Factores pronósticos relacionados con la mortalidad del paciente con trauma grave: desde la atención prehospitalaria hasta la Unidad de Cuidados Intensivos / Prognostic factors associated with mortality in patients with severe trauma: From prehospital care to the Intensive Care Unit

OBJETIVO: Identificar los factores relacionados con la mortalidad de los pacientes adultos politraumatizados, analizar las características clínicas, epidemiológicas y terapéuticas en los niveles prehospitalario, Servicio de Urgencias y Cuidados Intensivos. DISEÑO: Estudio retrospectivo, longitudinal y descriptivo. Análisis estadístico a través del programa SPSS, MultBiplot y la metodología de minería de datos. ÁMBITO: Pacientes adultos politraumatizados ingresados en el Complejo Hospitalario de Salamanca entre los años 2006 y 2011. VARIABLES DE INTERÉS PRINCIPALES: Variables demográficas, clínicas, terapéuticas y analíticas desde el lugar del accidente hasta el ingreso en la UCI. Variables evolutivas durante el ingreso en la UCI y hasta el alta hospitalaria. RESULTADOS: Se incluyó a 497 pacientes, con una mediana de edad 45,5 años. Predominio de varones (76,7%). La causa principal del traumatismo fueron los accidentes de tráfico (56,1%), precipitaciones (18,4%) y caídas (11%). Los factores con mayor asociación a un incremento del riesgo de mortalidad (p<0,05) fueron la edad > 65 años (OR 3,15), el traumatismo craneoencefálico (OR 3,1), las alteraciones pupilares (OR 113,88), el nivel de consciencia según la escala de Glasgow ≤ 8 (OR 12,97) y las cifras de lactato > 4 mmol/L (OR 9,7). CONCLUSIONES: Los principales factores de riesgo identificados en relación con el pronóstico de los pacientes politraumatizados son los relacionados con la presencia de traumatismo craneoencefálico. Mediante la utilización de distintas técnicas estadísticas menos conocidas como la minería de datos o el MultBiplot también se destaca la importancia de otros factores como el lactato. Los registros de traumatismos ayudan a conocer la asistencia sanitaria realizada para poder establecer medidas de mejora

OBJECTIVE: To identify factors related to mortality in adult trauma patients, analyzing the clinical, epidemiological and therapeutic characteristics at the pre-hospital levels, in the Emergency Care Department and in Intensive Care. DESIGN: A retrospective, longitudinal descriptive study was carried out. Statistical analysis was performed using SPSS, MultBiplot and data mining methodology. SETTING: Adult multiple trauma patients admitted to the Salamanca Hospital Complex (Spain) from 2006 to 2011. MAIN VARIABLES OF INTEREST: Demographic variables, clinical, therapeutic and analytical data from the injury site to ICU admission. Evolution from ICU admission to hospital discharge. RESULTS: A total of 497 patients with a median age of 45.5 years were included. Males predominated (76.7%). The main causes of injury were traffic accidents (56.1%), precipitation (18.4%) and falls (11%). The factors with the strongest association to increased mortality risk (P < .05) were age > 65 years (OR 3.15), head injuries (OR 3.1), pupillary abnormalities (OR 113.88), level of consciousness according to the Glasgow Coma Scale ≤ 8 (OR 12.97), and serum lactate levels > 4 mmol/L (OR 9.7). CONCLUSIONS: The main risk factors identified in relation to the prognosis of trauma patients are referred to the presence of head injuries. Less widely known statistical techniques such as data mining or MultBiplot also underscore the importance of other factors such as lactate concentration. Trauma registries help assess the healthcare provided, with a view to adopting measures for improvement

Información, comunicación y trato en un servicio de urgencias: evaluación mediante una encuesta de opinión / Opinion survey on information, communication and treatment in an Emergency Department

