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Blood loss and blood transfusion in relation to type of hip fracture
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S81–S141
confirmed a weak, independent contribution of TL to both RBC and WBC. Conclusions.– In the elderly, telomere shortening limits hematopoiesis capacity to a very limited extent. (Implemented under publicly-funded project no. PBZ-MEIN-9/2/2006, Ministry of Science and Higher Education). http://dx.doi.org/10.1016/j.eurger.2013.07.449 P387
Blood loss and blood transfusion in relation to type of hip fracture E.H. Azana Fernandez , Y.R. Davila Barboza Geriatric Department, Hospital San Juan de Dios, Leon, Spain Introduction.– Hip fracture is the most severe complication of osteoporosis, treatment includes emergency hospitalization and surgery. During postoperative a common complication is anemia. Method.– Retrospective study. Patients admitted with hip fracture to an orthogeriatric unit in a 5 months period. Preoperative and postoperative Hemoglobin (Hb) were studied as well as blood transfusion. Blood transfusion is indicated only if there is severe anemia or when the patient is hemodynamically unstable. Results.– 108 patients were included, with an average age 87,26 ± 7,07 years (range, 76–100). 86,6% were female. Type of hip fracture: Subtrochanteric (6,66%); intertrochanteric (51,1%) and intracapsular (42,2%). The mean Hb on admission was 12,34 ± 1,44 gr/dl. and the mean postoperative Hb (Hb. after 24 hr) was 9,65 ± 1,35 gr/dl. Postoperative drop in hemoglobin in relation to type of hip fracture: pertrochanteric (2,3 ± 1,14); intracapsular (2,6 ± 0,94) and subtrochanteric (3,36 ± 1,53). There were difference between subtrochanteric and the other two types of hip fractures. 66,6% of the patients required blood transfusion. 82 blood units were transfused. 34 blood units were administered to patients with Hb < 8 gr/dl. Percentage of patients transfused in relation to type of hip fracture: Subtrochanteric (100%); intertrochanteric (74%) and intracapsular (52,63%). Number of units transfused per patient in relation to type of hip fracture: Subtrochanteric (2,2); intertrochanteric (1,7) and intracapsular (1,5). Conclusions.– Subtrochanteric fracture reduced hemoglobin more than the other two types of hip fractures. Subtrochanteric fracture was the fracture that required more transfusions during postoperative. http://dx.doi.org/10.1016/j.eurger.2013.07.450 P388
Validation of PiPS (Prognosis in Palliative care Study) predictor models in terminal cancer in Korea E.S. Kim , J.K. Lee , Y.H. Jin , M.H. Kim , H.M. Noh Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Introduction.– PiPS (Prognosis in Palliative care Study) predictor models have been developed to estimate the survival of terminal cancer patients in United Kingdom in 2011. The aim of this study is to validate PiPS for advanced cancer patients in Korea in order to determine its value in clinical practice. Methods.– This study was performed on 202 advanced cancer patients who admitted to the palliative care unit of Samsung Medical Center from November 2011 to February 2013. PiPS and doctor’s prediction of inpatients were recorded on admission by physicians. Results.– Absolute agreement between PiPS-A, PiPS-B, doctor’s estimates of survival and actual survival was 52%, 49.5%, and 46.53%. In PiPS-A and PiPS-B “Days” group, survival of less than 14 days was predicted with a sensitivity of 52.1% and 64.0%, a specificity of 87.7% and 77.5%. In PiPS-A and PiPS-B “Weeks” group, survival
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of between 2 weeks and 7 weeks was predicted with a sensitivity of 59.2% and 44.7%, a specificity of 61.6% and 64.7%. In PiPS-A and PiPS-B “Months” group, survival of at least 8 weeks or more was predicted with a sensitivity of 37.1% and 37.1%, a specificity of 74.9% and 78.4%. Conclusions.– PiPS predictor models were superior to doctor’s prediction. Between PiPS-A and PiPS-B, PiPS-A was better than PiPS-B in absolute agreement. Using physicians’ survival prediction with PiPS predictor models may be more helpful to improve the accuracy of terminal cancer patients’ survival than using physicians’ survival prediction alone. http://dx.doi.org/10.1016/j.eurger.2013.07.451 P389
