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García-Lamberechts EJ, Fuentes Ferrer M, Fernández-Alonso C, Burillo-Putze G, Aguiló S, Alquezar-Arbé A, Montero-Pérez FJ, Jacob J, Piñera Salmerón P, Salido Mota M, Marchena MJ, Martínez Alonso A, Chacón García A, Güemes de la Iglesia C, Troiano Ungerer OJ, Eiroa-Hernández P, Parra-Esquivel P, Lázaro Aragüés P, Gantes Nieto P, Cuerpo Cardeñosa S, Chacón García C, Serrano Lázaro L, Caballero Martínez M, Guillen L, Muñoz Martos R, González Del Castillo J, Miró Ò. Predictive usefulness of qSOFA, NEWS and GYM scores in the elderly patient: EDEN-5 study. Enferm Infecc Microbiol Clin (Engl Ed) 2024:S2529-993X(24)00008-X. [PMID: 38296669 DOI: 10.1016/j.eimce.2024.01.002] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/18/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE To analyze the prognostic accuracy of the scores NEWS, qSOFA, GYM used in hospital emergency department (ED) in the assessment of elderly patients who consult for an infectious disease. METHODS Data from the EDEN (Emergency Department and Elderly Need) cohort were used. This retrospective cohort included all patients aged ≥65 years seen in 52 Spanish EDs during two weeks (from 1-4-2019 to 7-4-2019 and 30/3/2020 to 5/4/2020) with an infectious disease diagnosis in the emergency department. Demographic variables, demographic variables, comorbidities, Charlson and Barthel index and needed scores parameters were recorded. The predictive capacity for 30-day mortality of each scale was estimated by calculating the area under the receiver operating characteristic (ROC) curve, and sensitivity and specificity were calculated for different cut-off points. The primary outcome variable was 30-day mortality. RESULTS 6054 patients were analyzed. Median age was 80 years (IQR 73-87) and 45.3% women. 993 (16,4%) patients died. NEWS score had better AUC than qSOFA (0.765, 95CI: 0.725-0.806, versus 0.700, 95%CI: 0.653-0.746; P < .001) and GYM (0.716, 95%CI: 0.675-0.758; P = .024), and there was no difference between qSOFA and GYM (P = .345). The highest sensitivity scores for 30-day mortality were GYM ≥ 1 point (85.4%) while the qSOFA score ≥2 points showed high specificity. In the case of the NEWS scale, the cut-off point ≥4 showed high sensitivity, while the cut-off point NEWS ≥ 8 showed high specificity. CONCLUSION NEWS score showed the highest predictive capacity for 30-day mortality. GYM score ≥1 showed a great sensitivity, while qSOFA ≥2 scores provide the highest specificity but lower sensitivity.
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Affiliation(s)
| | - Manuel Fuentes Ferrer
- Unidad de Investigación, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Cesáreo Fernández-Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Guillermo Burillo-Putze
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain
| | - Sira Aguiló
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Aitor Alquezar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | | | | | | | - Patricia Eiroa-Hernández
- Servicio de Urgencias, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Patricia Parra-Esquivel
- Servicio de Urgencias, Hospital Norte Tenerife, Icod de los Vinos, Santa Cruz de Tenerife, Spain
| | - Paula Lázaro Aragüés
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, Spain
| | | | | | | | | | | | - Lara Guillen
- Servicio de Urgencias, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Rocío Muñoz Martos
- Servicio de Urgencias, Hospital de la Axarquía, Velez-Málaga, Málaga, Spain
| | | | - Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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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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Burillo-Putze G, Parra-Esquivel P, Aguiló S, Jiménez S, Jacob J, Piñera Salmerón P, Llorens P, García-Lamberechts EJ, Montero-Pérez FJ, Muñoz-Triano E, Gil-Rodrigo A, Fernández-Alonso C, Alquezar-Arbé A, Salido Mota M, Gil Hernández RJ, Pedraza García J, Cobos Requena A, Gargallo Garcia E, de Diego Arnaiz M, Iglesias Vela M, Pérez-Costa RA, Pérez Peñalva SDM, Valle Borrego B, Quero Motto E, Morales Franco B, Adroher Muñoz M, González Del Castillo J, Miró Ò. Study EDEN-12: Analysis of access to intensive care units of patients older than 65 years requiring emergency hospitalization. Med Intensiva 2023:S2173-5727(23)00068-1. [PMID: 37391317 DOI: 10.1016/j.medine.2023.05.