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Teissandier D, Philippon AL, Bannelier H, Roy PM, Penaloza A, Jiménez S, Freund Y, Roussel M, Catoire P. Pulmonary embolism rule-out decision-making tools for patients aged 35 years or younger in hospital emergency departments: a post-hoc analysis of performance in 3 prospective cohorts. Emergencias 2023; 35:432-436. [PMID: 38116967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To assess the performance of the Pulmonary Embolism Rule-out Criteria (PERC) and the age-modified PERC-35 tool in hospital emergency departments (EDs) for evaluating patients aged 35 years or younger. A secondary aim was to assess other decision-making criteria. MATERIAL AND METHODS Post-hoc analysis of 3 European cohort studies. We included data for patients aged 35 years or younger suspected of PE who were followed for 3 months. The safety and efficacy of applying the PERC and PERC-35 were assessed with the diagnostic error rate (failure to detect PE) and the proportion of patients in whom a diagnosis of PE was ruled out. We also assessed the safety and efficacy of applying the YEARS and PEGeD criteria. RESULTS Data for 1235 patients aged 35 years or younger were analyzed. Twenty-two (1.8%; 95% CI, 1.2%-2.7%) PE cases were diagnosed at 3 months. Six (1.0%; 95% CI, 0.5%-2.2%) and 5 (0.9%; 95% CI, 0.4%-2.1%) PE cases were not diagnosed by the PERC and PERC-35 tools, respectively. These tools allowed PE to be ruled out in 591 (48.2%; 95% CI, 45.4%-51.0%) and 554 (46.2%; 95% CI, 43.4%-49.0%) cases, respectively. The error rates of the YEARS and PEGeD criteria, respectively, were 0.4% (95% CI, 0.1%-1.1%) and 0.5% (95% CI, 0.2%-1.2%); their efficacy was similar. CONCLUSION The safety and efficacy profiles of the PERC and PERC-35 algorithms were similar in patients aged 35 years or younger. However, the large confidence intervals we report do not allow us to confirm the safety of using the tools in patients in this age group.
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Affiliation(s)
- Dorian Teissandier
- Servicio de Urgencias, Hôpital Pitié-Salpêtrière, Sorbonne Université, París, Francia
| | - Anne-Laure Philippon
- Servicio de Urgencias, Hôpital Pitié-Salpêtrière, Sorbonne Université, París, Francia. FHU IMPEC Improving Emergency Care, UMR 1166, IHU ICAN, Sorbonne Université, París, Francia
| | - Héloise Bannelier
- FHU IMPEC Improving Emergency Care, UMR 1166, IHU ICAN, Sorbonne Université, París, Francia
| | - Pierre-Marie Roy
- Servicio de Urgencias, Centre Hospitalier Universitaire Angers, Institut Mitovasc, Université d'Angers, Angers, Francia
| | - Andrea Penaloza
- Servicio de Urgencias, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Bélgica
| | - Sònia Jiménez
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Barcelona, Universidad de Barcelona, Barcelona, España
| | - Yonathan Freund
- Servicio de Urgencias, Hôpital Pitié-Salpêtrière, Sorbonne Université, París, Francia. FHU IMPEC Improving Emergency Care, UMR 1166, IHU ICAN, Sorbonne Université, París, Francia
| | - Melanie Roussel
- Servicio de Urgencias, Centre Hospitalier Universitaire de Rouen, Université de Normandie UNIROUEN, Rouen, Francia
| | - Pierre Catoire
- Servicio de Urgencias, Hôpital Pitié-Salpêtrière, Sorbonne Université, París, Francia. FHU IMPEC Improving Emergency Care, UMR 1166, IHU ICAN, Sorbonne Université, París, Francia
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Artajona L, García-Martínez A, Aguiló S, Burillo-Putze G, Alquézar-Arbé A, Fernández C, Fernández-Simón A, Fernández Cardona M, Maza Vera MT, Iglesias Vela M, Trenc Español P, Salido Mota M, García García Á, Lucena Aguilera C, Llopis F, Herrero P, Doi Grande AL, Serrano Lázaro L, Chacon García A, Noceda Bermejo JJ, Ibisate Cubillas A, Hernández Martínez MJ, Alemany González FX, Sánchez Ramón S, Espinosa Fernández B, González Del Castillo J, Miró Ò. Influence of income on in-hospital mortality in older adults during the first wave of the COVID-19 pandemic: results from the EDEN-33 study. Emergencias 2023; 35:423-431. [PMID: 38116966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To determine whether income was associated with unexpected in-hospital mortality in older patients treated in Spanish public health system hospital emergency departments. MATERIAL AND METHODS Fifty-one public health system hospital emergency departments in Spain voluntarily participated in the study. Together the hospitals covered 25% of the population aged 65 years or older included in all patient registers during a week in the pre-pandemic period (April 1-7, 2019) and a week during the COVID-19 pandemic (March 30 to April 5, 2020). We estimated a patient's gross income as the amount published for the postal code of the patient's address. We then calculated the standardized gross income (SGI) by dividing the patient's estimated income by the mean for the corresponding territory (Spanish autonomous community). The existence and strength of an association between the SGI and in-hospital mortality was evaluated by means of restricted cubic spline (RCS) curves adjusted for 10 patient characteristics at baseline. Odds ratios (ORs) for each income level were expressed in relation to a reference SGI of 1 (the mean income for the corresponding autonomous community). We compared the COVID-19 and pre-pandemic periods by means of first-order interactions. RESULTS Of the 35 280 patients attended in the 2 periods, gross income could be ascertained for 21 180 (60%), 15437 in the pre-pandemic period and 5746 during the COVID-19 period. SGIs were slightly higher for patients included before the pandemic (1.006 vs 0.994; P = .012). In-hospital mortality was 5.6% overall and higher during the pandemic (2.8% pre-pandemic vs 13.1% during COVID-19; P .001). The adjusted RCS curves showed that associations between income and mortality differed between the 2 periods (interaction P = .004). Whereas there were no significant income-influenced differences in mortality before the pandemic, mortality increased during the pandemic in the lowest-income population (SGI 0.5 OR, 1.82; 95% CI, 1.32-3.37) and in higher-income populations (SGI 1.5 OR, 1.32; 95% CI, 1.04-1.68, and SGI 2 OR, 1.92; 95% CI, 1.14-3.23). We found no significant differences between patients with COVID-19 and those with other diagnoses (interaction P = .667). CONCLUSION The gross income of patients attended in Spanish public health system hospital emergency departments, estimated according to a patient's address and postal code, was associated with in-hospital mortality, which was higher for patients with the lowest and 2 higher income levels. The reasons for these associations might be different for each income level and should be investigated in the future.
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Affiliation(s)
- Lourdes Artajona
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Ana García-Martínez
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Sira Aguiló
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, España
| | | | - Aitor Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Cesáreo Fernández
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
| | | | | | | | | | | | - Manuel Salido Mota
- Servicio de Urgencias, Hospital Regional Universitario de Málaga, España
| | | | | | - Ferran Llopis
- Servicio de Urgencias, Hospital Universitario de Bellvitge, Barcelona, España
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Universitario Central Asturias, Oviedo, España
| | | | | | | | | | | | | | | | | | | | | | - Òscar Miró
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, España
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Martín Mojarro E, Gil V, Llorens P, Álvarez J, Flores Quesada S, Troiano Ungerer OJ, Alquézar-Arbé A, Jacob J, Herrero-Puente P, Espinosa B, Sánchez C, Llauger L, Tost J, Serrano L, Dávila A, Torres Garate R, López-Grima ML, Lucas-Imbernón FJ, Alonso H, Pagán F, Garrido JM, Miró Ò. Use of digoxin in the emergency department to treat patients with acute heart failure and its impact on short-term outcomes. Emergencias 2023; 35:437-446. [PMID: 38116968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To analyze factors related to the use of digoxin to treat patients with acute heart failure (AHF) in emergency departments (EDs) and the impact of digoxin treatment on short-term outcomes. MATERIAL AND METHODS We included patients diagnosed with AHF in 45 Spanish EDs. The patients, who were not undergoing long-term treatment for heart failure, were classified according to whether or not they were given intravenous digoxin in the ED. Fifty-one patient or cardiac decompensation episode variables were recorded to profile ED patients treated with digoxin. Outcome variables studied were the need for hospital admission, prolonged stay in the ED (> 24 hours) for discharged patients, prolonged hospitalization (> 7 days) for admitted patients, and all-cause in-hospital or 30-day mortality. The associations between digoxin treatment and the outcomes were studied with odds ratios (ORs) adjusted for patient and AHF episode characteristics. RESULTS Data for 15 549 patients (median age, 83 years; 55% women) were analyzed; 1430 (9.2%) were treated with digoxin. Digoxin was used more often in women, young patients, and those with better New York Heart Association (NYHA) classifications but more severe cardiac decompensation, especially if the trigger was atrial fibrillation with rapid ventricular response. Admissions were ordered for 75.4% of the patients overall (81.6% of digoxin-treated patients vs 74.8% of nontreated patients; P .001). The ED stay was prolonged in 38.3% of patients discharged from the ED (52.9% of digoxin-treated patients vs 37.2% of nontreated patients; P .001). The duration of hospital stay was prolonged in 48.1% (digoxin-treated, 49.3% vs 47.9%; P = .385). In-hospital mortality was 7.2% overall (6.9% vs 7.2%, P= .712), and 30-day mortality was 9.7% (9.3% vs 9.7%, P = .625). ED use of digoxin was associated with a prolonged stay in the department (adjusted OR, 1.883; 95% CI, 1.359-2.608) but not with hospitalization or mortality. CONCLUSION Digoxin continues to be used in one out of ten ED patients who are not already on long-term treatment with the drug. Digoxin use is associated with cardiac decompensation triggered by atrial fibrillation with rapid ventricular response, younger age, women, and patients with better initial NYHA function status but possibly more severe decompensation. Digoxin use leads to a longer ED stay but is safe, as it is not associated with need for admission, prolonged hospitalization, or short-term mortality.
