Safety and Revisit Related to Discharge the Sixty-one Spanish Emergency Department Medical Centers Without Hospitalization in Patients with COVID-19 Pneumonia. A Prospective Cohort Study UMC-Pneumonia COVID-19.

BACKGROUND: Information is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. OBJECTIVES: The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). METHODS: Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. RESULTS: We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom weredischarged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176 3.037), age < 60 years (aOR 2.324; 95%CI 1.353-3.990), and lymphocyte count > 1200/mm3 (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A totalof 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). CONCLUSION: Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality.

[Positioning proposal on the recommendations for the use of masks in health centers after the cessation of the mandatory use in Spain]. / Propuesta de posicionamiento sobre las recomendaciones para el uso de mascarillas en los centros sanitarios tras el cese de la obligatoriedad de su uso en España.

Since the beginning of the COVID-19 pandemic in March 2020, the use of masks has been a fundamental pillar for controlling the transmission of SARS-CoV-2 in different areas. Its mandatory nature has been regulated by different regulations, and its effectiveness in reducing the transmission of SARS-CoV-2 and other respiratory viruses has been strongly proven. In this regard, the beneficial impact stands out in healthcare centers where it has been shown to reduce the transmission of respiratory infections, both in patients and healthcare professionals. This document proposes recommendations for the use of masks in health centers at the current time when we find ourselves with an end to the mandatory use of masks in Spain. They are aimed at healthcare professionals, patients and companions/visitors and aim to protect them from acquiring acute respiratory infections as a result of the complex relationships established in the healthcare field.

Desde el inicio de la pandemia de la COVID-19 en marzo de 2020, el uso de la mascarilla ha constituido un pilar fundamental para el control de la transmisión del SARS-CoV-2 en diferentes ámbitos. Su obligatoriedad ha sido regulada por diferentes normativas, y la efectividad de la misma para la reducción de la transmisión del SARS-CoV-2 y de otros virus respiratorios ha sido fuertemente probada. Al respecto, destaca el impacto beneficioso en los centros sanitarios en los que ha demostrado reducir la transmisión de las infecciones respiratorias, tanto en pacientes como en profesionales sanitarios. Este documento plantea una propuesta de recomendaciones para el uso de la mascarilla en los centros sanitarios en el momento actual en el que nos encontramos con un cese de la obligatoriedad de su uso en España. Están dirigidas a profesionales sanitarios, pacientes y acompañantes/visitantes y pretenden protegerles de adquirir infecciones respiratorias agudas como consecuencia de las complejas relaciones establecidas en el ámbito sanitario.

Factors associated with malaria and arboviral disease in patients with imported febrile syndrome: a retrospective cohort study. / Factores asociados con malaria y arboviriasis en pacientes con síndrome febril importado: estudio de cohortes retrospectivo.

OBJECTIVES: To identify predictors of malaria and arboviral disease in patients with febrile syndrome who seek care after traveling from tropical or subtropical locations. MATERIAL AND METHODS: Observational retrospective cohort study. We collected demographic, epidemiologic, and clinical data; laboratory findings; and the clinical and final microbiologic diagnoses. Multivariate analysis was used to calculate indices of diagnostic accuracy (sensitivity, specificity, and predictive values) and coefficients of probability of combinations of variables. RESULTS: Data for 291 patients with febrile syndrome were included; 108 had malaria (37.1%), 28 had an arboviral disease (9.6%), and 155 had other causes of fever (53.3%). Multivariate analysis showed patients most likely to have malaria were those from sub-Saharan Africa, adjusted odds ratio (aOR) of 45.85 (95% CI, 9.45-222.49); immigrants who returned to visit friends and relatives (VFR), aOR of 3.55 (95% CI, 1.21-10.46); or had platelet concentrations 150 000/mm3, aORa of 16.47 (95% CI, 5.46-49.70) or headache, aOR of 10.62 (95% CI, 3.20-35.28). The combination of these 4 variables gave a positive probability coefficient (PPC) of 23.72 (95% CI, 5.76-97.62). Patients with febrile syndrome most likely to have an arboviral disease were those from Central or South America, OR 5.07 (95% CI, 1.73-14.92), and those who had exanthems, OR 5.10 (95% CI, 1.72-17.02) or joint pain, OR 14.50 (95% CI, 3.05-68.80). The combination of these 3 variables gave a PPC of 20.66 (95% CI, 7.74-55.21). CONCLUSION: Patients with febrile syndrome with the greatest probability of having malaria are those from sub-Saharan Africa, those who are VFR, and those with platelet concentrations under 150.000/µL or headache. Arboviral disease was more likely in patients from Central and South America who had exanthems or joint pain.

