CLINICAL-SIGNIFICANCE OF CREPITATIONS IN ELDERLY PATIENTS FOLLOWING ACUTE HOSPITAL ADMISSION - A PROSPECTIVE-STUDY

Because of a clinical impression that lung crepitations are a common, non-specific sign in acutely ill elderly people, two investigators, blinded to each other's findings and to subject case notes, prospectively examined 207 consecutive elderly [aged 70-98 (mean 77) years] and 75 young patients [24-50 (41) years] acutely admitted to hospital. Crepitations and persistent crepitations (PCs) were commoner in the elderly patients (p < 0.001) but agreement over their presence/absence was reduced (p < 0.05). Both investigators agreed PCs were absent in 35% of elderly subjects suffering from conditions classically associated with their presence, and, conversely, were present in 29 elderly subjects in whom no cause for their presence was discovered (14% of the total elderly group or 42% of those with PCs). PCs without obvious cause were unrelated to smoking history and did not predict outcome, length of stay or development of cardiorespiratory complications. In view of poor sensitivity and specificity of crepitations in elderly patients undergoing acute hospital admission we caution against over-reliance on this sign in isolation in these circumstances.