COVID-19: Asociación entre la clasificación de riesgo y el Modified Early Warning Score y los resultados hospitalarios / COVID-19: Association of risk classification with the Modified Early Warning Score and hospital outcomes / COVID-19: Associação da classificação de risco com o Modified Early Warning Score e os desfechos hospitalares

Objetivo: evaluar la asociación entre las categorías de clasificación de riesgo y el Modified Early Warning Score y los resultados de los pacientes con COVID-19 en el servicio de emergencia Método: estudio transversal, realizado con 372 pacientes hospitalizados con diagnóstico de COVID-19 atendidos en la Recepción con Clasificación de Riesgo en Urgencias. En este estudio, el Modified Early Warning Score de los pacientes se clasificó como sin y con deterioro clínico, de 0 a 4 y de 5 a 9, respectivamente. Se consideró que había deterioro clínico cuando presentaban insuficiencia respiratoria aguda, shock y paro cardiorrespiratorio. Resultados: el Modified Early Warning Score promedio fue de 3,34. En cuanto al deterioro clínico de los pacientes, se observó que en el 43% de los casos el tiempo de deterioro fue menor a 24 horas y que el 65,9% ocurrió en urgencias. El deterioro más frecuente fue la insuficiencia respiratoria aguda (69,9%) y el resultado fue alta hospitalaria (70,3%). Conclusión: los pacientes con COVID-19 que presentaban Modified Early Warning Score 4 se asociaron a las categorías de clasificación de riesgo urgente, muy urgente y emergente y tuvieron más deterioro clínico, como insuficiencia respiratoria y shock, y murieron, lo que demuestra que el Protocolo de Clasificación de Riesgo priorizó correctamente a los pacientes con riesgo vital.

Objective: to evaluate the association of the risk classification categories with the Modified Early Warning Score and the outcomes of COVID-19 patients in the emergency service Method: a crosssectional study carried out with 372 patients hospitalized with a COVID-19 diagnosis and treated at the Risk Classification Welcoming area from the Emergency Room. In this study, the patients' Modified Early Warning Score was categorized into without and with clinical deterioration, from 0 to 4 and from 5 to 9, respectively. Clinical deterioration was considered to be acute respiratory failure, shock and cardiopulmonary arrest Results: the mean Modified Early Warning Score was 3.34. In relation to the patients' clinical deterioration, it was observed that, in 43%, the time for deterioration was less than 24 hours and that 65.9% occurred in the Emergency Room. The most frequent deterioration was acute respiratory failure (69.9%) and the outcome was hospital discharge (70.3%). Conclusion: COVID-19 patients who had a Modified Early Warning Scores > 4 were associated with the urgent, very urgent and emergency risk classification categories, had more clinical deterioration, such as respiratory failure and shock, and evolved more to death, which shows that the Risk Classification Protocol correctly prioritized patients at risk of life.

Objetivo: avaliar a associação das categorias de classificação de risco com o Modified Early Warning Score e os desfechos dos pacientes com COVID-19 no serviço de emergência Método: estudo transversal, realizado com 372 pacientes internados com diagnóstico de COVID-19 atendidos no Acolhimento com Classificação de Risco no Pronto-Atendimento. Neste estudo, o Modified Early Warning Score dos pacientes foi categorizado em sem e com deterioração clínica, de 0 a 4 e de 5 a 9, respectivamente. Foram consideradas deteriorações clínicas a insuficiência respiratória aguda, choque e parada cardiorrespiratória. Resultados: o Modified Early Warning Score médio foi de 3,34. Em relação à deterioração clínica dos pacientes, observou-se que em 43% o tempo para deterioração foi menor de 24 horas e que 65,9% delas ocorreu no pronto-socorro. A deterioração mais frequente foi a insuficiência respiratória aguda (69,9%) e o desfecho foi o de alta hospitalar (70,3%). Conclusão: pacientes com COVID-19 que tiveram Modified Early Warning Score 4 foram associados às categorias da classificação de risco urgente, muito urgente e emergente e tiveram mais deterioração clínica, como a insuficiência respiratória e o choque, e evoluíram mais a óbito, o que demonstra que o Protocolo de Classificação de Risco priorizou corretamente os pacientes com risco de vida.

COVID-19: Association of risk classification with the Modified Early Warning Score and hospital outcomes. / COVID-19: Asociación entre la clasificación de riesgo y el Modified Early Warning Score y los resultados hospitalarios.

OBJECTIVE: to evaluate the association of the risk classification categories with the Modified Early Warning Score and the outcomes of COVID-19 patients in the emergency service. METHOD: a crosssectional study carried out with 372 patients hospitalized with a COVID-19 diagnosis and treated at the Risk Classification Welcoming area from the Emergency Room. In this study, the patients' Modified Early Warning Score was categorized into without and with clinical deterioration, from 0 to 4 and from 5 to 9, respectively. Clinical deterioration was considered to be acute respiratory failure, shock and cardiopulmonary arrest. RESULTS: the mean Modified Early Warning Score was 3.34. In relation to the patients' clinical deterioration, it was observed that, in 43%, the time for deterioration was less than 24 hours and that 65.9% occurred in the Emergency Room. The most frequent deterioration was acute respiratory failure (69.9%) and the outcome was hospital discharge (70.3%). CONCLUSION: COVID-19 patients who had a Modified Early Warning Scores > 4 were associated with the urgent, very urgent and emergency risk classification categories, had more clinical deterioration, such as respiratory failure and shock, and evolved more to death, which shows that the Risk Classification Protocol correctly prioritized patients at risk of life.

