scholarly journals LO16: Predictors of appropriate hospitalization in elderly patients

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S12-S13
Author(s):  
G. Innes ◽  
A. McRae ◽  
E. Lang ◽  
D. Wang ◽  
J. Andruchow
Keyword(s):  
Older Patients ◽  
Vital Signs ◽  
Chief Complaint ◽  
Index Hospitalization ◽  
Clinical Predictors ◽  
Laboratory Findings ◽  
Living Situation ◽  
Advanced Directive ◽  
Care Level ◽  
Admission Decisions

Introduction: Admission decisions in older patients are often difficult. Our objectives were to identify clinical predictors of appropriate admission for older patients who attend the emergency department (ED). Methods: Administrative data were gathered on all Calgary ED patients >75 years old who were treated during 2017. We considered the following events indicative of appropriate admission: an index hospitalization lasting >72 hours, the need for ICU or CCU care, and 30-day death or readmission. Multivariable logistic regression was used to determine the association of the following potential predictors with appropriate admission: age, sex, EMS arrival, ILI symptoms, living situation (independent, homecare dependency or facility), acuity level, chief complaint, vital signs, need for IV fluid bolus ( >1Li), serum sodium, potassium, creatinine, hemoglobin, and advanced directive care level (comfort, medical, resuscitation, unspecified). Results: We studied 38866 older patients who were 55.9% female with a mean age of 84. Most (69%) lived independently, with 17% in a facility and 14% homecare dependent. Overall, 16,992 (43.7%) were admitted at their index visit and 17,340 had an outcome event, including index hospitalization >72 hours (N = 13,623, 35%), ICU care (352, 0.9%), CCU care (447, 1.2%), or 30-day death (2,241, 5.8%) or readmission (3,964 10.2%). Patients with appropriate admission events were more likely to have an advanced directive (80.7% v. 7.8%), triage hypoxia (30.5% v. 9.2%), EMS arrival (73% v. 48%), facility or homecare dependency (50% v. 15%), or to have a complaint of dyspnea (20.4% v. 8.6%), weakness (9.1% v. 3.8%) or altered mentation (8.8% v. 2.8%). Multivariable modeling showed that the strongest predictors of appropriate admission (adjusted odds ratio) were any advanced directive (OR = 30), need for IV bolus (OR = 1.67), homecare dependency (OR = 1.65), triage hypoxia (OR = 1.63), and a chief complaint of altered mentation (OR = 1.72), weakness (OR = 1.52) or dyspnea (OR = 1.25). Conclusion: The presence of an advanced care directive is strongly associated with appropriate admission in older ED patients. Other significant determinants include homecare dependency, EMS arrival, hypoxia or dyspnea, IV bolus and weakness or altered mentation. Age, sex, acuity, vital signs and laboratory findings were weak predictors.

scholarly journals Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e042351
Author(s):  
Kathryn Eastwood ◽  
Dhanya Nambiar ◽  
Rosamond Dwyer ◽  
Judy A Lowthian ◽  
Peter Cameron ◽  
...  
Keyword(s):  
Cohort Study ◽  
Older Adult ◽  
Retrospective Cohort Study ◽  
Older Patients ◽  
Retrospective Cohort ◽  
Vital Signs ◽  
Telephone Triage ◽  
Ambulance Dispatch ◽  
Emergency Ambulance ◽  
Primary Triage

BackgroundMost calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches.ObjectivesTo examine the appropriateness of secondary dispatch through a comparison of the characteristics and ambulance outcomes of older patients dispatched an emergency ambulance via direct or secondary dispatch.DesignA retrospective cohort study of ambulance patient data between September 2009 and June 2012 was conducted.SettingThe secondary telephone triage service operated in metropolitan Melbourne, Victoria, Australia during the study period.ParticipantsThere were 90 086 patients included aged 65 years and over who had an emergency ambulance dispatch via direct or secondary dispatch with one of the five most common secondary dispatch paramedic diagnoses.Main outcome measuresDescriptive analyses compared characteristics, treatment and transportation rates between direct and secondary dispatch patients.ResultsThe dispatch groups were similar in demographics, vital signs and hospital transportation rates. However, secondary dispatch patients were half as likely to be treated by paramedics (OR 0.51; CI 0.48 to 0.55; p<0.001). Increasing age was associated with decreasing treatment (p<0.005) and increasing transportation rates (p<0.005).ConclusionSecondary triage could identify patients who would ultimately be transported to an emergency department. However, the lower paramedic treatment rates suggest many secondary dispatch patients may have been suitable for referral to alternative low-acuity transport or referral options.

