Radiography-based triage for COVID-19 in the Emergency Department in a Spanish cohort of patients.

Background: Strategies to determine who could be safely discharged home from the Emergency Department (ED) in COVID-19 are needed to decongestion healthcare systems. Objectives: To describe the outcomes of an ED triage system for non-severe patients with suspected COVID-19 and possible pneumonia based on chest X-ray (CXR) upon admission. Material and methods: Retrospective, single-center study performed in Barcelona (Spain) during the COVID-19 peak in March-April 2020. Patients with COVID-19 symptoms and potential pneumonia, without respiratory insufficiency, with priority class IV-V (Andorran triage model) had a CXR upon admission. This approach tried to optimize resource use and to facilitate discharges. The results after adopting this organizational approach are reported. Results: We included 834 patients, 53% were female. Most patients were white (66%) or Hispanic (27%). CXR showed pneumonia in 523 (62.7%). Compared to those without pneumonia, patients with pneumonia were older (55 vs 46.6 years old) and had a higher Charlson comorbidity index (1.9 vs 1.3). Patients with pneumonia were at a higher risk for a combined outcome of admission and/or death (91 vs 12%). Death rates tended to be numerically higher in the pneumonia group (10 vs 1). Among patients without pneumonia in the initial CXR, 10% reconsulted (40% of them with new pneumonia). Conclusion: CXR identified pneumonia in a significant number of patients. Those without pneumonia were mostly discharged. Mortality among patients with an initially negative CXR was low. CXR triage for pneumonia in non-severe COVID-19 patients in the ED can be an effective strategy to optimize resource use.

Introducción: La pandemia de COVID-19 conlleva una alta ocupación de los servicios de urgencias (SU). Se requieren nuevas estrategias para optimizar la gestión de estos recursos. Objetivos: Describir los resultados de un sistema de triaje en urgencias para pacientes no graves con sospecha de COVID-19 y posible neumonía, basado en la radiografía de tórax (RT). Material y métodos: Estudio retrospectivo, unicéntrico realizado en Barcelona (España) entre marzo y abril de 2020. Se realizó una RT al ingreso en SU de pacientes con síntomas de COVID-19 y sospecha de neumonía, sin insuficiencia respiratoria, con una prioridad clase IV-V (sistema andorrano de triaje). Esta medida pretende optimizar los recursos y facilitar las altas. Se reportan los resultados tras adoptar esta estrategia. Resultados: Se incluyeron 834 pacientes (53% mujeres, 66% caucásicos, 27% hispánicos). La RT mostró neumonía en 523 (62,7%). Comparados con los pacientes sin neumonía, los que sí la padecían eran mayores (55 vs. 46,6 años), con un índice de comorbilidad de Charlson más elevado (1,9 vs. 1,3) y con mayor riesgo de ingreso y/o muerte (91 vs. 12%). La mortalidad fue numéricamente mayor en el grupo con neumonía (10 vs. 1). El 10% de los pacientes sin neumonía en RT consultaron de nuevo al SU (40% con neumonía). Conclusión: La RT identificó neumonía en múltiples pacientes. Los que no tenían neumonía fueron mayoritariamente dados de alta. La mortalidad entre pacientes con RT negativa fue baja. La RT como triaje para neumonía en pacientes con COVID-19 no grave puede ahorrar recursos.

Radiography-based triage for COVID-19 in the Emergency Department in a Spanish cohort of patients.

BACKGROUND: Strategies to determine who could be safely discharged home from the Emergency Department (ED) in COVID-19 are needed to decongestion healthcare systems. OBJECTIVES: To describe the outcomes of an ED triage system for non-severe patients with suspected COVID-19 and possible pneumonia based on chest X-ray (CXR) upon admission. MATERIAL AND METHODS: Retrospective, single-center study performed in Barcelona (Spain) during the COVID-19 peak in March-April 2020. Patients with COVID-19 symptoms and potential pneumonia, without respiratory insufficiency, with priority class IV-V (Andorran triage model) had a CXR upon admission. This approach tried to optimize resource use and to facilitate discharges. The results after adopting this organizational approach are reported. RESULTS: We included 834 patients, 53% were female. Most patients were white (66%) or Hispanic (27%). CXR showed pneumonia in 523 (62.7%). Compared to those without pneumonia, patients with pneumonia were older (55 vs 46.6 years old) and had a higher Charlson comorbidity index (1.9 vs 1.3). Patients with pneumonia were at a higher risk for a combined outcome of admission and/or death (91 vs 12%). Death rates tended to be numerically higher in the pneumonia group (10 vs 1). Among patients without pneumonia in the initial CXR, 10% reconsulted (40% of them with new pneumonia). CONCLUSION: CXR identified pneumonia in a significant number of patients. Those without pneumonia were mostly discharged. Mortality among patients with an initially negative CXR was low. CXR triage for pneumonia in non-severe COVID-19 patients in the ED can be an effective strategy to optimize resource use.

