Study EDEN-12: Analysis of access to intensive care units of patients older than 65 years requiring emergency hospitalization.

ABSTRACT

OBJECTIVE: To investigate the relationship between the age of an urgently hospitalized patient and his or her probability of admission to an intensive care unit (ICU). DESIGN: Observational, retrospective, multicenter study. SETTING: 42 Emergency Departments from Spain. TIME-PERIOD April 1-7, 2019. PATIENTS Patients aged ≥65 years hospitalized from Spanish emergency departments. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST ICU admission, age sex, comorbidity, functional dependence and cognitive impairment. RESULTS: 6120 patients were analyzed (median age 76 years; males 52%. 309 (5%) were admitted to ICU (186 from ED, 123 from hospitalization). Patients admitted to the ICU were younger, male, and with less comorbidity, dependence and cognitive impairment, but there were no differences between those admitted from the ED and from hospitalization. The OR for ICU-admission adjusted by sex, comorbidity, dependence and dementia reached statistical significance >83 years (OR 0.67; 95%CI 0.45-0.49). In patients admitted to the ICU from ED, the OR did not begin to decrease until 79 years, and was significant >85 years (OR 0.56, 95%CI 0.34-0.92); while in those admitted to ICU from hospitalization, the decrease began 65 years of age, and were significant from 85 years (OR 0.55, 95%CI 0.30-0.99). Sex, comorbidity, dependency and cognitive deterioration of the patient did not modify the association between age and ICU-admission (overall, from the ED or hospitalization). CONCLUSIONS: After taking into account other factors that influence admission to the ICU (comorbidity, dependence, dementia), the chances of admission to the ICU of older patients hospitalized on an emergency basis begin to decrease significantly after 83 years of age. There may be differences in the probability of admission to the ICU from the ED or from hospitalization according to age.