Código Sepsis Interhospitalario en Catalunya: modelo organizativo territorial para la atención inicial al paciente con sepsis / Interhospital Sepsis Code in Catalonia (Spain): Territorial model for initial care of patients with sepsis

La sepsis es una entidad sindrómica de elevada prevalencia y mortalidad. Su manejo está estandarizado y tiene una eficacia dependiente del tiempo. Sin embargo, el manejo de los pacientes con sepsis es complejo. La heterogeneidad de las formas de presentación puede dificultar su detección y manejo, así como las diferencias en formación, competencias o disponibilidad de recursos sanitarios. La Comisión Asesora para la Atención al PAciente con Sepsis (CAAPAS), formada por 7 sociedades científicas, el Sistema de Emergencias Médicas (SEM) y el Servei Català de la Salut (CatSalut), han desarrollado en Catalunya el Código Sepsis Interhospitalario (CSI). El objetivo general del CSI es facilitar la detección precoz, la atención inicial y la coordinación interhospitalaria para optimizar el tratamiento de los pacientes con sepsis o shock séptico en formato código de riesgo vital, de forma homogénea a lo largo de todo el territorio catalán

Sepsis is a syndromic entity with high prevalence and mortality. The management of sepsis is standardized and exhibits time-dependent efficiency. However, the management of patients with sepsis is complex. The heterogeneity of the forms of presentation can make it difficult to detect and manage such cases, in the same way as differences in training, professional competences or the availability of health resources. The Advisory Commission for Patient Care with Sepsis (CAAPAS), comprising 7 scientific societies, the Emergency Medical System (SEM) and the Catalan Health Service (CatSalut), have developed the Interhospital Sepsis Code (CSI) in Catalonia (Spain). The general objective of the CSI is to increase awareness, promote early detection and facilitate initial care and interhospital coordination to attend septic patients in a homogeneous manner throughout Catalonia

Interhospital Sepsis Code in Catalonia (Spain): Territorial model for initial care of patients with sepsis. / Código Sepsis Interhospitalario en Catalunya: modelo organizativo territorial para la atención inicial al paciente con sepsis.

Sepsis is a syndromic entity with high prevalence and mortality. The management of sepsis is standardized and exhibits time-dependent efficiency. However, the management of patients with sepsis is complex. The heterogeneity of the forms of presentation can make it difficult to detect and manage such cases, in the same way as differences in training, professional competences or the availability of health resources. The Advisory Commission for Patient Care with Sepsis (CAAPAS), comprising 7 scientific societies, the Emergency Medical System (SEM) and the Catalan Health Service (CatSalut), have developed the Interhospital Sepsis Code (CSI) in Catalonia (Spain). The general objective of the CSI is to increase awareness, promote early detection and facilitate initial care and interhospital coordination to attend septic patients in a homogeneous manner throughout Catalonia.

Un año de registro de traumatismos graves en Cataluña. Análisis de los primeros resultados / TraumCat: preliminary analysis of a year of severe trauma registry in Catalonia

Objetivo: Evaluar los resultados del primer año de implantación de un registro poblacional hospitalario de traumatismos graves en Cataluña (TraumCat). Método: Un total de 15 hospitales han recogido de forma prospectiva información sobre pacientes traumáticos graves, adultos y pediátricos (menores de 16 años), durante un periodo de un año (del 1 julio 2012 al 1 julio 2013) y la han introducido en un registro informatizado accesible en red. Resultados: Se han registrado 1.106 casos de pacientes con traumatismos de alta energía(12,2% en menores de 16 años). Un 84% de los traumatismos fueron no intencionales en adultos jóvenes. El 54,4% de los traumatismos se originaron en accidentes de circulación y el26,9% en precipitaciones. Un 5,4% correspondían a agresiones. Un 46% de pacientes presentaban un ISS mayor a 15, mientras que el NISS era mayor a 15 en un 51%. La tasa media de mortalidad fue del 10%. Sin embargo, en mayores de 60 años la tasa alcanzó el 25,2%.Conclusiones: TraumCat permite conocer la dimensión y evaluar el proceso asistencial en torno al traumatismo grave en Cataluña. Es preciso avanzar en la consolidación y mejora de esta herramienta como estrategia de monitorización del proceso asistencial y análisis de resultados (AU)

Objective: To analyze results of the first year’s use of the Hospital Population-Based Registry of Severe Trauma in Catalonia (TraumCat).Methods: Fifteen hospitals prospectively collected information on adults and children (< 16 years of age) with severetrauma for 1 year (July 1, 2012 to July 1, 2013). The information was stored in an online database. Results: The registry received 1106 cases of high-energy trauma (12.2% under the age of 16 years) were registered. Eight-four percent of the injuries in young adults were accidental; in the full cohort, 54.4% of the patients were injured in traffic accidents and 26.9% in falls. Personal violence accounted for 5.4%. The Injury Severity Score was over 15 in46% of the patients, and the New Injury Severity Score was over 15 in 51%. Mortality was 10% overall, but in patients aged over 60 years, mortality was 25.2%.Conclusions: TraumCat reveals the scope of severe trauma in Catalonia and facilitates analysis of the process of treatment of these injuries. This tool should be more firmly established and improved as a strategy for monitoring trauma care and outcomes (AU)