A case of delirium due to severe hypomagnesemia occurred during long-term PPIs treatment C. Sgarlata , M. Rollone , G. Ricevuti , N. Maurizi , M. Rondanelli , S. Perna , M.A. Faliva , F. Sardi , L. Venturini , F. Guerriero Azienda di Servizi alla Persona, Università degli Studi di Pavia, Pavia, Italy Text.– Hypomagnesemia incidence in the elderly is high and multifactorial however this condition is often unrecognized because it is mostly asymptomatic and generally the determination of magnesium is not performed on routine laboratory testing. Nevertheless, magnesium plays a central role in numerous cell functions and severe hypomagnesemia can be a life-threatening medical condition. Clinical manifestations of hypomagnesaemia are various and include, muscle cramps, arrhythmias, seizures and delirium. Therefore concomitant refractory hypokalemia and hypocalcaemia as like as electrocardiographic changes are common findings. Several mechanisms can cause magnesium depletion and the elderly population has an increased risk to develop this electrolyte disorder due to the high frequency of predisposing factors such as malnutrition, malabsortion and above all polimedications. Proton pump inhibitors (PPIs) are one of the most used classes of drugs in the elderly either for the treatment of gastric acid-related diseases or for a prophylactic use. In recent years increasing evidence have been reported suggesting a relationship between the long-term use of PPIs and the onset of a magnesium deficiency. We describe an uncommon case of delirium in a 81 years old woman associated with severe hypomagnesaemia (0.6 mg/dl), prolonged QT intervals and which has subsequently developed a supraventricular tachycardia, occurred during a long term PPIs treatment with pantoprazole and completely regressed after parenteral magnesium treatment and PPIs suspension. http://dx.doi.org/10.1016/j.eurger.2013.07.452 P390
The challenge of diagnosis and decision making in Geriatrics: A case of cerebral sinus thrombosis with intracerebral hemorrhage in a 87-year-old woman affected by multiple comorbidities F. Guerriero , C. Sgarlata , M. Rollone , N. Maurizi , M. Rondanelli , F. Sardi , L. Venturini , S. Perna , M.A. Faliva , G. Ricevuti Giovanni Azienda di Servizi alla Persona di Pavia, Università degli Studi di Pavia, Pavia, Italy Text.– Cerebral venous sinus thrombosis (CVST) is an uncommon form of stroke that unlike arterial stroke usually affects children and young individuals with a variable outcome ranging from com-
confirmed a weak, independent contribution of TL to both RBC and WBC. Conclusions.– In the elderly, telomere shortening limits hematopoiesis capacity to a very limited extent. (Implemented under publicly-funded project no. PBZ-MEIN-9/2/2006, Ministry of Science and Higher Education). http://dx.doi.org/10.1016/j.eurger.2013.07.449 P387
Blood loss and blood transfusion in relation to type of hip fracture E.H. Azana Fernandez , Y.R. Davila Barboza Geriatric Department, Hospital San Juan de Dios, Leon, Spain Introduction.– Hip fracture is the most severe complication of osteoporosis, treatment includes emergency hospitalization and surgery. During postoperative a common complication is anemia. Method.– Retrospective study. Patients admitted with hip fracture to an orthogeriatric unit in a 5 months period. Preoperative and postoperative Hemoglobin (Hb) were studied as well as blood transfusion. Blood transfusion is indicated only if there is severe anemia or when the patient is hemodynamically unstable. Results.– 108 patients were included, with an average age 87,26 ± 7,07 years (range, 76–100). 86,6% were female. Type of hip fracture: Subtrochanteric (6,66%); intertrochanteric (51,1%) and intracapsular (42,2%). The mean Hb on admission was 12,34 ± 1,44 gr/dl. and the mean postoperative Hb (Hb. after 24 hr) was 9,65 ± 1,35 gr/dl. Postoperative drop in hemoglobin in relation to type of hip fracture: pertrochanteric (2,3 ± 1,14); intracapsular (2,6 ± 0,94) and subtrochanteric (3,36 ± 1,53). There were difference between subtrochanteric and the other two types of hip fractures. 66,6% of the patients required blood transfusion. 82 blood units were transfused. 34 blood units were administered to patients with Hb < 8 gr/dl. Percentage of patients transfused in relation to type of hip fracture: Subtrochanteric (100%); intertrochanteric (74%) and intracapsular (52,63%). Number of units transfused per patient in relation to type of hip fracture: Subtrochanteric (2,2); intertrochanteric (1,7) and intracapsular (1,5). Conclusions.– Subtrochanteric fracture reduced hemoglobin more than the other two types of hip fractures. Subtrochanteric fracture was the fracture that required more transfusions during postoperative. http://dx.doi.org/10.1016/j.eurger.2013.07.450 P388
