Detección de problemas en pacientes geriátricos con fractura de cadera. Importancia de la colaboración entre traumatólogo y geriatra / Detection of health conditions in elderly patients with a hip fracture. Importance of collaboration between orthopedic and geriatric specialists

Objetivo. Evaluar el beneficio que proporciona un Equipo Consultor Geriátrico (ECG) a los pacientes geriátricos que ingresan con fractura de cadera en cuanto a la detección de problemas clínicos. Material y método. Estudio prospectivo y controlado que compara dos grupos: los pacientes manejados por el ECG y los que no conoció dicho equipo. Resultados. Fueron estudiados 449 pacientes, con una edad media de 83 años y el 80% mujeres. El ECG detectó más antecedentes personales (5,4 frente a 3,3) y más síndromes geriátricos previos (2 frente 0,4). A lo largo del ingreso el ECG detectó más complicaciones (3,8 frente a 0,4), más nuevos diagnósticos (2,1 frente a 0,4) y más síndromes geriátricos (3,6 frente a 0,5). Las diferencias resultaron significativas en los siguientes problemas: anemia, desnutrición, estreñimiento, delirium, osteoporosis, úlceras por presión, demencia, déficit sensoriales e incontinencia. Algunos de los datos recogidos nos sugieren que pudo haber diagnósticos no detectados en el grupo control. Conclusiones. La revisión diaria por parte del ECG de los pacientes ofrece una evaluación más completa y reduce la probabilidad de infradiagnóstico de problemas clínicos importantes. La colaboración entre traumatólogo y geriatra da como resultado un manejo del paciente más efectivo

Purpose. To assess the benefits of a Geriatric Consultant Team (GCT) to detect health conditions in elderly patients hospitalized for a hip fracture. Materials and methods. This was a prospective controlled study that compared two groups: patients under the care of a GCT and those not under the care of a GCT. Results. A total of 449 patients were studied; mean age 83 years; 80% women. The GCT detected more incidents in clinical records (5.4 compared to 3.3), and more previous geriatric syndromes (2 compared to 0.4). During hospitalization the GCT detected a higher rate of complications (2.1 compared to 0.4) and more geriatric syndromes (3.6 compared to 0.5). Significant differences were seen in the following conditions: anemia, malnutrition, constipation, delirium, osteoporosis, bedsores, dementia, sensory deficits and incontinence. Some of the data collected suggested that there might have been non-detected health conditions in the control group. Conclusions. The GCT reviewed patients daily, which resulted in a more complete assessment and a reduction in the probability of under-diagnosing significant clinical conditions. More effective patient care is achieved when Geriatric and Orthopedic Specialists work together (AU)

[The coronary sulcus and ischemic cardiopathy: an independent association of risk factors]. / Surco coronario y cardiopatía isquémica: una asociación independiente de los factores de riesgo.

BACKGROUND: Coronary sulcus of the auricular lobe has been related to the presence of ischemic cardiopathy although the nature of this relation has not been well defined. The aim of the present study was to determine whether there is a relation between the sulcus and the classical coronary risk factors, or whether the association between coronariopathy and sulcus is independent of such factors. METHODS: Patients admitted into an intensive care unit (n = 222) were divided into two groups according to whether coronary sulcus was present and the following analysis were performed: 1) comparative study between the groups for the variables: age, sex, coronariopathy, hyperglycemia, hyperlipidemia, hypertension, index of body mass, and tobacco habit. 2) logistic regression analysis used as a variable to study the existence of coronary sulcus and as independent factors the different coronary risk factors. 3) calculation of sensitivity and specificity of the coronary sulcus as a marker of ischemic cardiopathy. RESULTS: In the comparison between groups the individuals with coronary sulcus had greater age, cholesterolemia, index of body mass, with greater frequency found in females with ischemic cardiopathy. In the logistic regression analysis the presence of coronary sulcus was only associated by order of statistical significance to the variables of age and the female sex. In this study, coronary sulcus was a sensitive (87.6%) although unspecific (41.2%) marker of coronariopathy. CONCLUSIONS: The prevalence of coronary sulcus increases with age, and is greater in patients with ischemic cardiopathy. This relation is independent of the classical coronary risk factors.