Different studies report non-attendance to treatment of between 20 to 70% of patients after a suicide attempt. However, few studies have analyzed the characteristics of this non-attending population. To determine therefore the characteristics or profile of individuals who do not attend outpatient centres to which they are referred after a suicide attempt, we performed this study. A total of 232 patients who had attended the Emergency Department of our general hospital were interviewed. Instruments used included the suicide risk scale, the violent behaviour scale, the impulsivity scale, the hopelessness scale, and the Beck's depression scale. Seventy-three percent of the sample did not attend the mental health centre to which they had been referred. In comparison to the attending group, the non-attending group had the following characteristics: unmarried, residing in an urban area, took less precautions not to be discovered, were more critical of the attempt, and the purpose of the attempt was to resolve a conflict. Our data emphasize the importance of social and interpersonal aspects in determining the nature of the psychiatric care required by these types of patients.
Introducción. El tromboembolismo de pulmón agudo (TEP) representa la tercera causa de mortalidad cardiovascular. Sin embargo, existen pocos datos de esta patología en nuestro país. Objetivo. Describir las características basales, evolución y tratamiento implementado en pacientes internados por TEP agudo en Argentina. Métodos. Estudio multicéntrico, prospectivo y observacional de pacientes con diagnóstico de TEP agudo internados en centros con residencia de Cardiología desde octubre de 2016 a noviembre de 2017 independientemente si este fuere causa de la internación o surgiera como complicación de hospitalización por otra causa. Se remitirán datos en forma online a través de un sitio seguro con contraseña individual para cada centro participante. Se analizarán variables sociodemográfi cas, clínicas, estudios complementarios y evolución intrahospitalaria. Se realizará auditoría cruzada al 20% de los centros. Conclusiones. El registro CONAREC XX aportará valiosa información para conocer la realidad del TEP agudo en nuestro país.
Aims
Pulmonary embolism severity index (PESI) has been developed to help physicians make decisions about the treatment of patients with pulmonary embolism (PE). The combination of echocardiographic parameters could potentially improve PESI’s mortality prediction. To assess the additional prognostic value of tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) when combined with the PESI score in patients with PE to predict short-term mortality.
Methods and results
A multicentric prospective study database of patients admitted with PE in 75 academic centres in Argentina between 2016 and 2017 was analysed. Patients with an echocardiogram at admission with simultaneous measurement of TAPSE and PASP were included. PESI risk score was calculated blindly and prospectively, and in-hospital all-cause mortality was assessed. Of 684 patients, 91% had an echocardiogram, PASP and TAPSE could be estimated simultaneously in 355 (57%). All-cause in-hospital mortality was 11%. The receiver operating characteristic analysis showed an area under the curve (AUC) [95% confidence interval (CI)] of 0.76 (0.72–0.81), 0.74 (0.69–0.79), and 0.71 (0.62–0.79), for the PESI score, PASP, and TAPSE parameters, respectively. When PESI score was combined with the echocardiogram parameters (PESI + PASP-TAPSE = PESI-Echo), an AUC of 0.82 (0.77–0.86) was achieved (P = 0.007). A PESI-Echo score ≥128 was the optimal cut-off point for predicting hospital mortality: sensitivity 82% (95% CI 67–90%), specificity 69% (95% CI 64–74%). The global net reclassification improvement was 9.9%.
Conclusions
PESI-Echo score is a novel tool for assessing mortality risk in patients with acute PE. The addition of echocardiographic parameters to a validated clinical score improved the prediction of hospital mortality.
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