Emergency geriatric assessment: A novel comprehensive screen tool for geriatric patients in the emergency department

Background: The increase in life expectancy and low mortality have doubled the number of individuals older than 65 in the last 30 years. Methods: We conducted a retrospective study of 101 patients older than 80 years of age treated by low digestive hemorrhage (LDH) in an emergency department during 2018. Sociodemographic variables were evaluated, as well as comorbidity and survival at 18 months. Survival was assessed by a Kaplan-Meier test. Results: 52.5% of the subjects were women. The average comorbidity of the sample was 1.97. The survival rate per year was 60%. The finding on colonoscopy shows no association with mortality. However, those patients on anticoagulant/antiplatelet therapy have a higher survival rate. Conclusion: Survival per year is high, so urgent colonoscopy for an LDH should be performed after evaluating the patient’s stability and functional status in a scheduled and outpatient manner.

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The Hanging Chin Sign As A Mortality Predictor In Geriatric Patients At The Emergency Department: A Retrospective Cohort Study

10.21203/rs.3.rs-496256/v1 ◽

2021 ◽

Author(s):

Anneloes NJ Huijgens ◽

Laurens J van Baardewijk ◽

Carolina JPW Keijsers

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Geriatric Patients ◽

Lateral View ◽

X Ray ◽

Hospital Patients ◽

Chest X Ray

Abstract BACKGROUND: At the emergency department, there is a need for an instrument which is quick and easy to use to identify geriatric patients with the highest risk of mortality. The so- called ‘hanging chin sign’, meaning that the mandibula is seen to project over one or more ribs on the chest X-ray, could be such an instrument. This study aims to investigate whether the hanging chin sign is a predictor of mortality in geriatric patients admitted through the emergency department. METHODS: We performed an observational retrospective cohort study in a Dutch teaching hospital. Patients of ≥ 65 years who were admitted to the geriatric ward following an emergency department visit were included. The primary outcome of this study was mortality. Secondary outcomes included the length of admission, discharge destination and the reliability compared to patient-related variables and the APOP screener.RESULTS: 396 patients were included in the analysis. Mean follow up was 300 days; 207 patients (52%) died during follow up. The hanging chin sign was present in 85 patients (21%). Patients with the hanging chin sign have a significantly higher mortality risk during admission (OR 2.94 (1.61 to 5.39), p < 0.001), within 30 days (OR 2.49 (1.44 to 4.31), p = 0.001), within 90 days (OR 2.16 (1.31 to 3.56), p = 0.002) and within end of follow up (OR 2.87 (1.70 to 4.84),p < 0.001). A chest X-ray without a PA view or lateral view was also associated with mortality. This technical detail of the chest x-ray and the hanging chin sign both showed a stronger association with mortality than patient-related variables or the APOP screener. CONCLUSIONS: The hanging chin sign and other details of the chest x-ray were strong predictors of mortality in geriatric patients presenting at the emergency department. Compared to other known predictors, they seem to do even better in predicting mortality.

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Profile of geriatric patients presenting to the emergency department

Current Medical Issues ◽

10.4103/cmi.cmi_22_17 ◽

2017 ◽

Vol 15 (3) ◽

pp. 227 ◽

Cited By ~ 1

Author(s):

KundavaramPaul Prabhakar Abhilash ◽

MosesAmos Kirubairaj ◽

SaurabhRamesh Sahare

Keyword(s):

Emergency Department ◽

Geriatric Patients

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The development of a modified comprehensive geriatric assessment for use in the emergency department using a RAND/UCLA appropriateness method

International Emergency Nursing ◽

10.1016/j.ienj.2020.100847 ◽

2020 ◽

pp. 100847

Author(s):

Andrea Taylor ◽

Marc Broadbent ◽

Apil Gurung ◽

Marianne Wallis

Keyword(s):

Emergency Department ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment

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340 Cognition and Risk of Revisits to an Emergency Department in Ambulatory Geriatric Patients

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2015.07.376 ◽

2015 ◽

Vol 66 (4) ◽

pp. S122-S123

Author(s):

L. Pimentel ◽

G. Ostir ◽

S. Schenkel ◽

D.S. Abraham ◽

I.M. Berges ◽

...

Keyword(s):

Emergency Department ◽

Geriatric Patients

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Synthesised Geriatric Assessment in the Emergency Department setting: is it NEAT?

Australian Health Review ◽

10.1071/ah13217 ◽

2014 ◽

Vol 38 (4) ◽

pp. 370 ◽

Cited By ~ 3

Author(s):

Alan Nguyen ◽

Lahn Straney ◽

Peter Cameron ◽

Judy Lowthian

Keyword(s):

