Screening and management of peripheral arterial obstructive disease in the lower limb wounds amongst diabetic elderly patients / Dépistage et prise en charge de l'artériopathie oblitérante des membres inférieurs dans le cadre des plaies du membre inférieur chez le sujet âgé diabétique

Introduction: Diabetes, a high prevalence chronic disease, especially in the elderly, is a risk factor of chronic lower limb wounds, whose management involves screening and treatment of peripheral arterial obstructive disease (PAOD), which must be systematic. Aim : Evaluate the screening and the management of PAOD amongst those patients, hospitalized in a Geriatric Department. Methods: Observational, retrospective, monocentric study, including all the elderly above 75 years old, with diabetes, and a wound in the lower limb, hospitalized from 01/01/2018 to 29/02/2020 at Henri Mondor hospital in Créteil. Results: Over the study period, 2567 patients were hospitalized, including 501 diabetic patients (19,5 %). 38 patients were included. Amongst them, 66 % had a bedsore, 18 % a leg ulcer, and 24 % a diabetic foot ulcer. Concerning the screening of PAOD, 66 % was screened for peripheral pulses, 8 % had an ankle-brachial index, and 45 % at least an imaging including 39 % arterial doppler. Amongst the 21 patients with PAOD, only one had a complete medical treatment, 6 had a revascularization including 5 amputations. Conclusion: Management of PAOD in the wound of lower limb amongst diabetic elderly patients is insufficient. Although it can be difficult to revascularize them, the screening must be systematic. Educate geriatric doctors in the screening of PAOD and build an expert team amongst them would help to improve that problematic.

Objectifs: Évaluer le dépistage et la prise en charge de l'artériopathie oblitérante des membres inférieurs (AOMI) chez les patients âgés diabétiques, hospitalisés en court séjour gériatrique. Méthodes: Étude observationnelle, rétrospective et monocentrique sur le service de gériatrie de l'hôpital Henri-Mondor, du 1er janvier 2018 au 29 février 2020. Inclusion des patients de plus de 75 ans, diabétiques, avec une plaie du membre inférieur. Résultats: 2 567 patients ont été hospitalisés, dont 501 diabétiques (19,5 %). Trente-huit (38) patients ont été inclus. Parmi eux, 66 % présentaient une escarre, 18 % un ulcère et 24 % une plaie du pied diabétique. Dans le dépistage de l'AOMI, 66 % des patients avaient eu une recherche des pouls périphériques, 8 % un indice de pression systolique et 45 % au moins une imagerie dont 39 % un Doppler artériel. Parmi les 21 patients avec AOMI, un seul avait un traitement médicamenteux complet, un autre avait bénéficié d'un geste de revascularisation et cinq avaient subi une amputation. Conclusion: La prise en charge de l'AOMI dans la plaie du membre inférieur chez le sujet âgé diabétique est insuffisante. La réalisation d'un geste vasculaire peut être compliquée, mais le dépistage est simple et devrait être systématique.

Automated interpretation of home blood pressure assessment (Hy-Result software) versus physician's assessment: a validation study.

OBJECTIVE: Hy-Result is the first software for self-interpretation of home blood pressure measurement results, taking into account both the recommended thresholds for normal values and patient characteristics. We compare the software-generated classification with the physician's evaluation. DESIGN METHOD: The primary assessment criterion was whether algorithm classification of the blood pressure (BP) status concurred with the physician's advice (blinded to the software's results) following a consultation (n=195 patients). Secondary assessment was the reliability of text messages. RESULTS: In the 58 untreated patients, the agreement between classification of the BP status generated by the software and the physician's classification was 87.9%. In the 137 treated patients, the agreement was 91.9%. The κ-test applied for all the patients was 0.81 (95% confidence interval: 0.73-0.89). After correction of errors identified in the algorithm during the study, agreement increased to 95.4% [κ=0.9 (95% confidence interval: 0.84-0.97)]. For 100% of the patients with comorbidities (n=46), specific text messages were generated, indicating that a physician might recommend a target BP lower than 135/85 mmHg. Specific text messages were also generated for 100% of the patients for whom global cardiovascular risks markedly exceeded norms. CONCLUSION: Classification by Hy-Result is at least as accurate as that of a specialist in current practice (http://www.hy-result.com).