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Domínguez-Rodríguez A, Hernández-Vaquero D, Suero-Méndez C, Burillo-Putze G, Gil V, Calvo-Rodríguez R, Piñera-Salmerón P, Llorens P, Martín-Sánchez FJ, Abreu-González P, Formica F, Miró Ò. Effects of midazolam vs morphine in patients with acute pulmonary edema with left ventricular systolic dysfunction: a secondary analysis of data from the MIMO trial. Emergencias 2023; 35:25-30. [PMID: 36756913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES The midazolam vs morphine (MIMO) trial showed that patients treated with midazolam had fewer serious adverse events than those treated with morphine. In many patients with acute pulmonary edema, the left ventricular ejection fraction (LVEF) is preserved, at 50% or higher. We aimed to determine whether left ventricular (LV) systolic dysfunction (D), defined by an LVEF of less than 50%, modifies the protective effect of midazolam vs morphine. MATERIAL AND METHODS The MIMO trial randomized 111 patients with acute pulmonary edema to receive intravenous midazolam in 1-mg doses to a maximum of 3 mg (n = 55) or morphine in 2- to 4-mg doses to a maximum of 8 mg (n= 56). We calculated the relative risk (RR) for a serious adverse event in patients with and without systolic LVD. RESULTS LVEF was preserved in 84 (75.7%) of the patients with acute pulmonary edema. In patients with systolic LVD, 4 patients (26.9%) in the midazolam arm vs 6 (50%) in the morphine arm developed serious adverse events (RR, 0.53; 95% CI, 0.2-1.4). In patients without systolic LVD, 6 patients (15%) in the midazolam arm vs 18 (40.9%) in the morphine arm experienced such events (RR, 0.37; 95% CI, 0.16-0.83). The presence of systolic LVD did not modify the protective effect of midazolam on serious adverse effects (P=.57). CONCLUSION The effect of midazolam vs morphine in protecting against the development of serious adverse events or death is similar in patients with and without systolic LVD.
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Affiliation(s)
- Alberto Domínguez-Rodríguez
- Servicio de Cardiología, Hospital Universitario de Canarias, Universidad Europea de Canarias, Tenerife, España. CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
| | - Daniel Hernández-Vaquero
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, España. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España. Universidad de Oviedo, Oviedo, España
| | | | - Guillermo Burillo-Putze
- Servicio de Urgencias, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, España
| | - Victor Gil
- Servicio de Urgencias, Hospital Clinic, Barcelona, Institut d' Investigació Biomèdica August Pi iSunyer (IDIBAPS); Universidad de Barcelona, Cataluña, España
| | | | | | - Pere Llorens
- Servicio de Urgencias, Hospital General de Alicante, España
| | | | - Pedro Abreu-González
- Departmento de Fisiología, Facultad de Medicina, Universidad de La Laguna, Tenerife, España
| | - Francesco Formica
- Universidad de Parma, Departamento de Medicina y Cirugía, Parma, Italia
| | - Òscar Miró
- Servicio de Urgencias, Hospital Clinic, Barcelona, Institut d' Investigació Biomèdica August Pi iSunyer (IDIBAPS); Universidad de Barcelona, Cataluña, España
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Jacob J, Albert-Casado A, Del-Castillo JG, Llorens-Soriano P, Jiménez-Hernández S, Burillo-Putze G, Martín-Martínez A, Martín-Sánchez FJ, García-Lamberechts EJ, Piñera-Salmerón P, Alquézar-Arbé A, Ferre-Losa C, Juan-Gómez MÁ, Serrano-Lázaro L, Noceda-Bermejo J, Salido-Mota M, Fortuny-Bayarri MJ, González-Tejera M, Ferreras-Amez JM, Díaz-Fernández E, Quero-Motto E, Peiró-Gómez A, Martín-Mojarro E, Llopis-Roca F, Huerta-García A, Pedraza-García J, Meléndez-Cálix N, Brazó-Aznar JV, Cano-Cano MJ, Miró Ó. Safety and Revisit Related to Discharge the Sixty-one Spanish Emergency Department Medical Centers Without Hospitalization in Patients with COVID-19 Pneumonia. A Prospective Cohort Study UMC-Pneumonia COVID-19. Rev Invest Clin 2022; 74:135-146. [PMID: 35240755 DOI: 10.24875/ric.22000021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Information is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. OBJECTIVES The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). METHODS Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. RESULTS We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom weredischarged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176 3.037), age < 60 years (aOR 2.324; 95%CI 1.353-3.990), and lymphocyte count > 1200/mm3 (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A totalof 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). CONCLUSION Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality.
