Admission rates and outcomes of elderly patients in emergency department observation units. A Spanish multicentre study
Por:
Montero-Pérez, FJ, Bajo-Fernández, I, del Castillo, JG, Burillo-Putze, G, Fernández, C, Aguiló, S, Alquézar-Arbé, A, Jacob, J, Llorens, P, Ungerer, OJT, Eiroa-Hernández, P, Parra-Esquivel, P, Pineda, MCS, Grinspan, MR, Palacios, MFP, Tejera, MG, Garcia, MB, Benito, MV, Llopis, F, Martos, RM, Gallardo, VT, Hernández, RJG, García, JP, Aguilera, CL, Pulfer, MD, Rodríguez, ME, Vela, MI, Romero, MR, Gimenez, AM, Miró, O
Publicada:
1 oct 2025
Resumen:
Background: Emergency Department Observation Units (EDOUs) provide short-term treatment and monitoring for patients who require further evaluation. EDOUs may help reduce unnecessary hospital admissions in elderly adults, but their selection criteria and impact on outcomes remain unclear. The study, thus, aimed to identify clinical factors associated with using EDOUs in patients aged >= 65 years and to evaluate the relationship between EDOU care and short-term clinical outcomes. Methods: We analysed data from the Emergency Department and Elder Needs (EDEN) cohort, which included all emergency department visits by patients aged >= 65 years across 48 Spanish hospitals during seven days. We divided patients into two groups: those managed in an EDOU (EDOU group) and those managed without observation care (non-EDOU group). We examined demographic and clinical characteristics, emergency diagnoses, and 30-day outcomes. Multivariable logistic regression identified factors independently associated with EDOU use and subsequent outcomes. Results: Among 23,955 visits, 6393 (26.7%) involved EDOU management. Patients in the EDOU group were more likely to be >= 80 years and to present with tachypnoea, bradycardia, a Glasgow Coma Scale score <15, and anaemia. These variables showed significant independent associations with EDOU care. Compared to the non-EDOU group, the EDOU group had higher rates of hospital admission (adjusted odds Ratio (aOR) = 2.4; 95% confidence interval (CI): 2.0-2.8) and 30-day readmission (aOR = 1.6; 95% CI: 1.2-2.3), but similar rates of 30-day ED revisit, prolonged hospital stay, and mortality. Patient selection varied across centres and often lacked standardized protocols. Conclusions: EDOU care for elderly adults in Spanish emergency departments typically involves patients with greater clinical complexity. Although associated with higher hospital admission and readmission rates, EDOU use did not correlate with worse short-term outcomes. These findings support the need for standardized EDOU admission criteria in geriatric populations.
Filiaciones:
Montero-Pérez, FJ:
Reina Sofia Univ Hosp Cordoba, Maimonides Biomed Res Inst Cordoba IMIBIC, Emergency Dept, Cordoba 14004, Spain
Bajo-Fernández, I:
Reina Sofia Univ Hosp Cordoba, Maimonides Biomed Res Inst Cordoba IMIBIC, Emergency Dept, Cordoba 14004, Spain
del Castillo, JG:
Univ Complutense Madrid, Hosp Clin San Carlos, Emergency Dept, IDISSC, Madrid 28040, Spain
Burillo-Putze, G:
Univ La Laguna, Univ Hosp Canary Isl, Emergency Dept, Tenerife 38320, Canary Islands, 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
Alquézar-Arbé, A:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona 08041, Spain
Jacob, J:
Hosp Bellvitge Univ Hosp, Emergency Dept, Barcelona 08907, Spain
Llorens, P:
Dr Balmis Univ Gen Hosp, Alicante Biomed & Hlth Res Inst ISABIAL, Emergency Dept, Alicante 03010, Spain
Miguel Hernandez Univ, Clin Med Dept, Elche 03202, Spain
Ungerer, OJT:
Hosp Santa Tecla, Emergency Dept, Tarragona 43003, Spain
Eiroa-Hernández, P:
Univ La Laguna, Univ Hosp Canary Isl, Emergency Dept, Tenerife 38320, Canary Islands, Spain
Parra-Esquivel, P:
North Tenerife Hosp, Emergency Dept, Tenerife 38430, Canary Islands, Spain
Pineda, MCS:
Reina Sofia Univ Gen Hosp Murcia, Emergency Dept, Murcia 30003, Spain
Grinspan, MR:
Univ Hosp del Henares, Emergency Dept, Madrid 28822, Spain
Palacios, MFP:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Barcelona 08036, Spain
Tejera, MG:
Elche Univ Gen Hosp, Emergency Dept, Elche 03203, Spain
Garcia, MB:
La Fe Univ & Polytech Hosp, Valencia 46026, Spain
Benito, MV:
Dr Balmis Univ Gen Hosp, Alicante Biomed & Hlth Res Inst ISABIAL, Emergency Dept, Alicante 03010, Spain
Llopis, F:
Hosp Bellvitge Univ Hosp, Emergency Dept, Barcelona 08907, Spain
Martos, RM:
Hosp Axarquia, Emergency Dept, Malaga 29700, Spain
Gallardo, VT:
Hosp Reg Malaga, Emergency Dept, Malaga 29010, Spain
Hernández, RJG:
Hosp Santa Barbara, Emergency Dept, Soria 42002, Spain
García, JP:
Hosp Valle Pedroches, Emergency Dept, Cordoba 14400, Spain
Aguilera, CL:
Reina Sofia Univ Hosp Cordoba, Maimonides Biomed Res Inst Cordoba IMIBIC, Emergency Dept, Cordoba 14004, Spain
Pulfer, MD:
Univ Gen Hosp Gregorio Maranon, Madrid 28007, Spain
Rodríguez, ME:
Univ Hosp Burgos, Burgos 09001, Spain
Vela, MI:
Univ Care Complex Leon, Leon 24071, Spain
Romero, MR:
Hosp Gen Univ Morales Meseguer, Murcia 30008, Spain
Gimenez, AM:
Hosp Francesc Borja, Gandia 46701, Spain
Miró, O:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Barcelona 08036, Spain
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