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Fernández Alonso C, Fuentes Ferrer ME, García-Lamberechts EJ, Aguiló Mir S, Jiménez S, Jacob J, Piñera Salmerón P, Gil-Rodrigo A, Llorens P, Burillo-Putze G, Alquezar-Arbé A, Bretones Baena S, Fernández Cardona M, Hernández González R, Moreno Martín M, Barnes Parra A, El Farh I, Valle Borrego B, Quero Motto E, Artieda Larrañaga A, Soy Ferrer E, Hong Cho JU, Gros Bañeres B, Gayoso Martín S, Sánchez Sindín G, Prieto Zapico A, Cirera Lorenzo I, Guardiola Tey JM, Llauger L, González Del Castillo J, Miró Ò. Impact of dementia on 30-, 180-, and 365-day mortality during the first pandemic wave in older adults seen in spanish emergency departments diagnosed with or without COVID-19. Aging Ment Health 2024:1-9. [PMID: 38597417 DOI: 10.1080/13607863.2024.2337144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES To assess whether dementia is an independent predictor of death after a hospital emergency department (ED) visit by older adults with or without a COVID-19 diagnosis during the first pandemic wave. METHOD We used data from the EDEN-Covid (Emergency Department and Elderly Needs during Covid) cohort formed by all patients ≥65 years seen in 52 Spanish EDs from March 30 to April 5, 2020. The association of prior history of dementia with mortality at 30, 180 and 365 d was evaluated in the overall sample and according to a COVID-19 or non COVID diagnosis. RESULTS We included 9,770 patients aged 78.7 ± 8.3 years, 51.1% men, 1513 (15.5%) subjects with prior history of dementia and 3055 (31.3%) with COVID-19 diagnosis. 1399 patients (14.3%) died at 30 d, 2008 (20.6%) at 180 days and 2456 (25.1%) at 365 d. The adjusted Hazard Ratio (aHR) for age, sex, comorbidity, disability and diagnosis for death associated with dementia were 1.16 (95% CI 1.01-1.34) at 30 d; 1.15 at 180 d (95% CI 1.03-1.30) and 1.19 at 365 d (95% CI 1.07-1.32), p < .001. In patients with COVID-19, the aHR were 1.26 (95% CI: 1.04-1.52) at 30 days; 1.29 at 180 d (95% CI: 1.09-1.53) and 1.35 at 365 d (95% CI: 1.15-1.58). CONCLUSION Dementia in older adults attending Spanish EDs during the first pandemic wave was independently associated with 30-, 180- and 365-day mortality. This impact was lower when adjusted for age, sex, comorbidity and disability, and was greater in patients diagnosed with COVID-19.
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Affiliation(s)
- Cesáreo Fernández Alonso
- Emergency Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Manuel E Fuentes Ferrer
- Investigation Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Sira Aguiló Mir
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Sònia Jiménez
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Adriana Gil-Rodrigo
- Emergency Department, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Pere Llorens
- Emergency Department, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | | | - Aitor Alquezar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | - Ana Barnes Parra
- Emergency Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Imane El Farh
- Emergency Department, Hospital Francecs de Borja, Gandía, Spain
| | | | - Eva Quero Motto
- Emergency Department, Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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García-Lamberechts EJ, Fuentes Ferrer M, Fernández-Alonso C, Burillo-Putze G, Aguiló S, Alquezar-Arbé A, Montero-Pérez FJ, Jacob J, Piñera Salmerón P, Salido Mota M, Marchena MJ, Martínez Alonso A, Chacón García A, Güemes de la Iglesia C, Troiano Ungerer OJ, Eiroa-Hernández P, Parra-Esquivel P, Lázaro Aragüés P, Gantes Nieto P, Cuerpo Cardeñosa S, Chacón García C, Serrano Lázaro L, Caballero Martínez M, Guillen L, Muñoz Martos R, González Del Castillo J, Miró Ò. Predictive usefulness of qSOFA, NEWS and GYM scores in the elderly patient: EDEN-5 study. Enferm Infecc Microbiol Clin (Engl Ed) 2024:S2529-993X(24)00008-X. [PMID: 38296669 DOI: 10.1016/j.eimce.