Clinical Characteristics of Emergency Patients with Asthenia Universalis: Elderly Versus Adult Patients

ABSTRACT

PURPOSE: Asthenia universalis is a common symptoms complaint found in the emergency department (ED) especially among the elderly. However, emergency physicians often find it difficult to initiate evaluation given lack of research in this field. The aim of this study is to evaluate the clinical characteristics of asthenia universalis in elderly patients and compare them to adult patients presenting to the ED for similar complaints. METHODS: Patients who presented to the ED with asthenia universalis between March 2004 through February 2005 were obtained using data warehouse from electronic medical records. We excluded patients with underlying illness such as neurosis, organic diseases, depression, in addition to patients who refused to participate. Characteristics of the elderly group (> 64 years) were compared with the adult group (15~64 years) based on clinical and laboratory findings. Chi-square test a Fisher's test was used for nominal variables and a Mann-Whitney U test or Students t-test for continuous variables was used. RESULTS: During the study period asthenic patients comprised 0.81% (566/ 69,922) of total ED visits. Of those 566 patients, 82 patients were included in the study of which 25 were male and 56 female. Both genders were equally distributed between the two groups studied (elderly vs. adult). 58.3% of patients had an underlying medical illness (elderly group 81.1%, adult group 46.2%). The clinical impressions included infections or inflammation disorders (30.5%), endocrine disorders (17.1%), and psychiatric illnesses excluding depression (15.9%). Laboratory findings revealed a higher prevalence of hyponatremia (p=0.008), hypokalmia (p=0.033) and hypoalbuminemia (p=0.036) in the elderly group. CONCLUSION: In elderly patients presenting with asthenia universalis to the ED, a higher prevalence of underlying infections and endocrine disorders were present compared to adult patients presenting with asthenia universalis. In addition, the elderly more frequently had associated laboratory abnormalities to include hyponatremia, hypokalemia, hypoalbuminenia when compared to the adult patients.