In-hospital mortality and its predictors among critically ill geriatric patients presenting to emergency medicine department of a tertiary hospital

Abstract

ABSTRACT Background: Geriatric patients represent a growing proportion of the presentations to the Emergency Medicine Department (EMD). Given the frequently complex nature of their underlying medical illnesses, this population presents particular challenges to clinicians. The predictors of 48-hour in-hospital mortality for those attending EMD must be considered for early identification and prompt and effective resuscitation to improve outcomes. Objective: The objective of this study was to determine the 48-hour in-hospital mortality and its predictors among geriatric medical patients presenting to EMD of MNH Upanga and Mloganzila campus. Methodology: This was a prospective open cohort observational study involving medical geriatric individuals 60 years and older triaged to resuscitation rooms, consented, recruited consecutively between October and December 2023. The study's ethical clearance was given by MUHAS IRB and MNH. The primary outcome was in-hospital mortality at 48 hours with EMD mortality and EMD Length of Stay (LOS) as the secondary outcome. Univariate regression analysis was performed and those variables with p value <0.05 were subjected to multivariate analysis to identify independent predictors of mortality. Results: During the study period 13,957 patients presented to EMD, of whom 2,476 (17.7%) were geriatric individuals. Among the geriatric individuals, 436(17.6%) were triaged to the resuscitation room as emergency cases, whereas 293(67.2%) met the inclusion criteria for this study. The median age of study participants was 70 years IQR (65,76) more than half being males 174(59.4%). In-hospital Mortality at 48hours was 27(9.2%) with 6(2%) deaths occurring at EMD. Median EMD LOS was found to be 4 hours (238.5minutes). Independent predictors of mortality were found to be altered mental status (OR=2.96, 95% CI 1.24-7.06, P Value<0.014), difficulty in breathing (OR=2.41, 95% CI 1.08-5.37, P Value<0.031), Low SPO2 (OR=2.38, 95% CI 1.01-5.63, P Value<0.048) and electrolyte imbalance (OR=2.83,1.12-714, P Value<0.028). Conclusion: The mortality rate in geriatric medical patients who presented to the EMD resuscitation room as emergency cases is high with altered mental status, breathing vi difficulties, low oxygen saturation, and electrolyte imbalances being independent predictors of mortality.