COPD patient profiles in primary care. Referral criteria.

COPD is a disease with a high prevalence that diminishes the quality of life of many patients. Despite this, there are still high rates of under-diagnosis in Spain, partly due to a lack of recognition of the pathology by patients. In this context, the role played by primary care teams becomes fundamental, as they are one of the first lines of entry into the health system. In this paper we explain the different COPD profiles that may be present, and update the tools for diagnosis and treatment, which, together with an attitude of active suspicion of the disease, can help in the correct management of patients, whether they are undiagnosed or have subsequent complications.

Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels.

AIM: An increased risk of venous thromboembolism (VTE) in patients with COVID-19 pneumonia admitted to intensive care unit (ICU) has been reported. Whether COVID-19 increases the risk of VTE in non-ICU wards remains unknown. We aimed to evaluate the burden of asymptomatic deep vein thrombosis (DVT) in COVID-19 patients with elevated D-dimer levels. METHOD: In this prospective study consecutive patients hospitalized in non-intensive care units with diagnosis of COVID-19 pneumonia and D-dimer > 1000 ng/ml were screened for asymptomatic DVT with complete compression doppler ultrasound (CCUS). The study was approved by the Institutional Ethics Committee. RESULTS: The study comprised 156 patients (65.4% male). All but three patients received standard doses of thromboprophylaxis. Median days of hospitalization until CCUS was 9 (IQR 5-17). CCUS was positive for DVT in 23 patients (14.7%), of whom only one was proximal DVT. Seven patients (4.5%) had bilateral distal DVT. Patients with DVT had higher median D-dimer levels: 4527 (IQR 1925-9144) ng/ml vs 2050 (IQR 1428-3235) ng/ml; p < 0.001. D-dimer levels > 1570 ng/ml were associated with asymptomatic DVT (OR 9.1; CI 95% 1.1-70.1). D-dimer showed an acceptable discriminative capacity (area under the ROC curve 0.72, 95% CI 0.61-0.84). CONCLUSION: In patients admitted with COVID-19 pneumonia and elevated D-dimer levels, the incidence of asymptomatic DVT is similar to that described in other series. Higher cut-off levels for D-dimer might be necessary for the diagnosis of DVT in COVID-19 patients.

Clostridium difficile-related hospitalizations and risk factors for in-hospital mortality in Spain between 2001 and 2015.

AIMS: To examine trends in the incidence, characteristics and in-hospital outcomes of Clostridium difficile infection (CDI) hospitalizations from 2001 to 2015, to compare clinical variables among patients according to the diagnosis position (primary or secondary) of CDI, and to identify factors associated with in-hospital mortality (IHM). METHODS: A retrospective study was performed using the Spanish National Hospital Discharge Database, 2001-2015. The study population included patients who had CDI as the primary or secondary diagnosis in their discharge report. Annual hospitalization rates were calculated and trends were assessed using Poisson regression models and Jointpoint analysis. Multi-variate logistic regression models were performed to identify variables associated with IHM. FINDINGS: In total, 49,347 hospital discharges were identified (52.31% females, 33.69% with CDI as the primary diagnosis). The rate of hospitalization increased from 3.9 cases per 100,000 inhabitants in 2001-2003 to 12.97 cases per 100,000 inhabitants in 2013-2015. Severity of CDI and mean cost per patient increased from 6.36% and 3750.11€ to 11.19% and 4340.91€, respectively, while IHM decreased from 12.66% to 10.66%. Age, Charlson Comorbidity Index, severity, length of hospital stay and mean cost were significantly higher in patients with a primary diagnosis of CDI. Irrespective of the CDI diagnosis position, IHM was associated with male sex, older age, comorbidities, readmission and severity of CDI. Primary diagnosis of CDI was associated with lower IHM (odds ratio 0.60; 95% confidence interval 0.56-0.65). CONCLUSION: CDI-related hospitalization rates are increasing, leading to a high cost burden, although IHM has decreased in recent years. Factors associated with IHM should be considered in strategies for the prevention and management of CDI.

Adverse drug reactions to anticoagulants in Spain: analysis of the Spanish National Hospital Discharge Data (2010-2013).

