Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 72.918
Filtrar
1.
Med Lav ; 112(1): 68-81, 2021 Feb 23.
Artículo en Inglés | MEDLINE | ID: mdl-33635296

RESUMEN

BACKGROUND: Nurses, particularly emergency nurses, are among the health workers most exposed to workplace violence. Although reporting systems are increasingly used, under-reporting remains high. Recent studies suggest that the use of easy registration systems could facilitate violence reporting. OBJECTIVES: To verify if a friendly reporting system based on a Mobile-app can facilitate the reporting of violent episodes and reduce under-reporting. METHODS: Twenty emergency departments of five North and Central Italian regions participated in an interventional, multicentric, pre-post study to verify if a user-friendly reporting system based on a mobile app can facilitate the reporting of violent episodes and reduce under-reporting. RESULTS: Three hundred and eighty-four out of 754 potentially eligible nurses answered the short questionnaire at time T0, and 318 registered for the use of the app. One hundred and eighty-nine answered the questionnaire at time T1. The t-Test for Paired Samples, although with a low mean difference, shows a significant difference in the change in the frequency of the reporting of violent episodes. The correlational tests showed no significant differences in the subgroups divided by demographic and professional characteristics. The usability of the app was considered very high. CONCLUSIONS: The simplification of the reporting system and the preliminary acquisition of data on the characteristics of the ED and each nurse, can save time and facilitate the reporting, but technology alone is not enough to solve the under-reporting.


Asunto(s)
Aplicaciones Móviles , Violencia Laboral , Servicio de Urgencia en Hospital , Humanos , Italia , Teléfono Inteligente
2.
BMJ ; 372: n49, 2021 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-33541890

RESUMEN

OBJECTIVE: To validate the previously derived Canadian TIA Score to stratify subsequent stroke risk in a new cohort of emergency department patients with transient ischaemic attack. DESIGN: Prospective cohort study. SETTING: 13 Canadian emergency departments over five years. PARTICIPANTS: 7607 consecutively enrolled adult patients attending the emergency department with transient ischaemic attack or minor stroke. MAIN OUTCOME MEASURES: The primary outcome was subsequent stroke or carotid endarterectomy/carotid artery stenting within seven days. The secondary outcome was subsequent stroke within seven days (with or without carotid endarterectomy/carotid artery stenting). Telephone follow-up used the validated Questionnaire for Verifying Stroke Free Status at seven and 90 days. All outcomes were adjudicated by panels of three stroke experts, blinded to the index emergency department visit. RESULTS: Of the 7607 patients, 108 (1.4%) had a subsequent stroke within seven days, 83 (1.1%) had carotid endarterectomy/carotid artery stenting within seven days, and nine had both. The Canadian TIA Score stratified the risk of stroke, carotid endarterectomy/carotid artery stenting, or both within seven days as low (risk ≤0.5%; interval likelihood ratio 0.20, 95% confidence interval 0.09 to 0.44), medium (risk 2.3%; interval likelihood ratio 0.94, 0.85 to 1.04), and high (risk 5.9% interval likelihood ratio 2.56, 2.02 to 3.25) more accurately (area under the curve 0.70, 95% confidence interval 0.66 to 0.73) than did the ABCD2 (0.60, 0.55 to 0.64) or ABCD2i (0.64, 0.59 to 0.68). Results were similar for subsequent stroke regardless of carotid endarterectomy/carotid artery stenting within seven days. CONCLUSION: The Canadian TIA Score stratifies patients' seven day risk for stroke, with or without carotid endarterectomy/carotid artery stenting, and is now ready for clinical use. Incorporating this validated risk estimate into management plans should improve early decision making at the index emergency visit regarding benefits of hospital admission, timing of investigations, and prioritisation of specialist referral.


