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Mangal V, Kesavan Nair L, Timmalsugur R. Scrub typhus meningoencephalitis: An uncommon cause of acute febrile encephalopathy in the elderly. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_187_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kaeley N, Kumar J, Kumar M, Vempalli N, Dhar M, Bhardwaj BB, Kumar S, Kabi A, Arora P. Prevalence and pattern of geriatric emergencies in a teaching hospital of North India. J Family Med Prim Care 2021; 10:3899-3903. [PMID: 34934699 PMCID: PMC8653474 DOI: 10.4103/jfmpc.jfmpc_2450_20] [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: 12/11/2020] [Revised: 02/21/2021] [Accepted: 05/20/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Changing demographic patterns worldwide and improvement in healthcarehas contributed to increasing visits to the emergency department byelderly patients. Geriatric patients usually have multiple co-morbidities and declining physiological functional status. This complex interplay of various factors requires a specific and curated approach from the emergency physicians. Our aim was to study the pattern and prevalence of geriatric emergencies and the profile of infectious and non-infectious causes of fever in geriatric population in our tertiary care center. Materials and Methods This retrospective descriptive study was carried out at a tertiary care hospital of north India and included all patients aged more than 18 years who visited the emergency department over a period of six months (July 2018 to December 2018). Detailed data regarding demographic, clinical and diagnosis was obtained retrospectively from the hospital records system. The patients were divided into two groups, age less than 60 years and elderly patients more than 60 years of age for comparison. Results A total of 24768 patients above the age of 18 years visited the emergency department over a period of six months. Out of which 5399 (27.5%) patients belonged to the geriatric age group more than 60 years of age. 2474 (45.8%) geriatric age group patientswere triaged to critical areas level one and level two as compared to 4668 (24.1%) patients aged less than 60 years. Ninety (1.8%) geriatric patients succumbed to death as compared to 77 (0.4%) patients aged less than 60 years. 651 (21.9%) geriatric patients were shifted to intensive care unit as opposed to 1038 (14.8%) patients of the younger age group.226 (4.2%) geriatric patients presented with fever in the emergency department.116 (73.4%) patients having underlying co-morbidities , had fever due to infectious causes whereas 42 ( 26.5%) patients had fever due to non-infectious causes. Conclusion The clinical presentation mortality and morbidity pattern of geriatric patients differs significantly from that of younger population and requires a customized approach and dedicated emergency setups.
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Affiliation(s)
- Nidhi Kaeley
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Jainendra Kumar
- Department of Medicine, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Manish Kumar
- Department of Medicine, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Nagasubramanyam Vempalli
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mridul Dhar
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bharat B Bhardwaj
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Subodh Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ankita Kabi
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Poonam Arora
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Sert ET, Kokulu K. Role of thoracic and abdominal tomography in identifying a potential source of infection in patients with acute fever of unknown focus. Am J Emerg Med 2021; 50:256-259. [PMID: 34416517 DOI: 10.1016/j.ajem.2021.08.033] [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: 06/15/2021] [Revised: 08/04/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the relationship between clinical features and the presence of infection on thoracic and abdominal tomography (CT) scans in emergency department (ED) patients with acute febrile illness without apparent source. METHODS Patients aged 18 years and over who presented to ED with acute fever of unknown origin between January 1, 2020 and December 31, 2020 and underwent CT imaging (thoracic and abdomen) as a diagnostic test were included in the study retrospectively. Acute fever of unknown origin was defined as the absence of a history or physical examination finding that could explain the possible cause of fever, normal values of parameters that would suggest an infection in the urine analysis, and absence of infiltration on chest X-ray. The patients were divided into two groups according to the presence and absence of a source of infection on CT. The clinical and demographic data of the patients were evaluated. The effect of clinical factors on the presence of infection in CT scans was determined using the logistic regression analysis. RESULTS Among the 173 patients included in the study, the CT scans were positive for the source of infection in 31.2% (n = 54) and negative in 68.8% (n = 119). In the multiple logistic regression analysis, age ≥ 65 years [odds ratio (OR): 2.72, 95% confidence interval (CI):1.15-4.35, p < 0.001), presence of comorbidity (OR:2.37, 95%CI:1.08-4.14, p = 0.033), and procalcitonin positivity (PCT) (OR: 2.54, 95%CI: 1.29-4.95, p = 0.006) were identified as risk factors for the presence of infection in CT. CONCLUSION Patient's age, presence of comorbidity and PCT level should be considered when deciding on the use of CT in determining the source of infection in acute febrile patients without clinical clues.
