Adeyemi Oluwaseun, Hill Jacob, Siman Nina, Goldfeld Keith S, Cuthel Allison M, Grudzen Corita R
NYU Grossman School of Medicine (O.S., N.S., A.M.C.), Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA.
Cleveland Clinic (J.H.), Department of Wellness and Preventive Medicine, Cleveland, Ohio, USA.
J Pain Symptom Manage. 2025 Jun;69(6):559-568. doi: 10.1016/j.jpainsymman.2025.01.006. Epub 2025 Jan 31.
Understanding how prognosis influences acute care use among older adults at risk of short-term mortality is essential for providing care consistent with patients' wishes.
This study assesses whether prognosis is associated with acute care and Intensive Care Unit (ICU) transfer in older adults presenting to the Emergency Department (ED) at high and low risk of short-term mortality.
For this cross-sectional analysis, we pooled the Medicare claims for older adults 66 years and older from 2015 to 2019 who visited at least one of the 29 EDs participating in the Primary Palliative Care for Emergency Medicine study. Our outcome measures were defined as an acute care admission and ICU transfer resulting from an ED visit, both measured as binary variables. The predictor variables were age, sex, race/ethnicity, and Gagne score. We stratified the analysis into those with low (≤6) and high risk (>6) short-term mortality using the Gagne scores. To assess the odds of an acute care or ICU transfer, we used multivariable logistic regression via generalized estimating equation models and computed the adjusted odds ratios (AOR) among the general population and among those at high risk of short-term mortality.
Of the 301,083 older adults who visited one of the 29 EDs, 13% were at high risk for short-term mortality. Among this high-risk group, 64% had an acute care admission, and 15% of those admitted had an ICU transfer, as compared to 43% and 12% of those at low risk of short-term mortality. Among those at high risk for short-term mortality, prognosis was associated with 6% (AOR 1.06; 95% CI, 1.04-1.09) and 8% (AOR 1.08; 95% CI, 1.06-1.09) increased adjusted odds of inpatient admission and ICU transfer, respectively.
The prognosis of older adults, especially those at high risk of short-term mortality, predicts both inpatient admissions and ICU transfers.
了解预后如何影响有短期死亡风险的老年人的急性护理使用情况，对于提供符合患者意愿的护理至关重要。
本研究评估在急诊科就诊的短期死亡风险高和低的老年人中，预后是否与急性护理和重症监护病房（ICU）转诊相关。
对于这项横断面分析，我们汇总了2015年至2019年66岁及以上老年人的医疗保险索赔数据，这些老年人至少访问了参与急诊医学初级姑息治疗研究的29家急诊科中的一家。我们的结局指标定义为因急诊就诊导致的急性护理入院和ICU转诊，两者均作为二元变量进行测量。预测变量为年龄、性别、种族/族裔和加涅评分。我们使用加涅评分将分析分层为短期死亡风险低（≤6）和高（>6）的人群。为了评估急性护理或ICU转诊的几率，我们通过广义估计方程模型使用多变量逻辑回归，并计算了一般人群和短期死亡高风险人群中的调整优势比（AOR）。
在访问29家急诊科之一的301,083名老年人中，13%有短期死亡高风险。在这个高风险组中，64%有急性护理入院，其中15%的入院患者有ICU转诊，而短期死亡低风险人群的这一比例分别为43%和12%。在短期死亡高风险人群中，预后分别与住院入院和ICU转诊的调整优势比增加6%（AOR 1.06；95% CI，1.04 - 1.09）和8%（AOR 1.08；95% CI，1.06 - 1.09）相关。
老年人的预后，尤其是短期死亡高风险的老年人，可预测住院入院和ICU转诊情况。
