La gravité de l'atteinte explique l'inadéquation entre le système des groupes homogènes de malades et les patients de réanimation

ObjectiveTo assess the relationship between diagnosis related groups (DRG) and severity of illness in intensive care unit (ICU) patients in semantical and economical terms.Study designProspective, multicentric study including 13 medical and surgical ICUs for adults.MaterialDischarge reports of 3,215 ICU adminissions including age, gender, diagnosis, organ system failures, length of stay (LOS) and severity of illness evaluated with severity scores (SS): simplified acute physiological score (SAPS), Apache II, Glasgow score and physiological score (PS).MethodsSemantical homogeneity was evaluated from the percentage of well-classified patients established from the comparison between the official computerized method and a non-computerized method applied by three clinical experts. Economical homogeneity was evaluated from the relationship between SS and LOS.ResultsIn total, 88% (Cl: 87.7 – 88.2) of ICU stays were classified in eight main categories of diagnosis (MCD). According to the MCD, the percentage of well-classified patients varied from 28% (Cl: 27.6 – 28.3) to 97% (Cl: 96.8 – 97.1), decreasing with the association of several diagnoses and organ system failures. There was a large variability in the LOS of DRG, and a significant correlation between LOS and SS was found in only 8/16 DRG.ConclusionThe fact that the severity of illness is not taken into account in the elaboration of DRGs explains the inadequacy of the DRG system in intensive care.     

Comment expliquer l’augmentation des thromboses chez le sujet âgé ?: Données physiopathologiques

The incidence of both arterial and venous thrombosis increases with age. The explanation is probably multifactorial, since elderly patients often have several risk factors. Aging per se appears to be an independent risk factor for thrombosis: age-related modifications of the vascular apparatus and blood components contribute to the development of a procoagulant state. Arterial and venous thromboses involve varying degrees of coagulation and platelet activation.