Prognostic Value of a New Tool (the 3D/3D+) for Predicting 30-Day Mortality in Emergency Department Patients Aged 75 Years and Older.

The 3D/3D+ multidimensional geriatric assessment tool provides an optimal model of emergency care for patients aged 75 and over who attend the Emergency Department (ED). The baseline, or static, component (3D) stratifies the degree of frailty prior to the acute illness, while the current, or dynamic, component (3D+) assesses the multidimensional impact caused by the acute illness and helps to guide the choice of care facility for patients upon their discharge from the ED. The objective of this study was to evaluate the prognostic value of the 3D/3D+ to predict short- and long-term adverse outcomes in ED patients aged 75 years and older. Multivariable logistic regression models were used to identify the predictors of mortality 30 days after 3D/3D+ assessment. Two hundred and seventy-eight patients (59.7% women) with a median age of 86 years (interquartile range: 83-90) were analyzed. According to the baseline component (3D), 83.1% (95% CI: 78.2-87.3) presented some degree of frailty. The current component (3D+) presented alterations in 60.1% (95% CI: 54.1-65.9). The choice of care facility at ED discharge indicated by the 3D/3D+ was considered appropriate in 96.4% (95% CI: 93.0-98.0). Thirty-day all-cause mortality was 19.4%. Delirium and functional decline were the dimensions on the 3D/3D+ that were independently associated with 30-day mortality. These two dimensions had an area under receiver operating characteristic of 0.80 (95% CI: 0.73-0.86) for predicting 30-day mortality. The 3D/3D+ tool enhances the provision of comprehensive care by ED professionals, guides them in the choice of patients' discharge destination, and has a prognostic validity that serves to establish future therapeutic objectives.

[3D/3D+ as a tool for rapid geriatric assessment and adequacy of the care resource at discharge from the Emergency Department]. / Las 3D/3D+ como herramienta de valoración geriátrica rápida y de adecuación del recurso asistencial al alta de los Servicios de Urgencias.

OBJECTIVE: Assess the 3D/3D+ rapid geriatric assessment tool for the early detection of frailty, its usefulness to identify the effects of the acute process on the functional, physical, cognitive and socioenvironmental dimensions, as well as the medications that may have triggered the patient's reason for visit. Finally, assess the usefulness of 3D/3D+ together with the clinical diagnosis to adequate care resource at discharge from the emergency department (ED). METHOD: Retrospective observational cohort study. Patients ≥75 years old, with clinical complexity visited at the ED were included. Basal frailty status was assessed using 3D (basal component), and the multidimensional impact of the acute process using 3D+ (current component). The main dependent variable was adequacy of the care resource at ED discharge. RESULTS: 278 patients were included, mean age 86 years (interquartile range: 83-90), 59.7% were women. According to the basal component (3D), 83.1% (95%CI: 78.2-87.3) presented some degree of frailty. The current component (3D+) was altered in 60.1% (95%CI: 54.1-65.9). The adequacy of ED discharge was correct in 96.4% (95%CI: 93.0-98.0). One out of 4patients was admitted to a medicine ward. CONCLUSIONS: 3D/3D+ facilitates an optimal model of emergency care adapted to patients ≥ 75 years old treated in EDs. It stratifies the level of frailty (3D), detects the severity of patients' acute problems (3D+) and contributes to decision-making regarding the most appropriate care resource at ED discharge.

[Anti-inflammatory drugs for biliary colics: systematic review and meta-analysis of randomized controlled trials]. / Antiinflamatorios para el cólico biliar: revisión sistemática y metaanálisis de ensayos clínicos.

INTRODUCTION: In adults presenting to the emergency department with biliary colic, is treatment with non-steroid anti-inflammatory drugs (NSAIDs) safer and more effective than treatment with other analgesics? The aim of this study was to answer this clinical question by means of a systematic review and meta-analysis of randomized controlled trials (RCT). METHODS: A systematic search for RCT was performed in Medline, Central, ClinicalTrials.gov, Lilacs, Teseo, and IME. A manual search was carried out in the references of retrieved articles and through contact with the authors of the RCT. All RCT comparing NSAIDs with any other active intervention in adults diagnosed with uncomplicated biliary colic were included. Outcome measures consisted of rescue analgesia, the rapidity of analgesic effect, progression to acute cholecystitis, and adverse effects. The RevMan program was used with a fixed effects model. The results were expressed as odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was analyzed with the chi-squared test with a statistical significance level of p < or = 0.10. RESULTS: Seven RCT were selected, with 349 patients. Comparison between NSAIDs and all the other analgesics showed a benefit in favor of NSAIDs with a lower need for rescue analgesia (OR = 0.32; 95% CI, 0.16-0.61) and less progression to acute cholecystitis (OR = 0.19; 95% CI, 0.08-0.44). CONCLUSION: NSAIDs are the analgesics of choice in uncomplicated biliary colic since these drugs are more effective than other analgesics and can improve prognosis, limiting progression of colic to acute cholecystitis.