In-hospital complications after trauma due to road traffic accidents.

PURPOSE: The study aimed to verify the association between in-hospital complications and characterization and clinical variables including hospital care and trauma severity. METHODS: This analysis with the prospective cohort data was conducted at a municipal hospital in São Paulo, Brazil, and included participants aged 14 years or older, with traumatic injuries from traffic accidents. Data was collected from January 2015 to July 2016 and included demographics variables, type of traumatic event, clinical parameters, length of stay in the Emergency department and in the Intensive Care Unit, length of hospital stay, survival probability, trauma severity and mortality. RESULTS: Of the 327 patients, 25.1% had in-hospital complications and their occurrence was statistically associated with higher mean age, run-overs and higher trauma severity. The length of stay in the emergency room, hospital stay, ICU stay, percentage of deaths, and hospital readmission were higher in patients with complications. The number of complications was correlated with trauma severity, ICU stay, and mortality. CONCLUSION: Complications were associated with older age, run-overs, greater trauma severity, length of stay and readmission after hospital discharge.

Fatores relacionados à sobrecarga e ao autocuidado para hipertensão em cuidadores familiares / Factors related to burden and self-care for hypertension in family caregivers / Factores relacionados con la carga y el autocuidado de la hipertensión en cuidadores familiares

RESUMO Objetivo: identificar os fatores relacionados à sobrecarga e ao autocuidado para hipertensão em cuidadores familiares. Método: pesquisa online e transversal, com 68 cuidadores familiares de pessoas idosas, realizada entre dezembro de 2021 e fevereiro de 2022, no Brasil. Foram aplicados questionários sobre atividade de cuidador, Questionário de Avaliação da Sobrecarga do Cuidador Informal e Escala Autocuidado de Hipertensão. Foram realizadas análises descritivas e analíticas. Resultados: cuidadores que residiam com idoso (p=0,0006) e sem dia de descanso (p=0,0097) apresentaram maior sobrecarga. Quanto maior o tempo como cuidador (p=0,0411), menor o escore do domínio medidas de manejo do autocuidado durante a descompensação pressórica. Cuidadores que recebiam auxílio de outra pessoa (p=0,0379) apresentaram maior escore no domínio grau de confiança do paciente para o autocuidado relacionado à hipertensão. Conclusão: este estudo contribui para maior compreensão das variáveis referentes à atividade de cuidador relacionada à sobrecarga e ao autocuidado para hipertensão de cuidadores de pessoas idosas.

ABSTRACT Objective: To identify factors related to burden and self-care for hypertension in family caregivers. Method: an online, cross-sectional survey of 68 family caregivers of elderly people, carried out between December 2021 and February 2022 in Brazil. Questionnaires on caregiver activity, the Informal Caregiver Burden Assessment Questionnaire and the Hypertension Self-Care Scale were applied. Descriptive and analytical analyses were carried out. Results: caregivers who lived with the elderly (p=0.0006) and had no rest day (p=0.0097) showed greater burden. The longer the time as a caregiver (p=0.0411), the lower the score in the domain of self-care management measures during blood pressure decompensation. Caregivers who received help from someone else (p=0.0379) had a higher score in the domain of the patient's degree of confidence in self-care related to hypertension. Conclusion: This study contributes to a better understanding of the variables relating to caregiver activity related to burden and self-care for hypertension among caregivers of elderly people.

RESUMEN Objetivo: identificar los factores relacionados con la carga y el autocuidado de la hipertensión en cuidadores familiares. Material y método: encuesta transversal online a 68 cuidadores familiares de ancianos, realizada entre diciembre de 2021 y febrero de 2022 en Brasil. Se aplicaron cuestionarios sobre la actividad del cuidador, el Cuestionario de Evaluación de la Carga del Cuidador Informal y la Escala de Autocuidado de la Hipertensión. Se realizaron análisis descriptivos y analíticos. Resultados: los cuidadores que vivían con el anciano (p=0,0006) y no tenían día de descanso (p=0,0097) mostraron mayor carga. Cuanto mayor era el tiempo como cuidador (p=0,0411), menor era la puntuación en el dominio de las medidas de gestión del autocuidado durante la descompensación por presión. Los cuidadores que recibían ayuda de otra persona (p=0,0379) tenían una puntuación más alta en el dominio del grado de confianza del paciente en el autocuidado relacionado con la hipertensión. Conclusión: Este estudio contribuye a una mayor comprensión de las variables relativas a la actividad del cuidador relacionadas con la carga y el autocuidado de la hipertensión de los cuidadores de personas mayores.

Factors associated with risk, perception and knowledge of falls in elderly people.