OBJETIVO: Definir variables predictoras de malaria y arboviriasis en pacientes que consultan por síndrome febril tras la vuelta de un viaje a zonas tropicales/subtropicales. METODO: Estudio de cohortes retrospectivo. Se incluyeron variables demográficas, epidemiológicas, clínicas, analíticas y el diagnóstico final clínico y microbiológico. Se realizó un análisis multivariante y se calcularon los índices de exactitud diagnóstica (sensibilidad, especificidad, valores predictivos) y cocientes de probabilidad de la combinación de dichasvariables. RESULTADOS: Se incluyeron 291 pacientes con síndrome febril, 108 tenían malaria (37,1%), 28 arboviriasis (9,6%) y 155 otras causas de fiebre (53,3%). En el análisis multivariante, los pacientes con síndrome febril con más riesgo de padecer malaria fueron los que procedían de África subsahariana [odds ratio ajustado (ORa): 45,85; IC 95%: 9,45- 222,49], eran inmigrantes que visitan a familiares y amigos (VFA) (ORa = 3,55; IC 95%: 1,21-10,46), presentaban cifras de plaquetas 150.000/mm3 (ORa = 16,47; IC 95%: 5,46-49,70) o cefalea (ORa = 10,62; IC 95%: 3,20-35,28). La combinación de estas cuatro variables tiene un cociente de probabilidad positivo (CPP) de 23,72 (IC 95%: 5,76- 97,62). Los pacientes con síndrome febril que tienen más riesgo de padecer arboviriasis eran los que procedían de Centroamérica y Sudamérica (OR = 5,07; IC 95%: 1,73-14,92), presentaban exantema (OR = 5,10; IC 95%: 1,72- 17,02) o artromialgias (OR = 14,50; IC 95%: 3,05-68,80). La combinación de estas tres variables tiene un CPP de 20,66 (IC 95%: 7,74-55,21). CONCLUSIONES: Los pacientes con síndrome febril que tienen más riesgo de padecer malaria son los que procedían de África subsahariana, eran VFA, presentaban cifras de plaquetas 150.000/µl o cefalea, y tenían mayor riesgo de padecer arboviriasis si procedían de Centroamérica y Sudamérica, presentaban exantema o artromialgias.

The lung ultrasound "Rule of 7" in the prognosis of COVID-19 patients: Results from a prospective multicentric study.

Purpose: There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound (LUS), however the use of a combined prognostic and triage tool has yet to be explored.To determine the impact of the LUS in the prediction of the mortality of patients with highly suspected or confirmed COVID-19.The secondary outcome was to calculate a score with LUS findings with other variables to predict hospital admission and emergency department (ED) discharge. Material and methods: Prospective study performed in the ED of three academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a LUS examination and laboratory tests. Results: A total of 228 patients were enrolled between March and September 2020. The mean age was 61.9 years (Standard Deviation - SD 21.1). The most common findings in LUS was a right posteroinferior isolated irregular pleural line (53.9%, 123 patients). A logistic regression model was calculated, including age over 70 years, C-reactive protein (CRP) over 70 mg/L and a lung score over 7 to predict mortality, hospital admission and discharge from the ED. We obtained a predictive model with a sensitivity of 56.8% and a specificity of 87.6%, with an AUC of 0.813 [p < 0.001]. Conclusions: The combination of LUS, clinical and laboratory findings in this easy to apply "rule of 7" showed excellent performance to predict hospital admission and mortality.

