Podemos llamar hiperfrecuentadores a los pacientes con mayor número de atenciones en urgencias y atención primaria / We can call hiper frequent users to the patients with the highest number of attention in emergencies and primary care

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Hiperfrecuentación en Atención Primaria e hiperfrecuentadores en Urgencias / Frequent attenders in Primary Health Care Centres and frequent attenders in Emergency Departments

OBJETIVO: Identificar factores predictores de hiperfrecuentación en Atención Primaria (AP) en una muestra de pacientes hiperfrecuentadores (HF) en servicios de urgencias hospitalarios (SUH). DISEÑO: Estudio observacional retrospectivo multicéntrico. PARTICIPANTES: Se seleccionaron pacientes mayores de 14 años HF en el SUH entre el 1 de enero y el 31 de diciembre de 2013. Emplazamiento: se reclutaron pacientes atendidos en los SUH de 17 hospitales públicos de la Comunidad de Madrid. MÉTODO: Se recogieron variables relativas a la visita índice del SUH. Se analizó la muestra en función de ser o no HF en AP. Se considera HF al paciente que realizó al menos 10 visitas en cada nivel asistencial durante un año. RESULTADOS: Se incluyeron 1.284 pacientes HF en SUH. Se analizaron 423 (32,9%) HF en AP con 16 visitas (RIC 12-25) frente a 861 (67,1%) pacientes no HF en AP con 4 visitas (RIC 2-6). Factores independientes predictores de HF en AP fueron la edad > 65 años (OR: 1,51; IC 95%: 1,07-2,13; p = 0,019), el deterioro cognitivo (OR: 1,63; IC 95%: 1,01-2,65; p = 0,049), el número de fármacos ≥3 (OR: 1,56; IC 95%: 1,06-2,30; p = 0,025) y vivir en la comunidad frente a vivir institucionalizado o en la calle (OR: 3,05; IC 95%: 1,14-8,16; p = 0,026). CONCLUSIONES: En una muestra de pacientes HF en los SUH, el hecho de ser mayor de 65 años, tomar 3 o más fármacos, presentar deterioro cognitivo y vivir en la comunidad se consideran factores predictores de ser HF también en AP

OBJECTIVE: To identify predictors of frequent attenders (HF) in Primary Health Care (PHC) centres in a sample of frequent attenders (HF) in Emergency Departments (ED). DESIGN: This was an observational, retrospective, multicentre cohort study. PARTICIPANTS: The HF patients were selected from patients seen in the ED between January 1 and December 31, 2013. Setting Patients were recruited from 17 public hospitals of the Community of Madrid, Spain. METHOD: Variables on the index visit to the ED were collected. The sample was analysed in terms of being or not being an HF user in PHC. An HF user is considered a patient who made at least 10 visits in each level of care for a year. RESULTS: A total of 1284 HF patients were included. An analysis was performed on 423 (32.9%) HF users in ED with 16 (12-25) visits to PHC vs. 861 (67.1%) non-HF users in ED, with 4 (2-6) visits to PHC. Independent predictors of HF in PHC: over 65 years (OR: 1.51; 95% CI: 1.07-2.13; P=.019), cognitive impairment (OR: 1.63; 95% CI: 1.01-2.65; P = .049), taking > 3 drugs (OR: 1.56; 95% CI: 1.06-2.30; P = .025), and living in the community vs. nursing home or homeless (OR: 3.05; 95% CI: 1.14-8.16; P = .026). CONCLUSIONS: Among HF patients in the ED, the fact that of being over 65 years, taking 3 or more drugs, suffering cognitive impairment, and living in the community, are also considered to be predictors of HF in PHC

[Frequent attenders in Primary Health Care Centres and frequent attenders in Emergency Departments]. / Hiperfrecuentación en Atención Primaria e hiperfrecuentadores en Urgencias.