Códigos de activación: pasado, presente y futuro en España / Response protocols: their past, present, and future in Spain

Las estrategias de coordinación entre niveles asistenciales son relativamente recientes. Una de las consecuencias más visibles de esta coordinación son los códigos de activación, los cuales son potencialmente aplicables a toda patología tiempo-dependiente. En España, el código de activación más antiguo es el código ictus, iniciado en 1997, y cuya implantación se ha generalizado y ha permitido mejorar el pronóstico de los pacientes con un accidente vascular cerebral. A éste le han sucedido, en algunas ciudades, otros como el código donante a corazón parado o el código IAM (infarto agudo de miocardio), con los que también se está obteniendo unos buenos resultados. El código sepsis, en cambio, se ha encontrado con la dificultad específica de su bajo reconocimiento clínico en las primeras horas de asistencia por parte de los servicios de urgencias y los de emergencias, lo cual está limitando sus resultados. Finalmente, y por razones diversas, no ha sido posible poner en marcha códigos de activación en otras situaciones que potencialmente podrían beneficiarse de ellos, como son la intoxicación aguda o el paciente agitado. En cualquier caso, no hay que caer en la tentación de codificar la totalidad de la asistencia, ya que ello debilitaría el concepto de agilidad que se les supone a los códigos. Además, debe tenerse en cuenta que el nivel de calidad asistencial no depende de la activación o no de un código, sino que dicho código es un aspecto cualitativo más en determinadas situaciones clínicas que lo requieren. Creemos que el futuro de los códigos de activación pasa por consolidar los proyectos existentes, mejorar los registros, plantear nuevos proyectos y publicar sus resultados (AU)

Coordination between levels of health care is a relatively recent phenomenon. Response protocols, which are potentially applicable to all conditions requiring a prompt response, are among the most visible consequences of such coordination The response protocol with the longest history in Spain is the stroke code. Introduced in 1997, this code is now used throughout the country and has improved prognosis in this clinical setting. Some city health care systems have since adopted, with good results , codes for managing non heart-beating donors or acute myocardial infarction. The code for sepsis, on the other hand, has met with the difficulty that clinical recognition is not high in the first few hours of response by emergency services, and outcomes have therefore suffered. Finally, protocols that might potentially benefit patients with other conditions have not been put into practice for a variety of reasons. Examples are one for acute poisoning and another for managing the agitated patient. It is essential, however, to avoid trying to codify all health care responses given that the agility that codes presuppose would suffer. Furthermore, it is important to bear in mind that health care quality does not depend on whether a code is activated or not; instead, a code is one of many quality-related features to consider in the specific clinical situations that call for one. We believe that the future should focus on consolidating our experience with existing codes and on improving registries. New projects should be suggested and results studied and published (AU)

Códigos de activación en urgencias y emergencias. La utilidad de priorizar / Activation codes in urgency and emergency care. The utility of prioritising

Las patologías «tiempo-dependientes», entendiendocomo tales aquéllas en las que el retraso diagnósticoo terapéutico influye negativamente en la evolución yel pronóstico del proceso, son consideradas críticas enlas emergencias, ya que su morbimortalidad está directamenterelacionada con la demora en iniciar el tratamiento.Ejemplos de este tipo de patología existen enla práctica clínica habitual, desde la actuación ante laparada cardiorrespiratoria, continuando con el pacienteque sufre un accidente vascular cerebral, un politraumatismo,un síndrome coronario agudo o una sepsis.La creación de sistemas de coordinación entre nivelesasistenciales de diferente complejidad ha posibilitadola implantación y, finalmente, la consolidación de unosprocedimientos consensuados entre todos los profesionalessanitarios implicados en el proceso asistencialque, de forma espontánea y genérica, se han definidocomo «códigos de activación». La aparición de estos códigosaparentemente parece simple, pero se convierteen un reto. Al detectarse una emergencia, se procede alaviso del centro receptor adecuado para el paciente através de un centro coordinador de emergencias y setraslada al paciente a dicho centro.Con los códigos se busca trabajar en equipo, deforma coordinada, basado en protocolos científicosreconocidos por los implicados en la asistencia y la comunidadcientífica y evitar duplicidad de acciones y retrasosinnecesarios en las actuaciones con el paciente.En definitiva, tienen como una única finalidad trabajarconjuntamente para el beneficio del paciente(AU)

