Impact of the COVID-19 pandemic on demand for emergency department care for older patients: the EDEN-7 COVID cohort study. / Estudio EDEN-7: impacto de la pandemia COVID-19 sobre la demanda asistencial de personas mayores en los servicios de urgencias españoles.

OBJECTIVES: To analyze the impact of the COVID-19 pandemic on Spanish emergency department (ED) care for patients aged 65 years or older during the first wave vs. a pre-pandemic period. MATERIAL AND METHODS: Retrospective cross-sectional study of a COVID-19 portion of the EDEN project (Emergency Department and Elder Needs). The EDEN-COVID cohort included all patients aged 65 years or more who were treated in 52 EDs on 7 consecutive days early in the pandemic. We analyzed care variables, discharge diagnoses, use of diagnostic and therapeutic resources, use of observation units, need for hospitalization, rehospitalization, and mortality. These data were compared with data for an EDEN cohort in the same age group recruited during a similar period the year before the pandemic. RESULTS: The 52 participating hospital EDs attended 33 711 emergencies during the pandemic vs. 96 173 emergencies in the pre-COVID period, representing a 61.7% reduction during the pandemic. Patients aged 65 years or older accounted for 28.8% of the caseload during the COVID-19 period and 26.4% of the earlier cohort (P .001). The COVID-19 caseload included more men (51.0%). Comorbidity and polypharmacy were more prevalent in the pandemic cohort than in the earlier one (comorbidity, 92.6% vs. 91.6%; polypharmacy, 65.2% vs. 63.6%). More esturesources (analgesics, antibiotics, heparins, bronchodilators, and corticosteroids) were applied in the pandemic period, and common diagnoses were made less often. Observation wards were used more often (for 37.8% vs. 26.2% in the earlier period), and hospital admissions were more frequent (in 56.0% vs. 25.3% before the pandemic). Mortality was higher during the pandemic than in the earlier cohort either in ED (1.8% vs 0.5%) and during hospitalization (11.5 vs 2.9%). CONCLUSION: The proportion of patients aged 65 years or older decreased in the participating Spanish EDs. However, more resources were required and the pattern of diagnoses changed. Observation ward stays were longer, and admissions and mortality increased over the numbers seen in the reference period.

OBJETIVO: Analizar el impacto de la pandemia COVID-19 sobre la asistencia a las personas mayores ($ 65 años) en los servicios de urgencias hospitalarios (SUH) españoles durante la primera oleada pandémica, comparándola con un periodo previo. METODO: Estudio transversal retrospectivo de la cohorte EDEN-COVID (Emergency Department and Elder Needs during COVID), que incluyó a todos los pacientes $ 65 años atendidos en 52 SUH españoles durante 7 días consecutivos de un periodo pandémico. Se analizaron variables asistenciales, diagnósticos de alta, consumo de recursos diagnósticos y terapéuticos, utilización de las unidades de observación, necesidad de ingreso, rehospitalización y mortalidad. Estos datos se compararon con la cohorte EDEN (Emergency Department and Elder Needs), que reclutó a pacientes del mismogrupo de edad durante un periodo similar del año anterior. RESULTADOS: Durante el periodo COVID-19 se atendieron 33.711 episodios en los 52 SUH participantes, frente a 96.173 del periodo pre-COVID, lo que supone una disminución de la demanda de 61,7%. La proporción de asistencias a pacientes de 65 o más años fue de 28,8% en el periodo COVID-19 y 26,4% en el periodo previo (p 0,001). Durante el periodo COVID hubo mayor proporción de hombres (51,0% vs 44,9%), mayor comorbilidad (92,6% vs 91,6%) y polifarmacia (65,2% vs 63,6%), mayor uso de recursos, de analgésicos, antibióticos, heparinas, broncodilatadores y corticoides, menor proporción de los diagnósticos más habituales, mayor utilización de las unidades de observación (37,8% vs 26,2%) y un incremento de la proporción de ingresos (56,0% vs 25,3%), y de mortalidad en urgencias (1,8% vs 0,5%) y durante la hospitalización (11,5% vs 2,9%). CONCLUSIONES: La primera ola de la pandemia COVID-19 ha provocado una disminución global de las asistencias a personas mayores ($ 65 años) en los SUH españoles analizados, mayor consumo de recursos, un mapa diferente de procesos diagnósticos asistidos y un aumento proporcional de estancias en observación, de ingresos y de mortalidad, respecto al periodo de referencia.

