1.Older Adult Patients in the Emergency Department: Which Patients should be Selected for a Different Approach?
Nere Larrea AGUIRRE ; Susana García GUTIÉRREZ ; Oscar MIRO ; Sira AGUILÓ ; Javier JACOB ; Aitor ALQUÉZAR-ARBÉ ; Guillermo BURILLO ; Cesáreo FERNANDEZ ; Pere LLORENS ; Cesar Roza ALONSO ; Ivana Tavasci LOPEZ ; Mónica CAÑETE ; Pedro Ruiz ASENSIO ; Beatriz Paderne DÍAZ ; Teresa Pablos PIZARRO ; Rigoberto Jesús del Rio NAVARRO ; Núria Perelló VIOLA ; Lourdes HERNÁNDEZ-CASTELLS ; Alejandro Cortés SOLER ; Elena SÁNCHEZ FERNÁNDEZ-LINARES ; Jesús Ángel Sánchez SERRANO ; Patxi EZPONDA ; Andrea Martínez LORENZO ; Juan Vicente Ortega LIARTE ; Susana Sánchez RAMÓN ; Asumpta Ruiz ARANDA ; Francisco Javier MARTÍN-SÁNCHEZ ; Juan González DEL CASTILLO ;
Annals of Geriatric Medicine and Research 2024;28(1):9-19
Background:
While multidimensional and interdisciplinary assessment of older adult patients improves their short-term outcomes after evaluation in the emergency department (ED), this assessment is time-consuming and ill-suited for the busy environment. Thus, identifying patients who will benefit from this strategy is challenging. Therefore, this study aimed to identify older adult patients suitable for a different ED approach as well as independent variables associated with poor short-term clinical outcomes.
Methods:
We included all patients ≥65 years attending 52 EDs in Spain over 7 days. Sociodemographic, comorbidity, and baseline functional status data were collected. The outcomes were 30-day mortality, re-presentation, hospital readmission, and the composite of all outcomes.
Results:
During the study among 96,014 patients evaluated in the ED, we included 23,338 patients ≥65 years—mean age, 78.4±8.1 years; 12,626 (54.1%) women. During follow-up, 5,776 patients (24.75%) had poor outcomes after evaluation in the ED: 1,140 (4.88%) died, 4,640 (20.51) returned to the ED, and 1,739 (7.69%) were readmitted 30 days after discharge following the index visit. A model including male sex, age ≥75 years, arrival by ambulance, Charlson Comorbidity Index ≥3, and functional impairment had a C-index of 0.81 (95% confidence interval, 0.80–0.82) for 30-day mortality.
Conclusion
Male sex, age ≥75 years, arrival by ambulance, functional impairment, or severe comorbidity are features of patients who could benefit from approaches in the ED different from the common triage to improve the poor short-term outcomes of this population.
2.Clinical Parameters in the First 5 Minutes after Birth Have a Predictive Value for Survival of Extremely Preterm Infants
Laura TORREJÓN-RODRÍGUEZ ; Álvaro SOLAZ-GARCÍA ; Inmaculada LARA-CANTÓN ; Alejandro PINILLA-GONZÁLEZ ; Marta AGUAR ; Máximo VENTO
Maternal-Fetal Medicine 2023;05(4):244-247
Extreme preterm infants (<28 weeks' gestation) often require positive pressure ventilation with oxygen during postnatal stabilization in the delivery room. To date, optimal inspired fraction of oxygen (FiO 2) still represents a conundrum in newborn care oscillating between higher (>60%) and lower (<30%) initial FiO 2. Recent evidence and meta-analyses have underscored the predictive value for survival and/or relevant clinical outcomes of the Apgar score and the achievement of arterial oxygen saturation measured by pulse oximetry ≥85% at 5 minutes after birth. New clinical trials comparing higher versus lower initial FiO 2 have been launched aiming to optimize postnatal stabilization of extreme preterm while avoiding adverse effects of hypoxemia or hyperoxemia.
