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not followed in our ED. Falls training is mandatory and urgent for
clinical staff in our ED. It is critical to implement specific protocols
for fall treatment and follow up.
O-024
Frailty in older patients attending an emergency department
A. Fallon
1
, A. Dyer
2
, S. Nabeel
2
, T. Coughlan
1
, R. Collins
1
, D. O’Neill
3
,
S.P. Kennelly
1
1
Tallaght Hospital, Dublin, Ireland;
2
Trinity College, Dublin, Ireland;
3
Ireland
Objectives:
Older patients represent an increasing proportion
of those accessing acute hospital services. This study aimed
to examine outcomes in frail older patients presenting to the
emergency department (ED).
Methods:
A prospective cohort study was carried out. Information
was collected on patients aged ≥70 presenting between January and
August 2014. Frailty was assessed using the SHARE Frailty index
(SHARE-FI). Illness severity (Manchester Triage Category), delirium
(CAM-ICU), admission rates, length of stay and mortality rates were
examined.
Results:
212 patients had SHARE-FI assessment completed. 45.7%
(97/212) were identified as frail and a further 22.2% (47/212) pre-
frail.
Frail patients were older than non-frail (mean age 80.2 years vs 76.7
years). A similar proportion of all groups were identified as having
a severe illness (MTC 1–3) at presentation (89.7% frail; 91.5%; pre-
frail; 88.2% non-frail). Frail patients were more likely than non-frail
to present by ambulance (42.3% vs 32.3%), remain in ED for over 6
hours (mean ED stay 11.4 vs 9.7 hours) and be admitted (69.1% vs
52.9%). 14.4% of frail patients had delirium at presentation. None
of the non-frail group were delirious. Mean length of stay was
12.4 days for frail patients and 8.4 days for non-frail. Six-month
mortality rates were higher for frail (18.5%% (18/97)) and pre-frail
patients (14.9% (7/47)) than for non-frail (5.9% (4/68)).
Conclusions:
Frail patients have higher admission rates, longer
length of stay and higher mortality than non-frail. The SHARE-FI
may be a useful assessment to identify patients at risk of decline
in ED for enhanced gerontological assessment and intervention.
O-025
Non-invasive ventilation in acute care: a story of success in
older adults?
L. Mieiro
Geneva University Hospitals, Thˆonex, Switzerland
Objectives:
Non-invasive ventilation (NIV) is increasingly used in
older adults. However, its functional outcome is poorly understood.
The authors describe NIV use in acute setting and analyse its effect
on older patients.
Methods:
Observational retrospective study of routinely collected
data, over a 15-month period, in an acute medicine department
of a University Hospital. Patients aged 65 years and older that
had received NIV were included. Statistical analysis performed in
SPSS v21.
Results:
Amongst 99 identified patients, only 34 received NIV for
an acute condition. Median age 81 (88–77) years old, 52.9% women
(p=NS), length of stay 8.5 (15–3) days, Charlson Comorbidity Index
5 (7–3), and 23.5% mortality. NIV was introduced in the context
of decompensated heart failure in 41.2% of cases, community-
acquired pneumonia in 23.5%, and healthcare-related pneumonia
in 8.8%. All patients presented with type 2 respiratory failure and
received NIV for a median period of 3 (6–1) days. Complications
and adverse events were common: 29.4% delirium, 26.5% need
of physical restraint, 17.6% sedation, 8.8% pressure ulcers, 8.8%
aspiration pneumonia. However, NIV did not affect risk of falls,
pressure ulcers, or nutritional status at discharge (p=NS). Also,
patients were more engaged in activities of daily living (p=.002).
Conclusions:
This study confirms that NIV is a valid technique
in a cohort with high comorbidity and produces good clinical
outcomes in an acute setting. NIV did not have a negative impact
on functionality. Delirium and physical restraints remain a critical
concern and should be addressed when introducing NIV in an older
patient.
O-026
Validation of the Identification Seniors at Risk Tool (ISAR)
in acutely presenting older adults; the APOP study
J. de Gelder
1
, J. Lucke
2
, B. de Groot
2
, C. Heringhaus
2
, A.J. Fogteloo
2
,
G. Blauw
3
, S. Mooijaart
3
1
LUMC, Leiden, Netherlands;
2
Leiden University Medical Centre,
Leiden, Netherlands;
3
Netherlands
Objective:
The Identification of Seniors At Risk (ISAR) tool has been
developed for older Emergency Department patients to predict
negative outcomes. However, clinical usefulness is debated by lack
of accuracy and efficiency. In the present study we externally
validated the ISAR tool.
Methods:
We initiated the prospective Acutely Presenting Older
Patient (APOP) study, in which we included all consecutive patients
aged 70 and over 24h/7d presenting to the Emergency Department
of a university teaching hospital (LUMC) in the Netherlands. ISAR
is validated on ninety day mortality and ninety day functional
decline, defined by 1 point increase in Katz ADL score and/or new
institutionalisation.
Results:
757 patients were included from September 2014 until
November 2014 with a mean age of 78.67 years. A positive ISAR
score had a HR of 3.38 (95% CI 1.82–6.29) on mortality and an OR
of 4.18 (2.83–6.18) on functional decline. Predictive performance on
mortality showed a sensitivity of 0.83, a specificity of 0.41, a positive
predicting value (PPV) of 0.13, a negative predicting value (NPV) of
0.96 and an area under receiver operating curve (AUROC) of 0.666
(95% CI 0.605–0.727) and on functional decline a sensitivity of 0.79,
a specificity of 0.48, a PPV of 0.35, NPV of 0.87 and an AUROC of
0.675 (95% CI 0.627–0.723).
Conclusion:
In our study ISAR is able to stratify patients at risk
for adverse outcomes with moderate accuracy. Positive predictive
value is low, whereas negative predictive value is high, suggesting
that ISAR best performs to identify patients NOT at risk.
O-027
Chest ultrasound for the diagnosis of acute respiratory diseases
in frail multimorbid hospitalized elderly
A. Ticinesi
1
, A. Nouvenne
1
, M.D. Zani
2
, G. Folesani
3
, L. Guida
1
,
I. Morelli
1
, B. Prati
1
, F. Lauretani
4
, M. Maggio
5
, T. Meschi
1
1
Department of Clinical and Experimental Medicine, University of
Parma, Parma, Italy;
2
Department of Clinical and Experimental
Medicine, University of Parma, Italy, Italy;
3
Italian Workers’
Compensation Authority (INAIL) Research Center at University of
Parma, Parma, Italy;
4
Geriatrics Unit, Parma University Hospital,
Parma, Italy;
5
Italy
Objectives:
To compare the diagnostic accuracy of bedside chest
ultrasound vs chest X-ray in a cohort of frail multimorbid elderly
acutely hospitalized with respiratory symptoms.
Methods:
97 frail (Rockwood score≥4) multimorbid (≥3 chronic
comorbidities) elderly (age≥65, median 84, IQR 78–89) admitted
to an acute-care geriatric ward with sudden-onset respiratory
complaints (cough, dyspnea, hemoptysis, pleuritic pain) were
consecutively evaluated with a standard chest X-ray, carried out
in a radiology unit, and a bedside chest ultrasound, performed by
clinicians of the admitting ward. Chest contrast-enhanced CT was
performed only if other tests’ results were inconclusive. Ultrasound
and X-ray results were blindly categorized as positive or negative by
an expert clinician. Diagnostic accuracy, sensitivity and sensibility