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drainage (750 cc) which revealed a lung adenocarcinoma. The

gastrointestinal symptomatology improved, but nausea and vomi-

ting worsened refractory to therapy. He developed ipsilateral


s syndrome and contralateral facial paresis simultaneously.

Computerized tomography showed a large pulmonary mass in RSL

with metastatic ipsilateral and contralateral lung nodes, supra and

infra-diaphragmatic metastatic lymph nodes, and bilateral adrenal

metastasis. It was already identified 2 secondary bilateral cerebral

lesions at the level of the protuberance and a right cerebellum injury.

The biopsy taken by bronchoscopy confirmed the diagnosis. The

neurological symptoms worsened (left hemiparesis).

The patient died 15 days after diagnosis, about 1.5 months after the

onset of symptoms.


At what blood urea level should IV fluid replacement start in older


O. David




RBCH, NHS England, UK


The provision of intravenous (IV) fluid replacement is

considered a fundamental aspect of good medical care. The UKs NICE

fluid replacement guideline suggests it should be guided by renal

function, but does not specify when to intervene, and to what specific

values. Since blood Urea (BUN) is often more responsive to change

than creatine it is considered a better acute marker, but what evidence

links it to intervention in the older patient?


A Medline literature search was explored using several

terms for renal function (RF), intravenous fluid replacement (IV) and

comorbidities dementia and heart failure (CM). Without limitations

applied to the search groups (RF and IV), 1998 results were returned

and analysed, but none returned for the older age group. No search

results were returned for RF and IV and CM.


In older patients there is no prospective evidence to recom-

mend when to intervene to any given blood Urea level. Since the

NICE (CG174) guidance on Intravenous fluid, recommends the

reporting of

fluid mismanagement

as a critical incident, this will

be a subjective and controversial area. The expert opinion of

geriatricians for this patient group should remain key.


No prospective research evidence states when to start

intravenous fluid replacement to a set blood Urea level in older

patients. This questions how frequently blood Urea levels should be

requested and how they should be considered. Renal function

interpretation in patients with heart failure and dementia are both

common and problematic to assess, treat and evidently study.


Prediction of Glomerular Filtration Rate (GFR) in geriatric patients:

which formula to use?

J. Dekoninck


, N. Van Den Noortgate.


University of Ghent, Belgium


To compare four fomulas estimating GFR (eGFR), CKD-EPI,

BIS, Cockcroft&Gault(CG), and MDRD, with a Cr-EDTA clearance as

measured GFR (mGFR).


Eighty-nine patients (83,5 ± 6,8 y; 25 men) are included

in the study. eGFR

s are compared to mGFR in the total population as

well in a subpopulation with mGFR <60 mL/min and

60 mL/min.

Statistical analysis was perfomed using Spss version22. Bias is

measured as mean difference of eGFR minus mGFR, precision as

standard deviation of bias. The percentage of correct estimates within

30% of the mGFR is used as accuracy.


CG and BIS have the least bias (

3,0 resp

0,26). CG has

the highest precision (16,9) and accuracy (68,5%), followed by BIS

(respectively 20,9 and 66,3%). MDRD is the formula showing the

highest bias (15,4) and the lowest precision/accuracy (23,9/40,4%). In

the older patient with mGFR <60 mL/min, the CG has an even higher

precision/accuracy (9,9/75,4%). The BIS has the second best precision/

accuracy (11,4/64,2%) but overestimates more in mGFR <60 mL/min

(bias 7,3). MDRD remains the least adequate eGFR formula. None of

formulas has an acceptable estimating power for mGFR

60 mL/min.

Results are less consistent with the lowest bias, highest precision

and accuracy for respectively MDRD, CG and CKD-EPI. CKD-EPI tends

to perform best taking into account a considerable underestimation



Cockcroft&Gault formula has the lowest bias and highest

precision/accuracy, especially in an older population with mGFR

<60 mL/min. The newer formulas, BIS and CKD-EPI tends to be the

second best choice in respectively the lower and higher mGFR



A frailty score for the acute hospital setting: identifying vulnerable

patients at point of entry to care

L. Dinesen


, A.J. Poots


, F. Ciardi


, K. Warburton


, J. Soong



F.C. Martin


, D. Bell




NIHR CLAHRC Northwest London, Imperial

College London,


Dept. Acute Medicine, Chelsea and Westminster




s Health Partners, London, UK


Our objective is to operationalize a clinically usable tool,

frailty early warning score (FEWS; score range 0

15), which will

identify frailty (>1) and help predict significant outcomes.


Setting: Acute admission unit, urban university hospital

between 03.06.2015 and 27.08.2015. Sample: 700 admitted patients

>65 y. Data collected from clinical notes taken routinely as part of

the emergency admission process. The national early warning scores

(NEWS, score range 0

15), which reflects medical acuity, were

simultaneously collected.


Patients had average age of 81 years, and this was stable

regardless of the frailty score. 52.6% were female. Mortality increases

with increasing frailty score, in-hospital mortality is 2.6% for FEWS 0,

whilst 11.9% for FEWS 8. A similar trend is seen with readmissions

rates and length of stay (LOS): 30 day readmission is 21.6% for FEWS 0

and 28.6% for FEWS 8; mean LOS is 7.5 days for FEWS 0 and 12.4 days

for FEWS 8. NEWS and FEWS were cross-tabulated: 246 (35%) patients

or participants scored <3 NEWS (would not trigger escalation), of

which 206 (81%) scored FEWS



This study describes FEWS as a novel way of predicting a

frail individual

s outcomes. This score can be easily calculated at the

point of care using routinely corrected data. It is fast and simple to use;

it will not require additional clinical assessment. The threshold for

escalation due to frailty risk is as yet undetermined.


Age over 80 years old in acute pulmonary embolism

does it

influence Manchester triage and time until diagnosis?

K. Domingues, R.S. Almeida, M.J. Vieira, B. Santos, C. Costa, N. Craveiro,

I. Monteiro, M. Leal.

Cardiology Department, Internal Medicine



Early diagnosis of acute pulmonary embolism (PE) is

a challenge in Emergency Departments (ED), because of its diverse

clinical presentation. The Manchester triage system (MTS) depends

on the initial presentation, assigning higher priority to urgent

cases. We aimed to assess whether age over 80 years old (>80 yo)

influences presentation, MTS and time from admission to diagnosis

(TAD) in PE.


Retrospective study of patients admitted to our ED between

January 2011 and December 2015, with the final diagnosis of PE.

Demographic, clinical and triage data were analyzed.


We included 367 patients, 60.8% women, with a mean age of

71.6 ± 16.4 years. The three most common main complaints were




(30.8%) and

thoracic pain


Most patients were triaged as orange (51.5%), followed by yellow

(47.1%), red (0.8%) and green (0.5%). The group of patients >80 yo

(39.8%) had more women (68.5% vs 31.5%; p = 0.014). There was a

significantly higher number of patients with


as main

complaint (49.3% vs 31.7%; p = 0,001). Thoracic pain was less frequent

in this group (11.0% vs 26.7%; p < 0.0001). Triage color was not

significantly different between groups. TAD by computed tomography

pulmonary angiogram was marginally correlated with age (r = 0,095)

Poster presentations / European Geriatric Medicine 7S1 (2016) S29