scholarly journals Early prediction of hospital admission for emergency department patients: a comparison between patients younger or older than 70 years

2017 ◽  
Vol 35 (1) ◽  
pp. 18-27 ◽  
Author(s):  
Jacinta A Lucke ◽  
Jelle de Gelder ◽  
Fleur Clarijs ◽  
Christian Heringhaus ◽  
Anton J M de Craen ◽  
...  
Keyword(s):  
Heart Rate ◽  
Hospital Admission ◽  
Older Patients ◽  
Prediction Models ◽  
Age Groups ◽  
Vital Signs ◽  
Area Under The Curve ◽  
University Hospital ◽  
Multivariable Logistic Regression Analysis ◽  
Younger Patients

ObjectiveThe aim of this study was to develop models that predict hospital admission to ED of patients younger and older than 70 and compare their performance.MethodsPrediction models were derived in a retrospective observational study of all patients≥18 years old visiting the ED of a university hospital during the first 6 months of 2012. Patients were stratified into two age groups (<70 years old and ≥70 years old). Multivariable logistic regression analysis was used to identify predictors of hospital admission among factors available immediately after patient arrival to the ED. Validation of the prediction models was performed on patients presenting to the ED during the second half of the year 2012.Results10 807 patients were included in the derivation and 10 480 in the validation cohorts. The strongest independent predictors of hospital admission among the 8728 patients <70 years old were age, sex, triage category, mode of arrival, performance of blood tests, chief complaint, ED revisit, type of specialist, phlebotomised blood sample and all vital signs. The area under the curve (AUC) of the validation cohort for those <70 years old was 0.86 (95% CI 0.85 to 0.87). Among the 2079 patients ≥70 years, the same factors were predictive, except for gender, type of specialist and heart rate; the AUC was 0.77 (95% CI 0.75 to 0.79). The prediction models could identify a group of 10% of patients with the highest risk in whom hospital admission was predicted at ED triage, with a positive predictive value (PPV) of 71% (95% CI 68% to 74%) in younger patients and PPV of 87% (95% CI 81% to 92%) in older patients.ConclusionDemographic and clinical factors readily available early in the ED visit can be useful in identifying patients who are likely to be admitted to the hospital. While the model for the younger patients had a higher AUC, the model for older patients had a higher PPV in identifying the patients at highest risk for admission. Of note, heart rate was not a useful predictor in the older patients.

scholarly journals Clinical and laboratory findings in elderly with Community-Acquired Pneumonia in Babol, northern Iran – 2017-2019

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Saleh Habibi ◽  
Arefeh Babazadeh ◽  
Soheil Ebrahimpour ◽  
Parisa Sabbagh ◽  
Mehran Shokri
Keyword(s):  
Older Adults ◽  
Age Groups ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Vital Signs ◽  
The Elderly ◽  
Community Acquired Pneumonia ◽  
Northern Iran ◽  
Laboratory Findings ◽  
Cross Sectional

Abstract Morbidity and mortality are higher in older adults with community-acquired pneumonia (CAP) than in other age groups. Also, CAP in older adults has various clinical manifestations with other. A higher mortality rate in the elderly with CAP may contribute to a delay in management. Consequently, the purpose of this study was to investigate the clinical and laboratory manifestations of CAP in the elderly. This cross-sectional study was conducted on 221 elderly patients with CAP who were admitted to Ayatollah Rouhani Hospital, in Babol, northern of Iran, in 2017-2019. Patient outcomes included 170 cases that recovered from CAP, and 51 cases that died of complications. Patients were evaluated in terms of their clinical and laboratory manifestations. The most common symptoms of pneumonia were cough (79.6%), sputum (73.8%), weakness (72.9%), fever (56%), dyspnea (46.2%). The most frequent underlying disease was ischemic heart disease (43.9%). In our study, clinical and laboratory characteristics in older patients with CAP were evaluated and compared with other studies confirming past findings, but there were differences in some cases, such as vital signs, gastrointestinal symptoms, and disturbance of the level of consciousness. Therefore, it recommends carefully taking the patients’ initial histories and accurately recording their clinical and laboratory symptoms.