OBJECTIVE: To verify the factors associated with risk, perception, and knowledge of falls; and pain among older adults. METHOD: A cross-sectional study carried out in the Emergency Service of a teaching hospital in the city of São Paulo between September 2019 and March 2020. We selected 197 older adults aged 65 and over, who were not disoriented or confused, of both genders. The instruments Awareness Questionnaire on the Risk of Falls, Morse Fall Scale and Numerical Pain Scales were applied. Mann-Whitney and Kruskal-Wallis tests were used. RESULTS: Interviewees with a high risk of falls in older adults (p = 0.0041); those with a support network had a lower perception and knowledge about the risk of falls (p = 0.0025) and lower percentage of severe pain (p = 0.0033). CONCLUSION: Factors associated with risk, perception and knowledge of falls and pain among older adults were age, family income, number of dependents, caregiver, support network, hypertension, impaired walking, antihypertensive medication, lipid-lowering medication, level of education, comorbidities and religion.

Association of the Charlson index with risk classification, clinical aspects, and emergency outcomes.

OBJECTIVE: To exam the association of the age-adjusted Charlson comorbidity index with the categories of risk classification, the clinical aspects, and the patient outcomes in the emergency department. METHOD: Cross-sectional, analytical study that analyzed the medical records of 3,624 patients seen in the emergency department. Charlson index scores greater than 2 showed a high rate of comorbidity (mortality risk). T-test and analysis of variance were applied in the analyses. RESULTS: There was a significant difference between the Charlson comorbidity index and the risk classification, with higher scores found in patients classified in the white (2.57) and red (2.06) categories. Patients with vascular, endocrine, neurological, cardiologic, or device problems, and those who underwent a head tomography had a high rate of comorbidity. In addition, those admitted, transferred, or who died in the emergency room had significantly higher index scores compared to those who were discharged from the hospital. CONCLUSION: The high rate of comorbidity was associated with the categories of risk classification, main and nonspecific complaints, performance of a head tomography, and patient outcomes in the emergency room.

Association of the Charlson index with risk classification, clinical aspects, and emergency outcomes / Asociación del índice de Charlson con clasificación de riesgo, aspectos clínicos y resultados en urgencias / Associação do índice de Charlson com classificação de risco, aspectos clínicos e desfechos na emergência

Abstract Objective: To exam the association of the age-adjusted Charlson comorbidity index with the categories of risk classification, the clinical aspects, and the patient outcomes in the emergency department. Method: Cross-sectional, analytical study that analyzed the medical records of 3,624 patients seen in the emergency department. Charlson index scores greater than 2 showed a high rate of comorbidity (mortality risk). T-test and analysis of variance were applied in the analyses. Results: There was a significant difference between the Charlson comorbidity index and the risk classification, with higher scores found in patients classified in the white (2.57) and red (2.06) categories. Patients with vascular, endocrine, neurological, cardiologic, or device problems, and those who underwent a head tomography had a high rate of comorbidity. In addition, those admitted, transferred, or who died in the emergency room had significantly higher index scores compared to those who were discharged from the hospital. Conclusion: The high rate of comorbidity was associated with the categories of risk classification, main and nonspecific complaints, performance of a head tomography, and patient outcomes in the emergency room.

RESUMO Objetivo: Verificar a associação entre o índice de comorbidade de Charlson ajustado à idade e as categorias de classificação de risco, os aspectos clínicos e os desfechos de pacientes no serviço de emergência. Método: Estudo transversal, analítico que analisou prontuários de 3.624 pacientes atendidos na emergência. Escores do índice de Charlson superiores a 2 retrataram alto índice de comorbidade (risco de mortalidade). Teste t e análise de variância foram aplicados nas análises. Resultados: Houve diferença significativa entre o índice de comorbidade de Charlson e a classificação de risco, com maiores escores encontrados nos pacientes classificados nas categorias branca (2,57) e vermelha (2,06). Pacientes com queixas vasculares, endócrinas, neurológicas, cardiológicas ou com problemas em dispositivos, e os que realizaram tomografia de crânio apresentaram alto índice de comorbidade. Ademais, os internados, transferidos ou que morreram na emergência apresentaram significativamente maiores escores do índice em comparação com os que tiveram alta hospitalar. Conclusão: O alto índice de comorbidade teve associação com as categorias da classificação de risco, queixas principais e inespecíficas, realização de tomografia de crânio e desfechos dos pacientes na emergência.

RESUMEN Objetivo: Averiguar la asociación entre el índice de comorbidad de Charlson ajustado a la edad y las categorías de clasificación de riesgo, aspectos clínicos y resultados de pacientes en servicios de urgencias. Método: Estudio transversal, analítico que analizó la historia clínica de 3.624 pacientes atendidos en urgencias. Escores del índice de Charlson superiores a 2 demostraron alto índice de comorbidad (riesgo de mortalidad). Prueba T y análisis de varianza se aplicaron en los análisis. Resultados: Hubo una diferencia significativa entre el índice de comorbidad de Charlson y la clasificación de riesgo, con escores superiores encontrados entre los pacientes de la categoría blanca (2,57) y roja (2,06). Pacientes con quejas vasculares, endocrinas, neurológicas, cardiológicas o con problemas en dispositivos, y los que realizaron tomografía de cráneo presentaron alto índice de comorbidad. Además, los ingresados transferidos o los que murieron en urgencias presentaron escores bastante superiores del índice en comparación a los que tuvieron alta. Conclusión: El alto índice de comorbidad estuvo relacionado con las categorías de la clasificación de riesgo, quejas principales e inespecíficas, realización de tomografía de cráneo y resultados de pacientes en urgencias.

