A Nationwide Analysis of Hospital Disposition After Tracheal Intubation Among Elderly Patients Admitted From the Emergency Department

BACKGROUND: Tracheal intubation and mechanical ventilation are frequently required for critically ill patients, yet mortality remains high despite appropriate management. This risk is particularly pronounced among elderly patients. OBJECTIVE: To examine hospital disposition in a nationwide cohort of elderly emergency department (ED) patients who required endotracheal intubation. METHODS: We performed a retrospective cohort study of ED encounters involving patients aged ≥ 65 years who were intubated in the ED or after admission from the ED using the Nationwide Emergency Department Sample from 2018 to 2022. Those who died in the ED or were transferred were excluded. The primary outcome was hospital disposition, including in-hospital death. Interactions between age, diagnoses, and comorbidities were analyzed. All counts and estimates were weighted, accounting for the complex survey design. RESULTS: We identified 2,127,000 encounters with a median age of 75 (interquartile range 70, 81) years old. 995,890 (46.8%, 95% confidence interval or CI 46.3-47.4) died in the hospital, 729,034 (34.3%, 33.7-34.9) were discharged to a facility (eg, skilled nursing facility), 224,479 (10.6%, 10.3-10.8) were discharged home with home health, and 177,598 (8.3%, 8.1-8.6) were discharged home without home health. With each additional year of age, the probability of in-hospital mortality increased by 0.65% (95% CI 0.62-0.67). Cerebral hemorrhage, shock, sepsis, and traumatic brain injury (TBI) increased the probability of in-hospital mortality. Heart failure and chronic obstructive pulmonary disease (COPD) had significantly positive interactions with age for in-hospital mortality. CONCLUSION: Nearly half of elderly ED patients who require intubation will die in the hospital. These results may inform decisions and expectations regarding hospital disposition of the acutely ill or injured and intubated elderly patient.