scholarly journals Rib fractures following minor trauma in older patients: a not-so-benign injury

CJEM ◽  
2000 ◽  
Vol 2 (01) ◽  
pp. 32-34 ◽  
Author(s):  
Sam G. Campbell ◽  
Margaret A. Dingle
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Older Patients ◽  
Adverse Outcomes ◽  
Rib Fractures ◽  
Minor Trauma ◽  
Emergency Physicians

ABSTRACTTwo older adults presented to the emergency department with rib fractures following minor trauma. Both were discharged on oral analgesics and died within 2 days. Rib fractures more often lead to adverse outcomes in older adults. Emergency physicians should consider admitting any such patient who presents with two or more rib fractures.

Comparison of different risk stratification rules to predict short-term adverse outcomes after syncope in older Chinese adults 

2021 ◽  
Author(s):  
Hong Mu ◽  
Jiexin Liu ◽  
Hefei Tang ◽  
Cheng Huang ◽  
Limin Liu ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Risk Stratification ◽  
Older Patients ◽  
Adverse Outcomes ◽  
Chronic Obstructive Pulmonary Disorder ◽  
Likelihood Ratios ◽  
Short Term ◽  
Predictive Values ◽  
Older Chinese

Abstract Background: Older adults with syncope are commonly treated in the emergency department. Clinical decision rules have been developed to assess syncope patients, but there have been no application or comparative studies in older Chinese cohorts until now. This study aimed to compare the values of five existing rules in predicting the short-term adverse outcomes of older patients. Methods: From September 2018 to February 2021, older Chinese patients (≥60 yr) with syncope admitted to our hospital were investigated and evaluated by the Risk Stratification of Syncope in the Emergency Department (ROSE) rule, the San Francisco Syncope Rule (SFSR), the FAINT rule, the Canadian Syncope Risk Score (CSRS) and the Boston Syncope Criteria (BSC). After a one-month follow-up, the sensitivity, specificity, accuracy, positive predictive values (PPV), negative predictive values (NPV), positive likelihood ratios (PLR), and negative likelihood ratios (NLR) of each aforementioned rule were calculated and compared. Results: A total of 171 patients, with a mean age of 75.65±8.26 years and 48.54% male, were analysed in the study. Fifty-eight patients were reported to have experienced short-term adverse incidents during the month. The neurally mediated syncope group showed a significant sex-specific difference in adverse incidences but the cardiac syncope group did not. There were some factors associated with significant differences in adverse incidences, such as a history of hypertension, congestive heart failure, and chronic obstructive pulmonary disorder, as well as the levels of SpO2, B-type natriuretic peptide (BNP) and troponin T (TnT), while the levels of haemoglobin and creatinine suggested potential significance. In order of the ROSE, SFSR, FAINT, CSRS and BSC rules in the analysis, the sensitivities were 81.03%, 77.59%, 93.10%, 74.14% and 94.83%, the specificities were 86.73%, 84.96%, 38.94%, 60.18% and 56.64%, the NPVs were 89.91%, 88.07%, 91.67%, 81.93% and 95.52%, and the NLRs were 0.22, 0.26, 0.18, 0.43 and 0.09, respectively. Conclusions: This study revealed that the five mentioned rules for syncope risk stratification, with their own characteristics, all showed crucial significance for screening older adults. Therefore, physicians in the emergency department should flexibly understand and judge older patients’ potential risks according to the actual clinical situations.

scholarly journals SPMSQ for risk stratification of older patients in the emergency department

2019 ◽  
Vol 52 (S4) ◽  
pp. 222-228 ◽  
Author(s):  
A. Schönstein ◽  
H.-W. Wahl ◽  
H. A. Katus ◽  
A. Bahrmann
Keyword(s):  
Emergency Department ◽  
Nursing Home ◽  
Risk Stratification ◽  
Predictive Validity ◽  
Older Patients ◽  
Area Under The Curve ◽  
Composite Endpoint ◽  
Adverse Outcomes ◽  
Nursing Home Admission ◽  
Initial Contact

