• F Javier Montero-Pérez, Inmaculada Bajo-Fernández, Juan González-Del Castillo, Guillermo Burillo-Putze, Javier Jacob, Sira Aguiló, Pascual Piñera-Salmerón, Aitor Alquezar-Arbé, Cesáreo Fernández-Alonso, Pere Llorens, ChoJeong-Uh HongJHEmergency Department, Hospital de Mendaro, Gipuzkoa, Spain., Beatriz Casado-Ramón, Sara Gayoso-Martín, Goretti Sánchez-Sindín, María Esther Fernández-Álvarez, Patricia Gallardo-Vizcaíno, Carlos Romero-Carrete, Lluís Llauger, Verónica Vázquez-Rey, Sara Calle-Fernández, Mónica Cañete, Esther Ruescas, Fátima Fernández-Salgado, Òscar Miró, and researchers of the SIESTA network.
• Emergency Department, Hospital Universitario Reina Sofía, Córdoba, Spain.
• J Eval Clin Pract. 2024 Aug 21.

BackgroundThe selection of patients who are going to be admitted to an emergency department observation unit (EDOU) is essential for the good management of these units, intended fundamentally to avoid unnecessary hospitalization of patients. This is especially important when dealing with older patients. It would be important to know what factors are associated with discharge home and to have a clinical predictive scale that appropriately selects older patients who are going to be admitted to an EDOU.MethodsA retrospective cross-sectional study was conducted of all patients ≥65 years of age assisted in 48 Spanish Emergency Departments for 7 consecutive days and were admitted to the EDOU. Demographics-functional, vital signs data and initial laboratory results were analyzed to investigate its association with discharge home and develop and validate a prediction model for discharge home from EDOU. Multivariable logistic regression was performed to develop a prediction model, and a scoring system was created.ResultsAmong 5457 patients admitted to the EDOU from the emergency room, 2508 (46%) patients were discharged home, and 2949 (54%) were admitted to the hospital. Five variables were strongly associated with discharge home: the absence of fever (adjusted OR: 3.61, 95% CI:1.53-8.54), Glasgow Coma Scale score of 15 points (2.80, 1.63-4.82), absence of tachypnea (2.51, 1.74-3.64) or leukocytosis (2.07, 1.70-2.52) and oxygen saturation >94% (2.00, 1.64-2.43). The final model achieved an area under the receiver operating characteristic curve of 0.648 (IC95% = 0.627-0.668) in the development cohort and 0.635 (0.614-0.656) in the validation cohort.ConclusionsThere are factors associated with a greater probability of discharge home of older patients admitted to EDOUs. Prediction at the individual level remains elusive, as the best model obtained in this study did not have sufficient validity to be applied in the clinical setting.© 2024 John Wiley & Sons Ltd.

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