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Messelu MA, Amlak BT, Mekonnen GB, Belayneh AG, Tamre S, Adal O, Demile TA, Tsehay YT, Belay AE, Netsere HB, Wondie WT, Abebe GK, Mulatu S, Ayenew T. Mortality and its determinants among patients attending in emergency departments. BMC Emerg Med 2024; 24:125. [PMID: 39026180 PMCID: PMC11264723 DOI: 10.1186/s12873-024-01050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 07/12/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Due to the high burden of mortality from acute communicable and non-communicable diseases, emergency department's mortality has become one of the major health indices in Ethiopia that should be evaluated regularly in every health institution. However, there are inconsistencies between studies, and there is no systematic review or meta-analysis study about the prevalence of mortality in the emergency department. Therefore, this study aimed to determine the pooled prevalence of mortality and identify its determinants in the emergency departments of Ethiopian hospitals. METHODS This systematic review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and has been registered with PROSPERO. A structured search of databases (Medline/PubMed, Google Scholar, CINAHL, EMBASE, HINARI, and Web of Science) was undertaken. All observational studies reporting the prevalence of mortality of patients in emergency departments of Ethiopian hospitals, and published in English up to December 16, 2023, were considered for this review. Two reviewers independently assess the quality of the studies using the Joanna Briggs Institute (JBI) critical appraisal tool. A meta-analysis using a random-effects model was performed to estimate the pooled prevalence. The heterogeneity of studies was assessed using I2 statistics, and to identify the possible causes of heterogeneity, subgroup analysis and meta-regression were used. Egger's test and funnel plots were used to assess publication bias. STATA version 17.0 software was used for all the statistical analyses. A p-value less than 0.05 was used to declare statistical significance. RESULTS A total of 1363 articles were retrieved through electronic search databases. Subsequently, eighteen studies comprised 21,582 study participants were included for analysis. The pooled prevalence of mortality among patients in the Emergency Department (ED) was 7.71% (95% CI: 3.62, 11.80). Regional subgroup analysis showed that the pooled prevalence of mortality was 16.7%, 12.89%, 10.28%, and 4.35% in Dire Dawa, Amhara, Oromia, and Addis Ababa, respectively. Moreover, subgroup analysis based on patients' age revealed that the pooled prevalence of mortality among adults and children was 8.23% (95% CI: 3.51, 12.94) and 4.48% (95% CI: 2.88, 6.08), respectively. Being a rural resident (OR; 2.30, 95% CI: 1.48, 3.58), unconsciousness (OR; 3.86, 95% CI: 1.35, 11.04), comorbidity (OR; 2.82, 95% CI: 1.56, 5.09), and time to reach a nearby health facility (OR; 4.73, 95% CI: 2.19, 10.21) were determinants of mortality for patients in the emergency departments. CONCLUSION AND RECOMMENDATIONS This study found that the overall prevalence of mortality among patients in emergency departments of Ethiopian hospitals was high, which requires collaboration between all stakeholders to improve outcomes. Being a rural resident, unconsciousness, comorbidity, and time elapsed to reach health facilities were determinants of mortality. Improving pre-hospital care, training healthcare providers, early referral, and improving first-line management at referral hospitals will help to reduce the high mortality in our country.
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Affiliation(s)
- Mengistu Abebe Messelu
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
| | - Baye Tsegaye Amlak
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Gebrehiwot Berie Mekonnen
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Asnake Gashaw Belayneh
- Department of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Sosina Tamre
- Department of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ousman Adal
- Department of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tiruye Azene Demile
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yeshimebet Tamir Tsehay
- Department of Surgical Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Alamirew Enyew Belay
- Department of Surgical Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Henok Biresaw Netsere
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wubet Tazeb Wondie
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Gebremeskel Kibret Abebe
- Department of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Sileshi Mulatu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Temesgen Ayenew
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Iozzo P, Spina N, Cannizzaro G, Gambino V, Patinella A, Bambi S, Vellone E, Alvaro R, Latina R. Association between Boarding of Frail Individuals in the Emergency Department and Mortality: A Systematic Review. J Clin Med 2024; 13:1269. [PMID: 38592117 PMCID: PMC10932317 DOI: 10.3390/jcm13051269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Older patients who attend emergency departments are frailer than younger patients and are at a high risk of adverse outcomes; (2) Methods: To conduct this systematic review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. We systematically searched literature from PubMed, Embase, OVID Medline®, Scopus, CINAHL via EBSCOHost, and the Cochrane Library up to May 2023, while for grey literature we used Google Scholar. No time restrictions were applied, and only articles published in English were included. Two independent reviewers assessed the eligibility of the studies and extracted relevant data from the articles that met our predefined inclusion criteria. The Critical Appraisal Skills Program (CASP) was used to assess the quality of the studies; (3) Results: Evidence indicates that prolonged boarding of frail individuals in crowded emergency departments (Eds) is associated with adverse outcomes, exacerbation of pre-existing conditions, and increased mortality risk; (4) Conclusions: Our results suggest that frail individuals are at risk of longer ED stays and higher mortality rates. However, the association between the mortality of frail patients and the amount of time a patient spends in exposure to the ED environment has not been fully explored. Further studies are needed to confirm this hypothesis.