An Analysis of Factors that Predict Hospital Readmission after Surgery for Perforated Appendicitis

2017 ◽  
Vol 83 (9) ◽  
pp. 991-995 ◽  
Author(s):  
Jeffanne E. Millien ◽  
Michael Townsend ◽  
Joshua Goldberg ◽  
George M. Fuhrman
Keyword(s):  
Hospital Readmission ◽  
Open Surgery ◽  
Demographic Data ◽  
Vital Signs ◽  
Perforated Appendicitis ◽  
Laboratory Findings ◽  
Percutaneous Abscess Drainage ◽  
Increased Risk ◽  
Perforated Appendix ◽  
Clinically Significant

We performed this study to develop an understanding of why patients were readmitted after appendectomy for perforated appendicitis. Patients who required surgery for perforated appendicitis during a recent five-year period were identified. We recorded the demographic data, length of symptoms, length of stay, vital signs, laboratory findings, surgical approach, length of surgery, time to readmission, length of readmission, and intervention required after readmission. We divided the cohort into two groups depending on whether the patient was readmitted. We used chisquared analysis and t test to determine differences between the two groups. We identified 86 patients, with 14 (16.3%) requiring readmission. The only factors that predicted readmission were longer appendectomy surgery (P = 0.03) and open surgery (P = 0.04). After readmission, one patient required reoperation, and two required percutaneous abscess drainage. The remaining 11 patients were readmitted for a median of two days, received intravenous fluids, and required no additional clinically significant management. Patients requiring longer and open surgery are at an increased risk for hospital readmission after resection of a perforated appendix. Efforts to reduce readmission will likely be most successful if hydration and brief periods of clinical observation can be arranged when necessary for patients after discharge from surgery.

The utility of clinical findings to predict laboratory values in hypertensive disorders of pregnancy

2016 ◽  
Vol 44 (3) ◽  
Author(s):  
Jane So ◽  
Elizabeth Young ◽  
Natalie Crnosija ◽  
Joseph Chappelle
Keyword(s):  
Severe Disease ◽  
Vital Signs ◽  
Retrospective Chart Review ◽  
Clinical Findings ◽  
Bivariate Analysis ◽  
Test Results ◽  
Quadrant Pain ◽  
Laboratory Findings ◽  
Abnormal Laboratory ◽  
Laboratory Test Results

AbstractPreeclampsia is the 2A retrospective chart review of women who presented for evaluation of hypertension in pregnancy during 2010. Demographic information, medical history, symptoms, vital signs, and laboratory results were collected. Bivariate analysis was used to investigate associations between predictors and the outcome.Of the 481 women in the sample, 22 were identified as having abnormal laboratory test results (4.6%). Women who reported right upper quadrant pain or tenderness had significantly increased likelihood of having laboratory abnormalities compared to those without the complaint.Only a small percentage of women evaluated were determined to have abnormal laboratory findings, predominantly among women with severe preeclampsia. Right upper quadrant pain or tenderness was positively correlated with laboratory abnormalities. The restriction of laboratory analysis in women with clinical evidence of severe disease may be warranted – a broader study should, however, first be used to confirm our findings.

Safety and tolerability of LBR-101, a humanized monoclonal antibody that blocks the binding of CGRP to its receptor: Results of the Phase 1 program

Cephalalgia ◽  
2013 ◽  
Vol 34 (7) ◽  
pp. 483-492 ◽  
Author(s):  
Marcelo E Bigal ◽  
Rafael Escandon ◽  
Michele Bronson ◽  
Sarah Walter ◽  
Maria Sudworth ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Adverse Events ◽  
Phase 1 ◽  
Vital Signs ◽  
Laboratory Findings ◽  
Ehlers Danlos Syndrome ◽  
Humanized Monoclonal Antibody ◽  
Calcitonin Gene ◽  
History Of ◽  
Danlos Syndrome

Background LBR-101 is a fully humanized monoclonal antibody that binds to calcitonin gene-related peptide. Objective The objective of this article is to characterize the safety and tolerability of LBR-101 when administered intravenously to healthy volunteers, by presenting the pooled results of the Phase 1 program. Methods LBR-101 was administered to 94 subjects, while 45 received placebo. Doses ranged from 0.2 mg to 2000 mg given once (Day 1), as a single IV infusion, or up to 300 mg given twice (Day 1 and Day 14). Results Subjects receiving placebo reported an average of 1.3 treatment-emerging adverse events vs 1.4 per subject among those receiving any dose of LBR-101, and 1.6 in those receiving 1000 mg or higher. Treatment-related adverse events occurred in 21.2% of subjects receiving LBR-101, compared to 17.7% in those receiving placebo. LBR-101 was not associated with any clinically relevant patterns of change in vital signs, ECG parameters, or laboratory findings. The only serious adverse event consisted of “thoracic aortic aneurysm” in a participant later found to have an unreported history of Ehlers-Danlos syndrome. Conclusion Single IV doses of LBR-101 ranging from 0.2 mg up to 2000 mg and multiple IV doses up to 300 mg were well tolerated. Overt safety concerns have not emerged. A maximally tolerated dose has not been identified.