Factors associated with risk, perception and knowledge of falls in elderly people / Factores asociados con riesgo, percepción y conocimiento de caídas en ancianos / Fatores associados ao risco, à percepção e ao conhecimento de quedas em idosos

ABSTRACT Objective: To verify the factors associated with risk, perception, and knowledge of falls; and pain among older adults. Method: A cross-sectional study carried out in the Emergency Service of a teaching hospital in the city of São Paulo between September 2019 and March 2020. We selected 197 older adults aged 65 and over, who were not disoriented or confused, of both genders. The instruments Awareness Questionnaire on the Risk of Falls, Morse Fall Scale and Numerical Pain Scales were applied. Mann-Whitney and Kruskal-Wallis tests were used. Results: Interviewees with a high risk of falls in older adults (p = 0.0041); those with a support network had a lower perception and knowledge about the risk of falls (p = 0.0025) and lower percentage of severe pain (p = 0.0033). Conclusion: Factors associated with risk, perception and knowledge of falls and pain among older adults were age, family income, number of dependents, caregiver, support network, hypertension, impaired walking, antihypertensive medication, lipid-lowering medication, level of education, comorbidities and religion.

RESUMEN Objetivo: Verificar los factores associados al riesgo, percepción y conocimiento de caídas; y dolor em ancianos em un Servicio de Urgencias. Método: Estudio transversal realizado em el Servicio de Urgencias de um hospital universitário de la ciudad de São Paulo, entre septiembre de 2019 y marzo de 2020, se seleccionó a ancianos mayores de 65 años, que no se encontraban desorientados ni confundidos. Se incluyeron 197 ancianos de ambos sexos. Se aplicaron el Falls Risk Awareness Questionnaire, la Escala de Caídas Morse y la escala numérica de dolor. Se utilizaron las pruebas de Mann-Whitney y Kruskal-Wallis. Resultados: Los entrevistados com alto riesgo de caídas eran mayores (p=0,0041), los que tenían uma red de apoyo tenían menor percepción y conocimiento del riesgo de caídas (p=0,0025) y tenían menor percentaje de dolor severo (p= 0,0033). Conclusión: Los factores asociados al riesgo, percepción y conocimiento de caídas y dolor en los ancianos fueron edad, ingresos familiares, número de dependientes, cuidador, red de apoyo, hipertensión, discapacidad para caminar, antihipertensivos, hipolipemiantes, educación, comorbilidades y religión.

RESUMO Objetivo: Verificar os fatores associados ao risco, percepção e conhecimento de quedas; e dor em idosos. Método: Estudo transversal realizado no Serviço de Emergência de um hospital de ensino da cidade de São Paulo, entre setembro de 2019 e março de 2020, selecionados 197 idosos com 65 anos ou mais, que não estavam desorientados e confusos, de ambos os sexos. Aplicou-se: Falls Risk Awareness Questionnaire, Escalas de Queda de Morse e Numérica de Dor. Utilizaram-se testes Mann-Whitney e Kruskal-Wallis. Resultados: Entrevistados com risco alto de quedas apresentaram maior idade (p=0,0041), aqueles com rede de apoio tiveram menor percepção e conhecimento do risco de queda (p=0,0025) e apresentaram menor percentual de dor intensa (p=0,0033). Conclusão: Fatores associados ao risco, percepção e conhecimento de quedas e dor em idosos foram idade, renda familiar, número de dependentes da renda, cuidador, rede de apoio, hipertensão, défice de deambulação, anti-hipertensivos, hipolipemiantes, escolaridade, comorbidades e religião.

Evaluation of the Manchester Triage System quality indicator: service time.

OBJECTIVE: to verify the conformity of the time interval between the end of the risk classification and the beginning of medical care with that recommended by the Manchester protocol and to relate the times of care and the risk categories with the outcome. METHOD: Cross-sectional, retrospective, and analytical study. The t test, the analysis of variance and the generalized linear model were used. RESULTS: The average time for medical care in the red and orange categories was 3 and 39.5 minutes, respectively. Death outcome was associated with the red category, with an average time to start the classification of 5.5 minutes and an average length of stay of 2.3 hours. CONCLUSION: The waiting time for medical care in the high priority categories was longer than recommended, which suggests the need to continuously monitor the system. Shorter waiting times for classification and permanence were related to the red category and the outcome of death.

Manchester Triage System: assessment in an emergency hospital service.

OBJECTIVES: to analyze demographic data, clinical profile and outcomes of patients in emergency services according to Manchester Triage System's priority level. METHODS: a cross-sectional, analytical study, carried out with 3,624 medical records. For statistical analysis, the Chi-Square Test was used. RESULTS: white individuals were more advanced in age. In the red and white categories, there was a higher percentage of men when compared to women (p=0.0018) and higher prevalence of personal history. Yellow priority patients had higher percentage of pain (p<0.0001). Those in red category had a higher frequency of altered vital signs, external causes, and death outcome. There was a higher percentage of exams performed and hospitalization in the orange category. Blue priority patients had a higher percentage of non-specific complaints and dismissal after risk stratification. CONCLUSIONS: a higher percentage of altered vital signs, number of tests performed, hospitalization and death were evidenced in Manchester protocol's high priority categories.

