[Assessment and follow-up of patients with suspected COVID-19 in the first pandemic wave in an urban area of Andalusia (Spain)]. / Valoración y seguimiento de los pacientes con sospecha de COVID-19 en la primera ola pandémica en una zona urbana de Andalucía.

OBJECTIVE: To know the characteristics of the initial care and telephone follow-up of patients with suspected COVID-19 in the first wave of the pandemic. DESIGN: Observational, retrospective (audit of medical records). LOCATION: Urban Primary Care Center of Andalusia (Spain). PARTICIPANTS: Probable cases of SARS-CoV-2 (from 20/03/15 to 20/06/15). PRINCIPAL MEASUREMENTS: Initial medical assessment (place and modality) and telephone follow-up (number of calls and duration). Sociodemographic variables (including family structure). Clinical course (symptoms, vulnerability, tests, hospital admission and outcome). RESULTS: Three hundred one patients (51.5±17.8 years; 23% vulnerable people; 17% non-nuclear family structure). First assessment in Primary Care by phone (59.8%) and face-to-face (25.2%). At the hospital emergency department (11%), patients were more frequently from non-nuclear families (P<.05 χ2) and more tests were carried out (P<.05 χ2) despite having similar symptoms. Vulnerable elderly patients needed home health care (P<.01 ANOVA). 8.2±4.4 follow-up phone calls were made per patient, for 17.1±10.3 days. It increases after ≥2 face-to-face consultations (OR 4.8), the presence of alarm symptoms (OR 2.3) and age ≥45 years (OR 2.0). Few confirmatory tests were performed (19.3% antigenic, 13% serology). The 15.3% hospital admissions (all assessed previously in Primary Care), with 6.3% severe cases and 2.3% death. CONCLUSION: Population chose to be attended in Primary Care during the pandemic first wave, above all by phone. Telephone follow-up was well accepted and useful to select patients with serious complications. Initial medical assessment in the hospital emergency department was related to a lack of social support but not with greater clinical severity.

[Return rate to the Primary Care Emergency Service for elderly patients over 65 years old and their assistance requirements]. / Tasa de retorno y características asistenciales de pacientes mayores de 65 años en un servicio de Urgencias en Atención Primaria.

OBJECTIVE: To determine the unexpected return rate to the Primary Care Emergency Service of elderly patients over 65 years old within the following 72h of a previous visit, as well as to determine the clinical and assistance requirements of these patients. PROCEDURE: Retrospective and observational epidemiologic study. LOCATION: Cotolino's Primary Care Emergency Service in Cantabria, Spain. PARTICIPANTS: 1940 elderly patients over 65 years old were included. These patients returned to the Primary Care Emergency Service in 2016. MAIN DATA FOR THE STUDY: The dependent variable was the return rate to the Primary Care Emergency Service. The independent variables were socio-demographic characteristics, health details and medical assistance information. All data was collected from the Primary Care Emergency Service Management Office database. All variables were analysed applying Pearson's chi-squared test and Fisher's exact test, with statistical significance P≤.05. RESULTS: The rate of unexpected return was 2.3%. The average age was 77.4 years old (standard deviation (SD): 8.4), of which the 37.6% were male. The most frequent range of age was from 75 to 84 years old, with males being the predominant group. A history of polymedication was detected in 54.4% of the cases, as well as a medium cardiovascular risk within this group. Nursing professionals attended the 42.2% of these return cases (P<.001). Patients with dysnea (P=.015), scheduled care or scheduled injection returned with a higher frequency (P<.001). It was as well noticed a higher frequency of return for subsequent attention during the months of December and January (P<.001). CONCLUSIONS: The rate of unexpected return is low. The main causes why elderly patients returned to the service requiring urgent assistance were issues categorised as unspecific general health indicators and/or respiratory system illnesses. Our proposal is to develop specific protocols combining the work from both Geriatrics and Gerontology professionals, in order to improve the support to this group of population at every Primary Care Emergency Service.

[Differences between Spain's autonomous communities in the availability of semi-automatic external defibrillators outside the healthcare setting]. / Diferencias entre comunidades autónomas de España en la dotación de desfibriladores externos semiautomáticos fuera del ámbito sanitario.

BACKGROUND: Early defibrillation is one of the interventions that can most influence the prognosis of cardiac arrest. The objectives of this study were to determine the number of automatic external defibrillators outside the healthcare setting in each autonomous community in Spain and to compare the legislation of each autonomous community on the mandatory installation of defibrillators outside the healthcare setting. METHODS: A cross-sectional observational study was carried out between December 2021 and January 2022 by consulting official data in the 17 Spanish autonomous communities. RESULTS: Complete data on the number of registered defibrillators were obtained from 15 autonomous communities. The number of defibrillators ranged from 35 to 126 per 100,000 inhabitants. At the global level, differences were observed between communities with mandatory defibrillator installation and those without (92.1 vs. 57.8 defibrillators/100,000 inhabitants). CONCLUSIONS: There is heterogeneity in the provision of defibrillators outside the health care setting, which seems to be related to the diversity of legislation on the mandatory installation of defibrillators.

[Indicators to measure the performance of emergency trauma care]. / Principales indicadores para medir el desempeño de la atención de emergencias traumatológicas.

The objective of this paper was to identify the main indicators used to measure the performance in emergency trauma care. A literature review was carried out in the electronic databases: PubMEd, LILACS and Epistemónikos, including publications between January 2011 and December 31, 2021, in Spanish, English and Portuguese. A total of 962 publications were identified. When reviewing the full text, 48 articles were included. The indicators were classified in the dimensions of process and results. 100 different indicators were identified to analyze the performance of emergency trauma care. 71% were process indicators, including service time and triage. In the results dimension 29 indicators were identified; mortality was the indicator most analyzed as well as length of stay. Six indicators on the disability of injured people and 14 indicators related to satisfaction were identified, the most frequent being complaints. Various indicators have been used to assess the performance of emergency trauma care. In the results dimension, the indicators related to satisfaction and disability after injuries have been little explored. Decision-makers and those responsible for emergency care must promote performance evaluation exercises to learn about their current situation using appropriate and sensitive indicators with the available data.