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Affiliation(s)
- Pasquale Iozzo
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy; (E.V.); (R.A.)
| | - Noemi Spina
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”, Via del Vespro, 129, 90127 Palermo, Italy; (N.S.); (G.C.); (V.G.); (A.P.)
| | - Giovanna Cannizzaro
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”, Via del Vespro, 129, 90127 Palermo, Italy; (N.S.); (G.C.); (V.G.); (A.P.)
| | - Valentina Gambino
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”, Via del Vespro, 129, 90127 Palermo, Italy; (N.S.); (G.C.); (V.G.); (A.P.)
| | - Agostina Patinella
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”, Via del Vespro, 129, 90127 Palermo, Italy; (N.S.); (G.C.); (V.G.); (A.P.)
| | - Stefano Bambi
- Department of Health Sciences, University of Florence, Viale GB Morgagni, 48, 50134 Florence, Italy;
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy; (E.V.); (R.A.)
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wrocław, Poland
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy; (E.V.); (R.A.)
| | - Roberto Latina
- Department of Health Promotion Science, Maternal and Infant Care, Internal Medicine, and Medical Specialities (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy;
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Ren W, Ma X, Tarimo CS, Xing Y, Lv X, Liang Z. A study on the current state and equity level of the health promotion service demands among older adults in China. Int J Equity Health 2023; 22:67. [PMID: 37055791 PMCID: PMC10103517 DOI: 10.1186/s12939-023-01882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/04/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Meeting the demands of older adults for health promotion services (DOAHPS) is essential for maintaining their health and enhancing their quality of life. The purpose of this study was to construct a model for evaluating DOAHPS to quantitatively evaluate the current state and equity level of DOAHPS in China, as well as to explore the main factors affecting DOAHPS' current state and equity level. METHODS This study analyzed the DOAHPS data from the "Survey on Chinese Residents' Health Service Demands in the New Era", which included 1542 older adults aged 65 and older. Relationships between evaluation indicators of DOAHPS were explored using Structural Equation Modeling (SEM). The Weighted TOPSIS method and Logistic regression (LR) were used to analyze the current state and factors impacting DOAHPS. The equity level of DOAHPS' allocation among different older adult groups and its influencing factors were determined using the Rank Sum Ratio (RSR) method and T Theil index. RESULTS The evaluation score for DOAHPS was 42.57 ± 1.51. Health status, health literacy and behavior were positively correlated with DOAHPS (r = 0.40, 0.38; P < 0.05). The LR results revealed that the most significant determinants of DOAHPS were sex, residence, education level and pre-retirement occupation (all P < 0.05). The number of older adults with very poor, poor, general, high and very high level health promotion service demands accounted for 2.27%, 28.60%, 53.05%, 15.43% and 0.65%, respectively. The total T Theil index of DOAHPS was 2.7433*10-4, and the intra-group difference contribution rate exceeded 72%. CONCLUSIONS Compared to the maximum level, the total DOAHPS level was found to be moderate, although the demands of urban seniors with higher levels of education may be substantially greater. The observed inequities in the allocation of DOAHPS were primarily related to differences in education level and pre-retirement occupation within group. To better address health promotion services for older adults, policymakers could target older males with low education who reside in rural regions.
