RESUMO
Objetivos: Evaluar si existen diferencias en la presentación clínica y en la atención de pacientes adultos con crisis epilépticas (CE) en servicios de urgencias hospitalarios (SUH) en función de la edad ≥75 años y si esta se asocia de manera independiente a resultados en el SUH y a 30 días del alta. Material y métodos: ACESUR es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico, que se llevó a cabo en 2017. Se comparan la distribución de variables correspondientes a la presentación clínica y atención según la edad ≥75 años. Posteriormente se realizan modelos de regresión logística con el objetivo de evaluar el efecto de la edad ≥75 años sobre las variables de resultado. Resultados: Se analizan 541 (81,5%) pacientes <75 años frente a 123 (18,5%) >75 años. En el grupo de longevos se detectó de forma significativa: mayor probabilidad de dependencia, comorbilidad, polifarmacia, visita previa al SUH, llegada en ambulancia, primera CE y clasificación etiopatogénica sintomática. En el análisis multivariado tras ajustar por las variables anteriores, se objetiva que la edad ≥75 años se asocia de manera independiente a una mayor incidencia de prueba complementaria específica (OR: 2,31; IC95%: 1,21-4,44), pero no a intervención farmacológica (OR: 1,63; IC95%: 0,96-2,80) ni hospitalización o estancia prolongada en SUH (OR: 1,56; IC95%: 0,94-2,59). Al ajustar por todas las variables anteriores, la edad ≥75 años se asocia a menor incidencia de algún resultado adverso (recurrencia de CE, revisita al SUH, hospitalización y/o fallecimiento) a 30 días (OR: 0,43; IC95: 0,25-0,77). Conclusiones: En el registro ACESUR se identificaron diferencias en la presentación clínica y en la atención de pacientes con CE en SUH al comparar longevos frente a jóvenes. La edad ≥75 años no se asocia de manera independiente a mayor incidencia de intervención en el SUH ni a algún resultado adverso a 30 días del alta
Objectives: To determine whether there are differences in the profile and in the care of adult patients with epileptic seizures in emergency department according to age ≥75 years, and if this is independently associated with results in the emergency department and 30 days after discharge. Material and methods: ACESUR is a multicentre, prospective, observational cohort multipurpose register that was carried out in 2017. The distribution of the variables corresponding to the clinical presentation and care according to age ≥75 years were compared. Subsequently, logistic regression models were performed with the objective of evaluating the effect of age ≥75 years on the outcome variables. Results: A total of 541 (81.5%) cases younger than 75 years were analysed compared to 123 adult patients (18.5%) of ≥75 years or more. In the group of long-lived it was observed significantly greater probability of dependence, co-morbidity, polypharmacy, a previous visit to the hospital emergency department, arrived by ambulance, first seizures and a symptomatic aetiopathogenic classification. In the multivariate analysis, after adjusting for the above variables, it is observed that age >75 years is associated independently with a higher incidence of specific supplementary tests (OR: 2.31; 95% CI: 1.21-4.44), but not pharmacological intervention (OR: 1.63; 95% CI: 0.96-2.80), or hospitalisation or extended stay in emergency departments (OR: 1.56; 95% CI: 0.94-2.59). On adjusting for all previous variables, age >75 years is associated with lower incidence of adverse events at 30 days (OR: 0.43; 95% CI: 0.25-0.77). Conclusions: In the ACESUR Registry, differences in clinical presentation and in the care of patients with seizures in emergency departments were identified when comparing those patients >75 years with those <75 years. Age ≥75 years is not independently associated with a higher incidence of intervention in emergency departments, or with more adverse outcomes at 30 days after discharge
Assuntos
Humanos, Masculino, Feminino, Pessoa de Meia-Idade, Idoso, Fatores Etários, Anticonvulsivantes/uso terapêutico, Serviço Hospitalar de Emergência, Sistema de Registros/estatística & dados numéricos, Convulsões/tratamento farmacológico, Ambulâncias/estatística & dados numéricos, Tempo de Internação, Estudos Prospectivos, Análise de Regressão, Convulsões/diagnóstico, Resultado do TratamentoRESUMO
