Elderly patients with non-specific complaints at the emergency department have a high risk for admission and 30-days mortality
Abstract Background Older adults have complex medical needs that causes increased use of resources at the emergency department (ED). The prevalence of non-specific complaint (NSC) as a chief-complaint in the ED is common among older adults and is not prioritized even though possibly having worse cli...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-023-04621-7 |
| _version_ | 1797362912860307456 |
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| author | Karin Erwander Kjell Ivarsson Mona Landin Olsson Björn Agvall |
| author_facet | Karin Erwander Kjell Ivarsson Mona Landin Olsson Björn Agvall |
| author_sort | Karin Erwander |
| collection | DOAJ |
| description | Abstract Background Older adults have complex medical needs that causes increased use of resources at the emergency department (ED). The prevalence of non-specific complaint (NSC) as a chief-complaint in the ED is common among older adults and is not prioritized even though possibly having worse clinical outcome. The objective was to study hospital admission and mortality for older adults visiting the ED with NSC compared to specific complaints such as dyspnea, chest pain and abdominal pain. Methods A retrospective observational study of older adults visiting the ED with NSC and specific complaints; dyspnea, chest pain and abdominal pain was performed. Chief-complaint were collected from electronic medical records. Fatigue, confusion, non-specific complaints, generalized weakness and risk of falling were defined as non-specific complaint (NSC) when registered as chief-complaint at the ED. Admission rate and 30-days mortality were the primary outcomes. Results A total of 4927 patients were included in the study based on chief-complaint; patients with chest pain 1599 (32%), dyspnea 1343 (27%), abdominal pain 1460 (30%) and NSC 525 (11%). Patients with dyspnea and NSC had the highest hospital admission rate 79% vs 70% compared to patients with chest pain (63%) and abdominal pain (61%) (p = < 0.001). Patients with NSC had a mean LOS 4.7 h at the ED which was significantly higher compared to chest pain, dyspnea and abdominal pain. Mean bed-days for the whole population was 4.2 days compared to patients with NSC who had a mean LOS of 5.6 days. NSC and dyspnea were both associated with the highest 30-day mortality. Conclusion Older patients who present with NSC at the ED are associated with a high risk for admission and 30-days mortality. In addition, patients with NSC have a longer LOS at the ED, a high admission rate and the highest number of bed-days once admitted. This study indicates that ED staff should be more vigilant when an elderly patient presents with NSC at the ED. Further studies and guidelines are needed to improve the management of these individuals. |
| first_indexed | 2024-03-08T16:13:14Z |
| format | Article |
| id | doaj.art-515e62f538834f1aa682d3bfd479effb |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-03-08T16:13:14Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-515e62f538834f1aa682d3bfd479effb2024-01-07T12:44:00ZengBMCBMC Geriatrics1471-23182024-01-012411810.1186/s12877-023-04621-7Elderly patients with non-specific complaints at the emergency department have a high risk for admission and 30-days mortalityKarin Erwander0Kjell Ivarsson1Mona Landin Olsson2Björn Agvall3Department of Clinical Sciences, Lund UniversityDepartment of Clinical Sciences, Lund UniversityDepartment of Clinical Sciences, Lund UniversityDepartment of Research and DevelopmentAbstract Background Older adults have complex medical needs that causes increased use of resources at the emergency department (ED). The prevalence of non-specific complaint (NSC) as a chief-complaint in the ED is common among older adults and is not prioritized even though possibly having worse clinical outcome. The objective was to study hospital admission and mortality for older adults visiting the ED with NSC compared to specific complaints such as dyspnea, chest pain and abdominal pain. Methods A retrospective observational study of older adults visiting the ED with NSC and specific complaints; dyspnea, chest pain and abdominal pain was performed. Chief-complaint were collected from electronic medical records. Fatigue, confusion, non-specific complaints, generalized weakness and risk of falling were defined as non-specific complaint (NSC) when registered as chief-complaint at the ED. Admission rate and 30-days mortality were the primary outcomes. Results A total of 4927 patients were included in the study based on chief-complaint; patients with chest pain 1599 (32%), dyspnea 1343 (27%), abdominal pain 1460 (30%) and NSC 525 (11%). Patients with dyspnea and NSC had the highest hospital admission rate 79% vs 70% compared to patients with chest pain (63%) and abdominal pain (61%) (p = < 0.001). Patients with NSC had a mean LOS 4.7 h at the ED which was significantly higher compared to chest pain, dyspnea and abdominal pain. Mean bed-days for the whole population was 4.2 days compared to patients with NSC who had a mean LOS of 5.6 days. NSC and dyspnea were both associated with the highest 30-day mortality. Conclusion Older patients who present with NSC at the ED are associated with a high risk for admission and 30-days mortality. In addition, patients with NSC have a longer LOS at the ED, a high admission rate and the highest number of bed-days once admitted. This study indicates that ED staff should be more vigilant when an elderly patient presents with NSC at the ED. Further studies and guidelines are needed to improve the management of these individuals.https://doi.org/10.1186/s12877-023-04621-7Non-specific complaintAtypical presentationElderly patientsEmergency departmentGeriatric emergency medicineAdmissions |
| spellingShingle | Karin Erwander Kjell Ivarsson Mona Landin Olsson Björn Agvall Elderly patients with non-specific complaints at the emergency department have a high risk for admission and 30-days mortality BMC Geriatrics Non-specific complaint Atypical presentation Elderly patients Emergency department Geriatric emergency medicine Admissions |
| title | Elderly patients with non-specific complaints at the emergency department have a high risk for admission and 30-days mortality |
| title_full | Elderly patients with non-specific complaints at the emergency department have a high risk for admission and 30-days mortality |
| title_fullStr | Elderly patients with non-specific complaints at the emergency department have a high risk for admission and 30-days mortality |
| title_full_unstemmed | Elderly patients with non-specific complaints at the emergency department have a high risk for admission and 30-days mortality |
| title_short | Elderly patients with non-specific complaints at the emergency department have a high risk for admission and 30-days mortality |
| title_sort | elderly patients with non specific complaints at the emergency department have a high risk for admission and 30 days mortality |
| topic | Non-specific complaint Atypical presentation Elderly patients Emergency department Geriatric emergency medicine Admissions |
| url | https://doi.org/10.1186/s12877-023-04621-7 |
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