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Affiliation(s)
- Ekrem Taha Sert
- Department of Emergency Medicine, Aksaray University Medical School, Aksaray, Turkey.
| | - Kamil Kokulu
- Department of Emergency Medicine, Aksaray University Medical School, Aksaray, Turkey
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Menon VB, Ramesh M, Pereira P, Chilkunda Raviprakash V, Undela K. Inappropriate prescribing of antimalarial therapy for the treatment of undifferentiated febrile illness among the elderly. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Vineetha Bharathan Menon
- Department of Pharmacy Practice JSS College of Pharmacy JSS University Mysore India
- School of Pharmacy Monash University Bandar Sunway Selangor Malaysia
| | - Madhan Ramesh
- Department of Pharmacy Practice JSS College of Pharmacy JSS University Mysore India
| | - Pratibha Pereira
- Department of Internal Medicine JSS Hospital and Medical College JSS University Mysore India
| | | | - Krishna Undela
- Department of Pharmacy Practice JSS College of Pharmacy JSS University Mysore India
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Royer S, DeMerle KM, Dickson RP, Prescott HC. Shorter Versus Longer Courses of Antibiotics for Infection in Hospitalized Patients: A Systematic Review and Meta-Analysis. J Hosp Med 2018; 13:336-342. [PMID: 29370318 PMCID: PMC5945333 DOI: 10.12788/jhm.2905] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Infection is a leading cause of hospitalization with high morbidity and mortality, but there are limited data to guide the duration of antibiotic therapy. PURPOSE Systematic review to compare outcomes of shorter versus longer antibiotic courses among hospitalized adults and adolescents. DATA SOURCES MEDLINE and Embase databases, 1990-2017. STUDY SELECTION Inclusion criteria were human randomized controlled trials (RCTs) in English comparing a prespecified short course of antibiotics to a longer course for treatment of infection in hospitalized adults and adolescents aged 12 years and older. DATA EXTRACTION Two authors independently extracted study characteristics, methods of statistical analysis, outcomes, and risk of bias. DATA SYNTHESIS Of 5187 unique citations identified, 19 RCTs comprising 2867 patients met our inclusion criteria, including the following: 9 noninferiority trials, 1 superiority design trial, and 9 pilot studies. Across 13 studies evaluating 1727 patients, no significant difference in clinical efficacy was observed (d = 1.6% [95% confidence interval (CI), -1.0%-4.2%]). No significant difference was detected in microbiologic cure (8 studies, d = 1.2% [95% CI, -4.1%-6.4%]), short-term mortality (8 studies, d = 0.3% [95% CI, -1.2%-1.8%]), longer-term mortality (3 studies, d = -0.4% [95% CI, -6.3%-5.5%]), or recurrence (10 studies, d = 2.1% [95% CI, -1.2%-5.3%]). Heterogeneity across studies was not significant for any of the primary outcomes. CONCLUSIONS Based on the available literature, shorter courses of antibiotics can be safely utilized in hospitalized patients with common infections, including pneumonia, urinary tract infection, and intra-abdominal infection, to achieve clinical and microbiologic resolution without adverse effects on mortality or recurrence.
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Affiliation(s)
- Stephanie Royer
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kimberley M DeMerle
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert P Dickson
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Hallie C Prescott
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Wu CJ, Huang CC, Weng SF, Chen PJ, Hsu CC, Wang JJ, Guo HR, Lin HJ. Septic arthritis significantly increased the long-term mortality in geriatric patients. BMC Geriatr 2017; 17:178. [PMID: 28793879 PMCID: PMC5550948 DOI: 10.1186/s12877-017-0561-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 07/23/2017] [Indexed: 11/21/2022] Open
Abstract
Background The elderly are predisposed to septic arthritis (SA) because of the aging nature and increasing comorbidities. SA may in turn increase the long-term mortality in the geriatric patients; however, it remains unclear. We conducted this prospective nationwide population-based cohort study to clarify this issue. Methods Using Taiwan National Health Insurance Research Database (NHIRD), we identified 1667 geriatric participants (≥ 65 years) with SA and 16,670 geriatric participants without SA matched at a ratio of 1:10 by age, sex, and index date between 1999 and 2010. A comparison of the long-term mortality between the two cohorts through follow-up until 2011 was performed. Results Geriatric participants with SA had a significantly increased mortality than those without SA [Adjusted hazard ratio (AHR): 1.49, 95% confidence interval (CI): 1.34–1.66], particularly the old elderly (≥ 85 years, AHR: 2.12, 95% CI: 1.58–2.84) and males (AHR: 1.54, 95% CI: 1.33–1.79). These results were stated after adjustment for osteoarthritis, diabetes, gout, renal disease, liver disease, cancer, rheumatoid arthritis, systemic lupus erythematosus, alcoholism, and human immunodeficiency virus infection. The increased mortality risk was highest in the first month (AHR: 3.93, 95% CI: 2.94–5.25) and remained increased even after following up for 2–4 years (AHR: 1.30, 95% CI: 1.03–1.65). After Cox proportional hazard regression analysis, SA (AHR: 1.37, 95% CI: 1.20–1.56), older age (≥ 85 years, AHR: 1.79, 95% CI: 1.59–2.02, 75–84 years, AHR: 1.65, 95% CI: 1.53–1.78), male sex, diabetes, renal disease, liver disease, cancer, and gout were independent mortality predictors. There was no significant difference in the mortality for SA between upper limb affected and lower limb affected. Conclusions This study delineated that SA significantly increased the long-term mortality in geriatric participants. For the increasing aging population worldwide, strategies for the prevention and treatment of SA and concomitant control of comorbidities are very important.
