Department of Emergency Medicine, Holbaek Hospital, University of Copenhagen, Holbaek, Denmark.
Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Age Ageing. 2018 Nov 1;47(6):810-817. doi: 10.1093/ageing/afy090.
the effect of hospitalisation in emergency department-based short-stay units (SSUs) has not been studied in older patients. We compared SSU hospitalisation with standard care at an Internal Medicine Department (IMD) in acutely admitted older internal medicine patients.
pragmatic randomised clinical trial. We randomly assigned patients aged 75 years or older, acutely admitted for an internal medicine disease and assessed to be suitable for SSU hospitalisation to SSU hospitalisation or IMD hospitalisation. SSU hospitalisation was provided by a pragmatic 'fast-track' principle. The primary outcome was 90-day mortality. Secondary outcomes included adverse events, change in Lawton Instrumental Activities of Daily Living (IADL) score within 90 days from admission, in-hospital length of stay and unplanned readmissions within 30 days after discharge.
between January 2015 and October 2016, 430 participants were randomised (median age 84 years in both groups). Ninety-day mortality was 22(11%) in the SSU group and 32(15%) in the IMD group (odds ratio (OR) 0.66; 95% confidence interval (CI) 0.37-1.18; P = 0.16). When comparing the SSU group to the IMD group, 16(8%) vs. 45(21%) experienced at least one adverse event (OR 0.31; 95% CI 0.17-0.56; P < 0.001); 6(3%) vs. 35(20%) experienced a reduction in IADL score within 90 days from admission (P < 0.001); median in-hospital length of stay was 73 h [interquartile range, IQR 36-147] vs. 100 h [IQR 47-169], (P < 0.001), and 26(13%) vs. 58(29%) were readmitted (OR 0.37; 95% CI 0.22-0.61; P < 0.001).
mortality at 90 days after admission was not significantly lower in the SSU group, but SSU hospitalisation was associated with a lower risk of adverse events, less functional decline, fewer readmissions and shorter hospital stay.
NCT02395718.
在急诊科短期留观病房（SSU）住院的老年患者的效果尚未得到研究。我们比较了在老年内科急症患者中，SSU 住院治疗与内科病房（IMD）标准护理的效果。SSU 住院治疗采用实用的“快速通道”原则。主要结局为 90 天死亡率。次要结局包括 90 天内的不良事件、入院后 90 天内的 Lawton 工具性日常生活活动（IADL）评分变化、住院时间和出院后 30 天内的非计划再入院。
这是一项实用随机临床试验。我们将 75 岁或以上、因内科疾病急性入院且适合 SSU 住院的患者随机分配至 SSU 住院治疗或 IMD 住院治疗。SSU 住院治疗采用实用的“快速通道”原则。主要结局为 90 天死亡率。次要结局包括 90 天内的不良事件、入院后 90 天内的 Lawton 工具性日常生活活动（IADL）评分变化、住院时间和出院后 30 天内的非计划再入院。
2015 年 1 月至 2016 年 10 月，共有 430 名患者被随机分配（两组的中位年龄均为 84 岁）。SSU 组的 90 天死亡率为 22（11%），IMD 组为 32（15%）（优势比（OR）0.66；95%置信区间（CI）0.37-1.18；P=0.16）。与 IMD 组相比，SSU 组有 16（8%）例患者至少发生 1 次不良事件，而 IMD 组有 45（21%）例患者发生（OR 0.31；95%CI 0.17-0.56；P<0.001）；SSU 组有 6（3%）例患者的 IADL 评分在入院后 90 天内下降，而 IMD 组有 35（20%）例患者发生（P<0.001）；SSU 组的中位住院时间为 73 小时[四分位间距（IQR）36-147]，而 IMD 组为 100 小时[IQR 47-169]（P<0.001），SSU 组有 26（13%）例患者再入院，而 IMD 组有 58（29%）例患者再入院（OR 0.37；95%CI 0.22-0.61；P<0.001）。
SSU 组入院后 90 天的死亡率没有显著降低，但 SSU 住院治疗与不良事件风险降低、功能下降减少、再入院减少和住院时间缩短相关。
NCT02395718。
