Impacto clínico de una unidad de patología pleural en un hospital de tercer nivel / Clinical Impact of a Pleural Unit in a Tertiary Level Hospital

INTRODUCCIÓN: La enfermedad pleural conlleva un gran número de ingresos y elevadas estancias hospitalarias. Con el fin de mejorar esto, se creó en nuestro hospital una unidad de patología pleural (UPP). Nuestro objetivo es analizar el impacto clínico de dicha unidad. MATERIAL Y MÉTODOS: Estudio prospectivo en el que incluimos a los pacientes ingresados en la UPP del Hospital Universitario Central de Asturias por neumotórax espontáneo primario (NEP), secundario (NES), derrame pleural paraneumónico complicado (DPPC) y derrame pleural maligno (DPM), entre enero de 2015 y diciembre de 2018. Analizamos parámetros descriptivos, estancias medias, reingresos al mes, necesidad de cirugía y, en los DPPC, también la mortalidad hospitalaria. Los datos se compararon con los de los pacientes ingresados por la misma enfermedad en neumología durante los 2 años previos (2013-2014). Describimos además todos los procedimientos realizados en la UPP, tanto ambulatorios como en pacientes ingresados. RESULTADOS: Se incluyeron 741 pacientes. Objetivamos una disminución progresiva de los ingresos totales por enfermedad pleural y de la estancia media (días) en dichas afecciones, excepto en el DPM: NEP de 6,2 a 4,2 (p = 0,004), NES de 13,2 a 8,6 (p = 0,005), DPM de 10,3 a 12,3 (p = 0,05) y DPPC de 18,3 a 11,3 (p = 0,001). Existió una reducción de los reingresos al mes y de la mortalidad hospitalaria por DPPC en el periodo de la UPP (14,9% al 5,5%) (p = 0,021). CONCLUSIONES: La creación de una UPP podría disminuir el número de ingresos innecesarios, favoreciendo una reducción de las estancias medias y, en los DPPC, también la mortalidad hospitalaria

INTRODUCTION: Pleural disease involves a large number of admissions and long hospital stays. In order to improve this situation, a Pleural Unit (PU) was created in our hospital. Our aim was to analyze the clinical impact of this unit. MATERIAL AND METHODS: In this prospective study, we included patients admitted to the PU of the Hospital Universitario Central de Asturias for primary spontaneous pneumothorax (PSP), secondary spontaneous pneumothorax (SSP), complicated parapneumonic pleural effusion (CPPE), and malignant pleural effusion (MPE) between January 2015 and December 2018. We analyzed descriptive parameters, mean length of stay, readmissions at 1 month, need for surgery, and in the CPPE group, in-hospital mortality. The data were compared with those of patients admitted to the respiratory medicine department for the same diseases during the previous two years (2013-2014). We also describe all procedures performed in the PU, in both inpatients and outpatients. RESULTS: A total of 741 patients were included, We observed a progressive decrease in total admissions for pleural diseases and mean length of stay (days) (with the exception of MPE), as follows: PSP: from 6.2 to 4.2 (P = .004); SSP: 13.2 to 8.6 (P = .005), MPE: 10.3 to 12.3 (P = .05); and CPPE: 18.3 to 11.3 (P = .001) There was a reduction in hospital readmissions at 1 month and in in-hospital mortality due to CPPE in the PU period (14.9% to 5.5%) (P = .021). CONCLUSIONS: The creation of a PU could decrease the number of unnecessary admissions, and reduce mean lengths of stay and, in the case of CPPE, in-hospital mortality

Clinical Impact of a Pleural Unit in a Tertiary Level Hospital. / Impacto clínico de una unidad de patología pleural en un hospital de tercer nivel.

INTRODUCTION: Pleural disease involves a large number of admissions and long hospital stays. In order to improve this situation, a Pleural Unit (PU) was created in our hospital. Our aim was to analyze the clinical impact of this unit. MATERIAL AND METHODS: In this prospective study, we included patients admitted to the PU of the Hospital Universitario Central de Asturias for primary spontaneous pneumothorax (PSP), secondary spontaneous pneumothorax (SSP), complicated parapneumonic pleural effusion (CPPE), and malignant pleural effusion (MPE) between January 2015 and December 2018. We analyzed descriptive parameters, mean length of stay, readmissions at 1 month, need for surgery, and in the CPPE group, in-hospital mortality. The data were compared with those of patients admitted to the respiratory medicine department for the same diseases during the previous two years (2013-2014). We also describe all procedures performed in the PU, in both inpatients and outpatients. RESULTS: A total of 741 patients were included, We observed a progressive decrease in total admissions for pleural diseases and mean length of stay (days) (with the exception of MPE), as follows: PSP: from 6.2 to 4.2 (P=.004); SSP: 13.2 to 8.6 (P=.005), MPE: 10.3 to 12.3 (P=.05); and CPPE: 18.3 to 11.3 (P=.001) There was a reduction in hospital readmissions at 1 month and in in-hospital mortality due to CPPE in the PU period (14.9% to 5.5%) (P=.021). CONCLUSIONS: The creation of a PU could decrease the number of unnecessary admissions, and reduce mean lengths of stay and, in the case of CPPE, in-hospital mortality.

