Predictive usefulness of qSOFA, NEWS and GYM scores in the elderly patient: EDEN-5 study.

OBJECTIVE: To analyze the prognostic accuracy of the scores NEWS, qSOFA, GYM used in hospital emergency department (ED) in the assessment of elderly patients who consult for an infectious disease. METHODS: Data from the EDEN (Emergency Department and Elderly Need) cohort were used. This retrospective cohort included all patients aged ≥65 years seen in 52 Spanish EDs during two weeks (from 1-4-2019 to 7-4-2019 and 30/3/2020 to 5/4/2020) with an infectious disease diagnosis in the emergency department. Demographic variables, demographic variables, comorbidities, Charlson and Barthel index and needed scores parameters were recorded. The predictive capacity for 30-day mortality of each scale was estimated by calculating the area under the receiver operating characteristic (ROC) curve, and sensitivity and specificity were calculated for different cut-off points. The primary outcome variable was 30-day mortality. RESULTS: 6054 patients were analyzed. Median age was 80 years (IQR 73-87) and 45.3% women. 993 (16,4%) patients died. NEWS score had better AUC than qSOFA (0.765, 95CI: 0.725-0.806, versus 0.700, 95%CI: 0.653-0.746; P < .001) and GYM (0.716, 95%CI: 0.675-0.758; P = .024), and there was no difference between qSOFA and GYM (P = .345). The highest sensitivity scores for 30-day mortality were GYM ≥ 1 point (85.4%) while the qSOFA score ≥2 points showed high specificity. In the case of the NEWS scale, the cut-off point ≥4 showed high sensitivity, while the cut-off point NEWS ≥ 8 showed high specificity. CONCLUSION: NEWS score showed the highest predictive capacity for 30-day mortality. GYM score ≥1 showed a great sensitivity, while qSOFA ≥2 scores provide the highest specificity but lower sensitivity.

Influence of income on in-hospital mortality in older adults during the first wave of the COVID-19 pandemic: results from the EDEN-33 study. / Influencia de la renta económica en la mortalidad intrahospitalaria de las personas mayores durante la primera ola de la pandemia por COVID-19: resultados del estudio EDEN-33.

OBJECTIVES: To determine whether income was associated with unexpected in-hospital mortality in older patients treated in Spanish public health system hospital emergency departments. MATERIAL AND METHODS: Fifty-one public health system hospital emergency departments in Spain voluntarily participated in the study. Together the hospitals covered 25% of the population aged 65 years or older included in all patient registers during a week in the pre-pandemic period (April 1-7, 2019) and a week during the COVID-19 pandemic (March 30 to April 5, 2020). We estimated a patient's gross income as the amount published for the postal code of the patient's address. We then calculated the standardized gross income (SGI) by dividing the patient's estimated income by the mean for the corresponding territory (Spanish autonomous community). The existence and strength of an association between the SGI and in-hospital mortality was evaluated by means of restricted cubic spline (RCS) curves adjusted for 10 patient characteristics at baseline. Odds ratios (ORs) for each income level were expressed in relation to a reference SGI of 1 (the mean income for the corresponding autonomous community). We compared the COVID-19 and pre-pandemic periods by means of first-order interactions. RESULTS: Of the 35 280 patients attended in the 2 periods, gross income could be ascertained for 21 180 (60%), 15437 in the pre-pandemic period and 5746 during the COVID-19 period. SGIs were slightly higher for patients included before the pandemic (1.006 vs 0.994; P = .012). In-hospital mortality was 5.6% overall and higher during the pandemic (2.8% pre-pandemic vs 13.1% during COVID-19; P .001). The adjusted RCS curves showed that associations between income and mortality differed between the 2 periods (interaction P = .004). Whereas there were no significant income-influenced differences in mortality before the pandemic, mortality increased during the pandemic in the lowest-income population (SGI 0.5 OR, 1.82; 95% CI, 1.32-3.37) and in higher-income populations (SGI 1.5 OR, 1.32; 95% CI, 1.04-1.68, and SGI 2 OR, 1.92; 95% CI, 1.14-3.23). We found no significant differences between patients with COVID-19 and those with other diagnoses (interaction P = .667). CONCLUSION: The gross income of patients attended in Spanish public health system hospital emergency departments, estimated according to a patient's address and postal code, was associated with in-hospital mortality, which was higher for patients with the lowest and 2 higher income levels. The reasons for these associations might be different for each income level and should be investigated in the future.