OBJECTIVE: To identify predictors of frequent attenders (HF) in Primary Health Care (PHC) centres in a sample of frequent attenders (HF) in Emergency Departments (ED). DESIGN: This was an observational, retrospective, multicentre cohort study. PARTICIPANTS: The HF patients were selected from patients seen in the ED between January 1 and December 31, 2013. Setting Patients were recruited from 17 public hospitals of the Community of Madrid, Spain. METHOD: Variables on the index visit to the ED were collected. The sample was analysed in terms of being or not being an HF user in PHC. An HF user is considered a patient who made at least 10 visits in each level of care for a year. RESULTS: A total of 1284 HF patients were included. An analysis was performed on 423 (32.9%) HF users in ED with 16 (12-25) visits to PHC vs. 861 (67.1%) non-HF users in ED, with 4 (2-6) visits to PHC. Independent predictors of HF in PHC: over 65 years (OR: 1.51; 95% CI: 1.07-2.13; P=.019), cognitive impairment (OR: 1.63; 95% CI: 1.01-2.65; P=.049), taking >3 drugs (OR: 1.56; 95% CI: 1.06-2.30; P=.025), and living in the community vs. nursing home or homeless (OR: 3.05; 95% CI: 1.14-8.16; P=.026). CONCLUSIONS: Among HF patients in the ED, the fact that of being over 65 years, taking 3or more drugs, suffering cognitive impairment, and living in the community, are also considered to be predictors of HF in PHC.

Hiperfrecuentadores en urgencias. ¿Quiénes son? ¿Por qué consultan? / Frequent users in paediatric emergency departments. Who are they? Why do they consult?

OBJETIVO: Determinar la prevalencia de hiperfrecuentadores en urgencias y analizar sus características, comparando secundariamente las primeras consultas y las reconsultas. MÉTODO: Estudio multicéntrico de cohorte retrospectivo. Se cuantifican las visitas a urgencias de pediatría de 5 hospitales públicos entre el 1 de enero y 31 de diciembre de 2013 y se seleccionan los pacientes con 10 o más visitas realizadas. Se recogen variables demográficas y clínicas y se analiza cada visita en función de si se trata de una primera consulta o una reconsulta. RESULTADOS: Los pacientes hiperfrecuentadores constituyeron el 0,60% (IC 95%: 0,56-0,64%) de los usuarios de urgencias y generaron el 3,93% (IC 95%: 3,47-4,39%) de las consultas. Los menores de 2años fueron el grupo de edad más numeroso (66,6%). Distribuyeron sus consultas durante los 4 trimestres (62,3%; p < 0,001) y no presentaron patología de base relacionada con el motivo de consulta (86,4%; p < 0,001). La mayoría se clasificaron como poco urgentes (3.186 vs. 1.812; p < 0,001) y habitualmente no precisaron intervenciones en forma de pruebas complementarias (79,4%) u observación/tratamiento (60%). La tasa de ingreso fue similar a la de la población general pediátrica (5,3%). Las reconsultas representaron el 27% de las visitas de estos pacientes, el 13,82% de ellos consultó en atención primaria antes de las siguientes visitas y fueron justificadas preferentemente por persistencia de los síntomas (56,34%). CONCLUSIONES: El hiperfrecuentador pediátrico consulta en urgencias como primera opción por procesos generalmente poco urgentes que no requieren intervenciones diagnóstico-terapéuticas de forma sistemática. Las reconsultas constituyen un número importante de visitas, se caracterizan por precisar más intervenciones y se indican más ingresos hospitalarios

OBJECTIVE: To determine the prevalence of frequent Paediatric Emergency Departments users and to analyse their characteristics, comparing initial consultations and re-consultations. METHODS: This is a multicentre retrospective cohort study of all patients who made 10 or more visits to the Paediatric Emergency Departments of 5 public hospitals between 1 January 2013 and 31 December 2013. An analysis was performed on the patient demographics and clinical data of the first consultation and consecutive re-consultations. RESULTS: Frequent users represented 0.60% (95% CI: 0.56-0.64%) of Emergency Department users, and accounted for 3.93% (95% CI: 3.47-4.39%) of all visits. The most numerous age group consisted of children under 2 years old (66.6%). Frequent users distributed their visits throughout the year (62.3%; P<.001), and did not have a chronic condition associated with their chief complaint (86.4%; P<.001). They were usually classified as non-urgent or less urgent in triage (3,186 vs. 1,812; P<.001), and often did not require any intervention, such as complementary tests (79.4%) or observation/treatment (60%). Admission rate was similar to the general paediatric population (5.3%). Re-consultations represented 27% of these patient visits, mostly related to persistence of symptoms (56.3%), with 13.8% of them consulting their Primary Care physician before seeking successive medical attention in the Paediatric Emergency Department. CONCLUSIONS: Paediatric frequent users often ask for medical care in the Emergency Department before consulting their Primary Care physician. They present with less urgent processes and do not systematically need diagnostic or therapeutic interventions. Re-consultations make up a significant number of visits, in which more interventions are done and more children are admitted

[Frequent users in paediatric emergency departments. Who are they? Why do they consult?] / Hiperfrecuentadores en urgencias. ¿Quiénes son? ¿Por qué consultan?

