Eucapnic pH coupled with arterial cord pH improves hypoxic-ischemic encephalopathy prediction.

OBJECTIVE: To consider the classical use of "pH < 7.0 and/or a base deficiency ≥12 mmol/L" as markers of the risk of neonatal hypoxic-ischemic encephalopathy (HIE), recalling various criticisms of the use of these markers in favor of that of neonatal eucapnic pH, which appears to be a better marker of this risk. METHODS: Fifty-five cases of acidemia with pH < 7.00 were collected from a cohort from the Nice University Hospital with eight cases of HIE. We compared the receiver operating characteristics curves established from the positive likelihood ratio (+LR) for each case of: umbilical cord artery pH (pHa), neonatal eucapnic pH (pH euc-n) in isolation (not matched to pHa), and matched pHa to its own pH euc-n. RESULTS: The areas under the curve (AUC) are identical for pHa and pH euc-n, but AUC for the matched pair pHa-pH euc-n appears superior but non-significant because of the small number in our cohort. However, using the bootstrap method, the partial AUC for a sensitivity greater than 75% indicates the significant superiority (P < 0.01) of the matched pair pHa-pH euc-n approach. CONCLUSION: The originality of this study lies in the use of two methodologic approaches: (1) standardized partial analysis of the AUCs of the pHa curve and that of pHa matched to its own pH euc-n, and (2) bootstrap statistical technique, that allowed us to conclude (P < 0.01) that the combined use of pH measured at the cord coupled with its eucapnic correction is better for diagnosing metabolic acidosis and best predicting the risk of HIE.

Evolution of patients' complaints in a French university hospital: is there a contribution of a law regarding patients' rights?

BACKGROUND: Legislative measures have been identified as one effective way of changing attitude or behaviour towards health care. The aim of this study was to describe trends in patients' complaints for medical issues; to evaluate the contribution of a law regarding patients' rights, and to identify factors associated to patients' perception of a medical error. METHODS: Patients with a complaint letter for medical issues in a French university hospital were included. Trends in complaint rates were analysed. Comparisons were made between a first (1998-2000) and a second (2001-2004) time period, before and after the diffusion of the law, and according to the perception of a medical error. RESULTS: Complaints for medical issues increased from 1998 to 2004. Of 164 complaints analysed, 66% were motivated by the perception of a medical error (47% during the first time period vs. 73% during the second time period; p = 0.001). Error or delay in diagnosis/treatment and surgical/medical complication were the main reasons for complaints. Surgical departments had the higher number of complaints. Second time period, substandard care, disability, and adverse effect of a health product were independently associated with the perception of a medical error, positively for the formers, and negatively for the latter. CONCLUSION: This study revealed an increase with time in the number of complaints for medical issues in a university hospital, as well as an increase in the perception of a medical error after the passing of a law regarding patients' rights in France.