Ferran Llopis1, Carles Ferré2, Eric Jorge García-Lamberechts3, Mikel Martínez-Ortiz-de-Zárate4, Javier Jacob2, Juan González-Del-Castillo3. 1. Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. Electronic address: fllopis@bellvitgehospital.cat. 2. Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. 3. Servicio de Urgencias y Unidad de Corta Estancia, Hospital Clínico San Carlos, Madrid, España. 4. Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitario de Basurto, Bilbao, España.
Abstract
OBJECTIVE: To describe the clinical characteristics and outcomes of elderly patients (≥ 75 years) with suspected infection attending the emergency department (ED) and to compare patients admitted to a short-stay unit (SSU) with those admitted to a conventional hospital unit (CHU). MATERIAL AND METHODS: Prospective cohort study including, using opportunity sampling, patients ≥75 years treated for infection in the ED of 3 Spanish university hospitals (2013). Demographic variables, comorbidity, baseline performance status, presence of sepsis, infection type, destination on discharge, and mortality at 30 days were collected. RESULTS: During the study period, 330 patients ≥75 years (mean age 83.8±7.3) were evaluated for a suspected infection in the ED, and 306 (93%) were admitted to the hospital, 175 (53%) to the CHU and 87 (26%) to the SSU. Medical history included hypertension (74.5%), arrhythmia (30%), chronic obstructive pulmonary disease (28%), and diabetes mellitus (26%), and risk factors for multidrug resistance, such as antibiotic treatment in 3 months prior to admission (48%), and institutionalisation (26%). A classic sepsis syndrome was found to be the source of infection in 53%, and was respiratory in half of patients. When comparing patients admitted to SSU and CHU, statistically significant differences (p<.05) were found in the Charlson index (1.95 vs. 2.51), Glasgow coma scale (14.6 vs. 14.3), classic sepsis syndrome (67% vs. 53%), severe sepsis (2.3% vs. 18%), length of stay (4.2 vs. 10.4 days), and mortality within 30 days (3.4% vs. 18%), respectively. CONCLUSIONS: SSU may be an adequate alternative to CHU for elderly patients requiring admission with suspected infection.
OBJECTIVE: To describe the clinical characteristics and outcomes of elderly patients (≥ 75 years) with suspected infection attending the emergency department (ED) and to compare patients admitted to a short-stay unit (SSU) with those admitted to a conventional hospital unit (CHU). MATERIAL AND METHODS: Prospective cohort study including, using opportunity sampling, patients ≥75 years treated for infection in the ED of 3 Spanish university hospitals (2013). Demographic variables, comorbidity, baseline performance status, presence of sepsis, infection type, destination on discharge, and mortality at 30 days were collected. RESULTS: During the study period, 330 patients ≥75 years (mean age 83.8±7.3) were evaluated for a suspected infection in the ED, and 306 (93%) were admitted to the hospital, 175 (53%) to the CHU and 87 (26%) to the SSU. Medical history included hypertension (74.5%), arrhythmia (30%), chronic obstructive pulmonary disease (28%), and diabetes mellitus (26%), and risk factors for multidrug resistance, such as antibiotic treatment in 3 months prior to admission (48%), and institutionalisation (26%). A classic sepsis syndrome was found to be the source of infection in 53%, and was respiratory in half of patients. When comparing patients admitted to SSU and CHU, statistically significant differences (p<.05) were found in the Charlson index (1.95 vs. 2.51), Glasgow coma scale (14.6 vs. 14.3), classic sepsis syndrome (67% vs. 53%), severe sepsis (2.3% vs. 18%), length of stay (4.2 vs. 10.4 days), and mortality within 30 days (3.4% vs. 18%), respectively. CONCLUSIONS: SSU may be an adequate alternative to CHU for elderly patients requiring admission with suspected infection.
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