Lauren T Southerland1, Katherine M Hunold2, Christopher R Carpenter3, Jeffrey M Caterino2, Lorraine C Mion4. 1. Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: Lauren.Southerland@osumc.edu. 2. Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 3. Department of Emergency Medicine, Washington University at St. Louis, St. Louis, MO, USA. 4. College of Nursing, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Abstract
BACKGROUND: Emergency Department (ED) Observation Units (Obs Units) are prevalent in the US, but little is known regarding older adults in observation. Our objective was to describe the Obs Units nationally and observation patients with specific attention to differences in care with increasing age. DESIGN: This is an analysis of 2010-2013 data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), a national observational cohort study including ED patients. Weighted means are presented for continuous data and weighted percent for categorical data. Multivariable logistic regression was used to identify variables associated with placement in and admission from observation. RESULTS: The number of adult ED visits varied from 100 million to 107 million per year and 2.3% of patients were placed in observation. Adults ≥65 years old made up a disproportionate number of Obs Unit patients, 30.6%, compared to only 19.7% of total ED visits (odds ratio 1.5 (95% CI 1.5-1.6), adjusting for sex, race, month, day of week, payer source, and hospital region). The overall admission rate from observation was 35.6%, ranging from 31.3% for ages 18-64 years to 47.5% for adults ≥85 years old (p < 0.001). General symptoms (e.g., nausea, dizziness) and hypertensive disease were the most common diagnoses overall. Older adults varied from younger adults in that they were frequently observed for diseases of the urinary system (ICD-9 590-599) and metabolic disorders (ICD-9 270-279). CONCLUSIONS: Older adults are more likely to be cared for in Obs Units. Older adults are treated for different medical conditions than younger adults.
BACKGROUND: Emergency Department (ED) Observation Units (Obs Units) are prevalent in the US, but little is known regarding older adults in observation. Our objective was to describe the Obs Units nationally and observation patients with specific attention to differences in care with increasing age. DESIGN: This is an analysis of 2010-2013 data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), a national observational cohort study including ED patients. Weighted means are presented for continuous data and weighted percent for categorical data. Multivariable logistic regression was used to identify variables associated with placement in and admission from observation. RESULTS: The number of adult ED visits varied from 100 million to 107 million per year and 2.3% of patients were placed in observation. Adults ≥65 years old made up a disproportionate number of Obs Unit patients, 30.6%, compared to only 19.7% of total ED visits (odds ratio 1.5 (95% CI 1.5-1.6), adjusting for sex, race, month, day of week, payer source, and hospital region). The overall admission rate from observation was 35.6%, ranging from 31.3% for ages 18-64 years to 47.5% for adults ≥85 years old (p < 0.001). General symptoms (e.g., nausea, dizziness) and hypertensive disease were the most common diagnoses overall. Older adults varied from younger adults in that they were frequently observed for diseases of the urinary system (ICD-9 590-599) and metabolic disorders (ICD-9 270-279). CONCLUSIONS: Older adults are more likely to be cared for in Obs Units. Older adults are treated for different medical conditions than younger adults.
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: Fadi Nahab; George Leach; Carlene Kingston; Osman Mir; Jerome Abramson; Sarah Hilton; Matthew Keadey; Bryce Gartland; Michael Ross Journal: J Stroke Cerebrovasc Dis Date: 2011-04-09 Impact factor: 2.136
Authors: Cynthia M Boyd; C Seth Landefeld; Steven R Counsell; Robert M Palmer; Richard H Fortinsky; Denise Kresevic; Christopher Burant; Kenneth E Covinsky Journal: J Am Geriatr Soc Date: 2008-12 Impact factor: 5.562
Authors: Jin H Han; Eli E Zimmerman; Nathan Cutler; John Schnelle; Alessandro Morandi; Robert S Dittus; Alan B Storrow; E Wesley Ely Journal: Acad Emerg Med Date: 2009-01-20 Impact factor: 3.451
Authors: Arjun K Venkatesh; Benjamin P Geisler; Jennifer J Gibson Chambers; Christopher W Baugh; J Stephen Bohan; Jeremiah D Schuur Journal: PLoS One Date: 2011-09-14 Impact factor: 3.240
Authors: Patrick Chaftari; Demis N Lipe; Monica K Wattana; Aiham Qdaisat; Pavitra P Krishnamani; Jomol Thomas; Ahmed F Elsayem; Marcelo Sandoval Journal: JCO Oncol Pract Date: 2021-12-14