Necrotizing fasciitis: Usefulness of the LRINEC score in a third-level hospital.

AIM: To review patients seen in the emergency room, diagnosed with necrotizing fasciitis (NF) and the correlation of such complications with the Laboratory Risk Indicator for Necrotizing fasciitis scale (LRINEC). The purpose of this study is to assess the use of the LRINEC score for early diagnosis of NF and its prognostic use in a consecutive series of cases treated at our hospital. METHODS: Retrospective observational study including patients with a diagnosis of NF in the emergency room of a tertiary hospital over 11 years. The results are shown as median, interquartile range and absolute range for quantitative variables. In the case of qualitative variables, the results are shown as absolute and relative frequency. The comparison between the categories of the LRINEC scale was performed through a post-hoc comparison from a non-parametric rank-ANOVA analysis. Comparisons between LRINEC groups in the qualitative variables were performed using Fisher's exact test. RESULTS: A total of 45 patients with a mean age of 51 years were identified. There was a 20% mortality rate (9 cases). The highest mortality rate was registered in the high-risk group (LRINEC greater than 8) with 4 deceased individuals (44.44%), while in the low and moderate-risk groups, 3 and 2 deceased individuals (33% and 22%) were registered, respectively, without considering this result statistically significant (p=0.811). There was an amputation rate of 15.6% (7 cases). The average LRINEC score was greater in the cases that required amputation 9 (95% CI 7; 13) in comparison to the other patients, 6 (95% CI 5; 8), p=0.044. The average hospital stay lasted 32.5 days (95% CI: 25; 40); 30 days in the low-risk group, 41 days in the moderate-risk group and 40 days in the high-risk group. Mortality was associated to a smaller number of interventions (p=0.005) and was preceded by septic shock in all cases. CONCLUSIONS: The LRINEC score may be useful to aid diagnosis. However, clinical suspicion is the most important in diagnosis. A LRINEC low score does not exclude NF. In this retrospective series, 35.71% of cases presented a low LRINEC score, making the rate of false negatives high. In view of these results, The LRINEC score cannot be used as a prognostic value since an initial low score does not rule out serious evolution.

Evaluación de las cargas de enfermería en la atención del intoxicado en un servicio de urgencias / Assessment of the nursing burden in the care of intoxicated patients in the emergency department

Objetivos: Medir la intensidad de los cuidados enfermeros que precisan los intoxicados que acuden a Urgencias. Método: Durante cuatro meses se registraron los intoxicados remitidos a Urgencias y se seleccionó un subgrupo en el que se midieron los tiempos consumidos por enfermería en cada una de las actividades asistenciales. Resultados: Se registraron 155 intoxicados. La intoxicación medicamentosa fue más frecuente en días laborables (p < 0.05) y la alcohólica en los no laborables (p < 0.05). Al 72 % se les realizó una extracción de sangre y al 55 % de orina para identificar la presencia de tóxicos. Al 79 % se le administró alguna medicación y al 25% carbón activado. El consumo de tiempo en la comunicación verbal fue mayor en el grupo intoxicado con fármacos (p < 0.001). Conclusiones: La ingesta de fármacos ha sido la intoxicación atendida con mayor frecuencia, en particular en días laborables. El intoxicado por medicamentos es el que requiere más tiempo de comunicación verbal

Objectives: To describe and measure the intensity of nursing care in intoxicated patients attended by different levels of emergency care, depending on the day of admission and type of poison involved. Methods: Observational, cross-sectional, descriptive study. For four months, patients referred to the emergency department for acute poisoning were recorded. Of the total patients, a subgroup in which the nursing time used in each activity of the care process were measured was selected. Epidemiological variables (sex, age, date and time of admission to the emergency room), toxicology (type of poison), level of triage, nursing activities and patient outcomes were recorded. Results: 155 cases of poisoning were recorded. Drug poisoning was more common in working days (p < 0.05) and alcoholic in nonworking (p < 0.05). 72 % of patients underwent a blood test and 55 % a urine test to detect the presence of toxic substances. 79 % was administered any medication and 25 % activated carbon. The use of time in verbal communication was greater in patients consuming medicaments (p < 0.001) compared with patients consuming alcohol or illicit drugs. Conclusions: The intake of drugs has been the most frequently attended poisoning, particularly on working days. The intoxicated by drugs is the most time-consuming verbal communication

Need for sedation and analgesia in patients with a history of substance misuse admitted to an intensive care unit.