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Affiliation(s)
- Weicun Ren
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Xiwang Ma
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Clifford Silver Tarimo
- College of Public Health, Zhengzhou University, Zhengzhou, China
- Department of Science and Laboratory Technology, Dares Salaam Institute of Technology, Dares Salaam, Tanzania
| | - Yiqing Xing
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Xinyuan Lv
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Zhang Liang
- School of Political Science and Public Administration, Wuhan University, Wuhan, China.
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Tarkie K, Altaye KD, Berhe YW. Current patterns of care at adult emergency department in Ethiopian tertiary university hospital. Int J Emerg Med 2023; 16:25. [PMID: 37041467 PMCID: PMC10088255 DOI: 10.1186/s12245-023-00502-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/02/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND The complexity and demands of emergency healthcare service are continuously increasing, and it is important to regularly track the patterns of care at the emergency department (ED). METHODOLOGY A retrospective study was conducted at the ED of the University of Gondar Comprehensive Specialized Hospital (UoGCSH) from April 1 to June 30, 2021. Ethical approval was obtained from the Emergency and Critical Care Directorate of UoGCSH. Data was collected from the emergency registry and descriptive analysis was performed. RESULTS A total of 5232 patients have visited and triaged at the ED. All patients who visited the ED have received triage service within 5 min of arrival. The average length of stay at the ED was 3 days. About 79.1% of patients have stayed at the ED beyond 24 h, and the unavailability of beds at admission areas was responsible for 62% of delays. Mortality rate at the ED was 1.4%, and male to female ratio of death was 1.2 to 1. Shock (all types combined), pneumonia with/without COVID-19, and poisoning were the leading causes of death at the ED which were responsible for 32.5%, 15.5%, and 12.7% of deaths respectively. CONCLUSIONS Triage has been done within the recommended time after patient arrival. However, many patients were staying at the ED for an unacceptably prolonged time. Unavailability of beds at the admission areas, waiting long for senior clinicians' decisions, delays in investigation results, and lack of medical equipment were the causes of delayed discharge from the ED. Shock, pneumonia, and poisoning were the leading causes of death. Healthcare administrators should address the lack of medical resources, and clinicians should provide timely clinical decision and investigation results.
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Affiliation(s)
- Kibur Tarkie
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Kassaye Demeke Altaye
- Department of Emergency Medicine and Critical Care, University of Gondar, Gondar, Ethiopia
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Ng CJ, Chien LT, Huang CH, Chaou CH, Gao SY, Chiu SYH, Hsu KH, Chien CY. Integrating the clinical frailty scale with emergency department triage systems for elder patients: A prospective study. Am J Emerg Med 2023; 66:16-21. [PMID: 36657321 DOI: 10.1016/j.ajem.2023.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/14/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This prospective study investigated whether integrating the Clinical Frailty Scale (CFS) with a triage system would improve triage for older adult emergency department (ED) patients. METHODS We enrolled ED patients aged 65 years or older at 5 study sites in Taiwan between December 2020 and April 2021. All eligible patients were assigned a triage level by using the Taiwan Triage and Acuity Scale (TTAS) in accordance with usual practice. A CFS score was collected from them. The primary outcome was critical events, defined as ICU admission or in-hospital mortality. The secondary outcomes were ED medical expenditures, number of orders in the ED, and length of hospital stay (LOS). We applied a reclassification concept and integrated the CFS and TTAS to create the Triage Frailty Acuity Scale (TFAS). We compared the outcomes achieved between the TTAS and TFAS. RESULTS Of 1023 screened ED patients, 890 were enrolled. The majority were assigned to TTAS level 3 (73.26%) and had CFS scores of 4 to 9 (55.96%). The primary outcomes were better predicted by the TFAS than the TTAS (area under the curve [AUC] 0.82 vs. 064). Using multivariable approach, TTAS level 1 (odds ratio [OR], 4.8; 95% confidence interval [CI], 1.7-13.4) and CFS score (OR, 5.8; 95% CI, 1.9-17.2) were significantly associated with the primary outcomes. For older adults at the highest triage level, the TFAS was not associated with an increase in the primary outcomes compared with the TTAS; however, the TFAS was associated with a significant decrease in the number of older ED patients assigned to triage levels 3 to 5. In addition, TFAS had a longer average LOS but did not have a higher average number of orders or ED medical expenditures compared to TTAS. CONCLUSIONS The TFAS identified more older ED patients who had been triaged as less emergent but proceeded to need ICU admission or in-hospital death. Incorporating the CFS into triage may reduce the under-triage of older adults in the ED.