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Affiliation(s)
| | - Víctor Gil
- Área de Urgencias, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, España
| | - Pere Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Jesús Álvarez
- Área de Urgencias, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, España
| | | | | | - Aitor Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España
| | - Pablo Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Instituto de Investigación Biosanitaria del Principado de Asturias (ISPA), Oviedo, España
| | - Begoña Espinosa
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Carolina Sánchez
- Área de Urgencias, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, España
| | - Lluis Llauger
- Servicio de Urgencias, Althaia Xarxa Assistencial Universitària de Manresa, Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), Universitat de Vic-Central de Catalunya (UVIC-UCC), Barcelona, España
| | - Josep Tost
- Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, España
| | - Leticia Serrano
- Servicio de Urgencias, Hospital Politécnico la Fe, Valencia, España
| | - Aitor Dávila
- Servicio de Urgencias, Hospital Universitario de Salamanca, España
| | | | | | | | - Héctor Alonso
- Servicio de Urgencias, Hospital Marqués de Valdecilla, Santander, España
| | - Fran Pagán
- Área de Urgencias, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, España
| | | | - Òscar Miró
- Área de Urgencias, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, España
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Eiroa-Hernández P, Matos S, Aguiló S, Alquézar-Arbé A, Jacob J, Fernández C, Llorens P, Moreno Ruíz S, Cuevas Jiménez L, Vaswani-Bulchand A, Rodríguez-Cabrera M, Suárez Pineda MC, Alegre Fresno S, Gina Osorio I, Puche Alcaraz AM, Mansilla Collado J, Veguillas Benito M, Chamorro F, Álvarez Rocío L, Toro Gallardo V, Beddar Chaib F, Pedraza García J, Quero Espinosa FDB, Jiménez Lucena M, Yepez León G, González Revuelta E, Sánchez Aroca S, González Del Castillo J, Burillo-Putze G, Miró Ò. Factors related to bladder catheterization in older patients and its possible association with prognosis: results of the EDEN-30 study. Emergencias 2023; 35:415-422. [PMID: 38116965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVES The aims of this study in the Emergency Department and Elder Needs (EDEN) series were to explore associations between clinical variables on arrival at the ED (baseline) and the insertion of a bladder catheter, and the relation between catheterization and deterioration to a more complex or serious clinical state. MATERIAL AND METHODS Included were all patients aged 65 years or older attended during 1 week in 52 Spanish EDs. Patients were grouped according to whether a bladder catheter was or was not inserted in the ED. We used multivariable logistical regression to explore associations between catheterization and patient age, sex, 10 comorbidities, 7 baseline status variables, and 6 clinical variables. Progression was considered serious or complex if the patient died or required hospitalization, a prolonged hospital stay, or discharge to a care facility. We also explored the association between age and catheterization using adjusted restricted cubic spline (RCS) curves with a cutoff value of 65 years. RESULTS Participating hospitals enrolled 24 573 patients; bladder catheters were inserted in 976 (4%). Of these, 44.3% were discharged from the ED. Fifteen of the 24 variables were independently associated with bladder catheterization. Factors with the strongest associations according to odds ratios (ORs) were impaired consciousness (OR, 2.50; 95% CI, 1.90-3.30), dehydration (OR, 2.24; 95% CI, 1.85-2.72), and male sex (OR, 2.12; 95% CI, 1.84- 2.44). Age 80 years or older was also associated with bladder catheterization (OR, 1.17; 95% CI, 1.01-1.358). The adjusted RCS curves showed a progressive linear increase in the probability of catheterization with age. The increase was constant in men and stabilized after the age of 85 years in women (P-interaction .001). Bladder catheterization was associated with hospitalization (OR, 2.31; 95% CI, 1.99-2.68), intensive care unit admission (OR, 4.64; 95% CI, 3.04-7.09), prolonged stay in the ED for discharged patients (OR, 2.28; 95% CI, 1.75-2.96), in-hospital death (OR, 1.99; 95% CI, 1.54-2.57), and 30-day death (OR, 1.66; 95% CI, 1.33-2.08). No associations were found between catheterization and prolonged hospital stay (OR, 1.11; 95% CI, 0.92-1.34) or need for a care facility on discharge (OR, 1.50; 95% CI, 0.98-2.29). CONCLUSION Certain patient characteristics and baseline clinical conditions are associated with bladder catheterization in patients of advanced age. The main factors were decreased consciousness, dehydration, and male sex. Even after adjustment for related factors, catheterization is independently associated with progression to more complex or serious clinical states.
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Affiliation(s)
- Patricia Eiroa-Hernández
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España. Universidad de La Laguna, Tenerife, España
| | - Sebastián Matos
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, España
| | - Sira Aguiló
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Aitor Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España
| | - Cesáreo Fernández
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Sandra Moreno Ruíz
- Servicio de Urgencias, Hospital Universitario Infanta Cristina, Parla, España
| | | | | | | | | | - Sara Alegre Fresno
- Servicio de Urgencias, Hospital Universitario del Henares, Madrid, España
| | - Ivet Gina Osorio
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, España
| | | | | | - Mónica Veguillas Benito
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Francisco Chamorro
- Servicio de Urgencias, Hospital Universitario de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España
| | | | | | | | | | | | | | | | | | - Sara Sánchez Aroca
- Servicio de Urgencias, Hospital Universitario Morales Meseguer, Murcia, España
| | | | | | - Òscar Miró
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, España
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Montero-Pérez FJ, Cobos Requena ÁM, González Del Castillo J, Jacob J, García-Lamberechts EJ, Piñera Salmerón P, Alquézar-Arbé A, Aguiló S, Fernández Alonso C, Burillo-Putze G, Calderón Caro M, Díaz Salado ÁI, Martín Mojarro E, Eiroa-Hernández P, Parra-Esquivel P, López Pérez JJ, Ruiz Grinspan M, Osorio Quispe IG, González Tejera M, Serrano Lázaro L, Espinosa Fernández B, Fuentes L, Suero Méndez C, Del Valle Toro-Gallardo M, Beddar Chaib F, Pedraza Ramírez P, Miró Ò. Impact of the COVID-19 pandemic on demand for emergency department care for older patients: the EDEN-7 COVID cohort study. Emergencias 2023; 35:270-278. [PMID: 37439420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVES To analyze the impact of the COVID-19 pandemic on Spanish emergency department (ED) care for patients aged 65 years or older during the first wave vs. a pre-pandemic period. MATERIAL AND METHODS Retrospective cross-sectional study of a COVID-19 portion of the EDEN project (Emergency Department and Elder Needs). The EDEN-COVID cohort included all patients aged 65 years or more who were treated in 52 EDs on 7 consecutive days early in the pandemic. We analyzed care variables, discharge diagnoses, use of diagnostic and therapeutic resources, use of observation units, need for hospitalization, rehospitalization, and mortality. These data were compared with data for an EDEN cohort in the same age group recruited during a similar period the year before the pandemic. RESULTS The 52 participating hospital EDs attended 33 711 emergencies during the pandemic vs. 96 173 emergencies in the pre-COVID period, representing a 61.7% reduction during the pandemic. Patients aged 65 years or older accounted for 28.8% of the caseload during the COVID-19 period and 26.4% of the earlier cohort (P .001). The COVID-19 caseload included more men (51.0%). Comorbidity and polypharmacy were more prevalent in the pandemic cohort than in the earlier one (comorbidity, 92.6% vs. 91.6%; polypharmacy, 65.2% vs. 63.6%). More esturesources (analgesics, antibiotics, heparins, bronchodilators, and corticosteroids) were applied in the pandemic period, and common diagnoses were made less often. Observation wards were used more often (for 37.8% vs. 26.2% in the earlier period), and hospital admissions were more frequent (in 56.0% vs. 25.3% before the pandemic). Mortality was higher during the pandemic than in the earlier cohort either in ED (1.8% vs 0.5%) and during hospitalization (11.5 vs 2.9%). CONCLUSION The proportion of patients aged 65 years or older decreased in the participating Spanish EDs. However, more resources were required and the pattern of diagnoses changed. Observation ward stays were longer, and admissions and mortality increased over the numbers seen in the reference period.
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Affiliation(s)
| | | | | | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España
| | | | | | - Aitor Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Sira Aguiló
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Cesáreo Fernández Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
| | | | | | | | | | | | | | | | | | - Ivet Gina Osorio Quispe
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | | | | | | | - Lidia Fuentes
- Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España
| | | | | | | | | | - Òscar Miró
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
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Fernández Alonso C, Del Arco Galán C, Torres Garate R, Madrigal Valdés JF, Romero Pareja R, Bibiano Guillén C, Rodríguez Miranda B, Ruiz Grinspan MS, Gutiérrez Gabriel S, Del Rey Ubago A, Fuentes Ferrer ME, Martín-Sánchez FJ. Performance of 3 frailty scales for predicting adverse outcomes at 30 days in older patients discharged from emergency departments. Emergencias 2023; 35:196-204. [PMID: 37350602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To compare the ability of 3 frailty scales (the Clinical Frailty Scale [CFS], the Functional Index - eMergency [FIM], and the Identification of Seniors at Risk [ISAR] scale) to predict adverse outcomes at 30 days in older patients discharged from hospital emergency departments (EDs). MATERIAL AND METHODS Secondary analysis of data from the FRAIL-Madrid registry of patients aged 75 years or older who were discharged from Madrid EDs over a period of 3 months in 2018 and 2019. Frailty was defined by a CFS score over 4, a FIM score over 2, or an ISAR score over 3. The outcome variables were revisits to an ED, hospitalization, functional decline, death, and a composite variable of finding any of the previously named variables within 30 days of discharge. RESULTS A total of 619 patients were studied. The mean (SD) age was 84 (7) years, and 59.1% were women. The CFS identified as frail a total of 339 patients (54.8%), the FIM 386 (62.4%), and the ISAR 301 (48.6%). An adverse outcome occurred within 30 days in 226 patients (36.5%): 21.5% revisited, 12.6% were hospitalized, 18.4% experienced functional decline, and 3.6% died. The areas under the receiver operating characteristic curves were as follows: CFS, 0.66 (95% CI, 0.62-0.70; P = .022); FIM, 0.67 (95% CI, 0.62-0.71; P = .021), and ISAR, 0.64 (95% CI, 0.60-0.69; P = .023). Adjusted odds ratios (aOR) showed that frailty was an independent risk factor for presenting any of the named adverse outcomes: aOR for CFS >4, 3.18 (95% CI, 2.02-5.01), P .001; aOR for FIM > 2, 3.49 (95% CI, 2.15-5.66), P .001; and aOR for ISAR >3, 2.46 (95% CI, 1.60-3.79), P .001. CONCLUSION All 3 scales studied - the CFS, the FIM and the ISAR - are useful for identifying frail older patients at high risk of developing an adverse outcome (death, functional decline, hospitalization, or revisiting the ED) within 30 days after discharge.
