Factors related to bladder catheterization in older patients and its possible association with prognosis: results of the EDEN-30 study.

Patricia Eiroa-Hernández, Sebastián Matos, Sira Aguiló, Aitor Alquézar-Arbé, Javier Jacob, Cesáreo Fernández, Pere Llorens, Sandra Moreno Ruíz, Lidia Cuevas Jiménez, Aarati Vaswani-Bulchand, Montserrat Rodríguez-Cabrera, Maribel Coromoto Suárez Pineda, Sara Alegre Fresno, Ivet Gina Osorio, Ana María Puche Alcaraz, Jésica Mansilla Collado, Mónica Veguillas Benito, Francisco Chamorro, Lorenzo Álvarez Rocío, Valle Toro Gallardo, Fahd Beddar Chaib, Jorge Pedraza García, Francisco de Borja Quero Espinosa, Montserrat Jiménez Lucena, Gabriel Yepez León, Enrique González Revuelta, Sara Sánchez Aroca, Juan González Del Castillo, Guillermo Burillo-Putze, Òscar Miró
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引用次数: 0

Abstract

Objectives: The aims of this study in the Emergency Department and Elder Needs (EDEN) series were to explore associations between clinical variables on arrival at the ED (baseline) and the insertion of a bladder catheter, and the relation between catheterization and deterioration to a more complex or serious clinical state.

Material and methods: Included were all patients aged 65 years or older attended during 1 week in 52 Spanish EDs. Patients were grouped according to whether a bladder catheter was or was not inserted in the ED. We used multivariable logistical regression to explore associations between catheterization and patient age, sex, 10 comorbidities, 7 baseline status variables, and 6 clinical variables. Progression was considered serious or complex if the patient died or required hospitalization, a prolonged hospital stay, or discharge to a care facility. We also explored the association between age and catheterization using adjusted restricted cubic spline (RCS) curves with a cutoff value of 65 years.

Results: Participating hospitals enrolled 24 573 patients; bladder catheters were inserted in 976 (4%). Of these, 44.3% were discharged from the ED. Fifteen of the 24 variables were independently associated with bladder catheterization. Factors with the strongest associations according to odds ratios (ORs) were impaired consciousness (OR, 2.50; 95% CI, 1.90-3.30), dehydration (OR, 2.24; 95% CI, 1.85-2.72), and male sex (OR, 2.12; 95% CI, 1.84- 2.44). Age 80 years or older was also associated with bladder catheterization (OR, 1.17; 95% CI, 1.01-1.358). The adjusted RCS curves showed a progressive linear increase in the probability of catheterization with age. The increase was constant in men and stabilized after the age of 85 years in women (P-interaction .001). Bladder catheterization was associated with hospitalization (OR, 2.31; 95% CI, 1.99-2.68), intensive care unit admission (OR, 4.64; 95% CI, 3.04-7.09), prolonged stay in the ED for discharged patients (OR, 2.28; 95% CI, 1.75-2.96), in-hospital death (OR, 1.99; 95% CI, 1.54-2.57), and 30-day death (OR, 1.66; 95% CI, 1.33-2.08). No associations were found between catheterization and prolonged hospital stay (OR, 1.11; 95% CI, 0.92-1.34) or need for a care facility on discharge (OR, 1.50; 95% CI, 0.98-2.29).

Conclusion: Certain patient characteristics and baseline clinical conditions are associated with bladder catheterization in patients of advanced age. The main factors were decreased consciousness, dehydration, and male sex. Even after adjustment for related factors, catheterization is independently associated with progression to more complex or serious clinical states.

老年患者膀胱导尿的相关因素及其与预后的可能关联:EDEN-30 研究结果。
研究目的本研究是急诊科和老年人需求(EDEN)系列研究的一部分,旨在探讨患者到达急诊科(基线)时的临床变量与插入膀胱导尿管之间的关系,以及导尿与病情恶化至更复杂或更严重临床状态之间的关系:包括西班牙 52 家急诊室一周内接诊的所有 65 岁及以上患者。根据是否在急诊室插入膀胱导尿管对患者进行分组。我们使用多变量逻辑回归法探讨了导尿与患者年龄、性别、10 项合并症、7 项基线状态变量和 6 项临床变量之间的关系。如果患者死亡或需要住院、长期住院或出院到护理机构,则病情进展被视为严重或复杂。我们还使用调整后的限制性立方样条曲线(RCS)探讨了年龄与导管插入术之间的关系,并将截止值设定为 65 岁:参与研究的医院共收治了 24 573 名患者,为其中的 976 人(4%)插入了膀胱导管。其中 44.3% 的患者从急诊室出院。在 24 个变量中,有 15 个与膀胱导尿术有独立关联。根据几率比(ORs),与膀胱导尿术关系最大的因素是意识障碍(OR,2.50;95% CI,1.90-3.30)、脱水(OR,2.24;95% CI,1.85-2.72)和男性(OR,2.12;95% CI,1.84-2.44)。80 岁或以上也与膀胱导尿有关(OR,1.17;95% CI,1.01-1.358)。调整后的 RCS 曲线显示,随着年龄的增长,导尿概率呈逐渐线性上升趋势。在男性中,这种增长是恒定的,而在女性中,这种增长在 85 岁以后趋于稳定(P-交互作用 .001)。膀胱导尿与住院(OR,2.31;95% CI,1.99-2.68)、入住重症监护室(OR,4.64;95% CI,3.04-7.09)、出院患者在急诊室停留时间延长(OR,2.28;95% CI,1.75-2.96)、院内死亡(OR,1.99;95% CI,1.54-2.57)和 30 天死亡(OR,1.66;95% CI,1.33-2.08)有关。导管插入术与住院时间延长(OR,1.11;95% CI,0.92-1.34)或出院时需要护理设施(OR,1.50;95% CI,0.98-2.29)之间没有关联:结论:某些患者特征和基线临床条件与高龄患者的膀胱导尿术有关。主要因素包括意识减退、脱水和男性。即使对相关因素进行了调整,导尿术仍与进展到更复杂或更严重的临床状态独立相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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