title: Impact of older age and nursing home residence on clinical outcomes of US emergency department visits for severe sepsis.
abstract: OBJECTIVE
  The purpose of this study is to compare the impact of older age and nursing home residence on the incidence and morbidity of severe sepsis.
  
  
  METHODS
  This was a retrospective analysis of 19460 emergency department visits from the 2005 to 2009 National Ambulatory Medical Care Surveys with diagnosis of infection with or without severe sepsis (acute organ dysfunction). Clinical outcomes included intensive care unit (ICU) admission, hospital length of stay (LOS), and in-hospital mortality.
  
  
  RESULTS
  Older adults (age≥65 years) were 5-fold more likely to have infections classified as severe sepsis than younger adults (6.5% vs 1.3%), and nursing home residents were 7-fold more likely to have a severe sepsis diagnosis compared with nonnursing home residents (14% vs 1.9%). Among visits for severe sepsis, older adults, compared with younger adults, had modestly higher rates of ICU admission (27% vs 21%), hospital LOS (median, 6 vs 5 days), and in-hospital mortality (24% vs 16%). Nursing home residents with severe sepsis, compared with nonnursing home residents, had significantly higher rates of ICU admission (40% vs 21%), hospital LOS (median, 7 vs 5 days), and in-hospital mortality (37% vs 15%).
  
  
  CONCLUSIONS
  Older adults and particularly nursing home residents have a disproportionately high incidence of and morbidity from severe sepsis.
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA. Electronic address: adit.ginde@ucdenver.edu.
authors.forename: Adit A
authors.initials: AA
authors.lastname: Ginde
authors.forename: Marc
authors.initials: M
authors.lastname: Moss
authors.forename: Nathan I
authors.initials: NI
authors.lastname: Shapiro
authors.forename: Robert S
authors.initials: RS
authors.lastname: Schwartz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000628:therapy*; D014481:United States
keywords: Critical care; Emergency medicine; Epidemiology; Geriatrics; Infection; Nursing home; Organ failure; Sepsis