Performance of 3 frailty scales for predicting adverse outcomes at 30 days in older patients discharged from emergency departments. / Rendimiento de tres escalas de fragilidad para predecir resultados adversos a 30 días en los pacientes mayores dados de alta en los servicios de urgencias.

OBJECTIVES: To compare the ability of 3 frailty scales (the Clinical Frailty Scale [CFS], the Functional Index - eMergency [FIM], and the Identification of Seniors at Risk [ISAR] scale) to predict adverse outcomes at 30 days in older patients discharged from hospital emergency departments (EDs). MATERIAL AND METHODS: Secondary analysis of data from the FRAIL-Madrid registry of patients aged 75 years or older who were discharged from Madrid EDs over a period of 3 months in 2018 and 2019. Frailty was defined by a CFS score over 4, a FIM score over 2, or an ISAR score over 3. The outcome variables were revisits to an ED, hospitalization, functional decline, death, and a composite variable of finding any of the previously named variables within 30 days of discharge. RESULTS: A total of 619 patients were studied. The mean (SD) age was 84 (7) years, and 59.1% were women. The CFS identified as frail a total of 339 patients (54.8%), the FIM 386 (62.4%), and the ISAR 301 (48.6%). An adverse outcome occurred within 30 days in 226 patients (36.5%): 21.5% revisited, 12.6% were hospitalized, 18.4% experienced functional decline, and 3.6% died. The areas under the receiver operating characteristic curves were as follows: CFS, 0.66 (95% CI, 0.62-0.70; P = .022); FIM, 0.67 (95% CI, 0.62-0.71; P = .021), and ISAR, 0.64 (95% CI, 0.60-0.69; P = .023). Adjusted odds ratios (aOR) showed that frailty was an independent risk factor for presenting any of the named adverse outcomes: aOR for CFS >4, 3.18 (95% CI, 2.02-5.01), P .001; aOR for FIM > 2, 3.49 (95% CI, 2.15-5.66), P .001; and aOR for ISAR >3, 2.46 (95% CI, 1.60-3.79), P .001. CONCLUSION: All 3 scales studied - the CFS, the FIM and the ISAR - are useful for identifying frail older patients at high risk of developing an adverse outcome (death, functional decline, hospitalization, or revisiting the ED) within 30 days after discharge.

OBJETIVO: Comparar la capacidad de tres escalas de fragilidad, Clinical Frailty Scale (CFS), Functional Index ­ eMergency (FIM) e Identification Senior at Risk (ISAR), para predecir resultados adversos (RA) a 30 días en los pacientes mayores dados de alta desde el servicio de urgencias hospitalario (SUH). METODO: Análisis secundario del registro FRAIL-Madrid que incluyó pacientes 75 años dados de alta de 10 SUH de Madrid durante un periodo de 3 meses entre 2018 y 2019. Se definió fragilidad como CFS 4, FIM 2 e ISAR 3. Las variables de resultado fueron revisita en urgencias, hospitalización, deterioro funcional, muerte y la variable compuesta por algún RA de los anteriores en los 30 días posteriores al alta del SUH. RESULTADOS: Se incluyeron 619 pacientes, la edad media fue de 84 años (DE 7), 59,1% eran mujeres. Hubo 339 pacientes (54,8%) identificados como frágiles en el SUH según CFS 4, 386 (62,4%) según FIM 2 y 301 (48,6%) según ISAR 3. Hubo 226 pacientes (36,5%) que presentaron algún RA a los 30 días tras el alta (21,5% revisita, 12,6% hospitalización,18,4% deterioro funcional y 3,6% muerte). El área bajo la curva (ABC) de la escala CFS fue de 0,66 (0,62-0,70; p = 0,022), de FIM 0,67 (0,62-0,71; p = 0,021) y de ISAR 0,64 (0,60-0,69; p = 0,023). La presencia de fragilidad fue un factor independiente de presentar algún RA a los 30 días tras el alta (CFS 4 ORa 3,18 [IC 95% 2,02-5,01, p 0,001], FIM 2 ORa 3,49 [IC 95% 2,15-5,66, p 0,001] e ISAR 3 ORa 2,46 [IC 95% 1,60-3,79, p 0,001]). CONCLUSIONES: Las tres escalas estudiadas ­CFS, FIM, ISAR­ son útiles y tienen una capacidad similar para identificar al paciente mayor frágil dado de alta del SUH con alto riesgo de presentar RA (muerte, deterioro funcional, hospitalización o revisita al SUH) a los 30 días.

