Interpretación de la radiografía de tórax en los pacientes que ingresan en una Unidad de Corta Estancia. Relación con la estancia media / Chest X-ray interpretation on patients admitted in a short-stay unit. Relation with the mean length of stay

Introducción: Determinar la concordancia entre los médicos de un Servicio de Urgencias y un radiólogo en la interpretación de la radiografía de tórax (RxT) de pacientes ingresados en una unidad de estancia corta (UEC) y evaluar si ello influye en la estancia media. Material y método: Se revisaron las historias clínicas de los pacientes ingresados en una UEC durante 4 meses. Se comparó la interpretación de la RxT realizada por el médico responsable del paciente en urgencias con la interpretación realizada por un radiólogo. Se determinó la estancia media y se analizó si la lectura de la RxT previa al ingreso por el radiólogo hubiera mejorado la estancia media. Resultados: Se revisaron 260 historias clínicas. La concordancia total fue del 74,2%, siendo mayor cuando el médico de urgencias era un residente mayor o un adjunto que cuando era un residente menor (82% vs 66,4%; p < 0,003). No se observaron diferencias según el horario en el que se realizó la lectura. Solo en 9 casos (3,5%) se hubiera producido un cambio de diagnóstico y/o tratamiento. No se produjeron cambios en la estancia media de los pacientes según existiera concordancia o no, aunque en los casos en que se hubiera producido un cambio de diagnóstico y/o tratamiento se observó una tendencia a su aumento.Conclusiones: La lectura de la RxT por un radiólogo previa al ingreso en una UEC no está justificada en todos los casos. Podría realizarse cuando el residente mayor o el adjunto de guardia tuvieran dudas en su interpretación. Una mayor supervisión de los residentes menores podría mejorar el rendimiento diagnóstico de la RxT

Introduction: To assess the agreement between physicians of the emergency department and a radiologist in the interpretation of chest roentgenograms in patients admitted to the short-stay unit, and to determine the effect of concordance on the mean length of stay. Material and method: The medical records of patients admitted to the short-stay unit over a 4-month period were reviewed. The interpretation of the chest X-ray film made by the physician in charge of the patient at the emergency department with that made by the radiologist was compared. The mean length of stay was determined and it was analyzed if the reading of the radiograph made by the radiologist before admission would decrease the length of stay. Results: A total of 260 medical records were reviewed. The overall degree of agreement was 74.2% but it was greater when the physician at the emergency department was a staff physician or a resident in the final period of training than a resident in the initial period of training (82% vs 66.4%, p < 0.003). There were no statistically significant differences regarding the day hours at which readings were made. A change in the diagnosis and/or treatment of the patient would had occurred in only 9 cases (3.5%). There were no changes in the mean length of stay according to the presence or absence of concordance, although there was a trend towards an increase in the length of stay for those cases in which diagnosis and/or treatment would had been different. Conclusions: Readings of chest roentgenograms by a radiologist before admission to a short-stay unit does not appear to be justified for all patients, although it may be justified when a staff physician or a resident in the final period of training have doubts regarding interpretation of the radiographic images. A better supervision of residents in the initial period of training may contribute to improve the diagnostic reliability of chest X-ray films

[Chest X-ray interpretation on patients admitted in a short-stay unit. Relation with the mean length of stay]. / Interpretación de la radiografía de tórax en los pacientes que ingresan en una unidad de estancia corta. Relación con la estancia media.

INTRODUCTION: To assess the agreement between physicians of the emergency department and a radiologist in the interpretation of chest roentgenograms in patients admitted to the short-stay unit, and to determine the effect of concordance on the mean length of stay. MATERIAL AND METHOD: The medical records of patients admitted to the short-stay unit over a 4-month period were reviewed. The interpretation of the chest X-ray film made by the physician in charge of the patient at the emergency department with that made by the radiologist was compared. The mean length of stay was determined and it was analyzed if the reading of the radiograph made by the radiologist before admission would decrease the length of stay. RESULTS: A total of 260 medical records were reviewed. The overall degree of agreement was 74.2% but it was greater when the physician at the emergency department was a staff physician or a resident in the final period of training than a resident in the initial period of training (82% vs 66.4%, p < 0.003). There were no statistically significant differences regarding the day hours at which readings were made. A change in the diagnosis and/or treatment of the patient would had occurred in only 9 cases (3.5%). There were no changes in the mean length of stay according to the presence or absence of concordance, although there was a trend towards an increase in the length of stay for those cases in which diagnosis and/or treatment would had been different. CONCLUSIONS: Readings of chest roentgenograms by a radiologist before admission to a short-stay unit does not appear to be justified for all patients, although it may be justified when a staff physician or a resident in the final period of training have doubts regarding interpretation of the radiographic images. A better supervision of residents in the initial period of training may contribute to improve the diagnostic reliability of chest X-ray films.

Tira reactiva de orina como test determinante en el manejo del síndrome miccional en los servicios de urgencias / Urine reactive strip as the determinant test in the management of the mictional syndrome in the emergency services

No disponible

Neuritis óptica bilateral y síndrome de hipertensión endocraneal en una paciente afecta de linfoma no Hodgkin / Bilateral optic neuritis and endocranial hypertension syndrome in a woman with no-Hodgkin lymphoma

La afectación orbitaria es una complicación poco frecuente en los linfomas no Hodgkin, pudiendo manifestarse como pérdida de agudeza visual a consecuencia de una neuritis óptica. En aquellos casos en que se acompaña de deterioro del nivel de consciencia y clínica progresiva de hipertensión endocraneal debe descartarse la presencia de una carcinomatosis meníngea. El diagnóstico precoz en urgencias del cuadro de hipertensión endocraneal, y de la causa del mismo, permitirá instaurar un tratamiento precoz y de esa forma evitar las posibles secuelas que pudieran producirse. Presentamos el caso de una paciente afecta de un linfoma no Hodgkin en fase de remisión, que acudió a nuestro Servicio de Urgencias por un cuadro de pérdida de agudeza visual y en la que se diagnosticó un síndrome de hipertensión endocraneal. El rápido diagnóstico de una carcinomatosis meníngea fue fundamental para la evolución posterior de la paciente (AU)

[Mitral endocarditis secondary to Streptococcus mitis bacteremic pneumonia]. / Endocarditis mitral secundaria a neumonía bacteriémica por Streptococcus mitis.

Streptococcus viridans usually are an etiologic agent in odontogenic infection and endocarditis and only in some cases have been acknowledged as a respiratory pathogens. We present two cases of Streptococcus mitis bacteremic pneumonia with secondary mitral endocarditis in two patients that were been admitted by a respiratory infection (pneumonia), and later diagnosticated of mitral endocarditis. We dismiss the fisiopathogenic possibility of pneumonia with secondary pulmonary septic embolisms. With this description we help to prove the S. mitis respiratory system pathogenicity and show the known risk of endocarditis in any case of Streptococcus viridans bacteremic infection.