Construction and validation of an in-hospital transport simulation scenario.

OBJECTIVE: To build and validate the content of a clinical simulation scenario for teaching in-hospital transport of critically ill patients. METHODS: A descriptive study of construction and validation of a clinical simulation scenario for teaching in-hospital transport. A scenario based on the literature was built, followed by validation, using the Delphi technique, by five specialists, with an agreement of 80%. The experts were selected through snowball sampling. An instrument was developed containing 26 topics to be assessed for relevance, clarity, objectivity, feasibility, current content, vocabulary, and a field for observations. RESULTS: Two rounds were carried out by the specialists to reach a consensus of 80%. According to the experts´ recommendation, the initial scenario was written more clearly and objectively, and divided into two parts: patient preparation and patient transport. CONCLUSION: In this study, the construction and validation of the scenario for teaching in-hospital transport were successfully performed. It may be applied in several services to evaluate the training of nursing undergraduate students, as well as for the professional improvement of those who work in the in-hospital transport service.

Rastreamento de violência contra pessoas idosas: associação com estresse percebido e sintomas depressivos em idosos hospitalizados / Detección de violencia contra personas mayores: asociación con estrés percibido y síntomas depresivos en ancianos hospitalizados / Violence against elderly people screening: association with perceived stress and depressive symptoms in hospitalized elderly

Resumo Objetivo Avaliar a prevalência e fatores associados à violência em idosos hospitalizados. Método Estudo transversal realizado com 100 idosos internados. Aplicaram-se os instrumentos: H-S/EAST, Escala de Estresse Percebido e Escala de Depressão Geriátrica. Utilizou-se análise descritiva para a caracterização sociodemográfica e clínica. Para associar a idade ao H-S/EAST foi utilizado o teste de Mann-Whitney; estresse percebido com o H-S/EAST foi utilizado o teste T, e sintomas depressivos com o H-S/EAST foi utilizado o teste da Razão Verossimilhança. Resultados A média de idade dos idosos foi 70,39 e 56,0%, houve risco aumentado para violação de direitos pessoais, características de vulnerabilidade e situações potencialmente abusivas. Os fatores associados ao risco aumentado para violação de direitos pessoais ou abuso direto nos idosos foram maior idade, apresentar estresse percebido e ter sintomas de depressão leve a severa. Conclusão e implicação para a prática Esses resultados mostram, portanto, a importância da observação atenta do idoso por parte do enfermeiro para permitir a identificação do risco para violência ou violação de direitos. O que possibilita estabelecer ações preventivas, coordenadas com a participação dos demais profissionais bem como o encaminhamento correto de cada situação, cumprimento do dever legal da profissão e do papel cidadão.

Resumen Objetivo Evaluar la prevalencia y los factores asociados a la violencia en los ancianos hospitalizados. Método estudio transversal con 100 ancianos hospitalizados. Se aplicaron los instrumentos: H-S / EAST, Escala de estrés percibido y Escala de depresión geriátrica. Se utilizó el análisis descriptivo para la caracterización sociodemográfica y clínica. Para asociar la edad con el H-S / EAST, se utilizó la prueba de Mann-Whitney; estrés percibido con el H-S / EAST se utilizó la prueba T; y los síntomas depresivos con el H-S / EAST se utilizó la prueba de relación de probabilidad. Resultados La edad promedio de los ancianos era de 70,39 y el 56,0%, había un mayor riesgo de violación de los derechos personales, características de vulnerabilidad y situaciones potencialmente abusivas. Los factores asociados con un mayor riesgo de violación de los derechos personales en los ancianos fueron la edad más avanzada, el estrés percibido y los síntomas de depresión de leve a severa. Conclusión e implicación para la práctica Estos resultados muestran, por lo tanto, la importancia de la observación cuidadosa de los ancianos por parte de la enfermera para permitir la identificación del riesgo de violencia o violación de los derechos. Esto permite establecer acciones preventivas, coordinadas con la participación de los demás profesionales, así como la derivación correcta de cada situación, el cumplimiento del deber legal de la profesión y el rol ciudadano.

Abstract Objective To assess the prevalence and factors associated with violence in hospitalized elderly. Method Cross-sectional study conducted with 100 hospitalized elderly. The following instruments were applied: H-S / EAST, Perceived Stress Scale and Geriatric Depression Scale. Descriptive analysis was used for the sociodemographic and clinic characteristics. To associate age with H-S / EAST, the Mann-Whitney test was used; perceived stress with H-S / EAST the T test was used; and depressive symptoms with H-S / EAST the Likelihood Ratio test was used. Results The average age of the elderly was 70.39 and 56.0%, there was an increased risk for violation of personal rights, characteristics of vulnerability and potentially abusive situations. The factors associated with increased risk for violation of personal rights or direct abuse in the elderly were older age, perceived stress and symptoms of mild to severe depression. Conclusion and implication for practice These results show, the importance of careful observation of the elderly by the nurse to allow the identification of risk for violence or violation of rights. This allows establishing preventive actions, coordinated with the participation of other professionals as well as the correct referral of each situation, compliance with the legal duty of the profession and the citizen role.