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/18/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE To analyze the prognostic accuracy of the scores NEWS, qSOFA, GYM used in hospital emergency department (ED) in the assessment of elderly patients who consult for an infectious disease. METHODS Data from the EDEN (Emergency Department and Elderly Need) cohort were used. This retrospective cohort included all patients aged ≥65 years seen in 52 Spanish EDs during two weeks (from 1-4-2019 to 7-4-2019 and 30/3/2020 to 5/4/2020) with an infectious disease diagnosis in the emergency department. Demographic variables, demographic variables, comorbidities, Charlson and Barthel index and needed scores parameters were recorded. The predictive capacity for 30-day mortality of each scale was estimated by calculating the area under the receiver operating characteristic (ROC) curve, and sensitivity and specificity were calculated for different cut-off points. The primary outcome variable was 30-day mortality. RESULTS 6054 patients were analyzed. Median age was 80 years (IQR 73-87) and 45.3% women. 993 (16,4%) patients died. NEWS score had better AUC than qSOFA (0.765, 95CI: 0.725-0.806, versus 0.700, 95%CI: 0.653-0.746; P < .001) and GYM (0.716, 95%CI: 0.675-0.758; P = .024), and there was no difference between qSOFA and GYM (P = .345). The highest sensitivity scores for 30-day mortality were GYM ≥ 1 point (85.4%) while the qSOFA score ≥2 points showed high specificity. In the case of the NEWS scale, the cut-off point ≥4 showed high sensitivity, while the cut-off point NEWS ≥ 8 showed high specificity. CONCLUSION NEWS score showed the highest predictive capacity for 30-day mortality. GYM score ≥1 showed a great sensitivity, while qSOFA ≥2 scores provide the highest specificity but lower sensitivity.
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Affiliation(s)
| | - Manuel Fuentes Ferrer
- Unidad de Investigación, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Cesáreo Fernández-Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Guillermo Burillo-Putze
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain
| | - Sira Aguiló
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Aitor Alquezar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | | | | | | | - Patricia Eiroa-Hernández
- Servicio de Urgencias, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Patricia Parra-Esquivel
- Servicio de Urgencias, Hospital Norte Tenerife, Icod de los Vinos, Santa Cruz de Tenerife, Spain
| | - Paula Lázaro Aragüés
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, Spain
| | | | | | | | | | | | - Lara Guillen
- Servicio de Urgencias, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Rocío Muñoz Martos
- Servicio de Urgencias, Hospital de la Axarquía, Velez-Málaga, Málaga, Spain
| | | | - Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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Fernández Alonso C, Fuentes Ferrer ME, García-Lamberechts EJ, Aguiló Mir S, Jiménez S, Jacob Rodriguez J, Piñera Salmerón P, Gil-Rodrigo A, Llorens P, Burillo-Putze G, Montero Pérez FJ, Alquezar-Arbé A, Ríos Gallardo R, Berenguer Diez MA, Truyol Más M, López-Laguna N, Cortés Soler A, González Nespereira E, García García Á, Ezponda P, Martínez Lorenzo A, Ortega Liarte JV, Santos Martín JM, Herrero Puente P, Melcon Villalibre A, González Del Castillo J, Miró Ò. [Impacto de la dependencia funcional de los pacientes mayores atendidos en los servicios de Urgencias españoles durante la primera ola pandémica de la COVID-19 sobre la mortalidad a 30, 180 y 365 días en función del diagnóstico (COVID versus no COVID).]