Tratamiento de la neumonía adquirida en la comunidad en hospitalización a domicilio: resultado clínico en casos con diferente nivel de gravedad / Efficacy of hospital at home (HaH) in the treatment of community-acquired pneumonia (CAP) with different degrees of severity

Fundamento y objetivo: Diferentes sociedades científicas proponen el uso de escalas de severidad más otros criterios adicionales para determinar el lugar de tratamiento de la neumonía adquirida en la comunidad. El objetivo de este estudio es correlacionar el riesgo según 3 reglas de predicción clínica (PSI, CURB-65 y PSCURXO-80) y criterios adicionales con la efectividad de la hospitalización a domicilio (HaD).Pacientes y método: Revisión de los casos de neumonía adquirida en la comunidad remitidos por el servicio de urgencias a HaD entre enero de 2000 y mayo de 2008. Se clasifican según 3 escalas de riesgo y presencia de criterios adicionales y se analiza su asociación con la inefectividad de HaD durante el tratamiento.Resultados: Se admitieron 146 mujeres y 181 hombres (edad media=60,3 años). La media de estancia en HaD fue de 8,6 días. Dos pacientes murieron, 25 (7,7%) fueron reenviados a hospitalización convencional, 219 fueron dados de alta sin incidencias y 81 tras superar complicaciones. La HaD fue efectiva en el 92,3% de los pacientes. El porcentaje fue del 85% para PSI=IV o V sin o con CA, del 80% para CURB-65=2 y del 77,5% para valores entre 10–19 de PSCURXO-80. La eficacia de HaD se relaciona inversamente con la severidad.Conclusiones: La eficacia de HaD en el tratamiento de neumonía adquirida en la comunidad es menor en los pacientes con mayor gravedad definida por medio de diferentes escalas de predicción clínica, pero es eficaz en un elevado porcentaje de casos en los que está indicado el ingreso hospitalario (AU)

Background and objective: Different scientific societies propose the use of scales of severity and additional criteria (AC) in order to determine the setting for the treatment of Community-Acquired Pneumonia (CAP).The objective of this study is to correlate the risk regarding three clinical prediction rules (PSI, CURB-65 and PSCRUXO-80) and AC with the effectiveness of hospital at home (HaH). Patients and method: Evaluation of cases of CAP referred from the Emergency Unit to HaH between January 2000 and May 2008. They were classified regarding three risk scales and presence of AC and its association with the effectiveness of HaH during the treatment was analysed. Results: 146 women and 181 men were admitted, (mean age, 60.3 years). The average stay in HaH was 8.6 days. Two patients died, 25 (7.7%) were admitted to hospital, 219 progressed favourably throughout and 81 after overcoming complications. Hospital at Home was effective in 92.3% of total patients. The rate was 85% for those in PSI=IV or V with or without additional criteria; 80% for CURB-65=2 and 77.5% for a PSCURXO-80 score of 10–19. The effectiveness of HaH is inversely related to severity (AU)ConclusionsHospital a Home (HaD) is an effective and safe care option for many cases of CAP in which hospital admission is normally recommended on the basis of prediction rule scores or additional admission criteria

[Efficacy of hospital at home (HaH) in the treatment of community-acquired pneumonia (CAP) with different degrees of severity]. / Tratamiento de la neumonía adquirida en la comunidad en hospitalización a domicilio: resultado clínico en casos con diferente nivel de gravedad.

