Sistema de clasificación en emergencias - Escala canadiense de clasificación y severidad relacionado con aumento en fallecimientos en un hospital general / Emergency Classification System - CTAS is related to an increase in deaths in a tertiary hospital

Resumen Objetivo. El sistema de clasificación en servicios de emergencias fue implementado en todos los servicios de emergencias de la Caja Costarricense de Seguro Social alrededor del 2015, a pesar de que su utilidad y veracidad han sido cuestionadas. El presente estudio pretende establecer si existe una relación entre cambios en la cantidad de fallecimientos y en la mortalidad con la implementación de la Escala Canadiense de Clasificación y Severidad en los servicios de emergencias. Métodos. Se obtuvieron los registros correspondientes a las atenciones del Servicio de Emergencias del 2008 al 2022. Se realizó la comparación de los registros previos y posteriores a la implementación de la Escala Canadiense de Clasificación y Severidad en marzo del 2015. En total se tomaron en cuenta los datos referentes a 1 351 091 consultas, de las cuales 733 318 se dieron antes de la implementación de la escala canadiense de clasificación y severidad. Se compararon ambas poblaciones con respecto a tendencias temporales en fallecimientos, estancias en el servicio antes del fallecimiento, mortalidad y la relación entre fallecimientos y hora-paciente mensuales. Resultados. Se encontró un aumento significativo en los fallecimientos con la implementación de la Escala Canadiense de Clasificación y Severidad en un 19,8 % (p<0,001). La mortalidad en el servicio de emergencias mostró un aumento continuo desde el 2012. Sin embargo, una normalización del número de atenciones permitió observar un aumento de la mortalidad posterior, pero no previo a la implementación de la Escala Canadiense de Clasificación y Severidad (p<0,02). Por su parte, la cuantía de fallecimientos mensuales no ha mostrado relacionarse con cuantía de atenciones mensuales ni con hora-pacientes mensuales. Conclusión. La implementación de la Escala Canadiense de Clasificación y Severidad en el servicio de emergencias de un hospital de tercer nivel en Costa Rica se relacionó con un aumento en los fallecimientos, sin estar relacionado con indicadores de plétora del servicio.

Abstract Aim: The classification system in emergency rooms was implemented in all the emergency services of the Caja Costarricense de Seguro Social around 2015, despite the fact that its usefulness and veracity have been questioned. The present study aimed to establish changes in the number of deaths and in mortality with the implementation of the Canadian Triage and Severity Scale. Methods: The records corresponding to the attentions of the Emergency Service from 2008 to 2022 were obtained and comparisons were made of the records before and after the implementation of the Canadian Triage and Severity Scale in March 2015. In total, the data referring to 1,351,091 consultations were taken into account, of which 733,318 occurred before the implementation of the scale. Both populations were compared with respect to temporal trends in deaths, stays in the service before death, mortality, and the relationship between deaths and monthly patient-hours. Results: A significant increase in deaths was found after the implementation of the Canadian Triage and Severity Scale by 19.8% (p<0.001). Mortality showed a continuous increase since 2012, however a normalization of the number of visits allowed us to observe an increase in mortality after but not before the implementation of the scale (p<0.02). The number of monthly deaths has not been shown to be related to the amount of monthly consults or monthly patient-hours. Conclusions: The implementation of the Canadian Triage and Severity Scale in the emergency room of a third level hospital in Costa Rica was related in the present study to an increase in deaths, without being related to indicators of service plethora.

Embracement with risk classification: relationship of justice with the user / Acogida con clasificación de riesgo: relación de justicia con el usuario / Acolhimento com classificação de risco: relação de justiça com o usuário

ABSTRACT Objective: to describe the conception of justice of nurses and users regarding the Risk Classification in Emergency Unit; to analyze the conception of justice in the implementation of the Risk Classification in Emergency Unit from the user's recognition; to discuss, from Axel Honneth's Theory of Recognition, justice with the user in the Risk Classification in Emergency Unit. Method: qualitative research of descriptive, exploratory typology, which used action research as a method. Bardin's Content Analysis was carried out. Results: a category was created: "Justice versus Injustice" and three subcategories: "Autonomy/Freedom versus Heteronomy/Subordination"; "Communication versus Hermeneutic Problems"; "Contributions versus Conflicts". Final considerations: Embracement with Risk Classification presents difficulties in its interpretation and effectiveness; there are situations of disrespect that compete against the required ethics. Justice addressed by this study will be achieved by an emergency access system that meets user expectations, recognizing it as a subject of rights.