Evaluation of the Manchester Triage System quality indicator: service time / Evaluación del indicador de calidad del Sistema de Triaje Manchester: tiempo de servicio / Avaliação do indicador de qualidade do Sistema de Triagem de Manchester: tempo de atendimento

ABSTRACT Objective: to verify the conformity of the time interval between the end of the risk classification and the beginning of medical care with that recommended by the Manchester protocol and to relate the times of care and the risk categories with the outcome. Method: Cross-sectional, retrospective, and analytical study. The t test, the analysis of variance and the generalized linear model were used. Results: The average time for medical care in the red and orange categories was 3 and 39.5 minutes, respectively. Death outcome was associated with the red category, with an average time to start the classification of 5.5 minutes and an average length of stay of 2.3 hours. Conclusion: The waiting time for medical care in the high priority categories was longer than recommended, which suggests the need to continuously monitor the system. Shorter waiting times for classification and permanence were related to the red category and the outcome of death.

RESUMEN Objetivo: Verificar el cumplimiento del intervalo de tiempo entre el final de la clasificación de riesgo y el inicio de la atención médica con el recomendado por el protocolo de Manchester y relacionar los tiempos de atención y las categorías de riesgo con el resultado. Método: Estudio transversal, retrospectivo y analítico. Se utilizó la prueba t, el análisis de varianza y el modelo lineal generalizado. Resultados: El tiempo promedio de atención médica en las categorías rojo y naranja fue de 3 y 39,5 minutos, respectivamente. El resultado de la muerte se asoció con la categoría roja, con un tiempo promedio para iniciar la clasificación de 5,5 minutos y una estancia promedio de 2,3 horas. Conclusión: El tiempo de espera para la atención médica en las categorías de alta prioridad fue mayor al recomendado, lo que sugiere la necesidad de monitorear continuamente el sistema. Los tiempos de espera más cortos para la clasificación y la permanencia se relacionaron con la categoría roja y el resultado de la muerte.

RESUMO Objetivo: Verificar a conformidade do intervalo de tempo entre o término da classificação de risco e o início do atendimento médico com o recomendado pelo protocolo de Manchester e relacionar os tempos de atendimento e as categorias de risco com o desfecho. Método: Estudo transversal, retrospectivo e analítico. Foram utilizados o testet, a análise de variância e o modelo linear generalizado. Resultados: O tempo médio para atendimento médico nas categorias vermelha e laranja foi de 3 e 39,5 minutos, respectivamente. Desfecho óbito associou-se à categoria vermelha, com tempo médio para início da classificação de 5,5 minutos e tempo médio de permanência de 2,3 horas. Conclusão: O tempo de espera para atendimento médico nas categorias de alta prioridade foi maior que recomendado, o que sugere a necessidade de monitorar continuamente o sistema. Menores tempos de espera para a classificação e de permanência relacionaram-se à categoria vermelha e ao desfecho óbito.

Construction and validation of an in-hospital transport simulation scenario / Construção e validação de cenário de simulação de transporte intra-hospitalar

ABSTRACT Objective To build and validate the content of a clinical simulation scenario for teaching in-hospital transport of critically ill patients. Methods A descriptive study of construction and validation of a clinical simulation scenario for teaching in-hospital transport. A scenario based on the literature was built, followed by validation, using the Delphi technique, by five specialists, with an agreement of 80%. The experts were selected through snowball sampling. An instrument was developed containing 26 topics to be assessed for relevance, clarity, objectivity, feasibility, current content, vocabulary, and a field for observations. Results Two rounds were carried out by the specialists to reach a consensus of 80%. According to the experts´ recommendation, the initial scenario was written more clearly and objectively, and divided into two parts: patient preparation and patient transport. Conclusion In this study, the construction and validation of the scenario for teaching in-hospital transport were successfully performed. It may be applied in several services to evaluate the training of nursing undergraduate students, as well as for the professional improvement of those who work in the in-hospital transport service.

RESUMO Objetivo Construir e validar o conteúdo de um cenário de simulação clínica para ensino do transporte intra-hospitalar de pacientes críticos. Métodos Estudo descritivo de construção e validação de um cenário de simulação clínica para o ensino de transporte intra-hospitalar. Foi construído um cenário fundamentado na literatura seguido da validação, por meio da técnica Delphi, por cinco especialistas, com nível de concordância de 80%. Os especialistas foram selecionados por meio da amostragem do tipo bola de neve. Foi desenvolvido um instrumento contendo 26 tópicos, para serem avaliados quanto a pertinência, clareza, objetividade, exequibilidade, conteúdo atual e vocabulário. Havia ainda um campo para observações. Resultados Foram realizadas duas rodadas pelos especialistas para a obtenção de consenso de 80%. De acordo com a recomendação dos especialistas, o cenário inicial foi escrito de forma mais clara e objetiva, e divido em duas partes: preparo do paciente e transporte do paciente. Conclusão Neste estudo, foram realizadas, com êxito, a construção e a validação do cenário para ensino do transporte intra-hospitalar. Ele poderá ser aplicado em diversos serviços para avaliação da formação dos graduandos de enfermagem, assim como para aprimoramento profissional daqueles que atuam no serviço de transporte intra-hospitalar.