Abstract Background Risk stratification of older patients in the emergency department (ED) is seen as a promising and efficient solution for handling the increase in demand for geriatric emergency medicine. Previously, the predictive validity of commonly used tools for risk stratification, such as the identification of seniors at risk (ISAR), have found only limited evidence in German geriatric patient samples. Given that the adverse outcomes in question, such as rehospitalization, nursing home admission and mortality, are substantially associated with cognitive impairment, the potential of the short portable mental status questionnaire (SPMSQ) as a tool for risk stratification of older ED patients was investigated. Objective To estimate the predictive validity of the SPMSQ for a composite endpoint of adverse events (e.g. rehospitalization, nursing home admission and mortality). Method This was a prospective cohort study with 260 patients aged 70 years and above, recruited in a cardiology ED. Patients with a likely life-expectancy below 24 h were excluded. Follow-up examinations were conducted at 1, 3, 6 and 12 month(s) after recruitment. Results The SPMSQ was found to be a significant predictor of adverse outcomes not at 1 month (area under the curve, AUC 0.55, 95% confidence interval, CI 0.46–0.63) but at 3 months (AUC 0.61, 95% CI 0.54–0.68), 6 months (AUC 0.63, 95% CI 0.56–0.70) and 12 months (AUC 0.63, 95% CI 0.56–0.70) after initial contact. Conclusion For longer periods of observation the SPMSQ can be a predictor of a composite endpoint of adverse outcomes even when controlled for a range of confounders. Its characteristics, specifically the low sensitivity, make it unsuitable as an accurate risk stratification tool on its own.

scholarly journals Sex Differences in the Association between Atrial Fibrillation and 90-Day Adverse Outcomes among Older Adults with Heart Failure: A Retrospective Cohort Study

2021 ◽  
Vol 18 (5) ◽  
pp. 2237
Author(s):  
Youn-Jung Son ◽  
Da-Young Kim ◽  
Mi Hwa Won
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Older Adults ◽  
Sex Differences ◽  
Older Adult ◽  
Hospital Readmission ◽  
Older Patients ◽  
Adverse Outcomes ◽  
Prognostic Impact ◽  
Male And Female

Sex differences in the prognostic impact of coexisting atrial fibrillation (AF) in older patients with heart failure (HF) have not been well-studied. This study, therefore, compared sex differences in the association between AF and its 90-day adverse outcomes (hospital readmissions and emergency room (ER) visits) among older adults with HF. Of the 250 older adult patients, the prevalence rates of coexisting AF between male and female HF patients were 46.0% and 31.0%, respectively. In both male and female older patients, patients with AF have a significantly higher readmission rate (male 46.0%, and female 34.3%) than those without AF (male 6.8%, and female 12.8%). However, there are no significant differences in the association between AF and ER visits in both male and female older HF patients. The multivariate logistic analysis showed that coexisting AF significantly increased the risk of 90-day hospital readmission in both male and female older patients. In addition, older age in males and longer periods of time after an HF diagnosis in females were associated with an increased risk of hospital readmission. Consequently, prospective cohort studies are needed to identify the impact of coexisting AF on short- and long-term outcomes in older adult HF patients by sex.

scholarly journals Effectiveness of interventions to alleviate emergency department crowding by older adults: a systematic review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Gijs Hesselink ◽  
Özcan Sir ◽  
Yvonne Schoon
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Emergency Department ◽  
Older Patients ◽  
Elderly Care ◽  
Rapid Assessment ◽  
Experimental Studies ◽  
Design Quality ◽  
Content Type ◽  
Ed Crowding

Abstract Background The growing demand for elderly care often exceeds the ability of emergency department (ED) services to provide quality of care within reasonable time. The purpose of this systematic review is to assess the effectiveness of interventions on reducing ED crowding by older patients, and to identify core characteristics shared by successful interventions. Methods Six major biomedical databases were searched for (quasi)experimental studies published between January 1990 and March 2017 and assessing the effect of interventions for older patients on ED crowding related outcomes. Two independent reviewers screened and selected studies, assessed risk of bias and extracted data into a standardized form. Data were synthesized around the study setting, design, quality, intervention content, type of outcome and observed effects. Results Of the 16 included studies, eight (50%) were randomized controlled trials (RCTs), two (13%) were non-RCTs and six (34%) were controlled before-after (CBA) studies. Thirteen studies (81%) evaluated effects on ED revisits and four studies (25%) evaluated effects on ED throughput time. Thirteen studies (81%) described multicomponent interventions. The rapid assessment and streaming of care for older adults based on time-efficiency goals by dedicated staff in a specific ED unit lead to a statistically significant decrease of ED length of stay (LOS). An ED-based consultant geriatrician showed significant time reduction between patient admission and geriatric review compared to an in-reaching geriatrician. Conclusion Inter-study heterogeneity and poor methodological quality hinder drawing firm conclusions on the intervention’s effectiveness in reducing ED crowding by older adults. More evidence-based research is needed using uniform and valid effect measures. Trial registration The protocol is registered with the PROSPERO International register of systematic reviews: ID = CRD42017075575).