RESUMEN Objetivo: describir la concepción de justicia de enfermeros y usuarios en la Clasificación de Riesgo en Emergencia; analizar la concepción de justicia en la implementación de la Clasificación de Riesgo en la Emergencia a partir del reconocimiento del usuario; discutir, a partir de la Teoría del Reconocimiento de Axel Honneth, la justicia con el usuario en la Clasificación de Riesgo en Unidad de Emergencia. Método: investigación cualitativa de tipología descriptiva, exploratoria, que utilizó como método la investigación-acción. Análisis de Contenido de Bardin. Resultados: se organizó una categoría: "Justicia versus Injusticia" y tres subcategorías: "Autonomía/Libertad versus Heteronomía/Subordinación"; "Comunicación versus Problemas Hermenéuticos"; "Contribuciones versus Conflictos". Consideraciones finales: Acogida con Clasificación de Riesgo presenta dificultades en su interpretación y efectividad, con situaciones de incumplimiento que concurren contra la ética requerida. La justicia de que trata este estudio será alcanzada por un sistema de acceso a las emergencias que alcance las expectativas del usuario, reconociéndolo como sujeto de derechos.

RESUMO Objetivo: descrever a concepção de justiça de enfermeiros e usuários na Classificação de Risco em Emergência; analisar a concepção de justiça na implementação da Classificação de Risco na Emergência a partir do reconhecimento do usuário; discutir, a partir da Teoria do Reconhecimento de Axel Honneth, a justiça com o usuário na Classificação de Risco em Unidade de Emergência. Método: pesquisa qualitativa de tipologia descritiva, exploratória, que utilizou como método a pesquisa-ação. Análise de Conteúdo de Bardin. Resultados: foi organizada uma categoria: "Justiça versus Injustiça" e três subcategorias: "Autonomia/Liberdade versus Heteronomia/Subordinação"; "Comunicação versus Problemas Hermenêuticos"; "Contribuições versus Conflitos". Considerações finais: o Acolhimento com Classificação de Risco apresenta dificuldades em sua interpretação e efetividade, com situações de desrespeito que concorrem contra a ética requerida. A justiça de que trata esse estudo será alcançada por um sistema de acesso às emergências que atinja as expectativas do usuário, reconhecendo-o como sujeito de direitos.

Embracement with risk classification: relationship of justice with the user.

OBJECTIVE: to describe the conception of justice of nurses and users regarding the Risk Classification in Emergency Unit; to analyze the conception of justice in the implementation of the Risk Classification in Emergency Unit from the user's recognition; to discuss, from Axel Honneth's Theory of Recognition, justice with the user in the Risk Classification in Emergency Unit. METHOD: qualitative research of descriptive, exploratory typology, which used action research as a method. Bardin's Content Analysis was carried out. RESULTS: a category was created: "Justice versus Injustice" and three subcategories: "Autonomy/Freedom versus Heteronomy/Subordination"; "Communication versus Hermeneutic Problems"; "Contributions versus Conflicts". FINAL CONSIDERATIONS: Embracement with Risk Classification presents difficulties in its interpretation and effectiveness; there are situations of disrespect that compete against the required ethics. Justice addressed by this study will be achieved by an emergency access system that meets user expectations, recognizing it as a subject of rights.

¿Podemos comenzar a cambiar nuestra "mirada" ante la urgencia hipertensiva? / Can we start changing our viewpoint towards hypertensive urgency?

La urgencia hipertensiva (UH) es una situación muy frecuente que asusta tanto a los pacientes como a sus familiares y al personal de salud y representa aproximadamente el 30% de las consultas no programadas (o de urgencia). En el presente artículo, los autores se hacen eco de publicaciones recientes y proponen dejar de utilizar el término urgencia hipertensiva para describir las situaciones de elevación de la presión arterial por encima de una tensión arterial sistólica ≥ 180 mmHg y/o una tensión arterial diastólica (TAD) ≥ 110 mmHg, sin asociación con daño de órgano blanco (con o sin sintomatología inespecífica concurrente), ya que los pacientes con este cuadro no corren riesgo inminente, no requieren atención médica de urgencia y, por lo tanto, deberían enmarcarse dentro de los cuidados habituales de los pacientes con factores de riesgo cardiovascular y riesgo cardiovascular global elevado. Esto implica no solo un cambio semántico, sino un desafío en el abordaje y manejo de estas situaciones tan frecuentes. (AU)

Hypertensive urgency (UH) is a very frequent clinical situation that scares patients, their families as well as health care provid-ers and represents approximately 30% of the non-scheduled (or urgent) visits. In the present article, taking into account recent publications, the authors propose to stop using the term hypertensive urgency to describe situations of elevated blood pressure above systolic blood pressure ≥ 180 mmHg and / or diastolic blood pressure ( TAD) ≥ 110 mmHg, without end organ dam-age (with or without concurrent non-specific symptomatology), since patients with this condition are not at imminent risk, do not require urgent medical attention and should therefore be framed within usual care of patients with cardiovascular risk factors and high overall cardiovascular risk. This implies not only a semantic change, but a challenge in the approach and management of these frequent situations. (AU)

CLARIPED: a new tool for risk classification in pediatric emergencies. / CLARIPED: um novo instrumento para classificação de risco em emergências pediátricas.