OBJECTIVE: To describe and analyse hospitalisations for adverse drug reactions (ADRs) involving anticoagulants. We also analysed the progress of the reactions over time, the factors related with ADRs. DESIGN: A retrospective, descriptive, epidemiological study. SETTING: This study used the Spanish National Hospital Discharge Database (Conjunto Mínimo Básico de Datos, CMBD), over a 4-year period. PARTICIPANTS: We selected CMBD data corresponding to hospital discharges with a diagnosis of ADRs to anticoagulants (International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM) code E934.2) in any diagnostic field during the study period. MAIN OUTCOME MEASURES: We calculated the annual incidence of ADRs to anticoagulants according to sex and age groups. The median lengths of hospital stay and in-hospital mortality (IHM) were also estimated for each year studied. Bivariate analyses of the changes in variables according to year were based on Poisson regression. IHM was analysed using logistic regression models. The estimates were expressed as ORs and their 95% CI. RESULTS: During the study period, 50 042 patients were hospitalised because of ADRs to anticoagulants (6.38% of all ADR-related admissions). The number of cases increased from 10 415 in 2010 to 13 891 in 2013. Cumulative incidence of ADRs to anticoagulants was significantly higher for men than women and in all age groups. An adjusted multivariate analysis revealed that IHM did not change significantly over time. We observed a statistically significant association between IHM and age, with the highest risk for the ≥85 age group (OR 2.67; 95% CI 2.44 to 2.93). CONCLUSIONS: The incidence of ADRs to anticoagulants in Spain increased from 2010 to 2013, and was significantly higher for men than women and in all age groups. Older patients were particularly susceptible to being hospitalised with an adverse reaction to an anticoagulant.

Incidence, surgical procedures, and outcomes of hip fracture among elderly type 2 diabetic and non-diabetic patients in Spain (2004-2013).

UNLABELLED: Hip fracture is a serious public health problem. We used Spanish hospital discharge data to examine trends in 2004-2013 in the incidence of hip fracture among elderly patients. We found that hip fracture incidence is higher in subjects with than without diabetes and is much higher among women than men. INTRODUCTION: This study aimed to describe trends in the incidence of hip fracture hospitalizations, use of surgical procedures, and hospital outcomes among elderly patients with and without type 2 diabetes mellitus (T2DM) in Spain, 2004-2013. METHODS: We selected all patients with a discharge primary diagnosis of hip fracture using the Spanish national hospital discharge database. Discharges were grouped by diabetes status: Incidences were calculated overall and stratified by diabetes status and year. We analyzed surgical procedures, length of hospital stay (LOHS), and in-hospital mortality (IHM). Multivariate analysis was adjusted by age, year, comorbidity, and in-hospital complications (IHC). RESULTS: From 2004 to 2013, 432,760 discharges with hip fracture were identified (21.3 % suffered T2DM). Incidence among diabetic men and women increased until year 2010 and then remained stable. Diabetic women have three times higher incidence than diabetic men. Incidences and IHC were higher among patients with diabetes beside sex. The proportion of patients that underwent internal fixation increased for all groups of patients and the arthroplasty repair decreased. After multivariate analysis, IHM has improved over the study period for all patients. Suffering diabetes was associated to higher IHM in women (odds ratio (OR) 1.12; 95 % confidence interval (CI) 1.07-1.17). CONCLUSIONS: Hip fracture incidence is higher in subjects with than without diabetes and is much higher among women than men. In diabetic patients, incidence rates increased initially but have leveled from 2010 onwards. For all groups, the use of internal fixation has increased overtime and IHM and LOHS have decreased from 2004 to 2013.

Trend and seasonality in hospitalizations for pulmonary embolism: a time-series analysis.

BACKGROUND: The existence of seasonal variability in patients with acute pulmonary embolism (PE) has been debated for years, with contradictory results. The aim of this study was to identify the trend and possible existence of a seasonal pattern in hospitalizations for PE in Spain. METHODS: We analyzed the hospital discharge database of the Spanish National Health System from 2001 to 2010. Patients aged > 14 years diagnosed with PE were selected and a time series was constructed considering mean daily admissions for PE by month. The trend and seasonality factor of the series were determined using time-series analysis, and time-series modeling was used for analysis. Exponential smoothing models and the autoregressive integrated moving average test were used to generate a predictive model. RESULTS: From 2001 to 2010, there were 162,032 diagnoses of PE (5.07 per 1000 hospitalizations). In 105,168 cases, PE was the reason for admission. The PE diagnosis rate ranged from 4.14 per 1000 in 2001 to 6.56 per 1000 in 2010; and hospital admissions due to PE ranged from 2.67 to 4.28 per 1000 hospital discharges. Time-series analysis showed a linear increase in the incidence and a significant seasonal pattern with 17% more admissions in February and 12% fewer in June-July with respect to the central tendency (difference from February to June, 29%). CONCLUSIONS: The incidence of hospitalizations for PE showed a linear increase and a seasonal pattern, with the highest number of admissions in winter and the lowest number in summer.

