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 14,000/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.
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 14,000/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.
Authors: Michael A Ross; Scott Compton; Daniel Richardson; Ryan Jones; Tara Nittis; Andrew Wilson Journal: Ann Emerg Med Date: 2003-05 Impact factor: 5.721
Authors: Timothy F Platts-Mills; Debbie Travers; Kevin Biese; Brenda McCall; Steve Kizer; Michael LaMantia; Jan Busby-Whitehead; Charles B Cairns Journal: Acad Emerg Med Date: 2010-03 Impact factor: 3.451
Authors: Michael A LaMantia; Timothy F Platts-Mills; Kevin Biese; Christine Khandelwal; Cory Forbach; Charles B Cairns; Jan Busby-Whitehead; John S Kizer Journal: Acad Emerg Med Date: 2010-03 Impact factor: 3.451
Authors: Lauren T Southerland; Katherine M Hunold; Christopher R Carpenter; Jeffrey M Caterino; Lorraine C Mion Journal: Am J Emerg Med Date: 2018-12-13 Impact factor: 2.469
Authors: Lauren T Southerland; Anthony J Vargas; Lalitha Nagaraj; Tanya R Gure; Jeffery M Caterino Journal: Acad Emerg Med Date: 2017-11-24 Impact factor: 3.451
Authors: Camilla Strøm; Jakob S Stefansson; Maria Louise Fabritius; Lars S Rasmussen; Thomas A Schmidt; Janus C Jakobsen Journal: Cochrane Database Syst Rev Date: 2018-08-13