OBJECTIVE: To present a new pediatric risk classification tool, CLARIPED, and describe its development steps. METHODS: Development steps: (i) first round of discussion among experts, first prototype; (ii) pre-test of reliability, 36 hypothetical cases; (iii) second round of discussion to perform adjustments; (iv) team training; (v) pre-test with patients in real time; (vi) third round of discussion to perform new adjustments; (vii) final pre-test of validity (20% of medical treatments in five days). RESULTS: CLARIPED features five urgency categories: Red (Emergency), Orange (very urgent), Yellow (urgent), Green (little urgent) and Blue (not urgent). The first classification step includes the measurement of four vital signs (Vipe score); the second step consists in the urgency discrimination assessment. Each step results in assigning a color, selecting the most urgent one for the final classification. Each color corresponds to a maximum waiting time for medical care and referral to the most appropriate physical area for the patient's clinical condition. The interobserver agreement was substantial (kappa=0.79) and the final pre-test, with 82 medical treatments, showed good correlation between the proportion of patients in each urgency category and the number of used resources (p<0.001). CONCLUSIONS: CLARIPED is an objective and easy-to-use tool for simple risk classification, of which pre-tests suggest good reliability and validity. Larger-scale studies on its validity and reliability in different health contexts are ongoing and can contribute to the implementation of a nationwide pediatric risk classification system.

Assessment and risk classification protocol for patients in emergency units / Protocolo de avaliação e classificação de risco de pacientes em unidade de emergência / Protocolo de evaluación y clasificación de riesgo de pacientes en unidad de emergencia

OBJECTIVE: to develop, validate the contents and verify the reliability of a risk classification protocol for an Emergency Unit. METHOD: the content validation was developed in a University Hospital in a country town located in the state of Sao Paulo and was carried out in two stages: the first with the individual assessment of specialists and the second with the meeting between the researchers and the specialists. The use of the protocol followed a specific guide. Concerning reliability, the concordance or equivalent method among observers was used. RESULTS: the protocol developed showed to have content validity and, after the suggested changes were made, there were excellent results concerning reliability. CONCLUSION: the assistance flow chart was shown to be easy to use, and facilitate the search for the complaint in each assistance priority. .

OBJETIVO: elaborar e validar o conteúdo e verificar a confiabilidade de um protocolo de classificação de risco para Unidade de Emergência. MÉTODO: desenvolvido em um hospital universitário do interior paulista. A validação de conteúdo realizou-se em duas etapas: a primeira com a avaliação individual dos especialistas e a segunda com reunião entre as pesquisadoras e os especialistas. A aplicação do protocolo seguiu roteiro específico. Na confiabilidade utilizou-se o método de concordância ou equivalência entre observadores. RESULTADOS: o protocolo elaborado apresentou validade de conteúdo e, após a realização das alterações sugeridas, obtiveram-se resultados de confiabilidade excelentes. CONCLUSÃO: o fluxograma de atendimento mostrou-se de fácil aplicabilidade, sendo facilitador para a busca, pela queixa, em cada prioridade de atendimento. .

OBJETIVO: elaborar, validar el contenido y verificar la confiabilidad de un protocolo de clasificación de riesgo para Unidad de Emergencia. MÉTODO: desarrollada en un Hospital Universitario del interior paulista, la validación de contenido fue elaborada en dos etapas: la primera con la evaluación individual de los especialistas y la segunda con reunión entre las investigadoras y los especialistas. La aplicación del protocolo siguió guión específico. En la confiabilidad, se utilizó el método de concordancia o equivalencia entre observadores. RESULTADOS: el protocolo elaborado mostró validez de contenido y, después de efectuar las alteraciones sugeridas, la confiabilidad alcanzó resultados excelentes. CONCLUSIÓN: el diagrama del flujo de atención se mostró de aplicabilidad fácil, facilitando la búsqueda por la queja en cada prioridad de atención. .

Assessment and risk classification protocol for patients in emergency units.