Silicosis en trabajadores con conglomerados artificiales de cuarzo / Silicosis in Artificial Quartz Conglomerate Workers

Introducción: La silicosis es una enfermedad crónica progresiva producida por la inhalación de sílice cristalina. La mayoría de los casos aparecen en trabajadores de minería de interior y extracción de piedra natural (pizarra, granito). Ante la progresiva aparición de nuevos casos de silicosis en trabajadores con conglomerados artificiales de cuarzo (CAC), se planteó un estudio que tuvo como objetivo analizar las características de la silicosis producida por un nuevo agente en España. Métodos: El estudio consistió en una serie de 96 casos diagnosticados de silicosis según criterios internacionales durante el periodo comprendido entre 2010 y 2017. Se analizaron las características clínicas, radiológicas, funcionales y patológicas. Resultados: La edad media fue de 45 años, el 55% con silicosis simple y el 45% con silicosis complicada. En 10 pacientes se diagnosticó silicosis acelerada, con una media de 33 años de edad. El tiempo medio de exposición a los conglomerados fue de 15 años y en un 77% no se utilizaban medidas de protección adecuadas. La mitad de los pacientes estaban asintomáticos y presentaban diferentes formas clásicas en la radiografía de tórax y tomografía computarizada de alta resolución de tórax, así como imágenes de vidrio deslustrado. No se observaron alteraciones en la función pulmonar. Conclusiones: La silicosis en los trabajadores con CAC se observa en personas jóvenes, en activo, en un considerable porcentaje de forma acelerada, con escasos síntomas y sin alteración funcional. Las medidas de protección son escasas. Es importante conocer estas características para el diagnóstico precoz y las necesarias medidas preventivas

Introduction: Silicosis is a chronic progressive disease caused by inhalation of crystalline silica. Most cases develop in underground mine workers and in subjects involved in the extraction of natural stone (slate and granite). In view of the progressive emergence of new cases of silicosis in artificial quartz conglomerate workers, we performed a study to analyze the characteristics of silicosis produced by this new agent in Spain. Methods: The study consisted of a series of 96 cases of silicosis diagnosed according to international criteria during the period 2010-2017. We analyzed clinical, radiological, pathological and functional characteristics. Results: Mean age of participants was 45 years; 55% had simple silicosis and 45% had complicated silicosis. Ten patients were diagnosed with accelerated silicosis, with a mean age of 33 years. Mean time of exposure to conglomerates was 15 years, and 77% had not used appropriate protection measures. Half of the patients were asymptomatic and presented different classic forms on chest X-ray and chest high-resolution computed tomography, along with ground-glass images. No lung function changes were recorded. Conclusions: Silicosis in artificial quartz conglomerate workers occurs in a young, actively employed population, a considerable percentage of whom present an accelerated form. They have few symptoms and no functional limitations. Protection measures are scarce. It is important to characterize these features to provide early diagnosis and implement the necessary preventive measures

Silicosis in Artificial Quartz Conglomerate Workers. / Silicosis en trabajadores con conglomerados artificiales de cuarzo.

INTRODUCTION: Silicosis is a chronic progressive disease caused by inhalation of crystalline silica. Most cases develop in underground mine workers and in subjects involved in the extraction of natural stone (slate and granite). In view of the progressive emergence of new cases of silicosis in artificial quartz conglomerate workers, we performed a study to analyze the characteristics of silicosis produced by this new agent in Spain. METHODS: The study consisted of a series of 96 cases of silicosis diagnosed according to international criteria during the period 2010-2017. We analyzed clinical, radiological, pathological and functional characteristics. RESULTS: Mean age of participants was 45 years; 55% had simple silicosis and 45% had complicated silicosis. Ten patients were diagnosed with accelerated silicosis, with a mean age of 33 years. Mean time of exposure to conglomerates was 15 years, and 77% had not used appropriate protection measures. Half of the patients were asymptomatic and presented different classic forms on chest X-ray and chest high-resolution computed tomography, along with ground-glass images. No lung function changes were recorded. CONCLUSIONS: Silicosis in artificial quartz conglomerate workers occurs in a young, actively employed population, a considerable percentage of whom present an accelerated form. They have few symptoms and no functional limitations. Protection measures are scarce. It is important to characterize these features to provide early diagnosis and implement the necessary preventive measures.