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Affiliation(s)
| | | | - Raquel Torres Garate
- Servicio de Urgencias, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | | | | | | | | | | | | | - Ana Del Rey Ubago
- Servicio de Urgencias, Hospital Universitario de la Princesa, Madrid, España
| | - Manuel E Fuentes Ferrer
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, España
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Beddar Chaib F, Jiménez Hernández S, Pedrajas Navas JM, Lecumberri R, Guirado Torrecillas L, Alonso Valle H, Diego Roza S, Sendín Martín V, Rivera Núñez MA, Pedraza García J, Sánchez Díaz-Canel D, Ruiz Artacho P. Impact of emergency department management of isolated superficial vein thrombosis of the lower limbs: a secondary analysis of data from the ALTAMIRA study. Emergencias 2023; 35:109-116. [PMID: 37038941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVES To describe the management of superficial vein thrombosis (SVT) of the lower limbs in patients treated in Spanish hospital emergency departments (EDs). To evaluate the impact of ED management of venous thromboembolic complications on outcomes and to determine the characteristics of patients who develop complications. MATERIAL AND METHODS The retrospective multicenter ALTAMIRA study (Spanish acronym for risk factors, complications, and assessment of Spanish ED management of SVT) used recorded data for consecutive patients with a diagnosis of isolated SVT treated in 18 EDs. We gathered data on symptomatic venous thromboembolic disease (deep vein thrombosis, pulmonary embolism, or the extension or recurrence of SVT), clinically significant bleeding, and 180-day mortality. Cox regression analysis was used to explore variables associated with complications. RESULTS A total of 703 patients were included. Anticoagulation was prescribed for 84.1% of the patients for a median of 30 days (interquartile range, 15-42 days); 81.3% were treated with low molecular weight heparin. A prophylactic dose was prescribed for 48% and an intermediate therapeutic dose for 52%. Sixty-four patients (9.2%) developed symptomatic thromboembolic disease within 180 days, 12 (1.7%) experienced clinically significant bleeding, and 4 (0.6%) died. Complications developed later in patients receiving anticoagulant therapy than in those not taking an anticoagulant (66 vs 11 days , P=.009), and 76.6% of those developing complications were not on anticoagulant when symptoms appeared. A history of thromboembolic disease was associated with developing complications (adjusted hazard ratio, 2.20; 95% confidence interval, 1.34-3.62). CONCLUSION ED treatment of SVT varies and is often suboptimal. The incidence of thromboembolic complications after SVT is high. Starting anticoagulation in the ED delays the development of complications. Patients with a history of thromboembolic disease are more at risk of complications.
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Affiliation(s)
- Fahd Beddar Chaib
- Servicio de Urgencias, Complejo Asistencial de Soria, Soria, España. Universidad de Valladolid, Facultad de Ciencias de la Salud, Valladolid, España
| | | | | | - Ramón Lecumberri
- Servicio de Hematología, Clínica Universidad de Navarra, Pamplona, España. CIBER-CV, Madrid, España
| | | | | | | | | | | | | | | | - Pedro Ruiz Artacho
- Departamento de Medicina Interna, Clínica Universidad de Navarra, Madrid, España. CIBER de Enfermedades Respiratorias, CIBERES, Madrid, España. Interdisciplinar Teragnosis and Radiosomics (INTRA) Research Group, Universidad de Navarra, España
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Pascual-Izquierdo C, Piñera Salmerón P, Temboury Ruiz F, Valcárcel Ferreiras D, Jiménez Hernández S, Salinas Argente R, Del Arco Galán C, de la Rubia Comos J. Immune thrombotic thrombocytopenic purpura: clinical suspicion and basic management in emergency departments - an expert review and consensus statement from the Spanish societies of hematology and hemotherapy (SEHH) and emergency medicine (SEMES). Emergencias 2023; 35:44-52. [PMID: 36756916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
TEXT Acquired or immune thrombotic thrombocytopenic purpura (TTP) are thrombotic microangiopathies associated with high mortality if treatment is not started early. Onset is usually sudden, meaning that the condition is often diagnosed in hospital emergency departments, where TTP must be suspected as early as possible. These guidelines were drafted by specialists in emergency medicine and hematology to cover the diagnosis, referral, and treatment of patients suspected of immune-mediated TTP who require emergency care. Immune TTP should be suspected whenever a patient presents with hemolytic microangiopathy and has a negative Coombs test, and thrombocytopenia, possibly in conjunction with fever and neurologic and cardiac alterations. If one of the existing diagnostic algorithms indicates there is a high probability that the patient has immune TTP, plasma exchange therapy should be started along with immunosuppressants. Treatment with caplacizumab should also be considered. The patient should be referred immediately to the hematology department within the same hospital or a referral hospital.
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Affiliation(s)
- Cristina Pascual-Izquierdo
- Servicio de Hematología y Hemoterapia, Hospital General Universitario Gregorio Marañón, Madrid. Instituto de Investigación Gregorio Marañón, Miembro de SEHH
| | | | | | - David Valcárcel Ferreiras
- Servicio de Hematología, Vall d'Hebron Institut Oncologic (VHIO), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, España, Miembro de SEHH
| | | | | | - Carmen Del Arco Galán
- Servicio de Urgencias, Hospital Universitario La Princesa, Madrid. Instituto Investigación La Princesa, Madrid, España. Secretaria Científica SEMES
| | - Javier de la Rubia Comos
- Servicio de Hematología y Hemoterapia, HUP La Fe. Facultad de Medicina, Universidad Católica de Valencia, Valencia. Miembro de SEHH
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García-Martínez A, Gil-Rodrigo A, Placer A, Alemany X, Aguiló S, Torres-Machado V, Jacob J, Herrero P, Llorens P, Martín-Sánchez FJ, Miró Ò. Probability of new falls and factors associated with them in aged patients treated in emergency departments after falling: data from the FALL-ER registry. Emergencias 2022; 34:444-451. [PMID: 36625694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To identify characteristics associated with a new fall in a patient who received emergency department care after an accidental fall and to develop a risk model to predict repeated falls. MATERIAL AND METHODS The FALL-ER registry included accidental falls in patients over the age of 65 years treated in 5 Spanish emergency departments. Independent variables analyzed were patient characteristics at baseline, fall characteristics, immediate consequences, and functional status on discharge. Patients were followed with telephone interviews for 6 months to record the occurrence of new falls. Multivariate regression analysis was used to identify variables associated with falling again and to develop a risk model. We identified 3 levels of risk for new falls (low, intermediate, and high). RESULTS A total of 1313 patients were studied; 147 patients (11.2%) reported having another fall. Variables associated with risk of falling again were having had a fall in the 12 months before the index fall, neurological disease, anemia, use of non-opioid analgesics, falling at home, falling at night, head injury on falling, and need for help when rising from a chair. The probability of falling again was 3.5%, 10.5%, and 23.3%, respectively, in patients at low, intermediate, and high risk. The model's ability to discriminate was moderate: the area under the receiver operating characteristic curve was 0.688 (95% CI, 0.640-0.736). CONCLUSION One in 9 older adults treated in an emergency department for an accidental fall will fall again within 6 months. It is possible to identify patients at higher risk for whom preventive measures should be implemented.
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Affiliation(s)
| | - Adriana Gil-Rodrigo
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital General Universitario de Alicante, España
| | - Arrate Placer
- Servicio de Urgencias, Hospital Clínic, Barcelona, España
| | - Xavier Alemany
- Servicio de Urgencias, Hospital Clínic, Barcelona, España
| | - Sira Aguiló
- Servicio de Urgencias, Hospital Clínic, Barcelona, España
| | | | - Javier Jacob
- Servicio de Urgencias, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Central de Asturias, Oviedo, España
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital General Universitario de Alicante, España. Universidad Miguel Hernández, Elche, Alicante, España
| | | | - Òscar Miró
- Servicio de Urgencias, Hospital Clínic, Barcelona, España. Universidad de Barcelona, España
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10
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González Del Castillo J, Jacob J, García-Lamberechts EJ, Piñera Salmerón P, Alquézar-Arbé A, Llorens P, Jiménez S, Quero Espinosa FDB, Aguiló S, Gil-Rodrigo A, Fernández Alonso C, Burillo-Putze G, Espinosa Fernández B, Suero Méndez C, Iglesias Vela M, Quero Motto E, Hong Cho JU, Llopis F, Marrón R, Gayoso Martín S, Lucena Aguilera C, Alemany González X, Rizzi MA, Llauger L, Murcia Olagüenaga A, Vaswani-Bulchand A, Parra Esquivel P, Sánchez Nicolás JA, Carrasco Fernández E, Ruescas Escolano E, Chacón García A, Fernández Salgado F, Miró Ò. Sociodemographic characteristics, comorbidity, and baseline functional status of older patients treated in emergency departments during the COVID-19 pandemic and associations with mortality: an analysis based on the EDENCOVID cohort. Emergencias 2022; 34:428-436. [PMID: 36625692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To describe the sociodemographic characteristics, comorbidity, and baseline functional status of patients aged 65 or older who came to hospital emergency departments (EDs) during the first wave of the COVID-19 pandemic, and to compare them with the findings for an earlier period to analyze factors of the index episode that were related to mortality. MATERIAL AND METHODS We studied data from the EDEN-COVID cohort (Emergency Department and Elder Needs During COVID-19) of patients aged 65 years or older treated in 40 Spanish EDs on 7 consecutive days. Nine sociodemographic variables, 18 comorbidities, and 7 function variables were registered and compared with the findings for the EDEN cohort of patients included with the same criteria and treated a year earlier in the same EDs. In-hospital mortality was calculated in the 2 cohorts and a multivariable logistic regression model was used to explore associated factors. RESULTS The EDEN-COVID cohort included 6806 patients with a median age of 78 years; 49% were women. The pandemic cohort had a higher proportion of men, patients covered by the national health care system, patients brought from residential facilities, and patients who arrived in an ambulance equipped for advanced life support. Pandemic-cohort patients more often had diabetes mellitus, chronic kidney disease, and dementia; they less often had connective tissue and thromboembolic diseases. The Barthel and Charlson indices were worse in this period, and cognitive decline was more common. Fewer patients had a history of depression or falls. Eight hundred ninety these patients (13.1%) died, 122 of them in the ED (1.8%); these percentages were lower in the earlier EDEN cohort, at 3.1% and 0.5%, respectively. Independent sociodemographic factors associated with higher mortality were transport by ambulance, older age, male sex, and living in a residential facility. Mortalityassociated comorbidities were neoplasms, chronic kidney disease, and heart failure. The only function variable associated with mortality was the inability to walk independently. A history of falls in the past 6 months was a protective factor. CONCLUSION The sociodemographic characteristics, comorbidity, and functional status of patients aged 65 years or older who were treated in hospital EDs during the pandemic differed in many ways from those usually seen in this older-age population. Mortality was higher than in the prepandemic period. Certain sociodemographic, comorbidity, and function variables were associated with in-hospital mortality.
