Patients over 70 who present to the emergency department with sepsis have a higher disease severity, and therefore different risk stratification is needed, says Bas De Groot, Leiden University Medical Centre. He presented his recommendations at the European Society of Emergency Medicine annual congress, which met in Glasgow this week.
Their research group found in an observational multicentre study that older patients presented to the emergency department with a higher disease severity, as shown by the PIRO (Predisposition, Infection, Response, Organ dysfunction) score. After adjusting for do not resusication (DNR) orders, more older patients were admitted to the ICU.
Key Points
- Commonly used screening and
risk stratification tools are inappropriate in older patients
- A normal systolic blood
pressure maybe much higher than you ever thought
- Older patients possibly receive
too little fluids when they present with a ‘normal’ systolic blood pressure.
- Older patients may have medical
devices fitted, co-morbidities, lowered immunity, and frailty.
References:
de Groot B, Stolwijk F, Warmerdam M, Lucke JA, Singh GK, Abbas M, Mooijaart SP, Ansems A, Esteve Cuevas L, Rijpsma D (2017) The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study. Scand J Trauma Resusc Emerg Med, 25(1): 91. doi: 10.1186/s13049-017-04363
https://sjtrem.biomedcentral.com/articles/10.1186/s13049-017-0436-3
Warmerdam M, Stolwijk F, Boogert A, Sharma M, Tetteroo L, Lucke J, Mooijaart S, Ansems A, Esteve Cuevas L, Rijpsma D, de Groot B (2017) Initial disease severity and quality of care of emergency department sepsis patients who are older or younger than 70 years of age. PLoS One, 12(9): e0185214. doi: 10.1371/journal.pone.0185214. eCollection 2017.