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Affiliation(s)
- Chia-Jung Wu
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan.,Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ping-Jen Chen
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan.,Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Palliative Care Center, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan. .,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan. .,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan.
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Huang CC, Tsai KT, Weng SF, Lin HJ, Huang HS, Wang JJ, Guo HR, Hsu CC. Chronic osteomyelitis increases long-term mortality risk in the elderly: a nationwide population-based cohort study. BMC Geriatr 2016; 16:72. [PMID: 27029408 PMCID: PMC4815108 DOI: 10.1186/s12877-016-0248-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 03/23/2016] [Indexed: 11/29/2022] Open
Abstract
Background The elderly are predisposed to chronic osteomyelitis because of the immunocompromised nature of aging and increasing number of chronic comorbidities. Chronic osteomyelitis may significantly affect the health of the elderly; however, its impact on long-term mortality remains unclear. We conceived this retrospective nationwide population-based cohort study to address this issue. Methods We identified 10,615 elderly patients (≥65 years) comprising 965 patients with chronic osteomyelitis and 9650 without chronic osteomyelitis matched at a ratio of 1:10 by age and gender between 1999 and 2010 from the Taiwan National Health Insurance Research Database. The risk of chronic osteomyelitis between the two cohorts was compared by a following-up until 2011. Results Patients with chronic osteomyelitis had a significantly higher mortality risk than those without chronic osteomyelitis [incidence rate ratio (IRR): 2.29; 95 % confidence interval (CI): 2.01–2.59], particularly the old elderly (≥85 years; IRR: 3.27; 95 % CI: 2.22–4.82) and males (IRR: 2.7; 95 % CI: 2.31–3.16). The highest mortality risk was observed in the first month (IRR: 5.01; 95 % CI: 2.02–12.42), and it remained persistently higher even after 6 years (IRR: 1.53; 95 % CI: 1.13–2.06) of follow-up. Cox proportional hazard regression analysis showed that chronic osteomyelitis [adjusted hazard ratio (AHR): 1.89; 95 % CI: 1.66–2.15], advanced age (≥85 years; AHR: 2.02; 95 % CI: 1.70–2.41), male (AHR: 1.34; 95 % CI: 1.22–1.48), and chronic comorbidities were independent predictors of mortality. Conclusions This study demonstrated that chronic osteomyelitis significantly increased the long-term mortality risk in the elderly. Therefore, strategies for prevention and treatment of chronic osteomyelitis and concomitant control of chronic comorbidities are very important for the management of the elderly, particularly for a future with an increasingly aged population worldwide.
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Affiliation(s)
- Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Kang-Ting Tsai
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan.,Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hung-Sheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan. .,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
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The Optimal Management of Acute Febrile Encephalopathy in the Aged Patient: A Systematic Review. Interdiscip Perspect Infect Dis 2016; 2016:5273651. [PMID: 26989409 PMCID: PMC4773559 DOI: 10.1155/2016/5273651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/21/2016] [Accepted: 01/27/2016] [Indexed: 11/17/2022] Open
Abstract
The elderly comprise less than 13 percent of world population. Nonetheless, they represent nearly half of all hospitalized adults. Acute change in mental status from baseline is commonly seen among the elderly even when the main process does not involve the central nervous system. The term "geriatric syndrome" is used to capture those clinical conditions in older people that do not fit into discrete disease categories, including delirium, falls, frailty, dizziness, syncope, and urinary incontinence. Despite the growing number of elderly population, especially those who require hospitalization and the high burden of common infections accompanied by encephalopathy among them, there are several unresolved questions regarding the optimal management they deserve. The questions posed in this systematic review concern the need to rule out CNS infection in all elderly patients presented with fever and altered mental status in the routine management of febrile encephalopathy. In doing so, we sought to identify all potentially relevant articles using searches of web-based databases with no language restriction. Finally, we reviewed 93 research articles that were relevant to each part of our study. No prospective study was found to address how should AFE in the aged be optimally managed.
