• João Carlos Pereira Gomes, DiasRoger DagliusRDDepartment of Emergency Medicine, Harvard Medical School, Boston, MA, USA.STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA., Jacson Venancio de Barros, Irineu Tadeu Velasco, and Jacob FilhoWilsonWFaculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.Division of Geriatrics, Department of Internal Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil..
• Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr. Enéas Carvalho de Aguiar, 255, 5° andar, s.5023, São Paulo, SP, CEP: 05403-010, Brazil. joao.cpgomes@hc.fm.usp.br.
• BMC Emerg Med. 2020 Jun 11; 20 (1): 47.

BackgroundThe average age of the global population is rising at an increasing rate. There is a disproportional increase in Emergency Department (ED) visits by older people worldwide. In the Brazilian health system, complex and severely ill patients and those requiring specialized urgent procedures are referred to tertiary level care. As far as we know, no other study in Latin America has analyzed the impact of demographic changes in tertiary ED attendance.AimTo describe the sociodemographic characteristics and outcomes of tertiary Brazilian ED users.MethodsDesign: Observational cross-sectional analytic study.SettingEmergency Department, tertiary university hospital, São Paulo, Brazil.Participantspatients aged 18 years or older attending a tertiary ED (2009-2013). The primary outcomes were hospitalization and mortality; the secondary outcome was ICU admission. Age was categorized as 'young adults' (18-39y), 'adults' (40-59y), 'young-older adults' (60-79y), and 'old-older adults' (80-109y). Other variables included sex, reason for attendance, time of ED visit, mode of presentation, type of hospitalization, main procedure, length of hospital stay (LOS) and length of ICU stay (ICU-LOS). We calculated descriptive statistics, built generalized linear mixed models for each outcome and estimated Odds Ratios (95% CI) for the independent categorical variables. The significance level was 5% with Bonferroni correction.ResultsOlder age-groups represented 26.6% of 333,028 ED visits, 40.7% of admissions, 42.7% of ICU admissions and 58% of all deaths. Old-older patients accounted for 5.1% of ED visits, 9.5% of admissions and 10.1% of ICU admissions. Hospitalization, ICU admission and mortality rates increased with older age in both sexes. LOS and ICU-LOS were similar across age-groups. The proportions of visits and admissions attributed to young adults decreased annually, while those of people aged 60 or over increased. The ORs for hospitalization, ICU admission and mortality associated with the old-older group were 3.49 (95% CI = 3.15-3.87), 1.27 (1.15-1.39) and 5.93 (5.29-6.66) respectively, with young adults as the reference.ConclusionsIn tertiary ED, age is an important risk factor for hospitalization and mortality, but not for ICU admission. Old-older people are at the greatest risk and demand further subgroup stratification.

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