OBJECTIVES: To determine whether there are differences in the profile and in the care of adult patients with epileptic seizures in emergency department according to age ≥75 years, and if this is independently associated with results in the emergency department and 30 days after discharge. MATERIAL AND METHODS: ACESUR is a multicentre, prospective, observational cohort multipurpose register that was carried out in 2017. The distribution of the variables corresponding to the clinical presentation and care according to age ≥75 years were compared. Subsequently, logistic regression models were performed with the objective of evaluating the effect of age ≥75 years on the outcome variables. RESULTS: A total of 541 (81.5%) cases younger than 75 years were analysed compared to 123 adult patients (18.5%) of ≥75 years or more. In the group of long-lived it was observed significantly greater probability of dependence, co-morbidity, polypharmacy, a previous visit to the hospital emergency department, arrived by ambulance, first seizures and a symptomatic aetiopathogenic classification. In the multivariate analysis, after adjusting for the above variables, it is observed that age >75 years is associated independently with a higher incidence of specific supplementary tests (OR: 2.31; 95% CI: 1.21-4.44), but not pharmacological intervention (OR: 1.63; 95% CI: 0.96-2.80), or hospitalisation or extended stay in emergency departments (OR: 1.56; 95% CI: 0.94-2.59). On adjusting for all previous variables, age >75 years is associated with lower incidence of adverse events at 30 days (OR: 0.43; 95% CI: 0.25-0.77). CONCLUSIONS: In the ACESUR Registry, differences in clinical presentation and in the care of patients with seizures in emergency departments were identified when comparing those patients >75 years with those <75 years. Age ≥75 years is not independently associated with a higher incidence of intervention in emergency departments, or with more adverse outcomes at 30 days after discharge.
Assuntos
Fatores Etários, Anticonvulsivantes/uso terapêutico, Serviço Hospitalar de Emergência, Sistema de Registros, Convulsões/tratamento farmacológico, Idoso, Ambulâncias/estatística & dados numéricos, Feminino, Humanos, Tempo de Internação, Masculino, Pessoa de Meia-Idade, Estudos Prospectivos, Sistema de Registros/estatística & dados numéricos, Análise de Regressão, Convulsões/diagnóstico, Resultado do TratamentoRESUMO
No disponible
Assuntos
Humanos, Serviço Hospitalar de Emergência/organização & administração, Serviço Hospitalar de Emergência, Delírio/complicações, Delírio/tratamento farmacológico, Haloperidol/uso terapêutico, Cloridrato de Tiaprida/uso terapêutico, Aripiprazol/uso terapêutico, Benzodiazepinas/uso terapêuticoRESUMO
Objective: To estimate the prevalence of potentially inadequate drug prescriptions in elderly patients who attend the Emergency Department. Design: A multicentre randomized clinical trial. Patients over 65 years of age attending the Emergency Department are randomized to the control arm or the intervention arm. In the intervention arm, the pharmacist will review the chronic medication of patients and identify any potentially inadequate prescriptions, according to the STOPP-START criteria. The cases are discussed with the Emergency Specialist and, if considered adequate, a recommendation to modify the treatment is sent to the Primary Care Physician. The control arm will receive the standard of care, not including a systematic review of the adequacy to the STOPP-START criteria. This article presents preliminary outcomes regarding the prevalence of potentially inadequate prescriptions. Outcomes: Four hospitals participated in the study, and 665 patients were included (342 in the control arm and 305 in the intervention arm). The mean age in the control arm was 78.2 years vs. 78.99 in the intervention arm. The total number of medications received by patients at the time of inclusion was 3 275. Of these, 9.3% (CI 95%: 8.3-10.4) were considered potentially inadequate prescriptions according to the STOPP criteria. On the other hand, 81.1% (CI 95%: 76.8-85.4) of the patients evaluated presented potentially inadequate prescriptions. Conclusion: This study has detected a high prevalence of potentially inadequate prescriptions in elderly patients attending the Emergency Department (AU)
Objetivo: Estimar la prevalencia de prescripciones potencialmente inapropiadas en pacientes mayores que acuden a urgencias Diseño: Ensayo clínico multicéntrico aleatorizado. Los pacientes mayores de 65 años que acuden a urgencias son asignados al grupo control o al de intervención. En el grupo de intervención, el farmacéutico revisa la medicación crónica de los pacientes e identifica aquellas prescripciones potencialmente inapropiadas de acuerdo a los criterios STOPP START. Los casos se discuten con el médico de urgencias y, cuando se considera indicado, se envía una recomendación al médico de atención primaria para que modifique el tratamiento. El grupo control recibe los cuidados habituales, que no