Rendimiento de tres escalas de fragilidad para predecir resultados adversos a 30 días en los pacientes mayores dados de alta en los servicios de urgencias / Performance of 3 frailty scales for predicting adverse outcomes at 30 days in older patients discharged from emergency departments

Objetivo: Comparar la capacidad de tres escalas de fragilidad, Clinical Frailty Scale (CFS), Functional Index eMergency (FIM) e Identification Senior at Risk (ISAR), para predecir resultados adversos (RA) a 30 días en los pacientes mayores dados de alta desde el servicio de urgencias hospitalario (SUH). Método: Análisis secundario del registro FRAIL-Madrid que incluyó pacientes $ 75 años dados de alta de 10 SUH de Madrid durante un periodo de 3 meses entre 2018 y 2019. Se definió fragilidad como CFS $ 4, FIM $ 2 e ISAR $ 3. Las variables de resultado fueron revisita en urgencias, hospitalización, deterioro funcional, muerte y la variable compuesta por algún RA de los anteriores en los 30 días posteriores al alta del SUH. Resultados: Se incluyeron 619 pacientes, la edad media fue de 84 años (DE 7), 59,1% eran mujeres. Hubo 339 pacientes (54,8%) identificados como frágiles en el SUH según CFS $ 4, 386 (62,4%) según FIM $ 2 y 301 (48,6%) según ISAR $ 3. Hubo 226 pacientes (36,5%) que presentaron algún RA a los 30 días tras el alta (21,5% revisita, 12,6% hospitalización, 18,4% deterioro funcional y 3,6% muerte). El área bajo la curva (ABC) de la escala CFS fue de 0,66 (0,62-0,70; p = 0,022), de FIM 0,67 (0,62-0,71; p = 0,021) y de ISAR 0,64 (0,60-0,69; p = 0,023). La presencia de fragilidad fue un factor independiente de presentar algún RA a los 30 días tras el alta (CFS $ 4 ORa 3,18 [IC 95% 2,02-5,01, p < 0,001], FIM $ 2 ORa 3,49 [IC 95% 2,15-5,66, p < 0,001] e ISAR $ 3 ORa 2,46 [IC 95% 1,60-3,79, p < 0,001]). Conclusiones: Las tres escalas estudiadas –CFS, FIM, ISAR– son útiles y tienen una capacidad similar para identificar al paciente mayor frágil dado de alta del SUH con alto riesgo de presentar RA (muerte, deterioro funcional, hospitalización o revisita al SUH) a los 30 días. (AU)