OBJECTIVE: To determine the prevalence of frequent Paediatric Emergency Departments users and to analyse their characteristics, comparing initial consultations and re-consultations. METHODS: This is a multicentre retrospective cohort study of all patients who made 10 or more visits to the Paediatric Emergency Departments of 5 public hospitals between 1 January 2013 and 31 December 2013. An analysis was performed on the patient demographics and clinical data of the first consultation and consecutive re-consultations. RESULTS: Frequent users represented 0.60% (95% CI: 0.56-0.64%) of Emergency Department users, and accounted for 3.93% (95% CI: 3.47-4.39%) of all visits. The most numerous age group consisted of children under 2 years old (66.6%). Frequent users distributed their visits throughout the year (62.3%; P<.001), and did not have a chronic condition associated with their chief complaint (86.4%; P<.001). They were usually classified as non-urgent or less urgent in triage (3,186 vs. 1,812; P<.001), and often did not require any intervention, such as complementary tests (79.4%) or observation/treatment (60%). Admission rate was similar to the general paediatric population (5.3%). Re-consultations represented 27% of these patient visits, mostly related to persistence of symptoms (56.3%), with 13.8% of them consulting their Primary Care physician before seeking successive medical attention in the Paediatric Emergency Department. CONCLUSIONS: Paediatric frequent users often ask for medical care in the Emergency Department before consulting their Primary Care physician. They present with less urgent processes and do not systematically need diagnostic or therapeutic interventions. Re-consultations make up a significant number of visits, in which more interventions are done and more children are admitted.

Ensayo clínico aleatorizado triple ciego y multicéntrico para evaluar la eficacia en la disminución del dolor y el grado de satisfacción de una mezcla de óxido nitroso y oxígeno (N2O/O2) 50/50 como tratamiento añadido al convencional en los pacientes atendidos por cólico nefrítico en el servicio de urgencias / Multicenter, triple-blind randomized placebo controlled trial of adjuvant nitrous oxide 50% in oxygen 50%: efficacy for reducing pain and increasing satisfaction in patients treated for renal colic in the emergency department

Objetivo: Evaluar la eficacia en la disminución del dolor y el grado de satisfacción de una mezcla de óxido nitroso y oxígeno al 50% (N2O/O2 50/50) añadido al tratamiento convencional en los pacientes atendidos con sospecha de cólico nefrítico en los servicios de urgencias (SU). Método: Ensayo clínico aleatorizado triple ciego controlado con placebo multicéntrico. Se incluyeron 147 pacientes con el diagnóstico clínico de cólico nefrítico a grupo experimental con N2O/O2 50/50 (N = 70) o grupo control con una mezcla de aire medicinal con una proporción de oxígeno del 50% (N = 77). Ambos grupos recibieron el tratamiento convencional con dexketoprofeno, al que se añadió metamizol y opioides administrados de forma secuencial en caso de no control del dolor, así como medicación de rescate con opioides. La variable de resultado principal fue la reducción en la intensidad de dolor, según la escala visual analgésica (EVA), a los 5 minutos de inicio del tratamiento y el grado de satisfacción del paciente con el tratamiento administrado previo al alta. Resultados: El descenso del dolor medido por la EVA a los 5 minutos de iniciado el tratamiento fue de media 1,84 (DE 2,05) en el grupo tratado con N2O/O2 50/50 y de 1,67 (DE 1,91) en el grupo que recibió el placebo (p = 0,603). Tampoco se encontraron diferencias a los 10, 15, 30 y 60 minutos. La satisfacción con el tratamiento al alta se consideró adecuada (más que o igual a 9) en 53 de 70 pacientes (75,7%) en el grupo de N2O/O2 y en 56 de 77 (72,7%) en el grupo placebo (p = 0,412). Treinta y tres pacientes (48,5%) en el grupo N2O/O2 y 19 pacientes (24,7%) en el grupo placebo presentaron uno o más efectos secundarios (p = 0,003). Conclusiones: La adición de N2O/O2 50/50 al tratamiento estándar no ha demostrado una mayor eficacia en el control del dolor ni en la satisfacción del paciente con un diagnóstico clínico de cólico nefrítico en el SU (AU)