Objetivo. Conocer aspectos concretos acerca de la información y la comunicación con los usuarios de los servicios de urgencias hospitalarias y el trato recibido en ellos a través de una encuesta telefónica. Métodos. Estudio prospectivo en 2 servicios de urgencias hospitalarias de Salamanca. Se incluyeron en el estudio 400 pacientes (edad media 56,4 ± 20,5 años; 58,4% mujeres). Se realizó una encuesta telefónica con 19 ítems. Doce de ellos recogían las respuestas en escala tipo Likert, con puntuaciones de 1 (muy mal) a 5 (muy bien). El resto permitían responder «sí» o «no». Resultados. El 86% de los pacientes evaluaron positivamente el trato recibido por los profesionales en general, el 92% el respeto mostrado, el 87% el trato de los médicos y el 71% el trato recibido por enfermería. El 27,5% no recuerda haber recibido información del personal del punto azul (profesionales especialmente capacitados para dar información). Se encontró significación estadística (p = 0,045) en relación a la amabilidad y respeto mostrado por enfermería. La mayoría de los pacientes que fueron ingresados en el área de observación del servicio de urgencias no fueron informados sobre los horarios de visita (p = 0,003). Conclusiones. La percepción del trato recibido por los pacientes es buena, mientras que en relación a la información y comunicación es ostensiblemente mejorable y podría ser evaluada utilizando la encuesta que proponemos, ya que permite detectar y utilizar los puntos débiles de estos aspectos de la asistencia sanitaria como lanzaderas de las iniciativas de implementación (AU)

Objective. To gather specific details about the information, communication, and treatment as regards users of hospital emergency services using a telephone survey, in order to implement improvement measures, if necessary. Methods. A prospective study was conducted in two emergency departments in Salamanca. A total of 400 patients were included in the study (mean age 56.4 ± 20.5 years, 58.4% women). A telephone survey was performed with 19 items, of which 12 required responses on a Likert-type scale, with scores of 1 (very bad) to 5 (very good). The remainder of the questions allowed to answer 'yes' or 'no'. Results. The treatment received by the professionals in general was evaluated positively by 86% of the patients; with 92% reporting they were respectful, 87% were treated by doctors and 71% received treatment from nurses. More than one-quarter (27.5%) did not recall receiving information from blue point staff (personnel specially trained to provide information. Statistical significance (P = .045) was found in relation to the kindness and respect shown by nurses. Most patients that were admitted to the observation area of the emergency department were not informed about the visiting hours (P = .003). Conclusions. Perception of care received by patients is good, while in relation to information and communication it is evidently improvable, and could be assessed using the survey that is proposed in order to detect and use the weaknesses in these aspects of health care as implementation initiatives (AU)

[Opinion survey on information, communication and treatment in an Emergency Department]. / Información, comunicación y trato en un servicio de urgencias: evaluación mediante una encuesta de opinión.

OBJECTIVE: To gather specific details about the information, communication, and treatment as regards users of hospital emergency services using a telephone survey, in order to implement improvement measures, if necessary. METHODS: A prospective study was conducted in two emergency departments in Salamanca. A total of 400 patients were included in the study (mean age 56.4±20.5years, 58.4% women). A telephone survey was performed with 19 items, of which 12 required responses on a Likert-type scale, with scores of 1 (very bad) to 5 (very good). The remainder of the questions allowed to answer "yes" or "no". RESULTS: The treatment received by the professionals in general was evaluated positively by 86% of the patients; with 92% reporting they were respectful, 87% were treated by doctors and 71% received treatment from nurses. More than one-quarter (27.5%) did not recall receiving information from blue point staff (personnel specially trained to provide information. Statistical significance (P=.045) was found in relation to the kindness and respect shown by nurses. Most patients that were admitted to the observation area of the emergency department were not informed about the visiting hours (P=.003). CONCLUSIONS: Perception of care received by patients is good, while in relation to information and communication it is evidently improvable, and could be assessed using the survey that is proposed in order to detect and use the weaknesses in these aspects of health care as implementation initiatives.

Prognostic factors associated with mortality in patients with severe trauma: from prehospital care to the Intensive Care Unit.