OBJECTIVE: to develop, validate the contents and verify the reliability of a risk classification protocol for an Emergency Unit. METHOD: the content validation was developed in a University Hospital in a country town located in the state of Sao Paulo and was carried out in two stages: the first with the individual assessment of specialists and the second with the meeting between the researchers and the specialists. The use of the protocol followed a specific guide. Concerning reliability, the concordance or equivalent method among observers was used. RESULTS: the protocol developed showed to have content validity and, after the suggested changes were made, there were excellent results concerning reliability. CONCLUSION: the assistance flow chart was shown to be easy to use, and facilitate the search for the complaint in each assistance priority.

Armazenamento de sementes de Myracrodruon urundeuva Fr. All. em diferentes embalagens e ambientes / Storage of Myracrodruon urundeuva Fr. All. seeds in different packaging and environments

Myracrodruon urundeuva Fr. All. é uma espécie pertencente à família Anacardiaceae, cuja planta pode ser utilizada como medicinal, na indústria de curtimento de couro, na arborização de ruas e praças, produzindo madeira de grande resistência mecânica. Diante disso, o objetivo deste trabalho foi determinar as melhores condições e períodos de armazenamento para conservação da viabilidade e vigor das sementes de M. urundeuva. As embalagens utilizadas para acondicionamento das sementes foram sacos de papel Kraft, algodão e de polietileno transparente, bem como folhas de papel alumínio. Em seguida as sementes foram armazenadas em ambiente natural de laboratório (25 ± 2ºC), freezer (-20 ± 2ºC), câmara fria (8 ± 2ºC) e geladeira (6 ± 2ºC). Em intervalos pré-determinados (0, 30, 60, 90, 120, 150, 180, 210 e 240 dias) avaliou-se o teor de água das sementes, porcentagem de emergência, índice de velocidade de emergência, comprimento e massa seca de plântulas. No ambiente de laboratório não houve conservação do vigor das sementes de M. urundeuva. A melhor condição para conservação de sementes de M. urundeuva foi obtida com o acondicionamento em sacos de papel Kraft, pano de algodão, plástico ou papel alumínio e manutenção em geladeira ou freezer, podendo também ser conservadas embaladas em papel ou alumínio, quando estocadas em câmara fria, por 240 dias. Alteração no vigor de sementes dessa espécie é primeiramente identificada pela redução da velocidade de emergência.

Myracrodruon urundeuva Fr. All. is a species belonging to the Anacardiaceae family, which can be utilized as a medicinal plant, or in the leather tanning industry, urban afforestation, and the production of wood with great mechanic resistance. The objective of this study was to determine the best conditions and storage periods for preserving the viability and vigor of M. urundeuva. Seeds conditioned in bags of Kraft paper, cotton, polyethylene or aluminum foil of mesh polyethylene were stored at room temperature (25 ± 2ºC), freezer (-20 ± 2ºC), cold (8 ± 2ºC) and refrigerator (6 ± 2ºC). At 30, 60, 90, 120, 150, 180, 210 and 240 days they were evaluated for seed moisture content, percentage of emergence, emergence speed index (ESI), seedling length and seedling dry matter. In the natural environment of the laboratory, there was no conservation of seed vigor M. urundeuva. The best M. urundeuva seed conservation condition was obtained with bags of Kraft paper, cotton, polyethylene or aluminum foil of mesh polyethylene in the refrigerator or freezer. M. urundeuva seeds can also be kept in paper bags or aluminum foil when stored in a refrigerated chamber, for 240 days. Seed vigor change in this species is initially identified by decrease in the speed emergence.

Triage: experiencia en un servicio de urgencias pediátricas / Triage: experience in a pediatric emergency service

Identificar rápidamente a los pacientes con urgencias o condiciones que ponen en peligro la vida, determinar el área de tratamiento más apropiado, disminuir la congestión en las áreas de la sala de urgencias, proveer los mecanismos para la evaluación permanente de los pacientes, proveer información a los pacientes y sus familiares en relacióna los cuidados y al tiempo de espera y aportar información exacta sobre la precisión del trabajo en urgencias.

Emergencias médicas en un aeropuerto urbano: experiencia del SAME en la base Aeroparque Jorge Newbery / Medical emergencies in an urban airport: experience of the SAME in the base airport Jorge Newbery

Se presentan los resultados obtenidos luego de dos años de actuación del SAME, estadísticas de los auxilios prestados, y los operativos realizados en la base.

Emergencias médicas en un aeropuerto urbano: experiencia del SAME en la base Aeroparque Jorge Newbery / Medical emergencies in an urban airport: experience of the SAME in the base airport Jorge Newbery

Se presentan los resultados obtenidos luego de dos años de actuación del SAME, estadísticas de los auxilios prestados, y los operativos realizados en la base. (AU)