Manchester Triage System: assessment in an emergency hospital service / Sistema de Triaje Manchester: evaluación en un servicio hospitalario de emergencia / Sistema de Triagem de Manchester: avaliação em um serviço hospitalar de emergência

ABSTRACT Objectives: to analyze demographic data, clinical profile and outcomes of patients in emergency services according to Manchester Triage System's priority level. Methods: a cross-sectional, analytical study, carried out with 3,624 medical records. For statistical analysis, the Chi-Square Test was used. Results: white individuals were more advanced in age. In the red and white categories, there was a higher percentage of men when compared to women (p=0.0018) and higher prevalence of personal history. Yellow priority patients had higher percentage of pain (p<0.0001). Those in red category had a higher frequency of altered vital signs, external causes, and death outcome. There was a higher percentage of exams performed and hospitalization in the orange category. Blue priority patients had a higher percentage of non-specific complaints and dismissal after risk stratification. Conclusions: a higher percentage of altered vital signs, number of tests performed, hospitalization and death were evidenced in Manchester protocol's high priority categories.

RESUMEN Objetivos: analizar datos demográficos, perfil clínico y evolución de los pacientes en los servicios de urgencias según el nivel de prioridad del Sistema de Triaje Manchester. Métodos: estudio transversal, analítico, realizado con 3.624 historias clínicas. Para el análisis estadístico se utilizó la Prueba de Chi-Cuadrado. Resultados: los individuos de la categoría blanca tenían una edad más avanzada. En las categorías rojo y blanco, hubo un mayor porcentaje de hombres en comparación con las mujeres (p=0,0018) y una mayor prevalencia de antecedentes personales. Los pacientes con prioridad amarilla tenían un mayor porcentaje de dolor (p<0,0001). Aquellos en la categoría roja tenían una mayor frecuencia de signos vitales alterados, causas externas y resultado de muerte. Hubo un mayor porcentaje de exámenes realizados y hospitalización en la categoría naranja. Los pacientes con prioridad azul tuvieron un mayor porcentaje de quejas inespecíficas y despidos después de la clasificación de riesgo. Conclusiones: se encontró un mayor porcentaje de signos vitales alterados, número de pruebas realizadas, hospitalización y muerte en las categorías de alta prioridad del protocolo de Manchester.

RESUMO Objetivos: analisar os dados demográficos, perfil clínico e desfechos de pacientes em serviço de emergência segundo o nível de prioridade do Sistema de Triagem de Manchester. Métodos: estudo transversal, analítico, realizado com 3.624 prontuários. Para análise estatística, utilizou-se o Teste Qui-Quadrado. Resultados: indivíduos da categoria branca apresentaram idade mais avançada. Nas categorias vermelha e branca, observou-se um maior percentual de homens quando comparados às mulheres (p=0,0018) e maior prevalência de antecedentes pessoais. Pacientes com prioridade amarela apresentaram maior percentual de dor (p<0,0001). Aqueles da categoria vermelha tiveram maior frequência de sinais vitais alterados, causas externas e desfecho óbito. Houve maior percentual de exames realizados e internação na categoria laranja. Pacientes com prioridade azul apresentaram maior percentual de queixas inespecíficas e dispensa após classificação de risco. Conclusões: foi evidenciado maior percentual de sinais vitais alterados, número de exames realizados, internação e óbito nas categorias de alta prioridade do protocolo de Manchester.

Functional capacity and quality of life of elderly people admitted to emergency service. / Capacidade funcional e qualidade de vida de pessoas idosas internadas no serviço de emergência.

OBJECTIVE: To correlate the functional capacity and quality of life of elderly people admitted to emergency service. METHOD: This is a cross-sectional and analytical study carried out with elderly patients admitted to a university hospital's emergency service in the city of São Paulo, between December 2015 and January 2017. Data were collected through interviews using a structured questionnaire, the Medical Outcome Study 36, the Katz of Independence in Activities of Daily Living, and the Functional Independence Measure. RESULTS: Two hundred fifty elderly people with a mean age of 71.9 years, male (56.8%), white in color (67.2%), married (54.0%), with low education (32.0%), low income (58.0%), with comorbidities (81.2%) and home providers (53.6%) have participated. The most compromised Quality of Life dimensions were physical aspect (11.4%), emotional aspect (21.6%) and functional capacity (25.2%). Concerning functional capacity, independence was characterized for Basic Activities of Daily Living and moderate dependence for Instrumental Activities of Daily Living. The higher the scores of the Functional Independence Measure, the higher the quality of life scores. CONCLUSION: The more independent the elderly the better their quality of life.