OBJETIVO: Determinar si el nivel económico durante la primera ola pandémica tuvo una influencia diferente a la esperable en la mortalidad intrahospitalaria de los pacientes mayores atendidos en los servicios de urgencias (SU) de los hospitales públicos españoles. METODO: Cincuenta y un SU públicos españoles que participaron voluntariamente y que dan cobertura al 25% de la población incluyeron todos los registros de pacientes de edad 65 años atendidos durante una semana del periodo preCOVID (1-4-2019 a 7-4-2019) y una semana del periodo COVID (30-3-2020 a 5-4-2020). Se identificó la renta bruta (RB) asignada al código postal de residencia de cada paciente y se calculó la RB normalizada (RBN) dividiendo aquella por la RB media de su comunidad autónoma. La existencia y fuerza de la relación entre RBN y mortalidad intrahospitalaria se determinó mediante curvas spline cúbicas restringidas (SCR) ajustadas por 10 características basales del paciente. Las OR para cada situación económica se expresó en relación con una RBN de 1 (referencia, renta correspondiente a la media de la comunidad autónoma). La comparación entre periodo COVID y no COVID se realizó mediante el estudio de interacción de primer grado. RESULTADOS: De los 35.280 registros de pacientes atendidos en ambos periodos, se disponía de la RB en 21.180 (60%): 15.437 del periodo preCOVID y 5.746 del periodo COVID. La RBN de los pacientes incluidos fue discretamente superior en el periodo preCOVID (1,006 versus 0,994; p = 0,012). La mortalidad intrahospitalaria fue del 5,6%, y fue superior durante el periodo COVID (2,8% versus 13,1%; p 0,001). Las curvas SCR ajustadas mostraron una asociación entre nivel económico y mortalidad diferente entre ambos periodos (p interacción = 0,004): en el periodo preCOVID no hubo diferencias significativas de mortalidad en función de la RBN, mientras que en el periodo COVID la mortalidad se incrementó en rentas bajas (OR = 1,82, IC 95% = 1,32-3,37 para RBN de 0,5) y en rentas altas (OR = 1,32, IC 95% = 1,04-1,68 y OR = 1,92, IC 95% = 1,14-3,23 para RBN de 1,5 y 2, respectivamente), sin diferencias significativas entre pacientes con COVID y con otros diagnósticos (p interacción = 0,667). CONCLUSIONES: Durante la primera ola de la pandemia COVID, la RB asignada al código postal de residencia de los pacientes atendidos en los SU públicos españoles se asoció con la mortalidad intrahospitalaria, que aumentó en pacientes de rentas bajas y altas. Las razones de estas asociaciones pueden ser distintas para cada segmento económico y deben ser investigadas en el fututo.

Sociodemographic characteristics, comorbidity, and baseline functional status of older patients treated in emergency departments during the COVID-19 pandemic and associations with mortality: an analysis based on the EDENCOVID cohort. / Sociodemografía, comorbilidad y situación funcional basal de los pacientes mayores atendidos en urgencias durante la pandemia de COVID y su relación con la mortalidad: análisis a partir de la cohorte EDEN-Covid.

OBJECTIVES: To describe the sociodemographic characteristics, comorbidity, and baseline functional status of patients aged 65 or older who came to hospital emergency departments (EDs) during the first wave of the COVID-19 pandemic, and to compare them with the findings for an earlier period to analyze factors of the index episode that were related to mortality. MATERIAL AND METHODS: We studied data from the EDEN-COVID cohort (Emergency Department and Elder Needs During COVID-19) of patients aged 65 years or older treated in 40 Spanish EDs on 7 consecutive days. Nine sociodemographic variables, 18 comorbidities, and 7 function variables were registered and compared with the findings for the EDEN cohort of patients included with the same criteria and treated a year earlier in the same EDs. In-hospital mortality was calculated in the 2 cohorts and a multivariable logistic regression model was used to explore associated factors. RESULTS: The EDEN-COVID cohort included 6806 patients with a median age of 78 years; 49% were women. The pandemic cohort had a higher proportion of men, patients covered by the national health care system, patients brought from residential facilities, and patients who arrived in an ambulance equipped for advanced life support. Pandemic-cohort patients more often had diabetes mellitus, chronic kidney disease, and dementia; they less often had connective tissue and thromboembolic diseases. The Barthel and Charlson indices were worse in this period, and cognitive decline was more common. Fewer patients had a history of depression or falls. Eight hundred ninety these patients (13.1%) died, 122 of them in the ED (1.8%); these percentages were lower in the earlier EDEN cohort, at 3.1% and 0.5%, respectively. Independent sociodemographic factors associated with higher mortality were transport by ambulance, older age, male sex, and living in a residential facility. Mortalityassociated comorbidities were neoplasms, chronic kidney disease, and heart failure. The only function variable associated with mortality was the inability to walk independently. A history of falls in the past 6 months was a protective factor. CONCLUSION: The sociodemographic characteristics, comorbidity, and functional status of patients aged 65 years or older who were treated in hospital EDs during the pandemic differed in many ways from those usually seen in this older-age population. Mortality was higher than in the prepandemic period. Certain sociodemographic, comorbidity, and function variables were associated with in-hospital mortality.

