Observatory of elderly people cared in pre-hospital

Abstract

Introduction

Emergency medical services (EMS) supports an increasing number of elderly patients.

Aim: To evaluate outcome and autonomy of patients aged 65 and older who  managed in the prehospital theater

Methods

We conducted a prospective observational multicenter study over one year (October 2015 -September 2016). We included patients aged 65 or older managed in the pre hospital setting. We studied: demographic criteria, pre-hospital care, severity (IGSA score and GCS), baseline and 3-month autonomy was assessed using the Katz score. Multivariate analysis was performed to identify predictive factors of mortality at 24 hours. 

Results

we included 385 patients. Average age was 81 ± 8 years and sex ratio was equal to 1.08. Thirty eight (10%) patients were in cardiac arrest at the arrival of EMS team and 50% of them were resuscitated without recuperation. The IGSA score was 7 [5-10] on the initial examination versus 6  [4-7] on the arrival at the hospital (p<0.01). Baseline autonomy was 2 [0-6] versus 3 [0-6] at 3 months with p = 0.02. Ninety four patients (33%) regained their  baseline autonomy after the acute episode. At 24 hours the mortality rate was 9% (n=32). In multivariate analysis, the independent predictor factor of  mortality was GCS <8 with an adjusted OR=9,22 ;95%CI[3,44-24,70] ; p<0.001

Conclusion: Except out of hospital cardiac arrest, the survival of elderly subjects managed by EMS teams was encouraging. In the medium term, one-third of them regained their autonomy after the acute episode. These elements suggest successful integration into the emergency system.