El objetivo del presente trabajo fue identificar los principales indicadores utilizados para medir el desempeño en la atención de emergencias traumatológicas. Se realizó una revisión de la literatura de tipo narrativa en las bases de datos: PubMed, LILACS y Epistemónikos, se incluyeron publicaciones entre enero de 2011 y el 31 diciembre 2021, en español, inglés y portugués. Se identificaron 962 publicaciones. Tras revisar el texto completo, 48 artículos fueron incluidos. Los indicadores se clasificaron en las dimensiones de proceso y resultado. Se identificaron 100 diferentes indicadores para analizar el desempeño de la atención de emergencias traumatológicas. 71% fueron indicadores de proceso, entre ellos el tiempo de atención y el triaje. En la dimensión de resultados se identificaron 29 indicadores; la mortalidad fue el indicador mayormente analizado así como el periodo de estancia hospitalaria. Se identificaron seis indicadores sobre la discapacidad de las personas lesionadas y 14 indicadores relacionados con la satisfacción, el más frecuente fue quejas. Diversos indicadores han sido utilizados para evaluar el desempeño de la atención de emergencias traumatológicas. En la dimensión de resultados, los indicadores relacionados con la satisfacción y discapacidad han sido poco explorados. Los responsables de la atención de emergencias traumatológicas deben impulsar ejercicios de evaluación del desempeño para conocer su situación actual a través de indicadores sensibles y acordes con los datos disponibles.

Analysis of the validity of the five-level TRIPED-GM paediatric triage system.

OBJECTIVE: To determine the validity of the five-level TRIPED-GM pediatric triage system. METHODS: Unicentric, observational, descriptive, cross-sectional study of 485 patients aged 0-16 years in the pediatric emergency department of the HGU Gregorio Marañon. Two measures of validity were used: a direct measure calculated by the sensitivity and specificity obtained based on the number of infratriages and overtriages of the priorities given by classification nurses compared with a panel of experts and another indirect measure by the length of stay, the resources consumed and the percentage of income for each priority level. RESULTS: 10 patients were incorrectly classified, 4 (0.8%) were considered infratriages and 6 (1.2%) overtriages. The results showed a sensitivity of 99.45% (95% CI 96.5-99.97%) and a specificity of 99.01% (95% CI 96.9-99.7%) for high priorities (P2 and P3) and 98.99% (95% CI 96.8-99.6%) and 98.4% (95% CI 96.84-99.74%) respectively for low priorities (P4 and P5). The quadratic weighted Kappa index was 0.96 (95% CI 0.94-0.98; p = 0.0000). Resource consumption showed moderate Spearman correlation coefficients as the priority level increased. The percentage of admissions and the need for observation increased as the priority level p = 0,000 increased, not requiring observation or admitting any patients with priority 5. CONCLUSIONS: The TRIPED-GM pediatric triage system is valid for use in emergency departments with similar patients.

Impact of football matches on number of visits to an emergency department. / Impacto de los partidos de fútbol en la frecuentación de pacientes a un servicio de urgencias.

OBJECTIVES: To analyze the impact of a local football team's matches on patient demand for hospital emergency department care in Bilbao, in the Spanish province of Biscay. MATERIAL AND METHODS: Retrospective analysis. We retrieved the number of patients coming to the emergency department on the days and hours of matches played by Bilbao's Athletic Club during the 2017-2019 and 2018-2019 seasons and compared the caseloads with those on the same days of the weeks before and after the matches (control days). RESULTS: Ninety-five match days were studied. Nineteen of the matches were considered key events. Visits by adults to the emergency department fell by a statistically significant 7.5% (95% CI, 4.6%-11.6%) when matches were being played in Bilbao. The decrease was 8.4% (95% CI, 5.3%-12.6%) when matches were played away. The decrease in pediatric emergencies was 32.7% (95% CI, 7.4%-68.3%) in the hours while important matches were played outside the city. CONCLUSION: The impact of football on the number of visits to our hospital emergency department was modest, except during important away matches.

OBJETIVO: Analizar el impacto que tienen los partidos de fútbol del equipo local en la frecuentación de pacientes al servicio de urgencias hospitalario (SUH) de Bilbao (Bizkaia). METODO: Estudio analítico retrospectivo. Se comparó la afluencia al servicio de urgencias durante los días y horas de partido del Athletic Club de Bilbao de las temporadas 2017/18 y 2018/19 con la de los mismos días de las semanas previas y posteriores a los eventos deportivos (controles). RESULTADOS: Fueron estudiadas 95 días de partido celebrados, donde 19 fueron considerados de alta relevancia. En pacientes adultos, cuando el partido se jugó en Bilbao se registró una disminución estadísticamente significativa del 7,5% (IC95% 4,6-11,6) en el número de urgencias y del 8,4% (IC95% 5,3-12,6) cuando el partido se celebró en otra ciudad. En pacientes pediátricos, se halló un descenso de la afluencia del 32,7% (IC95% 7,4-68,3) en las horas correspondientes al desarrollo del partido cuando este era relevante y se jugaba fuera de la ciudad. CONCLUSIONES: El fútbol tiene una limitada capacidad moduladora de la frecuentación de pacientes al SUH tan solo cuando se trata de partidos de alta relevancia.

Reflexiones para optimizar el triaje en cirugía / Reflections to optimize triage in surgery

Introducción: La categorización de las urgencias quirúrgicas es una necesidad en razón al continuo desequilibrio entre la oferta y la demanda de servicios quirúrgicos en la mayoría de las instituciones donde se encuentra habilitada la prestación del servicio. Hay abordajes en el tema, con estrategias de priorización de los casos quirúrgicos, que consideran escalas y flujogramas, pero su ausente validez externa y las particularidades de las instituciones y aseguradores, han limitado una generalización de los resultados. Métodos: Se efectúa una conceptualización del triaje de las urgencias quirúrgicas con planteamientos críticos y reflexivos soportados en la evidencia. Se identifican, asimismo, las posibles oportunidades para la investigación. Discusión: Los beneficios potenciales de un triaje quirúrgico en situaciones de urgencia, son extensivos a todos los actores del sistema de salud, disminuyen la posibilidad de desenlaces y repercusiones económicas negativas para las instituciones y los aseguradores. La teoría de las colas ofrece el soporte para un entendimiento del tema y contribuye en las soluciones. Su adopción es escasa como parte de una estrategia local de priorización quirúrgica en un contexto de urgencia. Conclusión:La creación de estrategias que establezcan el triaje para el paciente con una urgencia quirúrgica están influenciadas por la participación continua y efectiva de los actores involucrados en el proceso y en su impacto en los desenlaces clínicos

Introduction: Categorizing surgical emergencies is necessary due to the continued imbalance between the supply and demand of surgical services in most institutions where the service is enabled. There are approaches to the subject, with strategies for prioritizing surgical cases, which consider scales and flowcharts, but their lack of external validity and the particularities of the institutions and insurers have limited the generalization of the results. Methods: A conceptualization of the triage of surgical emergencies is carried out with critical and reflective approaches supported by evidence. Potential research opportunities are also identified. Discussion: The potential benefits of surgical triage in emergent situations are extensive to all health system actors, reducing the possibility of adverse outcomes and economic repercussions for institutions and insurers. Queuing theory offers support for understanding the issue and contributes to solutions. However, its adoption is scarce in an emergency as part of a local surgical prioritization strategy. Conclusion: The creation of strategies that establish triage for the patient with a surgical emergency is influenced by the continuous and effective participation of the actors involved in the process and its impact on clinical outcomes

Regulations for using semiautomatic external defibrillators outside health care settings in Spain: a review and comparison of the current situation across autonomous communities. / Regulación de la desfibrilación externa semiautomática fuera del entorno sanitario en las comunidades autónomas de España: situación actual.

