Predicting adverse health outcomes in older patients presenting to the Emergency Department; the Acutely Presenting Older Patient study

J. de Gelder, J.A. Lucke, B. de Groot, A.J. Fogteloo, S. Anten, K. Mesri, C. Heringhaus, G.J. Blauw, S.P. Mooijaart

Woensdag 20 april 2016

15:10 - 15:20u in Zaal 2.1

Categorie├źn: Parallelsessie

Parallel sessie: Parallelsessie 5: Case reports/research

Background: Older patients experience high rates of adverse outcomes after an Emergency Department (ED) visit. Early identification of those at high risk could guide preventive interventions and tailored treatment decisions, but available models perform poorly in discriminating those at highest risk. The present study aims to develop and validate a prediction model for functional decline and mortality in older patients presenting to our ED.

Methods: A multi-centre prospective follow-up study in ED's of the LUMC (derivation) and Alrijne hospital (validation) was conducted. All presenting patients aged 70 and over were included during 12 weeks for 7 days per week. A baseline assessment shortly (<1hour) after presentation included demographics, severity of disease indicators and measurements of functional and cognitive impairment. The main outcomes were a composite of functional decline or mortality after ninety days, and mortality separately.

Results: 751 patients were included in the LUMC of whom 230(30.6%) experienced the adverse outcome and 71(9.5%) deceased. The final model for the adverse outcome resulted in an area under the curve (AUC) of 0.73(95%CI 0.67-0.77) and was experienced in 69% of the patients at highest risk. For mortality the AUC was 0.79(95%CI 0.73-0.85) and 36% of the patients at highest risk deceased. External validation in 881 patients of Alrijne hospital showed an AUC of 0.71(95%CI 0.67-0.75) for the adverse outcome and 0.69(95%CI 0.63-0.75) for mortality.

Conclusion: We successfully developed and validated prediction models for 90-day adverse outcome and 90-day mortality in older emergency patients. The LUMC will implement the screening and test effectiveness of preventive interventions.