Prevalencia y valor pronóstico al año de la anemia en pacientes ingresados en una unidad geriátrica de agudos / Anemia in elderly patients admitted to an acute geriatric ward

Objetivo: Analizar la prevalencia y características de pacientes con anemia ingresados en una unidad geriátrica de agudos, y su valor pronóstico de mortalidad al año. Material y métodos: Estudio descriptivo prospectivo en el que se incluyó a los pacientes ingresados en la unidad de geriatría. Se diagnosticó la anemia según los criterios de la Organización Mundial de la Salud. A todos los enfermos se les realizó una valoración geriátrica integral. Un año más tarde se realizó seguimiento vía telefónica y se valoró mortalidad y situación funcional. Resultados: Se incluyó a 145 pacientes, edad media de 81 años, de los cuales 93 (64,13%) presentaban anemia. Los tipos más frecuentes de anemia fueron la de procesos crónicos y la ferropénica. El índice de Barthel fue menor en los pacientes con anemia (p < 0,05). La mortalidad al año fue del 47,9%, sin diferencias significativas entre pacientes con y sin anemia (OR 2,07; [0,98-4,4]). Los valores del IB, el índice de Charlson, el Mini Nutritional Assessment method y el Mini Examen Cognoscitivo de Lobo basales fueron significativamente peores en los pacientes que fallecieron. Conclusión: La anemia es un enfermedad muy prevalente en pacientes de edad avanzada que ingresan por un proceso agudo y se asocia con una peor situación funcional (AU)

Objective: To describe the characteristics, prevalence and prognostic of anemia in older patients admitted to an acute geriatric unit. Material and methods: A prospective descriptive study was conducted on patients admitted to a geriatric unit. Anemia was defined using the World Health Organization criteria. A comprehensive geriatric assessment was performed on all patients. When possible, a telephone follow-up re-evaluation (mortality, functional status) was performed one year after discharge. Results: A total of 145 patients were studied. The mean age was 81 years, and 93 (64.13%) were anemic. Chronic diseases and iron deficiency anemia were the most frequent. Anemic patients had lower scores in the Barthel Index (P<.05). The mortality one year after discharge was 47.9%, with no differences between anemic or non-anemic patients (OR 2.07, [0.98-4.4]). All the geriatric indexes (Barthel index; Charlson comorbidity index, Mini-mental state examination and Mini Nutritional Assessment) showed worse scores in patients who died one year after discharge. Conclusions: The prevalence of anemia in the elderly admitted to a geriatric unit is elevated, and associated with a poorer functional status (AU)

[Anemia in elderly patients admitted to an acute geriatric ward]. / Prevalencia y valor pronóstico al año de la anemia en pacientes ingresados en una unidad geriátrica de agudos.

OBJECTIVE: To describe the characteristics, prevalence and prognostic of anemia in older patients admitted to an acute geriatric unit. MATERIAL AND METHODS: A prospective descriptive study was conducted on patients admitted to a geriatric unit. Anemia was defined using the World Health Organization criteria. A comprehensive geriatric assessment was performed on all patients. When possible, a telephone follow-up re-evaluation (mortality, functional status) was performed one year after discharge. RESULTS: A total of 145 patients were studied. The mean age was 81 years, and 93 (64.13%) were anemic. Chronic diseases and iron deficiency anemia were the most frequent. Anemic patients had lower scores in the Barthel Index (P<.05). The mortality one year after discharge was 47.9%, with no differences between anemic or non-anemic patients (OR 2.07, [0.98-4.4]). All the geriatric indexes (Barthel index; Charlson comorbidity index, Mini-mental state examination and Mini Nutritional Assessment) showed worse scores in patients who died one year after discharge. CONCLUSIONS: The prevalence of anemia in the elderly admitted to a geriatric unit is elevated, and associated with a poorer functional status.