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Affiliation(s)
- Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arantxa Albert-Casado
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan G Del-Castillo
- Emergency Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Pere Llorens-Soriano
- Emergency Department, Hospital General de Alicante, University Miguel Hernández, Elche, Alicante, Spain
| | | | | | | | | | | | | | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carles Ferre-Losa
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María Á Juan-Gómez
- Emergency Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | | | - José Noceda-Bermejo
- Emergency Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Manuel Salido-Mota
- Emergency Department, Hospital Universitario Regional de Málaga, Málaga, Spain
| | | | | | - José M Ferreras-Amez
- Emergency Department, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Eva Quero-Motto
- Emergency Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | - Ferran Llopis-Roca
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Jorge Pedraza-García
- Emergency Department, Hospital Valle de los Pedroche de Pozoblanco, Córdoba, Spain
| | | | - José V Brazó-Aznar
- Emergency Department, Hospital Universitario de la Ribera, Valencia, Spain
| | | | - Óscar Miró
- Emergency Department, Hospital Clínic de Barcelona, Spain
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García de Guadiana-Romualdo L, Martínez Martínez M, Rodríguez Mulero MD, Esteban-Torrella P, Hernández Olivo M, Alcaraz García MJ, Campos-Rodríguez V, Sancho-Rodríguez N, Galindo Martínez M, Alcaraz A, Ros Braquehais MS, Báguena Perez-Crespo C, Ramos Arenas V, Tomás Jiménez C, Consuegra-Sánchez L, Conesa-Hernandez A, Piñera-Salmerón P, Bernal-Morell E. Circulating MR-proADM levels, as an indicator of endothelial dysfunction, for early risk stratification of mid-term mortality in COVID-19 patients. Int J Infect Dis 2021; 111:211-218. [PMID: 34461254 PMCID: PMC8400460 DOI: 10.1016/j.ijid.2021.08.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 12/23/2022] Open
Abstract
Objectives Thromboinflammation, resulting from a complex interaction between thrombocytopathy, coagulopathy, and endotheliopathy, contributes to increased mortality in COVID-19 patients. MR-proADM, as a surrogate of adrenomedullin system disruption, leading to endothelial damage, has been reported as a promising biomarker for short-term prognosis. We evaluated the role of MR-proADM in the mid-term mortality in COVID-19 patients. Methods A prospective, observational study enrolling COVID-19 patients from August to October 2020. A blood sample for laboratory test analysis was drawn on arrival in the emergency department. The primary endpoint was 90-day mortality. The area under the curve (AUC) and Cox regression analyses were used to assess discriminatory ability and association with the endpoint. Results A total of 359 patients were enrolled, and the 90-day mortality rate was 8.9%. ROC AUC for MR-proADM predicting 90-day mortality was 0.832. An optimal cutoff of 0.80 nmol/L showed a sensitivity of 96.9% and a specificity of 58.4%, with a negative predictive value of 99.5%. Circulating MR-proADM levels (inverse transformed), after adjusting by a propensity score including eleven potential confounders, were an independent predictor of 90-day mortality (HR: 0.162 [95% CI: 0.043-0.480]) Conclusions Our data confirm that MR-proADM has a role in the mid-term prognosis of COVID-19 patients and might assist physicians with risk stratification.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Antonia Alcaraz
- Infectious Disease Unit, Hospital General Universitario Reina Sofía, Murcia, Spain
| | | | | | - Verónica Ramos Arenas
- Laboratory Medicine Department, Hospital Universitario Santa Lucía, Cartagena, Spain
| | | | | | | | | | - Enrique Bernal-Morell
- Infectious Disease Unit, Hospital General Universitario Reina Sofía, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB).
