Factors associated with discharge home in older patients admitted to emergency department observation units: Looking for a predictive scale
Year: 2024
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The selection of patients who are going to be admitted to an emergency department observation unit (EDOU) is essential for the good management of these units, intended fundamentally to avoid unnecessary hospitalization of patients. This is especially important when dealing with older patients. It would be important to know what factors are associated with discharge home and to have a clinical predictive scale that appropriately selects older patients who are going to be admitted to an EDOU. METHODS: A retrospective cross-sectional study was conducted of all patients ≥65 years of age assisted in 48 Spanish Emergency Departments for 7 consecutive days and were admitted to the EDOU. Demographics-functional, vital signs data and initial laboratory results were analyzed to investigate its association with discharge home and develop and validate a prediction model for discharge home from EDOU. Multivariable logistic regression was performed to develop a prediction model, and a scoring system was created. RESULTS: Among 5457 patients admitted to the EDOU from the emergency room, 2508 (46%) patients were discharged home, and 2949 (54%) were admitted to the hospital. Five variables were strongly associated with discharge home: the absence of fever (adjusted OR: 3.61, 95% CI:1.53-8.54), Glasgow Coma Scale score of 15 points (2.80, 1.63-4.82), absence of tachypnea (2.51, 1.74-3.64) or leukocytosis (2.07, 1.70-2.52) and oxygen saturation >94% (2.00, 1.64-2.43). The final model achieved an area under the receiver operating characteristic curve of 0.648 (IC95% = 0.627-0.668) in the development cohort and 0.635 (0.614-0.656) in the validation cohort. CONCLUSIONS: There are factors associated with a greater probability of discharge home of older patients admitted to EDOUs. Prediction at the individual level remains elusive, as the best model obtained in this study did not have sufficient validity to be applied in the clinical setting.
DOI: 10.1111/jep.14124
Authors: F. Javier Montero‐Pérez, Inmaculada Bajo‐Fernández, Juan González‐del Castillo, Guillermo Burillo‐Putze, Javier Jacob, Sira Aguiló, Pascual Piñera‐Salmerón, Aitor Alquezar‐Arbé, Cesáreo Fernández‐Alonso, Pere Llorens, Jeong‐Uh Hong Cho, Beatriz Casado‐Ramón, Sara Gayoso‐Martín, Goretti Sánchez‐Sindín, María Esther Fernández‐Álvarez, Patricia Gallardo‐Vizcaíno, Carlos Romero‐Carrete, Lluís Llauger, Verónica Vázquez‐Rey, Sara Calle‐Fernández, Mónica Cañete, Esther Ruescas, Fátima Fernández‐Salgado, Òscar Miró, researchers of the SIESTA network
Institutions: Hospital Universitario Reina Sofía, Universidad Complutense de Madrid, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad de La Laguna, Hospital Universitario de Canarias, Bellvitge University Hospital, Hospital Clínic de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Universitat de Barcelona, Hospital Reina Sofía de Murcia, Hospital de Sant Pau, Universitat de Miguel Hernández d'Elx, Hospital General Universitario de Alicante Doctor Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital Universitario Miguel Servet, Hospital El Escorial, Complejo Hospitalario de Pontevedra, Hospital Del Mar, Hospital Universitari de Vic, Hospital Valle del Nalón, Hospital General Nuestra Señora del Prado, Hospital Universitario del Vinalopó, Hospital Universitario de Móstoles
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4401779758