Department of Emergency Medicine, The Ohio State University, Columbus, OH 43210, USA.
Am J Emerg Med. 2013 Jan;31(1):1-7. doi: 10.1016/j.ajem.2012.01.002. Epub 2012 Mar 3.
The primary objective was to determine the relationship between advanced age and need for admission from an emergency department (ED) observation unit. The secondary objective was to determine the relationship between initial ED vital signs and admission.
We conducted a prospective, observational cohort study of ED patients placed in an ED-based observation unit. Multivariable penalized maximum likelihood logistic regression was used to identify independent predictors of need for hospital admission. Age was examined continuously and at a cutoff of 65 years or more. Vital signs were examined continuously and at commonly accepted cutoffs.We additionally controlled for demographics, comorbid conditions, laboratory values, and observation protocol.
Three hundred patients were enrolled, 12% (n = 35) were 65 years or older, and 11% (n = 33) required admission. Admission rates were 2.9% (95% confidence interval [CI], 0.07%-14.9%) in older adults and 12.1% (95% CI, 8.4%-16.6%) in younger adults. In multivariable analysis, age was not associated with admission (odds ratio [OR], 0.30; 95% CI, 0.05-1.67). Predictors of admission included systolic pressure 180 mm Hg or greater (OR, 4.19; 95% CI, 1.08-16.30), log Charlson comorbidity score (OR, 2.93; 95% CI, 1.57-5.46), and white blood cell count 14,000/mm(3) or greater (OR, 11.35; 95% CI, 3.42-37.72).
Among patients placed in an ED observation unit, age 65 years or more is not associated with need for admission. Older adults can successfully be discharged from these units. Systolic pressure 180 mm Hg or greater was the only predictive vital sign. In determining appropriateness of patients selected for an ED observation unit, advanced age should not be an automatic disqualifying criterion.
主要目的是确定年龄增长与从急诊科（ED）观察单元入院的需求之间的关系。次要目的是确定初始 ED 生命体征与入院之间的关系。
我们对安置在 ED 观察单元的 ED 患者进行了前瞻性、观察性队列研究。使用多变量惩罚最大似然逻辑回归来确定需要住院的独立预测因素。年龄连续检查，并以 65 岁或以上为截止值。生命体征连续检查，并以常用截止值检查。我们还控制了人口统计学、合并症、实验室值和观察方案。
共纳入 300 例患者，其中 12%（n=35）年龄在 65 岁或以上，11%（n=33）需要入院。年龄较大的成年人的入院率为 2.9%（95%置信区间[CI]，0.07%-14.9%），年龄较小的成年人的入院率为 12.1%（95% CI，8.4%-16.6%）。在多变量分析中，年龄与入院无关（优势比[OR]，0.30；95%CI，0.05-1.67）。入院的预测因素包括收缩压 180mmHg 或更高（OR，4.19；95%CI，1.08-16.30）、Charlson 合并症评分对数（OR，2.93；95%CI，1.57-5.46）和白细胞计数 14000/mm(3)或更高（OR，11.35；95%CI，3.42-37.72）。
在安置在 ED 观察单元的患者中，年龄 65 岁或以上与入院需求无关。老年人可以从这些单位成功出院。收缩压 180mmHg 或更高是唯一有预测价值的生命体征。在确定选择 ED 观察单元的患者的适宜性时，年龄增长不应成为自动排除标准。