Emergency Department ◽

Pilot Study ◽

Outcome Measures ◽

Geriatric Assessment ◽

Patient Characteristics ◽

Functional Independence ◽

Secondary Outcome ◽

Screening Instruments ◽

Geriatric Screening ◽

Time Critical

Objective To assess the time taken to complete a Synthesised Geriatric Assessment (SGA) in an Emergency Department (ED) and to determine what secondary patient characteristics affect results. Methods A convenience sample of 25 patients aged over 65 from an Australian single-centre ED was used for this pilot study. Primary outcome measures included the overall time taken as well as the times for individual screening instruments. Data regarding patient characteristics were taken as secondary outcome measures to assess impact on times. For each of the screening instruments, the mean, median, interquartile range and the 90th percentile for the test duration was calculated. Linear regression was used to evaluate univariate associations between times and patient characteristics. P-values < 0.05 were considered as statistically significant. Results Time required for completion of the SGA by 90% of the study population was 20 min and 40 s. This represents approximately 8.6% of new 4-h ED targets. Secondary characteristics that affected the time taken for screening included patients from non-English-speaking backgrounds (P < 0.05). Conclusions Use of the SGA for intra-ED geriatric risk stratification is feasible and practical in the time-critical National Emergency Access Target (NEAT) environment. The relatively short amount of time used for screening this vulnerable demographic has implications for interdisciplinary management and potentially represents an efficient intervention to reduce future re-presentations and overcrowding in Australian EDs. Future high-quality trials are required to assess the clinical benefit of the SGA. What is known about the topic? The newly introduced ED NEAT encourages patient discharge from ED within 4 h of arrival, placing increased pressure on ED protocols to be time efficient, while still maintaining safe quality care. The Comprehensive Geriatric Assessment in inpatient and ED settings has demonstrated improved outcomes in populations aged > 65, including parameters of ED re-presentations, functional independence and short-term mortality. Geriatric emergency patient guidelines have been recently adopted in the US and UK which incorporate intra-ED geriatric screening processes. Studies focusing on the feasibility of geriatric screening in Australian EDs are scarce. What does this paper add? Our pilot study focuses on the timing requirements of geriatric screening in time-critical ED environments. We analysed the time taken to conduct a SGA that was developed for a large research project, and the secondary patient characteristics that affected these times. Our paper provides valuable information for Australian EDs when considering the introduction of geriatric screening into EDs to optimise the care and outcomes of this patient group. Analysis of secondary patient characteristics and data patterns will further help EDs and future research into design of new protocols. What are the implications for practitioners? The results of our pilot study suggest that use of the SGA in Australian ED settings is feasible and practical. By using the results of our pilot study, EDs and clinician researchers can make informed decisions about implementation of new protocol to manage older patients. We suggest that implementation of intra-ED geriatric screening assessments will result in improved patient outcomes, including long-term functional independence and decreased rates of ED re-presentation. This in turn would help to unclog our currently overloaded EDs.

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Study protocol for IMAGE: implementing multidisciplinary assessments for geriatric patients in an emergency department observation unit, a hybrid effectiveness/implementation study using the Consolidated Framework for Implementation Research

Implementation Science Communications ◽

10.1186/s43058-020-00015-7 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Lauren T. Southerland ◽

Julie A. Stephens ◽

Christopher R. Carpenter ◽

Lorraine C. Mion ◽

Susan D. Moffatt-Bruce ◽

...

Keyword(s):

Emergency Department ◽

Study Protocol ◽

Implementation Research ◽

Geriatric Patients ◽

Implementation Study ◽

Observation Unit

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P118: Older adults in the emergency department: a retrospective cross-sectional study of the geriatric population in Edmonton emergency departments

CJEM ◽

10.1017/cem.2019.309 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S106-S107

Author(s):

K. Morch ◽

R. Schonnop ◽

A. Gauri ◽

D. Ha

Keyword(s):

Older Adults ◽

Emergency Department ◽

Geriatric Patient ◽

Geriatric Patients ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Health Region ◽

Area Of Interest ◽

Ed Visits

Introduction: The geriatric patient population accounts for an ever increasing proportion of emergency department (ED) visits. Geriatric centered EDs are an emerging area of interest and research. Though there have been past studies looking at older patient presentations at individual hospitals, there is limited data describing geriatric presentations within an entire Canadian geographic health region. This study characterizes the population of older adults utilizing the EDs in the Edmonton Zone, a health region that comprises a total of eleven tertiary (T), urban community (UC) and rural community (RC) hospitals. Methods: This retrospective cross-sectional study targeted all patients ≥65 years presenting to the Edmonton Zone EDs between April 1, 2017 to March 31, 2018. Data was extracted from the Emergency Department Information System (EDIS) database for ten EDs in the health region. Clinical and administrative data points were extracted and examined for each site. Results: We analyzed 100,813 ED geriatric patient visits during our study period, accounting for 18.7% of total ED visits to the Edmonton Zone. The five most common triage complaints at ED presentation were shortness of breath, abdominal pain, chest pain with cardiac features, general weakness, and back pain. CTAS scores 1-3 were assigned to 77.8% of geriatric presentations (T: 86.3%, UC: 77.4%, RC: 60.9%). 27.3% of geriatric patients had presented to an ED within the past 30 days (T: 30.0%, UC: 25.4%, RC: 27.7%). On average, 35.3% of older adult ED visits involved a consultation (T: 51.7%, UC 30.8%, RC 14.6%) and approximately 25% of geriatric patients were admitted to hospital during their ED visit (T: 42.8%, UC: 19.4%, RC: 7.1%). The average length of stay (LOS) in the ED (hh:mm) was 10:19 (T: 10:24, UC: 11:38, RC: 5:43). Overall, 2.4% of all geriatric patients left an ED without being seen after initial registration (T: 2.7%, UC: 2.2%, RC: 2.1%). Conclusion: Older adults represent a significant proportion of the ED visits in the Edmonton Zone. The triage acuity, LOS, re-presentation, consultation and admission rates varied based on the type of ED, which has implications for resource allocation within the health region. Our results can also direct future targeted initiatives and quality improvement projects to the various types of EDs in the Edmonton Zone, and facilitate planning of ED services for older adults in other health regions who have a similar geographic distribution of care sites.

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