scholarly journals SAT-168 Adrenal Incidentalomas: Impact of Patient Age on Referral Rates for Endocrine Evaluation

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Anthony Fryer ◽  
Sarah Hancock ◽  
Cherian George ◽  
Basil George Issa ◽  
Simon Lea ◽  
...  
Keyword(s):  
Age Groups ◽  
Adrenal Incidentaloma ◽  
Older Age ◽  
Age Group ◽  
Adrenal Incidentalomas ◽  
Patient Age ◽  
Radiology Reports ◽  
Patient Âgé ◽  
Mri Scans ◽  
Ct And Mri

Abstract It is estimated that the prevalence of adrenal incidentaloma increases with age: ~3% of those aged 50 years, rising to 10% in those >70 years (1). Given the aging population together with increased utilisation of cross-sectional imaging in the UK (eg CT urogram, MR angiogram), we explored the proportion of patients with adrenal incidentaloma by age based on current imaging trends. Furthermore, there is no information currently available on the relationship between age and pattern of endocrine referrals. We extracted data for all CT and MRI scans from Jan 2018-Oct 2019 and used key phrases in radiology reports (eg adrenal adenoma/lesion/mass/nodule/incidentaloma, incidental adrenal, indeterminate adrenal) to identify potential lesions. We also extracted data on patient age and referral patterns as identified by a logged referral or an attendance (new or follow-up) to endocrine clinic 3 months post index scan, stratified by 10 year age groups. Where possible, we excluded false hits (eg no adrenal lesion). Preliminary data showed that, of the 2604 potential lesions identified by CT and MRI scans, 78.7% were on patients aged over 60 years. The numbers of identified lesions gradually increased with age to a peak in the 71-80 year age group after which these declined. Whilst patients younger that 60 years had fewer potential lesions identified, they were more likely to be referred to endocrine services (73 out of 55 patients; 13.2%) than those in the older age group (168 out of 2049; 8.2%; p<0.001). Indeed there was a statistically significant trend towards decreasing referral with age group (Chi-squared test for trend; p<0.001). In conclusion, patients over 60 years have a higher number of potential adrenal incidentalomas. However, this group is less likely to be referred for endocrine evaluation. This is particularly concerning given the large number of scans requested and the higher prevalence of incidentalomas in this age group. This study represents preparatory work on innovations to enhance case detection, particularly in the older age groups (2). 1. Fassnacht M, Arlt W, Bancos I, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline. Eur J Endocrinol. 2016;175:G1-G34 2. Hanna FWF, Issa BG, Lea SC, George C, Golash A, Firn M, Ogunmekan S, Maddock E, Sim J, Xydopoulos G, Fordham R, Fryer AA. Adrenal lesions found incidentally: how to improve clinical and cost-effectiveness. BMJ Open Quality. 2019;In press.

scholarly journals SAT-161 Adrenal Incidentalomas: Pattern of Referral According to Clinical Specialty

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Fahmy W F Hanna ◽  
Sarah Hancock ◽  
Cherian George ◽  
Basil George Issa ◽  
Simon Lea ◽  
...  
Keyword(s):  
Adrenal Incidentaloma ◽  
Adrenal Incidentalomas ◽  
Referral Pattern ◽  
Clinical Specialty ◽  
Referral Patterns ◽  
Medical Specialties ◽  
Radiology Reports ◽  
Wide Range ◽  
Mri Scans ◽  
Ct And Mri