Asunto(s)
Ataque Isquémico Transitorio/diagnóstico , Medición de Riesgo/métodos , Accidente Cerebrovascular/epidemiología , Anciano , Anciano de 80 o más Años , Canadá , Comorbilidad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Endarterectomía Carotidea/estadística & datos numéricos , Femenino , Humanos , Ataque Isquémico Transitorio/epidemiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos
3.
BMC Infect Dis ; 21(1): 167, 2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-33568104

RESUMEN

BACKGROUND: Characteristics of COVID-19 patients have mainly been reported within confirmed COVID-19 cohorts. By analyzing patients with respiratory infections in the emergency department during the first pandemic wave, we aim to assess differences in the characteristics of COVID-19 vs. Non-COVID-19 patients. This is particularly important regarding the second COVID-19 wave and the approaching influenza season. METHODS: We prospectively included 219 patients with suspected COVID-19 who received radiological imaging and RT-PCR for SARS-CoV-2. Demographic, clinical and laboratory parameters as well as RT-PCR results were used for subgroup analysis. Imaging data were reassessed using the following scoring system: 0 - not typical, 1 - possible, 2 - highly suspicious for COVID-19. RESULTS: COVID-19 was diagnosed in 72 (32,9%) patients. In three of them (4,2%) the initial RT-PCR was negative while initial CT scan revealed pneumonic findings. 111 (50,7%) patients, 61 of them (55,0%) COVID-19 positive, had evidence of pneumonia. Patients with COVID-19 pneumonia showed higher body temperature (37,7 ± 0,1 vs. 37,1 ± 0,1 °C; p = 0.0001) and LDH values (386,3 ± 27,1 vs. 310,4 ± 17,5 U/l; p = 0.012) as well as lower leukocytes (7,6 ± 0,5 vs. 10,1 ± 0,6G/l; p = 0.0003) than patients with other pneumonia. Among abnormal CT findings in COVID-19 patients, 57 (93,4%) were evaluated as highly suspicious or possible for COVID-19. In patients with negative RT-PCR and pneumonia, another third was evaluated as highly suspicious or possible for COVID-19 (14 out of 50; 28,0%). The sensitivity in the detection of patients requiring isolation was higher with initial chest CT than with initial RT-PCR (90,4% vs. 79,5%). CONCLUSIONS: COVID-19 patients show typical clinical, laboratory and imaging parameters which enable a sensitive detection of patients who demand isolation measures due to COVID-19.


Asunto(s)
/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Servicio de Urgencia en Hospital , Femenino , Alemania/epidemiología , Hospitalización , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pandemias , Estudios Prospectivos , Infecciones del Sistema Respiratorio/epidemiología , Tomografía Computarizada por Rayos X , Adulto Joven
4.
Chest ; 159(2): e107-e113, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33563452

RESUMEN

CASE PRESENTATION: A 53-year-old man presented to the ED at a time of low severe acute respiratory syndrome coronavirus 2, also known as coronavirus disease 2019 (COVID-19), prevalence and reported 2 weeks of progressive shortness of breath, dry cough, headache, myalgias, diarrhea, and recurrent low-grade fevers to 39°C for 1 week with several days of recorded peripheral capillary oxygen saturation of 80% to 90% (room air) on home pulse oximeter. Five days earlier, he had visited an urgent care center where a routine respiratory viral panel was reportedly negative. A COVID-19 reverse transcriptase polymerase chain reaction test result was pending at the time of ED visit. He reported a past medical history of gastroesophageal reflux disease that was treated with famotidine. Travel history included an out-of-state trip 3 weeks earlier, but no recent international travel.


Asunto(s)
/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Bacteriemia/complicaciones , /fisiopatología , Enfermedades Cerebelosas/complicaciones , Enfermedades Cerebelosas/diagnóstico por imagen , Tos/fisiopatología , Diarrea/fisiopatología , Progresión de la Enfermedad , Disnea/fisiopatología , Servicio de Urgencia en Hospital , Fiebre/fisiopatología , Cefalea/fisiopatología , Humanos , /diagnóstico por imagen , Linfopenia/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Mialgia/fisiopatología , Oximetría , Neumonía Estafilocócica/complicaciones , Radiografía Torácica , Infecciones Estafilocócicas/complicaciones , Tomografía Computarizada por Rayos X
5.
BMC Med ; 19(1): 20, 2021 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-33541357

