ICH is common in elderly fallers presenting to the ED without focal findings. Anticoagulation alone did not appear to increase the risk of ICH, and aspirin was found to be protective, but prospective studies are needed to better assess this relationship.

OBJECTIVES: To identify independent risk factors for death in elderly emergency department (ED) patients admitted for infection and to derive and validate a mortalityprediction rule for such patients. MEASUREMENTS: Primary outcome: 28-day in-hospital mortality. Data were extracted from charts, and multivariate logistic regression were performed to identify independent mortality predictors. A prediction model was constructed and then validated in a second cohort. RESULTS: Nine hundred thirty-five patients were included in the derivation cohort and 2,015 in the validation cohort. Mortality was 6% in the derivation cohort and 7% in the validation cohort. In the derivation cohort, logistic regression revealed five independent mortality predictors: respiratory compromise (respiratory rate 420 breaths per minute or hypoxemia) (odds ratio (OR) 5 4.0, 95% confidence interval (CI) 5 1.7-9.4), tachycardia (heart rate !120 betas per minute; OR 5 3.2, 95% CI 5 1.6-6.3), cardiovascular failure (systolic blood pressure o90 mmHg despite fluid challenge or lactate !4.0; OR 5 9.0, 95% CI 5 4.7-17), preexisting terminal illness (OR 5 5.7, 95% CI 5 2.2-15), and platelet count less than 150,000/mm 3 (OR 5 2.7, 95% CI 5 1.3-5.6). Mortality increased with the number of factors: 0.51% for no factors, 3.1% for one factor, 14% for two factors, 47% for three or more risk factors. The c-statistic was 0.87 for the derivation model and 0.74 for the validation model. Almost 80% of patients in both cohorts were in low-risk groups (0 or 1 factor). CONCLUSION: A rule derived from five readily available variables predicts mortality in infected elderly ED patients and allows identification of a large low-risk subgroup.