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Affiliation(s)
- Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
| | - Liang-Tien Chien
- Graduate Institute of Management, Chang Gung University, Taoyuan 333, Taiwan; Taoyuan Fire Department, Taoyuan 333, Taiwan.
| | - Chien-Hsiung Huang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Graduate Institute of Management, Chang Gung University, Taoyuan 333, Taiwan.
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
| | - Shi-Ying Gao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan.
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management, College of Management, Chang Gung University, Taoyuan 333, Taiwan.
| | - Kuang-Hung Hsu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Laboratory for Epidemiology, Department of Health Care Management, Healthy Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan; Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan; Department of Safety, Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City 243, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan.
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Graduate Institute of Management, Chang Gung University, Taoyuan 333, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei 302, Taiwan; Minghsin University of Science and Technology, Hsinchu 304, Taiwan.
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Barbic D, Whyte M, Sidhu G, Luongo A, Chakraborty TA, Scheuermeyer F, Honer WG, Stenstrom R. One-year mortality of emergency department patients with substance-induced psychosis. PLoS One 2022; 17:e0270307. [PMID: 35727766 PMCID: PMC9212133 DOI: 10.1371/journal.pone.0270307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/07/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives Psychosis is a well established complication of non-prescription drug use. We sought to measure the 1-year mortality of emergency department patients with substance-induced psychosis (SIP). Methods This study was a multi-centre, retrospective electronic medical records review of patients presenting to the ED with substance-induced psychosis (SIP). We interrogated the hospital ED database from Jan 1, 2018 and Jan 1, 2019 to identify consecutive patients. All patients were followed for one year from index visit, and classified as alive/dead at that time. Patients were included in the study if they met the following criteria: 1) ED discharge diagnosis of psychosis NOS and a positive urine drugs of abuse screen (UDAS) or the patient verbally endorsed drug use, or 2) Mental disorder due to drug use and “disorganized thought”, “bizarre behavior” or “delusional behavior” documented in the chart and one or more of the following criteria: a) arrival with police, b) mental health certification, c) physical restraints, d) chemical restraints. We excluded patients who were not British Columbia residents, since we were unable to ascertain if they were alive or dead at 1 year from their index ED visit. Primary statistical analysis was logistic regression for risk of death in 1 year, based on plausible risk factors, selected a priori. Results We identified 813 presentations for SIP (620 unique patients). The median age of the entire cohort was 35 years (IQR 28–44), and 69.5% (n = 565) were male. Thirty five patients (4.3%; 95% CI 3.2–5.9) had died one year after their initial presentation to the ED for SIP. Separate multivariable logistic regression analyses, controlling for age, demonstrated schizophrenia (OR 4.2, 95% CI 1.8–11.1) significantly associated with increased 1-year mortality. Conclusions In our study of patients presenting to the ED with SIP, the 1-year mortality was 4.3%. Controlling for age, schizophrenia was a notable risk factor for increased 1-year mortality.