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Chung MH, Huang CC, Vong SC, Yang TM, Chen KT, Lin HJ, Chen JH, Su SB, Guo HR, Hsu CC. Geriatric Fever Score: a new decision rule for geriatric care. PLoS One 2014; 9:e110927. [PMID: 25340811 PMCID: PMC4207798 DOI: 10.1371/journal.pone.0110927] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/23/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Evaluating geriatric patients with fever is time-consuming and challenging. We investigated independent mortality predictors of geriatric patients with fever and developed a prediction rule for emergency care, critical care, and geriatric care physicians to classify patients into mortality risk and disposition groups. MATERIALS AND METHODS Consecutive geriatric patients (≥65 years old) visiting the emergency department (ED) of a university-affiliated medical center between June 1 and July 21, 2010, were enrolled when they met the criteria of fever: a tympanic temperature ≥37.2°C or a baseline temperature elevated ≥1.3°C. Thirty-day mortality was the primary endpoint. Internal validation with bootstrap re-sampling was done. RESULTS Three hundred thirty geriatric patients were enrolled. We found three independent mortality predictors: Leukocytosis (WBC >12,000 cells/mm3), Severe coma (GCS ≤ 8), and Thrombocytopenia (platelets <150 10(3)/mm3) (LST). After assigning weights to each predictor, we developed a Geriatric Fever Score that stratifies patients into two mortality-risk and disposition groups: low (4.0%) (95% CI: 2.3-6.9%): a general ward or treatment in the ED then discharge and high (30.3%) (95% CI: 17.4-47.3%): consider the intensive care unit. The area under the curve for the rule was 0.73. CONCLUSIONS We found that the Geriatric Fever Score is a simple and rapid rule for predicting 30-day mortality and classifying mortality risk and disposition in geriatric patients with fever, although external validation should be performed to confirm its usefulness in other clinical settings. It might help preserve medical resources for patients in greater need.
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Affiliation(s)
- Min-Hsien Chung
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Emergency Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Emergency Medicine, Kuo General Hospital, Tainan, Taiwan
| | - Si-Chon Vong
- Department of Emergency Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
| | - Tzu-Meng Yang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Kuo-Tai Chen
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jiann-Hwa Chen
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan
- Fu Jen Catholic University School of Medicine, Taipei, Taiwan
| | - Shih-Bin Su
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Medical Research, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- * E-mail: (HRG); (CCH)
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- * E-mail: (HRG); (CCH)
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Chung MH, Chu FY, Yang TM, Lin HJ, Chen JH, Guo HR, Vong SC, Su SB, Huang CC, Hsu CC. Hypotension, bedridden, leukocytosis, thrombocytopenia and elevated serum creatinine predict mortality in geriatric patients with fever. Geriatr Gerontol Int 2014; 15:834-9. [PMID: 25302851 DOI: 10.1111/ggi.12355] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 11/27/2022]
Abstract
AIM The geriatric population (aged ≥65 years) accounts for 12-24% of all emergency department (ED) visits. Of them, 10% have a fever, 70-90% will be admitted and 7-10% of will die within a month. Therefore, mortality prediction and appropriate disposition after ED treatment are of great concern for geriatric patients with fever. We tried to identify independent mortality predictors of geriatric patients with fever, and combine these predictors to predict their mortality. METHODS We enrolled consecutive geriatric patients visiting the ED between 1 June and 21 July 2010 with the following criteria of fever: a tympanic temperature ≥37.2°C or a baseline temperature elevated ≥1.3°C. We used 30-day mortality as the primary end-point. RESULTS A total of 330 patients were enrolled. Hypotension, bedridden, leukocytosis, thrombocytopenia and serum creatinine >2 mg/dL, but not age, were independently associated with 30-day mortality. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) ranged from 18.2% to 90.9%, 34.7% to 100%, 9.0% to 100% and 94.5% to 98.2%, respectively, depending on how many predictors there were. CONCLUSIONS The 30-day mortality increased with the number of independent mortality predictors. With at least four predictors, 100% of the patients died within 30 days. With none of the predictors, just 1.8% died. These findings might help physicians make decisions about geriatric patients with fever.
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Affiliation(s)
- Min-Hsien Chung
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Emergency Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
| | - Feng-Yuan Chu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Emergency Medicine, Chi-Mei Medical Center, Chiali, Tainan, Taiwan
| | - Tzu-Meng Yang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jiann-Hwa Chen
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan.,Fu Jen Catholic University School of Medicine, Taipei, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Si-Chon Vong
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Emergency Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
| | - Shih-Bin Su
- Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan.,Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.,Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Emergency Medicine, Kuo General Hospital, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
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