TY - JOUR
T1 - Older patients with nonspecific complaints at the Emergency Department are at risk of adverse health outcomes
AU - van Dam, C S
AU - Peters, M J L
AU - Hoogendijk, E O
AU - Nanayakkara, P W B
AU - Muller, M
AU - Trappenburg, M C
N1 - Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved. Funding Information: We would like to thank all the participants and the student researchers who contributed to the data collection. We would also like to thank the EDs of Amsterdam UMC and the Amstelland Hospital for their collaboration. The authors have no relevant financial or non-financial interests to disclose. Publisher Copyright: © 2023 The Author(s)
PY - 2023/6
Y1 - 2023/6
N2 - OBJECTIVE: Older adults at the Emergency Department (ED) often present with nonspecific complaints (NSC) such as 'weakness' or 'feeling unwell'. Health care workers may underestimate illness in patients with NSC, leading to adverse health outcomes. This study compares characteristics and outcomes of NSC-patients versus specific complaints (SC) patients.METHODS: Cohort study in patients ≥ 70 years in two Dutch EDs. NSC was classified according to the BANC-study-framework based on the medical history in the ED letter, before additional diagnostics took place. A second classification was performed at the end of the ED visit/hospital admission. Primary outcomes were functional decline, institutionalization, and mortality at 30 days.RESULTS: 26% (n = 228) of a total of 888 included patients presented with NSC. Compared with SC-patients, NSC-patients were older, more frail, and more frequently female. NSC-patients had a higher risk of functional decline and institutionalization at 30 days (adjusted ORs 1.84, 95% CI 1.27 - 2.72, and 2.46, 95% CI 1.51-4.00, respectively), but not mortality (adjusted OR 1.26, 95% CI 0.58 - 2.73). Reclassification to a specific complaint after the ED visit or hospital admission occurred in 54% of NSC-patients.CONCLUSION: NSC occur especially in older, frail female patients and are associated with an increased risk of functional decline and institutionalization, even after adjustment for worse baseline status. In half of the patients, a specific complaint revealed during ED or hospital stay. Physicians at the ED should consider NSC as a red flag needing appropriate observation and evaluation of underlying serious conditions and needs of this vulnerable patient group.
AB - OBJECTIVE: Older adults at the Emergency Department (ED) often present with nonspecific complaints (NSC) such as 'weakness' or 'feeling unwell'. Health care workers may underestimate illness in patients with NSC, leading to adverse health outcomes. This study compares characteristics and outcomes of NSC-patients versus specific complaints (SC) patients.METHODS: Cohort study in patients ≥ 70 years in two Dutch EDs. NSC was classified according to the BANC-study-framework based on the medical history in the ED letter, before additional diagnostics took place. A second classification was performed at the end of the ED visit/hospital admission. Primary outcomes were functional decline, institutionalization, and mortality at 30 days.RESULTS: 26% (n = 228) of a total of 888 included patients presented with NSC. Compared with SC-patients, NSC-patients were older, more frail, and more frequently female. NSC-patients had a higher risk of functional decline and institutionalization at 30 days (adjusted ORs 1.84, 95% CI 1.27 - 2.72, and 2.46, 95% CI 1.51-4.00, respectively), but not mortality (adjusted OR 1.26, 95% CI 0.58 - 2.73). Reclassification to a specific complaint after the ED visit or hospital admission occurred in 54% of NSC-patients.CONCLUSION: NSC occur especially in older, frail female patients and are associated with an increased risk of functional decline and institutionalization, even after adjustment for worse baseline status. In half of the patients, a specific complaint revealed during ED or hospital stay. Physicians at the ED should consider NSC as a red flag needing appropriate observation and evaluation of underlying serious conditions and needs of this vulnerable patient group.
KW - Acute medicine
KW - Emergency department
KW - Internal medicine
KW - Nonspecific complaints
KW - Older patients
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85151310343&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/37002150
U2 - https://doi.org/10.1016/j.ejim.2023.03.018
DO - https://doi.org/10.1016/j.ejim.2023.03.018
M3 - Article
C2 - 37002150
SN - 0953-6205
VL - 112
SP - 86
EP - 92
JO - European Journal of Internal Medicine
JF - European Journal of Internal Medicine
ER -