RESUMEN

BACKGROUND: There is little information on care-seeking patterns for sexual assault and domestic violence during the COVID-19 pandemic. The objective of this study was to examine the changes in emergency department (ED) admissions for sexual assault and domestic violence since the COVID-19 pandemic was declared. METHODS: Observational ED admissions data from The Ottawa Hospital were analyzed from March 4 to May 5 (62 days) in 2020 (COVID-19 period) and compared to the same period in 2018 (pre-COVID-19). Total and mean weekly admissions were calculated for all-cause ED admissions and for sexual and domestic violence cases. A Poisson regression (without offset term) was used to calculate the weekly case count ratio and 95% confidence intervals (CI) between the two time periods. Case characteristics were compared using chi-square tests, and percent differences were calculated. RESULTS: Compared to pre-COVID-19, total ED admissions dropped by 1111.22 cases per week (32.9% reduction), and the Sexual Assault and Domestic Violence Program cases dropped 4.66 cases per week. The weekly case count ratio for sexual assault cases was 0.47 (95% CI 0.79-0.27), equivalent of 53.49% reduction in cases, and 0.52 (95% CI 0.93-0.29), equivalent to a 48.45% reduction in physical assault cases. The characteristics of presenting cases were similar by age (median 25 years), sex (88.57% female), assault type (57.14% sexual assault, 48.57% physical assault), and location (31.43% patient's home, 40.00% assailant's home). There was a significant increase in psychological abuse (11.69% vs 28.57%) and assaults occurring outdoors (5.19% vs 22.86%). CONCLUSION: This study found a decrease in ED admissions for sexual assault and domestic violence during COVID-19, despite societal conditions that elevate risk of violence. Trends in care-seeking and assault patterns will require ongoing monitoring to inform the provision of optimal support for individuals experiencing violence, particularly as countries begin to re-open or lock-down again.


Asunto(s)
/epidemiología , Violencia Doméstica/tendencias , Servicio de Urgencia en Hospital/tendencias , Pandemias , Aceptación de la Atención de Salud , Delitos Sexuales/tendencias , Adulto , Control de Enfermedades Transmisibles/tendencias , Violencia Doméstica/psicología , Femenino , Humanos , Masculino , Ontario/epidemiología , Aceptación de la Atención de Salud/psicología , Delitos Sexuales/psicología , Adulto Joven
6.
Rev Bras Enferm ; 74(suppl 1): e20200687, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33566955

RESUMEN

OBJECTIVE: To analyze the change in the clinical-epidemiological profile of patients attended at the specialized triage service for COVID-19 (COVID-19 tent) in the first three months of operation. METHODS: Cross-sectional study, with users attended from March 2020 to May 2020 (n=379) at the COVID-19 tent in the city of Ponta Grossa, Paraná. Data collection was retrieved from an electronic form fed by tent professionals, which included sociodemographic characteristics, symptoms, risk factors of exposure, means of search and clinical conduct. Trend tests and chi-square tests were performed. RESULTS: March showed a greater demand (n=197), motivated by mild symptoms and direct search (p<0.05). In the following months, there was a decrease in demand (n=93; n=89), however the search for referrals, ambulances and conditions that required medical attention, observation and hospitalization increased (p<0.05). The search resulting from exposure to risk factors has not changed (p>0.05). CONCLUSION: the profile has changed over time, reflecting, in the end, severe and critical symptoms, requiring intervention.


Asunto(s)
/diagnóstico , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Anamnesis/métodos , Anamnesis/estadística & datos numéricos , Triaje/métodos , Triaje/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad
7.
Medicine (Baltimore) ; 100(6): e24690, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578603

