Effect of advanced age and vital signs on admission from an ED observation unit
Effect of advanced age and vital signs on admission from an ED observation unit
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DOI：
10.1016/j.ajem.2012.01.002
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发表时间：
2013-01-01
影响因子：
3.6
通讯作者：
Moseley, Mark G.
中科院分区：
文献类型：
--
作者：
Caterino, Jeffrey M.;Hoover, Emily M.;Moseley, Mark G.
目的：主要目的是确定高龄与急诊科（ED）观察单元入院需求之间的关系。次要目的是确定初始ED生命体征与入院之间的关系。方法：我们进行了一项前瞻性观察队列研究，将ED患者安置在基于ED的观察单元中。采用多变量惩罚最大似然逻辑回归来确定住院需求的独立预测因子。年龄以65岁或以上为限进行连续检查。在普遍接受的截止点连续检查生命体征。我们还控制了人口统计学、合并症、实验室值和观察方案。结果：纳入300例患者，12% （n = 35）年龄在65岁及以上，11% （n = 33）需要住院治疗。老年人入院率为2.9%(95%可信区间[CI]， 0.07%-14.9%)，年轻人入院率为12.1%（95%可信区间[CI]， 8.4%-16.6%）。在多变量分析中，年龄与入院无关（优势比[OR]， 0.30; 95% CI, 0.05-1.67）。入院的预测因素包括收缩压180毫米汞柱或更高（or, 4.19; 95% CI, 1.08-16.30）、Charlson合并症评分（or, 2.93; 95% CI, 1.57-5.46）和白细胞计数14000/mm(3)或更高（or, 11.35; 95% CI, 3.42-37.72）。结论：在ED观察单元的患者中，65岁或以上的患者与入院需求无关。老年人可以成功地从这些单位出院。收缩压≥180mmhg是唯一可预测的生命体征。在确定是否适合选择急诊科观察单元的患者时，高龄不应成为自动取消资格的标准。(C) 2013爱思唯尔公司版权所有。
Objectives: The primary objective was to determine the relationship between advanced age and need for admission from an emergency department (ED) observation unit. The secondary objective was to determine the relationship between initial ED vital signs and admission.Methods: We conducted a prospective, observational cohort study of ED patients placed in an ED-based observation unit. Multivariable penalized maximum likelihood logistic regression was used to identify independent predictors of need for hospital admission. Age was examined continuously and at a cutoff of 65 years or more. Vital signs were examined continuously and at commonly accepted cutoffs. We additionally controlled for demographics, comorbid conditions, laboratory values, and observation protocol.Results: Three hundred patients were enrolled, 12% (n = 35) were 65 years or older, and 11% (n = 33) required admission. Admission rates were 2.9% (95% confidence interval [CI], 0.07%-14.9%) in older adults and 12.1% (95% CI, 8.4%-16.6%) in younger adults. In multivariable analysis, age was not associated with admission (odds ratio [OR], 0.30; 95% CI, 0.05-1.67). Predictors of admission included systolic pressure 180 mm Hg or greater (OR, 4.19; 95% CI, 1.08-16.30), log Charlson comorbidity score (OR, 2.93; 95% CI, 1.57-5.46), and white blood cell count 14000/mm(3) or greater (OR, 11.35; 95% CI, 3.42-37.72).Conclusions: Among patients placed in an ED observation unit, age 65 years or more is not associated with need for admission. Older adults can successfully be discharged from these units. Systolic pressure 180 mm Hg or greater was the only predictive vital sign. In determining appropriateness of patients selected for an ED observation unit, advanced age should not be an automatic disqualifying criterion. (C) 2013 Elsevier Inc. All rights reserved.