Impact of First Wave of COVID-19 Pandemic on Mortality at Emergency Department in Older Patients with COVID and Non-COVID Diagnoses.

IF 3.1 3区医学 Q3 GERIATRICS & GERONTOLOGY Gerontology Pub Date : 2024-01-01 Epub Date: 2023-12-29 DOI:10.1159/000535913

Cesáreo Fernández Alonso, Manuel Fuentes Ferrer, Pere Llorens, Guillermo Burillo, Aitor Alquézar-Arbé, Javier Jacob, F Javier Montero-Pérez, Sira Aguiló, Vanesa Abad Cuñado, Lilia Amer Al Arud, Carmen Escudero Sánchez, Eduard Anton Poch Ferret, Jeong-Uh Hong Cho, María Teresa Escolar Martínez-Berganza, Sara Gayoso Martín, Goretti Sánchez Sindín, Azucena Prieto Zapico, María Carmen Petrus Rivas, Adriana Laura Doi Grande, Lluís Llauger, Celia Rodríguez Valles, Laura Marquez Quero, Ricardo Juárez González, Esther Ruescas, Fátima Fernández Salgado, Rafaela Ríos Gallardo, María Ángeles de Juan Gómez, Marta Masid Barco, Juan González Del Castillo, Òscar Miró

{"title":"Impact of First Wave of COVID-19 Pandemic on Mortality at Emergency Department in Older Patients with COVID and Non-COVID Diagnoses.","authors":"Cesáreo Fernández Alonso, Manuel Fuentes Ferrer, Pere Llorens, Guillermo Burillo, Aitor Alquézar-Arbé, Javier Jacob, F Javier Montero-Pérez, Sira Aguiló, Vanesa Abad Cuñado, Lilia Amer Al Arud, Carmen Escudero Sánchez, Eduard Anton Poch Ferret, Jeong-Uh Hong Cho, María Teresa Escolar Martínez-Berganza, Sara Gayoso Martín, Goretti Sánchez Sindín, Azucena Prieto Zapico, María Carmen Petrus Rivas, Adriana Laura Doi Grande, Lluís Llauger, Celia Rodríguez Valles, Laura Marquez Quero, Ricardo Juárez González, Esther Ruescas, Fátima Fernández Salgado, Rafaela Ríos Gallardo, María Ángeles de Juan Gómez, Marta Masid Barco, Juan González Del Castillo, Òscar Miró","doi":"10.1159/000535913","DOIUrl":null,"url":null,"abstract":"Introduction: Mortality in emergency departments (EDs) is not well known. This study aimed to assess the impact of the first-wave pandemic on deaths accounted in the ED of older patients with COVID and non-COVID diseases.Methods: We used data from the Emergency Department and Elderly Needs (EDEN) cohort (pre-COVID period) and from the EDEN-COVID cohort (COVID period) that included all patients ≥65 years seen in 52 Spanish EDs from April 1 to 7, 2019, and March 30 to April 5, 2020, respectively. We recorded patient characteristics and final destination at ED. We compared older patients in the pre-COVID period, with older patients with non-COVID and with COVID-19. ED-mortality (before discharge or hospitalization) is the prior outcome and is expressed as an adjusted odds ratio (aOR) with 95% interval confidence.Results: We included 23,338 older patients from the pre-COVID period (aged 78.3 [8.1] years), 6,715 patients with non-COVID conditions (aged 78.9 [8.2] years) and 3,055 with COVID (aged 78.3 [8.3] years) from the COVID period. Compared to the older patients, pre-COVID period, patients with non-COVID and with COVID-19 were more often male, referred by a doctor and by ambulance, with more comorbidity and disability, dementia, nursing home, and more risk according to qSOFA, respectively (p < 0.001). Compared to the pre-COVID period, patients with non-COVID and with COVID-19 were more often to be hospitalized from ED (24.8% vs. 44.3% vs. 79.1%) and were more often to die in ED (0.6% vs. 1.2% vs. 2.2%), respectively (p < 0.001). Compared to the pre-COVID period, aOR for age, sex, comorbidity and disability, ED mortality in elderly patients cared in ED during the COVID period was 2.31 (95% confidence interval [CI]: 1.76-3.06), and 3.75 (95% CI: 2.77-5.07) for patients with COVID. By adding the variable qSOFA to the model, such OR were 1.59 (95% CI: 1.11-2.30) and 2.16 (95% CI: 1.47-3.17), respectively.Conclusions: During the early first pandemic wave of COVID-19, more complex and life-threatening older with COVID and non-COVID diseases were seen compared to the pre-COVID period. In addition, the need for hospitalization and the ED mortality doubled in non-COVID and tripled in COVID diagnosis. This increase in ED mortality is not only explained by the complexity or severity of the elderly patients but also because of the system's overload.","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":" ","pages":"379-389"},"PeriodicalIF":3.1000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Gerontology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000535913","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/12/29 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: Mortality in emergency departments (EDs) is not well known. This study aimed to assess the impact of the first-wave pandemic on deaths accounted in the ED of older patients with COVID and non-COVID diseases.

