Shimoni Zvi, Firas Abu D, Hermush Vered, Froom Paul
Israel and Sanz Medical Centre, Laniado Hospital, The Adelson School of Medicine -Ariel University, Netanya, Israel.
Internal Medicine Department B, Sanz Medical Centre, Laniado Hospital, Netanya, Israel.
J Eval Clin Pract. 2025 Apr;31(3):e14183. doi: 10.1111/jep.14183. Epub 2024 Oct 13.
Older adults in the Emergency Department (ED) often present with nonspecific complaints (NSC) that might be associated with adverse health outcomes due to underestimating the seriousness of the illness by health care workers.
We selected a random sample of patients aged 65 or older who complained of weakness and were hospitalised in internal medicine departments in 2019-2021. We divided the patients into those with and without specific reasons for hospitalisation after the ED evaluation. Outcome variables included changes in medical care based on CT head scans and blood tests, and whether a delay in diagnosis led to a longer stay, in-hospital mortality, or readmission within 30 days.
Patients were aged 82 ± 8 years and 43.6% (233/536)were female. 46.8% (260/556) of the patients had a specific reason for hospitalisation after the ED evaluation including four patients presenting with confusion, without neurological findings but with acute ischaemia found on the brain CT. Patients without a specific presentation had fewer blood tests done due to a significantly shorter hospital stay (median (1st-3rd quartiles: 3 (2-4) vs. 4 (3-6) days, p < 0.001), a lower mortality rate, 0.3% (n = 1) compared to 4.2% (n = 11), p = 0.002), and fewer readmissions 13.5%(n = 40) compared to 20.4% (n = 53). The deaths and readmissions in both groups were not due to a delay in diagnosis.
Elderly patients with a chief complaint of weakness with and without a specific reason for hospitalisation were not at an increased risk for inappropriate treatment or a missed diagnosis.
急诊科（ED）的老年患者常出现非特异性主诉（NSC），医护人员可能因低估病情严重程度而导致不良健康后果。
我们随机抽取了2019 - 2021年因虚弱而在内科住院的65岁及以上患者样本。根据急诊科评估后，将患者分为有和没有特定住院原因的两组。结果变量包括基于头部CT扫描和血液检查的医疗护理变化，以及诊断延迟是否导致住院时间延长、院内死亡或30天内再次入院。
患者年龄为82±8岁，43.6%（233/536）为女性。46.8%（260/556）的患者在急诊科评估后有特定的住院原因，其中包括4名出现意识模糊的患者，虽无神经系统检查结果，但脑部CT发现急性缺血。没有特定表现的患者进行的血液检查较少，因为住院时间明显较短（中位数（第1 - 3四分位数）：3（2 - 4）天对4（3 - 6）天，p < 0.001），死亡率较低，为0.3%（n = 1），而有特定原因组为4.2%（n = 11），p = 0.002），再次入院率也较低，为13.5%（n = 40），而有特定原因组为20.4%（n = 53）。两组的死亡和再次入院均不是由于诊断延迟。
以虚弱为主诉且有或没有特定住院原因的老年患者，接受不适当治疗或漏诊的风险并未增加。
