Analysis of patient-related factors associated with post-discharge adverse events in older patients quickly discharged home after emergency department care with no complementary investigations
Por:
Burillo-Putze, G, Rodriguez-Cabrera, M, Parra-Esquivel, P, Alquézar, A, Fernández, C, Aguiló, S, Jacob, J, Montero-Pérez, FJ, García-Lamberechts, EJ, Piñera, P, Marinero-Noval, C, Paramas-Lopez, L, Rosendo-Mesino, D, Cuevas-Jiménez, L, Vaswani-Bolchand, A, Quesada-Martínez, MC, Díaz-Guerra, MLP, Amarilla-Molinas, CL, González-Tejera, M, Mansilla-Collado, J, Caballero-Martínez, M, Llopis, F, Zambrano-Serrano, L, Toro-Gallardo, V, Beddar-Chaib, F, Pedraza-Ramírez, P, González-del-Castillo, J, Miró, O
Publicada:
1 feb 2025
Resumen:
Background: To investigate factors associated with post-discharge adverse events in older patients discharged after emergency department (ED) care with no complementary investigations (CI)-blood test (BT), X-ray (XR) or both. Methods: We included patients >= 65 years who attended 52 Spanish EDs and were discharged home in <= 12 hours from 01-07 April 2019. The outcomes assessed were post-discharge combined adverse event (CAE) (all-cause ED revisit, hospitalization or death) occurring within the next 30 days. We analyzed whether age, sex, comorbidity, functional capacity, ability to walk, previous falls, dementia, depression and polypharmacy were associated with outcomes, and whether these outcomes differed compared to discharged patients undergoing CI. Results: We identified 4976 patients (mean time in ED: 1.44 hours, 95% confidence interval (CI): 1.41-1.47) and 1048 (21.4%) presented a CAE, associated with increased comorbidity, decreased functional capacity and polypharmacy but not with age. Compared with patients discharged after CI and spending 3.08 (3.05-3.11) hours in the ED, the CAE of patients without CI did not significantly differ (1208 cases, 22.2%, adjusted Hazard ratio (HR): 1.032, 95% CI: 0.949-1.122). Performing BT and XR increased ED time by 2.07 (1.59-2.15) and 0.35 (0.31-0.40) hours, respectively, while the increase when ordering both investigations was 2.23 (2.17-2.31) hours. Conclusions: ED discharge of older patients without CI does not increase risk of post-discharge events or shorten the time in ED. Age is not related to the risk of post-discharge adverse events, but comorbid and dependent patients with polypharmacy should be cautiously considered for being at increased risk of adverse outcomes.
Filiaciones:
Burillo-Putze, G:
Univ Europea Canarias, Canarias 38300, Spain
Hosp Univ Canarias, Emergency Dept, Tenerife 38320, Spain
Rodriguez-Cabrera, M:
Hosp Univ Canarias, Emergency Dept, Tenerife 38320, Spain
Univ La Laguna, Tenerife 38320, Spain
Parra-Esquivel, P:
Hosp Univ Canarias, Emergency Dept, Tenerife 38320, Spain
Univ La Laguna, Tenerife 38320, Spain
Alquézar, A:
Hosp Santa Creu & Sant Pau, Pharm Dept, Barcelona 08025, Spain
Fernández, C:
Univ Complutense Madrid, Hosp Clin San Carlos, Emergency Dept, IDISSC, Madrid 28040, Spain
Aguiló, S:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Barcelona 08036, Spain
Jacob, J:
Hosp Bellvitge Princeps Espanya, Dept Gastroenterol, Lhospitalet De Llobregat 08907, Barcelona, Spain
Montero-Pérez, FJ:
Hosp Univesitario Reina Sofia, Emergency Dept, Cordoba 14004, Spain
García-Lamberechts, EJ:
Univ Complutense Madrid, Hosp Clin San Carlos, Emergency Dept, IDISSC, Madrid 28040, Spain
Piñera, P:
Hosp Univesitario Reina Sofia, Emergency Dept, Murcia 30003, Spain
Marinero-Noval, C:
Hosp Cent Asturias, Emergency Dept, Oviedo 33011, Spain
Paramas-Lopez, L:
Univ Complutense Madrid, Hosp Clin San Carlos, Emergency Dept, IDISSC, Madrid 28040, Spain
Rosendo-Mesino, D:
Hosp Univ Infanta Cristina, Emergency Dept, Badajoz 06080, Spain
Cuevas-Jiménez, L:
Hosp Santa Tecla, Dept Radiol, Viladecans, Spain
Vaswani-Bolchand, A:
Hosp Univ Canarias, Emergency Dept, Tenerife 38320, Spain
Univ La Laguna, Tenerife 38320, Spain
Quesada-Martínez, MC:
Hosp Univesitario Reina Sofia, Emergency Dept, Murcia 30003, Spain
Díaz-Guerra, MLP:
Hosp Univ Henares, Emergency Dept, Madrid 28822, Spain
Amarilla-Molinas, CL:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Barcelona 08036, Spain
González-Tejera, M:
Hosp Gen Univ Elche, Emergency Dept, Elche 03203, Spain
Mansilla-Collado, J:
Hosp Univ & Politecn La Fe, Pathol Dept, Valencia 46026, Spain
Caballero-Martínez, M:
Hosp Gen Univ Dr Balmis, ISABIAL, Alicante 03010, Spain
Llopis, F:
Hosp Bellvitge Princeps Espanya, Dept Gastroenterol, Lhospitalet De Llobregat 08907, Barcelona, Spain
Zambrano-Serrano, L:
Hosp Gen Univ Dr Balmis, ISABIAL, Alicante 03010, Spain
Toro-Gallardo, V:
Hosp Comarcal Axarquia Velez Malaga, Med Interna Serv, Malaga, Spain
Beddar-Chaib, F:
Hosp Reg Univ Malaga, Emergency Dept, Malaga 29010, Spain
Pedraza-Ramírez, P:
Hosp Santa Barbara, Emergency Serv, Soria 42005, Spain
González-del-Castillo, J:
Univ Complutense Madrid, Hosp Clin San Carlos, Emergency Dept, IDISSC, Madrid 28040, Spain
Miró, O:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Barcelona 08036, Spain
gold
|