Final Diagnosis, Diagnostic Procedures, and Disease Course in Elderly Patients with General Weakness Referring to the Emergency Department; a Cross-sectional Descriptive Study
Iranian Journal of Emergency Medicine,
Vol. 9 No. 1 (2022),
16 March 2022
,
Page e33
https://doi.org/10.22037/ijem.v9i1.39746
Abstract
Introduction: General weakness and fatigue are among the most common complaints in neurological, psychological, and medical diseases. which can have various causes, some of which are life-threatening. Therefore, the present study was conducted with the aim of evaluating the final diagnosis, diagnostic measures, and disease course in elderly patients with general weakness.
Methods: This cross-sectional descriptive study was conducted from October 2015 to October 2016 in the emergency department of Imam Reza Hospital, Mashhad, Iran. All elderly patients over 60 years of age who referred to the emergency department of Imam Reza Hospital with general weakness and did not have a specific diagnosis were included in the study. Demographic information, underlying diseases, medications, and the diagnostic and therapeutic measures taken for them from the moment of arrival until the time of discharge or death were recorded in the checklist prepared for this purpose. Data analysis was done using SPSS software version 11.5 and descriptive (number, percentage, mean and standard deviation) and inferential (Mann-Whitney, chi-square, t-test) statistical tests.
Results: The average age of the participants in the study was 79.84 ± 8.6 years. The mean hemoglobin and white blood cell count (WBC) of the patients in the emergency room were higher than in the ward. Also, the platelets and international normalized ratio (INR) of people in the emergency department were higher. The median of onset of weakness in people was 7 (4-10) days. The duration of hospitalization of patients in the emergency room was 34.68 ± 21.7 hours and the duration of hospitalization in the ward was 6.06 ± 2.9 days. Also, the duration of hospitalization in ICU was 10.29 ± 5.2 days. Urinary tract infection (UTI) and electrolyte disorders were the most common diagnoses.
Conclusion: Based on the results of the present study, the highest mortality rate belonged to the ICU, ward, and emergency room, respectively. In addition, the highest discharge rates were observed in the emergency room, ward and ICU, respectively. Therefore, it seems that in the mentioned departments, it is very important to pay more attention to the patients in order to prevent further complications and the imposition of additional costs on the patients and the treatment system.
- Aged
- Aged, 80 and over
- Patients
- Frailty
- Fatigue
How to Cite
References
DeLuca J, Barrett A. Weakness and fatigue. Imaging Acute Neurologic Disease: A Symptom-Based Approach. 2014:347.
Skiendzielewski JJ, Martyak G. The weak and dizzy patient. Annals of emergency medicine. 1980;9(7):353-6.
Vanpee D, Swine C, Vandenbossche P, Gillet JB. Epidemiological profile of geriatric patients admitted to the emergency department of a university hospital localized in a rural area. European Journal of Emergency Medicine. 2001;8(4):301-4.
Nemec M, Koller MT, Nickel CH, Maile S, Winterhalder C, Karrer C, et al. Patients Presenting to the Emergency Department With Non‐specific Complaints: The Basel Non‐specific Complaints (BANC) Study. Academic emergency medicine. 2010;17(3):284-92.
Ruger JP, Lewis LM, Richter CJ. Identifying high-risk patients for triage and resource allocation in the ED. The American journal of emergency medicine. 2007;25(7):794-8.
Kongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Annals of Pharmacotherapy. 2008;42(7-8):1017-25.
Rutschmann OT, Chevalley T, Zumwald C, Luthy CS, Vermeulen B, Sarasin F. Pitfalls in the emergency department triage of frail elderly patients without specific complaints. Swiss medical weekly. 2005;135(9-10):145-50.
van Bokhoven MA, Koch H, van der Weijden T, Dinant G-J. Special methodological challenges when studying the diagnosis of unexplained complaints in primary care. Journal of clinical epidemiology. 2008;61(4):318.
Pinto A, Tuttolomondo A, Di Raimondo D, Fernandez P, Licata G, editors. Cerebrovascular risk factors and clinical classification of strokes. Seminars in vascular medicine; 2004: Copyright© 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.
Wilber S, Gerson L. Emergency department care. Hazzard’s geriatric medicine and gerontology, 6th edition New York: McGraw-Hill. 2009.
Bhalla MC, Wilber ST, Stiffler KA, Ondrejka JE, Gerson LW. Weakness and fatigue in older ED patients in the United States. The American journal of emergency medicine. 2014;32(11):1395-8.
Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. Journal of the American Medical Directors Association. 2011;12(4):249-56.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2001;56(3):M146-M57.
Quinlan N, Marcantonio ER, Inouye SK, Gill TM, Kamholz B, Rudolph JL. Vulnerability: the crossroads of frailty and delirium. Journal of the American Geriatrics Society. 2011;59(s2).
Stineman MG, Xie D, Pan Q, Kurichi JE, Zhang Z, Saliba D, et al. All‐Cause 1‐, 5‐, and 10‐Year Mortality in Elderly People According to Activities of Daily Living Stage. J Am Geriatr Soc. 2012 Mar;60(3):485-92.
Nickel CH, Nemec M, Bingisser R. Weakness as presenting symptom in the emergency department. Swiss medical weekly. 2009;139(17-18):271-2.
Chester JG, Rudolph JL. Vital signs in older patients: age-related changes. J Am Med Dir Assoc. 2011 Jun;12(5):337-43.
Gavazzi G, Krause K-H. Ageing and infection. The Lancet infectious diseases. 2002;2(11):659-66.
Norman DC. Fever in the elderly. Clinical Infectious Diseases. 2000;31(1):148-51.
Chew WM, Birnbaumer DM. Evaluation of the elderly patient with weakness: an evidence based approach. Emergency medicine clinics of North America. 1999;17(1):265-78.
Anderson RS, Hallen SA. Generalized weakness in the geriatric emergency department patient: an approach to initial management. Clinics in geriatric medicine. 2013;29(1):91-100.
Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, et al. Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clinical Infectious Diseases. 2010;50(5):625-63.
Glickman SW, Shofer FS, Wu MC, Scholer MJ, Ndubuizu A, Peterson ED, et al. Development and validation of a prioritization rule for obtaining an immediate 12-lead electrocardiogram in the emergency department to identify ST-elevation myocardial infarction. American heart journal. 2012;163(3):372-82.
Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. Journal of the American Geriatrics Society. 2007;55(5):780-91.
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