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

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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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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Assessing Risk of Falls Among Geriatric Patients Presenting to the Emergency Department

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2005.06.433 ◽

2005 ◽

Vol 46 (3) ◽

pp. 118

Author(s):

P.B. Dohrenwend ◽

O.L. Hung ◽

M. Silverman ◽

R.D. Shih

Keyword(s):

Emergency Department ◽

Geriatric Patients ◽

Risk Of Falls

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270 Hospital Outcomes in Geriatric Patients Who Had a 72-Hour Return Visit to the Emergency Department

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2011.06.300 ◽

2011 ◽

Vol 58 (4) ◽

pp. S268

Author(s):

A.R. Kanthala ◽

B.R. Allen ◽

J.A. Lee ◽

A.N. Bodhit ◽

S.K. Nayfield ◽

...

Keyword(s):

Emergency Department ◽

Geriatric Patients ◽

Hospital Outcomes ◽

Return Visit

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Cost Analysis of Emergency Department Visits by Geriatric Patients Living in Nursing Homes

Journal of College of Physicians And Surgeons Pakistan ◽

10.29271/jcpsp.2019.07.658 ◽

2019 ◽

Vol 29 (07) ◽

pp. 658-660

Author(s):

Murat Seyit ◽

Atakan Yilmaz ◽

Duygu Seyit ◽

Mert Ozen

Keyword(s):

Emergency Department ◽

Nursing Homes ◽

Cost Analysis ◽

Geriatric Patients ◽

Emergency Department Visits

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Diagnostic accuracy of the Ottawa 3DY and Short Blessed Test to detect cognitive dysfunction in geriatric patients presenting to the emergency department

BMJ Open ◽

10.1136/bmjopen-2017-019652 ◽

2018 ◽

Vol 8 (3) ◽

pp. e019652 ◽

Cited By ~ 10

Author(s):

David Barbic ◽

Brian Kim ◽

Qadeem Salehmohamed ◽

Kate Kemplin ◽

Christopher R Carpenter ◽

...

Keyword(s):

Emergency Department ◽

Inner City ◽

Diagnostic Accuracy ◽

Cognitive Dysfunction ◽

Sensitivity And Specificity ◽

Geriatric Patients ◽

Screening Tools ◽

Common Finding ◽

Rater Reliability ◽

Robust Likelihood

ObjectivesCognitive dysfunction (CD) is a common finding in geriatric patients presenting to the emergency department (ED). Our primary objective was to determine the diagnostic accuracy of the Ottawa 3DY (O3DY) and Short Blessed Test (SBT) as screening tools for the detection of CD in the ED. Our secondary objective was to estimate the inter-rater reliability of these instruments.MethodsWe conducted a prospective cross-sectional comparative study at an inner-city academic medical centre (annual ED visit census 86 000). Patients aged 75 years or greater were evaluated for inclusion, 163 were screened, 150 were deemed eligible and 117 were enrolled. The research team completed the O3DY, SBT and Mini-Mental State Exam (MMSE) for each participant. Descriptive statistics were calculated. Sensitivity and specificity of the O3DY and SBT were calculated in STATA V.11.2 using the MMSE as our criterion standard.ResultsWe enrolled 117 patients from June to November 2016. The median ED length of stay at the time of completion of all tests was 1:40 (IQR 1:34–1:46). The sensitivity of the O3DY was 71.4% (95% CI 47.8 to 95.1), and specificity was 56.3% (46.7–65.9). Sensitivity of the SBT was 85.7% (67.4–99.9) and specificity was 58.3% (48.7–67.8). The receiver operating characteristic area under the curve was calculated for the O3DY (0.51; 95% CI 0.42 to 0.61) and SBT (0.52; 95% CI 0.43 to 0.61) relative to the MMSE. Inter-rater reliability for the O3DY (k=0.64) and SBT (k=0.63) were good.ConclusionIn a cohort of geriatric patients presenting to an inner-city academic ED, the O3DY and SBT tools demonstrate moderate sensitivity and specificity for the detection of CD. Inter-rater reliability for the O3DY and SBT were good. Future research on this topic should attempt to derive and validate ED-specific screening tools, which will hopefully result in more robust likelihood ratios for the screening of CD in ED geriatric patients.

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