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P-177: The Sequential Organ Failure Assessment (SOFA) score is a predictive factor for 14-day mortality of elderly patients with advanced cancer who present to the ED
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
length of hospital stay after univariate analysis. Comparing with patients without anemia and BT as a reference, only patients who received BT had higher risk to have POD (anemia with BT: OR: 4.364, 95% CI: 1.580–12.053; without anemia but receiving BT: OR: 5.139, 95% CI: 1.848–14.294) after controlling confounders. Moreover, anemia is also not risk factor in both gender, and only men receiving BT had a significant risk for POD (OR 4.483; 95% CI: 1.266–15.869). Conclusions: Among older patients undergoing elective orthopedic surgery, receiving blood transfusion in operation is a significantly risk factor for postoperative delirium, not anemia at admission, and the risk was only found in men, not women. P-176 Are preoperative cerebrospinal fluid melatonin concentrations associated with postoperative delirium? R. Scholtens1 , S. De Rooij2 , B. Van Munster3 , A. Vellekoop4 , B. Vrouenraets5 1 AMC, Amsterdam, Netherlands; 2 UMCG, Groningen, Netherlands; 3 UMCG, Amsterdam, Netherlands; 4 Erasmus Medical Center, Rotterdam, Netherlands; 5 SLAZ, Amsterdam, Netherlands Objective: In delirious patients a disturbed sleep-wake rhythm is often observed. Melatonin, a hormone produced by the pineal gland, is a key factor in regulating circadian rhythm. Our aim is to investigate whether delirium is associated with cerebrospinal fluid (CSF) melatonin levels. Methods: Patients aged ≥65 years, acutely admitted to the hospital for surgical repair of a hip fracture and received spinal anaesthesia, were included. CSF was collected during cannulation prior to surgery. Melatonin was measured by direct radioimmuno assay (RIA). Patients were screened for delirium daily with the Delirium Observating Screening Scale (DOSS) by nursing staff. If the DOSS ≥3 a psychiatrist was consulted to confirm the diagnosis using the DSM-IV criteria. Results: Sixty patients were included in the analysis. Thirteen patients (21.7%) experienced delirium during admission of which one before surgery. Baseline characteristics did not differ between delirious and non-delirious patients. In subjects with and without postoperative delirium mean melatonin levels were 12.91 pg/ml (SD 6.6 pg/ml) and 11.72 pg/ml (SD 4.5 pg/ml) respectively, pvalue 0.48. No differences in mean melatonin levels were found between patients who experienced delirium and those who did not in analyses stratified for factors that could influence melatonin levels like cognitive impairment, age, use of medication, season, and part of day of CSF sampling. Conclusion: In this study preoperative CSF melatonin levels aren’t associated with postoperative delirium in older hip fracture patients. As melatonin was measured before surgery and delirium usually occurs 2–4 days after surgery this could have influenced the results.
Ethics and end of life care P-177 The Sequential Organ Failure Assessment (SOFA) score is a predictive factor for 14-day mortality of elderly patients with advanced cancer who present to the ED H.S. Choi1 , S.Y. Lee2 , Y.G. Ko1 , H.P. Hong1 , J.S. Lee1 , J.W. Park1 , S.K. Ko1 , S.W. Ko1 , H.J. Choo1 1 Kyung Hee University Hospital, Seoul, Republic of Korea; 2 Rosen Hospital, Dongducheon, Republic of Korea Background: There is limited literature describing clinical predictors for critically ill patients with cancer who present to the emergency department (ED).