. Rev Esp Salud Publica 2023; 97:e202310085. [PMID: 37921381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/21/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE Functional assessment is part of geriatric assessment. How it is performed in hospital Emergency Departments (ED) is poorly understood, let alone its prognostic value. The aim of this paper was to investigate whether baseline disability to perform basic activities of daily living (BADL) was an independent prognostic factor for death after the index visit to the ED during the first wave of the COVID-19 pandemic and whether it had a different impact on patients with and without diagnosis of COVID-19. METHODS A retrospective observational study of the EDEN-Covid (Emergency Department and Elder Needs during COVID) cohort was carried out, consisting of all patients aged ≥65 years seen in 52 Spanish EDs selected by chance during 7 consecutive days (30/3/2020 to 5/4/2020). Demographic, clinical, functional, mental and social variables were analyzed. Dependence was categorized with the Barthel index (BI) as independent (BI=100), mild-moderate dependence (100>BI>60) and severe-total dependence (BI<60), and their crude and adjusted association was evaluated with mortality at 30, 180 and 365 days using COX proportional hazards models. RESULTS Of 9,770 enrolled patients with a mean age of 79 years, 51% were men, 6,305 (64.53%) were independent, 2,340 (24%) had mild-moderate dependence, and 1,125 (11.5%) severe-total dependence. The number of deaths at 30 days in these three groups was 500 (7.9%), 521 (22.3%) and 378 (33.6%), respectively; at 180 days it was 757 (12%), 725 (30.9%) and 526 (46.8%); and at 365 days 954 (15.1%), 891 (38.1%) and 611 (54.3%). In relation to independent patients, the adjusted risks (hazard ratio) of dying within 30 days associated with mild-moderate and severe-total dependency were 1.91 (95% CI: 1.66-2.19) and 2.51. (2.11-2.98); at 180 days they were 1.88 (1.68-2.11) and 2.64 (2.28-3.05); and at 365 days they were 1.82 (1.64-2.02) and 2.47 (2.17-2.82). This negative impact of dependency on mortality was greater in patients diagnosed with COVID-19 than in non-COVID-19 (p interaction at 30, 180 and 365 days of 0.36, 0.05 and 0.04). CONCLUSIONS The functional dependence of older patients who attend Spanish EDs during the first wave of the pandemic is associated with mortality at 30, 180 and 365 days, and this risk is significantly higher in patients treated for COVID-19.
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Affiliation(s)
- Cesáreo Fernández Alonso
- Servicio de Urgencias; Hospital Clínico San Carlos. IDISSC. Universidad Complutense. Madrid. España
| | - Manuel E Fuentes Ferrer
- Unidad de Investigación; Hospital Universitario Nuestra Señora de Candelaria. Santa Cruz de Tenerife. España
| | | | - Sira Aguiló Mir
- Área de Urgencias; Hospital Clínic. IDIBAPS. Universitat de Barcelona. Barcelona. España
| | - Sònia Jiménez
- Área de Urgencias; Hospital Clínic. IDIBAPS. Universitat de Barcelona. Barcelona. España
| | - Javier Jacob Rodriguez
- Servicio de Urgencias; Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat (Barcelona). España
| | | | - Adriana Gil-Rodrigo
- Servicio de Urgencias; Unidad de Estancia Corta y Hospitalización a Domicilio; Hospital Doctor Balmis de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL); Universidad Miguel Hernández. Alicante. España
| | - Pere Llorens
- Servicio de Urgencias; Unidad de Estancia Corta y Hospitalización a Domicilio; Hospital Doctor Balmis de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL); Universidad Miguel Hernández. Alicante. España
| | - Guillermo Burillo-Putze
- Facultad de Ciencias de la Salud; Universidad Europea de Canarias. Santa Cruz de Tenerife. España
| | | | - Aitor Alquezar-Arbé
- Servicio de Urgencias; Hospital de la Santa Creu i Sant Pau. Barcelona. España
| | | | | | - Marina Truyol Más
- Servicio de Urgencias; Hospital Universitario Son Espases. Palma de Mallorca. España
| | | | | | | | - Ángel García García
- Servicio de Urgencias; Hospital Universitario de Salamanca. Salamanca. España
| | - Patxi Ezponda
- Servicio de Urgencias; Hospital de Zumárraga.Zumárraga. España
| | | | | | | | | | | | | | - Òscar Miró