BACKGROUND AND OBJECTIVE: Different scientific societies propose the use of scales of severity and additional criteria (AC) in order to determine the setting for the treatment of Community-Acquired Pneumonia (CAP).The objective of this study is to correlate the risk regarding three clinical prediction rules (PSI, CURB-65 and PSCRUXO-80) and AC with the effectiveness of hospital at home (HaH). PATIENTS AND METHOD: Evaluation of cases of CAP referred from the Emergency Unit to HaH between January 2000 and May 2008. They were classified regarding three risk scales and presence of AC and its association with the effectiveness of HaH during the treatment was analysed. RESULTS: 146 women and 181 men were admitted, (mean age, 60.3 years). The average stay in HaH was 8.6 days. Two patients died, 25 (7.7%) were admitted to hospital, 219 progressed favourably throughout and 81 after overcoming complications. Hospital at Home was effective in 92.3% of total patients. The rate was 85% for those in PSI=IV or V with or without additional criteria; 80% for CURB-65=2 and 77.5% for a PSCURXO-80 score of 10-19. The effectiveness of HaH is inversely related to severity. CONCLUSIONS: Hospital a Home (HaD) is an effective and safe care option for many cases of CAP in which hospital admission is normally recommended on the basis of prediction rule scores or additional admission criteria.

[Treatment of congestive heart failure in the setting of hospital at home. Study of 158 patients]. / Tratamiento de la insuficiencia cardíaca en régimen de hospitalización a domicilio. Estudio de 158 pacientes.

BACKGROUND AND OBJECTIVE: Hospital at Home might become a suitable alternative to traditional hospital admissions for several exacerbated chronic diseases. Congestive heart failure represents an important workload at the hospital level. In this study we present the results of our experience with congestive heart failure patients attended in Hospital at Home regimen during the period 1999-2001. PATIENTS AND METHOD: In 1999 we initiated a program to refer patients with congestive heart failure to Hospital at Home care. The program was agreed by the departments of emergency, cardiology, internal medicine and hospital at home. During the period 1999-2001, 158 patients (mean age = 76) were attended. Ninety one (58%) were women. At the moment of admission, 103 patients (68%) were on functional status IV of the NYHA. RESULTS: On average, patient's stay on hospital at home was 12,8 days. One hundred and twenty three (78%) of them were discharged, 29 (18%) had to be referred back to conventional hospitalisation and six (4%) died. During the 90 days following the discharge from Hospital at Home, the number of visits to the emergency department and the rate of hospital admissions decreased significantly. CONCLUSIONS: Our data confirm Hospital at Home as a valid option to conventional hospital admission for the management of patients with congestive heart failure.

Tratamiento de la insuficiencia cardíaca en régimen de hospitalización a domicilio. Estudio de 158 pacientes / Treatment of congestive heart failure in the setting of hospital at home. Study of 158 patients

FUNDAMENTO Y OBJETIVO: La hospitalización a domicilio puede convertirse en una alternativa real a la hospitalización tradicional en enfermedades crónicas reagudizadas como la insuficiencia cardíaca, que representa una carga asistencial importante en el ámbito hospitalario. En este trabajo presentamos los resultados de nuestra experiencia en el período 1999-2001 en pacientes con insuficiencia cardíaca atendidos en régimen de hospitalización a domicilio. PACIENTES Y MÉTODO: En 1999 se inició un programa de derivación de los pacientes con insuficiencia cardíaca a un régimen de hospitalización a domicilio en el Hospital Txagorritxu de Vitoria-Gasteiz, consensuado entre los Servicios de Urgencias, Cardiología, Medicina Interna y Hospitalización a Domicilio. Durante el período 1999-2001 se atendió a 158 pacientes con una edad media de 75,8 años siendo 91 (57,6 por ciento) mujeres. En el momento de su ingreso 103 pacientes (65,2 por ciento) se encontraban en grado funcional IV de la New York Heart Association. RESULTADOS: La estancia media de los pacientes fue de 12,8 días. Se pudo dar de alta a 123 pacientes (77,9 por ciento), 29 (18,3 por ciento) reingresaron en el hospital y 6 (3,8 por ciento) fallecieron. Se objetivó un descenso significativo tanto del número de visitas a urgencias como de los ingresos hospitalarios en los 90 días siguientes al alta del Servicio de Hospitalización a Domicilio. CONCLUSIONES: Nuestros datos confirman la validez de la hospitalización a domicilio como alternativa al ingreso hospitalario de pacientes con insuficiencia cardíaca descompensada (AU)