Direct and delayed ICU admission in elderly patients
Pijpers, E., Bosch, M., Zwietering, A., Stassen, P.M.
Voorzitter(s): dr. R. Heijligberg, Ede & dr. A.F. Mulder, Utrecht
Locatie(s): Zaal 0.2/0.3
Categorie(ën):
Introduction: The number of elderly people (≥ 65 years) in the emergency department (ED) population is quickly increasing. Therefore, the number of critically ill elderly patients are rising accordingly.
Aim of the study: To compare mortality rates between elderly patients admitted to the ICU either from the ED (direct admission) or from the general ward (delayed admission). To compare the reason of admission to the hospital, and the vital signs during stay at the ED were secondary goals.
Materials and Methods: We performed a retrospective cohort study of elderly patients admitted to the ICU of the MUMC+ for internal medicine in the year 2011.
Delayed admission was defined as admission to the ICU after admission to a general ward.
Results: Data on 1396 elderly patients admitted for internal medicine (mean age 77.6 years) were retrieved. Only 21 patients (1.5%) were directly admitted to the ICU and only 54 (3.5%) were admitted from a general ward. The group of patients with a delayed admission to the ICU less often had cardiopulmonary problems or abnormal vital signs (low blood pressure, tachypnea, hypoxia or low GCS scores) in the ED compared to the group of patients directly admitted to the ICU.
Mortality rates were higher in patients with a delayed admission to the ICU than in those who were directly admitted, however the difference between the two groups was not significant (19.0% (n=4) versus 38.9% (n=21), p=0.55) at 28 days and 42.9% (n=9) versus 66.7% (n=36, p=0.24) at one year.
Conclusion: The number of elderly people presented at the ED who are admitted to the ICU either directly or via delayed admission is very low. Admission to the ICU of the patients in the direct admission group is consistent with the cardiopulmonary status and abnormal vital signs in this group.The admission to the ICU of the group of patients with a delayed admission could not be predicted from their cardiopulmonary status and vital signs during stay at the ED. The mortality rates after 28 days and one year are high in both groups, but seem to be higher in patients with a delayed admission to the ICU than in patients directly admitted to the ICU, although the difference between the two groups is not significant.