OBJETIVO: Investigar sociodemografía, comorbilidad y situación funcional de los pacientes de 65 o más años de edad que consultaron a los servicios de urgencias hospitalarios (SUH) durante la primera oleada epidémica de COVID, compararlas con un periodo previo y ver su relación. METODO: Se utilizaron los datos obtenidos de la cohorte EDEN-Covid (Emergency Department and Elder Needs during COVID) en la que participaron 40 SUH españoles que incluyeron todos los pacientes de $ 65 años atendidos durante 7 días consecutivos. Se analizaron 9 características sociodemográficas, 18 comorbilidades y 7 variables de funcionalidad, que se compararon con las de la cohorte EDEN (Emergency Department and Elder Needs), que contiene pacientes con el mismo criterio de inclusión etario reclutados por los mismos SUH un año antes. Se recogió la mortalidad intrahospitalaria y se investigaron los factores asociados mediante regresión logística multivariable. RESULTADOS: La cohorte EDEN-Covid incluyó 6.806 pacientes (mediana edad: 78 años; 49% mujeres). Hubo más varones, con cobertura sanitaria pública, procedentes de residencia y que llegaron con ambulancia medicalizada que durante el periodo prepandemia. Presentaron más frecuentemente diabetes mellitus, enfermedad renal crónica, enfermedad cerebrovascular y demencia y menos conectivopatías y enfermedad tromboembólica, peores índices de Barthel y Charlson, más deterioro cognitivo y menos antecedentes de depresión o caídas previas. Fallecieron durante el episodio 890 pacientes (13,1%), 122 de ellos en urgencias (1,8%), porcentajes superiores al periodo prepandemia (3,1% y 0,5%, respectivamente). Se asociaron de forma independiente a mayor mortalidad durante el periodo COVID la llegada en ambulancia, mayor edad, ser varón y vivir en residencia como variables sociodemográficas, y neoplasia, enfermedad renal crónica e insuficiencia cardiaca como comorbilidades. La única variable funcional asociada a mortalidad fue no deambular respecto a ser autónomo, y la existencia de caídas los 6 meses previos resultó un factor protector. CONCLUSIONES: La sociodemografía, comorbilidad y funcionalidad de los pacientes de 65 o más años que consultaron en los SUH españoles durante la primera ola pandémica difirieron en muchos aspectos de lo habitualmente observado en esta población. La mortalidad fue mayor a la del periodo prepandémico. Algunos aspectos sociodemográficos, de comorbilidad y funcionales se relacionaron con la mortalidad intrahospitalaria.

Incidencia de neumonía adquirida en la comunidad en la cohorte poblacional de la base de datos en atención primaria (BIFAP) / Incidence Rate of Community Acquired Pneumonia in a population cohort registered in BIFAP

Objetivo: Estimar la tasa de incidencia (TI) de neumonía adquirida en la comunidad (NAC) a partir de la información procedente de las consultas en atención primaria (AP) de España y compararla con la del Reino Unido (RU). Diseño: Estudio de una cohorte retrospectiva (2003-2007) utilizando la información que se recoge en la base de datos para la Investigación : Farmacoepidemiológica en AP, BIFAP. Participantes: Sujetos de 20 a 79 años. Se siguieron hasta el primer episodio de neumonía, fallecimiento, edad de 80 años o finalización del estudio. Selección: de los casos. Se realiza una búsqueda automatizada en la base de datos utilizando los códigos CIAP (Clasificación Internacional de AP) relacionados con neumonía, así como el texto libre. Se revisaron las historias informatizadas de los casos identificados, seleccionando los que cumplían los criterios predefinidos de NAC. Mediciones principales: Se calculá la TI de NAC por edad, sexo y estación del año, y porcentaje de hospitalización. Se compararon con las tasas obtenidas en AP del RU obtenidas con la base de datos de AP THIN (The Health Improvement Network). Resultados: La TI de neumonía fue de 2,69 casos por mil personas-año (TI mujeres=2,29; TI hombres=3,16) en BIFAP. Un 32% de los casos de NAC fueron hospitalizados. En el RU, la TI fue de 1,07 (TI mujeres=0,93; TI hombres=1,22) y se ingresaron el 17%. Conclusión: La base de datos de BIFAP permite calcular la incidencia de NAC en España y comparar los resultados con los estimados en otras bases de datos europeas (AU)

