Functional Status Does Not Predict Complicated Clinical Course in Older Adults in the Emergency Department with Infection

Authors


Address correspondence to Jeffrey M. Caterino, Suite 4510 Cramblett Hall, 456 W. 10th Ave., Columbus, OH 43210. E-mail: jeffrey.caterino@osumc.edu

Abstract

Objectives

To identify the relationship between functional status and complicated clinical course in older adults in the emergency department (ED) with suspected infection and to identify other independent predictors of complicated clinical course.

Design

A prospective observational cohort study.

Setting

An academic, tertiary care ED with 70,000 visits per year.

Participants

Aged 65 and older, blood cultures obtained in the ED, and final ED physician diagnosis of acute infection.

Measurements

Functional status was obtained using the Older Americans Resources Scale (OARS). Complicated clinical course was defined as in-hospital mortality, need for intensive care unit (ICU)-level care, or worsening in sepsis criteria within 48 hours. Analysis was performed using multivariable logistic regression.

Results

One hundred five participants were enrolled, 34 with the primary outcome. OARS was not predictive of complicated clinical course in univariate (= .13) or multivariable (= .90) models. An OARS score of 25 or less was also not significant (= .22). Independent predictors were immunosuppression (odds ratio (OR) = 3.45, 95% confidence interval (CI) = 1.06–11.20), systolic blood pressure (OR = 0.98, 95% CI = 0.96–1.00), pulse (OR = 1.03, 95% CI = 1.00–1.06), metabolic acidosis (OR = 3.46, 95% CI = 1.08–11.09), severe sepsis or septic shock (OR = 10.24, 95% CI = 1.44–72.79), and suspected bloodstream infection (OR = 3.56, 95% CI = 1.13–11.16).

Conclusion

For older adults admitted to the ED with infection, functional status did not predict complicated clinical course, but several other variables were predictive, including immunosuppression, several variables associated with hypoperfusion, and suspected bloodstream infection. Emergency physicians could consider these variables as potential indicators of complicated clinical course when making disposition decisions for this population.

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