Objective: To compare the ability of 3 frailty scales (the Clinical Frailty Scale [CFS], the Functional Index – eMergency [FIM], and the Identification of Seniors at Risk [ISAR] scale) to predict adverse outcomes at 30 days in older patients discharged from hospital emergency departments (EDs). Methods: Secondary analysis of data from the FRAIL-Madrid registry of patients aged 75 years or older who were discharged from Madrid EDs over a period of 3 months in 2018 and 2019. Frailty was defined by a CFS score over 4, a FIM score over 2, or an ISAR score over 3. The outcome variables were revisits to an ED, hospitalization, functionaldecline, death, and a composite variable of finding any of the previously named variables within 30 days of discharge. Results: A total of 619 patients were studied. The mean (SD) age was 84 (7) years, and 59.1% were women. The CFS identified as frail a total of 339 patients (54.8%), the FIM 386 (62.4%), and the ISAR 301 (48.6%). An adverse outcome occurred within 30 days in 226 patients (36.5%): 21.5% revisited, 12.6% were hospitalized, 18.4% experienced functional decline, and 3.6% died. The areas under the receiver operating characteristic curves were as follows: CFS, 0.66 (95% CI, 0.62-0.70; P = .022); FIM, 0.67 (95% CI, 0.62-0.71; P = .021), and ISAR, 0.64 (95% CI, 0.60-0.69; P = .023). Adjusted odds ratios (aOR) showed that frailty was an independent risk factor for presenting anyof the named adverse outcomes: aOR for CFS >4, 3.18 (95% CI, 2.02-5.01), P < .001; aOR for FIM > 2, 3.49 (95% CI, 2.15-5.66), P < .001; and aOR for ISAR >3, 2.46 (95% CI, 1.60-3.79), P < .001. Conclusions: All 3 scales studied — the CFS, the FIM and the ISAR — are useful for identifying frail older patients at high risk of developing an adverse outcome (death, functional decline, hospitalization, or revisiting the ED) within 30 days after discharge. (AU)

Uso de escalas predictivas de tromboembolia pulmonar en un servicio de urgencias / Use of predictive scales for pulmonary thromboembolism in an emergency department

Antecedentes y objetivo: Diagnosticar la tromboembolia pulmonar (TEP) es difícil. Existen escalas de probabilidad clínica (EPC) que ayudan. Se quiere averiguar cuál es mejor.Pacientes y métodosSe realizó un estudio unicéntrico transversal retrospectivo que evaluó la validez de 4 EPC en 200 pacientes en los que se realizó una tomografía computarizada de arterias pulmonares: criterios Pulmonary Embolism Rule out Criteria (PERC), Wells, Ginebra y YEARS. Se estimó su grado de uso, y la posible correlación entre su puntuación y el dímero D (DD).ResultadosLas 4 EPC tienen una alta sensibilidad, cercana a uno y sin diferencias entre ellas. La escala YEARS resultó ser entre 2 y 4 veces más específica que las otras 3. El grado de uso de las escalas se estimó en un 14% (IC 95%: 9,19-18,81). Se halló una débil correlación positiva entre la puntuación de las escalas Wells y Ginebra y el DD.ConclusionesLa escala YEARS se muestra mejor que las demás por su potencial mayor número de pruebas de imagen evitadas y el grado de aplicación de las EPC es mejorable. (AU)

Background and objective: Diagnosing pulmonary thromboembolism (PTE) is difficult. Clinical probability scales (CPS) can help. The aim is to find out which one is the best.Patients and methodsA retrospective cross-sectional single-center study was conducted. It evaluated four CPS (Pulmonary Embolism Rule Out Criteria [PERC], Wells, Geneva, and YEARS criteria) validity in 200 patients who underwent computerized tomography angiography of the pulmonary arteries. Their degree of use was estimated, as well as the possible correlation between them and DD (D dimer).ResultsThe four CPS have a high sensitivity, close to 1 and without differences between them. The YEARS scale is between 2 and 4 times more specific than the others. The degree of use of the scales was estimated at 14% (95% CI: 9.19-18.81). A weak positive correlation was found between the scores on the Wells and Geneva scales and the DD.ConclusionsThe YEARS scale is shown to be better than the others due to its potential greater number of imaging tests avoided and the degree of application of the CPS could be improved. (AU)

Use of predictive scales for pulmonary thromboembolism in an emergency department. / Uso de escalas predictivas de tromboembolia pulmonar en un servicio de urgencias.