- Área de Urgencias; Hospital Clínic. IDIBAPS. Universitat de Barcelona. Barcelona. España
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Burillo-Putze G, Parra-Esquivel P, Aguiló S, Jiménez S, Jacob J, Piñera Salmerón P, Llorens P, García-Lamberechts EJ, Montero-Pérez FJ, Muñoz-Triano E, Gil-Rodrigo A, Fernández-Alonso C, Alquezar-Arbé A, Salido Mota M, Gil Hernández RJ, Pedraza García J, Cobos Requena A, Gargallo Garcia E, de Diego Arnaiz M, Iglesias Vela M, Pérez-Costa RA, Pérez Peñalva SDM, Valle Borrego B, Quero Motto E, Morales Franco B, Adroher Muñoz M, González Del Castillo J, Miró Ò. Study EDEN-12: Analysis of access to intensive care units of patients older than 65 years requiring emergency hospitalization. Med Intensiva 2023:S2173-5727(23)00068-1. [PMID: 37391317 DOI: 10.1016/j.medine.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/03/2023] [Accepted: 04/15/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To investigate the relationship between the age of an urgently hospitalized patient and his or her probability of admission to an intensive care unit (ICU). DESIGN Observational, retrospective, multicenter study. SETTING 42 Emergency Departments from Spain. TIME-PERIOD April 1-7, 2019. PATIENTS Patients aged ≥65 years hospitalized from Spanish emergency departments. INTERVENTIONS None. MAIN VARIABLES OF INTEREST ICU admission, age sex, comorbidity, functional dependence and cognitive impairment. RESULTS 6120 patients were analyzed (median age: 76 years; males: 52%. 309 (5%) were admitted to ICU (186 from ED, 123 from hospitalization). Patients admitted to the ICU were younger, male, and with less comorbidity, dependence and cognitive impairment, but there were no differences between those admitted from the ED and from hospitalization. The OR for ICU-admission adjusted by sex, comorbidity, dependence and dementia reached statistical significance >83 years (OR: 0.67; 95%CI: 0.45-0.49). In patients admitted to the ICU from ED, the OR did not begin to decrease until 79 years, and was significant >85 years (OR: 0.56, 95%CI: 0.34-0.92); while in those admitted to ICU from hospitalization, the decrease began 65 years of age, and were significant from 85 years (OR: 0.55, 95%CI: 0.30-0.99). Sex, comorbidity, dependency and cognitive deterioration of the patient did not modify the association between age and ICU-admission (overall, from the ED or hospitalization). CONCLUSIONS After taking into account other factors that influence admission to the ICU (comorbidity, dependence, dementia), the chances of admission to the ICU of older patients hospitalized on an emergency basis begin to decrease significantly after 83 years of age. There may be differences in the probability of admission to the ICU from the ED or from hospitalization according to age.
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Affiliation(s)
| | - Patricia Parra-Esquivel
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain.
| | - Sira Aguiló
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Sònia Jiménez
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Pere Llorens
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | | | | | | | - Adriana Gil-Rodrigo
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Cesáreo Fernández-Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Aitor Alquezar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | | | | | - Marta Iglesias Vela
- Servicio de Urgencias, Complejo Asistencial Universitario de León, León, Spain
| | | | | | | | - Eva Quero Motto
- Servicio de Urgencias, Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | - Belén Morales Franco
- Servicio de Urgencias, Hospital Universitario Lorenzo Guirao, Cieza, Murcia, Spain
| | - Maria Adroher Muñoz
- Servicio de Urgencias, Hospital Universitario Dr. Josep Trueta, Girona, Spain
| | | | - Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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