Associated Factors of In-hospital Mortality among Intubated Older Adults in Emergency Department; a Cross-sectional Study

A decision-making guideline on when to intubate an older person based on predictors of intubationoutcome would be extremely beneficial. This study aimed to identify the associated factors that could predict the out-comes of endotracheal intubation among older adults in the Emergency Department (ED).

In this retrospec-tive cross-sectional study, patients aged≥65 years intubated at the ED of University of Malaya Medical Centre, KualaLumpur, Malaysia, from 2015 to 2019 were studied. The association between age, gender, place of inhabitation, Identifi-cation of Seniors at Risk (ISAR) score for frailty, Charlson Comorbidity Index (CCI), Acute Physiology and Chronic HealthEvaluation-II (APACHE-II) score, indication for intubation, and diagnosis on admission with in-hospital mortality (pri-mary outcome) and duration of ventilation, and length of stay (secondary outcomes) were evaluated using univariateanalysis and Cox’s regression survival analysis.

889 cases aged 65 years and above were studied (61.5% male).The rate of in-hospital mortality was 71.4%. There was a significant association between age (p < 0.001), nursing homeresidency (p = 0.008), CCI≥5 (p = 0.001), APACHE-II (p < 0.001), pre-intubation Glasgow Coma Scale (GCS) (p < 0.001),cardiac arrest as indication of intubation (p < 0.001), diagnosis on admission (p < 0.001), length of stay (p < 0.001), andlength of ventilation (p = 0.003) and in-hospital mortality. Age≥85 years (HR= 1.270; 95%CI=1.074 to 1.502) and 75 to84 years (HR=1.642; 95%CI=1.167 to 2.076), cardiac arrest as indication of intubation (HR: 1.882; 95% CI: 1.554 – 2.279),and APACHE-II scores 25 – 34 (HR: 1.423; 95% CI: 1.171 - 1.730) and≥35 (HR: 1.789; 95%CI: 1.418 - 2.256) were amongstthe independent predictive factors of in-hospital mortality.

Nearly three out of four individuals aged≥65years intubated at the ED died during the same admission. Older age, cardiac arrest as indication of intubation, andAPACHE-II score were independent predictors of in-hospital mortality.