Objective: To assess the efficacy of a nitrous oxide and oxygen mixture (N2O/O2 50/50) for reducing pain and increasing satisfaction in patients with an initial clinical diagnosis of renal colic in the emergency department. Methods: Multicenter, triple-blind randomized placebo-controlled trial. We randomized 147 patients with a clinical diagnosis of renal colic to an experimental group to receive the N2O/O2 50/50 mixture (n = 70) or a control group to receive 50% oxygen in air (n = 77). Both groups also received conventional analgesia with dexketoprofen plus metamizol and opiates administered sequentially until pain was brought under control; rescue doses of opioids were also available. The endpoints were the reduction in pain intensity expressed on a visual analog scale (VAS) 5 minutes after the start of treatment and the patient's level of satisfaction with treatment on discharge. Results: The mean (SD) reduction in pain 5 minutes after starting analgesic treatment was 1.84 (2.05) VAS points in the intervention group and 1.67 (1.91) in the placebo group. The difference was not significant (P = .603). Neither were between-group differences significant at other pain evaluation times (10, 15, 30, and 60 minutes). Treatment was considered satisfactory (greater tan or equal to 9 on a VAS) by 53 of the 70 intervention-group patients (75.7%) and 56 of the 77 (72.7%) placebo-group patients (P = .412). Adverse effects appeared in 33 of the 70 patients (48.5%) who received the N2O/O2 mixture and in 19 patients (24.7%) who received the placebo (P = .003). Conclusions: The addition of N2O/O2 50/50 to standard analgesic therapy does not enhance the efficacy of pain control or the satisfaction of patients treated for renal colic in the emergency department (AU)

Proyecto FIDUR: pacientes hiperfrecuentadores fidelizados en servicios de urgencias hospitalarios / Loyal frequent users of hospital emergency departments: the FIDUR Project

Objetivos: Describir las características del paciente hiperfrecuentador (HF) en servicios de urgencias hospitalarios (SUH) y analizar si existen diferencias en función de la distribución de revisitas durante el periodo de estudio. Método: Estudio de cohorte retrospectivo que seleccionó a pacientes mayores de 14 años que frecuentaron el SUH al menos en 10 ocasiones en 2013. Se reclutaron pacientes de 17 hospitales públicos de la Comunidad de Madrid (CM). Se recogieron variables relativas a la visita índice y visitas sucesivas. Se analizó la muestra en función del número de trimestres (TM) en el que se reparten las revisitas. Resultados: Se incluyeron 2.340 pacientes con una edad media de 54 (DE 21) años, 1.361 (58,2%) fueron mujeres, 1.160 (50,0%) no presentaban comorbilidad, 1.366 (58,2%) consumían tóxicos y 25 (1,1%) vivían en la calle. En la visita índice, 2.038 (87,1%) acudieron por un problema de salud reciente, 289 (12,4%) fueron hospitalizados, 60 (2,6%) concentraron sus revisitas en un solo TM, 335 (14,3%) en 2 TM, 914 (39,1%) las repartieron en 3 TM y 1.005 (42,9%) en 4 TM. En el grupo de pacientes cuyas revisitas se reparten en mayor número de TM observamos que aumenta la edad (> 65 años), la comorbilidad y la polifarmacia (p < 0,001), el deterioro cognitivo (p = 0,039) y la dependencia (p = 0,007), así como la hospitalización en la visita índice (p < 0,001). A medida que las revisitas se concentran en un menor número de TM, aumenta la proporción de mujeres (p = 0,012), determinados diagnósticos (p < 0,001) y la coincidencia entre el motivo de las revisitas y la visita índice (p = 0,012). Conclusiones: El paciente HF tiene unas características determinadas y acude a urgencias de una forma homogénea a lo largo del año (fidelizado). A medida que las revisitas se dispersan más, se objetivan pacientes con mayor complejidad y que consumen más recursos en la visita índice (AU)

Objectives: To describe the characteristics of frequent users of hospital emergency departments and analyze whether characteristics varied in relation to how revisits were distributed over the course of the year studied. Methods: Retrospective study of patients over the age of 14 years who were treated in a hospital emergency department at least 10 times in 2013. Patients were identified in 17 public hospitals in the Spanish autonomous community of Madrid. Data related to the first and successive visits were gathered and analyzed by quarter year. Results: We included 2340 patients with a mean (SD) age of 54 (21) years. A total of 1361 (58.%) were women, 1160 (50%) had no concomitant diseases, 1366 (58.2%) were substance abusers, and 25 (1.1%) were homeless. During the first visit, 2038 (87.1%) complained of a recent health problem, and 289 (12.4%) were admitted. Sixty (2.6%) patients concentrated their revisits in a single quarters 335 (14.3%) in 2 quarters, 914 (39.1%) in 3, and 1005 (42.9%) in 4. Patients whose revisits were distributed over more quarters were older (> 65 years), had more concomitant conditions, were on more medications (P < .001), showed cognitive impairment (P = .039), and were more functionally dependent (P = .007). They were also more likely to have been hospitalized on the first visit (P < .001). Patients whose revisits were concentrated in fewer quarters were more often women (P = .012) and more likely to have a specific diagnosis (P < .001) and revisit for a reason related to the initial visit (P = .012). Conclusions: Our study shows that the frequent user has specific characteristics and loyally comes to the same emergency department over the course of a year. Patients whose revisits are dispersed over a longer period have more complex problems and use more resources during their initial visit (AU)

