Öz
Amaç: Geriatrik hastaların acil servise (AS) üç gün içerisindeki tekrar başvuruları ile ilgili literatürde yeterli veri yoktur. Bu çalışma ile bu hastaların karakteristik özelliklerini belirlemek ve sonrasında 90 günlük mortalite sonuçlarını saptamak amaçlandı.
Gereç ve Yöntem: Bu retrospektif çalışma Ocak 2018 tarihinde ikinci basamak bir devlet hastanesi acil servisinde gerçekleştirildi. Hasta popülasyonu 65 yaş ve üzeri hastalardan seçildi. Hastaların ilk başvuru ve 72 saat içerisindeki ikinci başvuru kayıtları not edildi.
Bulgular: Çalışma süresince 1422 geriatrik hasta AS’e başvurdu ve bu hastalar içerisinde 85 (%6) hasta 72 saat içerisinde tekrar AS’e başvurdu. Bu hastaların %54,1’i kadındı ve hastaların ortanca yaşı 74’tü (IQR 70-80). Tekrar başvuru yap-an geriatrik hastaların %77,6’sı (n=66) ilk başvurusu ile benzer şikâyetlere sahipti. Tekrar başvuruları farklı tanılarla gerçekleşen hastaların 90 günlük mortalite oranları, aynı tanı ile başvuranlara göre daha yüksek izlense de aradaki fark istatistiksel olarak anlamlı değildi (%26,3 ve %13,6; sırasıyla). Tüm tekrar başvurular içerisinde mortalite sonuçlarına bakıldığında, hastaların %16.5’inde (n=14) 90 gün içerisinde mortalite izlendi.
Sonuç: Geriatrik tekrar başvuru oranları literatürle kıyaslandığında bir miktar daha yüksek izlendi. Benzer tanılarla tekrar başvuru oranları oldukça yüksekti. Çalışma içerisinde yaklaşık her altı hastadan birinin 90 gün içerisinde mortalite ile sonuçlandığı görüldü.
Anahtar Kelimeler
Kaynakça
- 1. Han CY, Chen LC, Barnard A, et al. Early Revisit to the Emergency Department: An Integrative Review. Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association 2015;41(4):285-95. PMID: 25618557
- 2. McCusker J, Healey E, Bellavance F, Connolly B. Predictors of Repeat Emergency Department Visits by Elders. Academic Emergency Medicine 1997;4(6):581-8. PMID: 9189191
- 3. Friedmann PD, Jin L, Karrison TG, et al. Early revisit, hospitalization, or death among older persons discharged from the ED. The American journal of emergency medicine 2001;19(2):125-9. PMID: 11239256
- 4. Gelder J, Lucke JA, Groot B, et al. Predictors and Outcomes of Revisits in Older Adults Discharged from the Emergency Department. Journal of the American Geriatrics Society 2018;66(4):735-41. PMID: 29489015
- 5. McCusker J, Cardin S, Bellavance F, Belzile E. Return to the emergency department among elders: patterns and predictors. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2000;7(3):249-59. PMID: 10730832
- 6. Arendts G, Fitzhardinge S, Pronk K, Hutton M, Nagree Y, Donaldson M. Derivation of a nomogram to estimate probability of revisit in at-risk older adults discharged from the emergency department. Internal and Emergency Medicine 2013;8(3):249-54. PMID: 23462889
- 7. Aslaner MA, Akkas M, Eroglu S, Aksu NM, Ozmen MM. Admissions of critically ill patients to the ED intensive care unit. The American journal of emergency medicine 2015;33(4):501-5. PMID: 25737412
- 8. Hocagil AC, Bildik F, Kilicaslan I, et al. Evaluating Unscheduled Readmission to Emergency Department in the Early Period. Balkan medical journal 2016;33(1):72-9. PMID: 26966621
- 9. Duseja R, Bardach NS, Lin GA, et al. Revisit rates and associated costs after an emergency department encounter: a multistate analysis. Annals of internal medicine 2015;162(11):750-6. PMID: 26030633
- 10. Lowthian J, Straney LD, Brand CA, et al. Unplanned early return to the emergency department by older patients: the Safe Elderly Emergency Department Discharge (SEED) project. Age and Ageing 2016;45(2):255-61. PMID: 26764254
- 11. Moons P, De Ridder K, Geyskens K, et al. Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: predictive value of four instruments. European journal of emergency medicine : official journal of the European Society for Emergency Medicine 2007;14(6):315-23. PMID: 17968196
- 12. Bicakci S, Bicakci N, Duman A, Atilla R. Characteristics of recurrent emergency department visits within 72 hours of visits for the same or related complaints. Med Science 2016;5(4):937-40. doi: 10.5455/medscience.2016.05.8473
- 13. Akyol C, Oktay C, Hakbilir O, Akyol AJ, Tür FÇ. Evaluation of revisits to an emergency department. Turk J Emerg Med 2006;6(3):108-116. [Article in Turkish]
- 14. Chan AH, Ho SF, Fook-Chong SM, Lian SW, Liu N, Ong ME. Characteristics of patients who made a return visit within 72 hours to the emergency department of a Singapore tertiary hospital. Singapore medical journal 2016;57(6):301-6. PMID: 27353286
- 15. Cheng S-Y, Wang H-T, Lee C-W, Tsai T-C, Hung C-W, Wu K-H. The characteristics and prognostic predictors of unplanned hospital admission within 72 hours after ED discharge. The American journal of emergency medicine 2013;31(10):1490-4. PMID: 24029494
- 16. Aslaner MA, Baykan N, Doğan NÖ, Ziyan M. Documentation and standardization of altered mental status. Hong Kong Journal of Emergency Medicine. 2019; 26(5):299–308. DOI: 10.1177/1024907918799237
Öz
Aim: There isn’t enough data in the literature regarding the revisits of geriatric patients to the emergency department (ED) within three days. This study was aimed to determine the characteristics of these patients and to determine the results of 90-day mortality.