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Affiliation(s)
- David Barbic
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada
- * E-mail:
| | - Madelyn Whyte
- Faculty of Science, University of British Columbia, Vancouver, Canada
| | - Gurwinder Sidhu
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Allesandra Luongo
- Faculty of Science, University of British Columbia, Vancouver, Canada
| | | | - Frank Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- BC Centre for Mental Health and Substance Use Service Research, Vancouver, Canada
| | - Robert Stenstrom
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
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Olsson H, Karlson BW, Herlitz J, Karlsson T, Hellberg J, Prytz M, Sernert N, Ekerstad N. Predictors of short- and long-term mortality in critically ill, older adults admitted to the emergency department: an observational study. BMC Emerg Med 2022; 22:15. [PMID: 35086496 PMCID: PMC8793240 DOI: 10.1186/s12873-022-00571-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background In the future, we can expect an increase in older patients in emergency departments (ED) and acute wards. The main purpose of this study was to identify predictors of short- and long-term mortality in the ED and at hospital discharge. Methods This is a retrospective, observational, single-center, cohort study, involving critically ill older adults, recruited consecutively in an ED. The primary outcome was mortality. All patients were followed for 6.5–7.5 years. The Cox proportional hazards model was used. Results Regarding all critically ill patients aged ≥ 70 years and identified in the ED (n = 402), there was a significant association between mortality at 30 days after ED admission and unconsciousness on admission (HR 3.14, 95% CI 2.09–4.74), hypoxia on admission (HR 2.51, 95% CI 1.69–3.74) and age (HR 1.06 per year, 95% CI 1.03–1.09), (all p < 0.001). Of 402 critically ill patients aged ≥ 70 years and identified in the ED, 303 were discharged alive from hospital. There was a significant association between long-term mortality and the Charlson Comorbidity Index (CCI) > 2 (HR 1.90, 95% CI 1.46–2.48), length of stay (LOS) > 7 days (HR 1.72, 95% CI 1.32–2.23), discharge diagnosis of pneumonia (HR 1.65, 95% CI 1.24–2.21) and age (HR 1.08 per year, 95% CI 1.05–1.10), (all p < 0.001). The only symptom or vital sign associated with long-term mortality was hypoxia on admission (HR 1.70, 05% CI 1.30–2.22). Conclusions Among critically ill older adults admitted to an ED and discharged alive the following factors were predictive of long-term mortality: CCI > 2, LOS > 7 days, hypoxia on admission, discharge diagnosis of pneumonia and age. The following factors were predictive of mortality at 30 days after ED admission: unconsciousness on admission, hypoxia and age. These data might be clinically relevant when it comes to individualized care planning, which should take account of risk prediction and estimated prognosis.
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Affiliation(s)
- Henrik Olsson
- Department of Cardiology, NU Hospital Group, Trollhättan, Sweden
| | - Björn W Karlson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,AstraZeneca Gothenburg, Mölndal, Sweden
| | - Johan Herlitz
- Center for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Thomas Karlsson
- Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Hellberg
- Department of Cardiology, NU Hospital Group, Trollhättan, Sweden
| | - Mattias Prytz
- Department of Surgery, NU-Hospital Group, Region Västra Götaland, Trollhättan, Sweden
| | - Ninni Sernert
- Department of Orthopaedics Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Niklas Ekerstad
- Department of Gothenburg Health, Medicine and Caring Sciences, Unit of Health Care Analysis, Linköping University, Linköping, Sweden.
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Mikolaizak AS, Harvey L, Toson B, Lord SR, Tiedemann A, Howard K, Close JCT. Linking health service utilisation and mortality data-unravelling what happens after fall-related paramedic care. Age Ageing 2022; 51:6514234. [PMID: 35077557 DOI: 10.1093/ageing/afab254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A randomised controlled trial implemented and evaluated a new model of care for non-transported older fallers to prevent future falls and unplanned health service use. This current study uses linked data to evaluate the effects of the intervention beyond the initial 12-month study period. METHOD Study data from an established cohort of 221 adults were linked to administrative data from NSW Ambulance, Emergency Department Data Collection, Admitted Patient Data Collection and Registry of Births, Deaths and Marriages evaluating health service use at 12, 24 and 36 months following randomisation including time to event (health service utilisation) and mortality. Negative binomial and Cox's proportional hazard regression were performed to capture the impact of the study between groups and adherence status. RESULTS At 36 months follow-up, 89% of participants called an ambulance, 87% attended the Emergency Department and 91% were admitted to hospital. There were no significant differences in all-cause health service utilisation between the control and intervention group (IG) at 12, 24 and 36 months follow-up. Fall-related health service use was significantly higher within the IG at 12 (IRR:1.40 (95%CI:1.01-1.94) and 24 months (IRR:1.43 (95%CI:1.05-1.95)). Medication use, impaired balance and previous falls were associated with subsequent health service use. Over 40% of participants died by the follow-up period with risk of death lower in the IG at 36 months (HR:0.64, 95%CI:0.45-0.91). CONCLUSION Non-transported fallers have a high risk of future health service use for fall and other medical-related reasons. Interventions which address this risk need to be further explored.
