When to Admit to Observation: Predicting Length of Stay for Anticoagulated Elderly Fall Victims.
Accidental Falls
Aged
Aged, 80 and over
Anticoagulants
/ adverse effects
Blood Coagulation
/ drug effects
Clinical Decision-Making
Female
Head
/ diagnostic imaging
Head Injuries, Closed
/ diagnosis
Humans
Intracranial Hemorrhages
/ diagnosis
Length of Stay
/ economics
Male
Patient Admission
/ economics
Patient Selection
Retrospective Studies
Time Factors
Tomography, X-Ray Computed
Trauma Centers
/ statistics & numerical data
Financial toxicity
Geriatric
Head injury
Trauma
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
23
04
2019
revised:
28
10
2019
accepted:
19
01
2020
pubmed:
18
2
2020
medline:
22
8
2020
entrez:
18
2
2020
Statut:
ppublish
Résumé
Geriatric patients who fall while taking an anticoagulant have a small but significant risk of delayed intracranial hemorrhage requiring observation for 24 h. However, the medical complexity associated with geriatric care may necessitate a longer stay in the hospital. Little is known about the factors associated with a successful observational status stay (<2 d) for this population. Elderly patients who fell while taking an anticoagulant admitted from 2012 to 2017 at an ACS level II trauma center were included in a retrospective cohort study to determine what factors were associated with a stay consistent with observational status. age> 65 y old, negative initial head CT, and one of the following: INR>3.5 if on warfarin, GCS<14, external signs of trauma, or focal neurological deficits. The cohort included 369 patients. Factors associated with decreased likelihood of successful observational status included the need for services after discharge such as an extended care facility (OR 0.06, 95% CI 0.02-0.19, P < 0.001) or visiting nurse agency services (OR 0.27, 95% CI 0.10-0.75, P < 0.001), a dementia diagnosis (OR 0.17, 95% CI 0.04-0.70, P = 0.014), increasing number of medications (OR 0.91, 95% CI 0.84-0.99, P = 0.031), and the use of coumadin (OR 0.28, 95% CI 0.12-0.70, P = 0.006). For trauma providers, knowing your patient's medication use and particularly type of anticoagulant, comorbidities including dementia, and likely need for services after discharge will help guide the decision to admit the patient for what may be a reasonably lengthy stay versus a brief observation in the hospital for elderly fall victims on anticoagulation.
Sections du résumé
BACKGROUND
Geriatric patients who fall while taking an anticoagulant have a small but significant risk of delayed intracranial hemorrhage requiring observation for 24 h. However, the medical complexity associated with geriatric care may necessitate a longer stay in the hospital. Little is known about the factors associated with a successful observational status stay (<2 d) for this population.
MATERIALS AND METHODS
Elderly patients who fell while taking an anticoagulant admitted from 2012 to 2017 at an ACS level II trauma center were included in a retrospective cohort study to determine what factors were associated with a stay consistent with observational status.
INCLUSION CRITERIA
age> 65 y old, negative initial head CT, and one of the following: INR>3.5 if on warfarin, GCS<14, external signs of trauma, or focal neurological deficits.
RESULTS
The cohort included 369 patients. Factors associated with decreased likelihood of successful observational status included the need for services after discharge such as an extended care facility (OR 0.06, 95% CI 0.02-0.19, P < 0.001) or visiting nurse agency services (OR 0.27, 95% CI 0.10-0.75, P < 0.001), a dementia diagnosis (OR 0.17, 95% CI 0.04-0.70, P = 0.014), increasing number of medications (OR 0.91, 95% CI 0.84-0.99, P = 0.031), and the use of coumadin (OR 0.28, 95% CI 0.12-0.70, P = 0.006).
CONCLUSIONS
For trauma providers, knowing your patient's medication use and particularly type of anticoagulant, comorbidities including dementia, and likely need for services after discharge will help guide the decision to admit the patient for what may be a reasonably lengthy stay versus a brief observation in the hospital for elderly fall victims on anticoagulation.
Identifiants
pubmed: 32065966
pii: S0022-4804(20)30052-4
doi: 10.1016/j.jss.2020.01.006
pii:
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
156-160Subventions
Organisme : NCATS NIH HHS
ID : TL1 TR001864
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.