Quality of life and burden of caregivers of elderly people / Calidad de vida y sobrecarga de cuidadores de ancianos / Qualidade de vida e sobrecarga de cuidadores de idosos

ABSTRACT Objective: to assess caregivers' quality of life and correlate it with elderly people's quality of life, as well as assess the burden of caregivers of elderly people hospitalized in an Emergency Service and correlate it with their quality of life. Method: this is a cross-sectional and analytical study conducted with 250 caregivers of elderly patients admitted to the Emergency Service of Hospital São Paulo, Brazil, from December 2015 to January 2017. To assess caregivers' quality of life, the generic Short-Form-36 questionnaire, item short-form health survey was used; burden was assessed using the Zarit Burden Interview. Results: the mean age was 48.36 years, with a predominance of females, most of whon were elderly people's children. Caregivers showed mild to moderate burden, and in quality of life assessment, the most compromised domains were general health status, vitality, and social aspects. The Short-Form-36 dimensions that had a significant correlation with Zarit Burden Interview scores were physical aspect, general health status, vitality, social aspects, and emotional aspect. Conclusion: caregivers' quality of live is associated with elderly people's quality of life. Burden is related to the worsening quality of life of caregivers. It is necessary to identify the work demands and specific needs of caregivers of elderly people in order to develop care strategies involving this population.

RESUMEN Objetivo: evaluar la calidad de vida del cuidador y correlacionarla con la calidad de vida del anciano, así como evaluar la carga del cuidador de los ancianos hospitalizados en el Servicio de Urgencias y correlacionarla con su calidad de vida. Método: estudio transversal y analítico con 250 cuidadores de ancianos ingresados en el Servicio de Urgencias del Hospital São Paulo, Brasil, de diciembre de 2015 a enero de 2017. Para evaluar la calidad de vida de los cuidadores se utilizó el cuestionario encuesta de salud genérica Short-Form-36, item short-form; La sobrecarga se evaluó mediante la escala Zarit Burden Interview. Resultados: la edad promedio fue de 48,36 años, con predominio del sexo femenino, siendo la mayoría hijas de ancianos. Los cuidadores mostraron sobrecarga leve a moderada y en la evaluación de la calidad de vida, los dominios más comprometidos fueron: estado general de salud, vitalidad y aspectos sociales. Las dimensiones del Short-Form-36 que tuvieron una correlación significativa con los puntajes de la entrevista Zarit Burden Interview fueron aspecto físico, estado general de salud, vitalidad, aspectos sociales y aspecto emocional. Conclusión: la calidad de vida del cuidador está asociada con la calidad de vida del anciano. La carga está relacionada con el empeoramiento de la calidad de vida del cuidador. Es necesario identificar las demandas laborales y necesidades específicas del cuidador de ancianos para la elaboración de estrategias de cuidado que contemplen esta población.

RESUMO Objetivo: avaliar a qualidade de vida do cuidador e correlacioná-la com a qualidade de vida do idoso, bem como avaliar a sobrecarga do cuidador de idosos internados no Serviço de Emergência e correlacioná-la com sua qualidade de vida. Método: estudo transversal e analítico, com 250 cuidadores de idosos internados no Serviço de Emergência do Hospital São Paulo, Brasil, de dezembro de 2015 a janeiro de 2017. Para a avaliação da qualidade de vida dos cuidadores, utilizou-se o questionário genérico Short-Form-36, item short-form health survey; a sobrecarga foi avaliada por meio da escala Zarit Burden Interview. Resultados: a idade média foi 48,36 anos, com predomínio do sexo feminino, sendo a maioria filhas dos idosos. Os cuidadores apresentaram sobrecarga leve à moderada e na avaliação da qualidade de vida, os domínios mais comprometidos foram: estado geral da saúde, vitalidade e aspectos sociais. As dimensões do Short-Form-36 que tiveram correlação significativa com os escores da Zarit Burden Interview foram aspecto físico, estado geral de saúde, vitalidade, aspectos sociais e aspecto emocional. Conclusão: a qualidade de vida do cuidador está associada com a qualidade de vida do idoso. A sobrecarga está relacionada com a piora na qualidade de vida do cuidador. Faz-se necessário identificar as demandas de trabalho e necessidades específicas do cuidador de idosos para elaboração de estratégias de cuidado que contemplem essa população.

The association between burn and trauma severity and in-hospital complications.

OBJECTIVE: The aim of this study was to analyze the association between in-hospital complications and burn and trauma severity, inhalation injury, length of intensive care unit and hospital stay, and mortality in burned patients. METHOD: This observational and retrospective study included 68 burn patients hospitalized in a university hospital located in São Paulo, Brazil. The severity of the burn injury and trauma were measured by means of Abbreviated Injury Scale and the Injury Severity Score, respectively. Thecomplications were considered as a dependent variable. The statistical analysis for continuous variables was performed using the Student's t or the Mann-Whitney test and for categorical variables the Chi-square test, Fisher's Exact or Verisimilitude Ratio test, considering a significance level of 5%. RESULTS: The majority (60.3%) of patients had complications, and among them, those with infections were the most frequent (70.7%). Burned patients with complications had higher burn injury severity, were hospitalized for longer and their mortality was higher. Cardiovascular complications were associated with severe burns and mortality; infectious ones with a larger length of hospitalization. CONCLUSION: Complications are frequent in patients with severe burns and inhalation injuries, increasing length of hospital stay and mortality. Burn studies measuring severity of thermal and inhalation injuries and other associated traumas allow to expand the analysis of burned patients.