Methods: We used data from the Emergency Department and Elderly Needs (EDEN) cohort (pre-COVID period) and from the EDEN-COVID cohort (COVID period) that included all patients ≥65 years seen in 52 Spanish EDs from April 1 to 7, 2019, and March 30 to April 5, 2020, respectively. We recorded patient characteristics and final destination at ED. We compared older patients in the pre-COVID period, with older patients with non-COVID and with COVID-19. ED-mortality (before discharge or hospitalization) is the prior outcome and is expressed as an adjusted odds ratio (aOR) with 95% interval confidence.

Results: We included 23,338 older patients from the pre-COVID period (aged 78.3 [8.1] years), 6,715 patients with non-COVID conditions (aged 78.9 [8.2] years) and 3,055 with COVID (aged 78.3 [8.3] years) from the COVID period. Compared to the older patients, pre-COVID period, patients with non-COVID and with COVID-19 were more often male, referred by a doctor and by ambulance, with more comorbidity and disability, dementia, nursing home, and more risk according to qSOFA, respectively (p < 0.001). Compared to the pre-COVID period, patients with non-COVID and with COVID-19 were more often to be hospitalized from ED (24.8% vs. 44.3% vs. 79.1%) and were more often to die in ED (0.6% vs. 1.2% vs. 2.2%), respectively (p < 0.001). Compared to the pre-COVID period, aOR for age, sex, comorbidity and disability, ED mortality in elderly patients cared in ED during the COVID period was 2.31 (95% confidence interval [CI]: 1.76-3.06), and 3.75 (95% CI: 2.77-5.07) for patients with COVID. By adding the variable qSOFA to the model, such OR were 1.59 (95% CI: 1.11-2.30) and 2.16 (95% CI: 1.47-3.17), respectively.

Conclusions: During the early first pandemic wave of COVID-19, more complex and life-threatening older with COVID and non-COVID diseases were seen compared to the pre-COVID period. In addition, the need for hospitalization and the ED mortality doubled in non-COVID and tripled in COVID diagnosis. This increase in ED mortality is not only explained by the complexity or severity of the elderly patients but also because of the system's overload.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

第一波 COVID-19 大流行对急诊科患有合并症和非合并症的老年患者死亡率的影响。

引言人们对急诊科（ED）的死亡率知之甚少。本研究旨在评估第一波流感大流行对急诊室中患有 COVID 和非 COVID 疾病的老年患者死亡人数的影响：我们使用的数据来自 EDEN（急诊科和老年人需求）队列（COVID 前）和 EDEN-Covid 队列（COVID 期间），分别包括 2019 年 4 月 1 日至 7 日和 2020 年 3 月 30 日至 4 月 5 日在西班牙 52 家急诊科就诊的所有年龄≥65 岁的患者。我们记录了患者的特征和在急诊室的最终去向。我们对 COVID 前的老年患者、非 COVID 老年患者和 COVID-19 老年患者进行了比较。ED-死亡率（出院或住院前）是先验结果，用调整后的比值比（aOR）和 95% 置信区间（IC）表示：我们纳入了 COVID 前的 23338 名老年患者（年龄为 78.3 (8.1) 岁）、6715 名非合并症患者（年龄为 78.9 (8.2) 岁）和 3055 名合并症患者（年龄为 78.3 (8.3) 岁）。与COVID前的老年患者相比，非COVID患者和COVID-19患者更多是男性，由医生和救护车转诊，有更多的合并症和残疾、痴呆症、住养老院，根据qSOFA（p结论：在 COVID-19 第一次大流行的早期，与病毒感染前相比，COVID 和非病毒感染疾病导致的复杂和危及生命的老年患者更多。此外，非病毒性疾病的住院需求和急诊室死亡率增加了一倍，而 COVID 诊断的住院需求和急诊室死亡率增加了两倍。急诊室死亡率的增加不仅是因为老年患者病情复杂或严重，还因为系统超负荷运转。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Gerontology 医学-老年医学

CiteScore

6.00

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： In view of the ever-increasing fraction of elderly people, understanding the mechanisms of aging and age-related diseases has become a matter of urgent necessity. ''Gerontology'', the oldest journal in the field, responds to this need by drawing topical contributions from multiple disciplines to support the fundamental goals of extending active life and enhancing its quality. The range of papers is classified into four sections. In the Clinical Section, the aetiology, pathogenesis, prevention and treatment of agerelated diseases are discussed from a gerontological rather than a geriatric viewpoint. The Experimental Section contains up-to-date contributions from basic gerontological research. Papers dealing with behavioural development and related topics are placed in the Behavioural Science Section. Basic aspects of regeneration in different experimental biological systems as well as in the context of medical applications are dealt with in a special section that also contains information on technological advances for the elderly. Providing a primary source of high-quality papers covering all aspects of aging in humans and animals, ''Gerontology'' serves as an ideal information tool for all readers interested in the topic of aging from a broad perspective.