OBJECTIVE: To identify factors related to mortality in adult trauma patients, analyzing the clinical, epidemiological and therapeutic characteristics at the pre-hospital levels, in the Emergency Care Department and in Intensive Care. DESIGN: A retrospective, longitudinal descriptive study was carried out. Statistical analysis was performed using SPSS, MultBiplot and data mining methodology. SETTING: Adult multiple trauma patients admitted to the Salamanca Hospital Complex (Spain) from 2006 to 2011. MAIN VARIABLES OF INTEREST: Demographic variables, clinical, therapeutic and analytical data from the injury site to ICU admission. Evolution from ICU admission to hospital discharge. RESULTS: A total of 497 patients with a median age of 45.5 years were included. Males predominated (76.7%). The main causes of injury were traffic accidents (56.1%), precipitation (18.4%) and falls (11%). The factors with the strongest association to increased mortality risk (P<.05) were age > 65 years (OR 3.15), head injuries (OR 3.1), pupillary abnormalities (OR 113.88), level of consciousness according to the Glasgow Coma Scale ≤ 8 (OR 12.97), and serum lactate levels > 4 mmol/L (OR 9.7). CONCLUSIONS: The main risk factors identified in relation to the prognosis of trauma patients are referred to the presence of head injuries. Less widely known statistical techniques such as data mining or MultBiplot also underscore the importance of other factors such as lactate concentration. Trauma registries help assess the healthcare provided, with a view to adopting measures for improvement.

Results of allogeneic stem cell transplantation in the Spanish MDS registry: prognostic factors for low risk patients.

Although new agents have been approved for the treatment of MDS, the only curative approach is allogeneic hematopoietic stem cell transplantation (HSCT) and thus, in particular circumstances this procedure has been proposed as a treatment option for low risk patients. We have retrospectively analyzed the results of HSCT in 291 patients from the Spanish MDS registry with special attention to low risk MDS (LR-MDS) in order to define the variables that could impact their clinical evolution after transplantation. At 2 years OS was 51% and EFS was 50% (95% CI 0.7-4.5 years for OS and 95% CI 0.1-3.9 years for EFS). Among 43 LR-MDS, transplant-related mortality was 28%. At 3 years, OS was 67% (95% CI 264.7-8927.2 days for OS) and EFS was 64% (95% CI 0-9697.2 days for EFS). In the multivariate analysis only cytogenetics retained statistical significant effect on both OS (p=.047) and EFS (p=.046). Conditioning regimen could improve outcome among this subset of patients (OS 86% and RFS 100% for patients receiving RIC regimen). The present study confirms that specific disease characteristic as well as transplant characteristics have a significant impact on transplant outcome. Regarding low risk patients a non-myeloablative conditioning would be preferable especially in cases without high-risk cytogenetics.

Fagerström tolerance questionnaire y heavy smoking index. ¿Cuál de los dos test es suficiente para determinar la dependencia en la clínica diaria? / The Fagerström tolerance questionnaire & the heavy smoking index. Which of them is necessary to assess the dependence in the clinical practice?

Objetivo. Conocer la correlación existente entre el Fagerström Tolerance Questionnaire (FTQ) y el Heavy Smoking Index (HSI) para la valoración de la dependencia de la nicotina en la práctica clínica habitual. Métodos. Estudio prospectivo realizado durante el año 2010 en una consulta hospitalaria y en una de atención primaria. Se incluyeron en el estudio 792 fumadores, 437 (55,18%) hombres y 355 (44,82%) mujeres con una edad media de 45,3 {13} y 38,6 {11,8} años, respectivamente. Para valorar la correlación existente entre ambos test se ha utilizado el coeficiente de correlación de Spearman. Resultados. El consumo medio de cigarrillos/día fue de 25,0 y la concentración media de CO de 19,14 ppm. El valor medio del FTNC fue de 7,12 y del HSI 4,39. Ambos test presentan una alta correlación con un coeficiente de Spearman de 0,82 (p=0,000), que es significativa en los grupos con alta y baja dependencia (p=0,000), pero no en el grupo con dependencia moderada (p=0,176). La correlación en función del género fue alta tanto para hombres (r=0,771) como para mujeres (r=0,881). La correlación por grupos de edad fue alta para los tres grupos etarios estudiados: <25 años (r=0,828), 25-49 años (r=0,813) y >50 años (r=0,796). Conclusiones. Existe una buena correlación global entre el Fagerström Tolerance Questionnaire (FTQ) y el Heavy Smoking Index (HSI), que no se modifica en función de variables como edad o género. Por niveles de dependencia, la correlación es buena en pacientes con dependencia alta o moderada y no significativa en el grupo con dependencia moderada (AU)