ABSTRACT: We compared Spanish autonomous communities' regulations affecting the use of semiautomatic external defibrillators (semi-AEDs), including requirements for training and providing devices outside health care settings. We analyzed differences in the development of regulations across the different geographic areas. Regulations published in the official bulletins of Spain's 17 autonomous communities and 2 autonomous cities in effect in May 2019 were reviewed to extract directives affecting training, authorized use, and the provision of semi-AEDs outside health care centers. We found that both doctors and nurses are authorized to use the devices in most communities, with the exception of Murcia, where only doctors may use them. Fourteen communities also authorize emergency responders to operate semi-AEDs. Other individuals must call for emergency help before using one, and specific rules vary by community. In the Basque Country anyone may use them, but in other communities, only individuals who have taken a training course on how to use a semi-AED may. The duration of training programs varies from 4 to 9 hours in different parts of Spain, and retraining is required at intervals that vary from 1 to 3 years. However, in 11 communities any citizen may use a semi-AED in an emergency in which authorized persons are not present (after first calling for emergency responders). Eleven autonomous communities regulate the required provision of semi-AEDs outside health care centers. We conclude that although Spain's autonomous communities have regulations in place for the use of these devices, the regulatory map is highly diverse. Therefore, we think that harmonization is desirable in the interest of unifying criteria and encouraging the use of semi-AEDs when they are needed.

RESUMEN: El objetivo de este trabajo es comparar las legislaciones autonómicas españolas en materia de formación, utilización y obligatoriedad de la instalación de desfibriladores externos automatizados (DEA) fuera del ámbito sanitario y analizar la variabilidad territorial con que se han desarrollado las regulaciones. Llevamos a cabo una revisión de las normativas publicadas en los boletines oficiales de las 17 comunidades autónomas y las 2 ciudades autónomas de España hasta mayo de 2019, extrayendo datos referidos a la regulación de la formación, el uso y la instalación de los DEA fuera del ámbito sanitario. Observamos que médicos y enfermeros están autorizados a utilizar los DEA, salvo en Murcia, donde únicamente tienen autorizado su uso los médicos. En 14 comunidades autónomas también se consideran habilitados los técnicos en emergencias sanitarias. Excepto en el País Vasco, donde cualquier ciudadano puede utilizar un DEA previa alerta a los servicios de emergencia, es necesario realizar un curso inicial acreditado para estar habilitado en el uso de estos dispositivos (cuya duración varía, según la comunidad, entre 4 y 9 horas) y debe ser renovado con una periodicidad que oscila entre uno y 3 años. Sin embargo, 11 comunidades permiten que, en caso de emergencia y en ausencia de personal habilitado, cualquier ciudadano pueda utilizar un DEA, previa alerta a los servicios de emergencia. Once autonomías regulan la obligación de instalar DEA fuera del ámbito sanitario. Se concluye que si bien todas las comunidades autónomas de España disponen de una normativa reguladora del uso y la acreditación de DEA, el mapa legislativo es muy diverso, por lo que sería deseable una política armonizadora para unificar criterios e incentivar el uso de estos dispositivos en caso de necesidad.

Factors associated with the activation of emergency medical services in patients with acute stroke: a prospective study. / Factores asociados con la activación del servicio de emergencias médicas en el paciente con ictus agudo: un estudio prospectivo.

OBJECTIVES: To identify factors associated with activation of emergency medical services (EMS) in stroke. MATERIAL AND METHODS: Cross-sectional study of all patients admitted with stroke to Hospital Universitario de Burgos in Spain between September 1, 2015, and August 31, 2016. We recorded sociodemographic, clinical, behavioral, cognitive, and context information and explored possible associations with calls for EMS units. RESULTS: Three hundred eleven patients were included. EMS units were activated in 171 cases (55%) associated with an assessment that the patient was unable to manage the health situation from the onset of symptoms (adjusted odds ratio [OR], 6.95; 95% CI, 3.64-13.26), a witness's call for help (rather than the patient's) (OR, 5.68; 95% CI, 2.99-10.83), serious neurological deficit defined by a score over 16 on the National Institute of Health Stroke Scale (OR, 4.51; 95% CI, 1.10-18.46), a patient's awareness of serious symptoms leading to a call for help (OR, 4.03; 95% CI, 1.42-11.42), and a patient's history of high blood pressure (OR, 2.38; 95% CI, 1.25-4.54). CONCLUSION: Calls for EMS attendance from either a patient or a witness are associated with objective signs of severe stroke and subjective perception of severity.

OBJETIVO: Identificar los factores asociados con la activación del servicio de emergencias médicas (SEM) en pacientes que han padecido un ictus. METODO: Estudio transversal en el que se incluyeron a todos los pacientes con ictus ingresados en el Hospital Universitario de Burgos (España) entre el 01/09/2015 y el 31/08/2016. Se recogieron datos sociodemográficos, clínicos, conductuales, cognitivos y contextuales, y se estudió su posible relación con el uso del SEM. RESULTADOS: Se incluyeron 311 pacientes. El uso del SEM (n = 171; 55%) se asoció con el pensamiento del paciente de no ser capaz de manejar la situación en el momento de inicio de los síntomas con OR (ajustada) 6,95 (IC 95%: 3,64-13,26), con ser los testigos y no el paciente quienes solicitaran ayuda con OR 5,68 (IC 95%: 2,99-10,83), con presentar un déficit neurológico grave (NIHSS > 16) con OR 4,51 (IC 95%: 1,10-18,46), cuando el paciente solicitó ayuda atendiendo a la gravedad de los síntomas con OR 4,03 (IC 95%: 1,42-11,42) o cuando tenía antecedentes personales de hipertensión arterial OR 2,38 (IC 95%: 1,25-4,54). CONCLUSIONES: La solicitud de asistencia al SEM por parte del paciente o testigos se relaciona con factores objetivos de gravedad del ictus y con la percepción subjetiva de gravedad.

