title: Prediction of 90-day mortality in older patients after discharge from an emergency department: a retrospective follow-up study.
abstract: Older people frequently attend the emergency department (ED) and have a high risk of poor outcome as compared to their younger counterparts. Our aim was to study routinely collected clinical parameters as predictors of 90-day mortality in older patients attending our ED.
  
  
  
  We conducted a retrospective follow-up study at the Leiden University Medical Center (The Netherlands) among patients aged 70 years or older attending the ED in 2012. Predictors were age, gender, time and way of arrival, presenting complaint, consulting medical specialty, vital signs, pain score and laboratory testing. Cox regression analyses were performed to analyse the association between these predictors and 90-day mortality.
  
  
  
  Three thousand two hundred one unique patients were eligible for inclusion. Ninety-day mortality was 10.5 % for the total group. Independent predictors of mortality were age (hazard ratio [HR] 1.06, 95 % confidence interval [95 % CI] 1.04-1.08), referral from another hospital (HR 2.74, 95 % CI 1.22-6.11), allocation to a non-surgical specialty (HR: 1.55, 95 % CI 1.13-2.14), increased respiration rate (HR up to 2.21, 95 % CI 1.25-3.92), low oxygen saturation (HR up to 1.96, 95 % CI 1.19-3.23), hypothermia (HR 2.27, 95 % CI 1.28-4.01), fever (HR 0.43, 95 % CI 0.24-0.75), high pain score (HR 1.55, 95 % CI 1.03-2.32) and the indication to perform laboratory testing (HR 3.44, 95 % CI 2.13-5.56).
  
  
  
  Routinely collected parameters at the ED can predict 90-day mortality in older patients presenting to the ED. This study forms the first step towards creating a new and simple screening tool to predict and improve health outcome in acutely presenting older patients.
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands.
authors.forename: Susanna E
authors.initials: SE
authors.lastname: Hofman
authors.affiliation: Department of Emergency Medicine, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands. j.a.lucke@lumc.nl.
authors.forename: Jacinta A
authors.initials: JA
authors.lastname: Lucke
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands.
authors.forename: Noor
authors.initials: N
authors.lastname: Heim
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands.
authors.forename: Jelle
authors.initials: J
authors.lastname: de Gelder
authors.affiliation: Department of Internal Medicine, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands.
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Fogteloo
authors.affiliation: Department of Emergency Medicine, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands.
authors.forename: Christian
authors.initials: C
authors.lastname: Heringhaus
authors.affiliation: Department of Emergency Medicine, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: de Groot
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands.
authors.forename: Anton J M
authors.initials: AJ
authors.lastname: de Craen
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands.
authors.forename: Gerard Jan
authors.initials: GJ
authors.lastname: Blauw
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands.|Institute for Evidence-based Medicine in Old Age|IEMO, PO Box 9600, Leiden, 2300 RC, The Netherlands.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Mooijaart
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D009026:Mortality; D009426:Netherlands; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: Emergency medicine; Geriatrics; Mortality; Risk factors