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Affiliation(s)
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España
| | | | | | - Aitor Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital General Doctor Balmis, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Sònia Jiménez
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | | | - Sira Aguiló
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Adriana Gil-Rodrigo
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital General Doctor Balmis, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Cesáreo Fernández Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
| | | | - Begoña Espinosa Fernández
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital General Doctor Balmis, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | | | | | - Eva Quero Motto
- Hospital Clínico Universitario Virgen Arrixaca, Murcia, España
| | | | - Ferran Llopis
- Hospital De Bellvitge, L'hospitalet de Llobregat, Barcelona, España
| | - Rafael Marrón
- Hospital Universitario Miguel Servet. Zaragoza, España
| | | | | | - Xavier Alemany González
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Miguel A Rizzi
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | | | | | | | | | | | - Ana Chacón García
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
| | | | - Òscar Miró
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
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11
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Afonso-Argilés FJ, Comas Serrano M, Blázquez-Andión M, Castells Oliveres X, Cirera Lorenzo I, García Pérez D, Gómez Roldán JM, Pujadas Lafarga T, Ichart Tomás X, Puig-Campmany M, Rizzi MA, Sinfreu Pujol A, Tejero Cano I, Vena Martínez AB, Villanueva Sánchez H, Renom-Guiteras A. Factors associated with short-term mortality after emergency department care of residents living in aged care homes: findings from the multicenter Caregency study. Emergencias 2022; 34:437-443. [PMID: 36625693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate short-term mortality in people transferred from aged care homes for treatment in a hospital emergency department (ED) and to analyze factors associated with mortality. MATERIAL AND METHODS Multicenter study of a random sample of retrospective data of patients treated in 5 EDs in Catalonia in 2017. The patients were over the age of 65 years and lived in residential care facilities. In addition to short-term mortality (in the ED or within 30 days of discharge), we analyzed sociodemographic characteristics, prior functional and cognitive status, multimorbidity, triage level on arrival, length of stay in the ED, and hospital admission. Odds ratios (ORs) for factors associated with short-term mortality were calculated by multivariate regression analysis. RESULTS A total of 2444 ED admissions were analyzed. The patients' mean (SD) age was 85.9 (7.1) years, and 67.7% .were women. Short-term mortality (in 15.5%) was associated with age >90 years (OR, 1.50; 95% CI, 1.5-1.95 years), a Charlson index >2 (OR, 1.47; 95% CI, 1.14-1.90), and dependency assessed as moderate (OR, 1.50; 95% CI, 1.03- 2.20) or severe (OR, 2.56; 95% CI, 1.84-3.55). Other associated factors were a higher level of urgency on triage, duration of ED stay, and hospital admission. CONCLUSION The sociodemographic characteristics, comorbidity, and functional status of patients aged 65 years or older who were treated in hospital EDs during the pandemic differed in many ways from those usually seen in this older-age population. Mortality was higher than in the prepandemic period. Certain sociodemographic, comorbidity, and function variables were associated with in-hospital mortality.
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Affiliation(s)
- F Javier Afonso-Argilés
- Servicio de Geriatría, Fundació Sanitària Mollet, Barcelona, España. Estudiante de doctorado de la Universitat Autònoma de Barcelona, Barcelona, España
| | - Mercè Comas Serrano
- Servicio de Epidemiología y Evaluación, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, España. Miembro de la Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, España. Miembro de la Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España
| | | | - Xavier Castells Oliveres
- Servicio de Epidemiología y Evaluación, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, España. Miembro de la Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, España. Miembro de la Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España
| | | | - Dolors García Pérez
- Servicio de Urgencias, Fundació Althaia, Xarxa Assistencial Universitaria de Manresa, Barcelona, España
| | - J María Gómez Roldán
- Servicio de Geriatría y Cuidados Paliativos, Badalona Serveis Assistencials, Barcelona, España
| | - Teresa Pujadas Lafarga
- Servicio de Geriatría y Cuidados Paliativos, Badalona Serveis Assistencials, Barcelona, España
| | - Xavier Ichart Tomás
- Servicio de Urgencias, Hospital Universitari Arnau de Vilanova, Lleida, España
| | | | - Miguel A Rizzi
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Alba Sinfreu Pujol
- Servicio de Urgencias, Fundació Althaia, Xarxa Assistencial Universitaria de Manresa, Barcelona, España
| | - Isabel Tejero Cano
- Servicio de Geriatría, Hospital Universitario Parc de Salut Mar, Barcelona, España
| | - Ana B Vena Martínez
- Servicio de Geriatría, Hospital Universitari Arnau de Vilanova, Lleida, España
| | | | - Anna Renom-Guiteras
- Miembro de la Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, España. Miembro de la Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España. Servicio de Geriatría, Hospital Universitario Parc de Salut Mar, Barcelona, España
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12
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Miró Ò, Jacob J, García-Lamberechts EJ, Piñera Salmerón P, Llorens P, Jiménez S, Burillo-Putze G, Montero-Pérez FJ, Aguiló S, Gil-Rodrigo A, Fernández Alonso C, Alquézar-Arbé A, Parra-Esquivel P, Fortuny Bayarri MJ, González Tejera M, Millán Soria J, Cirera I, Adroher M, Martín Mojarro E, Gargallo García E, Valle B, Díaz Salado Á, Ruiz Grispán M, López Díez MP, Beddar Chaib F, Salido Mota M, Pedraza García J, Sánchez Sindín G, Juárez González R, Pérez Costa RA, Escudero Sánchez C, Prieto Zapico A, González Del Castillo J. Sociodemographic characteristics, functional status, and health resource use of older patients treated in Spanish emergency departments: a description of the EDEN cohort. Emergencias 2022; 34:418-427. [PMID: 36625691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To describe the sociodemographic characteristics of and the health care resources used to treat patients aged 65 years or older who come to hospital emergency departments (EDs) in Spain, according to age groups. MATERIAL AND METHODS We studied the phase-1 data for the EDEN cohort (Emergency Department and Elder Needs). Forty Spanish EDs collected data on all patients aged 65 years or older who were treated on the first 7 days in April 2019. We registered information on 6 sociodemographic and 5 function variables for all patients. For health resource use we used 6 diagnostic, 13 therapeutic, and 5 physical structural variables, for a total of 24 variables. Differences were analyzed according to age in blocks of 5 years. RESULTS A total of 18 374 patients with a median age of 78 years were included; 55% were women. Twenty-seven percent arrived by ambulance, 71% had not previously been seen by a physician, and 13% lived alone without assistance. Ten percent had a high level of functional dependence, and 14% had serious comorbidity. Resources used most often were blood analysis (in 60%) and radiology (59%), analgesics (25%), intravenous fluids (21%), antibiotics (14%), oxygen (13%), and bronchodilators (11%). Twenty-six percent were kept under observation in the ED, 26% were admitted to wards, and 2% were admitted to intensive care units (ICUs). The median stay in the ED was 3.5 hours, and the median hospital stay was 7 days. Sociodemographic characteristics changed according to age. Functional dependence worsened with age, and resource requirements increased in general. However, benzodiazepine use was unaffected, while the use of nonsteroidal anti-inflammatory drugs and ICU admission decreased. CONCLUSION The functional dependence of older patients coming to EDs increases with age and is associated with a high level of health care resource use, which also increases with age. Planners should take into consideration the characteristics of the older patients and the proportion of the caseload they represent when arranging physical spaces and designing processes for a specific ED.
