S100B blood level measurement to exclude cerebral lesions after minor head injury: the multicenter STIC-S100 French study.

BACKGROUND: S100B protein measurement in blood is proposed to exclude the presence of computed tomography (CT) lesions after minor head injury (MHI). We aimed to validate S100B as an accurate and valuable screening tool for MHI diagnosis in a large multicenter study, as well as: 1) to evaluate whether a second S100B blood level determination 3 h after the first one would be informative; 2) to compare the bioclinical performances of the two commercially available automated methods of measurement of S100B for the screening of patients. METHODS: Four thousand and thirty MHI subjects were enrolled in a prospective observational multicenter study; results for serum S100B measurement determined within 3 h after the clinical event (H0) then at H3 were compared to that of cranial CT scans performed with 6 h following the presentation to emergency department. Both the Diasorin and the Roche Diagnostics assays were systematically performed. RESULTS: Cerebral lesions on CT scan were identified with sensitivity and negative-predictive value (NPV) of 96.3% and 99.4% (Diasorin, 1 dissonant case), and of 100% and 100% (Roche Diagnostics, no dissonant case). Sensitivity and NPV at H3 appeared lower than those at H0, due to the rapid decrease in S100B levels. CONCLUSIONS: Serum S100B level on admission of patients with MHI is an accurate and useful screening tool to exclude intracranial lesions. Performing a second late S100B level determination is not informative. The two automated immunoassays appear usable in a similar manner, although the two methods are not interchangeable.

Importance of in-hospital initiation of therapies and therapeutic inertia in secondary stroke prevention: IMplementation of Prevention After a Cerebrovascular evenT (IMPACT) Study.

BACKGROUND AND PURPOSE: Many patients do not receive prevention consistent with recommendations after stroke, but the relative importance of patient- and physician-related factors is uncertain. METHODS: We prospectively assessed factors associated with blood pressure (BP) <140/90 mm Hg and low-density lipoprotein (LDL) cholesterol <1 g/L in a collaborative cohort of 240 consecutive patients experiencing stroke/transient ischemic attack (Rankin <4; /=140/90 mm Hg, approximately 40% received either no treatment or one drug only, and treatment was reinforced in 20% of them only. Results were similar at 12 months with no improvement in the rate of control of risk factors. CONCLUSIONS: Therapeutic inertia is an important impediment to achieve BP and LDL control goals after stroke, even in fairly motivated/adherent patients. In-hospital initiation of preventive therapies could improve quality of secondary stroke prevention in the long term.

Health network to improve elderly patients' flow in emergency department.

BACKGROUND: The French population has been growing older these past decades. The French Regional Health Organization System authorizes the creation of health networks in order to improve healthcare. We have developed since 2002 in our Tertiary Hospital Cochin, a health network inside Paris and its suburbs for the elderly to improve their flow from the emergency department. Our study, based on this organization, analyses the outcome of such a system. METHODS: From January 2002 to December 2002, we conducted a monocentric retrospective study from the emergency department including all polypathological elderly patients (older than 75 years) admitted for a medical purpose. We classified them according to triage level at arrival, their duration of stay in the emergency department and in the tertiary hospital/geriatric network and their in-hospital mortality. RESULTS: Elderly patients represented 12% of our recruitment of an overall number of 42 700 patients in 2002. Six hundred and ninety-nine (24.2%) patients needed admission in a geriatric field; 42.8% were hospitalized in our tertiary hospital and 57.2% in the geriatric network. The mean age was 86.5+/-6 years in the two groups. The triage scale shows that most elderly people needed rapid care in the emergency department. Our mean duration of stay in the emergency department was 11 h 30 min. No significant difference was observed in the two groups for the in-hospital duration of stay. Mortality rate was 10.2% with a significant difference in the two groups. CONCLUSION: We observed a decreasing number of elderly persons' admission in our tertiary hospital, allowing a specific activity in the referred medical units. Our contract with the geriatric hospital in the network favoured elderly patients' flow from the emergency department. The geriatric network hospitals could refer back any patient to the emergency department for emergent events.