S79
Purpose: This study aimed to investigate the potential of SOFA score as a predictor of death within 14 days in elderly patients with advanced cancer admitted to the emergency department (ED). Methods: This was a prospective observational study of 124 consecutive elderly patients (≥65 years old) with advanced cancer who presented to the ED. The outcome was defined as death within 14 days after admission. Results: The median survival time of the study subjects was 27.1 days (interquartile range, 9.1–77.2 days), and 35 patients (28.2%) died within 14 days after admission. In univariate analysis, SOFA score (≥4), previous chemotherapy, and altered mental status were predictive of 14-day mortality. Of those variables, only SOFA score was an independent predictor in multivariate analysis. Conclusions: The SOFA score may provide information on death within 14 days after the ED visit in elderly patients with advanced cancer. This score can help clinicians to predict 14-day mortality and plan appropriate treatment for critically ill patients with cancer who present to the ED. P-178 Communication of a hospital DNACPR order in the discharge summary in an acute London hospital T. Cronin1 , M. Pelly2 , E. Baldwin1 , Y. Khan2 1 Chelsea and Westminster Hospital, London, United Kingdom; 2 Chelsea and Westminster Hospital, London Background: In 2012, the UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD) produced a report stating ‘there is a requirement for a robust system to ensure . . . effective communication of DNACPR decisions between all healthcare workers and organisations involved with the patient’. The report also recommends CPR status should be recorded for all acute admissions. Consequently, this indicates a considerable group of patients who will be discharged with a hospital made DNACPR order. Indeed, previous research, reporting on outcomes of patients with DNACPR orders made in a UK hospital, found that 50% went on to be discharged. In addition to this, there exists significant regional variation in the validity of Hospital DNACPR orders in the community. This further illustrates the need for good communication of DNACPR orders in the hospital discharge summary. Methods: Data were collected from discharged hospital inpatients in three medical firms over a four month period. Results: Over the four month period 15% of patients discharged with DNACPR order had this communicated in the discharge summary. Conclusion: A low proportion of hospital DNACPR orders are communicated to GPs. Recommendations to improve communication includes having a section on whether a DNACPR order was completed added to the discharge summary pro forma. In addition, a clear pathway could be detailed on the DNACPR form on how it should be communicated across different settings. P-179 Effectiveness of the implementation of a protocol for palliative sedation in hospitalized older patients 2 2 L. Garc´ıa Cabrera1 , S. Fernandez-Villaseca ´ , J. Albeniz-L ´ opez ´ , P. Fernandez-Montalb ´ an ´ 2 , L. Rexach-Cano3 , A.J. Cruz-Jentoft4 1 Hospital Ram´ on y Cajal, Madrid, Spain; 2 H.U. Ram´ on y Cajal, Madrid, Spain; 3 Hospital Ramon Y Cajal, Madrid, Spain; 4 Hospital Universitario Ram´ on y Cajal, Madrid, Spain
Objective: To determine the effectiveness of a protocol for palliative sedation (PS) in older patients admitted for acute hospital care. Methods: Observational retrospective study. All patients older than 65 years who were sedated with palliative intent with midazolam in two three-months periods – before and after the implementation
length of hospital stay after univariate analysis. Comparing with patients without anemia and BT as a reference, only patients who received BT had higher risk to have POD (anemia with BT: OR: 4.364, 95% CI: 1.580–12.053; without anemia but receiving BT: OR: 5.139, 95% CI: 1.848–14.294) after controlling confounders. Moreover, anemia is also not risk factor in both gender, and only men receiving BT had a significant risk for POD (OR 4.483; 95% CI: 1.266–15.869). Conclusions: Among older patients undergoing elective orthopedic surgery, receiving blood transfusion in operation is a significantly risk factor for postoperative delirium, not anemia at admission, and the risk was only found in men, not women. P-176 Are preoperative cerebrospinal fluid melatonin concentrations associated with postoperative delirium? R. Scholtens1 , S. De Rooij2 , B. Van Munster3 , A. Vellekoop4 , B. Vrouenraets5 1 AMC, Amsterdam, Netherlands; 2 UMCG, Groningen, Netherlands; 3 UMCG, Amsterdam, Netherlands; 4 Erasmus Medical Center, Rotterdam, Netherlands; 5 SLAZ, Amsterdam, Netherlands Objective: In delirious patients a disturbed sleep-wake rhythm is often observed. Melatonin, a hormone produced by the pineal gland, is a key factor in regulating circadian rhythm. Our aim is to investigate whether delirium is associated with cerebrospinal fluid (CSF) melatonin levels. Methods: Patients aged ≥65 years, acutely admitted to the hospital for surgical repair of a hip fracture and received spinal anaesthesia, were included. CSF was collected during cannulation prior to surgery. Melatonin was measured by direct radioimmuno assay (RIA). Patients were screened for delirium daily with the Delirium Observating Screening Scale (DOSS) by nursing staff. If the DOSS ≥3 a psychiatrist was consulted to confirm the diagnosis using the DSM-IV criteria. Results: Sixty patients were included in the analysis. Thirteen patients (21.7%) experienced delirium during admission of which one before surgery. Baseline characteristics did not differ between delirious and non-delirious patients. In subjects with and without postoperative delirium mean melatonin levels were 12.91 pg/ml (SD 6.6 pg/ml) and 11.72 pg/ml (SD 4.5 pg/ml) respectively, pvalue 0.48. No differences in mean melatonin levels were found between patients who experienced delirium and those who did not in analyses stratified for factors that could influence melatonin levels like cognitive impairment, age, use of medication, season, and part of day of CSF sampling. Conclusion: In this study preoperative CSF melatonin levels aren’t associated with postoperative delirium in older hip fracture patients. As melatonin was measured before surgery and delirium usually occurs 2–4 days after surgery this could have influenced the results.