Abstract Whilst the estimated prevalence of adrenal incidentaloma is 0.5-2% following abdominal CT scan (1), little is known about subsequent endocrine referral patterns according to clinical specialty. We therefore examined the range of specialties that were responsible for requesting CT and MRI scans that led to reporting potential adrenal lesions. We also explored the referral pattern to endocrinology following identification. We extracted data from all radiology reports for all CT and MRI scans from Jan 2018-Oct 2019. We utilised a key phrase search strategy (eg adrenal adenoma/lesion/mass/nodule/incidentaloma, incidental adrenal, indeterminate adrenal). Where possible we excluded false hits (eg no adrenal lesion). These were lined to the referral patterns as identified by a referral logged or an attendance (new or follow-up) to endocrine clinic 3 months post index scan. These data were stratified by requesting specialty. Preliminary data showed that, out of 127878 scans, 2021 patients were identified to have a potential adrenal incidentaloma. These requests came from a total of 45 different clinical specialities (medical and surgical). The top 12 specialties accounted from 82.8% of these referrals. Medical specialties (renal, gastroenterology, respiratory, general medicine, acute medicine and geriatric medicine) accounted for 50.2%. The remaining 32.6% were via surgical specialities. The overall referral pattern in these cases was 8.5% with no difference between medical (8.6%) and surgical (8.4%) specialties. In conclusion, adrenal incidentalomas are potentially identifiable across a wide range of specialties. Currently, despite a dedicated adrenal multidisciplinary team and nationally-acknowledged quality improvement programme for the management of adrenal incidentalomas (2), the majority of cases are overlooked and not referred for endocrine review as suggested in current guidelines. We expect the findings in our centre to be reproducible elsewhere. We are considering innovative approaches to improve the process and cope with the additional workload cost-effectively. 1. Barzon L, Sonino N, Fallo F, Palu G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol. 2003;149:273-285. Hanna FWF, Issa BG, Lea SC, George C, Golash A, Firn M, Ogunmekan S, Maddock E, Sim J, Xydopoulos G, Fordham R, Fryer AA. Adrenal lesions found incidentally: how to improve clinical and cost-effectiveness. BMJ Open Quality. 2019;In press.

scholarly journals Early CT features of COVID-19 pneumonia, association with patients’ age and duration of presenting complaint

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Reem M. EL Kady ◽  
Hosam A. Hassan ◽  
Tareef S. Daqqaq ◽  
Rania Makboul ◽  
Hanan Mosleh Ibrahim
Keyword(s):  
Pleural Effusion ◽  
Ground Glass Opacity ◽  
Ct Imaging ◽  
Older Age ◽  
Ground Glass ◽  
Imaging Features ◽  
Age Group ◽  
Patient Age ◽  
Atypical Features ◽  
Patient Âgé

Abstract Background Coronavirus disease (COVID-19) is a respiratory syndrome with a variable degree of severity. Imaging is a vital component of disease monitoring and follow-up in coronavirus pulmonary syndromes. The study of temporal changes of CT findings of COVID-19 pneumonia can help in better understanding of disease pathogenesis and prediction of disease prognosis. In this study, we aim to determine the typical and atypical CT imaging features of COVID-19 and discuss the association of typical CT imaging features with the duration of the presenting complaint and patients’ age. Results The lesions showed unilateral distribution in 20% of cases and bilateral distribution in 80% of cases. The lesions involved the lower lung lobes in 30% of cases and showed diffuse involvement in 58.2% of cases. The lesions showed peripheral distribution in 74.5% of cases. The most common pattern was multifocal ground glass opacity found in 72.7% of cases. Atypical features like cavitation and pleural effusion can occur early in the disease course. There was significant association between increased number of the lesions, bilaterality, diffuse pattern of lung involvement and older age group (≥ 50 years old) and increased duration of presenting complaint (≥ 4 days). There was significant association between crazy-paving pattern and increased duration of presenting complaint. No significant association could be detected between any CT pattern and increased patient age. Conclusion The most common CT feature of COVID-19 was multifocal ground glass opacity. Atypical features like cavitation and pleural effusion can occur early in the course of the disease. Our cases showed more extensive lesions with bilateral and diffuse patterns of distribution in the older age group and with increased duration of presenting complaint. There was a significant association between crazy-paving pattern and increased duration of presenting complaint. No significant association could be detected between any CT pattern and increased patient age.

scholarly journals SAT-174 Adrenal Incidentalomas: Prevalence and Referral Patterns in a UK University Hospital Using Real-Life Data

