Decision tree for ward admissions of older patients at the emergency department after a fall.

AIM: Falls are a prevalent issue for the older population, and for the healthcare system in terms of emergency department (ED) access and hospitalizations. There is still a lack of knowledge and guidelines, however, regarding the need to hospitalize older patients accessing the ED after a fall. In the present study, we aimed to analyze the factors and the decisional process that led to older patients accessing the ED after a fall being admitted to hospital or discharged. METHODS: The study sample included 2144 older people who accessed the ED after a fall. For each patient, we obtained information on the nature of the fall and the related injuries, previous falls, dementia and ongoing medical therapies. As the outcome variable, we considered the indication for ward admission after the ED visit. RESULTS: Of the 2144 individuals who accessed the ED after a fall, 38% had at least one fracture, and 40.1% were admitted to a ward. The decision tree obtained using the chi-squared automatic interaction detection algorithm showed that the indication for ward admission could be accurately predicted (risk estimate 0.205) by just five factors, namely: presence and severity of fall-related injuries, reportedly suspicious fall dynamics, use of anticoagulants, polypharmacy, and dementia. CONCLUSIONS: The need for ward admission in older patients who access the ED after a fall seems to be determined not only by the severity of fall-related injuries, but also by the fall dynamics and the individual's clinical complexity. Geriatr Gerontol Int 2018; 18: 1388-1392.

Factors influencing short-term outcomes for older patients accessing emergency departments after a fall: The role of fall dynamics.

BACKGROUND: While the relevance of falls in raising the risk of fractures, hospitalization and disability in older age is well recognized, the factors influencing the onset of fractures and the need for ward admission after a fall have yet to be fully elucidated. We investigated which factors and fall dynamics were mainly associated with fall-related injuries and hospitalization among elderly persons accessing the Emergency Department (ED) following a fall. METHODS: The study involved 2144 older subjects who accessed the ED after a fall. Data on the fall´s nature and related injuries, ward admissions, history of falls, dementia, and medical therapies were examined for all patients. Considering dynamics, we distinguished accidental falls (due to interaction with environmental hazards while in motion) and falls from standing (secondary to syncope, lipothymia, drop attack, or vertigo). RESULTS: The overall prevalence of fractures in our population did not differ significantly with advancing age, though hip fractures were more common in the oldest, and upper limb fractures in the youngest patients. Falls from standing were associated with polypharmacy and with higher ward admission rate despite a lower fractures´ prevalence than accidental falls. The chances of fall-related fractures were more than fourfold as high for accidental dynamics (OR=4.05, 95%CI:3.10-5.29, p<0.0001). Ward admission was associated with polypharmacy, dementia, anticoagulants´ use and fall-related fractures (OR=6.84, 95%CI:5.45-8.58, p<0.0001), while it correlated inversely with accidental fall dynamics. CONCLUSIONS: Outcomes of falls in older age depend not only on any fall-related injuries, but also on factors such as polypharmacy, cognitive status and fall dynamics.

Neurilemoma del muslo de tipo Antoni A / Thigh neurilemoma of Antoni A type

El neurilemoma o schwannoma es un tumor poco frecuente y con origen en las células de Schwann de los nervios periféricos. Generalmente presenta un comportamiento benigno y su malignidad es baja. Se presenta el caso de un paciente que acudió a consulta por aumento de volumen en el tercio proximal del muslo izquierdo. Recibió tratamiento en su área de salud con medicamentos y fisioterapia. Se realizó intervención quirúrgica donde se halló una masa fibrosa, dura con pequeño quiste en su interior. Se envió una muestra para estudio anatomopatológico y se diagnosticó un neurilemoma de tipo Antony A. Se presenta este caso infrecuente y se ofrece una breve revisión de la literatura médica sobre la etiopatogenia, diagnóstico y orientación terapéutica en este raro tumor

Neurilemoma of Schwannoma is a uncommon tumor originating from Shwann cells of peripheral nerves. Generally, has a benign behavior and its malignancy is low. This patient came to consultation due to a increase of the proximal third of left thigh. Patient was treated in his health area with drugs and physiotherapy. Was operated on and we founded a fibrous and hard mass with a interior small cyst. Sample was sended of anatomical and pathologic study diagnosing a type Antony A neurilemoma. This is a uncommon case offering a brief review of medical literature on pathogeny, diagnosis and therapeutical guiding of this infrequent tumor