Objetivo: Existe una evidencia creciente con respecto a los hallazgos de imagen de la enfermedad por coronavirus 2019 (COVID-19) en la ecografía pulmonar (LUS), sin embargo, aún no se ha explorado el uso de una herramienta combinada de pronóstico y triaje.El objetivo principal de este estudio fue determinar el impacto de la LUS en la predicción de la mortalidad de los pacientes con sospecha de afectación pulmonar por COVID-19. El objetivo secundario fue calcular una puntuación con los hallazgos del LUS con otras variables para predecir el ingreso hospitalario y el alta del servicio de urgencias (SU). Material y métodos: Estudio prospectivo realizado en urgencias de tres hospitales académicos, en pacientes con sospecha de COVID-19 o confirmación de esta, a los que se sometió a un examen de LUS y pruebas de laboratorio. Resultados: Se inscribieron un total de 228 pacientes entre marzo y septiembre de 2020. La edad media fue de 61,9 años (DE 21,1). El hallazgo más común en la LUS fue la irregularidad pleural posteroinferior derecha (53,9%, 123 pacientes). Se calculó un modelo de regresión logística, que incluyó la edad mayor de 70 años, proteína C reactiva (PCR) mayor de 70 mg/L y puntuación de afectación pulmonar mediante LUS score superior a 7 para predecir la mortalidad, el ingreso hospitalario y el alta del SU. Se obtuvo una sensibilidad del 56,8% y una especificidad del 87,6%, con un AUC de 0,813 [p < 0,001] para dicho modelo predictivo, en materia de mortalidad. Conclusiones: La combinación de LUS, hallazgos clínicos y de laboratorio en esta «regla de 7¼ de fácil aplicación se mostró de utilidad para predecir el ingreso hospitalario y la mortalidad.

The lung ultrasound "Rule of 7" in the prognosis of COVID-19 patients: Results from a prospective multicentric study.

PURPOSE: There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound (LUS), however the use of a combined prognostic and triage tool has yet to be explored. To determine the impact of the LUS in the prediction of the mortality of patients with highly suspected or confirmed COVID-19.The secondary outcome was to calculate a score with LUS findings with other variables to predict hospital admission and emergency department (ED) discharge. MATERIAL AND METHODS: Prospective study performed in the ED of three academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a LUS examination and laboratory tests. RESULTS: A total of 228 patients were enrolled between March and September 2020. The mean age was 61.9 years (Standard Deviation - SD 21.1). The most common findings in LUS was a right posteroinferior isolated irregular pleural line (53.9%, 123 patients). A logistic regression model was calculated, including age over 70 years, C-reactive protein (CRP) over 70mg/L and a lung score over 7 to predict mortality, hospital admission and discharge from the ED. We obtained a predictive model with a sensitivity of 56.8% and a specificity of 87.6%, with an AUC of 0.813 [p<0.001]. CONCLUSIONS: The combination of LUS, clinical and laboratory findings in this easy to apply "rule of 7" showed excellent performance to predict hospital admission and mortality.

Effectivity of a Program for the Control and Prevention of COVID-19 Healthcare-Associated Infections in a Spanish Academic Hospital.

