Internal and emergency medicine
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Review Meta Analysis
Internal jugular vein ultrasound for the diagnosis of hypovolemia and hypervolemia in acutely ill adults: a systematic review and meta-analysis.
Accurate volume status assessments allow physicians to rapidly implement therapeutic measures in acutely unwell patients. However, existing bedside diagnostic tools are often unreliable for assessing intravascular volume. We searched PUBMED, EMBASE, CENTRAL, and Web of Science for English language articles without date restrictions on January 20, 2022. ⋯ For the diagnosis of hypervolemia, IJV-US had a pooled sensitivity of 0.84 (95% CI 0.70 to 0.92; moderate-certainty evidence) and specificity of 0.70 (95% CI 0.55 to 0.82; very low-certainty evidence). IJV-US has moderate sensitivity and specificity for the diagnosis of hypervolemia and hypovolemia. Randomized controlled trials are needed to determine the role of IJV-US for guiding therapeutic interventions aimed at optimizing volume status.
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Among nonagenarians admitted to our emergency department (ED) for ground-level falls, we assessed the impact of pre-injury antithrombotic (AT) treatment on the post-traumatic consequences, and identified risk factors for 1-month mortality. All eligible patients were consecutively included over an 18-month period. Head trauma was attested by reliable medical history, witnesses or recent external signs. ⋯ At 1 month, 103 patients (10.2%) had died. The independent risk factors for 1-month mortality were: ICH associated with head trauma (OR = 5.9, 95% CI 2.5-14), Glasgow coma score ≤ 12 at admission (OR = 10; 95% CI 2.2-46), atrial fibrillation (OR = 2.2, 95% CI 1.4-3.4) and age ≥ 95 years (OR = 1.6, 95% CI 1.0-2.5). Our results support accurate and regular assessment of the benefit/risk ratio for antithrombotic treatment among elderly people at high risk for falls.