Estimation de la prévalence de la précarité et analyse des facteurs associés à la précarité au Centre Hospitalier Intercommunal Eure-Seine

Dans le contexte hospitalier, le service social doit pouvoir prendre en charge les situations de précarité qui peuvent influer sur l’état de santé et la prise en charge du patient en cours de séjour et lors de son rétablissement. Il est donc nécessaire d’identifier au plus tôt ces problématiques, afin de les objectiver et de mettre en place les mesures adaptées. L’objectif de cette étude était d’estimer la prévalence de la précarité repérée par un questionnaire d’entrée en complément du repérage actuel par le signalement des soignants, et d’analyser les facteurs associés à la précarité. Méthode : Une étude transversale a été réalisée au Centre Hospitalier Intercommunal Eure-Seine à partir des bases de données médico-administratives de l’établissement et d’un questionnaire standardisé, et du signalement par les soignants des situations de précarité, auprès des patients adultes de plus de 18 ans hospitalisés dans des services de Médecine, Chirurgie, Obstétrique (MCO). Résultats : Parmi les 415 patients analysés, la prévalence de précarité a été mesurée à 47 %. La précarité était associée à une durée de séjour plus longue de 4,16 jours en moyenne (p Conclusion : Le mode de repérage proposé permet d’identifier une large population de patients précaires relevant potentiellement de l’intervention d’une assistante sociale hospitalière. Le fait de trouver des facteurs généraux connus de précarité montre que ce mode de repérage est cohérent, et pourrait être intégré en routine lors de l’hospitalisation des patients en court séjour

Risk factors for infection in spine surgery: Nested case-control in tertiary hospital in France

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Characterisation of a high-risk profile for maternal thrombotic and severe haemorrhagic complications in pregnant women with antiphospholipid syndrome in France (GR2): a multicentre, prospective, observational study

International audienceBackgroundProspective data about the risks of thrombotic and severe haemorrhagic complications during pregnancy and post partum are unavailable for women with antiphospholipid syndrome. We aimed to assess thrombotic and haemorrhagic events in a prospective cohort of pregnant women with antiphospholipid syndrome.MethodsThis multicentre, prospective, observational study was done at 76 centres in France. To be eligible for this study, women had to have diagnosis of antiphospholipid syndrome; have conceived before April 17, 2020; have an ongoing pregnancy that had reached 12 weeks of gestation; and be included in the study before 18 weeks of gestation. Exclusion criteria were active systemic lupus erythematosus nephropathy, or a multifetal pregnancy. Severe haemorrhage was defined as the need for red blood cell transfusion or maternal intensive care unit admission because of bleeding or invasive procedures, defined as interventional radiology or surgery, to control bleeding. The GR2 study is registered with ClinicalTrials.gov, NCT02450396.FindingsBetween May 26, 2014, and April 17, 2020, 168 pregnancies in 27 centres met the inclusion criteria for the study. 89 (53%) of 168 women had a history of thrombosis. The median term at inclusion was 8 weeks gestation. 16 (10%) of 168 women (95%CI 5–15) had a thrombotic (six [4%] women; 95% CI 1–8) or severe haemorrhagic event (12 [7%] women; 95% CI 4–12). There were no deaths during the study. The main risk factors for thrombotic events were lupus anticoagulant positivity at inclusion (six [100%] of six women with thrombosis vs 78 [51%] of 152 of those with no thrombosis; p=0·030) and placental insufficiency (four [67%] of six women vs 28 [17%] of 162 women; p=0·013). The main risk factors for severe haemorrhagic events were pre-existing maternal hypertension (four [33%] of 12 women vs 11 [7%] of 156 women; p=0·014), lupus anticoagulant positivity at inclusion (12 [100%] of 12 women vs 72 [49%] of 146 women; p<0·0001) and during antiphospholipid history (12 [100%] of 12 women vs 104 [67%] of 156 women; p=0·019), triple antiphospholipid antibody positivity (eight [67%] of 12 women vs 36 [24%] of 147 women; p=0·0040), placental insufficiency (five [42%] of 12 women vs 27 [17%] of 156 women; p=0·038), and preterm delivery at 34 weeks or earlier (five [45%] of 11 women vs 12 [8%] of 145 women; p=0·0030).InterpretationDespite treatment adhering to international recommendations, a proportion of women with antiphospholipid syndrome developed a thrombotic or severe haemorrhagic complication related to pregnancy, most frequently in the post-partum period. Lupus anticoagulant and placental insufficiency were risk factors for these life-threatening complications. These complications are difficult to prevent, but knowledge of the antenatal characteristics associated with them should increase awareness and help physicians manage these high-risk pregnancies