BACKGROUND: Although recommendations to prevent COVID-19 healthcare-associated infections (HAIs) have been proposed, data on their effectivity are currently limited. OBJECTIVE: The aim was to evaluate the effectivity of a program of control and prevention of COVID-19 in an academic general hospital in Spain. METHODS: We captured the number of COVID-19 cases and the type of contact that occurred in hospitalized patients and healthcare personnel (HCP). To evaluate the impact of the continuous use of a surgical mask among HCP, the number of patients with COVID-19 HAIs and accumulated incidence of HCP with COVID-19 was compared between the preintervention and intervention periods. RESULTS: Two hundred fifty-two patients with COVID-19 have been admitted to the hospital. Seven of them had an HAI origin (6 in the preintervention period and 1 in the intervention period). One hundred forty-two HCP were infected with SARS-CoV-2. Of them, 22 (15.5%) were attributed to healthcare (2 in the emergency department and none in the critical care departments), and 120 (84.5%) were attributed to social relations in the workplace or during their non-work-related personal interactions. The accumulated incidence during the preintervention period was 22.3 for every 1000 HCP and 8.2 for every 1000 HCP during the intervention period. The relative risk was 0.37 (95% confidence interval, 0.25 to 0.55) and the attributable risk was -0.014 (95% confidence interval, -0.020 to -0.009). CONCLUSIONS: A program of control and prevention of HAIs complemented with the recommendation for the continuous use of a surgical mask in the workplace and social environments of HCP effectively decreased the risk of COVID-19 HAIs in admitted patients and HCP.

Linear and nonlinear heart rate dynamics in elderly inpatients. Relations with comorbidity and depression.

BACKGROUND: Hospitalization processes are known to increase depressive symptoms arising among elderly population. Meanwhile, dysregulation of cardiac autonomic function has been suggested to link depression and cardiovascular mortality. In this context, analysis of heart rate variability (HRV) is emerging as a powerful mortality risk stratifier clinical tool. The purpose of the study was to examine the relationship among HRV, depression, and comorbidity risk among an elderly inpatient population. MATERIAL AND METHODS: Twenty-six subjects (aged 78±9 years) were recruited from the Short-Term Stay Unit at the Hospital General de Alicante. Before joining a Physical Activity Program aimed to prevent functional impairment and after medical selection and written consent, inpatients were tested for heart rate variability, Yesavage Geriatric Depression Scale, and Charlson comorbidity index score. RESULTS: Men compared to women showed a significantly larger CCI score. Short-term scaling exponent (α(1)), derived from detrended fluctuation analysis, showed a negative correlation with Charlson comorbidity index. Conversely, a positive correlation was found between sample entropy (SampEn) and Yesavage Scale. CONCLUSIONS: On the one hand, fractal analysis of HRV confirms to be useful as a risk stratifier tool. On the other hand, SampEn is proposed to be reflecting a non-neurally generated complexity when accompanied with low values of α(1). Accordingly, in this regime, it would be indicative of a paradoxical gradual reduction in cardiac autonomic control, accentuated with the severity of depressive symptoms.

Clinical findings, risk factors, and final outcome in patients diagnosed with pulmonary thromboembolism and COVID-19 in hospital emergency departments. / Características clínicas, factores de riesgo y resultados finales de pacientes con COVID-19 diagnosticados de tromboembolia de pulmón en urgencias.

OBJECTIVES: To analyze clinical, laboratory, and radiologic findings and final health outcomes in patients with pulmonary embolism and coronavirus disease 2019 (COVID-19). To compare them to findings and outcomes in patients with pulmonary embolism without COVID-19. MATERIAL AND METHODS: Multicenter, observational, retrospective study in 4 Spanish hospital emergency departments (EDs) from January 15 to April 15, 2020. Cases were located by reviewing all ED requests for pulmonary computed tomography angiography (CTA) procedures. Clinical, laboratory, and radiologic findings; medical histories and comorbidity; risk factors; and outcomes were compared between the 2 groups of patients (with or without COVID-19). RESULTS: A total of 399 CTAs were ordered; 88 pulmonary embolisms were diagnosed, 28 of them (32%) in patients with COVID-19. This group had more men, and a history of thromboembolic disease was more common. We found no between-group differences in clinical presentation, laboratory, or radiologic findings; nor were there differences in final outcomes. In-hospital mortality was 7% (2 cases) in patients with COVID-19 and 17% (10 cases) in patients without the virus (odds ratio for death in patients with pulmonary embolism and COVID-19, 0.38; 95% CI, 0.08-1.89). CONCLUSION: We found no clinically important differences in the clinical, laboratory, or radiologic findings between patients with or without COVID-19 who were treated for pulmonary embolism in our hospital EDs. Final outcomes also did not differ.