scholarly journals Frailty Predicts Some but Not All Adverse Outcomes in Older Adults Discharged from the Emergency Department

2008 ◽  
Vol 56 (9) ◽  
pp. 1651-1657 ◽  
Author(s):  
S. Nicole Hastings ◽  
Jama L. Purser ◽  
Kimberly S. Johnson ◽  
Richard J. Sloane ◽  
Heather E. Whitson
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Adverse Outcomes

scholarly journals Emergency medical service, nursing, and physician providers’ perspectives on delirium identification and management

Dementia ◽  
2016 ◽  
Vol 16 (3) ◽  
pp. 329-343 ◽  
Author(s):  
Michael A LaMantia ◽  
Frank C Messina ◽  
Shola Jhanji ◽  
Arif Nazir ◽  
Mungai Maina ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Emergency Medical Services ◽  
Mental Status ◽  
Medical Services ◽  
Diagnostic Strategy ◽  
Emergency Physicians ◽  
Emergency Nurses ◽  
Study Objective ◽  
Emergency Medical

Purpose of the study The study objective was to understand providers’ perceptions regarding identifying and treating older adults with delirium, a common complication of acute illness in persons with dementia, in the pre-hospital and emergency department environments. Design and methods The authors conducted structured focus group interviews with separate groups of emergency medical services staff, emergency nurses, and emergency physicians. Recordings of each session were transcribed, coded, and analyzed for themes with representative supporting quotations identified. Results Providers shared that the busy emergency department environment was the largest challenge to delirium recognition and treatment. When describing delirium, participants frequently detailed hyperactive features of delirium, rather than hypoactive features. Participants shared that they employed no clear diagnostic strategy for identifying the condition and that they used heterogeneous approaches to treat the condition. To improve care for older adults with delirium, emergency nurses identified the need for more training around the management of the condition. Emergency medical services providers identified the need for more support in managing agitated patients when in transport to the hospital and more guidance from emergency physicians on what information to collect from the patient’s home environment. Emergency physicians felt that delirium care would be improved if they could have baseline mental status data on their patients and if they had access to a simple, accurate diagnostic tool for the condition. Implications Emergency medical services providers, emergency nurses, and emergency physicians frequently encounter delirious patients, but do not employ clear diagnostic strategies for identifying the condition and have varying levels of comfort in managing the condition. Clear steps should be taken to improve delirium care in the emergency department including the development of mechanisms to communicate patients’ baseline mental status, the adoption of a systematized approach to recognizing delirium, and the institution of a standardized method to treat the condition when identified.

scholarly journals Timed Up and Go predicts functional decline in older patients presenting to the emergency department following minor trauma

2016 ◽  
Author(s):  
Debra Eagles ◽  
Jeffrey J. Perry ◽  
Marie-Josée Sirois ◽  
Eddy Lang ◽  
Raoul Daoust ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Functional Decline ◽  
Minor Trauma ◽  
Timed Up And Go

Older Patients' Understanding of Emergency Department Discharge Information and Its Relationship With Adverse Outcomes

2011 ◽  
Vol 7 (1) ◽  
pp. 19-25 ◽  
Author(s):  
Susan N. Hastings ◽  
Amanda Barrett ◽  
Morris Weinberger ◽  
Eugene Z. Oddone ◽  
Luna Ragsdale ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Adverse Outcomes ◽  
Emergency Department Discharge

scholarly journals A Delphi study to identify prehospital and emergency department trauma care modifiers for older adults