incluyen una evaluación sistemática de la adecuación a los criterios STOPP START. En este artículo se presentan resultados preliminares respecto a la prevalencia de prescripciones potencialmente inapropiadas. Resultados: En el estudio han participado cuatro centros y se han incluido 665 pacientes (342 en el grupo control y 305 en el de intervención). La edad media en el grupo control ha sido de 78,2 años frente a 78,99 en el grupo de intervención. El número total de medicamentos que recibían los pacientes en el momento de la inclusión fue de 3.243. De estos, el 9,3% (IC 95%: 8,3-10,4) fueron considerados prescripciones potencialmente inapropiadas de tipo STOPP. Por otro lado, el 81,1%. (IC 95%: 76,8-85,4) de los pacientes evaluados presentaron prescripciones potencialmente inapropiadas. Conclusiones: En el estudio se ha detectado una alta prevalencia de prescripciones potencialmente inapropiadas en pacientes mayores que acuden a urgencias (AU)
Assuntos
Humanos, Idoso, Equipe de Assistência ao Paciente/estatística & dados numéricos, Erros de Medicação/estatística & dados numéricos, Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia, Prescrição Inadequada/estatística & dados numéricos, Idoso/estatística & dados numéricos, Tratamento de Emergência/mortalidade, Indicadores de Morbimortalidade, Serviços Médicos de Emergência/estatística & dados numéricos, Serviço de Farmácia Hospitalar/organização & administraçãoRESUMO
OBJECTIVE: To estimate the prevalence of potentially inadequate drug prescriptions in elderly patients who attend the Emergency Department. DESIGN: A multicentre randomized clinical trial. Patients over 65 years of age attending the Emergency Department are randomized to the control arm or the intervention arm. In the intervention arm, the pharmacist will review the chronic medication of patients and identify any potentially inadequate prescriptions, according to the STOPP-START criteria. The cases are discussed with the Emergency Specialist and, if considered adequate, a recommendation to modify the treatment is sent to the Primary Care Physician. The control arm will receive the standard of care, not including a systematic review of the adequacy to the STOPP-START criteria. This article presents preliminary outcomes regarding the prevalence of potentially inadequate prescriptions. OUTCOMES: Four hospitals participated in the study, and 665 patients were included (342 in the control arm and 305 in the intervention arm). The mean age in the control arm was 78.2 years vs. 78.99 in the intervention arm. The total number of medications received by patients at the time of inclusion was 3 275. Of these, 9.3% (CI 95%: 8.3-10.4) were considered potentially inadequate prescriptions according to the STOPP criteria. On the other hand, 81.1% (CI 95%: 76.8-85.4) of the patients evaluated presented potentially inadequate prescriptions. CONCLUSION: This study has detected a high prevalence of potentially inadequate prescriptions in elderly patients attending the Emergency Department.
Objetivo: Estimar la prevalencia de prescripciones potencialmente inapropiadas en pacientes mayores que acuden a urgencias Diseño: Ensayo clínico multicéntrico aleatorizado. Los pacientes mayores de 65 años que acuden a urgencias son asignados al grupo control o al de intervención. En el grupo de intervención, el farmacéutico revisa la medicación crónica de los pacientes e identifica aquellas prescripciones potencialmente inapropiadas de acuerdo a los criterios STOPP START. Los casos se discuten con el médico de urgencias y, cuando se considera indicado, se envía una recomendación al médico de atención primaria para que modifique el tratamiento. El grupo control recibe los cuidados habituales, que no incluyen una evaluación sistemática de la adecuación a los criterios STOPP START. En este artículo se presentan resultados preliminares respecto a la prevalencia de prescripciones potencialmente inapropiadas. Resultados: En el estudio han participado cuatro centros y se han incluido 665 pacientes (342 en el grupo control y 305 en el de intervención). La edad media en el grupo control ha sido de 78,2 años frente a 78,99 en el grupo de intervención. El número total de medicamentos que recibían los pacientes en el momento de la inclusión fue de 3.243. De estos, el 9,3% (IC 95%: 8,3-10,4) fueron considerados prescripciones potencialmente inapropiadas de tipo STOPP. Por otro lado, el 81,1%. (IC 95%: 76,8-85,4) de los pacientes evaluados presentaron prescripciones potencialmente inapropiadas. Conclusiones: En el estudio se ha detectado una alta prevalencia de prescripciones potencialmente inapropiadas en pacientes mayores que acuden a urgencias.