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Affiliation(s)
- Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España
| | | | | | - Pere Llorens
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Sònia Jiménez
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | | | | | - Sira Aguiló
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Adriana Gil-Rodrigo
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Cesáreo Fernández Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
| | - Aitor Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | | | - Javier Millán Soria
- Servicio de Urgencias, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Isabel Cirera
- Servicio de Urgencias, Hospital del Mar, Barcelona, España
| | - María Adroher
- Servicio de Urgencias, Hospital Doctor Josep Trueta, Girona, España
| | | | | | - Beatriz Valle
- Servicio de Urgencias, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - Ángel Díaz Salado
- Servicio de Urgencias, Hospital Universitario Infanta Cristina, Parla, Madrid, España
| | | | | | | | - Manuel Salido Mota
- Servicio de Urgencias, Hospital Regional Universitario de Málaga, Málaga, España
| | - Jorge Pedraza García
- Servicio de Urgencias, Hospital Valle de los Pedroches, Pozoblanco, Córdoba, España
| | | | - Ricardo Juárez González
- Servicio de Urgencias, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, España
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Burillo-Putze G, Ibrahim-Achi D, Martínez-Sánchez L, Galicia M, Supervía A, Puiguriguer Ferrando J, Matos Castro S, Leciñena MÁ, Venegas de L'Hotellerie MªJ, Rodríguez Miranda B, Bajo Bajo Á, Martín-Pérez B, Dueñas-Laita A, Ferrer Dufol A, Callado-Moro F, Nogué-Xarau S, Miró Ò. Differences in clinical signs and severity of intoxication due to street drugs in adolescents and young adults treated in emergency departments. Emergencias 2022; 34:352-360. [PMID: 36217930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To determine whether symptoms and levels of severity of intoxication from street drugs differ between adolescents and young adults who come to hospital emergency departments for treatment. MATERIAL AND METHODS We studied a consecutive cohort of adolescents (aged 12-17 years) and young adults (aged 18-30 years) who were treated in 11 hospital emergency departments belonging to the Drug Abuse Network of Spanish Hospital Emergency Departments (REDURHE). Sociodemographic and clinical characteristics and level of severity were recorded for comparison between between adolescents and young adults, adjusted for sex, alcohol co-ingestion, and type of drug used. An intoxication was recorded as severe if at least 1 of the following indicators was present: cardiac arrest, tracheal intubation, intensive care unit admission, and in-hospital death. RESULTS We included a total of 2181 patients: 249 adolescents (11.4%) and 1932 young adults (88.6%). Alcohol coingestion and use of multiple drugs were less common in adolescents, who had significantly more events related to cannabis (in 81.1% vs 49.0% of young adults) and benzodiazepines (13.3% vs 5.5%). The adolescents had significantly fewer intoxications from the use of cocaine (10.8% vs 45.1%), amphetamines (17.3% vs 32.3%), ketamine (0.4% vs 6.0%) and gamma-hydroxybutyrate (0.4% vs 4.0%). A higher proportion of adolescents than young adults presented with diminished consciousness (23.0% vs 16.9%), but fewer manifested anxiety (15.9% vs 26.3%), palpitations (11.0% vs 19.5%), or chest pain (2.8% vs 9.2%). The pattern of associations was similar in the subgroup of intoxications due to cannabis. The adjusted model confirmed that the adolescents were more likely to have diminished consciousness, with an odds ratio (OR) of 1.851 (95% CI, 1.204-2.844) and less likely to have anxiety (OR, 0.529 (95% CI, 0.347-0.807). Intoxication was severe in 46 patients overall (2.1%); in adolescents and young adults the proportions were 0.8% and 2.3%, respectively (P = 0.129). In adolescents, the OR was 0.568 (95% CI, 0.131-2.468) for severity; for component indicators, the ORs were 0.494 (95% CI, 0.063-3.892) for intubation and 0.780 (95% CI, 0.175-3.475) for intensive care unit admission. No deaths occurred. CONCLUSION Adolescents requiring emergency care for street drug intoxication had co-ingested alcohol or taken multiple drugs less often than young adults. Cannabis was the drug most often used by adolescents, who presented more often with diminished consciousness but less often with anxiety. We detected no differences related to event severity.
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Affiliation(s)
- Guillermo Burillo-Putze
- Universidad Europea de Canarias, Facultad de Ciencias de la Salud, Tenerife, España. Red de Investigación en Atención Primaria de Adicciones (RIAPAD)
| | - Dima Ibrahim-Achi
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España
| | | | - Miguel Galicia
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | | | | | - Sebastián Matos Castro
- Universidad Europea de Canarias, Facultad de Ciencias de la Salud, Tenerife, España. Red de Investigación en Atención Primaria de Adicciones (RIAPAD)
| | | | | | | | - Ángel Bajo Bajo
- Servicio de Urgencias, Hospital Clínico de Salamanca, Salamanca, España
| | - Beatriz Martín-Pérez
- Servicio de Urgencias y Unidad de Toxicología Clínica, Hospital Universitario Río Hortega, Valladolid, España
| | - Antonio Dueñas-Laita
- Servicio de Urgencias y Unidad de Toxicología Clínica, Hospital Universitario Río Hortega, Valladolid, España
| | - Ana Ferrer Dufol
- Unidad de Toxicología Clínica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Francisco Callado-Moro
- Servicio de Urgencias y Unidad de Toxicología Clínica, Hospital Universitario de Burgos, España
| | | | - Òscar Miró
- Red de Investigación en Atención Primaria de Adicciones (RIAPAD)., Área de Urgencias Pediátricas, Hospital Sant Joan de Déu, Barcelona, España
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Miró Ò, Martínez-Nadal G, García A, López-Barbeito B, Carbó M, Placer A, Repullo D, Bragulat E, Sánchez M, Coll-Vinent B. Factors associated with erroneous emergency department noncardiac chest pain classifications in men and women. Emergencias 2022; 34:268-274. [PMID: 35833765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To analyze the frequency and clinical characteristics associated with erroneous initial classifications of noncardiac chest pain (NCP) in men and women. MATERIAL AND METHODS We analyzed all case records in which chest pain was initially classified as noncardiac in origin according to clinical signs and electrocardiograms evaluated in our emergency department between 2008 and 2017. We considered the initial evaluation of NCP to be in error if the final diagnosis was acute coronary syndrome. A risk model for an erroneous initial classification of NCP was developed based on multivariable analysis of our patient data. We also used multivariable analysis to explore associations between 10 clinical signs of chest pain and an erroneous initial NCP classification. The data for men and women were analyzed separately. RESULTS NCP was the initial classification for 8093 women; their median (interquartile range) age was 54 (38-73) years. The classification was in error for 72 women (0.9%). Odds ratios (ORs) showed that patient risk factors associated with an erroneous NCP classification in the women in our series were obesity (OR, 0.40; 95% CI, 0.17- 0.97) and cocaine consumption (OR, 5.18; 95% CI, 1.16-23.2). Clinical risk factors associated with erroneous NCP classification in women were recent physical exertion (OR, 2.01; 95% CI, 1.21-3.33), radiation exposure (OR, 2.05; 95% CI, 1.23-3.41), and vegetative symptoms (OR, 1.86; 95% CI, 1.02-3.41). For 9979 men with a median age of 47 (33-64) years, NCP was the initial classification; in 83 of the men (0.8%) the classification was erroneous. Patient factors associated with erroneous NCP classification in men were age over 40 years (OR, 1.74; 95% CI, 1.04-2.91) and hypertension (OR, 0.45; 95% CI, 0.24-0.84). No clinical signs of chest pain in men were associated with error. CONCLUSION More clinical characteristics are associated with an erroneous classification of NCP in women. Our findings underline the need to assess the possibility of acute coronary syndrome differently in women, in whom the signs have usually been considered to be atypical.
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Affiliation(s)
- Òscar Miró
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | | | - Ana García
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | | | - Míriam Carbó
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Arrate Placer
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Daniel Repullo
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Ernest Bragulat
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Miquel Sánchez
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Blanca Coll-Vinent
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
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Burillo-Putze G, Ibrahim-Ach D, Galicia M, Supervía A, Martínez-Sánchez L, Ortega Pérez J, Matos Castro S, Martín-Pérez B, López Hernández MªÁ, Miró Ò. Clinical manifestations and serious adverse effects after cannabis use: role of age according to sex and coingestion of alcohol. Emergencias 2022; 34:275-281. [PMID: 35833766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To study whether there are age-related differences in the clinical effects of cannabis poisoning and whether any age differences found are also related to sex or coingestion of alcohol. MATERIAL AND METHODS Descriptive observational study of patients treated in 11 emergency departments for symptoms related to cannabis use. We collected data on 11 clinical manifestations and used a restricted cubic spline model to analyze their relative frequency according to age. We also looked for any interactions between the findings and patient sex or alcohol coingestion. RESULTS A total of 949 patients were studied. The mean age was 29 years, 74% were males, and 39% had also consumed alcohol. We identified 3 symptom patterns related to age. One set of symptoms (vomiting, headache, convulsions, and hypotension) remained stable across all ages. Manifestations that increased in the middle of the age range studied were agitation and aggressivity, psychosis, palpitations and hallucinations. Chest pain and hypertension increased in older-aged patients. The frequencies of palpitations, vomiting, and headache differed according to sex. These manifestations held constant in males but were markedly higher in young-adult females. Coingestion of alcohol was associated with agitation and aggressivity (in 34.0% vs 23.4%, P .001), fewer reports of palpitations (in 9.8% vs 15.6%, P = .01), less anxiety (in 20.7% vs 27.8%, P = .01), less psychosis (in 10.3% vs 16.6%, P = .007), and less chest pain (in 3.8% vs 9.5%, P = .001). The only significant interaction between age and alcohol coingestion occurred with respect to vomiting and psychosis. CONCLUSION There are age-related differences in the acute clinical manifestations of cannabis poisoning requiring emergency hospital care. Sex and coingestion of alcohol modify the relationship between age and frequency of some manifestations.
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Affiliation(s)
- Guillermo Burillo-Putze
- Universidad Europea de Canarias, Facultad de Ciencias de la Salud, Tenerife, España. Red de Investigación en Atención Primaria de Adicciones (RIAPAD)
| | - Dima Ibrahim-Ach
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España
| | - Miguel Galicia
- Red de Investigación en Atención Primaria de Adicciones (RIAPAD). Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | | | | | - Juan Ortega Pérez
- Servicio de Urgencias y Unidad de Toxicología Clínica, Hospital Son Espases, Palma de Mallorca, España
| | - Sebastián Matos Castro
- Universidad Europea de Canarias, Facultad de Ciencias de la Salud, Tenerife, España. Red de Investigación en Atención Primaria de Adicciones (RIAPAD)
| | - Beatriz Martín-Pérez
- Servicio de Urgencias y Unidad de Toxicología Clínica, Hospital Universitario Río Hortega, Valladolid, España
| | | | - Òscar Miró
- Red de Investigación en Atención Primaria de Adicciones (RIAPAD). Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
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Leey-Echavarría C, Zorrilla-Riveiro J, Arnau A, Fernàndez-Puigbó M, Sala-Barcons E, Gené E. Model to predict risk for hospital admission and indicate the safety of reverse triage in a hospital emergency department: a prospective validation study. Emergencias 2022; 34:165-173. [PMID: 35736520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To prospectively validate a model to predict hospital admission of patients given a low-priority classification on emergency department triage and to indicate the safety of reverse triage. MATERIAL AND METHODS Single-center observational study of a prospective cohort to validate a risk model incorporating demographic and emergency care process variables as well as vital signs. The cohort included emergency visits from patients over the age of 15 years with priority level classifications of IV and V according to the Andorran-Spanish triage system (Spanish acronym, MAT-SET) between October 2018 and June 2019. The area under the receiver operating characteristic curve (AUC) of the model was calculated to evaluate discrimination. Based on the model, we identified cut-off points to distinguish patients with low, intermediate, or high risk for hospital admission. RESULTS A total of 2110 emergencies were included in the validation cohort; 109 patients (5.2%) were hospitalized. The median age was 43.5 years (interquartile range, 31-60.3 years); 55.5% were female. The AUC was 0.71 (95% CI, 0.64-0.75). The model identified 357 patients (16.9%) at low risk of hospitalization and 240 (11.4%) at high risk. A total of 15.8% of the high-risk patients and 2.8% of the low-risk patients were hospitalized. CONCLUSION The validated model is able to identify risk for hospitalization among patients classified as low priority on triage. Patients identified as having high risk of hospitalization could be offered preferential treatment within the same level of priority at triage, while those at low risk of admission could be referred to a more appropriate care level on reverse triage.