BACKGROUND AND OBJECTIVE: Diagnosing pulmonary thromboembolism (PTE) is difficult. Clinical probability scales (CPS) can help. The aim is to find out which one is the best. PATIENTS AND METHODS: A retrospective cross-sectional single-center study was conducted. It evaluated four CPS (Pulmonary Embolism Rule Out Criteria [PERC], Wells, Geneva, and YEARS criteria) validity in 200 patients who underwent computerized tomography angiography of the pulmonary arteries. Their degree of use was estimated, as well as the possible correlation between them and DD (D dimer). RESULTS: The four CPS have a high sensitivity, close to 1 and without differences between them. The YEARS scale is between 2 and 4 times more specific than the others. The degree of use of the scales was estimated at 14% (95% CI: 9.19-18.81). A weak positive correlation was found between the scores on the Wells and Geneva scales and the DD. CONCLUSIONS: The YEARS scale is shown to be better than the others due to its potential greater number of imaging tests avoided and the degree of application of the CPS could be improved.

Utilidad del dímero D en el diagnóstico de tromboembolismo pulmonar en los pacientes con COVID-19 en urgencias: estimación de su capacidad discriminativa, sensibilidad y especificidad / Usefulness of D-dimer concentration in the diagnosis of pulmonary thromboembolism in patients with COVID-19 in the emergency department: estimating its discriminative capacity, sensitivity, and specificity

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A case-control analysis of stroke in COVID-19 patients: Results of unusual manifestations of COVID-19-study 11.

OBJECTIVE: We investigated the incidence, predictor variables, clinical characteristics, and stroke outcomes in patients with COVID-19 seen in emergency departments (EDs) before hospitalization. METHODS: We retrospectively reviewed all COVID-19 patients diagnosed with stroke during the COVID-19 outbreak in 62 Spanish EDs. We formed two control groups: COVID-19 patients without stroke (control A) and non-COVID-19 patients with stroke (control B). We compared disease characteristics and four outcomes between cases and controls. RESULTS: We identified 147 strokes in 74,814 patients with COVID-19 seen in EDs (1.96‰, 95% confidence interval [CI] = 1.66‰ to 2.31‰), being lower than in non-COVID-19 patients (6,541/1,388,879, 4.71‰, 95% CI = 4.60‰ to 4.83‰; odds ratio [OR] = 0.42, 95% CI = 0.35 to 0.49). The estimated that standardized incidences of stroke per 100,000 individuals per year were 124 and 133 for COVID-19 and non-COVID-19 individuals, respectively (OR = 0.93 for COVID patients, 95% CI = 0.87 to 0.99). Baseline characteristics associated with a higher risk of stroke in COVID-19 patients were hypertension, diabetes mellitus, and previous cerebrovascular and coronary diseases. Clinically, these patients more frequently presented with confusion, decreased consciousness, and syncope and higher D-dimer concentrations and leukocyte count at ED arrival. After adjustment for age and sex, the case group had higher hospitalization and intensive care unit (ICU) admission rates (but not mortality) than COVID-19 controls without stroke (OR = 3.41, 95% CI = 1.27 to 9.16; and OR = 3.79, 95% CI = 1.69 to 8.50, respectively) and longer hospitalization and greater in-hospital mortality than stroke controls without COVID-19 (OR = 1.55, 95% CI = 1.24 to 1.94; and OR = 1.77, 95% CI = 1.37 to 2.30, respectively). CONCLUSIONS: The incidence of stroke in COVID-19 patients presenting to EDs was lower than that in the non-COVID-19 reference sample. COVID-19 patients with stroke had greater need for hospitalization and ICU admission than those without stroke and longer hospitalization and greater in-hospital mortality than non-COVID-19 patients with stroke.

Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients With Coronavirus Disease 2019: A Case-Control, Emergency Medicine-Based Multicenter Study.