Clinical Predictors for Laboratory-Confirmed Influenza Infections: Exploring Case Definitions for Influenza-Like Illness

2015 ◽  
Vol 36 (3) ◽  
pp. 241-248 ◽  
Author(s):  
Shital C. Shah ◽  
Dino P. Rumoro ◽  
Marilyn M. Hallock ◽  
Gordon M. Trenholme ◽  
Gillian S. Gibbs ◽  
...  
Keyword(s):  
Influenza A ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Signs ◽  
Case Definition ◽  
Chief Complaint ◽  
Nasopharyngeal Swab ◽  
Clinical Predictors ◽  
Case Definitions ◽  
Influenza Like Illness

OBJECTIVETo identify clinical signs and symptoms (ie, “terms”) that accurately predict laboratory-confirmed influenza cases and thereafter generate and evaluate various influenza-like illness (ILI) case definitions for detecting influenza. A secondary objective explored whether surveillance of data beyond the chief complaint improves the accuracy of predicting influenza.DESIGNRetrospective, cross-sectional study.SETTINGLarge urban academic medical center hospital.PARTICIPANTSA total of 1,581 emergency department (ED) patients who received a nasopharyngeal swab followed by rRT-PCR testing between August 30, 2009, and January 2, 2010, and between November 28, 2010, and March 26, 2011.METHODSAn electronic surveillance system (GUARDIAN) scanned the entire electronic medical record (EMR) and identified cases containing 29 clinical terms relevant to influenza. Analyses were conducted using logistic regressions, diagnostic odds ratio (DOR), sensitivity, and specificity.RESULTSThe best predictive model for identifying influenza for all ages consisted of cough (DOR=5.87), fever (DOR=4.49), rhinorrhea (DOR=1.98), and myalgias (DOR=1.44). The 3 best case definitions that included combinations of some or all of these 4 symptoms had comparable performance (ie, sensitivity=89%–92% and specificity=38%–44%). For children <5 years of age, the addition of rhinorrhea to the fever and cough case definition achieved a better balance between sensitivity (85%) and specificity (47%). For the fever and cough ILI case definition, using the entire EMR, GUARDIAN identified 37.1% more influenza cases than it did using only the chief complaint data.CONCLUSIONSA simplified case definition of fever and cough may be suitable for implementation for all ages, while inclusion of rhinorrhea may further improve influenza detection for the 0–4-year-old age group. Finally, ILI surveillance based on the entire EMR is recommended.Infect Control Hosp Epidemiol 2015;00(0): 1–8

Abstract 230: Improved Prediction of 30-day Mortality after Heart Failure Hospitalization by Utilization of Admission Vital Signs and Laboratory Findings.

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Robert G Zoble ◽  
Benji Torres ◽  
Adam Zoble ◽  
Ramona Gelzer Bell ◽  
Philip Foulis ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Score ◽  
Troponin I ◽  
Vital Signs ◽  
Primary Diagnosis ◽  
P Value ◽  
Continuous Variables ◽  
Variable Model ◽  
Laboratory Findings ◽  
C Statistic