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Fahmy W F Hanna ◽  
Sarah Hancock ◽  
Cherian George ◽  
Basil George Issa ◽  
Gillian Powner ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Real Life ◽  
University Hospital ◽  
Ct Scans ◽  
Adrenal Incidentalomas ◽  
Referral Patterns ◽  
Radiology Reports ◽  
Effective Manner ◽  
Mri Scans ◽  
Ct And Mri

Abstract The estimated prevalence of adrenal incidentaloma at abdominal CT scan is 0.5-2% (1). However, from clinical practice, we noticed that incidentalomas are referred from other imaging modalities (eg MRI) and of other sites (eg thorax, spine). We therefore explored the relationship between prevalence rates and (i) imaging modality and (ii) its change over time, in a real world clinical setting from a large UK teaching hospital/trauma centre. We also examined the referral pattern of potential lesions to endocrinology. We extracted data from all radiology reports for all CT and MRI scans from Jan 2018-Oct 2019. We utilised a key phrase search strategy (eg adrenal adenoma/lesion/mass/nodule/incidentaloma, incidental adrenal, indeterminate adrenal). Where possible we excluded false hits (eg no adrenal lesion). These were linked to the referral patterns as identified by a referral logged or an attendance (new or follow-up) to endocrine clinic 3 months post index scan. Preliminary data showed that, from a total of 127878 scans performed, 2604 potential lesions were reported (prevalence 2.0%), comprising 2496/88838 (2.8%) CT scans and 108/39040 (0.3%) MRI scans. The number of scans/month increased in 2019 vs 2018 (6.9% for CT and 12.6% for MRI). Only 9.0% and 15.7% of reported potential lesions detected by CT and MRI, respectively, were referred for endocrine review. Hence, MRI patients were more likely to be referred than those with CT scans (p=0.018). Referral rates were lower in 2019 than 2018 (8.6% vs 14.4%; p less than 0.001). This approach has its limitations but allows efficiently review of large cohorts. Adrenal incidentalomas pose a rising challenge in view of increasing reliance on scanning. Despite a dedicated adrenal multidisciplinary team with a national track record in improving management of incidentalomas (2), the referral rate of potential lesions is worryingly low and not improving, with >90% of cases overlooked. This work is part of on-going innovation to enhance the pick-up rate for these cases whilst addressing the increased endocrine workload in a cost-effective manner. 1. Barzon L, Sonino N, Fallo F, Palu G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol. 2003;149:273-285. 2. Hanna FWF, Issa BG, Lea SC, George C, Golash A, Firn M, Ogunmekan S, Maddock E, Sim J, Xydopoulos G, Fordham R, Fryer AA. Adrenal lesions found incidentally: how to improve clinical and cost-effectiveness. BMJ Open Quality. 2019;In press.

Results of a Colpocytologic Mass Screening and In-patient Casework: Comparison by Age Groups

1977 ◽  
Vol 63 (6) ◽  
pp. 575-584
Author(s):  
Piero Canevini ◽  
Maurizio Spinelli ◽  
Laura Fibbi
Keyword(s):  
Mass Screening ◽  
Invasive Carcinoma ◽  
Age Distribution ◽  
Age Groups ◽  
Age Group ◽  
Patient Age ◽  
Patient Âgé ◽  
Three Phase

This paper reports the results of cervico-vaginal examinations performed on the women (7,098) resident in the municipality of Bollate (mass screening) and the women (1,416) hospitalized in the Gynecologic ward in the same period (in-patients). Age distribution, prevalence of initial and invasive forms, and prevalence according to age groups have been considered. The results are: 1) any kind of lesion is more frequent among in-patient than mass-screening subjects; 2) the prevalence of benign displasia, incipient, in situ and invasive carcinoma per age group, considered per quinquennium, shows a three-phase trend, both in mass screening and in-patient cases; 3) the time of evolution is different for cervicocarcinoma in the different age groups of incipience. Periodic checks are a useful means of precocious diagnosis of cervicocarcinoma; the frequency of checks should vary according to patient age.

