Emergency presentations of older patients living with frailty: Presenting symptoms compared with non-frail patients.

BACKGROUND AND OBJECTIVE: Symptoms may differ between frail and non-frail patients presenting to Emergency Departments (ED). However, the association between frailty status and type of presenting symptoms has not been investigated. We aimed to systematically analyse presenting symptoms in frail and non-frail older emergency patients and hypothesized that frailty may be associated with nonspecific complaints (NSC), such as generalised weakness. METHODS: Secondary analysis of a prospective, single centre, observational all-comer cohort study conducted in the ED of a Swiss tertiary care hospital. All presentations of patients aged 65 years and older were analysed. At triage, presenting symptoms and frailty were systematically assessed using a questionnaire. Patients with a Clinical Frailty Scale (CFS) > 4 were considered frail. Presenting symptoms, stratified by frailty status, were analysed. The association between frailty and generalised weakness was tested by logistic regression. RESULTS: Overall, 2'416 presentations of patients 65 years and older were analysed. Mean age was 78.9 (SD 8.4) years, 1'228 (50.8%) patients were female, and 885 (36.6%) patients were frail (CFS > 4). Generalised weakness, dyspnea, localised weakness, speech disorder, loss of consciousness and gait disturbance were recorded more often in frail patients, whereas chest pain was reported more often by non-frail patients. Generalised weakness was reported as presenting symptom in 166 (18.8%) frail patients and in 153 (10.0%) non-frail patients. Frailty was associated with generalised weakness after adjusting for age, gender and elevated National Early Warning Score 2 (NEWS) ≥ 3 (OR 1.19, CI 1.10-1.29, p < 0.001). CONCLUSION: Presenting symptoms differ in frail and non-frail patients. Frailty is associated with generalised weakness at ED presentation.

D-dimer levels for Risk Stratification in Patients with Suspected COVID-19 - A Prospective Observational Study.

BACKGROUND: Elevated D-dimer levels have been observed in COVID-19 and are of prognostic value, but have not been compared to an appropriate control group. METHODS: Observational cohort study including emergency patients with suspected or confirmed COVID-19. Logistic regression defined the association of D-dimer levels, COVID-19 positivity, age, and gender with 30-day-mortality. RESULTS: 953 consecutive patients (median age 58, 43% women) presented with suspected COVID-19: 12 (7.4%) patients with confirmed SARS-CoV-2-infection died, compared with 28 (3.5%) patients without SARS-CoV-2-infection. Overall, most (56%) patients had elevated D-dimer levels (≥0.5mg/l). Age (OR 1.07, CI 1.05-1.10), D-dimer levels ≥0.5mg/l (OR 2.44, CI 0.98-7.39), and COVID-19 (OR 2.79, CI 1.28-5.80) were associated with 30-day-mortality. CONCLUSION: D-dimer levels are effective prognosticators in both patient groups.

A MEG study of sleep.

A 64-channel, whole cortex magnetoencephalographic system was employed to obtain sleep data from three healthy subjects. Based upon visual inspection of the signals and the corresponding power spectra, we were able to discern a number of features characterizing the evolution of sleep. These included: (1) the transition from records dominated by the alpha rhythm to records in which alpha is attenuated and slower waves increase; (2) the appearance of sleep spindles, particularly in the parietal channels; and, perhaps most interesting, (3) a slow wave phase whose multichannel spectral signature is a broad rounded maximum in the frequency region around 0.5 Hz. Topographical features of the sleep record were also studied. In two of our subjects, rough lateral symmetry was apparent. As their sleep deepened, the distribution of signal power over the head changed such that the maximum moved in the forward and lateral directions, with parietal and temporal signals strengthening relative to the occipital. The records of the third subject showed a tendency toward right dominance, while topographic changes with sleep depth were minimal. Only one of the subjects was able to sustain the deep, slow-wave stage. Here, characteristic multi-detector outbursts appeared, lasting between 150 and 500 ms. During these intervals, widespread topographic patterns were sustained over the head (often with striking dipolar or quadrupolar forms), while crude source modeling yielded two persisting dipoles, laterally paired. Thus, these outbursts seem to represent large-scale, quasi-static configurations of brain activity perhaps related to the K-complexes, which occur earlier in sleep. Finally, we compare our results with those of previous investigators, including work on human electroencephalographic data and research reported by Steriade et al. from animal studies.