Assuntos
Idoso de 80 Anos ou mais/estatística & dados numéricos, Idoso/estatística & dados numéricos, Equipe de Assistência ao Paciente, Prescrições de Medicamentos/estatística & dados numéricos, Serviços Médicos de Emergência, Serviço Hospitalar de Emergência, Feminino, Humanos, Masculino, Prevalência, Resultado do TratamentoRESUMO
Objetivos. Determinar el perfil clínico de los pacientes centenarios y desarrollar un modelo predictivo de muerte a los 90 días tras ser atendidos en un servicio de urgencias hospitalario (SUH). Metodología. Estudio observacional de cohortes retrospectivo multicéntrico que incluyó a pacientes > 99 años atendidos en 5 SUH de la Comunidad de Madrid, de enero a diciembre de 2012. Se recogieron variables demográficas, comorbilidad, situación basal cognitiva, funcional y social, síndromes geriátricos, datos del episodio agudo y del consumo de recursos hospitalarios y sociales, y la mortalidad global a los 90 días. Resultados. Se incluyeron 209 pacientes con una edad media de 101 años (DE 1,7), 161 (77,0%) de los cuales fueron mujeres. Sesenta y cuatro (32,5%) tenían comorbilidad grave (índice de Charlson ≥ 3); 101 (49,8%) ≥ 5 fármacos; 100 (52,6%) deterioro cognitivo; 82 (42,3%) dependencia grave; 85 (40,7%) estaban institucionalizados y 190 (94,5%) presentaron algún síndrome geriátrico. Los motivos de consulta más frecuentes fueron la disnea (26,8%) seguido de las caídas (12,4%). Ciento dieciocho (56,5%) ingresaron y 58 de 174 (33,3%) fallecieron a los 90 días. El modelo predictivo de mortalidad global a 90 días incluyó: sexo hombre (OR 2,42 IC 95% = 0,97-6,04; p = 0,059), visita a urgencias en 3 meses previos (OR 4,08 IC 95% = 1,26-13,16; p = 0,019) y la toma de decisión de ingreso (OR 8,63 IC 95% = 3,25-22,9; p < 0,001), y tuvo un área bajo la curva de 0,776 (IC 95% = 0,70-0,85; p < 0,001). Conclusiones. Los pacientes centenarios atendidos en los SUH presentan una importante fragilidad, falleciendo 1 de cada 3 a los 90 días, lo cual está asociado con el sexo, la atención en urgencias en los 3 meses previos y la hospitalización (AU)
Objectives. To determine the clinical profile and to develop a model to predict 90-day mortality in centenarian patients attended in emergency departments (ED). Methodology. This was an observational, retrospective, multicentre cohort study including patients > 99 years attended in 5 ED in the Community of Madrid from January to December 2012. Demographic variables were recorded, as well as, comorbidities, cognitive, functional, social basal status, geriatric syndromes, acute episode, and hospital and social resources use, and 90-day mortality. Results. The study included 209 patients aged 101 years (SD 1.7) of whom 161 (77.0%) were female. Sixty four (32.5%) had severe comorbidity (Charlson index ≥ 3), 101 (49.8%) on multiple medication, 100 (52.6%) had cognitive impairment, 82 (42.3%) had severe functional dependence, 85 (40.7%) were institutionalised, and 190 (94.5%) had a geriatric syndrome. Dyspnoea (26.8%), followed by falls (12.4%) were the most common causes of attendance. One hundred and eighteen (56.5%) were admitted, and 58 out of 174 (33.3%) died in the first 90 days. The model to predict 90-day overall mortality included male sex (OR 2.42 95% CI = 0.97-6.04; P = .059), emergency care in the previous 3 months (OR 4.08 95% CI = 1.26-13.16; P = .019) and the hospitalization by index event (OR 8.63 95% CI = 3.25-22.9; P < .001) and this model had an area under ROC curve of 0.776 (95% CI = 0.70-0.85; P < .001). Conclusions. Centenarian patients attended in ED had a significant frailty and one in three cases died in the first 90 days after being attended, and this was associated with male sex, emergency care in the previous 3 months, and hospitalisation (AU)
Assuntos
Humanos, Masculino, Feminino, Idoso de 80 Anos ou mais, Perfil de Saúde, Emergências/epidemiologia, Serviços Médicos de Emergência/métodos, Serviços Médicos de Emergência/normas, Hospitalização, Estudos de Coortes, Estudos Retrospectivos, Comorbidade, 28599RESUMO