Factors associated with external causes in elderly attended by the mobile emergency care service / Factores asociados a causas externas en ancianos atendidos por el servicio de atención móvil de urgencia / Fatores associados às causas externas em idosos atendidos pelo serviço de atendimento móvel de urgência

ABSTRACT Objective: To analyze the prevalence and factors associated with external causes in elderly people attended by the mobile emergency care service. Method: Cross-sectional study with 1,972 pre-hospital care records of elderly victims of external causes from 2019 to 2020. A descriptive and bivariate analysis was performed, with a significance level of 5% (p<0.05). Results: The prevalence of external causes in elderly people attended by the mobile emergency service was 12.2%. Falling was the most frequent occurrence. The associations of the occurrence of falls with age from 90 years old (OR=29.31; p<0.001) and female gender (OR=5.38; p<0.001) stood out, as well as the suspicion of ingestion of alcoholic beverages with occurrence of violence (OR=4.17; p<0.001) and traffic accidents (OR=1.97; p<0.001). Conclusion: The study showed factors associated with injuries due to external causes in theelderly and may support the formulation of coping strategies for this problem.

RESUMEN Objetivo: Analizar la prevalencia y los factores asociados a causas externas en ancianos atendidos por el servicio de atención móvil de urgencia. Método: Estudio transversal con 1.972 registros de atención pre hospitalaria de ancianos víctimas de causas externas en el período de 2019 a 2020.Se realizó un análisis descriptivo y bivariado, con un nivel de significación del 5% (p<0,05). Resultados: La prevalencia de causas externas en adultos mayores atendidos por el servicio de emergencia móvil fue de 12,2%. La caída fue la ocurrencia más frecuente. Se destacaron las asociaciones de la ocurrencia de caídas con la edad a partir de 90 años (OR=29,31; p<0,001) y el género femenino (OR=5,38; p<0,001), así como la sospecha de ingesta de bebidas alcohólicas con la ocurrencia de violencia (OR=4,17; p<0,001) y accidentes de tránsito (OR=1,97; p<0,001). Conclusión: El estudio mostró factores asociados a las lesiones por causas externas en ancianos y puede apoyar la formulación de estrategias de enfrentamiento de este problema.

RESUMO Objetivo: Analisar a prevalência e fatores associados a causas externas em idosos atendidos pelo serviço de atendimento móvel de urgência. Método: Estudo transversal com 1.972 fichas de atendimento pré-hospitalar de idosos vítimas de causas externas no período de 2019 a 2020. Realizou-se análise descritiva e bivariada, com nível de significância de 5% (p<0,05). Resultados: A prevalência de causas externas em idosos atendidos pelo serviço móvel de urgência foi de 12,2%. A queda foi a ocorrência mais frequente. Destacaram-se as associações da ocorrência de queda com a idade a partir de 90 anos (OR=29,31; p<0,001) e o sexo feminino (OR=5,38; p<0,001), bem como da suspeita de ingestão de bebida alcoólica com a ocorrência de violência (OR=4,17; p<0,001) e acidentes de trânsito (OR=1,97; p<0,001). Conclusão: O estudo evidenciou fatores associados aos agravos por causas externas em idosos e poderá subsidiar formulação de estratégias de enfrentamento a essa problemática.

Empoderamento estrutural de enfermeiros nos serviços de emergências: revisão integrativa / Empoderamiento estructural de enfermeros en los servicios de emergencias: revisión integradora / Structural empowerment of nurses in emergency services: an integrative review

Resumo Objetivo Sintetizar e analisar as evidências científicas acerca do empoderamento estrutural dos enfermeiros, especificamente no contexto da emergência. Métodos Revisão integrativa da literatura realizada nas bases de dados eletrônicas: Lilacs, PubMed, Scopus, Web of Science e Embase. Foram identificados 174 artigos nas bases de dados, considerando-se os critérios de inclusão e exclusão: estudos originais, nos idiomas português, inglês e espanhol, publicados a partir de 1996 e cujo escopo fossem os trabalhos acerca do empoderamento estrutural de enfermeiros atuantes nos diversos cenários da emergência. Após a avaliação e os refinamentos dos trabalhos por intermédio dos critérios estabelecidos, obteve-se um total de seis estudos para análise. Resultados Foram estabelecidas duas categorias temáticas para sintetizar o conhecimento: "as dimensões do empoderamento estrutural dos enfermeiros da emergência" e "a relação do empoderamento estrutural dos enfermeiros com outras variáveis e seu impacto no contexto da emergência". Essas categorias temáticas permitiram evidenciar que a oportunidade é fundamental para o empoderamento do enfermeiro nesse contexto, além disso, observou-se a relevância da liderança e o ambiente de trabalho como componentes importantes que influenciam no empoderamento e na prática profissional do enfermeiro. Conclusão O empoderamento estrutural é significativo para prática profissional do enfermeiro no contexto da emergência, pois ter acesso às dimensões de empoderamento resulta em autonomia no trabalho, níveis maiores de autoeficácia e melhoria na qualidade e segurança da assistência prestada.

Resumen Objetivo Sintetizar y analizar las evidencias científicas sobre el empoderamiento estructural de los enfermeros, específicamente en el contexto de emergencias. Métodos Revisión integradora de la literatura realizada en las bases de datos electrónicas Lilacs, PubMed, Scopus, Web of Science y Embase. Se identificaron 174 artículos en las bases de datos, con los siguientes criterios de inclusión y exclusión: estudios originales, en portugués, inglés y español, publicados a partir de 1996, cuyo alcance eran los trabajos sobre el empoderamiento estructural de enfermeros que trabajan en diferentes escenarios de emergencias. Después de la evaluación y la refinación de los trabajos mediante los criterios establecidos, se obtuvo un total de seis estudios para el análisis. Resultados Se establecieron dos categorías temáticas para sintetizar el conocimiento: "las dimensiones del empoderamiento estructural de los enfermeros de emergencias" y "la relación del empoderamiento estructural de los enfermeros con otras variables y el impacto en el contexto de emergencias". Estas categorías temáticas permitieron evidenciar que la oportunidad es fundamental para el empoderamiento de los enfermeros en este contexto. Además, se observó la relevancia del liderazgo y del ambiente de trabajo como componentes importantes que influyen en el empoderamiento y en la práctica profesional de los enfermeros. Conclusión El empoderamiento estructural es significativo para la práctica profesional de los enfermeros en el contexto de emergencias, ya que tener acceso a las dimensiones del empoderamiento tiene como resultado la autonomía en el trabajo, mayores niveles de autoeficacia y una mejora de la calidad y seguridad de la atención brindada.

