Article Data

  • Views 1835
  • Dowloads 157

Rapid Reports

Open Access

Resource consumption increased for older ED patients presenting with nonspecific complaints

  • Kirsi Kemp1,*,
  • Janne Alakare1,2
  • Reija Mertanen1
  • Lasse Lehtonen3
  • Maaret Castrén1

1Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Meilahden tornisairaala, 00029 Helsinki, Finland

2Geriatric Acute Care, City of Espoo, 02070 Espoo, Finland

3Department of Public Health, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland

DOI: 10.22514/sv.2023.071 Vol.19,Issue 6,November 2023 pp.207-211

Submitted: 09 January 2023 Accepted: 24 February 2023

Published: 08 November 2023

*Corresponding Author(s): Kirsi Kemp E-mail: kirsi.kemp@hus.fi

Abstract

Nonspecific complaints (NSC) are common in older emergency department (ED) patients. They are usually defined as the lack of a specific complaint such as fever. Negative ED outcomes are higher in this patient group. It is not known whether NSC patients have a greater need for intensive care admission or if they require more ED resources than other ED patients. The primary objective here was to compare intensive care admissions and resource consumption between NSC patients and patients presenting with specific complaints (SC). This was a descriptive, retrospective study from three EDs. All ≥65-year-old patients admitted to EDs within the study period were included. There were 224 NSC patients (median age 83, 44.1% male) and 4907 SC patients (median age 78, 44.1% male). Diagnostic testing in the ED was greater for NSC patients; blood tests were taken more often (Odds ratio (OR)) 1.88 (95% confidence interval (CI) 1.43–2.45). ED length of stay was longer (median 436 for NSC vs. 302 minutes for SC patients; p < 0.001). Admissions to high-dependency or intensive care units were not higher (OR 1.15 (0.70–1.89)). Three- and 30-day mortality were higher (OR 4.65 (1.78–12.30)) and 2.15 (1.33–3.47), respectively, as were hospital admission rates (OR 2.74 (2.02–3.72)). NSC patients were less often triaged as high acuity (OR 0.11 (0.03–0.46)). In conclusion, resource consumption for older adults presenting with nonspecific complaints was higher. There was no difference in high dependency unit/intensive care unit admission rates.


Keywords

Geriatric; Emergency department; Older adults; Nonspecific complaints


Cite and Share

Kirsi Kemp,Janne Alakare,Reija Mertanen,Lasse Lehtonen,Maaret Castrén. Resource consumption increased for older ED patients presenting with nonspecific complaints. Signa Vitae. 2023. 19(6);207-211.

References

[1] Wachelder JJH, Stassen PM, Hubens LPAM, Brouns SHA, Lambooij SLE, Dieleman JP, et al. Elderly emergency patients pre-senting with non-specific complaints: characteristics and outcomes. PLOS ONE. 2017; 12: e0188954.

[2] Peters M. The older adult in the emergency department: aging and atypical illness presentation. Journal of Emergency Nursing. 2010; 36: 29–34.

[3] Djärv T, Castrén M, Mårtenson L, Kurland L. Decreased general condition in the emergency department: high in-hospital mor-tality and a broad range of discharge diagnoses. European Journal of Emergency Medicine. 2015; 22: 241–246.

[4] Nemec M, Koller MT, Nickel CH, Maile S, Winterhalder C, Karrer C, et al. Patients presenting to the emergency de-partment with non-specific complaints: the basel non-specific complaints (BANC) study. Academic Emergency Medicine. 2010; 17: 284–292.

[5] Nickel CH, Malinovska A, Bingisser R. Should weakness be subsumed to nonspecific complaints?—Correspondence in re-sponse to Bhalla et al. The American Journal of Emergency Medicine. 2015; 33: 722–723.

[6] Bingisser R, Nickel CH. How should nonspecific complaints be defined?Comment to: “nonspecific complaints (NSCs) in the emergency depart-ment”. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2020; 28: 110.

[7] Bingisser R, Simon NR, Nickel CH. Comment to: non-specific clinical presentations are not prognostic and do not anticipate hospital length of stay or resource utilization. European Journal of Internal Medicine. 2021; 91: 85–86.

[8] Kemp K, Mertanen R, Lääperi M, Niemi-Murola L, Lehtonen L, Castren M. Nonspecific complaints in the emergency depart-ment—a systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2020; 28: 6.

[9] Bhalla MC, Wilber ST, Stiffler KA, Ondrejka JE, Gerson LW. Weakness and fatigue in older ED patients in the United States. The American Journal of Emergency Medicine. 2014; 32: 1395–1398.

[10] Patzen A, Simon NR, Jauslin AS, Nickel CH, Bingisser R. Nonspecific complaints in emergency medicine: contribution of clinical chemistry and diagnostic imaging to final diagnosis. An observational study. Signa Vitae. 2021; 17: 49–54.

[11] Digital and population data services agency Finland. 2021. Available at: https://dvv.fi/en/individuals (Accessed: 01 November 2021).

[12] Gilboy N, Tanabe P, Travers DA, Rosenau AM, Eitel DR. Emergency severity index, version 4: implementation handbook. Agency for Healthcare Research and Quality. 2005; 1–72.

[13] MedCal Software Ltd. Diagnostic test evaluation calculator (version 20.014). 2021. Available at: https://www.medcalc.org/ (Accessed: 19 October 2021).

[14] IBM Corp. IBM SPSS statistics for windows, version 25.0 released 2016. 2021. Available at: https://www.ibm.com/products/spss-statistics (Accessed: 14 October 2021).

[15] Sauter TC, Capaldo G, Hoffmann M, Birrenbach T, Hautz SC, Kämmer JE, et al. Non-specific complaints at emergen-cy department presentation result in unclear diagnoses and lengthened hospitalization: a prospective observational study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2018; 26: 60.

[16] Émond M, Boucher V, Carmichael PH, Voyer P, Pelletier M, Gouin É, et al. Incidence of delirium in the Canadian emergency department and its consequences on hospital length of stay: a prospective observational multicentre cohort study. BMJ Open. 2018; 8: e018190.

[17] Han JH, Eden S, Shintani A, Morandi A, Schnelle J, Dittus RS, et al. Delirium in older emergency department patients is an independent predictor of hospital length of stay. Academic Emergency Medicine. 2011; 18: 451–457.

[18] Kennedy M, Enander RA, Tadiri SP, Wolfe RE, Shapiro NI, Marcantonio ER. Delirium risk prediction, healthcare use and mortality of elderly adults in the emergency department. Journal of the American Geriatrics Society. 2014; 62: 462–469.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.3 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top