Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 6 de 6
Filtrar
Mais filtros










Intervalo de ano de publicação
3.
Emergencias ; 31(3): 167-172, 2019 Jun.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31210448

RESUMO

OBJECTIVES: To assess the accuracy, safety, and efficiency of ultrasound images obtained by emergency physician to diagnose deep vein thrombosis (DVT). patients with acute heart failure (AHF) attended in a hospital emergency department (ED). MATERIAL AND METHODS: Prospective multicenter cohort study. We assigned patients suspected of having DVT to an intervention or control group. Emergency physicians took ultrasound images that were later evaluated by a radiologist in the intervention group. In the control group, images were evaluated only by the radiologist. We analyzed patient, physician, and episode variables. Test results, times until imaging, and 30-day adverse events were also analyzed. Sensitivity, specificity, positive and negative likelihood ratios, and agreement between physicians and radiologists (κ statistic) were calculated. RESULTS: A total of 304 patients (209 in the intervention group and 95 controls) were included. The groups were comparable. The overall prevalence of DVT was 35.5% (95% CI, 30.3-41.0). The sensitivity of ultrasound images obtained by emergency physicians was superior in relation to experience: 71.4 (95% CI, 50.0-86.0) for those in a training course, 75.0 (95% CI, 80.0-95.4) for those with at least 2 months' practical experience, and 94.7 (95% CI, 82.7-98.5) for routine users. Specificity statistics for the 3 levels of physician experience were 83.3 (95% CI 55.2- 95.2), 100 (95% CI 83.0-100), and 96.6 (95% CI 88.4-99.0), respectively. The positive and negative likelihood ratios for ultrasound imaging by physicians were 27.94 and 0.054, respectively. The κ statistic was 0.80. Mean (SD) time until a physician took ultrasound images was 1.81 (1.46) hours versus 4.39 (1.81) hours until a radiologist obtained images (P = .007). Three deaths occurred within 30 days. They were not attributable to recurrence or bleeding. CONCLUSION: Ultrasound images taken by emergency physicians to diagnose DVT are accurate and safe and may be efficient. However, routine experience with ultrasound is necessary.

4.
Emergencias (Sant Vicenç dels Horts) ; 31(3): 167-172, jun. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182726

RESUMO

Objetivos: Evaluar la precisión, la seguridad y la eficiencia de la ecografía realizada por urgenciólogos para el diagnóstico de la trombosis venosa profunda (TVP). Métodos: Estudio prospectivo multicéntrico de cohortes que incluyó pacientes con sospecha de TVP asignados a un grupo intervención (evaluados ecográficamente por el urgenciólogo y posteriormente por el radiólogo) y a un grupo control (evaluados únicamente por el radiólogo). Se analizaron las variables relacionadas con el paciente, el urgenciólogo, el episodio, el resultado de la prueba y los tiempos de estancia y acontecimientos a 30 días. Se calcularon la sensibilidad, la especificidad, las razones de verosimilitud positiva y negativa, y el índice kappa. Resultados: Se incluyeron 304 pacientes (95 control, 209 intervención). Ambos grupos fueron comparables. La prevalencia de TVP en la cohorte global fue de 35,5% (IC 95% 30,3-41,0). La sensibilidad de la ecografía realizada por urgenciólogos fue superior según la experiencia-curso vs meses vs uso habitual: 71,4 (IC 95% 50,0-86,0) vs 75,0 (IC 95% 80,0-95,4) vs 94,7 (IC 95% 82,7-98,5), así como la especificidad 83,3 (IC 95% 55,2-95,2) vs 100 (IC 95% 83,0100) vs 96,6 (IC 95% 88,4-99,0). Las razones de verosimilitud positiva y negativa para la ecografía realizada por urgenciólogos fueron del 27,94 y del 0,054, respectivamente. El índice de kappa fue de 0,80. El tiempo hasta la realización de la ecografía por el urgenciólogo fue de 1,81 (DE 1,46) frente a 4,39 (DE 1,81) horas del radiólogo (p = 0,007). Durante el seguimiento a 30 días, se registraron 3 muertes, ninguna de ellas por recurrencia o hemorragia. Conclusión: La ecografía realizada por urgenciólogos para el diagnóstico de TVP es precisa, segura y podría resultar eficiente. Sin embargo, se requiere de experiencia basada en el uso habitual de esta técnica


