Misdiagnosis Worsens Prognosis in Subarachnoid Hemorrhage With Good Hunt and Hess Score.

Background and Purpose- Our aim was to describe variables associated with initial misdiagnosis of subarachnoid hemorrhage (SAH). We also analyzed the relationship of misdiagnosis with poor outcome and complications in good Hunt and Hess (HH) cases. Methods- In a prospective cohort of 401 patients with SAH, misdiagnosis was defined as failure to correctly identify, at first physician contact, a subsequently documented SAH; this meant no urgent radiological study and lumbar puncture was performed. Poor outcome was defined as modified Rankin Scale score 3 to 6 at 3-month follow-up. We recorded age, sex, hypertension, diabetes mellitus, current smoking, previous antithrombotic treatment, initial HH and radiological severity, presence of aneurysm, first therapeutic procedure, hydrocephalus, delayed cerebral ischemia (DCI), rebleeding, and procedure-related complications. Results- Misdiagnosis was confirmed in 104/401 (25.9%) patients, who also had a longer time-to-admission to hospital. Misdiagnosis was associated with less clinical and radiological severity, compared with a correct diagnosis; the 2 groups did not differ in age or cardiovascular risk factor profile. Poor outcome was registered in 167/401 patients (41.6%). Age, misdiagnosis, and greater clinical and radiological initial severity were independent predictors of poor outcome. In the 236 patients (58.8% of cohort) with HH 1-2, misdiagnosis was associated with poor outcome in univariate and multivariate analysis, respectively (odds ratio=3.89; 95% CI, 1.89-8.01). Delayed cerebral ischemia (odds ratio=2.47; 95% CI, 1.2-5.09) and procedure-related complications (odds ratio=2.27; 95% CI, 1.07-4.82) were independently associated with misdiagnosis. Conclusions- Misdiagnosis is an unresolved problem in SAH, and it is a missed opportunity for good outcome in patients with HH 1-2. The poor outcome is partially explained by a higher risk of delayed cerebral ischemia and procedure-related complications in misdiagnosed patients. There is a need to improve the diagnostic strategy in patients reporting only a headache (HH 1-2) after SAH.

Perfil de utilización de los servicios de salud durante los XVII Juegos Deportivos Centroamericanos y del Caribe: Delegación de Puerto Rico, Ponce 1993 / Profile of health services utilization during the XVII Central and Caribbean Sport Games: Delegation of Puerto Rico, Ponce 1993

During the XVII Central American and Caribbean Sports Games held in Ponce in 1993 the health services offered to the Puerto Rico Delegation included medical, dental and psychological assistance, physical therapy and services on the playing field. Information about the use of these services was obtained from the encounter sheets. The Puerto Rican delegation of 750 members had 1,800 encounters with the health team; 612 (34.0 per cent ) individual consults; 896 (54.8 per cent ) physical therapy sessions; 166 (9.2 per cent ) encounters in the sports venues; and 36 (20 per cent ) group therapies. The most common diagnoses were athletic injuries (304; 58.2 per cent ) and diseases of the respiratory system (76; 14.5 per cent ). The most frequent athletic injuries were first degree strains (75; 24.7 per cent ) and tendinitis (73, 24.0 per cent ). This pattern is similar to that observed in other sports games and delegations with mild conditions prevailing. An interdisciplinary work and biopsychosocial approach will be important for the better health and performance of our athletes

Patterns of injuries in athletes evaluated in an interdisciplinary clinic

The pattern of sports injuries appears to be population-specific. The purpose of the present study is to describe 1750 injuries evaluated between April 1988 and April 1994 in our Olympic Training Center Interdisciplinary Sports Injury Clinic. Our patient population included elite and recreational athletes of both sexes between the ages of 7 and 71 years. Males comprised 73 per cent of the patient population and approximately 80 per cent of the injuries corresponded to the 10 to 29 age range. The most frequent sports in males were baseball (21.9 per cent ) and basketball (15.9 per cent ) and in females were track and field (17.1 per cent ) and gymnastics (15.1 per cent ). Most injuries (52 per cent ) were traumatic in nature, chronic (71.6 per cent ), and occurred during training sessions (57.4 per cent ). The most commonly affected anatomical areas were the knee (31.2 per cent ) and shoulder (15.5 per cent ). The most common diagnoses were tendinitis (25.4 per cent ), and first degree strains (11.8 per cent ) and sprains (9.3 per cent ). Finally, treatment strategies included medications (61.0 per cent ), physical therapy (48.9 per cent ), relative rest (35.7 per cent ), and home exercise programs (35.2 per cent ). The variety of musculoskeletal disorders seen in combination with the frequent use of conservative treatment confirms the importance of an interdisciplinary approach to sports injuries

Morbilidad durante los XVI Juegos Deportivos Centroamericanos y del Caribe: Delegación de Puerto Rico, México 1990 / Morbidity during the XVI Central American and Caribbean Games: Puerto Rico delegation, Mexico 1990

The health services offered to the Puerto Rican Delegation during the XVI Central American and Caribbean Sports Games in México in 1990 included: medical, dental and psychological assistance, physical therapy and services on the playing field. From the consultation sheets completed during the Games we obtained information about the use of these services. The 336 members of the Puerto Rico Delegation in the village at México City had 1,838 encounters with the health team. Of these, 991 were medical consults, 55 group therapies, 466 physical therapy sessions and 326 encounters in the sports venues. Among the encounters for medical evaluation the most frequent problems were athletic injuries (318; 32.1 percent), respiratory problems (240; 24.2 percent), gastrointestinal conditions (126; 12.7 percent) and dental services (119; 12.0 percent). The most frequent athletic injuries were first degree strains (83; 26.1 percent), tendinitis (56; 17.6 percent), contusions (42; 13.2 percent), myositis (40; 12.6 percent) and first degree sprains (28; 8.8 percent). The health problems found were diversed and in the majority of cases mild in character, which can be attend by adequately trained on sports health primary health professionals