Abstract
Background
Emergency Department (ED) Observation Units (Obs Units) are prevalent in the US, but
little is known regarding older adults in observation. Our objective was to describe
the Obs Units nationally and observation patients with specific attention to differences
in care with increasing age.
Design
This is an analysis of 2010–2013 data from the National Hospital Ambulatory Medical
Care Survey (NHAMCS), a national observational cohort study including ED patients.
Weighted means are presented for continuous data and weighted percent for categorical
data. Multivariable logistic regression was used to identify variables associated
with placement in and admission from observation.
Results
The number of adult ED visits varied from 100 million to 107 million per year and
2.3% of patients were placed in observation. Adults ≥65 years old made up a disproportionate
number of Obs Unit patients, 30.6%, compared to only 19.7% of total ED visits (odds
ratio 1.5 (95% CI 1.5–1.6), adjusting for sex, race, month, day of week, payer source,
and hospital region). The overall admission rate from observation was 35.6%, ranging
from 31.3% for ages 18–64 years to 47.5% for adults ≥85 years old (p < 0.001). General
symptoms (e.g., nausea, dizziness) and hypertensive disease were the most common diagnoses
overall. Older adults varied from younger adults in that they were frequently observed
for diseases of the urinary system (ICD-9 590-599) and metabolic disorders (ICD-9
270-279).
Conclusions
Older adults are more likely to be cared for in Obs Units. Older adults are treated
for different medical conditions than younger adults.
Abbreviations:
ED (Emergency Department), Obs Units (Observation Units), NHAMCS (National Hospital Ambulatory Medical Care Survey), TIA (Transient Ischemic Attack)Keywords
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Article Info
Publication History
Published online: December 13, 2018
Accepted:
December 6,
2018
Received in revised form:
December 3,
2018
Received:
October 22,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