Abstract Objective to synthesize and analyze the scientific evidence on the structural empowerment of nurses, specifically in the context of the emergency room. Methods An integrative literature review was carried out using the electronic databases Lilacs, PubMed, Scopus, Web of Science and Embase. 174 articles were identified in the databases, considering the inclusion and exclusion criteria: original studies, in Portuguese, English and Spanish, published from 1996 onwards and whose scope was work on the structural empowerment of nurses working in the various emergency scenarios. After evaluating and refining the studies using the established criteria, a total of six studies were obtained for analysis. Results Two thematic categories were established to synthesize the knowledge: "the dimensions of structural empowerment of emergency nurses" and "the relationship between nurses' structural empowerment and other variables and their impact in the emergency context". These thematic categories made it clear that opportunity is fundamental to nurses' empowerment in this context, as well as the relevance of leadership and the work environment as important components that influence nurses' empowerment and professional practice. Conclusion Structural empowerment is significant for nurses' professional practice in the context of emergencies, since having access to the dimensions of empowerment results in autonomy at work, higher levels of self-efficacy and an improvement in the quality and safety of the care provided.

Traumatic Injury of the Petrous Part of the Temporal Bone: Keys for Reporting a Complex Diagnosis. / Patología traumática de peñascos, un diagnóstico complejo. Claves para el informe.

Fractures of the petrous part of the temporal bone are a common lesion of the base of the skull; most of these fractures result from high-energy trauma. In patients with multiple trauma, these injuries can be detected on CT scans of the head and neck, where the direct and indirect signs are usually sufficient to establish the diagnosis. It is important to these fractures because the temporal bone has critical structures and the complexity of this region increases the risk of error unless special care is taken. This article reviews the key anatomical points, the systematization of the imaging findings, and the classifications used for temporal bone fracture. We emphasize the usefulness of identifying and describing the findings in relation to important structures in this region, of looking for unseen fractures suspected through indirect signs, and of identifying anatomical structures that can simulate fractures. We point out that the classical classifications of these fractures are less useful, although they continue to be used for treatment decisions.

Team climate and job satisfaction in a mobile emergency service: a multilevel study / Clima en equipo y satisfacción laboral en un servicio de atención móvil de urgencia: estudio multinivel / Clima em equipe e satisfação no trabalho em um serviço de atendimento móvel de urgência: estudo multinível

Objective: to investigate the relationship between team climate and job satisfaction among professionals working in mobile pre-hospital care. Method: this is a quantitative, correlational study carried out in a mobile pre-hospital care service in the São Paulo Metropolitan Region. The participants were 95 professionals, allocated to 40 teams, who answered three questionnaires: sociodemographic/labor data, Team Climate Scale and S20/23 Job Satisfaction Scale. Descriptive statistics and multilevel linear models were used for the analysis, including moderation effects. The Backward method was used to ascertain the order of significance. Results: in the models, the relationships between satisfaction with hierarchical relationships and the factor "support for new ideas" moderated for men and "task orientation" for women were significant. For satisfaction with the physical environment, "working hours" and "participation in the team" were significant and, for intrinsic satisfaction, the regime, working hours and the factors "team objectives", "participation in the team" and "support for new ideas" remained significant, as did the moderation effect between length of service, "participation in the team" and "support for new ideas". Conclusion: team climate is influenced by job satisfaction in a heterogeneous way and the moderating effect of this relationship is associated with gender and length of service.

Objetivo: examinar la relación entre el clima en equipo y la satisfacción laboral de los profesionales que trabajan en servicios de atención prehospitalaria móvil. Método: estudio cuantitativo y correlacional realizado en un servicio de atención prehospitalaria móvil en la Región Metropolitana de São Paulo. Participaron 95 profesionales, distribuidos en 40 equipos, que respondieron a tres cuestionarios: datos sociodemográficos/laborales, Escalas de Clima en Equipo y de Satisfacción Laboral S20/23. Para el análisis, se utilizaron estadísticas descriptivas y modelos lineales multiniveles, incluyendo efectos de moderación. Se empleó el método Backward para determinar el orden de significancia. Resultados: en los modelos, fueron significativas las relaciones entre la satisfacción con las relaciones jerárquicas y el factor "apoyo para nuevas ideas" moderado por el género masculino y "orientación hacia las tareas" en mujeres. Para la satisfacción con el ambiente físico, fueron significativos "jornada laboral" y "participación en el equipo", y para la satisfacción intrínseca, se mantuvieron significativos el régimen, la jornada y los factores "objetivos del equipo", "participación en el equipo" y "apoyo para ideas nuevas", y el efecto de moderación entre el tiempo de actuación, "participación en el equipo" y "apoyo para ideas nuevas". Conclusión: el clima en equipo es influenciado por la satisfacción laboral de manera heterogénea y el efecto moderador de esta relación se asocia con el género y el tiempo de actuación en el servicio.

Objetivo: examinar a relação entre clima em equipe e satisfação no trabalho de profissionais atuantes em atendimento pré-hospitalar móvel. Método: estudo quantitativo, correlacional, realizado em um serviço de atendimento pré-hospitalar móvel da Região Metropolitana de São Paulo. Participaram 95 profissionais, alocados em 40 equipes, os quais responderam a três questionários: dados sociodemográficos/laborais, Escalas de Clima na Equipe e de Satisfação no Trabalho S20/23. Para a análise, foram usados a estatística descritiva e os modelos lineares multiníveis, incluindo efeitos de moderação. Empregou-se o método Backward para averiguar a ordem de significância. Resultados: nos modelos, foram significantes as relações entre satisfação com relações hierárquicas e fator "apoio para novas ideias" moderado ao gênero homem e "orientação para as tarefas" às mulheres. Para satisfação com ambiente físico, foram significantes "jornada de trabalho" e "participação na equipe" e, para satisfação intrínseca, permaneceram significantes o regime, a jornada e os fatores "objetivos da equipe", "participação na equipe" e "apoio para ideias novas", e efeito de moderação entre tempo de atuação, "participação na equipe" e "apoio para ideias novas". Conclusão: clima em equipe é influenciado pela satisfação no trabalho de modo heterogêneo e o efeito moderador dessa relação associa-se ao gênero e ao tempo de atuação no serviço.

