Min-Hsien Chung1,2, Feng-Yuan Chu1,3, Tzu-Meng Yang1, Hung-Jung Lin1,4,5, Jiann-Hwa Chen6,7, How-Ran Guo8,9, Si-Chon Vong1,2, Shih-Bin Su10,11,12, Chien-Cheng Huang1,13,8,14, Chien-Chin Hsu1,4. 1. Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan. 2. Department of Emergency Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan. 3. Department of Emergency Medicine, Chi-Mei Medical Center, Chiali, Tainan, Taiwan. 4. Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan. 5. Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan. 6. Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan. 7. Fu Jen Catholic University School of Medicine, Taipei, Taiwan. 8. Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan. 9. Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan. 10. Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan. 11. Medical Research, Chi-Mei Medical Center, Tainan, Taiwan. 12. Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan. 13. Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan. 14. Department of Emergency Medicine, Kuo General Hospital, Tainan, Taiwan.
Abstract
AIM: The geriatric population (aged ≥65 years) accounts for 12-24% of all emergency department (ED) visits. Of them, 10% have a fever, 70-90% will be admitted and 7-10% of will die within a month. Therefore, mortality prediction and appropriate disposition after ED treatment are of great concern for geriatric patients with fever. We tried to identify independent mortality predictors of geriatric patients with fever, and combine these predictors to predict their mortality. METHODS: We enrolled consecutive geriatric patients visiting the ED between 1 June and 21 July 2010 with the following criteria of fever: a tympanic temperature ≥37.2°C or a baseline temperature elevated ≥1.3°C. We used 30-day mortality as the primary end-point. RESULTS: A total of 330 patients were enrolled. Hypotension, bedridden, leukocytosis, thrombocytopenia and serum creatinine >2 mg/dL, but not age, were independently associated with 30-day mortality. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) ranged from 18.2% to 90.9%, 34.7% to 100%, 9.0% to 100% and 94.5% to 98.2%, respectively, depending on how many predictors there were. CONCLUSIONS: The 30-day mortality increased with the number of independent mortality predictors. With at least four predictors, 100% of the patients died within 30 days. With none of the predictors, just 1.8% died. These findings might help physicians make decisions about geriatric patients with fever.
AIM: The geriatric population (aged ≥65 years) accounts for 12-24% of all emergency department (ED) visits. Of them, 10% have a fever, 70-90% will be admitted and 7-10% of will die within a month. Therefore, mortality prediction and appropriate disposition after ED treatment are of great concern for geriatric patients with fever. We tried to identify independent mortality predictors of geriatric patients with fever, and combine these predictors to predict their mortality. METHODS: We enrolled consecutive geriatric patients visiting the ED between 1 June and 21 July 2010 with the following criteria of fever: a tympanic temperature ≥37.2°C or a baseline temperature elevated ≥1.3°C. We used 30-day mortality as the primary end-point. RESULTS: A total of 330 patients were enrolled. Hypotension, bedridden, leukocytosis, thrombocytopenia and serum creatinine >2 mg/dL, but not age, were independently associated with 30-day mortality. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) ranged from 18.2% to 90.9%, 34.7% to 100%, 9.0% to 100% and 94.5% to 98.2%, respectively, depending on how many predictors there were. CONCLUSIONS: The 30-day mortality increased with the number of independent mortality predictors. With at least four predictors, 100% of the patients died within 30 days. With none of the predictors, just 1.8% died. These findings might help physicians make decisions about geriatric patients with fever.