Poor Outcomes Among Patients Aged 65 and Older Presenting to the Emergency Department
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Enrollment
- 141,929
- Locations
- 1
- Primary Endpoint
- UCI and or death
Study Overview
Brief Summary
Our objective is to create and validate predictive models of poor outcome in people over 65 years of age seen in emergency departments. To this end, models will be developed and validated internally, adapting the reference values of vital signs to this population segment and also taking into account their most frequent reasons for consultation. We will use the EDEN cohort of 18374 patients recruited in one week in 2019 in 40 Spanish hospitals. Subsequently, they will be externally validated in a cohort of 18000 patients prospectively recruited in 7 hospitals in 2024. In addition, the predictive capacity of the FIM frailty scale will be measured. lnformation will be collected from electronic medical records regarding socio-demographic data, functional status, reasons for consultation, clinical and ED history including comorbidities, previous and prescribed ED treatments and vital signs. The main dependent variable is poor outcome defined as ED exitus, admission to ICU/ICU or conventional admission, as well as mortality, revisits and readmissions 30 days after hospital discharge. Updated poor outcome models will be provided that can serve as a basis for creating triage models adapted to the over-65s in the future.
Detailed Description
HYPOTHESIS
Current emergency triage systems (MAT, SET, others), as well as early warning systems (NEWS-2), are unable to detect all geriatric patients at risk of poor outcomes, partly due to:
- the reference values for vital signs are not the same as in the population under 65 years of age
- atypical presentations of diseases occur more frequently than in the population under 65 years of age.
3.- It is possible to develop and validate predictive models of poor outcomes in the emergency department (death in the emergency department, admission to the ICU or conventional admission, as well as mortality, revisits and readmissions within 30 days of hospital discharge) that incorporate adapted vital signs and symptoms that are more frequent in this population.
4.- Frailty is related to poor outcomes in the emergency department and will add predictive power to the above models.
Study Design
- Study Type
- Observational
- Observational Model
- Cohort
- Time Perspective
- Other
Eligibility Criteria
- Ages
- 65 Years to 120 Years (Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •patients over 65 years of age who attend the emergency department for any reason during the study period
Exclusion Criteria
- •arrival at the emergency department in critical condition in pre-mortem situations,
- •absence of a carer in situations of severe dependency
- •presence of mental illness, and refusal to participate in the study.
Outcomes
Primary Outcomes
UCI and or death
Time Frame: up to 72 hours
Intra-emergency room
Secondary Outcomes
- readmission or ICU admission or death(up to one month after discharge)
- UCI admission OR mortality(in-hospital mortality or up to 7 days in discharged patients)
Investigators
Susana García Gutiérrez
Principal Investigator
Hospital Galdakao-Usansolo