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Master Thesis

Évaluation diagnostique des patients présentant une hypertension artérielle sévère aux urgences de Pau

Abstract : Objective: to compare the frequency of acute organ damage’s research, made by emergency physicians from the hospital of Pau, among patients presenting a severe hypertension, before and after protocol. Methods: this was a monocentric, observational study, with retrospective data collection, conducted in patients presenting a severe hypertension (defined by at least two systolic blood pressure greater than 180mmHg), at the Emergency department of Pau, France. It was designed from January 1st to August 31st, 2020. Patients over 18 years old were admitted in the Emergency, for any medical request. Patients who were diagnosed a hypertensive emergency, were excluded. A protocol, based on a practice algorithm, started on July 9th, 2020. The primary outcome was the prevalence of fundoscopy realised within 48 hours, before and after protocol. Secondary outcome was the prevalence of other examens needed in the evaluation of hypertensive target organs. Results: above 25 546 patients admitted in the Emergency department, 190 patients (0.7%) presented a severe hypertension during this period, among which 153 were hypertensive urgencies. 5 (3.3%) have benefited from a fundoscopy; were realised 2 (5.3%) after protocol, 3 (2.6%) before protocol (p-value =0.59). Prevalence of other standardised exams was not modified by the creation of a protocol: ECG was realised in 71.1% after protocol, 72.2% before (p-value=0.89), troponins in 34.2% after, 41.7% before (p-value=0.41), NF-proBNP in 21.1% after, 23.5% before (p-value=0.09), creatinine in 81.6% after, 86.1% before (p-value=0.50), apart from haemolysis (haptoglobin) evaluated in 10.5% after protocol and 1.7% of patients before (p-value=0.03). Conclusions: the existence of a protocol concerning hypertension in an Emergency department did not bring a significant difference in terms of clinical practices for severe hypertension. It would be interesting to follow the study on a long term, after improving medical education, software, in order to improve medical and paramedical adhesion.
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https://dumas.ccsd.cnrs.fr/dumas-03048752
Contributor : Médecine Ub <>
Submitted on : Wednesday, December 9, 2020 - 3:10:06 PM
Last modification on : Tuesday, January 26, 2021 - 3:10:16 AM
Long-term archiving on: : Wednesday, March 10, 2021 - 7:26:25 PM

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Mathilde Lannes. Évaluation diagnostique des patients présentant une hypertension artérielle sévère aux urgences de Pau. Sciences du Vivant [q-bio]. 2020. ⟨dumas-03048752⟩

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