RESUMEN

ABSTRACT: Pediatric procedural sedation (PPS) is often performed outside of the operating room, and by various sub-specialty providers. There is no consistency in how pediatric emergency medicine (PEM) fellows are trained in PPS. The objective of this study was to survey PEM program directors (PDs) and PEM fellows about their current sedation teaching practices via a direct survey. While many fellowship programs train PEM fellows in PPS, we hypothesize that there is no consistent method of developing and measuring this skill.A 12-question survey was sent to PEM PDs directly via email. A separate 17-question survey was sent to current PEM fellows via their program coordinators by email. Each survey had multiple choice, yes-no and select-all program questions. Responses were collected in an online (REDCap) database and summarized as frequencies and percentages.Based on identifiable email, 67 programs were contacted, with a PD response rate of 46 (59%). Sixty-two program coordinators were contacted based on identifiable email with 78 fellow responses. We noted that 11/46 PD respondents offer a formal PPS rotation. Thirty programs report using propofol in the emergency department and 93% of PD respondents (28/30) actively train fellows in the use of propofol. Approximately 62% of PEM fellow respondents (48/78) report sedating without any attending oversight. Twenty-eight percent of PEM fellow respondents report using simulation as a component of their sedation training.PPS is a critical skill. However, there is a lack of consistency in both education and evaluation of competency in this area. An organized PPS rotation would improve PPS case exposure and PPS skills.


Asunto(s)
Anestesiología/educación , Educación de Postgrado en Medicina/estadística & datos numéricos , Becas/estadística & datos numéricos , Medicina de Urgencia Pediátrica/educación , Anestésicos Intravenosos/administración & dosificación , Anestésicos Intravenosos/uso terapéutico , Competencia Clínica/estadística & datos numéricos , Manejo de Datos , Educación de Postgrado en Medicina/métodos , Escolaridad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Internado y Residencia/normas , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Propofol/administración & dosificación , Propofol/uso terapéutico , Entrenamiento Simulado/estadística & datos numéricos , Encuestas y Cuestionarios
8.
FP Essent ; 501: 24-29, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33595265

RESUMEN

Dental and oral health conditions are widespread in the US population. Among children and teenagers, 46% have dental cavities; among adults, more than 90% have cavities and 46% have periodontal disease. In 2015, more than $117 billion was spent on dental care in the United States, with a significant share delivered in emergency departments (EDs). Common nontraumatic dental conditions seen in EDs include dental pain and infection. Less than one-third of patients seek follow-up dental care. The mildest form of oral disease is dental cavities. Gingivitis is inflammation of the gums. Left unmanaged, it can lead to necrotizing ulcerative gingivitis, periodontitis, and periodontal abscesses. Acute periodontal abscess can be managed by a nondental physician with simple incision and drainage. Rarely, patients will develop orofacial space infections from unrecognized or unmanaged dental infections. These medical emergencies require immediate surgical consultation. Initial management of postextraction bleeding consists of application of constant pressure for more than 30 min at the bleeding site. Dental conditions and their complications are preventable. Family physicians play a role in providing oral health education. The primary areas of needed intervention are continuity of dental care, healthy nutritional habits, oral hygiene education, systemic disease management, and smoking cessation.


Asunto(s)
Gingivitis , Periodontitis , Enfermedad Aguda , Adolescente , Adulto , Niño , Servicio de Urgencia en Hospital , Humanos , Estados Unidos/epidemiología
9.
Int Dent J ; 71(1): 27-31, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33616050

RESUMEN

OBJECTIVE: To retrospectively review the impact of the outbreak of coronavirus disease 2019 (COVID-19) on services in the oral emergency room. MATERIALS AND METHODS: A statistical analysis of epidemiological characteristics and the patients' diagnoses and treatments in the Emergency Department of Peking University Hospital of Stomatology during the outbreak of COVID-19 in 2020 compared with those in 2019 in Beijing, China. RESULTS: There were fewer total visits in 2020 than in 2019 (P = 0.001), and the proportions of patients who were children, adolescents and elderly people were lower in 2020 than in 2019 (P < 0.001). The proportions of patients with acute toothache and infections were higher in 2020 than in 2019, and the proportions of patients with maxillofacial trauma and non-emergencies were lower in 2020 than in 2019 (P < 0.001). Drug treatment for acute pulpitis was used more often in 2020 than in 2019, and endodontic treatment and examination consultations were less common in 2020 than in 2019 (P = 0.022). CONCLUSIONS: The outbreak of COVID-19 affected the patient population and structure of disease types and oral services in the emergency room. The number of visits to the oral emergency room and the proportions of the patients who were children, adolescents and elderly people were reduced, meanwhile the percentage of emergency cases, except trauma, and conservative treatments increased during the outbreak of COVID-19.