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Obi IR, Obi KM, Seer-Uke EN, Onuorah SI, Okafor NP. Preventive health care services utilization and its associated factors among older adults in rural communities in Anambra State, Nigeria. Pan Afr Med J 2021; 39:83. [PMID: 34466185 PMCID: PMC8379407 DOI: 10.11604/pamj.2021.39.83.26997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 05/15/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction quality of life and life expectancy of people are improved when preventive health care services are utilized because these identify treatable health problems and puts life-threatening diseases in check. Morbidity and mortality associated with age-related chronic disease among the older adults is on the increase, therefore, this study aims at determining preventive health care services utilization among older adults in rural communities in Anambra State. Methods a cross sectional design adopted for this study was carried out on older adults from the ages of 65 years and above in rural communities in Anambra State from October 2019 to January 2020. Data were collected through researcher-administered structured questionnaire. Data were analysed using univariable and multivariable regression analysis. Results a total of 1944 older adults participated with an overall cluster percentage of 40.6% older adults utilizing investigated preventive health care services. The results of the multivariable analysis indicates that the following factors were associated with utilization of preventive healthcare services: male gender (aOR: 0.443, 95%CI: 0.281 - 5.472, p=0.47), level of education; primary (aOR: 1.536, 95%CI: 1.201 - 5.261, p=0.00), secondary (aOR: 4.516, 95%CI: 3.192 - 6.242, p=0.00), and tertiary (aOR: 3.407, 95%CI: 3.199 - 5.666, p=0.00)], income of N50,000-N100,000 (aOR: 2.754, 95%CI: 1.066 - 10.766, p=0.01), and N100,000 and above (aOR: 4.233, 95%CI: 1.846 - 12.811, p=0.00)], and health insurance [aOR: 0.691, 95%CI: 0.422 - 1.945, p=0.03]. Conclusion preventive health care services were under-utilized. Creating awareness on the importance of utilizing preventive health care services is highly recommended since most age-related chronic diseases once established may last a lifetime and affect quality of life and wellbeing.
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Affiliation(s)
- Ifunanya Rosemary Obi
- Department of Physical and Health Education, Federal College of Education (Technical), Umunze, Nigeria
| | | | | | | | - Nonye Peculiar Okafor
- Department of Human Kinetics and Sports Studies, Alvan Ikoku College of Education, Owerri, Nigeria
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Ruiz VR, Grande-Ratti MF, Martínez B, Midley A, Sylvestre V, Mayer GF. In-hospital mortality associated factors in elderly patients with invasive mechanical ventilation in the emergency department. ENFERMERIA INTENSIVA 2021; 32:145-152. [PMID: 34340950 DOI: 10.1016/j.enfie.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/04/2020] [Indexed: 10/20/2022]
Abstract
AIMS To identify factors associated with in-hospital mortality, to estimate the intubation rate and to describe in-hospital mortality in patients over 65 years old with invasive mechanical ventilation (IMV) in the emergency department (ED). METHODS Retrospective cohort study of patients over 65 years old, who were intubated in an ED of a high complexity hospital between 2016 and 2018. Demographic data, comorbidities, and severity scores on admission were described. Bivariate and multivariate analyses were performed with logistic regression according to mortality and possible confounders. RESULTS A total of 285 patients with a mean age of 80 years required IMV in the emergency department, for a median of 3 days, and with a mean APACHE II score of 20 points of severity. The IMV rate was .48% (95% CI .43-.54), and 55.44% (158) died. Mortality-associated factors after age and sex adjustment were stroke (OR 2.13; 95% CI 1.21-3.76), chronic kidney failure, (OR 4.,38; 95% CI 1.91-10.04), Charlson index (OR 1.19; 95% CI 1.02-1.38), APACHE II score (OR 1.07; 95% CI 1.02-1.12), and SOFA score (OR 1.14; 95% CI 1.03-1.27). DISCUSSION Our IMV rate was lower than that stated by Johnson et al. in the United States in 2018 (.59%). In-hospital mortality in our study exceeded that predicted by the APACHE II score (40%) and SOFA (33%). However it was consistent with that reported by Lieberman et al. in Israel and Esteban et al. in the United States. CONCLUSIONS Although the IMV rate was low in the ED, more than half the patients died during hospitalization. Pre-existing cerebrovascular and renal diseases and high results in the comorbidities index and severity scores on admission were independent factors associated with in-hospital mortality.