[Loyal frequent users of hospital emergency departments: the FIDUR project]. / Proyecto FIDUR: pacientes hiperfrecuentadores fidelizados en servicios de urgencias hospitalarios.

OBJECTIVES: To describe the characteristics of frequent users of hospital emergency departments and analyze whether characteristics varied in relation to how revisits were distributed over the course of the year studied. MATERIAL AND METHODS: Retrospective study of patients over the age of 14 years who were treated in a hospital emergency department at least 10 times in 2013. Patients were identified in 17 public hospitals in the Spanish autonomous community of Madrid. Data related to the first and successive visits were gathered and analyzed by quarter year. RESULTS: We included 2340 patients with a mean (SD) age of 54 (21) years. A total of 1361 (58.%) were women, 1160 (50%) had no concomitant diseases, 1366 (58.2%) were substance abusers, and 25 (1.1%) were homeless. During the first visit, 2038 (87.1%) complained of a recent health problem, and 289 (12.4%) were admitted. Sixty (2.6%) patients concentrated their revisits in a single quarters 335 (14.3%) in 2 quarters, 914 (39.1%) in 3, and 1005 (42.9%) in 4. Patients whose revisits were distributed over more quarters were older (> 65 years), had more concomitant conditions, were on more medications (P < .001), showed cognitive impairment (P = .039), and were more functionally dependent (P = .007). They were also more likely to have been hospitalized on the first visit (P < .001). Patients whose revisits were concentrated in fewer quarters were more often women (P = .012) and more likely to have a specific diagnosis (P < .001) and revisit for a reason related to the initial visit (P = .012). CONCLUSION: Our study shows that the frequent user has specific characteristics and loyally comes to the same emergency department over the course of a year. Patients whose revisits are dispersed over a longer period have more complex problems and use more resources during their initial visit.

OBJETIVO: Describir las características del paciente hiperfrecuentador (HF) en servicios de urgencias hospitalarios (SUH) y analizar si existen diferencias en función de la distribución de revisitas durante el periodo de estudio. METODO: Estudio de cohorte retrospectivo que seleccionó a pacientes mayores de 14 años que frecuentaron el SUH al menos en 10 ocasiones en 2013. Se reclutaron pacientes de 17 hospitales públicos de la Comunidad de Madrid (CM). Se recogieron variables relativas a la visita índice y visitas sucesivas. Se analizó la muestra en función del número de trimestres (TM) en el que se reparten las revisitas. RESULTADOS: Se incluyeron 2.340 pacientes con una edad media de 54 (DE 21) años, 1.361 (58,2%) fueron mujeres, 1.160 (50,0%) no presentaban comorbilidad, 1.366 (58,2%) consumían tóxicos y 25 (1,1%) vivían en la calle. En la visita índice, 2.038 (87,1%) acudieron por un problema de salud reciente, 289 (12,4%) fueron hospitalizados, 60 (2,6%) concentraron sus revisitas en un solo TM, 335 (14,3%) en 2 TM, 914 (39,1%) las repartieron en 3 TM y 1.005 (42,9%) en 4 TM. En el grupo de pacientes cuyas revisitas se reparten en mayor número de TM observamos que aumenta la edad (> 65 años), la comorbilidad y la polifarmacia (p < 0,001), el deterioro cognitivo (p = 0,039) y la dependencia (p = 0,007), así como la hospitalización en la visita índice (p < 0,001). A medida que las revisitas se concentran en un menor número de TM, aumenta la proporción de mujeres (p = 0,012), determinados diagnósticos (p < 0,001) y la coincidencia entre el motivo de las revisitas y la visita índice (p = 0,012). CONCLUSIONES: El paciente HF tiene unas características determinadas y acude a urgencias de una forma homogénea a lo largo del año (fidelizado). A medida que las revisitas se dispersan más, se objetivan pacientes con mayor complejidad y que consumen más recursos en la visita índice.