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Affiliation(s)
- Connie Leey-Echavarría
- Servicio de Urgencias y Emergencias, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, España. Programa de Doctorado en Ciencias de la Salud, Universidad Internacional de Catalunya, Barcelona, España
| | - José Zorrilla-Riveiro
- Servicio de Urgencias y Emergencias, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, España. Departamento de Medicina, Universitat Internacional de Catalunya, Sant Cugat del Vallès, España
| | - Anna Arnau
- Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Unitat de Recerca i Innovació, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, España. Centre d'Estudis Sanitaris i Socials (CESS), Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, España
| | - Mireia Fernàndez-Puigbó
- Servicio de Urgencias y Emergencias, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, España
| | - Ester Sala-Barcons
- Servicio de Urgencias y Emergencias, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, España
| | - Emili Gené
- Departamento de Medicina, Universitat Internacional de Catalunya, Sant Cugat del Vallès, España. Servicio de Urgencias, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, España
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Miró Ò, Sánchez C, Gil V, Repullo D, García-Lamberechts EJ, González Del Castillo J, Llorens P. Current Spanish emergency department organization and clinical practicesin caring for patients with acute heart failure. Emergencias 2022; 34:85-94. [PMID: 35357780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To describe routine diagnostic and therapeutic care processes and assignment of resources available for treating patients with acute heart failure (AHF) in Spanish hospital emergency departments (EDs). MATERIAL AND METHODS We surveyed the heads of all hospital EDs in the Spanish national health service concerning their routine diagnostic, therapeutic, and decision-making processes for treating patients with AHF. Questions also covered processes related to continuity of care for patients after discharge. Responses were grouped by hospital size and location (Spanish autonomous community) for comparison. RESULTS Heads of 250 of the 282 EDs (89%) responded. Thirty-two percent had a cardiologist on call, and a specialized AHF unit was present in 35%. Such untis were present in more than half the EDs in the Community of Madrid and in Catalonia. Eighty-four percent of EDs measured natriuretic peptide (NP) levels, 80% carried out echocardiographic assessments (although only 24% reported that more than half their staff were trained to undertake echocardiography), and 64% had high-flow nasal cannula (HFNC) systems. Only the Community of Valencia, Navarre, and La Rioja had the capacity for NP analysis, echocardiography, and HFNC therapy in 80% or more of their hospital EDs. Forty-six percent had admission protocols for patients with AHF, and 60% scheduled outpatient clinic appointments on discharge. Fifty-seven percent of the hospitals with AHF units had consensus-based protocols with their EDs, and 40% of them could schedule clinic appointments from the ED. Large hospitals had significantly better conditions with respect to some of these aspects of organization and care. CONCLUSION There is room for improvement in the diagnosis and treatment of patients with AHF. We detected opportunities to ensure more effective continuity of care for these patients.
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Affiliation(s)
- Òscar Miró
- Área de Urgencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España. Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, España
| | - Carolina Sánchez
- Área de Urgencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Víctor Gil
- Área de Urgencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Daniel Repullo
- Área de Urgencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Eric Jorge García-Lamberechts
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, España
| | - Juan González Del Castillo
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, España. Facultad de Medicina, Universidad Complutense de Madrid, España
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Estancia Corta y Hospital a Domicilio, Hospital General d'Alacant. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España. Facultad de Medicina, Universitat Miguel Hernández, Elx, Alacant, España
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López-Ayala P, Alcaraz-Serna A, Valls Carbó A, Cuadrado Cenzual MÁ, Torrejón Martínez MJ, López Picado A, Martínez Valero C, Miranda JD, Díaz Del Arco C, Cozar López G, Suárez-Cadenas MDM, Jerez Fernández P, Angós B, Rodríguez Adrada E, Cardassay E, Del Toro E, Chaparro D, Montalvo Moraleda MT, Espejo Paeres C, García Briñón MÁ, Hernández Martín-Romo V, Ortega L, Fernández Pérez C, Martínez-Novillo M, González Armengol JJ, González Del Castillo J, Mueller CE, Martín-Sánchez FJ. Procalcitonin concentration in the emergency department predicts 30-day mortality in COVID-19 better than the lymphocyte count, the neutrophil-tolymphocyte ratio, or the C-reactive protein level. Emergencias 2022; 34:119-127. [PMID: 35275462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Although many demographic and clinical predictors of mortality have been studied in relation to COVID-19, little has been reported about the prognostic utility of inflammatory biomarkers. MATERIAL AND METHODS Retrospective cohort study. All patients with laboratory-confirmed COVID-19 treated in a hospital emergency department were included consecutively if baseline measurements of the following biomarkers were on record: lymphocyte counts, neutrophil-to-lymphocyte ratio NRL, and C-reactive protein (CRP) and procalcitonin (PCT) levels. We analyzed associations between the biomarkers and all-cause 30-day mortality using Cox regression models and dose-response curves. RESULTS We included 896 patients, 151 (17%) of whom died within 30 days. The median (interquartile range) age was 63 (51-78) years, and 494 (55%) were men. NLR, CRP and PCT levels at ED presentation were higher, while lymphocyte counts were lower, in patients who died compared to those who survived (P .001). The areas under the receiver operating characteristic curves revealed the PCT concentration (0.79; 95% CI, 0.75-0.83) to be a better predictor of 30-day mortality than the lymphocyte count (0.70; 95% CI, 0.65-0.74; P .001), the NLR (0.74; 95% CI, 0.69-0.78; P = .03), or the CRP level (0.72; 95% CI, 0.68-0.76; P .001). The proposed PCT concentration decision points for use in emergency department case management were 0.06 ng/L (negative) and 0.72 ng/L (positive). These cutoffs helped classify risk in 357 patients (40%). Multivariable analysis demonstrated that the PCT concentration had the strongest association with mortality. CONCLUSION PCT concentration in the emergency department predicts all-cause 30-day mortality in patients with COVID-19 better than other inflammatory biomarkers.
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Affiliation(s)
- Pedro López-Ayala
- Instituto de Investigación Cardiovascular de Basel (CRIB), Servicio de Cardiología, Hospital Universitario de Basel, Universidad de Basel, Basel, Suiza
| | - Ana Alcaraz-Serna
- Hospital Universitario de Lausanne (CHUV), Departamento de Medicine, Servicio de Inmunología y Alergología, Lausanne, Suiza
| | | | - Mª Ángeles Cuadrado Cenzual
- Servicio de Laboratorio de Análisis Biomédicos, Hospital Clínico San Carlos, Madrid, España. Facultad de Medicina, Universidad Complutense de Madrid, España
| | | | | | | | | | | | | | - María Del Mar Suárez-Cadenas
- Instituto de Investigación de la Salud, Hospital San Carlos, Madrid, España. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | | | - Beatriz Angós
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | | | | | - Enrique Del Toro
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | - David Chaparro
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | | | | | - Miguel Ángel García Briñón
- Instituto de Investigación de la Salud, Hospital San Carlos, Madrid, España. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | | | - Luis Ortega
- Servicio de Laboratorio de Análisis Biomédicos, Hospital Clínico San Carlos, Madrid, España. Facultad de Medicina, Universidad Complutense de Madrid, España
| | | | - Mercedes Martínez-Novillo
- Servicio de Laboratorio de Análisis Biomédicos, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación de la Salud, Hospital San Carlos, Madrid, España
| | - Juan Jorge González Armengol
- Facultad de Medicina, Universidad Complutense de Madrid, España. Instituto de Investigación de la Salud, Hospital San Carlos, Madrid, España. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | - Juan González Del Castillo
- Instituto de Investigación de la Salud, Hospital San Carlos, Madrid, España. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | - Christian E Mueller
- Instituto de Investigación Cardiovascular de Basel (CRIB), Servicio de Cardiología, Hospital Universitario de Basel, Universidad de Basel, Basel, Suiza
| | - F Javier Martín-Sánchez
- Facultad de Medicina, Universidad Complutense de Madrid, España. Instituto de Investigación de la Salud, Hospital San Carlos, Madrid, España. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
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Gómez-Morán Quintana M, Horrillo García C, Gutiérrez Misis A, Quesada-Cubo V, Torres Poza A, Cintora Sanz A, Carrillo Fernández Ó, Rendo Murillo JA, Pérez Alonso AM, Pastor Cabanillas L, Leco Gil N, Chaya Romero C, Parejo García L, Rubio Riballo AB, Canales Corcho I, Rodríguez Rodríguez Ó, Gómez de la Oliva S, García Benavent E, Antiqueira Pérez A, González Viñolis M, Aranda García Y, Albiñana Pérez A, Rincón Francés M, Martín Jiménez ML, Fernández Del Blanco C, Barros González R. Factors associated with in-hospital mortality and readmission in a cohort of patients treated with noninvasive ventilation during emergency department or out-of-hospital emergency care: the VentilaMadrid study. Emergencias 2022; 34:7-14. [PMID: 35103438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To describe clinical, outcome, and risk factors in a cohort of patients treated with noninvasive ventilation (NIV) in a hospital emergency department (ED) or by out-of-hospital emergency medical services (OHEMSs). MATERIAL AND METHODS Multicenter, prospective cohort study enrolling consecutive patients with acute pulmonary edema and/or exacerbated chronic obstructive pulmonary disease who were treated with NIV between November 2018 and November 2020 in a hospital ED or OHEMS setting in Madrid. We recorded baseline data, variables related to the acute episode, and outcome variables, including in-hospital mortality and 30-day readmission. RESULTS A total of 317 patients were included; 132 (41.6%) were treated in an OHEMS setting and 185 (58.4%) in a hospital ED. Forty-seven (16.3%) in-hospital deaths occurred, and 78 patients (28.8%) were readmitted within 30 days. Mortality in the hospital ED and OHEMS subsamples did not differ, but the patients who received NIV in an OHEMS setting had a lower 30-day readmission rate. On multivariate analysis, in-hospital mortality was associated with prior dependence in activities of daily living in the multivariate analysis (odds ratio [OR], 2.4; 95% CI, 1.11-5.27) and a low-moderate score on the Simplified Acute Physiology Score II (SAPS II) versus a high-very high one (OR, 2.69; 95% CI, 1.26-5.77). Mortality after OHEMS ventilation was associated with discontinuance of NIV during transfer (OR, 8.57; 95% CI, 2.19-33.60). Readmission within 30 days was associated with group (in-hospital ED application of NIV) (OR, 3.24; 95% CI, 2.62-6.45) and prior dependence (OR, 2.08; 95% CI, 1.02-4.22). CONCLUSION Patients treated in the hospital ED and OHEMS setting have similar baseline characteristics, although acute episodes were more serious in the OHEMS group. No significant differences were found related to in-hospital mortality. Higher mortality was associated with dependence, a SAPS II score greater than 52, and discontinuance of NIV. Readmission was associated with dependence and NIV treatment in the hospital ED setting.