OBJECTIVES: To determine the clinical profile and to develop a model to predict 90-day mortality in centenarian patients attended in emergency departments (ED). METHODOLOGY: This was an observational, retrospective, multicentre cohort study including patients >99years attended in 5 ED in the Community of Madrid from January to December 2012. Demographic variables were recorded, as well as, comorbidities, cognitive, functional, social basal status, geriatric syndromes, acute episode, and hospital and social resources use, and 90-day mortality. RESULTS: The study included 209patients aged 101years (SD 1.7) of whom 161 (77.0%) were female. Sixty four (32.5%) had severe comorbidity (Charlson index≥3), 101 (49.8%) on multiple medication, 100 (52.6%) had cognitive impairment, 82 (42.3%) had severe functional dependence, 85 (40.7%) were institutionalised, and 190 (94.5%) had a geriatric syndrome. Dyspnoea (26.8%), followed by falls (12.4%) were the most common causes of attendance. One hundred and eighteen (56.5%) were admitted, and 58 out of 174 (33.3%) died in the first 90days. The model to predict 90-day overall mortality included male sex (OR 2.42 95% CI=0.97-6.04; P=.059), emergency care in the previous 3months (OR 4.08 95% CI=1.26-13.16; P=.019) and the hospitalization by index event (OR 8.63 95% CI=3.25-22.9; P<.001) and this model had an area under ROC curve of 0.776 (95% CI=0.70-0.85; P<.001). CONCLUSIONS: Centenarian patients attended in ED had a significant frailty and one in three cases died in the first 90days after being attended, and this was associated with male sex, emergency care in the previous 3months, and hospitalisation.
Assuntos
Serviço Hospitalar de Emergência, Hospitalização, Longevidade, Idoso de 80 Anos ou mais, Comorbidade, Feminino, Humanos, Masculino, Prognóstico, Estudos Prospectivos, Estudos RetrospectivosRESUMO
Las personas mayores son uno de los grupos poblacionales de mayor riesgo de reacción adversa a medicamentos (RAM). Su prevalencia media en el anciano es del 30%. La demencia no es un factor de riesgo independiente de RAM pero, sin embargo, es la principal situación que favorece y multiplica todos los factores de riesgo (polifarmacia, comorbilidad, prescripción inadecuada, interacción medicamentosa, edad avanzada y adherencia terapéutica). Se exponen recomendaciones revisadas y consensuadas para prevenir las RAM en las personas mayores, a la vez que las propias de las personas con demencia en relación con el manejo de la comorbilidad y de los síntomas cognitivos, psicológicos y conductuales(AU)
The elderly are one of the groups at greatest risk for adverse drugs reactions (ADR). The mean prevalence of these reactions in this population is 30%. Dementia is not an independent risk factor of ADR, but is the main condition that increases all risk factors (polypharmacy, comorbidity, inappropriate prescribing, drugdrug interactions, advanced age, and treatment adherence). The present article discusses revised and consensual recommendations for the prevention of ADR in the elderly, as well as recommendations specifically for dementia patients in relation to the management of comorbidity and cognitive, behavioral and psychological symptoms(AU)
Assuntos
Humanos, Masculino, Feminino, Idoso, Preparações Farmacêuticas/efeitos adversos, /epidemiologia, Demência/complicações, /prevenção & controle, Fatores de Risco, Comorbidade, PolimedicaçãoRESUMO
The elderly are one of the groups at greatest risk for adverse drugs reactions (ADR). The mean prevalence of these reactions in this population is 30%. Dementia is not an independent risk factor of ADR, but is the main condition that increases all risk factors (polypharmacy, comorbidity, inappropriate prescribing, drug-drug interactions, advanced age, and treatment adherence). The present article discusses revised and consensual recommendations for the prevention of ADR in the elderly, as well as recommendations specifically for dementia patients in relation to the management of comorbidity and cognitive, behavioral and psychological symptoms.