OBJETIVO: Analizar las características clínicas, analíticas, radiológicas y los resultados finales de salud en una cohorte de pacientes con embolia pulmonar (EP) y COVID-19, y compararlas con un grupo de pacientes con EP sin COVID-19. METODO: Estudio multicéntrico, observacional y retrospectivo realizado en cuatro servicios de urgencias hospitalarios (SUH) españoles del 15 de enero al 15 de abril de 2020. La detección de EP se hizo mediante la revisión de todas las angiografías por tomografía computarizada (angioTC) pulmonares solicitadas desde los SUH. Se han analizado dos grupos de pacientes con EP, con o sin enfermedad por COVID-19, y se comparan las características clínicas, analíticas, radiológicas, antecedentes y comorbilidad, factores de riesgo y resultados finales. RESULTADOS: Se realizaron 399 angioTC y se diagnosticaron 88 EP, 28 (32%) en pacientes con COVID-19. Estos pacientes fueron con más frecuencia hombres y tenían más antecedentes de enfermedad tromboembólica previa. No hubo diferencias en la presentación clínica, características analíticas o radiológicas ni en los resultados finales entre ambos grupos. La mortalidad intrahospitalaria fue del 7% (2 casos) en pacientes COVID y del 17% (10 casos) en pacientes sin COVID (OR de muerte en pacientes COVID con EP: 0,38, IC 95%: 0,08-1,89). CONCLUSIONES: No se han observado diferencias clínicamente relevantes en las características clínicas, analíticas, radiológicas y los resultados finales de salud en una cohorte de pacientes con EP y COVID-19 respecto a los pacientes con EP sin esta enfermedad atendidos en los SUH.

Frequency, Associated Risk Factors, and Characteristics of COVID-19 Among Healthcare Personnel in a Spanish Health Department.

INTRODUCTION: This study examines the frequency, associated factors, and characteristics of healthcare personnel coronavirus disease 2019 cases in a healthcare department that comprises a tertiary hospital and its associated 12 primary healthcare centers. METHODS: This study included healthcare personnel that showed symptoms or were in contact with a coronavirus disease 2019 case patient from March 2, 2020 to April 19, 2020. Their evolution and characteristics (age, sex, professional category, type of contact) were recorded. Correlations between the different characteristics and risk of developing coronavirus disease 2019 and severe coronavirus disease 2019 were analyzed using chi-square tests. Their magnitudes were quantified with ORs, AORs, and their 95% CIs using a logistic regression model. RESULTS: Of the 3,900 healthcare professionals in the department, 1,791 (45.9%) showed symptoms or were part of a contact tracing study. The prevalence of those with symptoms was 20.1% (784/3,900; 95% CI=18.8, 21.4), with coronavirus disease 2019 was 4.0% (156/3,900; 95% CI=3.4, 4.6), and with severe coronavirus disease 2019 was 0.5% (18/3,900; 95% CI=0.2, 0.7). The frequency of coronavirus disease 2019 in symptomatic healthcare personnel with a nonprotected exposure was 22.8% (112/491) and 13.7% (40/293) in those with a protected exposure (AOR=2.2, 95% CI=1.2, 3.9). The service in which the healthcare personnel performed their activity was not significantly associated with being diagnosed with coronavirus disease 2019. A total of 26.3% (10/38) of male healthcare personnel with coronavirus disease 2019 required hospitalization, compared with 6.8% (8/118) among female healthcare personnel (OR=4.9, 95% CI=1.8, 13.6). CONCLUSIONS: A surveillance and monitoring program centred on healthcare personnel enables an understanding of the risk factors that lead to coronavirus disease 2019 among this population. This knowledge allows the refinement of the strategies for disease control and prevention in healthcare personnel during the coronavirus disease 2019 pandemic.