Objective. To know what is the correlation between Fagerström Tolerance Questionnaire (FTQ) and the Heavy Smoking Index (HSI) in order to examine nicotine dependence in current clinical practice. Methods. Prospective study made in 2010’s tobacco specific medical clinic and primary care. It includes 792 smokers, 437 (55,18%) men and 355 (44,82%) women, with a mean of years old 45,3 [13] and 38,6 [11,8] respectively. In order to assess the existent correlation between both tests we used Spearman’s Correlation Coefficient. Results. The average daily consumption of cigarettes was 25.5 and the mean concentration of CO was 19.14 ppm. The mean value of FTNC was 7.12 and HSI 4.39. Both tests present a high correlation, with a Spearman coefficient of 0.82 (p=0.000). The correlation is significant in high and low dependency groups (p=0.000), but not in the group with moderate dependency (p=0.176). Gender-wise, the correlation was high for men (r=0.771) and women (p=0.881). Regarding age groups, correlation was high for the three groups analyzed: <25 years (r=0.828), 25-49 years (r=0.813) and >50 years (r=0.796). Conclusions. There is a respectable global correlation between Fagerström Tolerance Questionnaire (FTQ) and the Heavy Smoking Index (HSI). This correlation does not vary in front of variables like age or gender. When considering dependency levels, the correlation is significant among high or low dependency and non-significant within the moderate dependency group (AU)

Clinical and epidemiological characteristics of adult patients hospitalized for erysipelas and cellulitis.

The purpose of this investigation was to analyze the clinical and epidemiological aspects of all cases of erysipelas and infectious cellulitis admitted to a tertiary hospital during a period of five years. All patients admitted with the main diagnosis of erysipelas or cellulitis to the Department of Dermatology of the author's institution from January 2005 to May 2010 were included. Seventy patients were identified and their medical records were retrospectively reviewed so as to record the epidemiological and clinical data. Univariate and multivariable analyses were performed to analyze variables that predicted longer length of stay. The frequency of cellulitis in the lower limbs was higher in men and patients older than 65 years. Moderate/severe cellulitis in patients with basal comorbidity followed by a poor response to oral antibiotic therapy for 48 h were the most common reasons for admission. At arrival, four patients had abscessed areas. Fourteen patients developed local complications and 18 cases developed general in-hospital complications. Most patients improved or were healed with intravenous amoxicillin-clavulanate 1 g-200 mg/8 h. Intravenous amoxicillin-clavulanate 1 g-200 mg/8 h may be a good choice for empiric treatment in our setting. The development of in-hospital complications and the need for changing empiric antibiotic therapy were significant and independent variables associated with longer length of stay.

The degree of neutropenia has a prognostic impact in low risk myelodysplastic syndrome.

The severity of neutropenia in myelodysplastic syndrome (MDS) has not been completely studied. We analyzed the prognostic significance of severe neutropenia (neutrophils count <0.5×10(9)/L) at diagnosis in 1109 patients with de novo MDS and low/intermediate-1 IPSS included in the Spanish MDS Registry. Severe neutropenia was present at diagnosis in 48 of 1109 (4%). Patients with severe neutropenia were most strongly represented within the groups of refractory cytopenia with multilineage dysplasia (40%) and refractory anemia with excess of blast type 1 (29%). Severe neutropenia had negative effects on the low/intermediate-1 risk group. A significant difference in overall survival was observed between patients with severe neutropenia (28 months) and patients with a neutrophil count higher than 0.5×10(9)/L (66 months) (p<0.0001). Also, severe neutropenia predicted a significantly reduced on leukemia-free survival (p<0.0001). In the multivariate analysis, severe neutropenia retained its independent prognostic influence on overall survival [HR: 2.19, 95% CI (1.41-3.10), p<0.0001] and leukemia free survival [HR: 3.51, 95% CI (1.97-6.26), p<0.0001]. The degree of neutropenia should be considered as additional prognostic factor in low/intermediate-1 IPSS MDS.