2021 ◽  
Vol 64 (3) ◽  
pp. E339-E345
Author(s):  
Krishan Yadav ◽  
Valérie Boucher ◽  
Natalie Le Sage ◽  
Christian Malo ◽  
Éric Mercier ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Trauma Care ◽  
Delphi Study ◽  
Older Patients ◽  
Major Trauma ◽  
Trauma Centre ◽  
Expert Consensus ◽  
Consensus Methods ◽  
Modified Delphi

Background: Older patients (age ≥ 65 yr) with trauma have increased morbidity and mortality compared to younger patients; this is partly explained by undertriage of older patients with trauma, resulting in lack of transfer to a trauma centre or failure to activate the trauma team. The objective of this study was to identify modifiers to the prehospital and emergency department phases of major trauma care for older adults based on expert consensus. Methods: We conducted a modified Delphi study between May and September 2019 to identify major trauma care modifiers for older adults based on national expert consensus. The panel consisted of 24 trauma care professionals from across Canada from the prehospital and emergency department phases of care. The survey consisted of 16 trauma care modifiers. Three online survey rounds were distributed. Consensus was defined a priori as a disagreement index score less than 1. Results: There was a 100% response rate for all survey rounds. Three new trauma care modifiers were suggested by panellists. The panel achieved consensus agreement for 17 of the 19 trauma care modifiers. The prehospital modifier with the strongest agreement to transfer to a trauma centre was a respiratory rate less than 10 or greater than 20 breaths/min or need for ventilatory support. The emergency department modifier with the strongest level of agreement was obtaining 12-lead electrocardiography following the primary and secondary survey. Conclusion: Using a modified Delphi process, an expert panel agreed on 17 trauma care modifiers for older adults in the prehospital and emergency department settings. These modifiers may improve the delivery of trauma care for older adults and should be considered when developing local and national trauma guidelines.

scholarly journals A physiotherapy-led transition to home intervention for older adults following emergency department discharge: protocol for a pilot feasibility randomised controlled trial

2022 ◽  
Vol 8 (1) ◽  
Author(s):  
Mairéad Conneely ◽  
Aoife Leahy ◽  
Margaret O’Connor ◽  
Louise Barry ◽  
Gillian Corey ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Randomised Controlled Trial ◽  
Usual Care ◽  
Controlled Trial ◽  
Adverse Outcomes ◽  
Medical Assessment ◽  
Index Visit ◽  
Randomised Controlled ◽  
Feasibility Rct

Abstract Background Older adults frequently attend the emergency department (ED) and experience high rates of adverse outcomes following ED presentation including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. This paper reports a protocol designed to evaluate the feasibility of conducting a three arm randomised controlled trial (RCT) within the ED setting and in the patient’s home. The interventions are comprehensive geriatric assessment (CGA), ED PLUS and usual care. Methods The ED PLUS pilot trial is designed as a feasibility RCT conducted in the ED and Acute Medical Assessment Unit of a university teaching hospital in the mid-west region of Ireland. We aim to recruit 30 patients, aged 65 years and over presenting to the ED with undifferentiated medical complaints and discharged within 72 h of index visit. Patients will be randomised by a computer in a ratio of 1:1:1 to deliver usual care, CGA or ED PLUS during a 6-month study period. A randomised algorithm is used to perform randomization. CGA will include a medical assessment, medication review, nursing assessment, falls assessment, assessment of mobility and stairs, transfers, personal care, activities of daily living (ADLs), social supports and baseline cognition. ED PLUS, a physiotherapist led, multidisciplinary intervention, aims to bridge the transition of care between the index visit to the ED and the community by initiating a CGA intervention in the ED and implementing a 6-week follow-up self-management programme in the patient’s own home following discharge from the ED. The outcomes will be parameters of the feasibility of the intervention and trial methods and will be assessed quantitatively and qualitatively. Discussion Rising ED visits and an ageing population with chronic health issues render ED interventions to reduce adverse outcomes in older adults a research priority. This feasibility RCT will generate data and experience to inform the conduct and delivery of a definite RCT. Trial registration The trial was registered in Clinical Trials Protocols and Results System as of 21st July 2021, with registration number NCT049836020.

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