Contribuições dos aplicativos móveis para o atendimento pré-hospitalar: revisão integrativa / Contribuciones de las aplicaciones móviles para la atención prehospitalaria: revisión integradora / Contributions of mobile applications to pre-hospital care: integrative review

Resumo Objetivo Analisar as contribuições científicas dos aplicativos móveis desenvolvidos para o atendimento pré-hospitalar. Métodos Estudo de revisão integrativa da literatura; as bases de dados usadas foram Scopus, Web of Science, CINAHL, SciELO, Embase, Lilacs, BDENF, Medline/PubMed, Biblioteca Digital Brasileira de Teses e Dissertações e ProQuest Dissertations & Theses Global; (período de 2017-2022), incluindo todas as categorias de artigo, (com resumo e textos completos, disponíveis com acesso gratuito) nos idiomas português, inglês ou espanhol, contendo as palavras-chave "Assistência Pré-Hospitalar", "Atendimento Pré-Hospitalar", "Serviços Pré-Hospitalares", "Atendimento de Emergência Pré-Hospitalar", "Enfermagem", "Aplicativos móveis", "Aplicativos de Software Portáteis", "Apps Móveis", nos títulos e/ou resumos. Dois pesquisadores aplicaram os critérios de elegibilidade dos estudos e coletaram os dados a partir do instrumento elaborado previamente. Resultados De um total de 944 estudos, 07 foram selecionados para avaliação. Os aplicativos móveis desenvolvidos para a área de atendimento pré-hospitalar são ferramentas tecnológicas que contribuíram para a triagem, primeiros socorros pediátricos, segurança do paciente, preparação de medicações durante parada cardíaca, qualidade da ressuscitação cardiopulmonar, comunicação entre equipe de emergência e registro eletrônico de enfermagem. Conclusão Os estudos apontaram as potencialidades referentes à utilização dos aplicativos móveis no atendimento pré-hospitalar, contribuindo especialmente para melhoria da segurança dos pacientes e a qualidade do cuidado prestado nas situações de urgência e emergência pré-hospitalar. A otimização do tempo de assistência e do diagnóstico precoce foram também mostrados como contribuições dos aplicativos na assistência, além de alertar para os detalhes que podem passar despercebidos.

Resumen Objetivo Analizar las contribuciones científicas de las aplicaciones móviles para la atención prehospitalaria. Métodos Estudio de revisión integradora de la literatura. Las bases de datos utilizadas fueron Scopus, Web of Science, CINAHL, SciELO, Embase, Lilacs, BDENF, Medline/PubMed, Biblioteca Digital Brasileira de Teses e Dissertações y ProQuest Dissertations & Theses Global (período de 2017-2022). Se incluyeron todas las categorías de artículos, con resumen y texto completo, disponibles con acceso gratuito, en los idiomas portugués, inglés o español, que contuvieran las palabras clave "Asistencia Prehospitalaria", "Atención Prehospitalaria", "Servicios Prehospitalarios", "Atención de Emergencia Prehospitalaria", "Enfermería", "Aplicaciones Móviles", "Aplicaciones de Software Portátiles", "Apps Móviles", en el título o resumen. Dos investigadores aplicaron los criterios de elegibilidad de los estudios y recopilaron los datos a partir de un instrumento elaborado previamente. Resultados De un total de 944 estudios, se seleccionaron siete para evaluación. Las aplicaciones móviles desarrolladas para el área de atención prehospitalaria son herramientas tecnológicas que contribuyeron para la clasificación, los primeros auxilios pediátricos, la seguridad del paciente, la preparación de medicaciones durante paro cardíaco, la calidad de la reanimación cardiopulmonar, la comunicación entre los equipos de emergencia y el registro electrónico de enfermería. Conclusión Los estudios señalaron el potencial referente a la utilización de las aplicaciones móviles en la atención prehospitalaria, lo que contribuye especialmente a la mejora de la seguridad del paciente y a la calidad del cuidado ofrecido en las situaciones de urgencia y emergencia prehospitalaria. La optimización del tiempo de la atención y el diagnóstico temprano también demostraron ser contribuciones de las aplicaciones de asistencia, además de advertir detalles que pueden pasar desapercibidos.

Abstract Objective Analyze the scientific contribution of mobile applications developed for pre-hospital care. Methods Integrative literature review study; the databases used were the following: Scopus, Web of Science, CINAHL, SciELO, Embase, Lilacs, BDENF, Medline/PubMed, Brazilian Digital Library of Theses and Dissertations, and ProQuest Dissertations & Theses Global; (period 2017-2022), including all article categories (with abstract and full texts available with free access) in Portuguese, English, or Spanish, containing the keywords "Pre-Hospital Assistance", "Pre-Hospital Care", "Pre-Hospital Services", "Pre-Hospital Emergency Care", "Nursing", "Mobile applications", "Portable Software Applications", and "Mobile Apps" in titles and/or abstracts. Two researchers applied the eligibility criteria of the studies and collected data using a previously prepared instrument. Results From a total of 944 studies, seven were selected for evaluation. Mobile applications developed for the pre-hospital care area are technological tools that have contributed to triage, pediatric first aid, patient safety, preparation of medications during cardiac arrest, quality of cardiopulmonary resuscitation, and communication between the emergency team and the electronic nursing record. Conclusions The studies highlighted the potential related to the use of mobile applications in pre-hospital care, contributing especially to improving patient safety and the quality of care provided in pre-hospital urgency and emergencies. The optimization of assistance and early diagnosis times was also shown as a contribution of applications to assistance, in addition to alerting to details that may be unnoticed.

Avaliação da qualidade do sono em profissionais de saúde da emergência / Evaluación de la calidad del sueño en profesionales de la salud de emergencia / Sleep quality assessment in emergency health professionals

Resumo Objetivo Avaliar a qualidade do sono de profissionais dos serviços de emergência e sua associação com o nível de fadiga e qualidade de vida. Métodos Estudo descritivo, transversal e correlacional, realizado nas unidades do Serviço de Atendimento Móvel de Urgência (SAMU) e na Unidade de Pronto Atendimento (UPA), no ano de 2021, com 108 participantes. Para avaliação da qualidade do sono, foi utilizado o Índice de Qualidade do Sono de Pittsburgh versão Brasileira (PSQI-BR); para avaliação da Fadiga, foi utilizada a Escala de Fadiga de Chalder, em conjunto com a Escala de Necessidade de Descanso (ENEDE); e para avaliação da qualidade de vida, foi utilizado o World Health Organization Quality of Life Brief Version (WHOQOL-bref), sendo que os instrumentos utilizados foram adaptados para a língua portuguesa em estudos anteriores. Foram aplicados testes de associação para a análise estatística, tendo sido utilizados o Teste Qui-Quadrado de Pearson, o Teste U Mann-Whitney ou Kruskal Wallis e a correlação de Spearman. Valores de p <0,05 foram considerados como significativos. Resultados Foi identificado que 72,2% dos participantes apresentaram má qualidade do sono e 75,9% estavam fadigados. Foi observada associação significativa entre a qualidade do sono e a fadiga, a necessidade de descanso e a qualidade de vida. Conclusão Foi identificado que os profissionais de saúde que trabalham em serviço de urgência e emergência apresentam má qualidade do sono e de vida e níveis elevados de fadiga e necessidade de descanso, o que pode impactar diretamente suas atividades pessoais e profissionais.