Dispatcher CPR Instructions Across the Age Continuum

2018 ◽  
Vol 33 (3) ◽  
pp. 342-345 ◽  
Author(s):  
Kristi L. Weinmeister ◽  
E. Brooke Lerner ◽  
Clare E. Guse ◽  
Khalid A. Ateyyah ◽  
Ronald G. Pirrallo
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Survival Rates ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Age Group ◽  
Publication Type ◽  
Patient Age ◽  
Patient Âgé ◽  
Significant Difference ◽  
Bystander Cpr

AbstractBackgroundSurvival rates following out-of-hospital cardiac arrest (OHCA) increase two to three times when cardiopulmonary resuscitation (CPR) is started by bystanders, as compared to starting CPR when Emergency Medical Services (EMS) arrives. Municipalities that have implemented dispatcher-assisted bystander CPR programs have seen increased rates of bystander CPR. Cardiopulmonary resuscitation instructions are given for victims of all ages, but it is unknown if offering instructions results in similar rates of EMS-documented bystander CPR across the age continuum in these municipalities.ObjectivesThe aim of this study was to determine if there is a difference in EMS-documented bystander CPR rates based on the age group of the OHCA victim when dispatcher CPR instructions are available in the community.MethodsThis was a three-year, retrospective chart review of OHCA patients in two municipalities within a single county that provided dispatcher-assisted CPR instructions. Bystander CPR and patient age were determined based on EMS documentation. Age was stratified into three groups: child (0-12 years), adult (13-54 years), and geriatric (≥55 years). Chi square was used to compare the rate of bystander CPR in each age group.ResultsDuring the study period, 1,993 patients were identified as being in OHCA at the time of EMS arrival. The overall bystander CPR rate was 10%. The highest rate of bystander CPR was in the child age group (19%). The lowest rate of bystander CPR was in the geriatric age group (9%). There was a statistically significant difference between age groups (P≤.01).ConclusionsThe rate of EMS-documented bystander CPR was low, even though these municipalities provided dispatcher-assisted CPR instructions. The highest rates of bystander CPR were observed in children (0-12 years). Future investigations should determine why this occurs and if there are opportunities to modify dispatcher coaching based on patient age so that bystander CPR rates improve.WeinmeisterKL, LernerEB, GuseCE, AteyyahKA, PirralloRG. Dispatcher CPR instructions across the age continuum. Prehosp Disaster Med. 2018;33(3):342–345.

scholarly journals PROMET: the effect of age on patient outcomes in non-laser transvenous lead extraction

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
Z Akhtar ◽  
A Elbatran ◽  
CT Starck ◽  
L WM Leung ◽  
M Sohal ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Multivariate Regression ◽  
Age Groups ◽  
Multivariate Regression Analysis ◽  
Lead Extraction ◽  
Similar Proportion ◽  
Age Group ◽  
Patient Age ◽  
Patient Âgé ◽  
Two Age Groups