Asunto(s)
Adolescente , Anciano , Niño , China/epidemiología , Servicio de Urgencia en Hospital , Humanos , Estudios Retrospectivos
10.
Bratisl Lek Listy ; 122(3): 224-229, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33618533

RESUMEN

OBJECTIVE: This study was conducted with an aim to determine whether biochemical parameters could be used to identify the individuals at risk of suicide. METHODS: The experimental group consisted of a total of 46 patients that presented to the emergency department after a suicide attempt. 45 healthy individuals constituted the control group. All subjects were evaluated by using the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the Beck Scale for Suicidal Ideation (BSSI). All subjects were evaluated for leukocyte count, mean platelet volume (MPV), C-reactive protein (CRP), cholesterol, triglyceride levels and neutrophil-lymphocyte ratio (NLR). The Vitamin D levels of the subjects in the experimental group were also measured. RESULTS: The BAI (p < 0.01), BDI (p < 0.01), and BSSI (p < 0.01) scores of the two groups were significantly different. The two groups were also significantly different in terms of CRP (p < 0.01), cholesterol (p < 0.05), NLR (p < 0.01), MPV (p < 0.01), triglyceride (p < 0.01) and leukocyte (p < 0.01) results. The vitamin D levels of the experimental group were found to be below normal vitamin D levels. High CRP levels were found to be a predictor of anxiety symptoms, and MPV and triglyceride levels were found to be predictors of depressive symptoms. CONCLUSION: We believe that biochemical parameters can be used to identify people with increased suicide risk, and suicide rates can be reduced by ensuring that these patients receive mental health care in the early period (Tab. 5, Ref. 42).


Asunto(s)
Linfocitos , Intento de Suicidio , Servicio de Urgencia en Hospital , Humanos , Recuento de Leucocitos , Neutrófilos
11.
Ann Intern Med ; 174(2): JC19, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33524284

RESUMEN

SOURCE CITATION: Goldberg EM, Marks SJ, Resnik LJ, et al. Can an emergency department-initiated intervention prevent subsequent falls and health care use in older adults? A randomized controlled trial. Ann Emerg Med. 2020;76:739-50. 32854965.


Asunto(s)
Accidentes por Caídas , Servicios Médicos de Urgencia , Accidentes por Caídas/prevención & control , Anciano , Prestación de Atención de Salud , Servicio de Urgencia en Hospital , Humanos
12.
J Med Internet Res ; 23(2): e25518, 2021 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-33529157

RESUMEN

BACKGROUND: COVID-19 has necessitated the implementation of innovative health care models in preparation for an influx of patients. A virtual ward model delivers clinical care remotely to patients in isolation. We report on an Australian cohort of patients with COVID-19 treated in a virtual ward. OBJECTIVE: The aim of this study was to describe and evaluate the safety and efficacy of a virtual ward model of care for an Australian cohort of patients with COVID-19. METHODS: Retrospective clinical assessment was performed for 223 patients with confirmed COVID-19 treated in a virtual ward in Brisbane, Australia, from March 25 to May 15, 2020. Statistical analysis was performed for variables associated with the length of stay and hospitalization. RESULTS: Of 223 patients, 205 (92%) recovered without the need for escalation to hospital care. The median length of stay in the virtual ward was 8 days (range 1-44 days). In total, 18 (8%) patients were referred to hospital, of which 6 (33.3%) were discharged after assessment at the emergency department. Furthermore, 12 (5.4%) patients were admitted to hospital, of which 4 (33.3%) required supplemental oxygen and 2 (16.7%) required mechanical ventilation. No deaths were recorded. Factors associated with escalation to hospital care were the following: hypertension (odds ratio [OR] 3.6, 95% CI 1.28-9.87; P=.01), sputum production (OR 5.2, 95% CI 1.74-15.49; P=.001), and arthralgia (OR 3.8, 95% CI 1.21-11.71; P=.02) at illness onset and a polymerase chain reaction cycle threshold of ≤20 on a diagnostic nasopharyngeal swab (OR 5.0, 95% CI 1.25-19.63; P=.02). CONCLUSIONS: Our results suggest that a virtual ward model of care to treat patients with COVID-19 is safe and efficacious, and only a small number of patients would potentially require escalation to hospital care. Further studies are required to validate this model of care.