180-day risk of mortality in older patients admitted to short-stay units: the 6-Month Short-Stay Unit (6M UCE) Score. / Modelo de riesgo de mortalidad a 180 días en los pacientes ancianos ingresados en unidades de corta estancia: 6M UCE-SCORE.

OBJECTIVES: To develop a multidimensional score to assess risk of death for patients of advanced age 180 days after their admission to short-stay units (SSUs). MATERIAL AND METHODS: Prospective, multicenter, observational and analytical study of a cohort of patients aged 75 years or older who were admitted to 5 Spanish SSUs between February 1 and April 30, 2014. We recorded demographic and clinical data as well as geriatric assessment scores. A multilevel logistic regression model was developed to identify independent factors associated with 180-day mortality. The model was used to construct a scale for scoring risk. RESULTS: Data for 593 patients with a mean (SD) age of 83.4 (5.9) years entered the model; 359 (60.7%) were women. Ninety-two patients (15.5%) died within 180 days of SSU admission. Factors included in the final risk score were age over 85 years (1 point), male sex (1), loss of appetite or weight loss in the 3 months before admission (1), acute confusional state (2), functional dependence for basic activities of daily living at admission (2), and pressure ulcers (2). Low risk was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 9 points. Mortality rates at 180 days in these 3 risk groups were 5%, 18%, and 54%, respectively. The area under the receiver operating characteristic curve for the model after boots trapping was 0.72 (95% CI, 0.65-0.78). CONCLUSION: The SSU score could be useful for stratifying risk of death within 6 months of SSU admission of older patients, so that type of care can be tailored to risk.

OBJETIVO: Diseñar una escala de puntuación multidimensional con el fin de estratificar el riesgo de mortalidad a 180 días entre los ancianos ingresados en las unidades de corta estancia (UCE). METODO: Estudio analítico observacional de cohortes prospectivo multicéntrico que seleccionó todos los pacientes 75 años ingresados en 5 UCE españolas del 1 de febrero al 30 de abril de 2014. Se recogieron variables demográficas, clínicas y de la valoración geriátrica. Se derivó un modelo de regresión logística multinivel para identificar los factores independientemente asociados con la mortalidad a 180 días y después se construyó una escala de puntuación. RESULTADOS: Se incluyeron 593 pacientes (edad media 83,4 años, DE: 5,9; 359 mujeres, 60,7%), y 92 (15,5%) fallecieron a los 180 días. La escala de puntuación 6M UCE-SCORE incluyó la edad 85 años (1 punto), sexo varón (1 punto), presencia de pérdida de apetito o peso involuntaria en los últimos 3 meses (1 punto), síndrome confusional agudo (2 puntos), dependencia en las actividades básicas de la vida diaria al ingreso (2 puntos) y úlceras por presión (2 puntos). Se categorizó a los pacientes en bajo (0-2 puntos), intermedio (3-5 puntos) y alto (6-9 puntos) riesgo, con una mortalidad a 180 días de 5%, 18% y 54%, respectivamente. El ABC COR del modelo tras remuestreo fue de 0,72 (IC95%: 0,65-0,78). CONCLUSIONES: La escala de puntuación 6M UCE-SCORE podría ser de utilidad a la hora de estratificar el riesgo a 6 meses entre los ancianos ingresados en las UCE con el fin de diseñar un plan individualizado de cuidados.