[Influence of systemic corticosteroid administration in the prognosis of patients with community-acquired pneumonia]. / Influencia de la administración de corticoides sistémicos en el pronóstico de los pacientes con neumonía adquirida en la comunidad.

INTRODUCTION: Community-acquired pneumonia (CAP) is a common and potentially serious disease. In recent years, control of the inflammatory response has begun to be taken into account as a new therapeutic target. This study has aimed to analyze the influence of the administration of systemic corticosteroids on mortality of patients admitted with CAP in the common clinical practice. PATIENTS AND METHODS: A prospective observational study was carried out. The study included patients with CAP admitted to Internal Medicine and Pulmonology services of a tertiary hospital in 2007. Treatment given during admission was recorded and mortality during hospitalization and at 30 and 90 days after discharge was determined. RESULTS: A total of 257 patients, 179 men (69.6%) and 78 women (30.4%) were analyzed. Mean age was 72±15 years. Both in-hospital mortality as well as at 30 days of discharge was 10.2%, while overall mortality at 90 days was 14.8%. No relation was found between the use of corticosteroids and mortality. Use of corticosteroids also did not modify the length of hospital stay or readmission rate. CONCLUSIONS: It was observed in this study that treatment with corticosteroids in CAP is not associated with lower mortality and does not affect the rate of readmissions. It also does not change the length of hospital stay.

[Unsuspected pulmonary thromboembolism in the Emergency Department]. / Tromboembolismo pulmonar no sospechado en el Servicio de Urgencias.

BACKGROUND AND OBJECTIVES: Pulmonary embolism (PE) is a disease that sometimes has a significant delay in diagnosis. This situation may lead to an increase in morbidity and mortality in patients who have it. The aim of our study has been to define the clinical profile of patients with unsuspected PE in the emergency department and the factors that influence the delayed diagnosis. PATIENTS AND METHODS: A total of 148 patients admitted with diagnosis of PE confirmed by CT (n=133) or by high-probability ventilation-perfusion scintigraphy scan (n=15) were retrospectively analyzed. They were divided into two groups: those with unsuspected disease in the emergency department (USPE) and those who it was suspected (SPE). Baseline characteristics of the patients, risk factors, signs and symptoms in the emergency department, complementary test, days of hospitalization and mortality were studied. RESULTS: The USPE was found in 63/148 patients (42.6%) in the emergency department. Dyspnea and chest pain were the most frequent clinical manifestations of this disease, this being more commonly identified in the SPE group than in the USPE group, with significant differences (OR=0.4 [0.2-0.9] for dyspnea and OR=0.3 [0.2-0.7] for chest pain). However, However, the presence of thrombocytopenia (OR=3.4 [1.1-10.2], P<.05), normal electrocardiogram (EC) (OR=3.4 [1.1-10.2], P<.05), and localization of PE in right lung (OR=4.7 [2-11.3], P<.001) were risk factors for not suspect it. Days of hospitalization, days of symptoms and mortality were not statistically different between groups. CONCLUSIONS: According to the results, the proportion of unsuspected PE in the emergency department was high (close to 40%). The presence of dyspnea and chest pain was associated to suspicion of SPE. On the contrary, the presence of thrombocytopenia, normal EC and right localization of PE were associated to the non-suspicion of SPE in the emergency department.