BACKGROUND: Patients with a history of substance misuse may develop tolerance to analgesics and psychotropic drugs which alter the need for sedation and analgesia after ICU admittance. AIMS: The objective was to qualify and quantify the needs for sedation and analgesia in critically ill patients with and without a history of substance misuse admitted to an intensive care unit (ICU). DESIGN: A 2-year prospective, observational study. METHODS: Patients admitted to an ICU who required sedation and analgesia for ≥72 h were included and were classified as substance misusers and non-substance misusers. We analysed demographic data and the consumption of alcohol and other substances. Comparisons between groups were made using the non-parametric Mann-Whitney test for quantitative variables and Fisher's exact test for qualitative variables. The analysis was made using SPSS version 17.0 (SPSS Inc., Chicago, IL, USA) for Windows. Statistical significance was established as p < 0·05. RESULTS: We included 44 patients, of whom 31 (70·3%) were users of ≥1 substance. The median age was 47 years, 8 (18·2%) patients were female. The most-consumed substances were tobacco (56·8%), alcohol (54·5%), cannabis (13·6%), amphetamines (11·4%) and cocaine (9·1%). Toxicological samples were positive for alcohol (65·2%, mean blood alcohol level 1·38 ± 1·05 g/L). There were no significant differences in the need for sedation between substance misusers and non-substance misusers (p > 0·05). CONCLUSIONS: The prevalence of substance misuse in this population was high. We found no greater need for sedation in patients with a history of substance misuse although these patients often require three or more drugs to achieve optimal sedation. RELEVANCE TO CLINICAL PRACTICE: Physicians and nurses should be aware of substance misuse in order to provide adequate care by optimizing drug administration and dosages in the ICU.

Descripción de las agresiones sexuales atendidas en el servicio de urgencias de un centro hospitalario de referencia / Description of sexual assaults treated in the emergency department of a referral hospital

Objetivo: Describir los factores relacionados con las agresiones sexuales que se atienden en el hospital de referencia de la ciudad de Barcelona.Métodos: Estudio transversal de base individual de las agresiones sexuales atendidas en el servicio de urgencias entre los años 2005 y 2008. Resultados: Se atendieron 712 pacientes, con predominio femenino (95,5%). Las mujeres agredidas y atendidas presentan una edad mediana de 25 años, realizaron denuncia el 87,5% de los casos y fueron agredidas por un único agresor el 84,5%. El perfil de la agredida (p≤0,05) cuando el agresor es conocido es: agredida en el domicilio (81,5%), el agresor actúa solo (94,2%), el mecanismo de agresión es la penetración(89,3%) y en días laborables (63,3%).Conclusiones: El análisis de las agresiones sexuales permite establecer distintos grupos de riesgo, lo cual facilita la elaboración de protocolos y guías de actuación específicos para una ayuda eficaz y un tratamiento completo (AU)

Objective: To describe the factors related to adult sexual assaults attended in a referral hospital in thecity of Barcelona (Spain).Methods: We carried out an individual-based cross-sectional study of sexual assaults treated in the emergency department between 2005 and 2008.Results: A total of 712 patients (95.5% female) were treated. The median age of assaulted women was25 years. Complaints were made in 87.5% of cases and assaults were made by a single attacker in 84.5%.When the perpetrator was known, the profile of the victim (p≤0.05) was as follows: the victim was assaulted at home (81.5%), the perpetrator acted alone (94.2%), the mechanism of aggression was penetration(89.3%) and the attack took place during the week (63.3%).Conclusions: Analysis of sexual assaults allows for different risk groups to be established, which facilitates the development of specific protocols and guidelines for effective aid and full treatment (AU)

[Description of sexual assaults treated in the emergency department of a referral hospital]. / Descripción de las agresiones sexuales atendidas en el servicio de urgencias de un centro hospitalario de referencia.

OBJECTIVE: To describe the factors related to adult sexual assaults attended in a referral hospital in the city of Barcelona (Spain). METHODS: We carried out an individual-based cross-sectional study of sexual assaults treated in the emergency department between 2005 and 2008. RESULTS: A total of 712 patients (95.5% female) were treated. The median age of assaulted women was 25 years. Complaints were made in 87.5% of cases and assaults were made by a single attacker in 84.5%. When the perpetrator was known, the profile of the victim (p ≤ 0.05) was as follows: the victim was assaulted at home (81.5%), the perpetrator acted alone (94.2%), the mechanism of aggression was penetration (89.3%) and the attack took place during the week (63.3%). CONCLUSIONS: Analysis of sexual assaults allows for different risk groups to be established, which facilitates the development of specific protocols and guidelines for effective aid and full treatment.