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf PROMET group Background Cardiac implantable electronic devices (CIEDs) improve morbidity and mortality. This has fuelled an upsurge in implantation of these devices across all patient cohorts, simultaneously increasing the need for transvenous lead extractions (TLE). As the global population expands and life-expectancy extends, TLE will play a significant role in CIED management. Advancing patient age is a recognised risk factor for poor outcomes however the association between patient age and TLE outcomes remains unclear.  We sought to evaluate the relationship between patient age and non-laser TLE outcomes. Method Data of 2205 patients (3849 leads) was collected retrospectively from six high-volume TLE institutes across Europe (PROMET) between January 2005-December 2018. Propensity 1:1 score matching was performed to limit the effects of confounding variables, pairing 353 patients in the >80 years of age category with 353 patients in <80 years of age group. Procedural outcomes were compared between the two age groups and multivariate regression analysis was used for predictors of 30-day mortality. Results In the <80 and >80 years-of-age cohorts, there was a similar proportion of male patients (65.3% vs 67.9%, p = 0.47) treated under general anaesthesia (96.5% vs 93.4%, p = 0.078) for a pre-dominant infectious indication (56.7% vs 60.3%, p = 0.52) but with a higher requirement of the EvolutionTM sheath in the octogenarians (39.4% vs 48.4%, p = 0.015). A similar clinical success per lead was achieved between the two age groups (96.6% vs 98%, <80 vs >80 years, p = 0.245) as was complete lead extraction (95.5% vs 96.6%, <80 vs >80 years, p = 0.44) with a comparable minor complication rate (2.3% vs 3.1%, <80 vs >80 years, p = 0.29) and major complications (1.1% vs 1.4%, <80 vs >80 years, p = 0.74). Thirty-day mortality was higher in the octogenarian cohort than the <80-year-olds without reaching statistical significance (5.4% vs 2.6%, p = 0.08); peri-procedural mortality was similar in both age groups (0.3% vs 0.6%, respectively, p = 0.56). Multivariate regression analysis revealed age (p = 0.013, OR 1.06 [1.01-1.12]), systemic infection (p = 0.026, OR 3.4 [1.16-10.35]) and lead dwell time (p = 0.007, OR 1.01 [1.003-1.017]) increased the odds of 30-day mortality. Conclusion Transvenous lead extraction is similar in efficacy and safety across all age groups. Thirty-day mortality is higher in the advanced age group, signifying the importance of post-procedural management in this cohort.

scholarly journals Drug Value Along the Treatment Continuum in Hodgkin Lymphoma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4728-4728
Author(s):  
Ohad Oren
Keyword(s):  
Hodgkin Lymphoma ◽  
Early Phase ◽  
Late Phase ◽  
Survival Rates ◽  
Age Groups ◽  
Treatment Phase ◽  
Age Group ◽  
Patient Age ◽  
Patient Âgé ◽  
Anti Cancer

Abstract Background The drug value movement aims to assess the clinical-economical merit of anti-cancer medications. A major caveat of quantifying the overall value of an intervention, however, is that patients with distinct clinical features may derive different degrees of benefit: elderly and frail patients with comorbid conditions are more likely to develop early toxicity than younger and otherwise healthier individuals who are more likely to survive for longer periods of time and develop late effects. In addition, patients may prioritize survival to early side effects or to late sequel, or vice versa, which further mandates a more individualised assessment of drug value. We estimated the value of two common chemotherapy combinations used in Hodgkin Lymphoma (HL), as experienced by patients in different age groups, in the early versus the late phases of care. The data were derived from the hematological literature. Methods Pubmed was reviewed for long-term prospective studies of chemotherapy combinations in HL. Data about overall survival rates, incidences of early and late adverse effects, was collected. A scoring system that incorporates efficacy, toxicity and cost was devised (Table 1). Efficacy was derived from overall survival rates at 4 years. Toxicity was categorized as early-serious, early-non-serious, late-serious, late-non-serious, based on the typical time of presentation (early, < 2 years from treatment) and associated mortality (severe > 10% mortality). Cost estimates were derived from the average whole price values available in uptodate.com. The various value determinants (efficacy, early toxicity, late toxicity, cost) were integrated into a grading system (Table 1), factoring each component based on the relative patient-reported preference (per patient age group), as documented in a previous study (1). A value score was calculated for (8 cycles of) ABVD and for (4+4 cycles of) BEACOPP in both the early and the late phase of illness in two age groups. Results ABVD and BEACOPP scored differently based on the patient's age group and the phase of care (Tables 2A, 2B). In patients younger than 55 years of age, ABVD achieved an overall score of 25.3 (out of a maximum of 31.7; 79.8%) while BEACOPP scored 24.5 (77.2%). For patients older than 55 years of age, the total scores for ABVD and BEACOPP were 22.6 (71.3%) and 21.45 (63.4%), respectively. Stratification of each age strata to treatment phase showed that ABVD obtained a score superior to that of BEACOPP in the early phase of care (ABVD 90.5% versus 78.1%, younger than 55; 87.5% versus 77.8%, older than 55). In contrast, BEACOPP achieved a higher score than ABVD in the late phase of care (81.6% versus 71.4%, <55; 77.4% versus 73.4%, >55). The superiority of ABVD to BEACOPP in the early phase persisted in both age groups while the advantage of BEACOPP over ABVD in the late phase diminished significantly in the older patient age group. Conclusions Drug value is not a uniform figure along the treatment continuum of cancer but rather reflects a dynamic equilibrium between benefits and risks that a patient may experience over time. The value of a drug may vary between patients with different clinical profiles. It may also change throughout the course of a patient's illness, thus requiring a more nuanced and longitudinal appraisal. In our work, similar overall value scores for ABVD and BEACOPP were translated into meaningfully different estimates in different disease phases (ABVD superior in early phase, BEACOPP superior in late phase). However, the degree of superiority was tightly associated with patient age group, with BEACOPP's value in the late phase exceeding that of ABVD in younger but not in elderly patients. Our work shows that patient age and treatment phase determine a drug's value in a manner reflective of patients' needs and preferences. The impact of these and other factors on the value of anti-cancer drugs demands further investigation. References: 1. Patient and Physician Preferences for Front-Line Treatment of Advanced Stage Hodgkin Lymphoma in Germany, France and the United Kingdom. Blood 2017 130:4082 Disclosures No relevant conflicts of interest to declare.