Ethics and end of life care P-177 The Sequential Organ Failure Assessment (SOFA) score is a predictive factor for 14-day mortality of elderly patients with advanced cancer who present to the ED H.S. Choi1 , S.Y. Lee2 , Y.G. Ko1 , H.P. Hong1 , J.S. Lee1 , J.W. Park1 , S.K. Ko1 , S.W. Ko1 , H.J. Choo1 1 Kyung Hee University Hospital, Seoul, Republic of Korea; 2 Rosen Hospital, Dongducheon, Republic of Korea Background: There is limited literature describing clinical predictors for critically ill patients with cancer who present to the emergency department (ED).
S79
Purpose: This study aimed to investigate the potential of SOFA score as a predictor of death within 14 days in elderly patients with advanced cancer admitted to the emergency department (ED). Methods: This was a prospective observational study of 124 consecutive elderly patients (≥65 years old) with advanced cancer who presented to the ED. The outcome was defined as death within 14 days after admission. Results: The median survival time of the study subjects was 27.1 days (interquartile range, 9.1–77.2 days), and 35 patients (28.2%) died within 14 days after admission. In univariate analysis, SOFA score (≥4), previous chemotherapy, and altered mental status were predictive of 14-day mortality. Of those variables, only SOFA score was an independent predictor in multivariate analysis. Conclusions: The SOFA score may provide information on death within 14 days after the ED visit in elderly patients with advanced cancer. This score can help clinicians to predict 14-day mortality and plan appropriate treatment for critically ill patients with cancer who present to the ED. P-178 Communication of a hospital DNACPR order in the discharge summary in an acute London hospital T. Cronin1 , M. Pelly2 , E. Baldwin1 , Y. Khan2 1 Chelsea and Westminster Hospital, London, United Kingdom; 2 Chelsea and Westminster Hospital, London Background: In 2012, the UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD) produced a report stating ‘there is a requirement for a robust system to ensure . . . effective communication of DNACPR decisions between all healthcare workers and organisations involved with the patient’. The report also recommends CPR status should be recorded for all acute admissions. Consequently, this indicates a considerable group of patients who will be discharged with a hospital made DNACPR order. Indeed, previous research, reporting on outcomes of patients with DNACPR orders made in a UK hospital, found that 50% went on to be discharged. In addition to this, there exists significant regional variation in the validity of Hospital DNACPR orders in the community. This further illustrates the need for good communication of DNACPR orders in the hospital discharge summary. Methods: Data were collected from discharged hospital inpatients in three medical firms over a four month period. Results: Over the four month period 15% of patients discharged with DNACPR order had this communicated in the discharge summary. Conclusion: A low proportion of hospital DNACPR orders are communicated to GPs. Recommendations to improve communication includes having a section on whether a DNACPR order was completed added to the discharge summary pro forma. In addition, a clear pathway could be detailed on the DNACPR form on how it should be communicated across different settings. P-179 Effectiveness of the implementation of a protocol for palliative sedation in hospitalized older patients 2 2 L. Garc´ıa Cabrera1 , S. Fernandez-Villaseca ´ , J. Albeniz-L ´ opez ´ , P. Fernandez-Montalb ´ an ´ 2 , L. Rexach-Cano3 , A.J. Cruz-Jentoft4 1 Hospital Ram´ on y Cajal, Madrid, Spain; 2 H.U. Ram´ on y Cajal, Madrid, Spain; 3 Hospital Ramon Y Cajal, Madrid, Spain; 4 Hospital Universitario Ram´ on y Cajal, Madrid, Spain
Objective: To determine the effectiveness of a protocol for palliative sedation (PS) in older patients admitted for acute hospital care. Methods: Observational retrospective study. All patients older than 65 years who were sedated with palliative intent with midazolam in two three-months periods – before and after the implementation