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Affiliation(s)
- V R Ruiz
- Sección de Rehabilitación y Cuidados Respiratorios del Paciente Crítico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - M F Grande-Ratti
- Área de Investigación en Medicina Interna, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - B Martínez
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Midley
- Sección de Rehabilitación y Cuidados Respiratorios del Paciente Crítico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - V Sylvestre
- Central de Emergencias del Adulto, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G F Mayer
- Sección de Rehabilitación y Cuidados Respiratorios del Paciente Crítico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Kim S, Kang H, Cho Y, Lee H, Lee SW, Jeong J, Kim WY, Kim SJ, Han KS. Emergency department utilization and risk factors for mortality in older patients: an analysis of Korean National Emergency Department Information System data. Clin Exp Emerg Med 2021; 8:128-136. [PMID: 34237818 PMCID: PMC8273668 DOI: 10.15441/ceem.20.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022] Open
Abstract
Objective With trends in population aging an increasing number of older patients are visiting the emergency department (ED). This study aimed to identify the characteristics of ED utilization and risk factors for in-hospital mortality in older patients who visited EDs. Methods This nationwide observational study used National Emergency Department Information System data collected during a 2-year period from January 2016 to December 2017. The characteristics of older patients aged 70 years or older were compared with those of younger patients aged 20 to 69 years. Risk factors associated with in-hospital mortality were analyzed by multivariable logistic regression. Results A total of 6,596,423 younger patients and 1,737,799 older patients were included. In the medical and nonmedical older patient groups, significantly higher proportions of patients were transferred from another hospital, utilized emergency medical services, had Korean Triage and Acuity Scale scores of 1 and 2, required hospitalization, and required intensive care unit admission in the older patient group than in the younger patient group. ED and post-hospitalization mortality rates increased with age; in particular, older medical patients aged 90 or older had an in-hospital mortality rate of 9%. Older age, male sex, transfer from another hospital, emergency medical service utilization, a high Korean Triage and Acuity Scale score, systolic blood pressure <100 mmHg, respiratory rate >20/min, heart rate >100/min, body temperature <36°C, and altered mental status were associated with in-hospital mortality. Conclusion Development of appropriate decision-making algorithms and treatment protocols for high risk older patients visiting the ED might facilitate appropriate allocation of medical resources to optimize outcomes.
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Affiliation(s)
- Soyoon Kim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yongil Cho
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Heekyung Lee
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Woo Lee
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jinwoo Jeong
- Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Jin Kim
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kap Su Han
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
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Factores asociados a mortalidad intrahospitalaria en pacientes adultos mayores con asistencia ventilatoria mecánica invasiva en el servicio de urgencias. ENFERMERIA INTENSIVA 2021. [DOI: 10.1016/j.enfi.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Low Back Pain in a Nova Scotian Emergency Department: Prevalence and Patient Characteristics in the Older Adult Patient Population. Can J Aging 2021; 41:145-153. [PMID: 34039455 DOI: 10.1017/s0714980821000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Low back pain is a major cause of disability in older adults, and results in many emergency department visits each year. Characteristics of the older back pain population are largely unknown. We conducted a retrospective study to examine the prevalence and patient characteristics for older (≥ 65 years of age) and younger (16-64 years of age) adults presenting with back pain. Study objectives were to describe the characteristics of older adults with back pain presenting to an emergency department and to identify age-group based differences in management. Older adults were most commonly diagnosed with non-specific low back pain (49%). For older adults with this diagnosis, the length of stay was 2.1 times longer (p < 0.001), and odds of being admitted to the hospital were 5.1 times higher (p < 0.001) than for younger adults. Patterns of management are different for younger and older adults with low back pain; this information can be used to direct future resource planning.
