Prognostic accuracy of SIRS criteria, qSOFA score and GYM score for 30-day-mortality in older non-severely dependent infected patients attended in the emergency department.

The aim of this study was to determine the accuracy of systemic inflammatory response syndrome (SIRS), quick Sepsis-related Organ Failure Assessment (qSOFA) score and GYM score to predict 30-day mortality in older non-severely dependent patients attended for an episode of infection in the emergency department (ED). We performed an analytical, observational, prospective cohort study including patients 75 years of age or older, without severe functional dependence, attended for an infectious process in 69 Spanish EDs for 2-day three-seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event. We included 1071 patients, with a mean age of 83.6 [standard deviation (SD) 5.6] years; 544 (50.8%) were men. Seventy-two patients (6.5%) died within 30 days. SIRS criteria ≥ 2 had a sensitivity of 65% [95% confidence interval (CI) 53.1-75.9] and a specificity of 49% (95% CI 46.0-52.3), a qSOFA score ≥ 2 had a sensitivity of 28% (95% CI 18.2-39.8) and a specificity of 94% (95% CI 91.9-95.1), and a GYM score ≥ 1 had a sensitivity of 81% (95% CI 69.2-88.6) and a specificity of 45% (95% CI 41.6-47.9). A GYM score ≥ 1 and a qSOFA score ≥ 2 were the cut-offs with the highest sensitivity (p < 0.001) and specificity (p < 0.001), respectively. The area under the curve (AUC) was 0.73 (95% CI 0.66-0.79; p < 0.001) for the GYM score, 0.69 (95% CI 0.61-0.76; p < 0.001) for the qSOFA score and 0.65 (95% CI 0.59-0.72; p < 0.001) for SIRS. A GYM score ≥ 1 may be the most sensitive score and a qSOFA score ≥ 2 the most specific score to predict 30-day mortality in non-severely dependent older patients attended for acute infection in EDs.

[Prevalence of restless legs syndrome at the office in primary health care]. / Prevalencia del síndrome de piernas inquietas en las consultas de atención primaria.

INTRODUCTION: Restless legs syndrome (RLS) is a usual neurologic disorder, often undiagnosed and treatable, usually associated with sleep disturbance. Our goal was to study prevalence of RLS in our practice. PATIENTS AND METHODS: Descriptive, cross-sectional study, in a Primary care center. 283 patients 50 years old or older, which come to the office for any reason, were evaluated with a questionnaire about the four essential criteria stated by the international RLS study group in 1995. RESULTS: Prevalence of RLS was 11.6% (95% CI: 7.9-15.3%). 73.5% were women and 26.5% men (ratio 3:1). Only 15% reported major repercussion in their quality of life, them we estimated that RLS clinically significant is present in 1.9% of our patients. By means of logistic regression only high number of consults at the office, daily sleepiness and use of hypnotics were associated to RLS. CONCLUSIONS: Prevalence of RLS in more than 50 years old patients is high: 11.6% but 1.9% of medically significant RLS. Must be suspected specially in women, frequent consultants or with sleep disorders in treatment with hypnotics.

Prevalencia del síndrome de piernas inquietas en las consultas de atención primaria / Prevalence of restless legs syndrome at the office in primary health care

Introducción. El síndrome de piernas inquietas (SPI) es un trastorno neurológico común, infradiagnosticado y tratable, que se asocia casi siempre con problemas de sueño. Nos planteamos estudiar su prevalencia en nuestro medio. Pacientes y métodos. Estudio descriptivo transversal desarrollado en un centro de atención primaria. 283 pacientes mayores de 50 años que consultaron por cualquier motivo fueron encuestados sobre cumplimiento de los criterios diagnósticos establecidos internacionalmente en 1995 por el Grupo Internacional para el Estudio del SPI. Resultados. La prevalencia hallada fue del 11,6% (IC 95%: 7,9-15,3%). Un 73,5% fueron mujeres y un 26,5%, hombres (razón casi de 3 a 1). Sólo un 15% refieren repercusión importante en su calidad de vida, por lo que estimamos el SPI clínicamente relevante en un 1,9%. Por regresión logística sólo la frecuentación elevada, la somnolencia diurna y precisar hipnóticos para dormir, se asoció al SPI. Conclusiones. La prevalencia de SPI hallada en pacientes mayores de 50 años en nuestro medio es elevada, un 11,6%; un 1,9% si nos ceñimos al clínicamente relevante. Debe descartarse especialmente en mujeres, pacientes frecuentadores o con trastornos del sueño en tratamiento con hipnóticos

Introduction. Restless legs syndrome (RLS) is a usual neurologic disorder, often undiagnosed and treatable, usually associated with sleep disturbance. Our goal was to study prevalence of RLS in our practice. Patients and methods. Descriptive, cross-sectional study, in a Primary care center. 283 patients 50 years old or older, which come to the office for any reason, were evaluated with a questionnaire about the four essential criteria stated by the international RLS study group in 1995. Results. Prevalence of RLS was 11,6% (95% CI: 7,9-15,3%). 73.5% were women and 26,5% men (ratio 3:1). Only 15% reported major repercussion in their quality of life, them we estimated that RLS clinically significant is present in 1,9% of our patients. By means of logistic regression only high number of consults at the office, daily sleepiness and use of hypnotics were associated to RLS. Conclusions. Prevalence of RLS in more than 50 years old patients is high: 11,6% but 1,9% of medically significant RLS. Must be suspected specially in women, frequent consultants or with sleep disorders in treatment with hypnotics