Safety and Revisit Related to Discharge the Sixty-one Spanish Emergency Department Medical Centers Without Hospitalization in Patients with COVID-19 Pneumonia. A Prospective Cohort Study UMC-Pneumonia COVID-19

ABSTRACT Background: Information is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. Objectives: The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). Methods: Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. Results: We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom were discharged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176-3.037), age < 60 years (aOR 2.324; 95%CI 1.353-3.990), and lymphocyte count > 1200/mm3 (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A total of 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). Conclusion: Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality.

[Consensus-based recommendations and proposals for improving the management of elderly emergency patients with suspected infection in the Spanish autonomous community of Valencia: the PIPA project]. / Proyecto PIPA: consenso de recomendaciones y propuestas de mejora para el manejo del paciente anciano con sospecha de infección en los servicios de urgencias de la Comunidad Valenciana.

OBJECTIVES: To develop expert consensus-based recommendations and proposals on how to improve the care of elderly emergency patients with suspected infection in the autonomous community of Valencia. MATERIAL AND METHODS: This project was carried out in 3 phases: 1) design of a questionnaire by means of consensus among a group of experts; 2) online survey to determine the opinions of emergency physicians in the community of Valencia; and 3) drafting of expert consensus-based recommendations and proposals arising from the results of the survey. The experts used the Delphi method to reach consensus and the survey was posted online. RESULTS: After 2 rounds of voting, 21 emergency medicine experts reached consensus on 15 of the 30 survey items initially proposed: 4 items (26.6%) referred to patient classification and placement, 5 (33.3%) to diagnosis, and 6 (40.0%) to treatment. The resulting online questionnaire was returned by 142 (77.2%) of the 184 emergency physicians belonging to 21 hospital emergency departments in the community of Valencia. The experts reached a high level of consensus (mean score, > 7) on 11 (73.3%) of the 15 recommendations posed by the group's coordinator after the survey. CONCLUSION: The experts were able to propose 11 consensus-based recommendations and proposals for improving the care of elderly patients with suspected infection in emergency departments in Valencia.

OBJETIVO: Desarrollar una serie de recomendaciones y propuestas de mejora basadas en un consenso clínico de expertos sobre aspectos relacionados con la atención del paciente anciano con sospecha de infección en los Servicios de Urgencias y Emergencias (SUH-E) de la Comunidad Valenciana (CV). METODO: El estudio se divide en tres fases: 1) Diseño de un cuestionario por consenso de un grupo de expertos; 2) Realización de una encuesta electrónica para conocer la opinión de los médicos de urgencias y emergencias (MUyE) de la CV; 3) Elaboración de una serie de recomendaciones y propuestas de mejora por consenso de un grupo de expertos a partir de los resultados de dicha encuesta. El consenso se llevó a cabo mediante una metodología Delphi y la encuesta a través de una página web. RESULTADOS: Un grupo de expertos de 21 MUyE consensuaron, tras dos rondas de votación, un cuestionario final de 15 preguntas de las 30 inicialmente planteadas [4 (26,6%) relativas a la clasificación y ubicación del paciente, 5 (33,3%) al diagnóstico, y 6 (40,0%) al tratamiento]. El cuestionario final fue sometido a una votación, mediante una encuesta electrónica, de 142 MUyE (77,2%) de los 184 posibles procedentes de 21 SUH-E de la CV. De las 15 recomendaciones planteadas por el grupo coordinador tras la encuesta, se alcanzó un alto grado de consenso (mediana con puntuación > 7) en 11 (73,3%) de ellas por parte del grupo de expertos. CONCLUSIONES: Se establecieron once recomendaciones y propuestas de mejora con un alto grado de consenso para la atención del paciente anciano con sospecha de infección en los SUH-E de la CV.

[Spanish short-stay-units: results according to department designated to manage the unit]. / Análisis de los resultados de gestión de las unidades de corta estancia españolas según su dependencia funcional.

