LUCIANA ANDREA AVENA SMEILI
Projetos de Pesquisa
Unidades Organizacionais
SCPACEX-62, Hospital Universitário
3 resultados
Resultados de Busca
Agora exibindo 1 - 3 de 3
- Discrepancies Between Clinical and Autopsy Diagnoses in Rapid Response Team-Assisted Patients: What Are We Missing?(2022) GIUGNI, Fernando Rabioglio; SALVADORI, Fernanda Aburesi; SMEILI, Luciana Andrea Avena; MARCILIO, Izabel; PERONDI, Beatriz; MAUAD, Thais; PAIVA, Edison Ferreira de; DUARTE-NETO, Amaro NunesObjectives The rapid response team (RRT) assists hospitalized patients with sudden clinical deterioration. There is scarce evidence of diagnostic accuracy in this scenario, but it is possible that a considerable rate of misdiagnosis exists. Autopsy remains a valuable tool for assessing such question. This study aimed to compare clinical (premortem) and autopsy (postmortem) diagnoses in patients assisted by the RRT and describe major discrepancies. Methods We reviewed 104 clinical data and autopsies from patients assisted by the RRT during a cardiac arrest event in a tertiary care hospital in Brazil. Clinical and autopsy diagnostic discrepancies were classified using the Goldman criteria. Other clinical and pathological data were described, and the group with major diagnostic discrepancies was further analyzed. Results We found 39 (37.5%) patients with major diagnostic discrepancies. Most frequent immediate causes of death in this group determined by autopsy were sepsis (36%), pulmonary embolism (23%) and hemorrhagic shock (21%). Pulmonary embolism was the cause of death significantly more frequent in the major discrepancy group than in the minor discrepancy group (23% versus 3%, P = 0.002). We individually described all major diagnostic discrepancies. Conclusions We found a high rate (37.5%) of major misdiagnosis in autopsies from patients assisted by the RRT in a tertiary teaching hospital. Pulmonary embolism was the most inaccurate fatal diagnosis detected by autopsy.
- Incidence and Predictors of Cardiovascular Complications and Death after Vascular Surgery(2015) SMEILI, Luciana Andrea Avena; LOTUFO, Paulo AndradeBackground: Patients undergoing arterial vascular surgery are considered at increased risk for post-operative complications. Objective: To assess the incidence and predictors of complications and death, as well as the performance of two models of risk stratification, in vascular surgery. Methods: This study determined the incidence of cardiovascular complications and deaths within 30 days from surgery in adults. Univariate comparison and logistic regression assessed the risk factors associated with the outcomes, and the receiver operating characteristic (ROC) curve assessed the discriminatory capacity of the revised cardiac risk index (RCRI) and vascular study group of New England cardiac risk index (VSG-CRI). Results: 141 patients (mean age, 66 years; 65% men) underwent the following surgeries: carotid (15); lower limbs (65); abdominal aorta (56); and others (5). Cardiovascular complications and death occurred within 30 days in 28 (19.9%) and 20 (14.2%) patients, respectively. The risk predictors were: age, obesity, stroke, poor functional capacity, altered scintigraphy, surgery of the aorta, and troponin change. The scores RCRI and VSG-CRI had area under the curve of 0.635 and 0.639 for early cardiovascular complications, and 0.562 and 0.610 for death in 30 days. Conclusions: In this small and selected group of patients undergoing arterial vascular surgery, the incidence of adverse events was elevated. The risk assessment indices RCRI and VSG-CRI did not perform well for complications within 30 days.
bookPart Avaliação Clínica Pré-operatória(2015) MACHADO, Fábio Santana; SMEILI, Luciana Andrea Avena