Asunto(s)
Atención Ambulatoria/métodos , Hospitalización/estadística & datos numéricos , Aislamiento de Pacientes , Telemedicina/métodos , Adolescente , Adulto , Anciano , Australia , Estudios de Cohortes , Manejo de la Enfermedad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitales , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Evaluación en Enfermería , Alta del Paciente , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Teléfono , Adulto Joven
13.
Isr Med Assoc J ; 23(2): 82-86, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33595211

RESUMEN

BACKGROUND: The novel coronavirus disease (COVID-19) pandemic changed medical environments worldwide. OBJECTIVES: To evaluate the impact of the COVID-19 pandemic on trauma-related visits to the emergency department (ED). METHODS: A single tertiary center retrospective study was conducted that compared ED attendance of patients with injury-related morbidity between March 2020 (COVID-19 outbreak) and pre-COVID-19 periods: February 2020 and the same 2 months in 2018 and 2019. RESULTS: Overall, 6513 patients were included in the study. During the COVID-19 outbreak, the daily number of patients visiting the ED for acute trauma declined by 40% compared to the average in previous months (P < 0.01). A strong negative correlation was found between the number of trauma-related ED visits and the log number of confirmed cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Israel (Pearson's r = -0.63, P < 0.01). In the COVID-19 period there was a significant change in the proportion of elderly patients (7% increase, P = 0.002), admissions ratio (12% increase, P < 0.001), and patients brought by emergency medical services (10% increase, P < 0.001). The number of motor vehicle accident related injury declined by 45% (P < 0.01). CONCLUSIONS: A significant reduction in the number of trauma patients presenting to the ED occurred during the COVID-19 pandemic, yet trauma-related admissions were on the rise.


Asunto(s)
/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Estudios Transversales , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Humanos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Centros de Atención Terciaria , Heridas y Traumatismos/terapia , Adulto Joven
15.
BMJ Open ; 11(2): e041118, 2021 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-33568367

RESUMEN

INTRODUCTION: In the context of the COVID-19 pandemic, early identification of patients who are likely to get worse is a major concern. Severity mainly depends on the development of acute respiratory distress syndrome (ARDS) with a predominance of subpleural lesions. Lung point-of-care ultrasonography (L-POCUS) is highly effective in detecting pulmonary peripheral patterns and may be appropriate for examining patients with COVID-19. We suggest that L-POCUS performed during the initial examination may identify patients with COVID-19 who are at a high risk of complicated treatment or unfavourable evolution. METHODS AND ANALYSIS: Point-of-care ultrasonography for risk stratification of non-critical COVID-19 patients on admission is a prospective, multicentre study. Adult patients visiting the emergency department (ED) of participating centres for suspected or confirmed COVID-19 are assessed for inclusion. Included patients have L-POCUS performed within 48 hours following ED admission. The severity of lung damage is assessed using the L-POCUS score based on 36 points for ARDS. Apart from the L-POCUS score assessment, patients are treated as recommended by the WHO. For hospitalised patients, a second L-POCUS is performed at day 5±3. A follow-up is carried out on day 14, and the patient's status according to the Ordinal Scale for Clinical Improvement for COVID-19 from the WHO is recorded.The primary outcome is the rate of patients requiring intubation or who are dead from any cause during the 14 days following inclusion. We will determine the area under the ROC curve of L-POCUS. ETHICS AND DISSEMINATION: The protocol has been approved by the French and Belgian Ethics Committees and is carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. The study is funding by a grant from the French Health Ministry, and its findings will be disseminated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION NUMBER: NCT04338100.


