The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
The Department of Emergency Medicine, Chaophya Abhaibhubejhr Hospital, Bangkok, Thailand.
BMC Infect Dis. 2019 Jul 25;19(1):662. doi: 10.1186/s12879-019-4301-z.
This study aimed to determine the prevalence of infectious diseases and risk factors for one-year mortality in elderly emergency department (ED) patients.
A retrospective cohort study of patients aged 65 and over who visited the ED of one urban teaching hospital in Bangkok, Thailand and who were diagnosed with infectious diseases between 1 January 2016 and 30 June 2016.
There were 463 elderly patients who visited ED with infectious diseases, accounting for 14.5% (463/3,196) of all elderly patients' visits. The most common diseases diagnosed by emergency physicians (EPs) were pneumonia [151 (32.6%) patients] followed by pyelonephritis [107 (23.1%) patients] and intestinal infection [53 (11.4%) patients]. Moreover, 286 (61.8%) patients were admitted during the study period. The in-hospital mortality rate was 22.7%. 181 (39.1%) patients died within 1 year. Our multivariate analysis showed that age 85 years and older [odds ratio (OR) = 1.89; 95% confidence interval (CI): 1.36-2.63], Charlson Co-morbidity Index score ≥ 5 (OR = 3.51; 95% CI2.14-5.77), lactate ≥4 mmol/l (OR = 2.66;95% CI 1.32-5.38), quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2 (OR = 5.46; 95% CI 2.94-10.12), and platelet count < 100,000 cells/mm (OR = 3.19; 95% CI 1.15-8.83) were associated with 1-year mortality.
In one middle-income country, infectious diseases account for 14.5% of elderly ED patients. Almost two-thirds of patients presenting to ED with infection are admitted to hospital. One-third of elderly ED patients with infection died within 1 year. Age ≥ 85 years, Charlson Co-morbidity Index score ≥ 5, lactate ≥4 mmol/l, qSOFA score ≥ 2, and platelet count < 100,000 cells/mm predicted 1-year mortality rate.
本研究旨在确定老年急诊科（ED）患者感染性疾病的患病率和一年死亡率的危险因素。
对 2016 年 1 月 1 日至 6 月 30 日期间在泰国曼谷一家城市教学医院急诊科就诊并被诊断为感染性疾病的年龄在 65 岁及以上的患者进行回顾性队列研究。
共有 463 名老年患者因感染性疾病就诊 ED，占所有老年患者就诊人数的 14.5%（463/3196）。急诊医师（EP）诊断的最常见疾病是肺炎[151 例（32.6%）患者]，其次是肾盂肾炎[107 例（23.1%）患者]和肠道感染[53 例（11.4%）患者]。此外，286 名（61.8%）患者在研究期间住院。院内死亡率为 22.7%。181 名（39.1%）患者在 1 年内死亡。多变量分析显示，85 岁及以上[比值比（OR）=1.89；95%置信区间（CI）：1.36-2.63]、Charlson 合并症指数评分≥5（OR=3.51；95%CI 2.14-5.77）、乳酸≥4mmol/L（OR=2.66；95%CI 1.32-5.38）、快速序贯器官衰竭评估（qSOFA）评分≥2（OR=5.46；95%CI 2.94-10.12）和血小板计数<100,000 细胞/mm（OR=3.19；95%CI 1.15-8.83）与 1 年死亡率相关。
在一个中等收入国家，感染性疾病占老年 ED 患者的 14.5%。近三分之二的因感染到急诊科就诊的患者住院。三分之一的老年 ED 感染患者在 1 年内死亡。年龄≥85 岁、Charlson 合并症指数评分≥5、乳酸≥4mmol/L、qSOFA 评分≥2 和血小板计数<100,000 细胞/mm 预测 1 年死亡率。