Materials and Methods: This retrospective study was carried out in a secondary care emergency department of a state hospital on January 2018. The patient population was 65 years old and over. The first presentation records of revisited patients and the second revisit records within 72 hours were noted.
Results: During the study period, 1422 geriatric patients presented to the ED and 85 (6%) of them had ED revisit within 72 hours. Of all revisited patients, 54.1% were female and the median age was 74 (IQR 70-80). The rate of similar compliants for revisits was 77.6% (n=66). Although the 90-day mortality rate of patients with different diagnoses was higher than that with the same diagnoses, the difference was not statistically significant (26.3% and 13.6%, respectively). Of all revisited patients, mortality was observed in 16.5% (n=14) within 90 days.
Conclusion: Geriatric revisit rate within 72 hours was slightly higher when compared with those in the literature. Revisit rate with the similar diagnoses was quite high. Approx-imately one in six patients in the study had mortality within 90 days.
Anahtar Kelimeler
Kaynakça
- 1. Han CY, Chen LC, Barnard A, et al. Early Revisit to the Emergency Department: An Integrative Review. Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association 2015;41(4):285-95. PMID: 25618557
- 2. McCusker J, Healey E, Bellavance F, Connolly B. Predictors of Repeat Emergency Department Visits by Elders. Academic Emergency Medicine 1997;4(6):581-8. PMID: 9189191
- 3. Friedmann PD, Jin L, Karrison TG, et al. Early revisit, hospitalization, or death among older persons discharged from the ED. The American journal of emergency medicine 2001;19(2):125-9. PMID: 11239256
- 4. Gelder J, Lucke JA, Groot B, et al. Predictors and Outcomes of Revisits in Older Adults Discharged from the Emergency Department. Journal of the American Geriatrics Society 2018;66(4):735-41. PMID: 29489015
- 5. McCusker J, Cardin S, Bellavance F, Belzile E. Return to the emergency department among elders: patterns and predictors. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2000;7(3):249-59. PMID: 10730832
- 6. Arendts G, Fitzhardinge S, Pronk K, Hutton M, Nagree Y, Donaldson M. Derivation of a nomogram to estimate probability of revisit in at-risk older adults discharged from the emergency department. Internal and Emergency Medicine 2013;8(3):249-54. PMID: 23462889
- 7. Aslaner MA, Akkas M, Eroglu S, Aksu NM, Ozmen MM. Admissions of critically ill patients to the ED intensive care unit. The American journal of emergency medicine 2015;33(4):501-5. PMID: 25737412
- 8. Hocagil AC, Bildik F, Kilicaslan I, et al. Evaluating Unscheduled Readmission to Emergency Department in the Early Period. Balkan medical journal 2016;33(1):72-9. PMID: 26966621
- 9. Duseja R, Bardach NS, Lin GA, et al. Revisit rates and associated costs after an emergency department encounter: a multistate analysis. Annals of internal medicine 2015;162(11):750-6. PMID: 26030633
- 10. Lowthian J, Straney LD, Brand CA, et al. Unplanned early return to the emergency department by older patients: the Safe Elderly Emergency Department Discharge (SEED) project. Age and Ageing 2016;45(2):255-61. PMID: 26764254
- 11. Moons P, De Ridder K, Geyskens K, et al. Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: predictive value of four instruments. European journal of emergency medicine : official journal of the European Society for Emergency Medicine 2007;14(6):315-23. PMID: 17968196
- 12. Bicakci S, Bicakci N, Duman A, Atilla R. Characteristics of recurrent emergency department visits within 72 hours of visits for the same or related complaints. Med Science 2016;5(4):937-40. doi: 10.5455/medscience.2016.05.8473
- 13. Akyol C, Oktay C, Hakbilir O, Akyol AJ, Tür FÇ. Evaluation of revisits to an emergency department. Turk J Emerg Med 2006;6(3):108-116. [Article in Turkish]
- 14. Chan AH, Ho SF, Fook-Chong SM, Lian SW, Liu N, Ong ME. Characteristics of patients who made a return visit within 72 hours to the emergency department of a Singapore tertiary hospital. Singapore medical journal 2016;57(6):301-6. PMID: 27353286
- 15. Cheng S-Y, Wang H-T, Lee C-W, Tsai T-C, Hung C-W, Wu K-H. The characteristics and prognostic predictors of unplanned hospital admission within 72 hours after ED discharge. The American journal of emergency medicine 2013;31(10):1490-4. PMID: 24029494
- 16. Aslaner MA, Baykan N, Doğan NÖ, Ziyan M. Documentation and standardization of altered mental status. Hong Kong Journal of Emergency Medicine. 2019; 26(5):299–308. DOI: 10.1177/1024907918799237
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 26 Ekim 2019 |
| Gönderilme Tarihi | 10 Mayıs 2019 |
| Kabul Tarihi | 28 Haziran 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 3 Sayı: 3 |
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