scholarly journals Survival Associations between Patient Age and Treatment Modality in Olfactory Neuroblastoma: A Retrospective Population-Based Study

2021 ◽  
Vol 10 (12) ◽  
pp. 2685
Author(s):  
Andre J. Burnham ◽  
Phillip A. Burnham ◽  
Edwin M. Horwitz
Keyword(s):  
Treatment Modality ◽  
Age Groups ◽  
Olfactory Neuroblastoma ◽  
Population Based ◽  
Treatment Modalities ◽  
Long Term Outcomes ◽  
Patient Age ◽  
Population Based Study ◽  
Patient Âgé

Olfactory neuroblastoma (ONB) is a rare neuroepithelial-derived malignancy that usually presents in the nasal cavity. The rarity of ONB has led to conflicting reports regarding associations of patient age and ONB survival and outcome. Moreover, long-term outcomes of chemotherapy and other treatment modalities are speculated. Here, we aimed to compare survival outcomes across age groups through time and determine associations between treatment modality and survival. In this retrospective population-based study, we analyzed the SEER 2000–2016 Database for patients with ONB tumors. Using Kaplan–Meier survival analysis, a significant effect of age and cancer-specific survival (CSS) was observed; geriatric ONB patients had the lowest CSS overall. Generalized linear models and survival analyses demonstrated that CSS of the pediatric patient population was similar to the geriatric group through 100 months but plateaued thereafter and was the highest of all age groups. Radiation and surgery were associated with increased CSS, while chemotherapy was associated with decreased CSS. GLM results showed that tumor grade, stage and lymph node involvement had no CSS associations with age or treatment modality. Our results provide insight for future investigations of long-term outcomes associated with ONB patient age and treatment modality, and we conclude that survival statistics of ONB patients should be analyzed in terms of trends through time rather than fixed in time.