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Affiliation(s)
| | | | - Alicia Gutiérrez Misis
- Departamento de Medicina. Unidad Clínica departamental de Medicina de Familia y AP. Facultad de Medicina de la UAM, Madrid, España
| | - Víctor Quesada-Cubo
- Departamento de Medicina Preventiva, Hospital Gregorio Marañón, Madrid, España
| | - Ana Torres Poza
- Servicio de Urgencias Médicas de la Comunidad de Madrid (SUMMA 112), Madrid, España
| | - Ana Cintora Sanz
- Servicio de Urgencias Médicas de la Comunidad de Madrid (SUMMA 112), Madrid, España
| | | | | | | | | | | | | | | | | | | | | | | | - Eva García Benavent
- Servicio de Urgencias Médicas de la Comunidad de Madrid (SUMMA 112), Madrid, España
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Albert A, Jacob J, Malchair P, Llopis F, Fuentes L, Martín C, García C, Rodríguez O, Ruibal JC, Martínez C, Fuentes E, Cordero M, Guillén L, Chamorro F, Quetglas S, Ferre C. Predictors of revisits within 1 year by patients after acute COVID-19: the HUBCOVID365 cohort study. Emergencias 2022; 34:38-46. [PMID: 35103442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To analyze the frequencies of 3 types of hospital revisits by patients after treatment for COVID-19 in the emergency department. MATERIAL AND METHODS Retrospective observational study of consecutive patients who came to the emergency department in March and April 2020 and were discharged alive with a diagnosis of COVID-19. Baseline and acute episode data were collected and the patients were followed for 1 year. We analyzed variables associated with revisits for any reason, revisits related to COVID-19, and early COVID-19-related revisits (within 30 days). RESULTS A total of 1352 patients with a mean age of 62.1 years (52.9% male) were studied. A total of 553 revisits were made by 342 patients (25.3%) for any reason; 132 (9.8%) revisited in relation to COVID-19 at least once. Of those, 103 (7.6%) revisited within 30 days (early) and 29 (2.2%) came later. COVID-19-related revisits were associated with thrombotic events (odds ratio [OR], 7.58; 95% CI, 1.75-32.81) and pulmonary fibrosis (OR, 4.95; 95% CI, 1.27-19.24); early revisits were inversely associated with follow-up management by a contracted health care support service (OR, 0.18; 95% CI, 0.03-0.92). Hospital admission during the initial visit was significantly associated with fewer revisits for any reason or related to COVID-19 at any time. CONCLUSION Fewer than half the total number of emergency department revisits after initial care for COVID-19 were related to the novel coronavirus infection. Revisits occurred more often in the first 30 days after discharge. Later COVID-19-related revisits were uncommon, but given the large number of patients with this infection, such visits can be expected.
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Affiliation(s)
- Arantxa Albert
- Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España
| | - Javier Jacob
- Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España
| | - Pierre Malchair
- Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España
| | - Ferrán Llopis
- Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España
| | - Lidia Fuentes
- Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España
| | - Cristina Martín
- Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España
| | - Cristina García
- Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España
| | - Orlando Rodríguez
- Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España
| | - José Carlos Ruibal
- Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España
| | | | - Elena Fuentes
- Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España
| | - Marco Cordero
- Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España
| | - Lara Guillén
- Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España
| | - Francisco Chamorro
- Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España
| | - Sebastián Quetglas
- Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España
| | - Carles Ferre
- Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España
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Beddar Chaib F, Jiménez Hernández S, Pedrajas Navas JM, Carriel Mancilla J, Castro Arias L, Merlo Loranca M, Peiró Gómez A, Álvarez Márquez Á, Lozano Polo L, Sánchez Garrido-Lestache Á, Lecumberri R, Ruiz Artacho P. Characteristics of isolated superficial vein thrombosis and diagnostictherapeutic management in Spanish hospital emergency departments: the ALTAMIRA study. Emergencias 2021; 33:433-440. [PMID: 34813190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To describe the characteristics of patients with isolated lower-limb superficial vein thrombosis (SVT) treated in hospital emergency departments and to evaluate adherence to clinical practice guidelines on diagnosis (vein ultrasound imaging) and therapeutic management (start of anticoagulant therapy). MATERIAL AND METHODS Retrospective cohort study in 18 Spanish emergency departments. We included all patients with a final emergency department diagnosis of lower-limb SVT aged 18 years or older between January 2016 and May 2017. Backward stepwise multiple logistic regression analysis was used to evaluate adherence to clinical practice guidelines on ordering vein ultrasound imaging and starting anticoagulant therapy. RESULTS A total of 1166 patients were included. The mean patient age was 59.6 years, and 67.9% were women. About a quarter of the patients (24.4%) had a history of venous thromboembolic disease. Complications developed in 8.9% within 180 days: 4.6% experienced a recurrence and 3.6% progressed to SVT and 1.8% to deep vein thrombosis; pulmonary thromboembolism occurred in 0.9%. Hemorrhagic complications developed in 17 patients (1.5%). Sixteen patients (1.4%) died. Vein ultrasound imagine was ordered for 703 patients (60.3%). Anticoagulant agents were prescribed for 898 (77%) for a median period of 22 days. Variables associated with a decision to order anticoagulants were a history of venous thromboembolic disease (odds ratio [OR], 1.60; 95% CI, 1.12-2.30), varicose veins (OR, 1.40; 95% CI, 1.12-2.30); limb pain (OR, 1.44; 95% CI, 1.08-1.91); painful cord (OR, 1.30; 95% CI, 0.97-1.73); and availability of vein ultrasound images (OR, 1.60; 95% CI, 1.94-3.45). CONCLUSION Adherence to clinical practice guidelines for the diagnosis and treatment of isolated lower-limb SVT is low in Spanish emergency departments. Ultrasound imaging is not ordered for 1 out of every 2 to 3 patients, and anticoagulant treatment is not started in 1 out of 4 patients. There is great room for improvement.
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Affiliation(s)
- Fahd Beddar Chaib
- Servicio de Urgencias, Complejo Asistencial de Soria, España. Universidad de Valladolid, Facultad de Ciencias de la Salud, Valladolid, España
| | | | | | - Jorge Carriel Mancilla
- Servicio de Medicina Interna, Gastro Obeso Center, Guayaquil, Ecuador. Facultad de Ciencias Médicas, Universidad Católica De Santiago de Guayaquil, Ecuador
| | | | | | - Ana Peiró Gómez
- Servicio de Urgencias, Hospital Arnau de Vilanova-Lliria, Valencia, España
| | - Ángel Álvarez Márquez
- Servicio de Urgencias, Hospital Universitario Nuestra Señora de Valme, Sevilla, España
| | - Laura Lozano Polo
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | - Ramón Lecumberri
- Servicio de Hematología, Clínica Universidad de Navarra, Pamplona, Navarra, España. CIBER-CV, Pamplona, Navarra, España
| | - Pedro Ruiz Artacho
- Departamento de Medicina Interna, Clínica Universidad de Navarra, Madrid, España. CIBER de Enfermedades Respiratorias, CIBERES, Madrid, España. Interdisciplinar Teragnosis and Radiosomics (INTRA) Research Group, Universidad de Navarra, España
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22
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Ibrahim-Achi D, Miró Ò, Galicia M, Supervía A, Puiguriguer Ferrando J, Ortega Pérez J, Leciñena MÁ, Venegas de L'Hotellerie MªJ, Rodríguez Miranda B, Martínez-Sánchez L, Bajo Bajo Á, Martín-Pérez B, Dueñas-Laita A, Ferrer Dufol A, Callado-Moro F, Nogué-Xarau S, Burillo-Putze G. Spanish Research Network on Drugs in Hospital Emergency Departments - the REDUrHE registry: general analysis and comparisons between weekend and weekday poisonings. Emergencias 2021; 33:335-344. [PMID: 34581526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To describe the sociodemographic characteristics, drug use patterns, and the severity of drug overdoses treated in hospital emergency departments according to the registry of the Spanish Research Network on Drugs in Hospital Emergency Departments (REDUrHE project), and to identify differences between patterns on weekdays and weekends/national holidays. MATERIAL AND METHODS Eleven hospitals participated in the REDUrHE project, studying consecutive patients with symptoms of drug overdose over a 24-month period. The drugs implicated were extracted from clinical records or toxicology reports. An overdose was considered severe if management required intubation, cardiopulmonary resuscitation, or admission to the intensive care unit, or if in-hospital death occurred (composite event). Each of these variables was also analyzed by itself. RESULTS A total of 4526 patients were studied (2218 [49%] on weekends/holidays; 2308 [51%] on workdays). The mean (SD) age was 33 (11) years, and 75.5% were men. The most commonly used drugs were cocaine (47.8%), paciencannabis (44.4%), amphetamine derivatives (25.5%), benzodiazepines (8.8%), and opioids (7.3%). Patients treated on weekends/holidays were younger (32.1 vs 33.1 years on weekdays, P = .006), and they were more often taken to the hospital in an ambulance (60.5% vs 57.3%, P = .035). Hospitals in large cities (Barcelona and Madrid) saw more patients on weekends/holidays (55.8%). Major tourist destinations (the Balearic and Canary Islands) saw fewer patients on weekends/holidays (44.7%, P .001). Alcohol was ingested along with a drug by 58.2%; this combination was more common on weekends/holidays (in 63.3% vs 52.9% on weekdays, P .001), and 39.4% used more than 1 drug. Use of more than 1 drug was less common on weekends (in 37.6% vs 41.2%, P = .013). Opioid emergencies were also less frequent on weekends (6.0% vs 8.6%, P = .001), when gamma-hydroxybutyrate (GHB) overdoses were more common (5.8% vs 3.6%, P .001). Severity indicators were present (the composite event) more often on weekends (in 3.6% vs 2.2%, P = .006). Likewise, weekends saw more intubations (in 2.3% vs 1.0%, P = .001) and intensive care unit admissions (2.4% vs 1.6%, P = .047). Twelve patients (0.3%) died; mortality was similar on weekends (0.2%) and weekdays (0.3%) (P = .826). After adjusting for age, sex, combined use of alcohol, and type of drug, the risk of the severe-event composite was greater on weekends (odds ratio, 1.569; 95% CI, 1.088-2.263). CONCLUSION Weekend and holiday emergencies due to drug overdoses are more frequent in large city hospitals. Weekend emergencies share certain distinctive characteristics: patients are younger, alcohol more often is ingested with drugs but multiple-drug combinations are less common, and GHB is used more often while opioids are used less often. Severe poisonings occur more often on weekends and holidays.
