Resource consumption increased for older ED patients presenting with nonspecific complaints

Abstract

Nonspecific complaints (NSC) are common in older emergency department (ED) patients. They are usually defined as the lack of a specific complaint such as fever. Negative ED outcomes are higher in this patient group. It is not known whether NSC patients have a greater need for intensive care admission or if they require more ED resources than other ED patients. The primary objective here was to compare intensive care admissions and resource consumption between NSC patients and patients presenting with specific complaints (SC). This was a descriptive, retrospective study from three EDs. All ≥65-year-old patients admitted to EDs within the study period were included. There were 224 NSC patients (median age 83, 44.1% male) and 4907 SC patients (median age 78, 44.1% male). Diagnostic testing in the ED was greater for NSC patients; blood tests were taken more often (Odds ratio (OR)) 1.88 (95% confidence interval (CI) 1.43–2.45). ED length of stay was longer (median 436 for NSC vs. 302 minutes for SC patients; p < 0.001). Admissions to high-dependency or intensive care units were not higher (OR 1.15 (0.70–1.89)). Three- and 30-day mortality were higher (OR 4.65 (1.78–12.30)) and 2.15 (1.33–3.47), respectively, as were hospital admission rates (OR 2.74 (2.02–3.72)). NSC patients were less often triaged as high acuity (OR 0.11 (0.03–0.46)). In conclusion, resource consumption for older adults presenting with nonspecific complaints was higher. There was no difference in high dependency unit/intensive care unit admission rates.