Validation of PiPS (Prognosis in Palliative care Study) predictor models in terminal cancer in Korea E.S. Kim , J.K. Lee , Y.H. Jin , M.H. Kim , H.M. Noh Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Introduction.– PiPS (Prognosis in Palliative care Study) predictor models have been developed to estimate the survival of terminal cancer patients in United Kingdom in 2011. The aim of this study is to validate PiPS for advanced cancer patients in Korea in order to determine its value in clinical practice. Methods.– This study was performed on 202 advanced cancer patients who admitted to the palliative care unit of Samsung Medical Center from November 2011 to February 2013. PiPS and doctor’s prediction of inpatients were recorded on admission by physicians. Results.– Absolute agreement between PiPS-A, PiPS-B, doctor’s estimates of survival and actual survival was 52%, 49.5%, and 46.53%. In PiPS-A and PiPS-B “Days” group, survival of less than 14 days was predicted with a sensitivity of 52.1% and 64.0%, a specificity of 87.7% and 77.5%. In PiPS-A and PiPS-B “Weeks” group, survival
S137
of between 2 weeks and 7 weeks was predicted with a sensitivity of 59.2% and 44.7%, a specificity of 61.6% and 64.7%. In PiPS-A and PiPS-B “Months” group, survival of at least 8 weeks or more was predicted with a sensitivity of 37.1% and 37.1%, a specificity of 74.9% and 78.4%. Conclusions.– PiPS predictor models were superior to doctor’s prediction. Between PiPS-A and PiPS-B, PiPS-A was better than PiPS-B in absolute agreement. Using physicians’ survival prediction with PiPS predictor models may be more helpful to improve the accuracy of terminal cancer patients’ survival than using physicians’ survival prediction alone. http://dx.doi.org/10.1016/j.eurger.2013.07.451 P389
A case of delirium due to severe hypomagnesemia occurred during long-term PPIs treatment C. Sgarlata , M. Rollone , G. Ricevuti , N. Maurizi , M. Rondanelli , S. Perna , M.A. Faliva , F. Sardi , L. Venturini , F. Guerriero Azienda di Servizi alla Persona, Università degli Studi di Pavia, Pavia, Italy Text.– Hypomagnesemia incidence in the elderly is high and multifactorial however this condition is often unrecognized because it is mostly asymptomatic and generally the determination of magnesium is not performed on routine laboratory testing. Nevertheless, magnesium plays a central role in numerous cell functions and severe hypomagnesemia can be a life-threatening medical condition. Clinical manifestations of hypomagnesaemia are various and include, muscle cramps, arrhythmias, seizures and delirium. Therefore concomitant refractory hypokalemia and hypocalcaemia as like as electrocardiographic changes are common findings. Several mechanisms can cause magnesium depletion and the elderly population has an increased risk to develop this electrolyte disorder due to the high frequency of predisposing factors such as malnutrition, malabsortion and above all polimedications. Proton pump inhibitors (PPIs) are one of the most used classes of drugs in the elderly either for the treatment of gastric acid-related diseases or for a prophylactic use. In recent years increasing evidence have been reported suggesting a relationship between the long-term use of PPIs and the onset of a magnesium deficiency. We describe an uncommon case of delirium in a 81 years old woman associated with severe hypomagnesaemia (0.6 mg/dl), prolonged QT intervals and which has subsequently developed a supraventricular tachycardia, occurred during a long term PPIs treatment with pantoprazole and completely regressed after parenteral magnesium treatment and PPIs suspension. http://dx.doi.org/10.1016/j.eurger.2013.07.452 P390
The challenge of diagnosis and decision making in Geriatrics: A case of cerebral sinus thrombosis with intracerebral hemorrhage in a 87-year-old woman affected by multiple comorbidities F. Guerriero , C. Sgarlata , M. Rollone , N. Maurizi , M. Rondanelli , F. Sardi , L. Venturini , S. Perna , M.A. Faliva , G. Ricevuti Giovanni Azienda di Servizi alla Persona di Pavia, Università degli Studi di Pavia, Pavia, Italy Text.– Cerebral venous sinus thrombosis (CVST) is an uncommon form of stroke that unlike arterial stroke usually affects children and young individuals with a variable outcome ranging from com-