OBJECTIVES: To compare the efficiency of short-stay units (SSUs) managed by different departments within hospitals. MATERIAL AND METHODS: Cross-sectional study in 40 hospitals with SSUs. From June 1 to December 31, 2012,we gathered data on clinical caseloads and management. Variables directly related to efficiency were mean length of stay, bed rotation index, and weekend discharge rate. RESULTS: Forty SSUs were studied; 25 (62.5%) were managed by the hospital's emergency department (ED), 9 (22.5%) were managed by the internal medicine department (IMD), 5 (12.5%) were independent, and 1 was jointly managed by the hospital's ED and the IMD. A total of 45 140 patients were discharged from the SSUs. The most common diagnoses were exacerbation of chronic heart or respiratory disease, urinary tract infection, and respiratory infection. Age was the only variable that was related to the hospital department designated to manage these SSUs. The mean ages by management type were as follows: independent SSUs (75.6 years) vs ED-managed SSUs (67.2 years) vs IMD-managed SSUs (57.8 years) (P=.02). Group-by-group comparisons showed that the mean length of stay was shorter in ED-managed SSUs than in IMD-managed units (2.65 vs 3.73 respectively; P=.047), and overall mortality was lower in IMD-managed SSUs than in ED-managed SSUs (0.64% vs 3%; P=.033). However, unforeseen mortality (after excluding patients under palliative care or judged to be in the final hours of life) did not differ significantly between groups. CONCLUSION: We did not detect important differences between SSUs managed by different departments in the hospitals in this series. However, mean length of stay was found to be shorter in ED-managed SSUs than in IMD-managed units.

OBJETIVO: Comparar los resultados de gestión clínica de las unidades de corta estancia (UCE) según su dependencia funcional. METODO: Estudio de análisis transversal realizado en 40 hospitales con UCE (1 junio-31 diciembre 2012). Se recogieron datos de actividad y gestión clínica, considerando como variables directamente relacionadas con la eficiencia la estancia media, el índice de rotación por cama y el porcentaje de altas en fin de semana. RESULTADOS: Se analizaron 40 UCE, 25 (62,5%) dependientes del servicio de urgencias (UCEU), 9 (22,5%) de medicina interna (UCEMI), 5 (12,5%) independientes (UCEI) y 1 con dependencia mixta (UCEU + UCEMI). El número total de altas fue de 45.140. Los diagnósticos más frecuentes fueron la exacerbación de la patología crónica cardiaca y respiratoria, la infección urinaria y la respiratoria. En relación a su dependencia funcional no se observaron diferencias en los parámetros analizados intergrupos salvo en la edad media (UCEI 75,6 años vs UCEU 67,2 vs UCEMI 57,8; p = 0,02). Al realizar la comparación intragrupos, la estancia media fue menor en las UCEU que las UCEMI (2,65 días vs 3,73; p = 0,047) y la mortalidad global menor en las UCEMI que las UCEU (0,64% vs 3%; p = 0,033), pero sin diferencias al comparar la mortalidad no esperada una vez excluidos los pacientes paliativos y/o en situación de últimas horas. CONCLUSIONES: En la serie analizada no se observan diferencias destacables al comparar las UCE en conjunto según dependencia funcional. Sin embargo, en el análisis intragrupos las UCEU lograron menor estancia media que las UCEMI.

[Clinical experience with levosimendan in the emergency department of a tertiary care hospital]. / Experiencia clínica con levosimendán en un servicio de urgencias de un hospital de tercer nivel.

The efficacy and safety of levosimendan administration in patients with acute heart failure admitted to intensive care units has been well established. However, no information is available on the drug's beneficial effects in emergency departments. We studied 40 patients with acute heart failure who showed no or only partial improvement after conventional treatment and who received levosimendan during the period 2005-2006. The patients' mean age was 76 (9) years. The most common etiology was ischemic heart disease, and 85% of patients were in New York Heart Association (NYHA) class III or IV. The clinical response was favorable in 82% of patients, while adverse effects occurred in 18%. Some 70% were admitted to the emergency department short-stay unit. These findings indicate that levosimendan can be used safely and effectively in hospital emergency departments.