scholarly journals Prospective Validation of a Checklist to Predict Short‐term Death in Older Patients After Emergency Department Admission in Australia and Ireland

2018 ◽  
Vol 26 (6) ◽  
pp. 610-620 ◽  
Author(s):  
Magnolia Cardona ◽  
Michael O'Sullivan ◽  
Ebony T. Lewis ◽  
Robin M. Turner ◽  
Frances Garden ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Short Term ◽  
Emergency Department Admission

Geriatric assessment in frail older patients in the emergency department

2013 ◽  
Vol 23 (4) ◽  
pp. 275-282 ◽  
Author(s):  
Cesáreo Fernández-Alonso ◽  
F Javier Martín-Sánchez
Keyword(s):  
Emergency Department ◽  
Geriatric Assessment ◽  
Emergency Care ◽  
Older Patients ◽  
Sufficient Evidence ◽  
Short Term ◽  
Intervention Models ◽  
Patients At Risk ◽  
Geriatric Intervention ◽  
Care Of Elderly

SummaryEmergency care of elderly patients is frequent and complex in the emergency department. Frail older patients have a high risk of poor short-term results following emergency care. There is no practical universal or standardized tool defining frailty. It must be systematically identified in older patients at risk using a screening test, and in those who are positive, a diagnostic scale of frailty or preferably a geriatric scale adapted to emergency care is carried out. An adapted geriatric assessment including brief scales related to clinical, mental, functional and social aspects has been proposed. There are currently no geriatric intervention models with sufficient evidence in frail older patients.

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 Validating the RISE UP score for predicting prognosis in patients with COVID-19 in the emergency department: a retrospective study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045141
Author(s):  
Paul MEL van Dam ◽  
Noortje Zelis ◽  
Patricia Stassen ◽  
Daan J L van Twist ◽  
Peter W De Leeuw ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Adverse Outcome ◽  
Characteristic Curve ◽  
Favourable Outcome ◽  
Secondary Outcome ◽  
Care Hospital ◽  
Short Term ◽  
Short Term Mortality ◽  
Patients At Risk

ObjectiveTo mitigate the burden of COVID-19 on the healthcare system, information on the prognosis of the disease is needed. The recently developed Risk Stratification in the Emergency Department in Acutely ill Older Patients (RISE UP) score has very good discriminatory value for short-term mortality in older patients in the emergency department (ED). It consists of six readily available items. We hypothesised that the RISE UP score could have discriminatory value for 30-day mortality in ED patients with COVID-19.DesignRetrospective analysis.SettingTwo EDs of the Zuyderland Medical Centre, secondary care hospital in the Netherlands.ParticipantsThe study sample consisted of 642 adult ED patients diagnosed with COVID-19 between 3 March and until 25 May 2020. Inclusion criteria were (1) admission to the hospital with symptoms suggestive of COVID-19 and (2) positive result of the PCR or (very) high suspicion of COVID-19 according to the chest CT scan.OutcomePrimary outcome was 30-day mortality, secondary outcome was a composite of 30-day mortality and admission to intensive care unit (ICU).ResultsWithin 30 days after presentation, 167 patients (26.0%) died and 102 patients (15.9%) were admitted to ICU. The RISE UP score showed good discriminatory value for 30-day mortality (area under the receiver operating characteristic curve (AUC) 0.77, 95% CI 0.73 to 0.81) and for the composite outcome (AUC 0.72, 95% CI 0.68 to 0.76). Patients with RISE UP scores below 10% (n=121) had favourable outcome (zero deaths and six ICU admissions), while those with scores above 30% (n=221) were at high risk of adverse outcome (46.6% mortality and 19.0% ICU admissions).ConclusionThe RISE UP score is an accurate prognostic model for adverse outcome in ED patients with COVID-19. It can be used to identify patients at risk of short-term adverse outcome and may help guide decision-making and allocating healthcare resources.

scholarly journals MEESSI-AHF risk score performance to predict multiple post-index event and post-discharge short-term outcomes