Le neurinome ou schwannome est une tumeur rare, dont l'origine est aux cellules de Schwann des nerfs périphériques. Elle a en général un comportement bénin, et son taux de malignité est bas. Le cas d'un patient assistant en consultation à cause d'une augmentation du volumen du tiers proximal de la cuisse gauche, est présenté. Il a été traité par médicaments et kinésithérapie. Il a subi une chirurgie, où une masse fibreuse et dure, avec une petite tumeur dans son intérieur, est trouvée. Un prélèvement a été pris pour un examen anatomopathologique, et un neurinome type Anthony A a été diagnostiqué. Ce cas peu fréquent est présenté, et une revue de presse sur la pathogénie, le diagnostic et l'orientation thérapeutique de cette tumeur, est offerte

Condrometaplasia tenosinovial extraarticular / Extra-articular tenosynovitis chondrometaplasia / Chondrométaplasie ténosynoviale extraarticulaire

La condromatosis tenosinovial es una metaplasia idiopática benigna de la membrana sinovial. Se caracteriza por la formación de nódulos cartilaginosos en la membrana sinovial y en la cavidad articular. La localización extraarticular es un hallazgo poco frecuente. Los síntomas predominantes son dolor, inflamación y limitación de los movimientos. Los métodos diagnósticos más efectivos comprenden la radiología, la tomografía computarizada, la resonancia magnética y la ecografía. Se presenta un nuevo caso de condromatosis tenosinovial extraarticular, se incluyen imágenes diagnósticas, se exponen el tratamiento realizado y los resultados histológicos. Además se ofrece una revisión de la literatura médica sobre el tema.

Tenosynovitis chondromatosis is a benign idiopathic metaplasia os sinovial membrane. It is characterized by formation of cartilaginous nodules in synovial membrane and in the articular cavity. Extra-articular location is an infrequent finding. Predominant symptoms are: pain, inflammation and movements limitation. The more effective diagnostic methods include radiology, computed tomography, magnetic resonance and echography. This is a new case of extra-articular tensosynovial chondromatosis where diagnostic images are included, as well as the treatment applied and histological results. Also, a review of medical literature on this subject is offered.

La chondromatose ténosynoviale est une métaplasie idiopatique benigne de la membrane synoviale. Elle est caractérisée par la formation de nodules cartilagineux dans la membrane synoviale et dans la cavité articulaire. Sa localisation extraarticulaire est une anomalie très rare. Les symptômes prédominants sont la douleur, l'inflammation et la limitation des mouvements. Les méthodes diagnostiques les plus effectives comprennent la radiologie, la tomographie informatisée, la résonance magnétique et l'échographie. Un nouveau cas de chondromatose ténosynoviale extraarticulaire, dont les images diagnostiques sont inclues, est présenté; le traitement réalisé et les résultats histologiques sont exposés. Une revision de la littérature médicale est également présentée.

Tratamiento acupuntural de la bursitis subdeltoidea calcificada en la atención primaria de salud / Acupuncture treatment of calcified subdeltoid bursitis in health primary care

Se presenta el caso de un paciente del sexo masculino, de 43 años de edad, con historia de dolor en el hombro derecho desde hace aproximadamente 3 meses, a raíz de una contusión superficial, el cual recibió tratamiento conservador con reposo y medicamentos, pero no resolvió la sintomatología. Ahora, con diagnóstico de bursitis subdeltoidea calcificada, recibe tratamiento acupuntural en el Departamento de Medicina Natural y Tradicional de la sala de rehabilitación de su área de salud. Se presenta esta variante de tratamiento mediante sus estudios radiológicos...

This is the case of a male patient aged 43 with a pain history in right shoulder of approximately 3 months ago caused by a superficial contusion receiving conservative treatment with rest and drugs, without symptoms resolution. For the tine being time diagnosed with calcified subdeltoid bursitis and acupuncture treatment in Natural and Traditional Medicine Service of rehabilitation ward of his health area. This treatment variant is presented by its radiologic studies...

Enfermedad de Gorham: revisión bibliográfica e informe de caso / Gorham's disease: bibliographic review and a case report

Se detectó la enfermedad de Gorham en un paciente con fractura conminuta del polo inferior de la rótula izquierda, que durante el transoperatorio presentó sangramiento abundante e incontrolable por los métodos hemostáticos locales, el cual originó el shock hipovolémico de difícil solución, por lo que fue necesario la amputación supracondilea de la extremidad inferior izquierda. Se profundiza en los aspectos histopatológicos y radiológicos de la enfermedad, así como las particularidades del cuadro clínico