Asunto(s)
/diagnóstico , Sistemas de Atención de Punto , Medición de Riesgo , Ultrasonografía , Adolescente , Servicio de Urgencia en Hospital , Humanos , Estudios Multicéntricos como Asunto , Pandemias , Admisión del Paciente , Estudios Prospectivos
16.
BMJ Open ; 11(2): e045015, 2021 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-33608406

RESUMEN

OBJECTIVES: To determine the impact of the first lockdown in the Netherlands' measures during the COVID-19 pandemic on the number and type of trauma-related injuries presenting to the emergency department (ED). DESIGN: A single-centre retrospective cohort study. SETTING: A level 2 trauma centre in Breda, The Netherlands. PARTICIPANTS: All patients with trauma seen at the ED between 11 March and 10 May 2020 (the first Dutch lockdown period) were included in this study. Comparable groups were generated for 2019 and 2018. MAIN OUTCOME MEASURES: Primary outcomes were the total number of patients with trauma admitted to the ED and the trauma mechanism. Secondary outcomes were triage categories, time of ED visit, trauma severity (Injury Severity Score (ISS) >12), anatomical region of injury and treatment. RESULTS: A total of 4674 patients were included in this study. During the first months of the COVID-19 pandemic, there was a decrease of 32% in traumatic injuries at the ED (n=1182) compared with the previous years 2019 (n=1717) and 2018 (n=1775) (p<0.001). Sports-related injuries decreased most during the lockdown (n=164) compared with 2019 (n=386) and 2018 (n=367) (p<0.001). We observed more frequent injuries due to a fall from standing height (p<0.001) and work-related injuries (p<0.05). The mean age was significantly higher (mean 48 years vs 42 and 43 years). There was no difference in anatomical place of injury or ISS >12. The amount of patients admitted for emergency surgery was significantly higher (14.6% vs 9.4%; 8.6%, p<0.001). Seven patients (0.6%) tested positive for COVID-19. CONCLUSIONS: Measures taken in the COVID-19 outbreak result in a predictable decrease in the total number of patients with trauma, especially sports-related trauma. Although the trauma burden on the emergency room appears to be lower, more people have been admitted for trauma surgery, possibly due to increased throughput in the operating theatres.


Asunto(s)
/psicología , Hospitalización/estadística & datos numéricos , Pandemias , Conducta Autodestructiva/epidemiología , Aislamiento Social , Centros Traumatológicos/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Adolescente , Adulto , Niño , Control de Enfermedades Transmisibles , Servicio de Urgencia en Hospital , Femenino , Humanos , Persona de Mediana Edad , Países Bajos/epidemiología , Estudios Retrospectivos
18.
Medicine (Baltimore) ; 100(7): e24809, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607844

RESUMEN

BACKGROUND: Previous studies suggest that free thyroxine may be used as a severity indicator of patients with acute pancreatitis (AP) in emergency department, helping determine the differential care of AP. However, there are no systematic reviews and the association between free thyroxine and AP is still not completely understood. Therefore, we will undertake a systematic review of the literature to summarize previous evidence regarding this topic, in order to clarify whether free thyroxine can help us pick out the mild AP cases. METHODS: : We will search the EMBASE, Web of Knowledge, PubMed, ClinicalTrials.gov, and Cochrane Library from inception to Mar 2021 to retrieve relevant studies using the search strategy: ("free thyroxine") AND (pancreatitis OR pancreatitides). Two authors independently judged study eligibility and extracted data. Heterogeneity will be examined by computing the Q statistic and I2 statistic. RESULTS: : This study proved the efficiency of free thyroxine in predicting the severity of patients with AP. CONCLUSIONS: : This study will provide reliable evidence-based evidence for the clinical application of free thyroxine predicting the severity of patients with AP. ETHICS AND DISSEMINATION: Ethical approval is unnecessary as this protocol is only for systematic review and does not involve privacy data. The findings of this study will be disseminated electronically through a peer-review publication or presented at a relevant conference.