[Multicenter, triple-blind randomized placebo controlled trial of adjuvant nitrous oxide 50% in oxygen 50%: efficacy for reducing pain and increasing satisfaction in patients treated for renal colic in the emergency department]. / Ensayo clínico aleatorizado triple ciego y multicéntrico para evaluar la eficacia en la disminución del dolor y el grado de satisfacción de una mezcla de óxido nitroso y oxígeno (N2O/O2) 50/50 como tratamiento añadido al convencional en los pacientes atendidos por cólico nefrítico en el servicio de urgencias.

OBJECTIVES: To assess the efficacy of a nitrous oxide and oxygen mixture (N2O/O2 50/50) for reducing pain and increasing satisfaction in patients with an initial clinical diagnosis of renal colic in the emergency department. MATERIAL AND METHODS: Multicenter, triple-blind randomized placebo-controlled trial. We randomized 147 patients with a clinical diagnosis of renal colic to an experimental group to receive the N2O/O2 50/50 mixture (n = 70) or a control group to receive 50% oxygen in air (n = 77). Both groups also received conventional analgesia with dexketoprofen plus metamizol and opiates administered sequentially until pain was brought under control; rescue doses of opioids were also available. The endpoints were the reduction in pain intensity expressed on a visual analog scale (VAS) 5 minutes after the start of treatment and the patient's level of satisfaction with treatment on discharge. RESULTS: The mean (SD) reduction in pain 5 minutes after starting analgesic treatment was 1.84 (2.05) VAS points in the intervention group and 1.67 (1.91) in the placebo group. The difference was not significant (P = .603). Neither were between-group differences significant at other pain evaluation times (10, 15, 30, and 60 minutes). Treatment was considered satisfactory (􀀀 9 on a VAS) by 53 of the 70 intervention-group patients (75.7%) and 56 of the 77 (72.7%) placebo-group patients (P = .412). Adverse effects appeared in 33 of the 70 patients (48.5%) who received the N2O/O2 mixture and in 19 patients (24.7%) who received the placebo (P = .003). CONCLUSION: The addition of N2O/O2 50/50 to standard analgesic therapy does not enhance the efficacy of pain control or the satisfaction of patients treated for renal colic in the emergency department.

OBJETIVO: Evaluar la eficacia en la disminución del dolor y el grado de satisfacción de una mezcla de óxido nitroso y oxígeno al 50% (N2O/O2 50/50) añadido al tratamiento convencional en los pacientes atendidos con sospecha de cólico nefrítico en los servicios de urgencias (SU). METODO: Ensayo clínico aleatorizado triple ciego controlado con placebo multicéntrico. Se incluyeron 147 pacientes con el diagnóstico clínico de cólico nefrítico a grupo experimental con N2O/O2 50/50 (N = 70) o grupo control con una mezcla de aire medicinal con una proporción de oxígeno del 50% (N = 77). Ambos grupos recibieron el tratamiento convencional con dexketoprofeno, al que se añadió metamizol y opioides administrados de forma secuencial en caso de no control del dolor, así como medicación de rescate con opioides. La variable de resultado principal fue la reducción en la intensidad de dolor, según la escala visual analgésica (EVA), a los 5 minutos de inicio del tratamiento y el grado de satisfacción del paciente con el tratamiento administrado previo al alta. RESULTADOS: El descenso del dolor medido por la EVA a los 5 minutos de iniciado el tratamiento fue de media 1,84 (DE 2,05) en el grupo tratado con N2O/O2 50/50 y de 1,67 (DE 1,91) en el grupo que recibió el placebo (p = 0,603). Tampoco se encontraron diferencias a los 10, 15, 30 y 60 minutos. La satisfacción con el tratamiento al alta se consideró adecuada (ô€€€ 9) en 53 de 70 pacientes (75,7%) en el grupo de N2O/O2 y en 56 de 77 (72,7%) en el grupo placebo (p = 0,412). Treinta y tres pacientes (48,5%) en el grupo N2O/O2 y 19 pacientes (24,7%) en el grupo placebo presentaron uno o más efectos secundarios (p = 0,003). CONCLUSIONES: La adición de N2O/O2 50/50 al tratamiento estándar no ha demostrado una mayor eficacia en el control del dolor ni en la satisfacción del paciente con un diagnóstico clínico de cólico nefrítico en el SU.

Pacientes frecuentadores/as en servicios de urgencias hospitalarios / Frequent users of hospital emergency departments

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