Objective: To assess the accuracy, safety, and efficiency of ultrasound images obtained by emergency physician to diagnose deep vein thrombosis (DVT). Methods: Prospective multicenter cohort study. We assigned patients suspected of having DVT to an intervention or control group. Emergency physicians took ultrasound images that were later evaluated by a radiologist in the intervention group. In the control group, images were evaluated only by the radiologist. We analyzed patient, physician, and episode variables. Test results, times until imaging, and 30-day adverse events were also analyzed. Sensitivity, specificity, positive and negative likelihood ratios, and agreement between physicians and radiologists ( Kappa statistic) were calculated. Results: A total of 304 patients (209 in the intervention group and 95 controls) were included. The groups were comparable. The overall prevalence of DVT was 35.5% (95% CI, 30.3-41.0). The sensitivity of ultrasound images obtained by emergency physicians was superior in relation to experience: 71.4 (95% CI, 50.0-86.0) for those in a training course, 75.0 (95% CI, 80.0-95.4) for those with at least 2 months' practical experience, and 94.7 (95% CI, 82.7-98.5) for routine users. Specificity statistics for the 3 levels of physician experience were 83.3 (95% CI 55.2- 95.2), 100 (95% CI 83.0-100), and 96.6 (95% CI 88.4-99.0), respectively. The positive and negative likelihood ratios for ultrasound imaging by physicians were 27.94 and 0.054, respectively. The Kappa statistic was 0.80. Mean (SD) time until a physician took ultrasound images was 1.81 (1.46) hours versus 4.39 (1.81) hours until a radiologist obtained images (P = .007). Three deaths occurred within 30 days. They were not attributable to recurrence or bleeding. Conclusions: Ultrasound images taken by emergency physicians to diagnose DVT are accurate and safe and may be efficient. However, routine experience with ultrasound is necessary


Assuntos
Humanos , Trombose Venosa/diagnóstico por imagem , Serviços Médicos de Emergência/estatística & dados numéricos , Ultrassonografia/métodos , Eficiência , Fatores de Risco , Trombose Venosa/epidemiologia , Sensibilidade e Especificidade , Tempo de Internação
6.
Emergencias (St. Vicenç dels Horts) ; 20(2): 135-138, abr. 2008. ilus
Artigo em Espanhol | IBECS | ID: ibc-63105

RESUMO

La pericarditis purulenta presenta, en la actualidad, diversos retos. Primero, en el aspecto epidemiológico, a su rareza lo que nos exige tenerla siempre in mente para evitar un retraso fatal en el diagnóstico. Segundo, en el aspecto etiológico debido a los cambios en el espectro bacteriológico responsable del cuadro (desde el descubrimiento y generalización de las drogas antimicrobianas han aumentado los casos asociados a gérmenes anaerobios, gram negativos y fúngicos frente a los clásicos aerobios gram positivos de otras etapas), así como por su cada vez mayor vinculación con enfermedades y condiciones predisponentes, no necesariamente infecciosas ni previamente conocidas. Tercero, en el aspecto terapéutico, alimentado por la aún viva polémica en torno a la técnica de drenaje más eficaz. Presentamos un caso de pericarditis purulenta en el que la práctica de la ecografía a la cabecera del enfermo acortó los tiempos de diagnóstico y tratamiento del proceso y permitió que el paciente no abandonase el medio y lugar más apropiado: el Servicio de Urgencias (AU)


The diagnosis of purulent pericarditis (PP) faces several challenges at the present time. The first of them is the epidemiology of the disease. PP is very uncommon and requires the physician best efforts to avoid a fatal diagnostic delay. The second challenge is the aetiology of the disease. On one hand deep changes in the bacteriological spectra has been reported since the antibiotic drug era began. An increasing trend of PP cases are now caused by anaerobic, gram– and fungus species in contrast with gram+ bacteria cultured before. There is also a predominant role of underlying conditions neither necessarily infectious nor previously diagnosed that increase the risk for PP. On the other hand a controversy related to the most efficient surgical drainage technique still remains. We report a case of a patient with PP who underwent bedside ultrasound at emergency department that reduced both diagnostic and treatment times and achieved an important aim: the patient remained in the most adequate setting for medical assistance, the Emergency Department (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Pericardite , Artrite Reumatoide/complicações , Serviço Hospitalar de Emergência/tendências , Diagnóstico Precoce , Tamponamento Cardíaco , Derrame Pericárdico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA