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Zaalberg T, Barten DG, van Heugten CM, Klijnsma P, Knarren L, Hiemstra Y, Kurvers RAJ, Lekx AW, Mooijaart SP, Janssen-Heijnen M. Prevalence and risk factors of burden among caregivers of older emergency department patients. Sci Rep 2023; 13:7250. [PMID: 37142628 PMCID: PMC10160020 DOI: 10.1038/s41598-023-31750-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/16/2023] [Indexed: 05/06/2023] Open
Abstract
The number of older individuals that live independently at home is rising. These older individuals often rely on caregivers who have a similar age and health status. Therefore, caregivers may experience a high burden. We determined the prevalence and associating factors of burden among caregivers of older patients in the emergency department (ED). A cross-sectional study of primary caregivers of patients aged ≥ 70 years visiting the ED of a Dutch teaching hospital was performed. Structured interviews were conducted with patients and their caregivers. Caregiver burden was measured using the caregiver strain index (CSI). Additionally, data from questionnaires and medical records were extracted to determine potential associating factors. Univariate and multivariate regression analyses were conducted to identify independent determinants for burden. Seventy-eight caregivers (39%) experienced a high burden. Multivariate analysis showed a significant association between high caregiver burden and patients with cognitive impairment or dependency for instrumental activities of daily living (IADL) and more self-reported hours of care per day. Almost 40% of older patients in the ED have a caregiver who experiences a high burden. Formal assessment in the ED may help provide adequate care to the patients and their caregivers.
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Affiliation(s)
- Tessel Zaalberg
- Department of Emergency Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands.
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
| | - Caroline M van Heugten
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
- Limburg Brain Injury Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Petra Klijnsma
- Department of Geriatric Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Lieve Knarren
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Ytje Hiemstra
- Caregiver Representative, MantelzorgNL, Zeist, The Netherlands
| | - Roel A J Kurvers
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands
| | - Anita W Lekx
- Department of Emergency Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maryska Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, The Netherlands
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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Hensgens KR, van Rensen IH, Lekx AW, van Osch FH, Knarren LH, Wyers CE, van den Bergh JP, Barten DG. Sort and Sieve: Pre-Triage Screening of Patients with Suspected COVID-19 in the Emergency Department. Int J Environ Res Public Health 2021; 18:9271. [PMID: 34501861 PMCID: PMC8431352 DOI: 10.3390/ijerph18179271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION To reduce the risk of nosocomial transmission, suspected COVID-19 patients entering the Emergency Department (ED) were assigned to a high-risk (ED) or low-risk (acute medical unit, AMU) area based on symptoms, travel and contact history. The objective of this study was to evaluate the performance of our pre-triage screening method and to analyse the characteristics of initially undetected COVID-19 patients. METHODS This was a retrospective, observational, single centre study. Patients ≥ 18 years visiting the AMU-ED between 17 March and 17 April 2020 were included. Primary outcome was the (correct) number of COVID-19 patients assigned to the AMU or ED. RESULTS In total, 1287 patients visited the AMU-ED: 525 (40.8%) AMU, 762 (59.2%) ED. Within the ED group, 304 (64.3%) of 473 tested patients were COVID-19 positive, compared to 13 (46.4%) of 28 tested patients in the AMU group. Our pre-triage screening accuracy was 63.7%. Of the 13 COVID-19 patients who were initially assigned to the AMU, all patients were ≥65 years of age and the majority presented with gastro-intestinal or non-specific symptoms. CONCLUSION Older COVID-19 patients presenting with non-specific symptoms were more likely to remain undetected. ED screening protocols should therefore also include non-specific symptoms, particularly in older patients.
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Affiliation(s)
- Kirsten R.C. Hensgens
- VieCuri Medical Centre, Department of Emergency Medicine, 5912 BL Venlo, The Netherlands; (I.H.T.v.R.); (A.W.L.); (D.G.B.)
- VieCuri Medical Centre, Department of Intensive Care, 5912 BL Venlo, The Netherlands
| | - Inge H.T. van Rensen
- VieCuri Medical Centre, Department of Emergency Medicine, 5912 BL Venlo, The Netherlands; (I.H.T.v.R.); (A.W.L.); (D.G.B.)
| | - Anita W. Lekx
- VieCuri Medical Centre, Department of Emergency Medicine, 5912 BL Venlo, The Netherlands; (I.H.T.v.R.); (A.W.L.); (D.G.B.)
| | - Frits H.M. van Osch
- VieCuri Medical Centre, Department of Clinical Epidemiology, 5912 BL Venlo, The Netherlands;
- School of Nutrition and Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.E.W.); (J.P.v.d.B.)
| | - Lieve H.H. Knarren
- VieCuri Medical Centre, Department of Internal Medicine, T5912 BL Venlo, The Netherlands;
| | - Caroline E. Wyers
- School of Nutrition and Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.E.W.); (J.P.v.d.B.)
- VieCuri Medical Centre, Department of Internal Medicine, T5912 BL Venlo, The Netherlands;
| | - Joop P. van den Bergh
- School of Nutrition and Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.E.W.); (J.P.v.d.B.)
- VieCuri Medical Centre, Department of Internal Medicine, T5912 BL Venlo, The Netherlands;
| | - Dennis G. Barten
- VieCuri Medical Centre, Department of Emergency Medicine, 5912 BL Venlo, The Netherlands; (I.H.T.v.R.); (A.W.L.); (D.G.B.)
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van Rensen IHT, Hensgens KRC, Lekx AW, van Osch FHM, Knarren LHH, van Kampen-van den Boogaart VEM, Mehagnoul-Schipper JDJ, Wyers CE, van den Bergh JP, Barten DG. Early detection of hospitalized patients with COVID-19 at high risk of clinical deterioration: Utility of emergency department shock index. Am J Emerg Med 2021; 49:76-79. [PMID: 34087575 PMCID: PMC8137356 DOI: 10.1016/j.ajem.2021.05.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/02/2021] [Accepted: 05/16/2021] [Indexed: 12/31/2022] Open
Abstract
Background The COVID-19 outbreak has put an unprecedented strain on Emergency Departments (EDs) and other critical care resources. Early detection of patients that are at high risk of clinical deterioration and require intensive monitoring, is key in ED evaluation and disposition. A rapid and easy risk-stratification tool could aid clinicians in early decision making. The Shock Index (SI: heart rate/systolic blood pressure) proved useful in detecting hemodynamic instability in sepsis and myocardial infarction patients. In this study we aim to determine whether SI is discriminative for ICU admission and in-hospital mortality in COVID-19 patients. Methods Retrospective, observational, single-center study. All patients ≥18 years old who were hospitalized with COVID-19 (defined as: positive result on reverse transcription polymerase chain reaction (PCR) test) between March 1, 2020 and December 31, 2020 were included for analysis. Data were collected from electronic medical patient records and stored in a protected database. ED shock index was calculated and analyzed for its discriminative value on in-hospital mortality and ICU admission by a ROC curve analysis. Results In total, 411 patients were included. Of all patients 249 (61%) were male. ICU admission was observed in 92 patients (22%). Of these, 37 patients (40%) died in the ICU. Total in-hospital mortality was 28% (114 patients). For in-hospital mortality the optimal cut-off SI ≥ 0.86 was not discriminative (AUC 0.49 (95% CI: 0.43–0.56)), with a sensitivity of 12.3% and specificity of 93.6%. For ICU admission the optimal cut-off SI ≥ 0.57 was also not discriminative (AUC 0.56 (95% CI: 0.49–0.62)), with a sensitivity of 78.3% and a specificity of 34.2%. Conclusion In this cohort of patients hospitalized with COVID-19, SI measured at ED presentation was not discriminative for ICU admission and was not useful for early identification of patients at risk of clinical deterioration.
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Affiliation(s)
- Inge H T van Rensen
- VieCuri Medical Center, Department of Emergency Medicine, Venlo, the Netherlands.
| | - Kirsten R C Hensgens
- VieCuri Medical Center, Department of Emergency Medicine, Venlo, the Netherlands; VieCuri Medical Center, Intensive Care Unit, Venlo, the Netherlands.
| | - Anita W Lekx
- VieCuri Medical Center, Department of Emergency Medicine, Venlo, the Netherlands.
| | - Frits H M van Osch
- VieCuri Medical Center, Department of Epidemiology, Venlo, the Netherlands; Maastricht University Medical Center, School of Nutrition and Metabolism (NUTRIM), Maastricht, the Netherlands.
| | - Lieve H H Knarren
- VieCuri Medical Center, Department of Internal Medicine, Venlo, the Netherlands.
| | | | | | - Caroline E Wyers
- Maastricht University Medical Center, School of Nutrition and Metabolism (NUTRIM), Maastricht, the Netherlands; VieCuri Medical Center, Department of Internal Medicine, Venlo, the Netherlands; Maastricht University Medical Center, Department of Internal Medicine, Maastricht, the Netherlands.
| | - Joop P van den Bergh
- Maastricht University Medical Center, School of Nutrition and Metabolism (NUTRIM), Maastricht, the Netherlands; VieCuri Medical Center, Department of Internal Medicine, Venlo, the Netherlands; Maastricht University Medical Center, Department of Internal Medicine, Maastricht, the Netherlands.
| | - Dennis G Barten
- VieCuri Medical Center, Department of Emergency Medicine, Venlo, the Netherlands.
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