Evaluación de las intoxicaciones agudas por productos químicos atendidas en un Servicio de Urgencias / Evaluation of acute poisonings due to chemical agents treated in an Emergency Department

Fundamento y objetivo: Evaluar las características epidemiológicas y toxicológicas de las exposiciones a productos químicos que requieren consulta a un Servicio de Urgencias hospitalario. Método: Estudio descriptivo de las consultas realizadas a Urgencias y derivadas de la exposición a un producto químico.Resultados: Se han incluido 992 pacientes, con una edad media (DE) de 42,7 (18) años, siendo el 58,1% mujeres. La mayoría de casos han sido accidentes domésticos (67,3%) o laborales (14,8%), pero también se registraron tentativas suicidas (11,2%) y agresiones (3,2%). Hubo una mayor proporción de mujeres en los accidentes domésticos y de varones en los laborales (p<0,05). Los productos implicados con mayor frecuencia fueron cáusticos (39,9%), gases irritantes (13,8%), detergentes (12,3%), disolventes (12%) y gases asfixiantes (9,5%). Precisaron ingreso hospitalario el 10,8% de los pacientes y se registraron 10 fallecimientos (1%), constatándose una mayor gravedad en los accidentes no laborales (p<0,05). Conclusiones: Las exposiciones a productos químicos son un motivo relevante de consulta a Urgencias. El accidente doméstico es mucho más frecuente que el laboral, afecta mayoritariamente a mujeres e implica sobre todo a productos cáusticos. El pronóstico general es bueno y la mortalidad baja (AU)

Background and objectives: The objective of this study is to evaluate the epidemiological and toxicological characteristics of chemical exposures requiring Emergency Department consultation. Methodology: Descriptive study of Hospital Emergency Department consultations between 2000 and 2008 derived from exposure to a chemical agent. Results: A total of 992 patients were included; the mean age was 42.7+18 years and 58.1% were female. The main causes were domestic accidents (67.3%), occupational accidents (14.8%), attempted suicides (11.2%) and incidents of violence (3.2%). There was a significantly greater proportion of females involved in domestic accidents and males in occupational accidents (p<0.05). The most-frequently involved products were caustic substances (39.9%), irritating gases (13.8%), detergents (12.3%), solvents (12%) and asphyxiating gases (9.5%). Hospital admission was necessary in 10.8% of patients and 10 deaths occurred (1%), with non-occupational accidents being more severe (p<0.05). Conclusions: Exposures to chemical agents represent a high number of poisonings in Emergency Department. Domestic accidents, which mainly affect women and often involve caustic substances, are much more frequent than occupational accidents. The general prognosis is good and mortality is very low (AU)

[Evaluation of acute poisonings due to chemical agents treated in an emergency department]. / Evaluación de las intoxicaciones agudas por productos químicos atendidas en un servicio de urgencias.

BACKGROUND AND OBJECTIVES: The objective of this study is to evaluate the epidemiological and toxicological characteristics of chemical exposures requiring Emergency Department consultation. METHODOLOGY: Descriptive study of Hospital Emergency Department consultations between 2000 and 2008 derived from exposure to a chemical agent. RESULTS: A total of 992 patients were included; the mean age was 42.7+18 years and 58.1% were female. The main causes were domestic accidents (67.3%), occupational accidents (14.8%), attempted suicides (11.2%) and incidents of violence (3.2%). There was a significantly greater proportion of females involved in domestic accidents and males in occupational accidents (p<0.05). The most-frequently involved products were caustic substances (39.9%), irritating gases (13.8%), detergents (12.3%), solvents (12%) and asphyxiating gases (9.5%). Hospital admission was necessary in 10.8% of patients and 10 deaths occurred (1%), with non-occupational accidents being more severe (p<0.05). CONCLUSIONS: Exposures to chemical agents represent a high number of poisonings in Emergency Department. Domestic accidents, which mainly affect women and often involve caustic substances, are much more frequent than occupational accidents. The general prognosis is good and mortality is very low.