Association between Boarding of Frail Individuals in the Emergency Department and Mortality: A Systematic Review.

(1) Background: Older patients who attend emergency departments are frailer than younger patients and are at a high risk of adverse outcomes; (2) Methods: To conduct this systematic review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. We systematically searched literature from PubMed, Embase, OVID Medline®, Scopus, CINAHL via EBSCOHost, and the Cochrane Library up to May 2023, while for grey literature we used Google Scholar. No time restrictions were applied, and only articles published in English were included. Two independent reviewers assessed the eligibility of the studies and extracted relevant data from the articles that met our predefined inclusion criteria. The Critical Appraisal Skills Program (CASP) was used to assess the quality of the studies; (3) Results: Evidence indicates that prolonged boarding of frail individuals in crowded emergency departments (Eds) is associated with adverse outcomes, exacerbation of pre-existing conditions, and increased mortality risk; (4) Conclusions: Our results suggest that frail individuals are at risk of longer ED stays and higher mortality rates. However, the association between the mortality of frail patients and the amount of time a patient spends in exposure to the ED environment has not been fully explored. Further studies are needed to confirm this hypothesis.

Litiasis intrahepatica / Intrahepatic lithiasis

Se presentan 4 enfermos de litiasis intrahepática operados entre octubre de 1986 y abril de 1988. Dos pacientes eran mujeres y la edad promedio fue de 61,8 años. En la totalidad de los casos el cuadro clínico fue el de colangitis. La ecografía hepatobiliar, la tomografía axial computada y la colangiografía retrógrada endoscópica fueron los métodos diagnósticos utilizados. El tratamiento quirúrgico fue en 2 casos la extracción de los cálculos intrahepáticos de los conductos principales y anastomosis intrahepática en "Y" según técnica de Hepp-Couinaud. En los 2 enfermos restantes se practicó bisegmentectomía hepática (segmentos II y III). Las complicaciones fueron 1 absceso de laparotomía y una evisceración aguda cubierta con supuración de la herida operatoria. No hubo mortalidad operatoria y los resultados fueron satisfactorios dentro de los 15 meses de control postoperatorio