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García-Villalba E, Cano-Sánchez A, Alcaraz-García A, Cinesi-Gómez C, Piñera-Salmerón P, Marín I, Muñoz Á, Vicente Vera T, Bernal-Morell E. [Nomogram to predict a poor outcome in emergency patients with sepsis and at low risk of organ damage according to Sepsis-related Organ Failure Assessment (SOFA)]. Emergencias 2018; 29:81-86. [PMID: 28825248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To develop a nomograph to predict a poor outcome (death during hospitalization or a hospital stay longer than 15 days) in emergency patients with sepsis and at low risk of organ damage according to Sepsis-related Organ Failure Assessment (SOFA). MATERIAL AND METHODS Prospective, observational study carried out in a single universitary hospital. All patients admitted from the emergency department with sepsis and SOFA scores of 6 or lower were enrolled. We used bivariate logistic regression analysis to develop a predictive nomogram. RESULTS A total of 174 patients were included. Seventeen patients (9.8%) died during hospitalization and the average hospital stay was greater than 15 days in 29 (16.7%) patient. The outcome was poor in a total of 42 patients (24.1%);. Independent variables that were significantly associated with a poor outcome were SOFA score (odds ratio [OR], 1.3; 95% CI, 1.06-1.71; P<.05), C-reactive protein (CRP) concentration (OR, 1.04; 95% CI, 1.0-1.09; P<.05), N-terminal fragment of brain natriuretic peptide (NT-proBNP) concentration over 1330 ng/mL (OR, 2.64; 95% CI, 1.17-6.22; P<.05), and septic shock (OR, 8.3; 95% CI, 1.16-166.5; P<.05). For a SOFA score of 2 or more the crude OR was 4.44 (95%, CI, 1.91-10.34) and the OR adjusted for other variables was 3.08 (95% CI, 1.24-7.69). CONCLUSION A high percentage of patients predicted to be at low risk of organ failure had poor outcomes, associated with SOFA score, the presence of septic shock, CRP concentration, and elevated NT-proBNP concentration. The SOFA score by itself is an inadequate prognostic tool in patients at low risk of organ damage. Other clinical and analytical variables are required to complement the SOFA score.
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Affiliation(s)
- Eva García-Villalba
- Sección de Enfermedades Infecciosas, Hospital General Universitario Reína Sofía de Murcia, España
| | - Alfredo Cano-Sánchez
- Sección de Enfermedades Infecciosas, Hospital General Universitario Reína Sofía de Murcia, España
| | - Antonia Alcaraz-García
- Sección de Enfermedades Infecciosas, Hospital General Universitario Reína Sofía de Murcia, España
| | - César Cinesi-Gómez
- Servicio de Urgencias, Hospital General Universitario Reína Sofía, Murcia, España
| | | | - Irene Marín
- Sección de Enfermedades Infecciosas, Hospital General Universitario Reína Sofía de Murcia, España
| | - Ángeles Muñoz
- Sección de Enfermedades Infecciosas, Hospital General Universitario Reína Sofía de Murcia, España
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Alcaraz-Martínez J, Aranaz-Andrés JM, Cantero-Sandoval A, Piñera-Salmerón P, Mas-Luzón J, Serrano-Martínez JA, González Garro E. [Use of complementary tests in emergencies and their relation with patient safety incidents]. J Healthc Qual Res 2018. [PMID: 29534933 DOI: 10.1016/j.cali.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To analyse the use of complementary tests and their relationship with safety incidents in hospital emergency departments. METHODOLOGY An analysis was performed on 935 patients seen in the 9 hospital emergency departments. The source of data used for the detection of incidents were: emergency department clinical record and reports, together with face-to-face observation in the department, plus a telephone survey of the patient or family member at one week after the care. Statistical tests used: The Student t test for quantitative variables, Chi squared test for qualitative variables, and