van Zwet
- Department of Biostatistics, Leiden University Medical Centre, Leiden
| | - Evert de Jonge
- Department of Intensive Care, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Bas de Groot
- Department of Emergency Medicine, Leiden University Medical Centre, Leiden
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Pakdemirli A, Bayram B, Güvenç E, Ellidokuz H. Evaluation of ambulance calls for patients over 65 years of age in İzmir, Turkey: a two- year retrospective analysis. Turk J Med Sci 2021; 51:1253-1260. [PMID: 33726483 PMCID: PMC8283469 DOI: 10.3906/sag-2010-152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background/aim Analysis of interventions for special patient groups is important for the planning of health services, especially emergency medical services. In this study, we aimed to evaluate emergency medical service (EMS) interventions for the elderly and determine the decisive factors affecting transfer to the hospital of EMS team over 2 years (2017 and 2018) in İzmir. Materials and methods Records of 112 emergency calls that were made between 2017 and 2018 followed up with interventions for patients aged 65 years and older were obtained from the 112 system. The reasons for the calls, outcomes, possible diagnoses of the patients, differences in time intervals and seasons, characteristics of the patients transferred to the hospital, and factors affecting the need for transfer to the hospital were investigated. Results A total of 176,104 elderly patients with a mean age of 78.02 ± 8.0 years required ambulance services, and out of them, 66% were transferred to the hospital. Transfer to the hospital was significantly associated with the event location, sex, time interval, international classification of diseases (ICD) codes, and physical examination findings. Conclusion Ambulance interventions are more frequently required in urban areas than in the countryside, and calls are mostly made during daytime hours and during winter months. The decision to transfer a patient to the hospital is based on the patient’s respiratory status, skin examination, state of consciousness, pulse, systolic blood pressure, call time, and the preliminary diagnosis of the crew.
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Affiliation(s)
- Ahu Pakdemirli
- Department of Physiology, Gülhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Başak Bayram
- Department of Emergency Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Erkan Güvenç
- Department of Emergency Medicine, Buca Seyfi Demirsoy State Hospital, İzmir, Turkey
| | - Hülya Ellidokuz
- Department of Preventative Oncology, Dokuz Eylül University, İzmir, Turkey
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Kelly AM, Keijzers G, Klim S, Craig S, Kuan WS, Holdgate A, Graham CA, Jones P, Laribi S. Epidemiology and outcome of older patients presenting with dyspnoea to emergency departments. Age Ageing 2021; 50:252-257. [PMID: 32997140 DOI: 10.1093/ageing/afaa121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/02/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To describe the epidemiology and outcomes of non-traumatic dyspnoea in patients aged 75 years or older presenting to emergency departments (EDs) in the Asia-Pacific region. METHODS A substudy of a prospective interrupted time series cohort study conducted at three time points in EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia of patients presenting to the ED with dyspnoea as a main symptom. Data were collected over three 72-h periods and included demographics, co-morbidities, mode of arrival, usual medications, ED investigations and treatment, ED diagnosis and disposition, and outcome. The primary outcomes of interest are the epidemiology and outcome of patients aged 75 years or older presenting to the ED with dyspnoea. RESULTS 1097 patients were included. Older patients with dyspnoea made up 1.8% [95% confidence interval (CI) 1.7-1.9%] of ED presentations. The most common diagnoses were heart failure (25.3%), lower respiratory tract infection (25.2%) and chronic obstructive pulmonary disease (17.6%). Hospital ward admission was required for 82.6% (95% CI 80.2-84.7%), with 2.5% (95% CI 1.7-3.6%) requiring intensive care unit (ICU) admission. In-hospital mortality was 7.9% (95% CI 6.3-9.7%). Median length of stay was 5 days (interquartile range 2-8 days). CONCLUSION Older patients with dyspnoea make up a significant proportion of ED case load, and have a high admission rate and significant mortality. Exacerbations or worsening of pre-existing chronic disease account for a large proportion of cases which may be amenable to improved chronic disease management.
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Affiliation(s)
- Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine Australia and Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, St Albans, VLC, Parkville, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia and School of Medicine, Bond University, Gold Coast, QLD, Australia and School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Sharon Klim
- Joseph Centre for Emergency Medicine Research @ Western Health, Sunshine, Australia and The University of Melbourne, Parkville, Australia
| | - Simon Craig
- Emergency Department, Monash Medical Centre, Clayton, Australia; School of Clinical Sciences, Monash University, Clayton, Australia and Murdoch Children’s Research Institute, Parkville, Australia
| | - Win Sen Kuan
- Emergency Medicine Department, National University Health System, Singapore and Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore
| | - Anna Holdgate
- Department of Emergency Medicine, Liverpool Hospital, Sydney, Australia and University of New South Wales (Southwest Clinical School), Sydney, Australia
| | - Colin A Graham
- Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Peter Jones
- Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, 37044 Tours, France
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