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Neumonía lipoidea por aspiración accidental de queroseno en un «comedor de fuego» / Lipoid pneumonia by accidental aspiration of kerosene in a «fire eater»

La neumonía lipoidea es una entidad clínica causada por la aspiración o inhalación de sustancias grasas de origen animal. En este artículo se presenta el caso de un paciente de 24 años que realizaba actuaciones esporádicas como «tragafuegos», utilizando el queroseno como elemento fundamental, y que presentó una neumonía lipoidea aguda con resolución completa. Asimismo, se realiza una revisión del tema hasta la fecha actual (AU)

Lipoid pneumonia is a clinical entity caused by aspiration of animal fat substances or their inhalation. This article presents the case of a 24-year old male patient who performed sporadic performances as a «fire eater», using kerosene as a fundamental element, and who had acute lipoid pneumonia with complete resolution. Furthermore, a review is made of the subject up to the present date (AU)

Aspergilosis pulmonar invasiva en un hospital terciario durante un periodo de 10 años / Invasive pulmonary aspergillosis in a tertiary hospital over a 10-year period

Introducción: En los últimos años se ha producido un aumento de la incidencia de las aspergilosis pulmonar invasiva (API), no sólo en pacientes inmunodeprimidos u oncohematológicos, sino también en aquellos con patología pulmonar crónica en tratamiento esteroideo. El objetivo de este estudio es analizar las características de los pacientes ingresados por API en un hospital terciario durante un periodo de 10 años y evaluar los factores asociados con su desarrollo. Materia y métodos: Se han revisado todos los pacientes diagnosticados de API ingresados en los servicios de Medicina Interna, Neumología y Cuidados Intensivos de nuestro hospital entre el 1 de enero de 1997 y el 31 de diciembre de 2006. La información se ha obtenido a través de la base de datos del servicio de archivo de nuestro hospital. Resultados: Se han encontrado 39 pacientes, detectándose en dicho grupo una elevada incidencia de uso de ventilación mecánica invasiva previa a la aparición de la infección, así como de enfermedad pulmonar y de empleo de esteroides en su tratamiento previo. La mayoría de los pacientes han sido diagnosticados por cultivo, mientras que las técnicas antigénicas han mostrado un 17,9% de falsos negativos. El tratamiento antifúngico más ampliamente utilizado ha sido la anfotericina. Conclusiones: Tanto la patología pulmonar como el tratamiento esteroideo asociado, así como el ingreso en una unidad de cuidados intensivos y la utilización de técnicas ventilatorias invasivas son factores que pueden predisponer a la aparición de una API (AU)

Introduction: In recent years there has been an increase in the incidence of invasive pulmonary aspergillosis (IPA) not only in immunosuppressed or oncohematological patients but also in those suffering from chronic lung diseases treated with corticosteroids. This study has aimed to analyze the characteristics of patients admitted for IPA in a tertiary hospital over a 10-year period and to assess the associated factors with its development. Material and methods: We reviewed the cases of all IPA-diagnosed patients admitted to Internal Medicine, Pneumology and Intensive Care Unit of our hospital between January 1, 1997 and December 31, 2006, obtaining the information through the service's database file of our hospital. Results: A total of 39 patients were found. A high incidence of use of invasive mechanical ventilation was observed before the onset of infection as well as lung disease and previous use of corticosteroids. Most of the patients had been diagnosed by culture, whereas antigenic techniques showed 17.9% false negatives. The most widely used antifungal treatment was amphotericin. Conclusions: Pulmonary disease associated with steroid treatment and admission to an intensive care unit and the use of noninvasive ventilatory techniques are factors that may predispose to the emergence of an IPA (AU)

Marcadores biológicos en el diagnóstico del derrame pleural maligno / Biological markers for malignant pleural effusions

En el proceso diagnóstico de los pacientes con derrame pleural y alta sospecha de malignidad, nos preguntamos con cierta frecuencia sobre la utilidad de algunos marcadores tumorales séricos o del líquido pleural. Hasta la fecha, los marcadores tumorales analizados de forma aislada no han mostrado una precisión diagnóstica lo suficientemente elevada como para prescindir del estudio mediante citología e histología de la pleura. Esta cuestión ha estimulado el desarrollo de múltiples paneles de marcadores bioquímicos e inmunohistoquímicos cuya combinación ha permitido mejorar la sensibilidad y la especificidad, discriminar entre lesiones benignas y malignas, y entre diferentes estirpes tumorales. Asimismo, ha permitido que dichos paneles de marcadores sirvan como factores pronósticos y de supervivencia. Hoy por hoy, no es posible recomendar unos paneles de marcadores específicos para cada estirpe. Nuestro objetivo es acercar al clínico la evidencia existente sobre esta materia para que tenga un conocimiento del significado de estos marcadores y de la conveniencia de saber interpretar los resultados obtenidos (AU)