BACKGROUND: Recent reports of patients with coronavirus disease 2019 (COVID-19) developing pneumothorax correspond mainly to case reports describing mechanically ventilated patients. The real incidence, clinical characteristics, and outcome of spontaneous pneumothorax (SP) as a form of COVID-19 presentation remain to be defined. RESEARCH QUESTION: Do the incidence, risk factors, clinical characteristics, and outcomes of SP in patients with COVID-19 attending EDs differ compared with COVID-19 patients without SP and non-COVID-19 patients with SP? STUDY DESIGN AND METHODS: This case-control study retrospectively reviewed all patients with COVID-19 diagnosed with SP (case group) in 61 Spanish EDs (20% of Spanish EDs) and compared them with two control groups: COVID-19 patients without SP and non-COVID-19 patients with SP. The relative frequencies of SP were estimated in COVID-19 and non-COVID-19 patients in the ED, and annual standardized incidences were estimated for both populations. Comparisons between case subjects and control subjects included 52 clinical, analytical, and radiologic characteristics and four outcomes. RESULTS: We identified 40 occurrences of SP in 71,904 patients with COVID-19 attending EDs (0.56‰; 95% CI, 0.40‰-0.76‰). This relative frequency was higher than that among non-COVID-19 patients (387 of 1,358,134, 0.28‰; 95% CI, 0.26‰-0.32‰; OR, 1.93; 95% CI, 1.41-2.71). The standardized incidence of SP was also higher in patients with COVID-19 (34.2 vs 8.2/100,000/year; OR, 4.19; 95% CI, 3.64-4.81). Compared with COVID-19 patients without SP, COVID-19 patients developing SP more frequently had dyspnea and chest pain, low pulse oximetry readings, tachypnea, and increased leukocyte count. Compared with non-COVID-19 patients with SP, case subjects differed in 19 clinical variables, the most prominent being a higher frequency of dysgeusia/anosmia, headache, diarrhea, fever, and lymphopenia (all with OR > 10). All the outcomes measured, including in-hospital death, were worse in case subjects than in both control groups. INTERPRETATION: SP as a form of COVID-19 presentation at the ED is unusual (< 1‰ cases) but is more frequent than in the non-COVID-19 population and could be associated with worse outcomes than SP in non-COVID-19 patients and COVID-19 patients without SP.

A multidrug-resistant microorganism infection risk prediction model: development and validation in an emergency medicine population.

The aim was to develop a predictive model of infection by multidrug-resistant microorganisms (MDRO). A national, retrospective cohort study was carried out including all patients attended for an infectious disease in 54 Spanish Emergency Departments (ED), in whom a microbiological isolation was available from a culture obtained during their attention in the ED. A MDRO infection prediction model was created in a derivation cohort using backward logistic regression. Those variables significant at p < 0.05 assigned an integer score proportional to the regression coefficient. The model was then internally validated by k-fold cross-validation and in the validation cohort. A total of 5460 patients were included; 1345 (24.6%) were considered to have a MDRO infection. Twelve independent risk factors were identified in the derivation cohort and were combined into an overall score, the ATM (assessment of threat for MDRO) score. The model achieved an area under the curve-receiver operating curve of 0.76 (CI 95% 0.74-0.78) in the derivation cohort and 0.72 (CI 95% 0.70-0.75) in the validation cohort (p = 0.0584). Patients were then split into 6 risk categories and had the following rates of risk: 7% (0-2 points), 16% (3-5 points), 24% (6-9 points), 33% (10-14 points), 47% (15-21 points), and 71% (> 21 points). Findings were similar in the validation cohort. Several patient-specific factors were independently associated with MDRO infection risk. When integrated into a clinical prediction rule, higher risk scores and risk classes were related to an increased risk for MDRO infection. This clinical prediction rule could be used by providers to identify patients at high risk and help to guide antibiotic strategy decisions, while accounting for clinical judgment.

