RESUMEN
The number of elderly patients with aneurysmal subarachnoid hemorrhage (SAH) is increasing with the aging of the population. However, management recommendations based on long-term outcome data and analyses of prognostic factors are scarce. Our study focused exclusively on elderly patients aged ≥ 60 years at the onset of SAH. Patients were selected from an in-house database and compared in cohorts of age 60-69, 70-79, and ≥ 80, regarding pre-existing medical conditions, treatment, clinical course including complications, and outcome. A multivariate analysis was conducted to identify prognostic factors for death and disability. A total of 256 patients (138 aged 60-69, 93 aged 70-79, 25 aged ≥ 80) with putative aneurysmal SAH who had been admitted to our hospital between January 1, 1996 and June 30, 2007 were extracted. The median follow-up of our total cohort was 35.5 months (range <1-154 months). Endovascular or conservative aneurysm treatment was applied more often with increasing age (p < 0.006). The 1-year survival rate was 78, 65, and 38 % in the three age groups, respectively (p = 0.0002); most of the patients died from the initial hemorrhage or from medical complications. Patients aged <70 with an initial World Federation of Neurosurgical Societies (WFNS) score of I-III showed the best clinical recovery. WFNS score, age, and clipping/coiling were extracted as prognostic factors from the Cox model. Elderly patients who get admitted with a good WFNS score (I-III) seem to benefit from aggressive treatment whereas caution seems to be warranted particularly in patients ≥ 70 years of age who get admitted in a WFNS score of IV and V because of their limited short- and long-term prognosis.
Asunto(s)
Procedimientos Endovasculares/métodos , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/terapia , Factores de Edad , Anciano , Anciano de 80 o más Años , Causas de Muerte , Estudios de Cohortes , Femenino , Geriatría , Escala de Consecuencias de Glasgow , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Hemorragia Subaracnoidea/mortalidad , Hemorragia Subaracnoidea/fisiopatología , Resultado del TratamientoRESUMEN
OBJECTIVES: The purpose of this study was to identify predictors for nausea and vomiting during pregnancy (NVP). STUDY DESIGN: A large German health insurance company provided data on prescription reimbursements and socio-demographics for all women giving birth between June 2000 and May 2001. The prescribed drugs were classified according to the Anatomical Therapeutic Chemical (ATC) code. The data was linked to the database of the Bavarian Perinatal Study in psychosocial variables as possible predictors of NVP. RESULTS: The risk of developing NVP was two times higher for non-smokers than for smokers (OR=2.03 KI [1.02-4.05]) and dropped about 3% (OR=0.97 KI [0.94-0.99]) with every year of age. Being single raised the risk of NVP by about 50% (OR=1.49 KI [1.24-1.79]) compared to women who lived with a partner, and among these women living alone, working lowered the adjusted risk about two thirds (OR=0.34 KI [0.24-0.49]) compared to women who did not work. CONCLUSION: Psychosocial variables have a clear influence on nausea and vomiting during pregnancy. Physicians should be aware of this fact when seeing women asking for treatment.
Asunto(s)
Náuseas Matinales/psicología , Estrés Psicológico/complicaciones , Adolescente , Adulto , Antieméticos , Utilización de Medicamentos , Femenino , Alemania , Humanos , Modelos Logísticos , Persona de Mediana Edad , Náuseas Matinales/tratamiento farmacológico , Análisis Multivariante , Embarazo , Factores de Riesgo , Factores SocioeconómicosRESUMEN
OBJECTIVES: The purpose of this study was to examine the prescribing patterns of anti-emetics for pregnant women in Germany. METHOD: A large, nation-wide German statutory sickness fund provided data of reimbursed prescriptions and personal data for all insured women giving birth between June 2000 and May 2001 (n = 41,293). The prescribed drugs were classified according to the Anatomical Therapeutic Chemical code. RESULT: About 13.9% (n = 5,746) of all pregnant women received an anti-emetic prescription. Over 98.5% of these women were treated with anti-emetics that are considered safe. But only 27.8% received the recommended anti-histamine meclozine and 2.1% the safest drug pyridoxine. CONCLUSION: As there are no official guidelines for the treatment of nausea and vomiting during pregnancy in Germany, many different drugs are used, sometimes ignoring effectiveness and even safety. Therefore, evidence-based guidelines for anti-emetic therapy are needed.