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Pérez-Zepeda MU, Carrillo-Vega MF, Theou O, Jácome-Maldonado LD, García-Peña C. Hospital Complications and Frailty in Mexican Older Adults: An Emergency Care Cohort Analysis. Front Med (Lausanne) 2020; 7:505. [PMID: 33134303 PMCID: PMC7550456 DOI: 10.3389/fmed.2020.00505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives: To describe the association of frailty level on admittance to the Emergency Department (ED) with various hospital complications including delirium, low phase angle, and low handgrip strength. Design: Prospective cohort. Setting: ED rooms of two public general hospitals in Mexico City. Participants: A total of 548 persons 60 years or older who were admitted to the ED and who were alive during follow-up testing at home were included. Measurements: A 32-item frailty index (FI) was measured on admission to the ED. Outcome measures included delirium, phase angle, and hand grip strength measured during different stages of the hospitalization (i.e., from admission to the ED through to follow-up at home). Results: From this final sample, mean age was 76 years (± SD 7.2) and 58.4% (n = 320) were women. Mean waiting time in the ED was 5.1 h (± SD 6.2), the average stay in the ED was 99.9 (±68.2) h, and 274 subjects (50%) were admitted to a general ward after ED admission. FI was not associated with phase angle and was negatively associated with handgrip strength at admission to ED (β = −3.97, confidence interval [CI] 95% −5.56 −2.38, p < 0.001), discharge from ED (β = −3.94, CI 95% −5.97 −1.90, p < 0.001), and discharge from hospital (β = −4.93, CI 95% −7.68 −2.18, p = 0.01). FI was positively associated with delirium (β = 3.68, CI 95% 1.53–5.83, p < 0.01). Conclusion: Higher frailty at ED admission was associated with lower hand grip strength and delirium during hospitalization in Mexican older adults.
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Affiliation(s)
- Mario Ulises Pérez-Zepeda
- Dirección de Investigación, Instituto Nacional de Geriatría, México City, México.,Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Huixquilucan de Degollado, Mexico
| | | | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, NS, Canada.,School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | | | - Carmen García-Peña
- Dirección de Investigación, Instituto Nacional de Geriatría, México City, México
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Curiati PK, Gil-Junior LA, Morinaga CV, Ganem F, Curiati JA, Avelino-Silva TJ. Predicting Hospital Admission and Prolonged Length of Stay in Older Adults in the Emergency Department: The PRO-AGE Scoring System. Ann Emerg Med 2020; 76:255-265. [DOI: 10.1016/j.annemergmed.2020.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/16/2019] [Accepted: 01/02/2020] [Indexed: 01/13/2023]
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Gasperini B, Pierri F, Espinosa E, Fazi A, Maracchini G, Cherubini A. Is the fast-track process efficient and safe for older adults admitted to the emergency department? BMC Geriatr 2020; 20:154. [PMID: 32345234 PMCID: PMC7189513 DOI: 10.1186/s12877-020-01536-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficiency of the fast-track (FT) process in the management of patients in Emergency Departments is well demonstrated, but there is a lack of research focused on older adults. The aim of our study was to verify whether the FT process is efficient and safe for older adults admitted to ED. METHODS Observational case-control single-centre study. RESULTS Five hundred four cases and 504 controls were analysed. The mean age was 75 years, and there was a predominance of women. In total 96% of subjects were classified with a "less-urgent" tag. The length of stay was significantly lower in the fast-track group than in the control group (median 178 min, interquartile range 184 min, and 115 min, interquartile range 69 min, respectively, p < 0.001), as well as the time spent between the ED physician's visit and patient discharge (median 78 min, interquartile range 120 min, and median 3 min, interquartile range 6 min, respectively, p < 0.001). There weren't any increases in the number of unplanned readmissions within 48 h, 7 days and 30 days. CONCLUSIONS The fast-track appears to be an efficient and safe strategy to improve the management of older adults admitted to the ED with minor complaints.
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Affiliation(s)
- B Gasperini
- Department of Geriatrics and Rehabilitation, Santa Croce Hospital, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Viale Vittorio Veneto 2, 61032, Fano, Italy.
| | - F Pierri
- Department of Economics, Statistical Section, University of Perugia, Perugia, Italy
| | - E Espinosa
- Department of Geriatrics and Rehabilitation, Santa Croce Hospital, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Viale Vittorio Veneto 2, 61032, Fano, Italy
| | - A Fazi
- Agenzia Regionale Sanitaria-Regione Marche, Senigallia, Ancona, Italy
| | - G Maracchini
- Emergency Department Ospedale Principe di Piemonte, Area Vasta 2, Senigallia, AN, Italy
| | - A Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
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