Predictive accuracy of triage nurses evaluation in risk stratification of syncope in the emergency department.

BACKGROUND: Syncope is a common clinical problem that accounts for 1-3% of all emergency department (ED) visits. Its prognosis is extremely variable with a 1-year mortality that may reach 30%. There are no available data about the accuracy of nursing triage in identifying high-risk syncope. The aim of our study was to evaluate the predictive accuracy of nursing triage in identifying high-risk syncope. METHODS: We conducted a retrospective study on 678 consecutive patients who presented with syncope at four EDs. For each patient, nursing triage, comorbidities, clinical features and adverse events that occurred both in the ED and at 10-day follow-up were assessed. Adverse events included death, readmission to ED, need for major therapeutic procedures, cardiopulmonary resuscitation, intensive care unit admittance, acute antiarrhythmic therapy and major causes of syncope identified during the ED evaluation. Predictive accuracy of nursing triage was evaluated. RESULTS: We observed a total of 55 (8.1%) adverse events. Eight of them (9.4%) occurred among the 85 patients who were identified as high priority by nursing triage. Sensitivity (Sn) and specificity (Sp) of urgent nursing triage in identifying adverse outcomes in the ED (19 patients) were 21% (95% CI 3% to 39%) and 88% (95% CI 85% to 90%), while the positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were 1.7 and 0.9, respectively. Sn and Sp for 10-day adverse events were 15% (95% CI 5% to 24%) and 88% (95% CI 85% to 90%), respectively, with a LR+ of 1.18 and a LR- of 0.98. CONCLUSIONS: Nursing triage was characterised by a low predictive accuracy in identifying high-risk individuals.

[Syncope and work. STePS study (Short Term Prognosis of Syncope)]. / La sincope in età lavorativa. Studio multicentrico prospettico STePS.

BACKGROUND: Recurrent syncope is a common medical problem responsible for 3-5% of emergency department (ED) accesses and 1-6% of hospital admissions. If syncope occurs in a subject working in a critical safety task, the consequences of this event might be very dangerous for the worker, colleagues, others or for the environment. Therefore, syncope management is a major problem for occupational medicine, converning the general safety at work. AIMS: To evaluate the syncope events in a group of potential workers aged 18 to 65 years; to evaluate the symptoms preceding syncope and the presence of associated illnesses and recurrent events. POPULATION AND RESULTS: This study is part of the prospective study STePS (Short Term Prognosis of Syncope), and included 305 consecutive patients (aged 18-65 years, female 56%) who had syncope as a main symptom and presented at ED of four general hospitals in the Milan area, Italy, between the 23rd of January and 30th of June 2004. The 24% of subjects were hospitalized. In 21% the syncope occurs suddenly without any preceding symptom. The 67% of subjects didn't have any important illness at the time. 50% of subjects had recurrent syncope. In four subjects another syncope occurred in a 10 day follow-up. CONCLUSIONS: occupational medicine should consider syncope scrupulously. Proper diagnostic management is important to permit a correct evaluation of work safety issues.

Cervicography: adjunctive cervical cancer screening by primary care clinicians.

BACKGROUND: Cervicography is an adjunct method of cervical cancer screening intended to complement cervical cytologic sampling, ie, Papanicolaou (Pap) smear. Cervicography involves obtaining and evaluating a photographic image of the cervix. The purpose of this investigation was to evaluate the screening use of cervicography as an adjunct to clinical cytologic screening. METHODS: Women presenting at four clinical sites for annual cervical cytologic screening or for follow-up evaluation after receiving an abnormal Pap smear result were enrolled in the study. Each patient received a Pap smear and a cervigram. Those women in whom abnormalities were detected by either test subsequently underwent colposcopy, and when appropriate, histologic specimens were obtained. RESULTS: Pap smear and cervigram data were obtained for 1449 women. When premalignant or malignant histologic test results were considered as a true positive, the Pap smear correctly identified 25.6% of subjects with dysplasia and 37.5% with severe dysplasia. The Pap smear failed to identify the one patient with invasive cancer. The cervigram detected 50.5% of the subjects with dysplasia and 77.8% of the subjects with severe dysplasia, and it identified the one patient with invasive cancer when a positive cervigram was considered a true positive. When the results were combined, the two tests identified 62.9% of subjects with histologically confirmed dysplasia, 81.3% of subjects with severe dysplasia, and 100% (one patient) with cancer. CONCLUSIONS: The cervigram detected twice the number of patients with premalignant disease as the Pap smear alone, and correctly identified the invasive cancer. Cervicography improved the detection of cervical disease.

Bilateral posterolateral approach to the thoracolumbar spine through transversoarthropediculectomy with corporectomy.

Surgery of the dorsolumbar spine is currently benefiting from diverse approaches and the advent of computed tomography. This report describes a bilateral posterolateral approach with transversoarthropediculectomy and corporectomy. The advantages and disadvantages of this approach and its indications are discussed.