Postoperative outcomes following closed head injury and craniotomy for evacuation of hematoma in patients older than 80 years

2012 ◽  
Vol 116 (1) ◽  
pp. 234-245 ◽  
Author(s):  
Darryl Lau ◽  
Abdulrahman M. El-Sayed ◽  
John E. Ziewacz ◽  
Priya Jayachandran ◽  
Farhan S. Huq ◽  
...  
Keyword(s):  
Head Injury ◽  
Hospital Stay ◽  
Intracranial Hemorrhage ◽  
Closed Head Injury ◽  
Older Age ◽  
Postoperative Outcomes ◽  
Medical Attention ◽  
Patient Age ◽  
Patient Âgé ◽  
Closed Head

Object Advances in the management of trauma-induced intracranial hematomas and hemorrhage (epidural, subdural, and intraparenchymal hemorrhage) have improved survival in these conditions over the last several decades. However, there is a paucity of research investigating the relation between patient age and outcomes of surgical treatment for these conditions. In this study, the authors examined the relation between patient age over 80 years and postoperative outcomes following closed head injury and craniotomy for intracranial hemorrhage. Methods A consecutive population of patients undergoing emergent craniotomy for evacuation of intracranial hematoma following closed head trauma between 2006 and 2009 was identified. Using multivariable logistic regression models, the authors assessed the relation between age (> 80 vs ≤ 80 years) and postoperative complications, intensive care unit stay, hospital stay, morbidity, and mortality. Results Of 103 patients, 27 were older than 80 years and 76 patients were 80 years of age or younger. Older age was associated with longer length of hospital stay (p = 0.014), a higher rate of complications (OR 5.74, 95% CI 1.29–25.34), and a higher likelihood of requiring rehabilitation (OR 3.28, 95% CI 1.13–9.74). However, there were no statistically significant differences between the age groups in 30-day mortality or ability to recover to functional baseline status. Conclusions The findings suggest that in comparison with younger patients, patients over 80 years of age may be similarly able to return to preinjury functional baselines but may require increased postoperative medical attention in the forms of rehabilitation and longer hospital stays. Prospective studies concerned with the relation between older age, perioperative parameters, and postoperative outcomes following craniotomy for intracranial hemorrhage are needed. Nonetheless, the findings of this study may allow for more informed decisions with respect to the care of elderly patients with intracranial hemorrhage.

scholarly journals TSH enhancement of FT4 to FT3 conversion is age dependent

2016 ◽  
Vol 175 (1) ◽  
pp. 49-54 ◽  
Author(s):  
David Strich ◽  
Gilad Karavani ◽  
Shalom Edri ◽  
David Gillis
Keyword(s):  
Age Groups ◽  
Thyroid Stimulating Hormone ◽  
Older Age ◽  
Age Group ◽  
Free T4 ◽  
Free T3 ◽  
Age Related ◽  
Differential Increase ◽  
Retrospective Examination ◽  
Tsh Levels

ObjectiveWe previously reported increasing free T3 (FT3) to free T4 (FT4) ratios as thyroid-stimulating hormone (TSH) increases within the normal range in children. It is not known if this phenomenon is age-related among humans, as previously reported in rats. This study examines the relationships between TSH and FT3/FT4 ratios in different ages.DesignRetrospective examination of thyroid tests from patients without thyroid disease from community clinics.MethodsFree T3, free T4, and TSH levels from 527 564 sera collected from patients aged 1 year or greater were studied. Exclusion criteria were the following: missing data, TSH greater than 7.5mIU/L, and medications that may interfere with thyroid hormone activity. A total of 27 940 samples remaining after exclusion were stratified by age. Samples with available anthropometric data were additionally stratified for body mass index (BMI). Correlations of TSH to FT4, FT3, and FT3/FT4 ratios by age group were examined.ResultsUp to age 40, for each increasing TSH quartile, FT3 and the FT3/FT4 ratio increased and FT4 decreased significantly (for both FT3, FT4 and FT3/FT4 ratio,P<0.05 for every TSH quartile when compared with the 1st quartile, except FT3 in the 30–40 age group). In older age groups, increasing TSH was not associated with increased FT3/FT4 ratio.ConclusionAs TSH levels increase, FT3/FT4 ratios increase until age 40, but this differential increase does not occur in older age groups. This may reflect a decrease in thyroxine (T4) to triiodothyronine (T3) conversion with age, which may be part of the aging process.

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