When to Admit to Observation: Predicting Length of Stay for Anticoagulated Elderly Fall Victims

O’Neill, Kathleen; Jean, Raymond; Savetamal, Alisa; Dyke, Ann; Prunty, Roseanne; Stone, Andrew; Castillo, Andrea; Gregg, Shea C.

doi:10.1016/j.jss.2020.01.006

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…48 Finally, there was great heterogeneity across definitions of patient complexity, while some authors even wrote about patient complexity without providing any definition. [88][89][90][91][92][93][94][95][96][97][98] Developing and using a more standardized definition of patient complexity that can also help to identify complex patients in clinical practice may ease study comparison. However, it may not be achievable or desirable, since patient complexity is to a certain extent context-and practitioner-dependent.…”

Section: Discussionmentioning

confidence: 99%

Definition of patient complexity in adults: A narrative review

Nicolaus

Crelier

Donzé

et al. 2022

Journal of Multimorbidity and Comorbidity

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Background Better identification of complex patients could help to improve their care. However, the definition of patient complexity itself is far from obvious. We conducted a narrative review to identify, describe, and synthesize the definitions of patient complexity used in the last 25 years. Methods We searched PubMed for articles published in English between January 1995 and September 2020, defining patient complexity. We extended the search to the references of the included articles. We assessed the domains presented in the definitions, and classified the definitions as based on (1) medical aspects (e.g., number of conditions) or (2) medical and/or non-medical aspects (e.g., socio-economic status). We assessed whether the definition was based on a tool (e.g., index) or conceptual model. Results Among 83 articles, there was marked heterogeneity in the patient complexity definitions. Domains contributing to complexity included health, demographics, behavior, socio-economic factors, healthcare system, medical decision-making, and environment. Patient complexity was defined according to medical aspects in 30 (36.1%) articles, and to medical and/or non-medical aspects in 53 (63.9%) articles. A tool was used in 36 (43.4%) articles, and a conceptual model in seven (8.4%) articles. Conclusion A consensus concerning the definition of patient complexity was lacking. Most definitions incorporated non-medical factors in the definition, underlining the importance of accounting not only for medical but also for non-medical aspects, as well as for their interrelationship.

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Section: Discussionmentioning

confidence: 99%

Definition of patient complexity in adults: A narrative review

Nicolaus

Crelier

Donzé

et al. 2022

Journal of Multimorbidity and Comorbidity

View full text Add to dashboard Cite

show abstract

“…Despite limitations, this study has key strengths and expands on the existing literature showing adverse outcomes in trauma patients on AC. [3][4][5][6][7][8][9] Patients with a variety of mechanisms and all ages were included. Given the comprehensive nature of patients included, the findings may help frame conversations with patients as an outpatient prior to any possible traumatic injury when starting AAT as well as help guide discussions on restarting AAT during the hospital visit or in follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…3 Patients who fall while taking AAT have a longer length of stay (LOS) or intensive care unit (ICU) stay, 4 increased mortality, 5 increased mortality with recurrent falls, 6 or higher rate of readmission. 7 Warfarin use in older trauma patients is also associated with decreased likelihood of having a successful observational LOS, 8 and antithrombotic use has been associated with severity of intracranial hemorrhage as measured by Glasgow Coma Scale (GCS). 9 Some studies have not found an association of AC with adverse outcomes and instead found that mortality after a fall in the elderly is related to frailty rather than AC itself.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Anticoagulation and Antiplatelet Use in Trauma Patients on Mortality and Length of Stay

Narula

Tsikis

Jinadasa

et al. 2021

The American Surgeon

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Background Though many trauma patients are on anticoagulation or antiplatelet therapy (AAT), there are few generalizable data on the risks for these patients. The purpose of this study was to analyze the impact of anticoagulation (AC) and antiplatelet (AP) therapy on mortality and length of stay (LOS) in general trauma patients. Methods A retrospective review was performed of patients in the institutional trauma registry during 2019 to determine AAT use on admission and discharge. Outcomes were compared using standard statistics. Results Of 2261 patients who met the inclusion criteria, 2 were excluded due to an incomplete medication reconciliation, resulting in 2259 patients. Patients on AAT had a higher mortality (4.5% vs 2.1%). On multivariable analysis, preadmission AC (odds ratio OR, 3.325, P = .001), age (OR 1.040, P < .001), and injury severity score ((ISS) 1.094, P < .001) were associated with mortality. Anticoagulation use was also associated with longer LOS on multivariable analysis (OR: 1.626, P = .005). Antiplatelet use was not associated with higher mortality or longer LOS. More patients on AAT were unable to be discharged home. However, patients on AAT did not have a greater blood transfusion requirement or need more hemorrhage control procedures. Lastly, 23.7% of patients on preadmission AAT were not discharged on any AAT. Discussion These data demonstrate that patients on AC, but not AP, have greater mortality and longer hospital LOS. This may provide guidance for those being newly started on AAT. Further work to determine which patients benefit most from restarting AAT would lead to improvement in the care of trauma patients.

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Trauma (Excluding Falls) in the Older Adult

Burton¹,

Magidson²

2023

Clinics in Geriatric Medicine

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When to Admit to Observation: Predicting Length of Stay for Anticoagulated Elderly Fall Victims

Cited by 4 publications

References 12 publications

Definition of patient complexity in adults: A narrative review

Definition of patient complexity in adults: A narrative review

The Effect of Anticoagulation and Antiplatelet Use in Trauma Patients on Mortality and Length of Stay

Trauma (Excluding Falls) in the Older Adult

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