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Risk Factors for Death in Elderly Emergency Department Patients with Suspected Infection
Author(s) -
Caterino Jeffrey M.,
Kulchycki Lara K.,
Fischer Christopher M.,
Wolfe Richard E.,
Shapiro Nathan I.
Publication year - 2009
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2009.02320.x
Subject(s) - medicine , cohort , odds ratio , emergency department , logistic regression , confidence interval , mortality rate , prospective cohort study , risk factor , cohort study , psychiatry
OBJECTIVES: To identify independent risk factors for death in elderly emergency department (ED) patients admitted for infection and to derive and validate a mortality‐prediction rule for such patients. DESIGN: Prospective cohort study. SETTING: Tertiary hospital ED with 55,000 annual visits. PARTICIPANTS: ED patients aged 65 and older admitted for infection between December 2003 and September 2004 in the derivation cohort and October 2005 and October 2006 in the validation cohort. MEASUREMENTS: Primary outcome: 28‐day in‐hospital mortality. Data were extracted from charts, and multivariate logistic regression were performed to identify independent mortality predictors. A prediction model was constructed and then validated in a second cohort. RESULTS: Nine hundred thirty‐five patients were included in the derivation cohort and 2,015 in the validation cohort. Mortality was 6% in the derivation cohort and 7% in the validation cohort. In the derivation cohort, logistic regression revealed five independent mortality predictors: respiratory compromise (respiratory rate >20 breaths per minute or hypoxemia) (odds ratio (OR)=4.0, 95% confidence interval (CI)=1.7–9.4), tachycardia (heart rate ≥120 betas per minute; OR=3.2, 95% CI=1.6–6.3), cardiovascular failure (systolic blood pressure <90 mmHg despite fluid challenge or lactate ≥4.0; OR=9.0, 95% CI=4.7–17), preexisting terminal illness (OR=5.7, 95% CI=2.2–15), and platelet count less than 150,000/mm 3 (OR=2.7, 95% CI=1.3–5.6). Mortality increased with the number of factors: 0.51% for no factors, 3.1% for one factor, 14% for two factors, 47% for three or more risk factors. The c‐statistic was 0.87 for the derivation model and 0.74 for the validation model. Almost 80% of patients in both cohorts were in low‐risk groups (0 or 1 factor). CONCLUSION: A rule derived from five readily available variables predicts mortality in infected elderly ED patients and allows identification of a large low‐risk subgroup.