RESUMO
BACKGROUND: There is a lack of trustworthy evidence-informed guidelines on the diagnosis and management of acute appendicitis in elderly patients. METHODS: We developed a rapid guideline in accordance with GRADE and AGREE II standards. The steering group consisted of general surgeons, members of the EAES Research Committee/Guidelines Subcommittee with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, biostatisticians, and a guideline methodologist. The guideline panel consisted of three general surgeons, an intensive care physician, a geriatrician and a patient advocate. We conducted systematic reviews and the results of evidence synthesis were summarized in evidence tables. Recommendations were authored and published through an online authoring and publication platform (MAGICapp), with the guideline panel making use of an evidence-to-decision framework and a Delphi process to arrive at consensus. RESULTS: This rapid guideline provides a weak recommendation against the use of clinical scoring systems to replace cross-sectional imaging in the diagnostic approach of suspected appendicitis in elderly patients. It provides a weak recommendation against the use of antibiotics alone over surgical treatment in patients who are deemed fit for surgery, and a weak recommendation for laparoscopic over open surgery. Furthermore, it provides a summary of surgery-associated risks in elderly patients. The guidelines, with recommendations, evidence summaries and decision aids in user-friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/4494 . CONCLUSIONS: This rapid guideline provides evidence-informed trustworthy recommendations on the diagnosis and management of acute appendicitis in elderly patients.
Assuntos
Apendicite , Laparoscopia , Doença Aguda , Idoso , Apendicite/diagnóstico , Apendicite/cirurgia , HumanosRESUMO
OBJECTIVE: To describe the characteristics, prevalence and prognostic of anemia in older patients admitted to an acute geriatric unit. MATERIAL AND METHODS: A prospective descriptive study was conducted on patients admitted to a geriatric unit. Anemia was defined using the World Health Organization criteria. A comprehensive geriatric assessment was performed on all patients. When possible, a telephone follow-up re-evaluation (mortality, functional status) was performed one year after discharge. RESULTS: A total of 145 patients were studied. The mean age was 81 years, and 93 (64.13%) were anemic. Chronic diseases and iron deficiency anemia were the most frequent. Anemic patients had lower scores in the Barthel Index (P<.05). The mortality one year after discharge was 47.9%, with no differences between anemic or non-anemic patients (OR 2.07, [0.98-4.4]). All the geriatric indexes (Barthel index; Charlson comorbidity index, Mini-mental state examination and Mini Nutritional Assessment) showed worse scores in patients who died one year after discharge. CONCLUSIONS: The prevalence of anemia in the elderly admitted to a geriatric unit is elevated, and associated with a poorer functional status.
Assuntos
Anemia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Geriatria , Departamentos Hospitalares , Humanos , Masculino , Admissão do Paciente , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de TempoRESUMO
OBJECTIVE: We evaluated the rapid discharge of older patients with reactivated chronic diseases from an acute general hospital to an intermediate care hospital. METHODS: A cohort study was carried out. Compliance with predefined quality standards and patient selection were evaluated. RESULTS: Sixty-eight patients (mean age 82.6 years, 48.5% men) were discharged from the emergency department (69.1%) or medical wards (mean [SD] global length of stay 2.6 [2.9] days in acute wards and 1.5 [1.6] days in the emergency department). Mean post-acute length of stay (SD) was 11.4 (4.2) days. Fifty-six patients (82.4%) were discharged to their previous living situation (home or nursing home), two back to the emergency department, seven to long-term care, and three died. All quality standards were met. In a multivariate analysis, male gender and a higher risk of malnutrition were associated with an increased risk of not returning to the previous living situation (p <0.05). CONCLUSIONS: Intermediate care for selected patients with reactivated chronic diseases might represent an alternative to prolonged acute hospitalization.