the ANOVA test. RESULTS A peripheral venous catheter was used in 397 patients (42.4% (95% CI; 39.3-45.5%)), with a variability with significant differences between hospitals (P<.01), with a range of use from 37% to 81.8%. It was also observed that in 23.4% (95% CI; 19.2-27.6%) of the cases, the catheter was not used after the first blood draw. Radiological tests were requested for 351 patients, 37.7% (95% CI; 34.6-40.8%), also with significant differences between hospitals (P<.01), ranging from 24.6 to 65, 1%. Incidents were detected in 95 (10.2%) patients (95% CI; 8.3-12.1%) in the all the study centres. A higher proportion of safety incidents have been observed in patients where peripheral venous catheter has been used (12.8%) than in those in whom they had not been used (8.5%) (P=.03), as well as in patients on whom an x-ray was requested (12.8%) compared to those who did not (8.64%) (P=.04). A longer stay was also observed in cases with an incident (mean 248.9minutes) than in those where there were none (mean 164.1minutes) (P<.001). No statistically significant differences were found in the other parameters studied. CONCLUSION A relationship was observed between the use of a peripheral venous catheter (many of them without use) and radiological tests and the occurrence of safety incidents in the Emergency Departments.
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Affiliation(s)
- J Alcaraz-Martínez
- Unidad de Calidad y Servicio de Urgencias, Hospital Universitario J.M. Morales Meseguer, Murcia, España.
| | - J M Aranaz-Andrés
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, Centro de Investigación Biomédica enRed en Epidemiología y Salud Pública (CIBERESP), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
| | - A Cantero-Sandoval
- Servicio de Urgencias, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | - J Mas-Luzón
- Servicio de Urgencias, Hospital Universitario J.M. Morales Meseguer, Murcia, España
| | - J A Serrano-Martínez
- Servicio de Urgencias, Hospital Universitario J.M. Morales Meseguer, Murcia, España
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Sánchez-Nicolás JA, Cinesi-Gómez C, Villén-Villegas T, Piñera-Salmerón P, García-Pérez B. [Relation between ultrasound-measured diaphragm movement and partial pressure of carbon dioxide in blood from patients with acute hypercapnic respiratory failure after the start of noninvasive ventilation in an emergency department]. Emergencias 2016; 28:345-348. [PMID: 29106106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the correlation between variations in ultrasound-measured diaphragm movement and changes in the arterial partial pressure of carbon dioxide (PCO2) after the start of noninvasive ventilation (NIV). MATERIAL AND METHODS RDescriptive study of a prospective case series comprised of nonconsecutive patients aged 18 years or older with hypercapnic respiratory failure who were placed on NIV in an emergency department. We recorded clinical data, blood gas measurements, and ultrasound measurements of diaphragm movement. RESULTS Twenty-one patients with a mean (SD) age of 83 (13) years were studied; 11 (52.4%) were women. The mean (SD) range of diaphragm movement and PCO2 values at 4 moments were as follows: 1) at baseline: diaphragm movement, 13.90 (7.7) mm and PCO2, 71.75 (11.4) mm Hg; 2) after 15 minutes on NIV: diaphragm movement, 17.10 (9.1) mm; 3) at 1 hour: diaphragm movement, 22.40 (10.4) mm and PCO2, 63.45 (16.0) mm Hg; and 4) at 3 hours: diaphragm movement, 26.60 (19.5) mm and PCO2, 61.85 (13.0) mm Hg. We detected a statistically significant correlation between the difference in range of diaphragm movement at baseline and at 15 minutes and the decrease in PCO2 after 1 hour of NIV (r=-0.489, P=.035). CONCLUSION In patients with hypercapnic respiratory failure, the increase in range of diaphragm movement 15 minutes after starting NIV is associated with a decrease in PCO2 after 1 hour.