“Time-dependent” pathologies, understood as thosein which diagnostic or therapeutic delay negativelyinfluences the evolution and prognosis of a case, areconsidered to be critical in emergencies, as their morbidityand mortality is directly related to delay in startingtreatment. Examples of this type of pathology canbe found in normal clinical practice, i.e. cardiac arrest,stroke, trauma, acute coronary syndrome or sepsis.The creation of systems of coordination between carelevels involving different levels of complexity has madepossible the implementation and, finally, the consolidationof certain procedures agreed upon amongst allhealth professionals involved in the care process. Theseprocedures, in a spontaneous and generic way, havebeen defined as “activation codes”. The appearance ofthese codes apparently seems simple, but representsa challenge. On an emergency being detected, the receivingcentre appropriate for the patient is warnedthrough an emergency coordinating centre and the patientis taken to that centre.What is sought with the codes is coordinated teamwork, based on scientific protocols recognised by thoseinvolved in care and the scientific community, and avoidanceof duplicated actions and unnecessary delays inactions with the patient. In short, their single aim is jointwork in the patient’s benefit(AU)

Comparison between exclusively school teacher-based and mixed school teacher and healthcare provider-based programme on basic cardiopulmonary resuscitation for secondary schools.

OBJECTIVE: To compare two teaching methodologies for PROCES (a basic cardiopulmonary resuscitation (b-CPR) programme for secondary school students): one exclusively performed by school teachers (study group) and another by a mixed team of school teachers and healthcare providers (control group). METHODS: According to their preferences, teachers chose either method and students were consequently assigned to the control or study group. All participants took a 10 multiple-choice question exam regarding b-CPR skills twice: immediately after PROCES and one year later. Eight or more correct answers was considered satisfactory learning. Results between groups were compared. Associations between satisfactory learning and some student characteristics were analysed. RESULTS: Immediately after PROCES, 442 students (219 in the study group and 223 in the control group) took the exam. The percentage of satisfactory learning was not different: 67.1% in the study group and 64.6% in the control group. Immediate satisfactory learning was related to the absence of pending subjects in the control (odds ratio (OR) 2.31, 95% CI 1.16 to 4.64) and study (OR 5.87, 95% CI 1.22 to 28.20) groups. One year later, a greater percentage of retention of b-CRP skills was detected in the study group (57.1% vs 40.6%; p = 0.01). The absence of any pending subject (OR 6.86, 95% CI 1.83 to 25.66) was independently associated with better retention in the study group, but not the control group. CONCLUSIONS: Secondary school teachers, previously trained in b-CPR, can teach these skills effectively to 14-16-year-old students using PROCES. The retention of b-CPR skills is greater with this methodology compared with a more standardised programme.

[The prevalence of infection by the hepatitis B, C and human immunodeficiency viruses in drug users]. / Prevalencia de la infección por los virus de la hepatitis B, C e inmunodeficiencia humana en usuarios de drogas.

OBJECTIVE: Estimate the prevalence of the hepatitis B (HBV) infection, hepatitis C (HCV) and human immunodeficiency virus (HIV) and its coexistence in intravenous drug users, in order to start afterwards a vaccination and sanitary training programmes. PATIENTS AND METHODS: Intravenous drug users attended in a health centre and in the drugs addition deshabitation centre of reference located in a marginal urban quarter. Patients were detected from the health centre. During one year (June 1995-1996) facts were collected. The age, sex, consumption, type, administration mechanism and also the described serologies were analysed. It has been carried out descriptive statistics and applied the chi-square [correction of square-ji] test. RESULTS: A study of 355 patients, 295 (83.1%) males and 60 (16.9%) females was carried out. The average age was 28.6 years (SD = 6.5). All serologies in 113 (31.8%) were available. The positive serologies for HIV, 64.6% for HBV and 64.4% had 71.1% for HCV. The three of them coexisted in a 35.4% between HIV, 39.1% of them were VHB and 88% VHC. 49.1% were VHB and VHC. The infection from any of the three virus was related with intravenous administration mechanism, but not with sex or drug type. CONCLUSION: The infection caused from the virus above mentioned is frequent in drug users. A not negligible percentage of patients could benefit from the hepatitis B vaccine administration (67.6%) or other preventive measures.

[Intraparotid lymphoepithelial cysts and the human immunodeficiency virus]. / Quistes linfoepiteliales intraparotídeos y virus de la inmunodeficiencia humana.

Lymphoepithelial lesions in the parotid gland are an uncommon benign entity, with an increasing incidence since 1980 due to the involvement of HIV infected patients. We report here three cases recorded at the ORL service in Viladecans Hospital, with cytologic investigation with echo-guided fine needle aspiration. A discussion follows on the theory that these cysts are part, together with persistent polyadenopathies, of the immune response to HIV infection. The course towards malignancy is exceptional and conservative management is most accepted.