3.Clinical Parameters in the First 5 Minutes after Birth Have a Predictive Value for Survival of Extremely Preterm Infants
Laura TORREJÓN-RODRÍGUEZ ; Álvaro SOLAZ-GARCÍA ; Inmaculada LARA-CANTÓN ; Alejandro PINILLA-GONZÁLEZ ; Marta AGUAR ; Máximo VENTO
Maternal-Fetal Medicine 2023;05(4):244-247
Extreme preterm infants (<28 weeks' gestation) often require positive pressure ventilation with oxygen during postnatal stabilization in the delivery room. To date, optimal inspired fraction of oxygen (FiO 2) still represents a conundrum in newborn care oscillating between higher (>60%) and lower (<30%) initial FiO 2. Recent evidence and meta-analyses have underscored the predictive value for survival and/or relevant clinical outcomes of the Apgar score and the achievement of arterial oxygen saturation measured by pulse oximetry ≥85% at 5 minutes after birth. New clinical trials comparing higher versus lower initial FiO 2 have been launched aiming to optimize postnatal stabilization of extreme preterm while avoiding adverse effects of hypoxemia or hyperoxemia.
4.Clinical Outcomes of Mechanical Thrombectomy in Stroke Tandem Lesions According to Intracranial Occlusion Location
Elena ZAPATA-ARRIAZA ; Asier de ALBÓNIGA-CHINDURZA ; Joaquin ORTEGA-QUINTANILLA ; Irene ESCUDERO-MARTÍNEZ ; Francisco MONICHE ; Manuel MEDINA-RODRÍGUEZ ; Blanca PARDO-GALIANA ; Juan Antonio Cabezas RODRÍGUEZ ; Lucía Lebrato HERNÁNDEZ ; Leire AINZ ; Soledad PÉREZ-SÁNCHEZ ; Ana DOMÍNGUEZ-MAYORAL ; Ana BARRAGÁN ; Aurelio CAYUELA ; Joan MONTANER ; Alejandro González GARCÍA
Journal of Stroke 2021;23(1):124-127
5.Sex Differences by Hospital-Level in Performance and Outcomes of Endovascular Treatment for Acute Ischemic Stroke
Soledad PÉREZ-SÁNCHEZ ; Ana BARRAGÁN-PRIETO ; Joaquín ORTEGA-QUINTANILLA ; Ana DOMÍNGUEZ-MAYORAL ; Miguel Ángel GAMERO-GARCÍA ; Elena ZAPATA-ARRIAZA ; Reyes de TORRES-CHACÓN ; Asier de ALBÓNIGA-CHINDURZA ; Montserrat ZAPATA-HIDALGO ; Francisco MONICHE ; Irene ESCUDERO-MARTÍNEZ ; Pablo BAENA ; Juan Antonio CABEZAS ; Juan Miguel OROPESA-RUIZ ; Gema SANZ-FERNÁNDEZ ; Alejandro GONZÁLEZ ; Joan MONTANER
Journal of Stroke 2020;22(2):258-261
6.The Value of Transcranial Doppler Sonography in Hyperperfusion Syndrome after Carotid Artery Stenting: A Nationwide Prospective Study
Francisco MONICHE ; Irene ESCUDERO-MARTÍNEZ ; Fernando MANCHA ; Alejandro TOMASELLO ; Marc RIBÓ ; Fernando DELGADO-ACOSTA ; Juán José OCHOA ; Joaquín GIL ; Rosario GIL ; Montserrat GONZÁLEZ-DELGADO ; Eduardo MURIAS ; Alain LUNA ; Alberto GIL ; Sonia MOSTEIRO ; María Dolores FERNÁNDEZ-COUTO ; Luis Fernández de ALARCÓN ; José M. RAMÍREZ-MORENO ; Joaquín ZAMARRO ; Guillermo PARRILLA ; José L. CANIEGO ; Gustavo ZAPATA-WAINBERG ; Andrés GONZÁLEZ-MANDLY ; José A. de las HERAS ; Luis LÓPEZ-MESONERO ; Joaquín ORTEGA ; Juan F. ARENILLAS ; Ernesto GARCÍA ; Pedro P. ALCÁZAR ; Elena ZAPATA-ARRIAZA ; Asier de ALBÓNIGA-CHINDURZA ; Juan Antonio CABEZAS ; Pilar ALGABA ; Aurelio CAYUELA ; Joan MONTANER ; Alejandro González GARCÍA
Journal of Stroke 2020;22(2):254-257

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