Resumen Objetivo Evaluar la calidad del sueño de profesionales de los servicios de emergencia y su relación con el nivel de fatiga y calidad de vida. Métodos Estudio descriptivo, transversal y correlacional, realizado en las unidades del Servicio de Atención Móbil de Urgencia (SAMU) y en la Unidad de Pronta Atención (UPA), en el año 2021, con 108 participantes. Para evaluar la calidad del sueño, se utilizó el Índice de Calidad del Sueño de Pittsburgh, versión brasileña (PSQI-BR). Para evaluar la fatiga, se utilizó la Escala de Fatiga de Chalder, junto con la Escala de Necesidad de Descanso (ENEDE). Para evaluar la calidad de vida, se utilizó el World Health Organization Quality of Life Brief Version (WHOQOL-bref). Los instrumentos utilizados fueron adaptados al idioma portugués en estudios anteriores. Se aplicaron pruebas de asociación para el análisis estadístico, para lo cual se utilizó la Prueba χ2 de Pearson, la Prueba U de Mann-Whitney o la prueba de Kruskal-Wallis y la correlación de Spearman. Se consideraron valores de p<0,05 como significativos. Resultados Se identificó que el 72,2 % de los participantes presentó una mala calidad de sueño y el 75,9 % tenía fatiga. Se observó una asociación significativa entre la calidad del sueño y la fatiga, la necesidad de descanso y la calidad de vida. Conclusión Se identificó que los profesionales de la salud que trabajan en servicios de urgencia y emergencia presentaron mala calidad de sueño y de vida y niveles elevados de fatiga y necesidad de descanso, lo que puede impactar directamente en sus actividades personales y profesionales.

Abstract Objective To assess emergency service professionals' sleep quality and its association with the level of fatigue and quality of life. Methods A descriptive, cross-sectional and correlational study, carried out in the units of the Mobile Emergency Care Service (SAMU) and in the Emergency Care Unit (ECU), in 2021, with 108 participants. To assess sleep quality, the Pittsburgh Sleep Quality Index, Brazilian version (PSQI-BR), was used; to assess fatigue, the Chalder Fatigue Scale was used, together with the Need for Recovery Scale (NFR); and to assess quality of life, the World Health Organization Quality of Life Brief Version (WHOQOL-bref) was used, and the instruments used were adapted to Portuguese in previous studies. Association tests were applied for statistical analysis, using Pearson's chi-square test, Mann-Whitney U test or Kruskal Wallis and Spearman's correlation. P-values <0.05 were considered significant. Results It was identified that 72.2% of participants had poor sleep quality and 75.9% were fatigued. A significant association was observed between sleep quality and fatigue, the need for recovery and quality of life. Conclusion It was identified that health professionals working in emergency services have poor sleep quality and life, and high levels of fatigue and need for recovery, which can directly impact their personal and professional activities.

Resultados del trabajo del Sistema Integrado de Urgencia Médicas. Cienfuegos, septiembre 2021 a septiembre 2022

Fundamento: el sistema integrado de urgencias médicas tiene como propósito mejorar la calidad de la atención al paciente tributario de los servicios de urgencias médicas. Objetivo: describir resultados del trabajo del Sistema Integrado de Urgencias Médicas. Métodos: estudio descriptivo, transversal, realizado en el período comprendido entre septiembre de 2021 y septiembre de 2022 en la provincia Cienfuegos, acerca del funcionamiento del sistema de urgencias. Se analizaron las variables siguientes: afecciones y causas más frecuentes de traslado por el sistema; días y horario en que son solicitados los servicios. Resultados: las enfermedades respiratorias agudas fueron las que más provocaron traslados. Dentro de las crónicas no transmisibles, el infarto agudo de miocardio, el síndrome coronario agudo y la enfermedad cerebrovascular fueron las enfermedades, en orden ascendente, que más provocaron la solicitud de traslados médicos; el martes el día de más solicitudes. Conclusiones: las enfermedades respiratorias provocan un número elevado de solicitudes de traslado a urgencias médicas, seguidas de las crónicas no trasmisibles.

Foundation: the medical emergencies integrated system has the purpose of improving the care quality for patients receiving emergency medical services. Objective: to describe the Integrated System of Medical Emergencies' work results. Methods: descriptive, cross-sectional study, carried out between September 2021 and September 2022 in the Cienfuegos province, about the emergency system operation. The analyzed variables were: conditions and most frequent causes of transfer through the system; days and hours in which the services are requested. Results: acute respiratory diseases were the ones that most caused transfers. Among the chronic non-communicable diseases, acute myocardial infarction, acute coronary syndrome and cerebrovascular disease were the diseases, in ascending order, that most caused requests for medical transfers; Tuesday the day with the most requests. Conclusions: respiratory diseases cause a high number of requests for transfer to medical emergencies, followed by chronic non-communicable diseases.

Seguridad en urgencias sobre la referencia de pacientes no urgentes a centros de atención primaria / Safety of referral of patients with non-urgent conditions from the emergency room to primary care centers

Objetivos: determinar la seguridad al referir pacientes triage 4 y 5 desde un servicio de urgencias a centros de atención primaria, conociendo su disposición final y las posibles complicaciones por esta estrategia. Métodos: estudio observacional retrospectivo de 333 pacientes clasificados como triage 4 y 5 que fueron referidos desde el servicio de urgencias a un centro de atención primaria en febrero 2019. A través de la aseguradora se obtuvo la información sobre si asistieron o no a dicha cita programada y la conclusión final de la consulta. Resultados: 52 pacientes (15,6%) no asistieron a la cita programada sin que esto causara alguna complicación para su salud. De los 281 que sí asistieron, 1,4% fueron referidos a valoración especializada urgente sin que requirieran ingreso hospitalario y 98,6% fueron atendidos y manejados en forma ambulatoria por el médico de atención primaria. Se encontraron diferencias entre los no asistentes a la atención primaria en los subgrupos de edad entre 3 a 17 (p=0,009) y 18 a 37 años (p=0,04). Conclusiones: la estrategia de referencia de pacientes clasificados en 4 o 5 desde un servicio de urgencias a centros de atención primaria es segura, incluso si estos no asisten a la cita programada