Background: Heart failure (HF) is associated with high mortality so early identification of those at high risk may be useful in reducing mortality rates. We sought to develop a simple risk score from data readily available at the time of HF admission. Methods: We studied Veterans hospitalized from January 2004 to December 2009, who were discharged alive with a primary diagnosis of HF (based on ICD-9 coding). For the purposes of these analyses, only the 869 who had complete data for admission vital signs, laboratory parameters, ECG, co-morbidities and ejection fraction were included. Univariate analyses were employed to identify variables associated with mortality at a p-value < 0.10. These variables were then analyzed by MVA to determine independent predictors of mortality. The c-statistic was utilized to determine cutpoints for continuous variables. A risk score was developed by assigning risk points based on the odds ratio for each variable. Model calibration was assessed by the Hosmer-Lemeshow (H-L) statistic and by plotting observed vs. expected mortality (Figure below). Results: Of the 869, 35 (4.0%) died within 30-days of discharge. Twelve independent predictors of 30-day mortality were identified: admission pulse, systolic and diastolic BP, BNP, troponin-I, sodium, glucose, ALT, atrial fibrillation and absence of dyslipdemia diagnosis, and not admitted on an oral anticoagulant or a calcium channel blocker. All vartiables were assigned 1 risk point, except for not on an oral anticoagualnt, which was asigned two points. Patients with a risk score < 6 (57% of the group) had a mortality rate of only 0.4%, while a risk score > 6 (20% of the group) was associated with a 15.3% mortality, corresponding to a 49-fold range. Conclusion: 30-day mortality can be predicted by the developed risk score which has excellent discrimination (c-statistic = 0.87), adequate calibration (H-L = 0.11) and covers a mortality range from 0% to nearly 50%. This risk score also has the advantage of being easily calculated within 24 hours of admission. Validation of the model will be an important next step.

Peritoneal Ultrafiltration and Serum Icodextrin Concentration during Dialysis with 7.5% Icodextrin Solution in Japanese Patients

2003 ◽  
Vol 23 (4) ◽  
pp. 356-361
Author(s):  
◽  
Kazuo Ota ◽  
Takashi Akiba ◽  
Toshiaki Nakao ◽  
Masaaki Nakayama ◽  
...  
Keyword(s):  
Adverse Events ◽  
Treatment Period ◽  
Negative Impact ◽  
Vital Signs ◽  
Major Change ◽  
Japanese Patients ◽  
Baseline Period ◽  
Serious Adverse Events ◽  
Laboratory Findings ◽  
Serum Osmolarity

♦ Objectives To assess the efficacy and safety of icodextrin in Japanese patients and to investigate the relationship between net ultrafiltration (UF) during the long dwell and plasma oligosaccharides. ♦ Design Open-labeled clinical trial involving patients on continuous ambulatory peritoneal dialysis (CAPD) receiving icodextrin during the 12-hour long dwell for 6 weeks, preceded by and followed by a 2-week baseline period and a follow-up period during which 1.36% glucose was used for the 8-hour long dwell. ♦ Setting A prospective, randomized multicenter study done in tertiary medical centers. ♦ Patients 18 stable patients on CAPD for 3 months or longer. ♦ Main Outcomes Measures Net UF (in milliliters), UF rate (in milliliters per hour), plasma oligosaccharides, serum osmolarity (in milliosmoles per liter), peritoneal absorption of icodextrin, and peritoneal clearances of icodextrin, creatinine, and urea were assessed. Adverse events, laboratory findings, and vital signs were also monitored. ♦ Results Long-dwell net UF (544.4 ± 96.7 mL at day 3, p < 0.001; 309.4 ± 60.7 mL at week 4, p < 0.001; and 391.7 ± 61.1 mL at week 6, p< 0.001) and UF rate (48.2 ± 38.8 mL/hour at day 3, p < 0.001; 26.9 ± 22.1 mL/hr at week 4, p < 0.002; and 35.3 ± 22.9 mL/hr at week 6, p = 0.0002) were significantly greater during the icodextrin period than at baseline (-25.9 ± 46.0 mL and -2.2 ± 22.1 mL/hr, respectively). Plasma oligosaccharides reached steady state within 2 weeks, remained stable during the treatment period, and returned to baseline level 2 weeks after discontinuation of icodextrin. Serum osmolarity increased during the use of icodextrin by approximately 5 mOsm/L. No statistically significant relationship was found between plasma oligosaccharides and net UF. Peritoneal absorption of icodextrin (36.3% ± 5.1% at day 3,42.2% ± 5.9% at week 4, and 38.0% ± 6.3% at week 6) and peritoneal clearance of icodextrin (10.1 mL/minute at day 3,10.1 mL/min at week 4, and 10.3 mL/min at week 6) showed no major change over time. Serum sodium and serum chloride both decreased by 5 mEq/L with icodextrin but remained within the normal range during the treatment period and returned to baseline levels immediately after discontinuation. No serious adverse events were observed during the study. ♦ Conclusion The results of this study do not support the hypothesis that an increased blood oligosaccharide level and the concomitant elevation in serum osmolarity have a negative impact on peritoneal UF. Therefore, the increase in plasma oligosaccharides appears to be too small to be of clinical significance.

Sign in / Sign up

Export Citation Format

Share Document