Objetive: To estimate the incidence rate (IR) of community acquired pneumonia (CAP) using the information in the Primary Healthcare database in Spain. Design: Retrospective study (2003¨C2007) using the information registered in the Database for Pharmaco-Epidemiological Research in Primary Care (BIFAP).Study PopulationSubjects aged 20 to 79 years old, were followed up until the occurrence of a pneumonia episode, death, age of 80, or the end of the study, whichever came first. Case selection: A computerised search was performed to detect suggestive cases of pneumonia using ICPC codes (International Classification of Primary Care) and free text. The computerised histories were manually reviewed in order to identify those cases fullfilling the CAP¡äs determined definition. Analyse: IR of pneumonia was computed by age, sex and season. The percentage of hospitalisation was estimated. These results were compared with the IR from the United Kingdom using THIN database (The Health Improvement Network). Results: IR of CAP was 2.69 per 1000 persons-year (IR women=2.29; IR men=3.16) with BIFAP database, and 32 % of the CAP cases were hospitalised. In United Kingdom, IR was 1.07 per 1000 persons-year (IR women=0.93; IR men=1.22) and 17% of CAP were hospitalised. Conclusion: The BIFAP computerised Primary Care database is useful to estimate the incidence rate of CAP in Spain, as well as to compare the results with those obtained using other European computerised Primary Care databases(AU)

[Incidence rate of community acquired pneumonia in a population cohort registered in BIFAP]. / Incidencia de neumonía adquirida en la comunidad en la cohorte poblacional de la base de datos en atención primaria (BIFAP).

OBJECTIVE: To estimate the incidence rate (IR) of community acquired pneumonia (CAP) using the information in the Primary Healthcare database in Spain. DESIGN: Retrospective study (2003-2007) using the information registered in the Database for Pharmaco-Epidemiological Research in Primary Care (BIFAP). STUDY POPULATION: Subjects aged 20 to 79 years old, were followed up until the occurrence of a pneumonia episode, death, age of 80, or the end of the study, whichever came first. CASE SELECTION: A computerised search was performed to detect suggestive cases of pneumonia using ICPC codes (International Classification of Primary Care) and free text. The computerised histories were manually reviewed in order to identify those cases fulfilling the CAP's determined definition. ANALYSE: IR of pneumonia was computed by age, sex and season. The percentage of hospitalisation was estimated. These results were compared with the IR from the United Kingdom using THIN database (The Health Improvement Network). RESULTS: IR of CAP was 2.69 per 1000 persons-year (IR women=2.29; IR men=3.16) with BIFAP database, and 32 % of the CAP cases were hospitalised. In United Kingdom, IR was 1.07 per 1000 persons-year (IR women=0.93; IR men=1.22) and 17% of CAP were hospitalised. CONCLUSION: The BIFAP computerised Primary Care database is useful to estimate the incidence rate of CAP in Spain, as well as to compare the results with those obtained using other European computerised Primary Care databases.

Diseño y validación de un cuestionario para evaluar la satisfacciónde los pacientes atendidos en las consultas externas de un hospital de Madrid en 2006 / Design and validation of a questionnaire to evaluate satisfaction of patients of the hospital outpatient clinics in Madrid, Spain, 2006