Objectives: to determine the safety of referral of triage category 4 and 5 patients from the emergency room to primary care centers, aware of their final disposition and the potential complications of this strategy. Methods: a retrospective observational study of 333 triage category 4 and 5 patients who were referred from the emergency room to a primary care center in February 2019. Information on scheduled appointment attendance, and final consultation diagnosis was obtained from the insurer. Results: 52 patients (15.6%) failed to attend their scheduled appointment presenting no health complications. Of the 281 who attended their clinic appointment, 1.4% were referred for urgent specialist consultation without requiring hospital admission. The primary care physician provided care and management to 98.6% of studied patients on an outpatient basis. Differences were found among those failing to attend primary care in the 3 to 17 (p=0.009) and 18 to 37 years (p=0.04) age subgroups. Conclusions: triage category 4 and 5 patients referral strategy from the emergency service to primary care centers is safe, even if patients fail to attend their scheduled appointment

Evaluation of the triage performed by registered nurses in the Hospital Clínico Universitario «Lozano Blesa¼ Emergency service (Saragossa, Spain). / Evaluación del triaje realizado por enfermeras en el Servicio de Urgencias del Hospital Clínico Universitario «Lozano Blesa¼ (Zaragoza).

OBJECTIVE: To evaluate nurses' triage quality and adequacy in Saragossa's Hospital Clínico and to compare the main characteristics of "urgent" and "non-urgent" visits to the Hospital Emergency Department (HED). METHOD: This exploratory-retrospective research study was carried out over the last 3 months of 2015 (paediatrics, gynaecological and ophthalmologic emergencies were excluded). Data were obtained from the "Puesto Clínico Hospitalario" programme used in the HED. The quality of the triage performed by nurses was assessed using the 4 indexes proposed by Gómez Jimenez and the adequacy of patient classification was established by relating the level of triage assigned with the place of care, length of stay in the HED and type of discharge. Differences between "non-urgent" (seen in outpatient consultations of the HED) and "urgent" visits were analysed, RESULTS: 22,047 individuals were included. Quality indices relating to waiting times were not fully met. Higher severity of triage was associated with being attended in the area of Vital and Medical Care, a longer stay in the HED and a higher proportion of hospital admissions (p<.001), so that triage performed by nursing is considered adequate. "Non-urgent" visits obtained less severity of triage, a shorter stay in HED and a greater proportion of hospital discharges (p<.001). CONCLUSIONS: Nursing triage needs to improve quality aspects related to waiting times but is appropriate enough as it discriminates between place of care and type of discharge for each level of triage within the desirable limits.

Relation of femur fractures location with clinical outcomes in elderly patients / Relação da localização das fraturas de fêmur com desfechos clínicos em pacientes idosos

ABSTRACT Objectives: This study was designed to investigate the possible relationship between the anatomical location of the PFF (head-neck fractures) and the demographic features, comorbidities, and risk factors of elderly patients. Methods: 233 patients aged 65 years and over, who were admitted to the emergency department with a diagnosis of proximal femur fracture were included in this study. Results: Most patients (59.6%) had a trochanteric fracture. The incidence of trochanteric fractures had a statistically significant positive correlation with age. Falls at ground level were found to be highly associated with trochanteric fractures (92,8%). At least one complication was observed in 57 (41,0%) cases and 31 (22,3%) died in one year, of the patients with trochanteric fractures. Comorbidity was not related to fracture location statistically. Fall ground level (p = 0.013), complication rate (73.7%; p <0.001), and Charlesen comorbidity index (p = 0.019) were statistically significantly associated with death. The logistic regression analysis of variables determined that only the quantity of comorbidities may be related to femoral neck fractures (p = 0.047). Conclusion: Female patients with trochanteric fractures were found to be older than male patients. Fall ground level, mortality, and complications were more frequently seen in patients with trochanteric fractures. Level of Evidence II, Retrospective study.

RESUMO Objetivos: Este estudo foi desenhado para investigar a possível relação entre a localização anatômica da PFP (fraturas de cabeça e pescoço) e as características demográficas, comorbidades e fatores de risco de pacientes idosos. Métodos: Foram incluídos 233 pacientes com idade igual ou superior a 65 anos, admitidos no pronto-socorro com diagnóstico de fratura do fêmur proximal. Resultados: A maioria dos pacientes (59,6%) apresentou fratura trocantérica. A incidência de fraturas trocanterianas apresentou correlação positiva estatisticamente significativa com a idade. Verificou-se que as quedas no nível do solo estão altamente associadas às fraturas trocantéricas (92,8%). Pelo menos uma complicação foi observada em 57 (41%) casos e 31 (22,3%) morreram em um ano, dos pacientes com fraturas trocantéricas. A comoborbidade não foi realizada estatisticamente com a localização da fratura. Queda do nível do solo (p = 0,013), taxa de complicações (73,7%; p < 0,001), índice de comorbidade charlesen (p = 0,019) foram estatisticamente significativamente associados à morte. Na análise de regressão logística das variáveis, determinou-se que apenas a quantidade de comorbidades pode estar relacionada às fraturas do colo do fêmur (p = 0,047). Conclusão: Pacientes do sexo feminino com fraturas trocantéricas foram consideradas mais velhas do que pacientes do sexo masculino. Queda no nível do solo, mortalidade e complicações foram observadas com mais frequência em pacientes com fraturas trocantéricas. Nível de evidência II, Estudo retrospectivo.

[Assessment of an educational intervention regarding blood cultures as process indicators in an emergency department in Argentina]. / Evaluación del impacto de una intervención educativa en indicadores de gestión de un servicio médico de urgencias de Argentina.

OBJECTIVE: The aim of this study was to describe 2 process indicators related to taking blood cultures (BC) in an Adult Emergency Department of a tertiary university hospital in Buenos Aires,and to describe the changes after a series of educational activities for health professionals was implemented during May 2016 as regards the appropriate indication of BC and the proper collection technique. MATERIALS AND METHODS: A retrospective cohort study was designed to assess its effectiveness, which consecutively included all patients admitted during 2015-2016. The BC request rate was used as a process indicator, and the percentage of contaminated BCs and the true positives rate were used as quality indicators. Both were measured monthly and prospectively during the period of study. RESULTS: The annual adjusted rate of BC requests was 4.9% (95% CI 4.8-5) in 2015 and 2.9% (95% CI 2.8-2.9) in 2016. The rate of false positive (contaminated) BCs was 4.5% in 2015 and 4.3% after the educational intervention. The true positive BCs were 8.3% in 2015 and 12% post-intervention. CONCLUSIONS: These findings prove how important and effective the educational interventions are.