The diagnostic process of patients with pleural effusion and high suspicion of malignancy often leads us to question the utility of some serum or pleural fluid tumor markers. Up to date, the tumor markers analyzed separately have not demonstrated sufficiently high diagnostic accuracy to obviate the study by cytology and histology of the pleura. This question has encouraged the development of multiple biochemical and immunohistochemical marker panels whose combination has made it possible to improve sensitivity and specificity, discriminate between benign and malignant lesions and between different tumor strains and it behaves as prognostic and survival factors. Currently, it is not possible to recommend specific marker panels for each strain, our objective being to make the existing evidence on this material more available to the clinician in order to have knowledge of the meanings of these markers and the convenience of knowing how to interpret the results obtained (AU)

Neumotórax de repetición / Recurrent pneumothorax

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Coverage and predictors of adherence to influenza vaccination among Spanish children and adults with asthma.

BACKGROUND: Influenza infections are frequently implicated in the exacerbation of asthma. The aim of this study was to assess vaccination coverage among Spanish children and adults with asthma and to describe the factors associated(predictors) with vaccination, using data from the 2006 Spanish National Health Survey. PATIENTS AND METHODS: Subjects were classified as asthma sufferers if they answered affirmatively to the question, "Has your doctor told you that you (or your child) currently suffer from asthma?" Influenza vaccination status was assessed via the question, "Did you (or your child) have a flu shot in the latest campaign?" The following were analyzed as possible predictors of influenza vaccination: sociodemographic variables;health-related and lifestyle variables; variables linked to the use of healthcare services. RESULTS: A total of 38,329 records of individuals aged over 6 months were analyzed, and of these, 2,337 were classified as asthmatics. Among asthmatics, overall influenza coverage was 32.6% (18.8% among children, and 38% among adults).Whereas the sole variable that predicted a higher coverage among children was parents' negative perception of their child's health, among adults positive predictors included older age, lower educational level, suffering from concomitant chronic disease, and non- or ex-smoker status. CONCLUSIONS: The overall influenza vaccination coverage among subjects who suffer from asthma in Spain is very low. Special attention should be paid to children, younger adults, and smokers, since these subjects have the lowest adherence to vaccine recommendations. Strategies focused on health-care providers and patients must be urgently implemented to improve influenza vaccination coverage among asthma sufferers.

Cáncer de pulmón y estado nutricional / Lung cancer and nutritional condition

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Linfangioleiomiomatosis / Lymphangioleiomyomatosis

Resumen. La linfangioleiomiomatosis (LAM) es una enfermedad poco frecuente caracterizada por una proliferación anormal de células del músculo liso, fundamentalmente a nivel pulmonar. Afecta generalmente a mujeres en edad fértil. La forma de presentación clínica más frecuente es la disnea de esfuerzo. En relación a las pruebas de imagen cabe destacar la inespecificidad de la radiografía simple de tórax, en parte debido a la aparición tardía de alteraciones en la misma. La tomografia computarizada (TC) torácica muestra, de una manera característica, imágenes quísticas de pared fina distribuidas uniformemente por todo el parénquima pulmonar. La biopsia pulmonar constituye el método diagnóstico definitivo. Presentamos los casos de 6 pacientes diagnosticadas de LAM en el área 1 de Madrid (AU)

Abstract. Lymphangioleiomyomatosis (LAM) is a rare disease characterized by abnormal smooth muscle cell proliferation throughout the bronchioles, basically in the lung. It generally affects child-bearing aged women. Its most frequent clinical presentation form is exertional dyspnea. In relationship with the imaging test, the non-specificity of the simple chest x-ray, partially due to the later appearance of its alterations, stands out. The thoracic CT scan (CT) characteristically shows cystic images of the thin cystic wall uniformly distributed throughout the pulmonary parenchyma. The lung biopsy is a definitive diagnostic method. We present the cases of 6 patients diagnosed of LAM in area 1 of Madrid (AU)

[Therapeutic alternatives to CPAP in the sleep apnea-hypopnea syndrome. Scientific evidence]. / Alternativas terapéuticas a la CPAP en el síndrome de apnea-hipopnea del sueño. Evidencias científicas.