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Affiliation(s)
- Dima Ibrahim-Achi
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Miguel Galicia
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - August Supervía
- Servicio de Urgencias y Unidad Funcional de Toxicología, Hospital del Mar, Barcelona, España
| | | | - Joan Ortega Pérez
- Servicio de Urgencias y Unidad de Toxicología Clínica, Hospital Son Espases, Palma de Mallorca, España
| | | | | | | | | | - Ángel Bajo Bajo
- Servicio de Urgencias, Hospital Clínico de Salamanca, Salamanca, España
| | - Beatriz Martín-Pérez
- Servicio de Urgencias y Unidad de Toxicología Clínica, Hospital Universitario Río Hortega, Valladolid, España
| | - Antonio Dueñas-Laita
- Servicio de Urgencias y Unidad de Toxicología Clínica, Hospital Universitario Río Hortega, Valladolid, España
| | - Ana Ferrer Dufol
- Unidad de Toxicología Clínica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Francisco Callado-Moro
- Servicio de Urgencias y Unidad de Toxicología Clínica, Hospital Universitario de Burgos, España
| | - Santiago Nogué-Xarau
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
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Markarian T, Persico N, Roch A, Ahriz D, Taguet C, Birman G, Mahboubi A, Ducassou J, Bourenne J, Zieleskiewicz L, Bobbia X, Michelet P. Early assessment of patients with COVID-19 and dyspnea using lung ultrasound scoring. Emergencias 2021; 33:354-360. [PMID: 34581528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The main objective was to evaluate the precision of the Modified Lung Ultrasound (MLUS score) for predicting the need for respiratory support in the first 48 hours in patients with dyspnea due to the coronavirus disease 2019 (COVID-19). The secondary objectives were 1) to compare the MLUS and National Early Warning Score 2 (NEWS2), as well as the combination of both scores, as predictors of severity according to the World Health Organization (WHO) Ordinal Scale for Clinical Improvement; and 2) to compare severity assessed by ultrasound scoring to severity assessed by lung computed tomography (CT). MATERIAL AND METHODS Multicenter prospective observational cohort study conducted from March 30 to April 30, 2020, in 2 university hospitals. Adult patients with dyspnea due to COVID-19 were included. An initial lung ultrasound was performed, and the results of MLUS, NEW2, and lung CT evaluations were recorded. Patients were classified by risk according to the WHO scale at 48 hours, as follows: low risk (score less than 5) or high risk (score of 5 or more). RESULTS A total of 100 patients were included: 35 (35%) were classified as low risk and 65 (65%) as high risk. The correlation between the MLUS and WHO assessments was positive and very high (Spearman rank correlation = 0.832; P .001). The area under the receiver operating characteristic curves of the MLUS, NEW2 and combined ultrasound scores, in relation to prediction of risk classification were, respectively, 0.96 (0.93-0.99), 0.89 (0.82-0.95) and 0.98 (0.96-1.0). The MLUS and lung CT assessments were correlated. CONCLUSION An early lung ultrasound score can predict clinical severity in patients with dyspnea due to COVID-19.
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Affiliation(s)
- Thibaut Markarian
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia. UMR 1263 Center of Cardiovascular and Nutrition Research (C2VN), Aix-Marseille University, INSERM, INRAE, Marsella, Francia
| | - Nicolas Persico
- Department of Emergency Medicine, North University Hospital, Marsella, Francia. Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279, CEReSS - Health Services Research and Quality of Life Center, Marsella, Francia
| | - Antoine Roch
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia. Department of Emergency Medicine, North University Hospital, Marsella, Francia. Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279, CEReSS - Health Services Research and Quality of Life Center, Marsella, Francia
| | - Dalia Ahriz
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia
| | - Chloe Taguet
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia
| | - Guillaume Birman
- Department of Emergency Medicine, North University Hospital, Marsella, Francia
| | - Adela Mahboubi
- Department of Emergency Medicine, North University Hospital, Marsella, Francia
| | - Justine Ducassou
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia
| | - Jeremy Bourenne
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279, CEReSS - Health Services Research and Quality of Life Center, Marsella, Francia. Medecine Intensive Réanimation, Réanimation des Urgences, Timone University Hospital, Marsella, Francia
| | - Laurent Zieleskiewicz
- UMR 1263 Center of Cardiovascular and Nutrition Research (C2VN), Aix-Marseille University, INSERM, INRAE, Marsella, Francia. Department of Anesthesiology and Intensive Care Medicine, North University Hospital, Marsella, Francia
| | - Xavier Bobbia
- Medecine Intensive Réanimation, Réanimation des Urgences, Timone University Hospital, Marsella, Francia
| | - Pierre Michelet
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia. Department of Emergency Medicine, North University Hospital, Marsella, Francia
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24
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García-Martínez A, Carbó M, Aniyar V, Antolín A, Miró Ò, Gómez-Angelats E. Undertriage of patients requiring direct admission to intensive care from the emergency department for medical conditions: impact on prognosis and associated factors. Emergencias 2021; 33:361-367. [PMID: 34581529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To determine whether undertriage affects the outcome for patients requiring direct admission to the intensive care unit (ICU) from the emergency department due to a medical condition. To identify factors associated with undertriage. MATERIAL AND METHODS Retrospective review of patients treated in 2018 for medical emergencies requiring direct admission to the ICU from the emergency department. The cases were classified in 2 groups according to the assigned triage level. Underestimation was defined as a triage level of III or more. Independent variables were demographic and epidemiologic data and indicators of severity recorded in the emergency department. The main outcome was 30-day mortality. Secondary outcomes were in-hospital mortality, prolonged ICU stay, and prolonged hospital stay. RESULTS We included 470 patients with a median age of 68 years (first-third quartile range, 57-78 years); 61.1% were men, and 151 (32.1%) were undertriaged. Factors directly related to undertriage according to odds ratios (ORs) were age (OR = 1.017; 95% CI, 1.003-1.032), Quick Sequential Organ Failure Assessment score of 0 or 1 (OR = 1.761; 95% CI, 1.038-2.988), ratio of oxygen saturation to fraction of inspired oxygen greater than 300 (OR = 2.447; 95% CI, 1.418-4.223), a diagnosis of infection (OR = 5.003, 95% CI 2.727-9.188) whether respiratory (OR = 3.993, 95% CI 1.919-8.310) or other (OR = 1.980, 95% CI, 1.036-3.785) versus a diagnosis of cardiovascular disease. Factors inversely related to undertriage were admission during the afternoon (OR = 0.512, 95% CI, 0.306-0.856) and ambulance transfer (OR = 0.373; 95% CI, 0.232-0.600). Ninety patients (19.1%) died within 30 days. Undertriage was not related to 30-day mortality or the other outcomes analyzed. CONCLUSION Undertriage was not associated with a worse outcome in patients requiring direct admission to the ICU for a medical emergency. The factors we found to be associated with undertriage, such as patient age and time of day admitted, merit special attention given that these factors should not be affecting the triage process.
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Affiliation(s)
- Ana García-Martínez
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Miriam Carbó
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Victoria Aniyar
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Albert Antolín
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
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25
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Montero-Pérez FJ, Jiménez Murillo LM. Impact of the first COVID-19 pandemic wave on the care and quality indicators of a hospital emergency department. Emergencias 2021; 33:345-353. [PMID: 34581527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To study the impact of the first COVID-19 pandemic wave state of emergency on qualitative and quantitative indicators of demand for the services of a hospital emergency department. MATERIAL AND METHODS Retrospective cross-sectional analysis of all visits by adults to the department during the Spanish state of emergency. The findings were compared to those for a similar period before the pandemic. We collected data for care variables, triage levels, wait times before triage, triage times, and times to first contact with a physician, discharge diagnostic codes, revisits within 72 hours, among other information. We also analyzed demand for timesensitive emergencies. RESULTS Demand for emergency department care decreased overall by 48.3% (95% CI, 0.48%-0.49%) while the state of emergency was in effect. The decrease was 60.7% (95% CI, 0.60%-0.61%) during phase 0 (lockdown). The decrease was more marked for the lower priority emergencies during lockdown (phase 0), at 60.5% for the lowest (level V) versus 35.1% for the highest priority (level I). The most frequent diagnoses were for respiratory conditions, followed by abdominal pain. There was a decrease in demand for treatment for all time-sensitive conditions. CONCLUSION Overall demand for emergency care for adults fell during the first COVID-19 pandemic wave state of emergency in Spain. Lower priority emergencies for less serious problems saw the greatest decreases. We also saw a decrease in the use of time-dependent procedures.
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