[Ability of qSOFA1-lactate to predict 30-day mortality in patients seen for infection in the Emergency Department]. / Capacidad del qSOFA1-lactato para predecir mortalidad a 30 días en los pacientes atendidos por infección en urgencias.

OBJECTIVE: To evaluate lactate and the Quick Sepsis-Related Organ Failure Assessment (qSOFA) and compare their ability to predict 30-day mortality in patients treated for infection in emergency departments (ED). METHODS: Prospective multicenter observational cohort study. We enrolled a convenience sample of patients aged 18 years or older attended in 71 Spanish ED from October 1, 2019, to March 31, 2020. Each model's predictive power was analyzed with the area under the receiver operating characteristic curve (AUC), and its values of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative (NPV). RESULTS: A total of 4439 patients with a mean (SD) age of 18 years were studied; 2648 (59.7%) were men and 459 (10.3%) died within 30 days. For 30-day mortality, the AUC-COR obtained with the qSOFA = 1 model plus 2 mmol/l lactate was 0.66 (95% CI, 0.63-0.69) with Se: 68%, Es: 70% and NPV:92%, while qSOFA = 1 obtained AUC-COR of 0.52 (95% CI, 0.49-0.55) with a Se:42%, Es:64% and NPV:90%. CONCLUSIONS: To predict 30-day mortality in patients presenting to the ED due to an episode of infection, the qSOFA =1 + lactate≥2 mmol/L model significantly improves the predictive power achieved individually by qSOFA1 and becomes very similar to qSOFA≥2.

Utilidad del modelo 5MPB-Toledo para predecir bacteriemia en el paciente con infección del tracto urinario en el servicio de urgencias / Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with urinary tract infections in the emergency department

Objetivo: Analizar la utilidad de un nuevo modelo predictivo de bacteriemia (5MPB-Toledo) en pacientes atendidos por infección del tracto urinario (ITU) en los servicios de urgencias (SU). Métodos: Estudio observacional, prospectivo y multicéntrico de los hemocultivos (HC) obtenidos en pacientes mayores de 18 años atendidos por ITU en 65SU desde el 1 de octubre de 2019 hasta el 30 de abril de 2020. Se analizó la capacidad predictiva del modelo con el área bajo la curva (ABC) de la característica operativa del receptor (COR) y se calculó el rendimiento diagnóstico del punto de corte elegido con su sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo. Resultados: Se incluyeron 1.499 episodios de HC extraídos. De ellos se consideraron como bacteriemias verdaderas 277 (18,5%) y como HC negativos 1.222 (81,5%). Entre los negativos 94 (6,3%) se consideraron contaminados. El ABC-COR del modelo fue de 0,937 (IC 95%: 0,926-0,949). El rendimiento diagnóstico del modelo con un PC≥5 puntos consigue una sensibilidad de 97,47% (IC 95%: 94,64-98,89), especificidad de 76,68% (IC 95%: 74,18-79,00), un valor predictivo positivo de 48,65% (IC 95%: 44,42-52,89) y un valor predictivo negativo de 99,26% (IC 95%: 98,41-99,67). Conclusión: El modelo 5MPB-Toledo podría ser útil para predecir bacteriemia en los pacientes adultos atendidos en el SU por un episodio de ITU (AU)

Objective: To analyze the usefulness of a new predictive model of bacteremia (5MPB-Toledo) in patients treated for urinary tract infection (UTI) in the emergency department (ED). Methods: Prospective and multicenter observational cohort study of the blood cultures (BC) ordered for patients with UTIs in 65 Spanish ED from October 1, 2019, to April 30, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The diagnostic performance was calculated with the chosen cut-off point for sensitivity, specificity, positive predictive value, and negative predictive value. Results A total of 1,499 blood cultures were evaluated. True cases of bacteremia were confirmed in 277 (18.5%). The remaining 1,222 cultures (81.5%) were negative. Ninety-four (6.3%) were considered contaminated. The model's area under the ROC curve was 0.937 (95% CI, 0.926-0.949). The prognostic performance with a model's cut-off value of≥5 points achieved 97.47% (95% CI, 94.64-98.89) sensitivity, 76.68% (95% CI, 74.18-79.00) specificity, 48.65% (95% CI, 44.42-52.89) positive predictive value and 99.26% (95% CI, 98.41-99.67) negative predictive value. Conclusion: The 5MPB-Toledo score is useful for predicting bacteremia in patients with UTIs who visit the ED (AU)

Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with urinary tract infections in the emergency department.

OBJECTIVE: To analyze the usefulness of a new predictive model of bacteremia (5MPB-Toledo) in patients treated for urinary tract infection (UTI) in the emergency department (ED). METHODS: Prospective and multicenter observational cohort study of the blood cultures (BC) ordered for patients with UTIs in 65 Spanish ED from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The diagnostic performance was calculated with the chosen cut-off point for sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: A total of 1,499 blood cultures were evaluated. True cases of bacteremia were confirmed in 277 (18.5%). The remaining 1,222 cultures (81.5%) were negative. Ninety-four (6.3%) were considered contaminated. The model's area under the ROC curve was 0.937 (95% CI, 0.926-0.949). The prognostic performance with a model's cut-off value of ≥5 points achieved 97.47% (95% CI, 94.64-98.89) sensitivity, 76.68% (95% CI, 74.18-79.00) specificity, 48.65% (95% CI, 44.42-52.89) positive predictive value and 99.26% (95% CI, 98.41-99.67) negative predictive value. CONCLUSION: The 5MPB-Toledo score is useful for predicting bacteremia in patients with UTIs who visit the ED.

[Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with community-acquired pneumonia in the Emergency Department]. / Utilidad del modelo 5MPB-Toledo para predecir bacteriemia en el paciente con neumonía adquirida en la comunidad en el Servicio de Urgencias.

OBJECTIVE: To analyse a new risk score to predict bacteremia in the patients with Community-acquired Pneumonia (CAP) in the emergency departments. METHODS: Prospective and multicenter observational cohort study of the blood cultures ordered in 74 Spanish emergency departments for patients with CAP seen from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the chosen cut-off for getting the sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: A total of 1,020 blood samples wered cultured. True cases of bacteremia were confirmed in 162 (15.9%). The remaining 858 cultures (84.1%) wered negative. And, 59 (5.8%) were judged to be contaminated. The model´s area under the receiver operating characteristic curve was 0.915 (95% CI, 0.898-0.933). The prognostic performance with a model´s cut-off value of ≥ 5 points achieved 97.5% (95% CI, 95.1-99.9) sensitivity, 73.2% (95% CI, 70.2-76.2) specificity, 40.9% (95% CI, 36.4-45.1) positive predictive value and 99.4% (95% CI, 99.1-99.8) negative predictive value. CONCLUSIONS: The 5MPB-Toledo score is useful for predicting bacteremia in the patients with CAP seen in the emergency departments.

[Delayed administration of thrombolytic therapy in minor stroke]. / Retraso en la administración de tratamiento trombolítico en el ictus minor.

INTRODUCTION: Minor strokes are considered to be those that present with few symptoms, although up to 40% of them entail long-term disability. The rate of thrombolysis in these patients is also lower than in other strokes. The aim of this study is to explore whether there are any differences in intravenous thrombolysis care times in minor strokes. PATIENTS AND METHODS: We conducted a retrospective review of strokes treated with intravenous thrombolysis at our centre and a comparative analysis of the care times in minor strokes and in the other types. RESULTS: Longer times were found in minor strokes in terms of door-to-CT scan and door-to-needle time. This was not the case, however, for the time from the onset of symptoms to arrival at the hospital. CONCLUSIONS: The presence of few symptoms in minor strokes can make them difficult to recognise and could be a reason for delaying treatment. Training among staff caring for these patients is essential to improve this aspect.

TITLE: Retraso en la administración de tratamiento trombolítico en el ictus minor.Introducción. Se considera ictus minor a aquel que se presenta con escasos síntomas; sin embargo, hasta un 40% presenta discapacidad a largo plazo. La tasa de trombólisis en estos pacientes también es inferior a la del resto de ictus. En este estudio se pretende explorar si existen diferencias en los tiempos de atención en la trombólisis intravenosa en los pacientes con ictus minor. Material y métodos. Revisión retrospectiva de los ictus tratados con trombólisis intravenosa en nuestro centro y análisis comparativo de los tiempos de asistencia entre ictus minor y el resto. Resultados. Se encontraron tiempos más alargados en los casos de ictus minor en cuanto al tiempo puerta-tomografía computarizada y puerta-aguja. No fue así, sin embargo, para el tiempo desde el inicio de los síntomas hasta la llegada al hospital. Conclusiones. La presencia de escasos síntomas en el ictus minor puede hacer difícil su reconocimiento y podría ser un motivo de retraso en el tratamiento. La formación entre el personal que atiende a estos pacientes es fundamental para mejorar este aspecto.

Prognostic accuracy of SIRS criteria, qSOFA score and GYM score for 30-day-mortality in older non-severely dependent infected patients attended in the emergency department.

The aim of this study was to determine the accuracy of systemic inflammatory response syndrome (SIRS), quick Sepsis-related Organ Failure Assessment (qSOFA) score and GYM score to predict 30-day mortality in older non-severely dependent patients attended for an episode of infection in the emergency department (ED). We performed an analytical, observational, prospective cohort study including patients 75 years of age or older, without severe functional dependence, attended for an infectious process in 69 Spanish EDs for 2-day three-seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event. We included 1071 patients, with a mean age of 83.6 [standard deviation (SD) 5.6] years; 544 (50.8%) were men. Seventy-two patients (6.5%) died within 30 days. SIRS criteria ≥ 2 had a sensitivity of 65% [95% confidence interval (CI) 53.1-75.9] and a specificity of 49% (95% CI 46.0-52.3), a qSOFA score ≥ 2 had a sensitivity of 28% (95% CI 18.2-39.8) and a specificity of 94% (95% CI 91.9-95.1), and a GYM score ≥ 1 had a sensitivity of 81% (95% CI 69.2-88.6) and a specificity of 45% (95% CI 41.6-47.9). A GYM score ≥ 1 and a qSOFA score ≥ 2 were the cut-offs with the highest sensitivity (p < 0.001) and specificity (p < 0.001), respectively. The area under the curve (AUC) was 0.73 (95% CI 0.66-0.79; p < 0.001) for the GYM score, 0.69 (95% CI 0.61-0.76; p < 0.001) for the qSOFA score and 0.65 (95% CI 0.59-0.72; p < 0.001) for SIRS. A GYM score ≥ 1 may be the most sensitive score and a qSOFA score ≥ 2 the most specific score to predict 30-day mortality in non-severely dependent older patients attended for acute infection in EDs.

