Journal of the American Medical Directors Association · 2026
Clinical and Care Coordination Predictors of Adverse Outcomes in a Geriatric Emergency Department.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Henrique Expedita A, Pereira Rafael S S, Gil Luiz A, Penna Luis F, Ganem Fernando, Morinaga Christian V, Curiati Pedro K, Avelino-Silva Thiago J
Аннотация
OBJECTIVES: Identifying high-risk older adults in emergency settings is crucial for optimizing care and preventing complications. This study aimed to describe the characteristics of patients in a geriatric emergency department (GED) and to identify factors associated with hospital admission, prolonged length of stay, unplanned intensive care unit admission, and in-hospital mortality.
DESIGN: Retrospective cohort study.
SETTING AND PARTICIPANTS: A total of 9814 visits by patients aged ≥70 years at a tertiary GED in Brazil (August 2017-October 2024).
METHODS: We assessed baseline sociodemographic and clinical features, vulnerability measures [Identification of Seniors at Risk (ISAR), Fatigue, Resistance, Ambulation, Illness, Loss of weight (FRAIL) scale, brief Confusion Assessment Method (bCAM), and Physical impairment, Recent hospitalization, Older age (≥ 90), Acute mental alteration, Getting thinner, and Exhaustion (PRO-AGE) score], and communication with primary physicians. Multivariable logistic regression was used to identify independent predictors for admission (primary outcome) and in-hospital outcomes.
RESULTS: Among 9814 visits, 31.5% resulted in hospital admission. Factors significantly associated with admission included frailty [adjusted odds ratio (aOR), 1.99; 95% CI, 1.68-2.37], delirium (aOR, 2.12; 95% CI, 1.70-2.65), higher ISAR score (aOR, 1.25; 95% CI, 1.19-1.32), and contact with primary physician (aOR, 3.42; 95% CI, 2.86-4.10). In-hospital mortality was predicted by age (aOR per year, 1.05; 95% CI, 1.02-1.09) and the Charlson Comorbidity Index (aOR, 1.19; 95% CI, 1.09-1.34), whereas having a primary physician, regardless of successful contact and agreement about admission, was associated with lower odds of mortality. Prolonged stay was associated with frailty (aOR, 1.49; 95% CI, 1.09-2.04), ISAR score (aOR, 1.17; 95% CI, 1.08-1.26), and delirium (aOR, 1.36; 95% CI, 1.05-1.76). Male sex was a predictor of unplanned intensive care unit admission (aOR, 1.48; 95% CI, 1.02-2.12).
CONCLUSIONS AND IMPLICATIONS: Geriatric vulnerability screening strongly predicted adverse outcomes. Although successful contact with the primary physician was associated with a higher likelihood of admission, the existence of an established primary care relationship significantly predicted lower in-hospital mortality. GED models that combine systematic screening with structured communication and coordination may reduce avoidable admissions and improve outcomes.
DESIGN: Retrospective cohort study.
SETTING AND PARTICIPANTS: A total of 9814 visits by patients aged ≥70 years at a tertiary GED in Brazil (August 2017-October 2024).
METHODS: We assessed baseline sociodemographic and clinical features, vulnerability measures [Identification of Seniors at Risk (ISAR), Fatigue, Resistance, Ambulation, Illness, Loss of weight (FRAIL) scale, brief Confusion Assessment Method (bCAM), and Physical impairment, Recent hospitalization, Older age (≥ 90), Acute mental alteration, Getting thinner, and Exhaustion (PRO-AGE) score], and communication with primary physicians. Multivariable logistic regression was used to identify independent predictors for admission (primary outcome) and in-hospital outcomes.
RESULTS: Among 9814 visits, 31.5% resulted in hospital admission. Factors significantly associated with admission included frailty [adjusted odds ratio (aOR), 1.99; 95% CI, 1.68-2.37], delirium (aOR, 2.12; 95% CI, 1.70-2.65), higher ISAR score (aOR, 1.25; 95% CI, 1.19-1.32), and contact with primary physician (aOR, 3.42; 95% CI, 2.86-4.10). In-hospital mortality was predicted by age (aOR per year, 1.05; 95% CI, 1.02-1.09) and the Charlson Comorbidity Index (aOR, 1.19; 95% CI, 1.09-1.34), whereas having a primary physician, regardless of successful contact and agreement about admission, was associated with lower odds of mortality. Prolonged stay was associated with frailty (aOR, 1.49; 95% CI, 1.09-2.04), ISAR score (aOR, 1.17; 95% CI, 1.08-1.26), and delirium (aOR, 1.36; 95% CI, 1.05-1.76). Male sex was a predictor of unplanned intensive care unit admission (aOR, 1.48; 95% CI, 1.02-2.12).
CONCLUSIONS AND IMPLICATIONS: Geriatric vulnerability screening strongly predicted adverse outcomes. Although successful contact with the primary physician was associated with a higher likelihood of admission, the existence of an established primary care relationship significantly predicted lower in-hospital mortality. GED models that combine systematic screening with structured communication and coordination may reduce avoidable admissions and improve outcomes.