RESUMEN
The aim of the study was to determine incidence, features and outcomes of the adverse drug reactions (ADR) among emergency department (ED) visits of S. Giovanni Battista Hospital in Turin. We evaluated 16.055 patients among ED visits in a period of five months; the mean age was 59.6 +/- 20.2 year (range 17-93 y; 8.054 women and 8.001 men); 426 (2.6%) had ADRs, and 91 (21.4%) were admitted to the hospital. In multivariate analysis only the number of medicines was positive correlated with ADR. The drugs most frequently ADR-related were: anticoagulants (21.8%), antibiotics (17.6%), NSAIDs (9.9%), hypoglycaemic agents (9.6%), ACE-inhibitors (4.7%), antipyretics (4%) and alfa-litics (3.3%); the most common clinic events were: gastrointestinal bleeding (21.1%), rash (19.7%), confusion (23.9%), hypoglycaemia (8.4%), dyspnoea (7.0%), syncope and wheezing (5.6%), gastrointestinal bleeding (2.8%), anaemia (2.8%), haematomas (4.2%), vomiting (4.2%). Factor associated with increased ADR-hospital admission were increasing age (over 65 years old), gastrointestinal diseases, dementia and ADL-dependence. ADR-patients' Emergency Department mortality was higher than noADR-patients' one. The mean duration of hospitalization was higher in ADR-patients. It is necessary to reduce the number of drugs and improve studies and prevention strategies targeted to reduce the impact of ADR, specially in the elderly population.
Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Adulto , Sistemas de Registro de Reacción Adversa a Medicamentos , Anciano , Analgésicos no Narcóticos/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antibacterianos/efectos adversos , Antiinflamatorios no Esteroideos/efectos adversos , Anticoagulantes/efectos adversos , Confusión/inducido químicamente , Erupciones por Medicamentos/etiología , Femenino , Hemorragia Gastrointestinal/inducido químicamente , Humanos , Hipoglucemiantes/efectos adversos , Incidencia , Italia/epidemiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Resultado del TratamientoRESUMEN
The aim of this study was to discuss about prevalence and clinical rilevance of comorbidity in the elderly patients. Our sample included 2373 (mean age 77.8 +/- 8.5; 1302 men and 1071 woman) consecutively admitted to the University Department of Geriatric Medicine of Torino. We examined some demographic variables, cognitive and functional status, main pathologies. Severity of illness was assessed using the C.I.R.S. The coexistence of two or more diseases was 83%: cardiovascular and chronic pulmonary diseases were the most frequently recorded (respectively 68% and 27%). The comorbidity and severity indexes of C.I.R.S. were associated respectively with mortality (O.R. 1.78; C.I. 1.36 - 2.33) and length of hospital staying (O.R. 2.35; C.I. 1.19 - 4.65). Comorbidity is an important specific prognostic indicator for reliable risk stratification of older patients.
Asunto(s)
Geriatría , Hospitalización , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
OBJECTIVES: To evaluate whether home treatment of elderly patients with acute uncomplicated first ischemic stroke is associated with different mortality rates and clinical outcomes from those of patients treated on a general medical ward (GMW). DESIGN: Randomized, controlled, single-blind trial. SETTING: S. Giovanni Battista Hospital of Turin. PARTICIPANTS: One hundred twenty elderly patients admitted to the emergency department of the hospital with first acute ischemic stroke were randomized to home treatment from a geriatric home hospitalization service (GHHS) or to GMW treatment. MEASUREMENT: Main outcome was cumulative survival at 6 months in the two groups. Residual functional impairment, neurological deficit, depression, morbidity, and admission to rehabilitation and long-term care facilities were considered as secondary outcomes in survivors. RESULTS: One hundred twenty patients (mean age 82; 54 men and 66 women) were enrolled (60 in each study arm). The cumulative proportion of cases surviving at 6 months was 0.65 in the GHHS group and 0.60 in GMW group (log-rank test P=.53). Functional and neurological parameters were significantly improved in both GHHS and GMW patients, without significant differences between the two groups. Depression score was significantly better in home-treated patients (P<.001), who were more likely to remain at home at 6 months than hospital-treated patients and had a lower rate of select medical complications. CONCLUSION: Home-treated elderly patients with ischemic stroke have better depressive scores and lower rates of admission to nursing homes. These results should prompt further studies to evaluate home hospitalization for elderly stroke patients.