Fundamento: Para conocer la calidad de la asistenciasanitaria es imprescindible incorporar el punto de vista delpaciente realizando estudios de satisfacción. Las encuestas desatisfacción precisan unas propiedades psicométricas quegaranticen su fiabilidad y validez. El objetivo de este trabajo esdiseñar y validar un cuestionario para conocer la satisfacciónde los pacientes con las consultas externas hospitalarias.Métodos: Estudio de validación de un cuestionarioautocumplimentado, diseñado por un grupo de expertos,compuesto por 12 preguntas que se aplicó a una muestra de677 pacientes de las consultas externas del hospital GregorioMarañón. Se analizó el comportamiento métrico delcuestionario en cuanto a validez de constructo, de criterio ycapacidad predictiva y la consistencia interna.Resultados: Se analizó el comportamiento métrico delcuestionario respecto a la validez de constructo identificándose 2factores “calidad clínica” y “calidad administrativa” que explicanel 63% de la varianza, validez de criterio concurrente (coeficientede correlación de Spearman de 0,85 respecto al criterio dereferencia “satisfacción global con la atención recibida enconsultas externas”, OR 1,19 respecto al criterio de referencia“conoce el nombre del médico que le atiende en la consulta”),capacidad predictiva del cuestionario medida mediante análisisdiscriminante obteniéndose un 84% de los casos clasificadoscorrectamente y consistencia interna (Alfa de Cronbach 0,90).Conclusiones: El cuestionario reúne suficientes propiedadespsicométricas como para que pueda ser considerado unaherramienta útil y fiable para medir la satisfacción de lospacientes con las consultas externas hospitalarias(AU)

Background: In order to improve the quality of healthcare it is necessary to know the point of view of the patientsthrough satisfaction surveys. Satisfaction surveys need somepsychometric properties to guarantee its reliability andvalidity. The aim of this paper is to design and to validate aquestionnaire to determine the satisfaction of patients of thehospital outpatient clinics.Methods: Validation of a satisfaction questionnaire,designed by an expert group and composed for 12 questions.The questionnaire was given to a sample of 677 patientsattended in the hospital Gregorio Marañón outpatient clinics.The psychometric properties of the questionnaire wereestablished: construct validity, concurrent criterion validity,predictive capacity and internal consistency.Results: Two dimensions were identified in the constructvalidity analyses, explaining 63% of the variance: “clinicalquality” and “administrative quality”. The concurrent validityanalysis showed a Spearman’s rank correlation coefficient of0.85 related to the standard criterion “global satisfaction withthe attention provided in outpatient clinics” and an OR of 1.19related to the criterion “do you know the name of the physicianwho attended you?” The predictive capacity of the questionnairewas measured by discriminated analysis, obtaining 84% ofcorrect classified, and the internal consistency test gave aCronbach´s alpha of 0.90.Conclusions: Our questionnaire has enough psychometricproperties to be considered an useful and feasible tool tomeasure the satisfaction of patients of the hospital outpatientclinics(AU)

Caídas en el hospital: registro del año 2005 / In-hospital falls: register for 2005

Objetivos: Describir la incidencia de caídas en pacientes ingresados en el Hospital General Universitario Gregorio Marañón durante el año 2005, así como las características de éstos y del contexto en que se producen estas caídas. Material y método: Estudio descriptivo realizado en 2005. Cuando se producía una caída se recogían en una ficha prediseñada las variables referentes al estado físico y mental del paciente y su entorno. Los datos se analizaron calculando frecuencias absolutas, porcentajes, medias, desviaciones típicas, rango y mediana. Resultados: La incidencia de caídas en el año 2005 fue del 0,6%. La edad media fue de 71,4 ± 14,89 años, con más frecuencia en varones (55,4%). El 14,7% de los pacientes presentaba un antecedente de caídas en el último mes. El 65,9% se produjo en la habitación; el 69,2%, en días laborables, y el 47%, en el turno de noche. Destaca que los pacientes presentaban más frecuentemente limitaciones de la movilidad y alteración de los sentidos, y tomaban varios fármacos. El timbre inalcanzable, el calzado inadecuado y la escasa iluminación fueron las características del entorno más registradas. Conclusiones: Es importante intensificar el registro de caídas para conocer las circunstancias en que éstas se producen y así poder instaurar estrategias de prevención

Objective: To describe the incidence of falls in patients admitted to the Hospital General Universitario Gregorio Marañón in 2005 and to identify the clinical characteristics and context of these falls. Material and method: A descriptive study was carried out during 2005. When a fall was reported, variables related to the patient's physical and mental status and to the context in which the fall was produced were recorded on a predesigned sheet. Data were analyzed using absolute frequencies, proportions, means, standard deviations, median, and range. Results: The incidence of falls in 2005 was 0.6%.The mean age was 71.4 (14.89) years. Falls were more frequent among males (55.4%). Of patients who fell, 14.7% had suffered a fall in the previous month. A total of 65.9% of falls occurred inside the patient's room, 69.2% on work days and 47% in the night shift. Gait impairment, sensory defects and use of several drugs were more frequent among patients who fell. The most frequently reported environmental characteristics were an unreachable bell, unsuitable footwear, and insufficient lighting. Conclusions: Recording of falls should be increased to identify their causes and to design new prevention strategies