Sleep apnea-hypopnea syndrome (SAPS) is a very prevalent disease in the general population.Its existence has been related with the appearance of cardiovascular and cerebrovascular events, greater risk of traffic accidents and deterioration of the quality of life of the patients.Currently, continuous positive airway pressure (CPAP) is the treatment of choice in SAPS. Although it is generally well-tolerated and the side effects derived from its use are generally mild and transient, there are some patients who refuse it or do not tolerate it. Other alterative or complementary treatments should be offered to these patients.

Identificación de pacientes con un tromboembolismo pulmonar de bajo riesgo / Identification of patients with low risk pulmonary thromboembolism

Objetivo. Determinar las características de los pacientes diagnosticados de tromboembolismo pulmonar (TEP) en el Servicio de Urgencias del Hospital Gregorio Marañón, para valorar la aplicabilidad de un modelo basado en criterios clínicos que permite identificar a pacientes con bajo riesgo de complicaciones. Material y métodos. Se evaluaron todos los pacientes que ingresaron por urgencias con el diagnóstico de TEP agudo. Se recogieron las siguientes variables: edad, sexo, comorbilidad (antecedentes personales de insuficiencia cardiaca, enfermedad pulmonar crónica, enfermedad renal crónica, enfermedad cerebrovascular y cáncer), tensión arterial, frecuencia cardiaca, saturación arterial de oxígeno y estado mental. También se recogió el tratamiento recibido y la presencia de complicaciones durante su estancia en el hospital. Se identificó como enfermos con TEP de bajo riesgo a aquellos pacientes que no presentaban ninguna de estas características en la evaluación inicial. Resultados. Se incluyeron en el estudio 101 pacientes, de los que 16 cumplían todos los criterios para ser considerados de bajo riesgo (15,8%). Al comparar este subgrupo con el resto de los enfermos, se detectaron diferencias en la edad, que fue significativamente menor en los pacientes de bajo riesgo. También se apreciaron diferencias estadísticamente significativas en la frecuencia cardiaca y en la saturación arterial de oxígeno. Todos los pacientes, excepto 1 que se encontraba en situación terminal, recibieron tratamiento anticoagulante. La evolución de los enfermos durante el ingreso fue satisfactoria en el 100% de los individuos del grupo de bajo riesgo frente al 88,1% en el de pacientes de no bajo riesgo. En este último grupo 7 enfermos (6,93%) presentaron complicaciones durante el ingreso y se produjeron 5 fallecimientos (4,95%). Conclusiones. La aplicación de un modelo basado en criterios clínicos permite identificar a un subgrupo de pacientes con TEP con bajo riesgo de complicaciones. Dicho subgrupo de enfermos no se beneficia por tanto de un ingreso hospitalario, con la ventaja del confort que proporciona al paciente el tratamiento ambulatorio y de la disminución de costes que dicha estrategia supone (AU)

Objective. Determine the characteristics of the patients diagnosed of pulmonary thromoembolism (PTE) in the Emergency Service of the Hospital Gregorio Marañón, in order to evaluate the applicability of a clinical-criteria based model that makes it possible to identify patients at low risk of complications. Material and methods. All the patients who were admitted to emergency with the diagnosis of acute PTE were evaluated. The following variables were collected: age, gender, comorbidity (personal background of heart failure, chronic pulmonary disease, chronic renal disease, cerebrovascular disease and cancer), blood pressure, heart rate, arterial oxygen saturation and mental condition. The treatment received and the presence of complications during the patient’s stay in the hospital were also collected. Those patients with PTE who did not present any of these characteristics in the initial evaluation were identified as being at low risk. Results. A total of 101 patients, 16 of whom fulfilled all the criteria to be considers at low risk (15.8%), were included in the study. When this subgroup was compared with the rest of the patients, differences in age that were significantly lower in the low risk patients were detected. Statistically significant differences in heart rate and in arterial oxygen saturation were also observed. All the patient, except for one who was in end-state condition, received anticoagulant treatment. The evolution of the patients during admission was satisfactory in 100% of the low risk group individuals versus 88.1% of the non-low risk patients. In the latter group, 7 patients (6.93%) presented complications during admission and there were 5 deaths (4.95%). Conclusions: Application of the clinical-criteria based model makes it possible to identify a subgroup of patients with PTE at low risk of complications. Thus, this subgroup of patients does not benefit from hospitalization, with the advantage of the comfort provided to the patient of by out-patient treatment and of the decrease in costs obtained from this strategy (AU)