Estudio comparativo de la estructura física, recursos humanos e indicadores de actividad asistencial entre los servicios de urgencias hospitalarios públicos de las comunidades autónomas de Madrid y Cataluña / Physical structure, human resources, and health care quality indicators in public hospital emergency departments in the autonomous communities of Madrid and Catalonia: a comparative study

Objetivos. Comparar las características generales, estructurales y organizativas de los servicios de urgencias de hospitales públicos (SUHP) de la Comunidad de Madrid con los de Cataluña. Método. Estudio descriptivo tipo encuesta estructurada con 3 apartados: aspectos generales del hospital (18 preguntas), aspectos generales y estructurales de urgencias (14 preguntas), y aspectos organizativos y laborales de urgencias (30 preguntas). Los centros se agruparon según complejidad: niveles I-hospital comarcal y niveles II y III-hospital de alta tecnología o de referencia. Resultados. Se incluyeron los 26 SUHP de la Comunidad de Madrid (21 nivel II-III y 5 nivel I), y 55 de Cataluña (24 nivel II- III y 31 nivel I). En Madrid, comparada con Cataluña: los hospitales son de construcción mas reciente (p = 0,002); tienen mayor número de camas de hospitalización (p < 0,001) y de cuidados críticos (p < 0,001); están más frecuentemente vinculados a la universidad (p < 0,001) y cubren mayor población (p = 0,027). Los servicios de urgencias: tienen mayor superficie para la actividad clínica (p < 0,001) y la primera asistencia (p < 0,001); mayor número de puestos de primera asistencia (p < 0,001) y camas de observación (p = 0,001) y la mediana del número de atenciones urgentes es mayor (p < 0,001). De forma global, hay más facultativos contratados en Cataluña, pero el número de horas de médico y enfermera contratadas por centro es mayor en Madrid, donde los médicos suelen realizar su actividad exclusivamente en urgencias (92,5% frente a 56,8%; p < 0,001), muy pocos con contrato fijo indefinido (30,5% frente a 75,1%; p < 0,001) con relación médico residente/adjunto diferente en turnos de tarde, noche y días festivos en comparación con los SUHP catalanes (3:1 frente a 1:1). Conclusiones. La estructura física y funcional de los SUHP madrileños y catalanes difiere de forma significativa sin que pueda explicarse, exclusivamente, por los aspectos geográficos (AU)

Objective. To compare the general, structural, and organizational characteristics of public hospital emergency departments in the Spanish autonomous communities of Madrid and Catalonia. Methods. Descriptive survey-based study covering 3 areas of inquiry: general hospital features (18 questions), structural features of the emergency department (14 questions), and organizational and work-related policies of the emergency department (30 questions). Hospitals were grouped according to complexity: local hospitals (level 1), high-technology or referral hospitals (levels 2-3). Results. We studied 26 hospital departments in Madrid (21, levels 2-3; 5, level 1) and 55 in Catalonia (24, levels 2-3; 31, level 1). Hospitals in Madrid are in newer buildings (P=.002), have more beds on conventional wards and in critical care units (P<.001, both comparisons), are more often affiliated with a university (P<.001), and serve larger populations (P=.027). The emergency departments in Madrid have larger surface areas available for clinical care and more cubicles for preliminary evaluations and observation beds (P=.001, all comparisons). Hospitals in Madrid also attended a larger median number of emergencies (P<.001). More physicians were employed in Catalonia overall, but the numbers of physician- and nurse-hours per hospital were higher in Madrid, where it was more usual for physicians to work exclusively in the emergency department (92.5% in Madrid vs 56.8% in Catalonia, P<.001). However, fewer of the employed physicians had permanent contracts in Madrid (30.5% vs 75.1% in Catalonia, P<.001). The ratio of resident physicians to staff physicians differs between the 2 communities on afternoon/evening, night, and holiday shifts (3:1 in Madrid; 1:1 in Catalonia). Conclusions. The physical and functional structures of hospital emergency departments in the communities of Madrid and Catalonia differ significantly. The differences cannot be attributed exclusively to geographic location (AU)