Elaboración de una relación de nombres de medicamentos similares en los que se recomienda utilizar letras mayúsculas resaltadas / Development of a List of Look-alike Drug Names With Recommended Tall Man Letters

Objetivo Elaborar una relación de nombres de medicamentos similares con letras mayúsculas resaltadas, que facilite y estandarice la implantación de esta técnica en prácticas dirigidas a reducir errores por similitud de nombres. Material y métodos Se realizaron dos encuestas estructuradas. La primera incluyó 46 pares, grupos o nombres de medicamentos similares con letras mayúsculas, procedentes de las listas establecidas por la FDA, ISMP y CAPCA/ISMP-Canadá, y 32 seleccionados de la base de datos del ISMP-España y Consejo de COF. La segunda incluyó 27 pares, grupos o nombres propuestos por los encuestados y 11 procedentes de la actualización del ISMP. Se formularon preguntas sobre la utilidad de la técnica y su implantación en los hospitales. Participaron en la primera encuesta 90 farmacéuticos de diferentes hospitales y 89 en la segunda. Resultados La relación de nombres de medicamentos similares con letras mayúsculas resaltadas elaborada recoge 107 nombres agrupados en 44 pares o grupos. Un 93,3% de los encuestados opinó que esta técnica debería implantarse para denominar a los medicamentos, tanto en el etiquetado de la industria farmacéutica (91,1%) como en otros lugares donde aparecen los nombres, como en las pantallas de prescripción informatizada (90%), de farmacia (82,2%) o de los sistemas automatizados de dispensación (81,1%), en etiquetado de preparaciones y estantes, etc. Solo 9 (10%) de los hospitales utilizaban esta técnica. Conclusiones La disponibilidad de esta relación de nombres similares en los que se recomienda utilizar letras mayúsculas resaltadas podría facilitar su aplicación en prácticas de diferenciación de nombres, actualmente reducida en nuestro país(AU)

Objective To develop a list of look-alike drug names with tall man letters, that will facilitate and standardize the implementation of this technique in safety practices designed to reduce errors caused by look-alike names. Material and methods Two structured surveys were carried out. The first survey included 46 pairs, groups, or individual look-alike drug names with tall man letters from the lists established by the FDA, ISMP and CAPCA/ISMP-Canada, and 32 selected from ISMP-Spain and the COF Council database. The second survey included 27 proposals made by those respondents who completed the first survey and 11 from the ISMP updated list. Participants were asked about the usefulness and current implementation of the technique. Ninety pharmacists from different hospitals participated in the first survey and 89 in the second. Results The list of look-alike drug names with tall man letters which has been developed includes 107 names structured into 44 pairs or groups. Of the respondents, 93.3% felt that this technique should be implemented for identifying medications, not only on pharmaceutical industry labels (91.1%) but also in other places where drug names appear, including computerized prescription screens (90%), pharmacy system screens (82.2%), automated dispensing cabinet screens (81.1%), labels for pharmacy preparations and shelves, etc. Only 9 hospitals (10%) were using this technique. Conclusions The availability of this list of look-alike drug names for which tall man lettering is recommended may encourage the use of this technique for differentiating names in Spain where it is currently not greatly used (AU)

Development of a list of look-alike drug names with recommended tall man letters.

OBJECTIVE: To develop a list of look-alike drug names with tall man letters, which will facilitate and standardize the implementation of this technique in safety practices designed to reduce errors caused by look-alike names. MATERIAL AND METHODS: Two structured surveys were carried out. The first survey included 46 pairs, groups, or individual look-alike drug names with tall man letters from the lists established by the FDA, ISMP and CAPCA/ISMP-Canada, and 32 selected from ISMP-Spain and the COF Council database. The second survey included 27 proposals made by those respondents who completed the first survey and 11 from the ISMP updated list. Participants were asked about the usefulness and current implementation of the technique. Ninety pharmacists from different hospitals participated in the first survey and 89 in the second. RESULTS: The list of look-alike drug names with tall man letters which has been developed includes 107 names structured into 44 pairs or groups. Of the respondents, 93.3% felt that this technique should be implemented for identifying medications, not only on pharmaceutical industry labels (91.1%) but also in other places where drug names appear, such as computerized prescription screens (90%), pharmacy system screens (82.2%), automated dispensing cabinet screens (81.1%), labels for pharmacy preparations and shelves, etc. Only 9 hospitals (10%) were using this technique. CONCLUSIONS: The availability of this list of look-alike drug names for which tall man lettering is recommended may encourage the use of this technique for differentiating names in Spain where it is currently not greatly used.