Asunto(s)
Pancreatitis/metabolismo , Pancreatitis/mortalidad , Tiroxina/sangre , Adulto , Servicio de Urgencia en Hospital , Humanos , Valor Predictivo de las Pruebas , Pronóstico , Índice de Severidad de la Enfermedad , Pruebas de Función de la Tiroides/métodos
19.
Medicine (Baltimore) ; 100(7): e24835, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607851

RESUMEN

ABSTRACT: The 2016 Surviving Sepsis Campaign guidelines suggest guiding resuscitation to normalize lactate levels in patients with sepsis-associated hyperlactatemia as a marker of tissue hypoperfusion. This study evaluated the prognostic value of lactate levels and lactate clearance for 30-day mortality in patients with sepsis and septic shock diagnosed in the emergency department.We performed a retrospective cohort study of sepsis patients with initial lactate levels of ≥2 mmol/L. All patients met the Sepsis-3 definitions. The prognostic value of 6-hour lactate levels, 6-hour lactate clearance, 6-hour lactate metrics (≥2 mmol/L), and lactate clearance metrics (<10%, <20%, and <30%) was evaluated. We compared the sensitivity and specificity between metrics.Of the 363 sepsis and septic shock patients, 148 died (30-day mortality: 40.8%). Nonsurvivors had significantly higher 6-hour lactate levels and lower 6-hour lactate clearance than those of survivors. Six-hour lactate levels and 6-hour lactate clearance were associated with 30-day mortality after adjusting for potential confounders (odds ratio, 1.191 [95% confidence interval (CI), 1.097-1.294] and 0.989 [0.983-0.995], respectively). Six-hour lactate levels had better prognostic value than 6-hour lactate clearance (area under the curve, 0.720 [95% CI, 0.670-0.765] vs 0.656 [0.605-0.705]; P = .02). Six-hour lactate levels of ≥3.5 mmol/L and 6-hour lactate clearance of <24.4% were the optimal cut-off value in predicting the 30-day mortality. The prognostic value of 6-hour lactate metrics and 6-hour lactate clearance metrics did not differ. Six-hour lactate levels (≥2 mmol/L) had the highest sensitivity (89.2%).Six-hour lactate levels proved to be more accurate in predicting 30-day mortality than 6-hour lactate clearance and initial lactate levels.


Asunto(s)
Hiperlactatemia/complicaciones , Ácido Láctico/metabolismo , Sepsis/metabolismo , Choque Séptico/metabolismo , Anciano , Anciano de 80 o más Años , Biomarcadores , Estudios de Casos y Controles , Servicio de Urgencia en Hospital , Femenino , Humanos , Ácido Láctico/farmacocinética , Masculino , Tasa de Depuración Metabólica , Persona de Mediana Edad , Puntuaciones en la Disfunción de Órganos , República de Corea/epidemiología , Resucitación/normas , Estudios Retrospectivos , Sensibilidad y Especificidad , Sepsis/epidemiología , Sepsis/mortalidad , Choque Séptico/epidemiología , Choque Séptico/mortalidad
20.
R I Med J (2013) ; 104(1): 55-60, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33517602

RESUMEN

OBJECTIVE: To describe characteristics of children undergoing SARS-CoV-2 testing during the initial wave of infections in Rhode Island. METHODS: This is a descriptive study of 729 children tested for SARS-CoV-2 at four emergency departments April 9 to May 7, 2020 in Rhode Island. Demographic information and symptoms were cataloged for those tested. RESULTS: 81 (11%) children tested positive for SARS-CoV-2. 94% of positive children were symptomatic. 74% of positive cases had constitutional symptoms and 72% had upper respiratory symptoms. While only 34% of those tested were Hispanic, 68% of the SARS-CoV-2- positive cases occurred in Hispanic children. CONCLUSION: This study details the pediatric population's experience during the first wave of the pandemic in Rhode Island. It could inform testing allocation strategies in healthcare settings. It also highlights vulnerable populations in need of further public health support in our state.


Asunto(s)
/diagnóstico , Adolescente , Enfermedades Asintomáticas , /patología , Niño , Preescolar , Servicio de Urgencia en Hospital , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Rhode Island/epidemiología , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...