Predictors and Outcomes of Revisits in Older Adults Discharged from the Emergency Department
- Autores: Jelle de Gelder, Jacinta A. Lucke, Bas de Groot, Anne J. Fogteloo, Sander Anten, Christian Heringhaus, Olaf M. Dekkers, Gerard J. Blauw, Simon P. Mooijaart
- Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 66, Nº. 4, 2018, págs. 735-741
- Idioma: inglés
- Enlaces
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Resumen
Objectives To study predictors of emergency department (ED) revisits and the association between ED revisits and 90‐day functional decline or mortality.
Design Multicenter cohort study.
Setting One academic and two regional Dutch hospitals.
Participants Older adults discharged from the ED (N=1,093).
Measurements At baseline, data on demographic characteristics, illness severity, and geriatric parameters (cognition, functional capacity) were collected. All participants were prospectively followed for an unplanned revisit within 30 days and for functional decline and mortality 90 days after the initial visit.
Results The median age was 79 (interquartile range 74–84), and 114 participants (10.4%) had an ED revisit within 30 days of discharge. Age (hazard ratio (HR)=0.96, 95% confidence interval (CI)=0.92–0.99), male sex (HR=1.61, 95% CI=1.05–2.45), polypharmacy (HR=2.06, 95% CI=1.34–3.16), and cognitive impairment (HR=1.71, 95% CI=1.02–2.88) were independent predictors of a 30‐day ED revisit. The area under the receiver operating characteristic curve to predict an ED revisit was 0.65 (95% CI=0.60–0.70). In a propensity score–matched analysis, individuals with an ED revisit were at higher risk (odds ratio=1.99 95% CI=1.06–3.71) of functional decline or mortality.
Conclusion Age, male sex, polypharmacy, and cognitive impairment were independent predictors of a 30‐day ED revisit, but no useful clinical prediction model could be developed. However, an early ED revisit is a strong new predictor of adverse outcomes in older adults.