[Characteristics and epidemiological changes for patients with urinary tract infection in the emergency department]. / Características y cambios epidemiológicos de los pacientes coninfección del tracto urinario en los servicios de urgencias hospitalarios.

BACKGROUND: The aim of this paper is to determine both the prevalence of urinary tract infection (UTI) in the emergency department (ED) and the most relevant epidemiological changes in the last decade, as well as the profile and management of these patients. METHODS: Descriptive cross-sectional analysis at 49 Spanish ED during 12 months. All patients with infections and UTI diagnosis were included. All patients attended to in ED during the study were recorded as well. RESULTS: The study included 2,517 patients diagnosed with UTI, with a mean age of 55 (SD 23) years, 64.6%of whom were women. These patients represent 22%of infections in the ED and 3.2% of all patients in the ED. Thirty-six per cent were over 70 years old. Fifty one point nine per cent had some underlying disease (16.5%diabetes mellitus) and 32.7% had some risk factors for multi-resistant strains of bacteria. Eight point three percent met sepsis criteria. Seventy-one point nine percent of patients were directly discharged from the ED. CONCLUSIONS: UTI are very common infections in ED, with important associated comorbidities, high mean ages and a predominance in women. With respect to a decade before UTI has increased its prevalence (3.2%vs 2.1%) and the patients have a greater age [55.5 (SD 23) vs 52 (SD 22) years], more comorbidities (51.9% vs 40.6%) and clinical severity (8.3% vs 6.5%).

Características y cambios epidemiológicos de los pacientes con infección del tracto urinario en los servicios de urgencias hospitalarios / Characteristics and epidemiological changes for patients with urinary tract infection in the emergency department

Fundamento: El objetivo de este artículo es determinar la prevalencia y conocer los cambios epidemiológicos más relevantes en la última década en la infección del tracto urinario (ITU) en los servicios de urgencias (SU), así como el perfil y manejo de los pacientes. Métodos: Estudio descriptivo con análisis transversal, multicéntrico en 49 SU españoles durante 12 meses. Se incluyeron todos los pacientes con el diagnóstico de ITU y de infección. Se registraron todos los pacientes atendidos en los SU. Resultados: Se incluyeron 2.517 casos diagnosticados de ITU con una edad media de 55 ± 23 años, el 64,6% mujeres. Estos representan el 22% de las infecciones y el 3,2% de todos los pacientes del SU. El 36% de las ITU se registraron en pacientes con 70 o más años. El 51,9% tenían alguna enfermedad de base (16,5% diabetes mellitus) y el 32,7% alguno de los factores de riesgo de multirresistencia para bacterias. El 8,3% cumplían criterios de sepsis. El 71,9% de los pacientes recibieron el alta desde el SU. Conclusiones: Las ITU son infecciones muy frecuentes en los SU, con importante comorbilidad asociada, elevada edad media y predominio en mujeres. Respecto a una década anterior, las ITU han aumentado su prevalencia (3,2% frente a 2,1%) y el paciente tiene más edad [55,5 (DE 23) frente a 52 (DE 22) años], mayor comorbilidad (51,9% frente a 40,6%) y gravedad clínica (8,3% frente a 6,5%) (AU)

Background: The aim of this paper is to determine both the prevalence of urinary tract infection (UTI) in the emergency department (ED) and the most relevant epidemiological changes in the last decade, as well as the profile and management of these patients. Methods: Descriptive cross-sectional analysis at 49 Spanish ED during 12 months. All patients with infections and UTI diagnosis were included. All patients attended to in ED during the study were recorded as well. Results: The study included 2,517 patients diagnosed with UTI, with a mean age of 55 (SD 23) years, 64.6% of whom were women. These patients represent 22% of infections in the ED and 3.2% of all patients in the ED. Thirty-six per cent were over 70 years old. Fifty one point nine per cent had some underlying disease (16.5% diabetes mellitus) and 32.7% had some risk factors for multi-resistant strains of bacteria. Eight point three per cent met sepsis criteria. Seventy-one point nine per cent of patients were directly discharged from the ED. Conclusions: UTI are very common infections in ED, with important associated comorbidities, high mean ages and a predominance in women. With respect to a decade before UTI has increased its prevalence (3.2% vs 2.1%) and the patients have a greater age [55.5 (SD 23) vs 52 (SD 22) years], more comorbidities (51.9% vs 40.6%) and clinical severity (8.3% vs 6.5%) (AU)