2020 ◽  
pp. 204887262093431
Author(s):  
Xavier Rossello ◽  
Héctor Bueno ◽  
Víctor Gil ◽  
Javier Jacob ◽  
Francisco Javier Martín-Sánchez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Hospital Admission ◽  
Acute Heart Failure ◽  
Risk Score ◽  
Short Term ◽  
Emergency Department Admission ◽  
Heart Failure Patients ◽  
C Statistic

Background: The multiple estimation of risk based on the emergency department Spanish score in patients with acute heart failure (MEESSI-AHF) is a risk score designed to predict 30-day mortality in acute heart failure patients admitted to the emergency department. Using a derivation cohort, we evaluated the performance of the MEESSI-AHF risk score to predict 11 different short-term outcomes. Methods: Patients with acute heart failure from 41 Spanish emergency departments ( n=7755) were recruited consecutively in two time periods (2014 and 2016). Logistic regression models based on the MEESSI-AHF risk score were used to obtain c-statistics for 11 outcomes: three with follow-up from emergency department admission (inhospital, 7-day and 30-day mortality) and eight with follow-up from discharge (7-day mortality, emergency department revisit and their combination; and 30-day mortality, hospital admission, emergency department revisit and their two combinations with mortality). Results: The MEESSI-AHF risk score strongly predicted mortality outcomes with follow-up starting at emergency department admission (c-statistic 0.83 for 30-day mortality; 0.82 for inhospital death, P=0.121; and 0.85 for 7-day mortality, P=0.001). Overall, mortality outcomes with follow-up starting at hospital discharge predicted slightly less well (c-statistic 0.80 for 7-day mortality, P=0.011; and 0.75 for 30-day mortality, P<0.001). In contrast, the MEESSI-AHF score predicted poorly outcomes involving emergency department revisit or hospital admission alone or combined with mortality (c-statistics 0.54 to 0.62). Conclusions: The MEESSI-AHF risk score strongly predicts mortality outcomes in acute heart failure patients admitted to the emergency department, but the model performs poorly for outcomes involving hospital admission or emergency department revisit. There is a need to optimise this risk score to predict non-fatal events more effectively.

Hypotension at emergency department admission and hospital-acquired pressure ulcers in older patients: prospective study

2019 ◽  
Vol 28 (8) ◽  
pp. 527-531
Author(s):  
Xiang Gong ◽  
Hong-Lin Chen ◽  
Jun-Hua Shen ◽  
Bao-Feng Zhu
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Pressure Ulcers ◽  
Eastern China ◽  
Tertiary Care ◽  
Large Sample Size ◽  
Care Hospital ◽  
Emergency Department Admission ◽  
Hospital Acquired ◽  
The Relationship

Objective:To investigate the relationship between admission hypotension and hospital acquired pressure ulcers (PU) among older patients in an emergency department.Methods:The study was a prospective cohort conducted between March and May 2017 in the emergency department of a tertiary care hospital in Eastern China. Data on PUs and possible PU risk factors were collected using a pre-designed form. Multivariate logistic regression was used to calculate the adjusted odds ratio (OR).Results:A total of 157 older patients were included in the study. PU incidence was 8.3%, with 95% confidence interval (CI) of 4.5 to 13.7%. The majority (76.9%) of PUs developed in the first three days of admission. On admission, 28 patients were found to be hypotensive, and 129 non-hypotensive. In the hypotensive group, PU incidence was 21.4% (6/28), and 5.4% (7/129) in the non-hypotensive group, respectively. The crude OR was 4.753 (95%CI: 1.183 to 18.086). After adjustment by patients' age, admission to emergency intensive care unit and if requiring assistance to move, the adjusted OR of hypotension on admission for PU risk was 1.755 (95%CI: 1.356 to 3.224).Conclusion:Our study showed that admission hypotension was an independent risk factor of PU among elderly patients in emergency department. However, this conclusion should be confirmed by further studies with large sample size.

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