Abstract
Objective:
Emergency physicians are always faced with the challenge of choosing the appropriate disposition for elderly patients in order to ensure an acceptable care plan and effective use of resources. A clinical decision rule has been proposed but not validated to help ED physicians with decision making. This rule employs leukocytosis, severe coma, and thrombocytopenia as predictors of 30-day mortality. We sought to determine the performance of this clinical prediction rule in a prospective study in a setting different from where it was developed.
Method and Materials:
In this prospective cohort study in a 1200-bed tertiary care, patients older than 65 years old who visited the ED with fever were enrolled. All elements of the rule were collected and the total score was calculated for each patient. Patients were also categorized as low risk (score 0-1) or high risk (score≥2). Thirty-day follow-up was performed to determine the patient outcome (survival or mortality).
Result:
A total of 296 patients were entered our final analysis. The mortality rate by the Geriatric Fever Score was 62.5% for patients with a score of 0, 35.1% for 1, 42.4% for 2, and 60% for 3. When divided into two risk groups low risk group had a mortality of 36.6% and high-risk group had a mortality of 44.2%.
Conclusion:
We concluded that elderly patients who present to ED with fever and have a score of 2 or higher on Geriatric Fever Score are at higher risk of mortality at 30 days.