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Affiliation(s)
| | - César Cinesi-Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, España
| | | | | | - Bartolo García-Pérez
- Unidad de Corta Estancia, Hospital Virgen de la Arrixaca, Facultad de Medicina de la UCAM, Murcia, España
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Julián-Jiménez A, González-Del-Castillo J, Martínez-Ortiz-de-Zárate M, Arranz-Nieto MJ, González-Martínez F, Piñera-Salmerón P, Navarro-Bustos C, Henríquez-Camacho C, García-Lamberechts EJ. Short-term prognostic factors in the elderly patients seen in emergency departments due to infections. Enferm Infecc Microbiol Clin 2015; 35:214-219. [PMID: 26702902 DOI: 10.1016/j.eimc.2015.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/25/2015] [Accepted: 10/26/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To analyse factors associated with short-term mortality in elderly patients seen in emergency departments (ED) for an episode of infectious disease. MATERIALS AND METHODS A prospective, observational, multicentre, analytical study was carried out on patients aged 75years and older who were treated in the ED of one of the eight participating hospitals. An assessment was made of 26 independent variables that could influence mortality at 30days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Multivariate logistic regression analysis was performed. RESULTS The study included 488 consecutive patients, 92 (18.9%) of whom died within 30days of visiting the ED. Three variables were significantly associated with higher mortality: severe functional dependence, with Barthel index ≤60 [odds ratio (OR) 8,92; 95% confidence interval (CI): 4.98-15.98, P=.003], systolic blood pressure <90mmHg [OR 7.34; 95%CI: 4.39-12.26, P=.005] and serum lactate >4mmol/l [OR 21.14; 95%CI: 8.94-49.97, P=.001]. The area under the curve for the model was 0.971 (95%CI: 0.951-0.991; P<.001). CONCLUSIONS Several factors evaluated in an initial assessment in the ED, including the level of functional dependence, systolic blood pressure and, especially, serum lactate, were found to determine a poor short-term prognosis in the elderly patients who presented with an episode of an infectious disease.
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Affiliation(s)
| | | | | | | | | | | | - Carmen Navarro-Bustos
- Servicio de Urgencias, Hospital Universitario Virgen de la Macarena, Sevilla, España
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Bauset-Navarro JL, Sánchez-Ortuño IM, Gómez-Cárdenas C, Sanz-Monllor A, Cinesi-Gómez C, Piñera-Salmerón P. [Iatrogenic after spinal puncture technique. Prevalence study of headache and associated factors]. Rev Neurol 2014; 58:193-198. [PMID: 24570357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To determine the prevalence of headache following a transdural lumbar puncture and the risk factors involved. PATIENTS AND METHODS The method used was a prospective observation-based cohort study. Patients were recruited from the A and E Department, Neurology Service and Day Care Clinic. The following data were collected: physician's experience, number of punctures, variations in the plane, patient's posture, local anaesthetic, needle calibre and bevel, degrees of inclination, amount of liquid, fluid overload and whether or not rest is indicated after the puncture. After 48 hours, the appearance of headache (or not) was determined. RESULTS The sample consisted of 59 patients, 31 (52.5%) of whom were males. Mean age: 47 years; 32 patients (54.2%) came from A and E, 18 (30.5%) from Neurology and 9 (15.3%) from the Day Care Clinic. Forty-one (69.5%) received the lumbar puncture in a lateral decubitus position and 7 (11.9%) in a seated position. All the needles were bevelled, 21 (35.6%) with a calibre of 20 and 38 (64.4%) of calibre 22. Eight patients (13.56%) were without repose and 18 (33.3%) had no fluid overload. Twenty-three (38.98%) had post-lumbar-puncture headache, 12 (52.2%) of them females, with a mean age of 38.3 ± 16.4 years. The median of the headache intensity was 2.6. The mean time of appearance was seven hours. There were no differences for any of the factors studied, except the observed tendency towards a higher incidence of headache at younger ages. CONCLUSIONS Rates of post-lumbar-puncture headache in our series are high, and no differences were found in terms of the service where it was performed or experience. No influence was observed due to the amount of liquid extracted, the patient's position, the indication of repose or fluid overload.
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