In-Hospital Mortality and Its Predictors Among Critically Ill Geriatric Patients Presenting to Emergency Medicine Department of a Tertiary Hospital

Abstract

Introduction: In resource-limited settings, critically ill geriatric patients present to the Emergency Medicine Departments (EMD) with a wide range of undifferentiated clinical presentations. These presentations could aid in predicting their health outcomes.

Main purpose: This study determined the 48-hour in-hospital mortality and its predictors among critically ill geriatric patients who presented to an urban EMDs of tertiary hospitals in Tanzania.

Materials and Methods: A single centre prospective observational open cohort study of medical geriatric patients, 60 years and older, triaged to resuscitation rooms between October and December 2023, who consented. We documented their sociodemographic and clinical characteristics. The primary outcome was in-hospital mortality at 48 hours including EMD mortality and Length of Stay (LOS) as secondary outcome. Logistic regression was performed to identify and measure the strength of associations between these variables.

Results: We analyzed 293(67.2%) of geriatric patients with median age of 70 years, over half being males. In-hospital mortality at 48 hours was 27(9.2%) with 6(2.1%) deaths occurring at EMD. Median EMD LOS was 4 hours (238.5 minutes). Independent predictors of mortality were altered mental status (aOR=2.96, 95% CI 1.24-7.06, P Value<0.014), difficulty in breathing (aOR=2.41, 95% CI 1.08-5.37, P Value<0.031), hypoxia (aOR=2.38, 95% CI 1.01-5.63, P Value<0.048) and electrolyte imbalance (aOR=2.83,1.12-7.14, P Value<0.028).

Conclusion: The mortality rate for geriatric patients who came to EMD for resuscitation was high. Altered mental status, breathing difficulties, hypoxia and electrolyte imbalances were independent predictors of mortality. Therefore, healthcare providers should assess the risk and predicted prognosis when planning care for geriatric patients.