Wilson William, Ravindra Prithvishree, Khasage Udaykumar J, Raj Jeffrey Pradeep, Jain Vinayak, Bose Bijoyini, Kosuri Sreenidhi
Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
Department of Emergency Medicine, BLDE (DU), Vijaypur, Karnataka, India.
J Family Med Prim Care. 2021 Oct;10(10):3791-3796. doi: 10.4103/jfmpc.jfmpc_630_21. Epub 2021 Nov 5.
Emergency intensive care of the elderly is often complicated and multifaceted. Understanding the clinical profile of elderly patients admitted in an emergency department-intensive care unit (ED-ICU) is crucial in planning health policies in geriatric emergency medicine. Thus, the aim of the study was to create a local registry of elderly people utilizing the ED-ICU services and to understand the rate and predictors of mortality.
A retrospective chart analysis was performed including all patients aged ≥60 years who had an ED-ICU admission during a 6-month period (August 2018-January 2019). A structured case record form was used to capture information such as basic demography, clinical profile, and outcomes.
Total number of records considered for final analysis were 503. Mortality was seen in 21.07% (n = 106/503). The most common presenting complaint and cause of death was breathing difficulty (n = 48/503; 29.42%) and pneumonia (n = 41/106; 38.67%), repectively. The significant predictors of mortality [adjusted odds ratio; 95% confidence intervals; value] were hypertension (2.195; 1.255, 3.840; 0.006), chronic liver disease (CLD) (4.324; 1.170, 15.979; 0.028), malignancy (2.854; 1.045, 7.796; 0.041), requiring noninvasive ventilation (NIV) (2.618; 1.449, 4.730; 0.001), requiring intubation (6.638; 3.705, 11.894; <0.001), and requiring vasopressors (3.583; 1.985, 6.465; <0.001).
Approximately one in every five elderly patients getting admitted in ED-ICU died, and respiratory illness was the common diagnosis leading to death. Those with comorbidities such as hypertension, CLD, or malignancy and those requiring NIV, intubation, or vasopressors had higher mortality.
老年患者的急诊重症监护往往复杂且涉及多方面。了解入住急诊科重症监护病房（ED - ICU）的老年患者的临床特征对于制定老年急诊医学的卫生政策至关重要。因此，本研究的目的是建立一个利用ED - ICU服务的老年人本地登记册，并了解死亡率及其预测因素。
进行了一项回顾性病历分析，纳入了在6个月期间（2018年8月至2019年1月）所有年龄≥60岁且入住ED - ICU的患者。使用结构化病例记录表收集基本人口统计学、临床特征和结局等信息。
最终分析纳入的记录总数为503份。死亡率为21.07%（n = 106/503）。最常见的就诊主诉和死因分别是呼吸困难（n = 48/503；29.42%）和肺炎（n = 41/106；38.67%）。死亡率的显著预测因素[调整后的优势比；95%置信区间；P值]为高血压（2.195；1.255，3.840；0.006）、慢性肝病（CLD）（4.324；1.170，15.979；0.028）、恶性肿瘤（2.854；1.045，7.796；0.041）、需要无创通气（NIV）（2.618；1.449，4.730；0.001）、需要插管（6.638；3.705，11.894；<0.001）以及需要血管活性药物（3.583；1.985，6.465；<0.001）。
每五名入住ED - ICU的老年患者中约有一人死亡，呼吸系统疾病是导致死亡的常见诊断。患有高血压、CLD或恶性肿瘤等合并症以及需要NIV、插管或血管活性药物的患者死亡率更高。