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/03/2023] [Accepted: 04/15/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To investigate the relationship between the age of an urgently hospitalized patient and his or her probability of admission to an intensive care unit (ICU). DESIGN Observational, retrospective, multicenter study. SETTING 42 Emergency Departments from Spain. TIME-PERIOD April 1-7, 2019. PATIENTS Patients aged ≥65 years hospitalized from Spanish emergency departments. INTERVENTIONS None. MAIN VARIABLES OF INTEREST ICU admission, age sex, comorbidity, functional dependence and cognitive impairment. RESULTS 6120 patients were analyzed (median age: 76 years; males: 52%. 309 (5%) were admitted to ICU (186 from ED, 123 from hospitalization). Patients admitted to the ICU were younger, male, and with less comorbidity, dependence and cognitive impairment, but there were no differences between those admitted from the ED and from hospitalization. The OR for ICU-admission adjusted by sex, comorbidity, dependence and dementia reached statistical significance >83 years (OR: 0.67; 95%CI: 0.45-0.49). In patients admitted to the ICU from ED, the OR did not begin to decrease until 79 years, and was significant >85 years (OR: 0.56, 95%CI: 0.34-0.92); while in those admitted to ICU from hospitalization, the decrease began 65 years of age, and were significant from 85 years (OR: 0.55, 95%CI: 0.30-0.99). Sex, comorbidity, dependency and cognitive deterioration of the patient did not modify the association between age and ICU-admission (overall, from the ED or hospitalization). CONCLUSIONS After taking into account other factors that influence admission to the ICU (comorbidity, dependence, dementia), the chances of admission to the ICU of older patients hospitalized on an emergency basis begin to decrease significantly after 83 years of age. There may be differences in the probability of admission to the ICU from the ED or from hospitalization according to age.
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Affiliation(s)
| | - Patricia Parra-Esquivel
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain.
| | - Sira Aguiló
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Sònia Jiménez
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Pere Llorens
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | | | | | | | - Adriana Gil-Rodrigo
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Cesáreo Fernández-Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Aitor Alquezar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | | | | | - Marta Iglesias Vela
- Servicio de Urgencias, Complejo Asistencial Universitario de León, León, Spain
| | | | | | | | - Eva Quero Motto
- Servicio de Urgencias, Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | - Belén Morales Franco
- Servicio de Urgencias, Hospital Universitario Lorenzo Guirao, Cieza, Murcia, Spain
| | - Maria Adroher Muñoz
- Servicio de Urgencias, Hospital Universitario Dr. Josep Trueta, Girona, Spain
| | | | - Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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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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Hernández-Ramos I, Parra-Esquivel P, López-Hernández Á, Burillo-Putze G. [Spontaneuos pneumomediastinum secondary to cannabinoid hyperemesis syndrome]. An Sist Sanit Navar 2019; 42:227-230. [PMID: 31133765 DOI: 10.23938/assn.0635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cannabinoid hyperemesis syndrome (CHS) is little known amongst clinicians and is characterised by abdominal pain and cyclical vomiting, after intense consumption of cannabis over several years. It does not respond to treatment with antiemetics, but does respond to showers in very hot water. We present the case of a 24-year-old patient whose antecedents included cannabis consumption since the age of 14 and an episode of spontaneous idiopathic pneumomediastinum (PM) the previous month, which presented an association of CHS and secondary pneumomediastinum with the intense, repeated vomiting of the CHS. He was given topical capsaicin and 5 mg of intravenous haloperidol, and was kept for 48 hours in the in A and E Short Stay Unit. This isolated clinical observation appears to indicate the need to rule out CHS as the cause of PM in young patients and, similarly, to consider the presence of PM in the clinical exploration of young people with CHS and in patients with pathologies whose aetiology might be influenced by an increase in intrathoracic pressure.
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Affiliation(s)
- I Hernández-Ramos
- Servicio de Urgencias. Hospital Universitario de Canarias. La Laguna. Tenerife..
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