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1.
Artigo em Inglês | MEDLINE | ID: mdl-31720894

RESUMO

The aim was to develop a predictive model of infection by multidrug-resistant microorganisms (MDRO). A national, retrospective cohort study was carried out including all patients attended for an infectious disease in 54 Spanish Emergency Departments (ED), in whom a microbiological isolation was available from a culture obtained during their attention in the ED. A MDRO infection prediction model was created in a derivation cohort using backward logistic regression. Those variables significant at p < 0.05 assigned an integer score proportional to the regression coefficient. The model was then internally validated by k-fold cross-validation and in the validation cohort. A total of 5460 patients were included; 1345 (24.6%) were considered to have a MDRO infection. Twelve independent risk factors were identified in the derivation cohort and were combined into an overall score, the ATM (assessment of threat for MDRO) score. The model achieved an area under the curve-receiver operating curve of 0.76 (CI 95% 0.74-0.78) in the derivation cohort and 0.72 (CI 95% 0.70-0.75) in the validation cohort (p = 0.0584). Patients were then split into 6 risk categories and had the following rates of risk: 7% (0-2 points), 16% (3-5 points), 24% (6-9 points), 33% (10-14 points), 47% (15-21 points), and 71% (> 21 points). Findings were similar in the validation cohort. Several patient-specific factors were independently associated with MDRO infection risk. When integrated into a clinical prediction rule, higher risk scores and risk classes were related to an increased risk for MDRO infection. This clinical prediction rule could be used by providers to identify patients at high risk and help to guide antibiotic strategy decisions, while accounting for clinical judgment.

2.
Med. clín (Ed. impr.) ; 153(5): 205-212, sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183997

RESUMO

El incremento de los viajes internacionales, la creciente presencia de vectores transmisores de arbovirus en nuestro país, las alertas de fiebres hemorrágicas, como el actual brote de ébola en la R. D. del Congo y los casos autóctonos de fiebre hemorrágica de Crimea-Congo en nuestro país, ponen de nuevo en primer plano las enfermedades tropicales. El aislamiento de los casos sospechosos de enfermedades de alta transmisibilidad y letalidad ha de ser una prioridad (fiebres hemorrágicas, MERS-CoV). Al valorar al paciente, una cuidadosa historia clínica basada en los aspectos epidemiológicos de la zona de procedencia, las actividades realizadas, el tiempo de estancia en el mismo y el inicio de los síntomas nos ayudarán finalmente, si no al diagnóstico definitivo, sí al menos a descartar las enfermedades que signifiquen una amenaza para él. Por su frecuencia y gravedad la malaria debe ser descartada, sin olvidar las otras causas habituales de fiebre con las que el médico de urgencias debe estar familiarizado también


The increase in international travel, the growing presence of arbovirus vectors in our country, and notifications of haemorrhagic fever such as the current outbreak of Ebola in D.R. Congo and the cases of Crimea-Congo haemorrhagic fever in our country have again cast the spotlight on tropical diseases Isolating suspected cases of highly contagious and lethal diseases must be a priority (Haemorrhagic fever, MERS-CoV). Assessing the patient, taking a careful medical history based on epidemiological aspects of the area of origin, activities they have carried out, their length of stay in the area and the onset of symptoms, will eventually help us, if not to make a definitive diagnosis, at least to exclude diseases that pose a threat to these patients. Malaria should be ruled out because of its frequency, without forgetting other common causes of fever familiar to emergency doctors


Assuntos
Humanos , Controle Sanitário de Viajantes , Doença Relacionada a Viagens , Isolamento de Pacientes/tendências , Saúde do Viajante , Doenças Transmissíveis Importadas/epidemiologia , Febres Hemorrágicas Virais/epidemiologia , Infecções por Arbovirus/epidemiologia , Arbovirus/isolamento & purificação , Meningite/epidemiologia , Febre Tifoide/epidemiologia , Rickettsia/isolamento & purificação , Coronavirus/isolamento & purificação , Esquistossomose/epidemiologia
3.
Med Clin (Barc) ; 153(5): 205-212, 2019 09 13.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31155384

RESUMO

The increase in international travel, the growing presence of arbovirus vectors in our country, and notifications of haemorrhagic fever such as the current outbreak of Ebola in D.R. Congo and the cases of Crimea-Congo haemorrhagic fever in our country have again cast the spotlight on tropical diseases Isolating suspected cases of highly contagious and lethal diseases must be a priority (Haemorrhagic fever, MERS-CoV). Assessing the patient, taking a careful medical history based on epidemiological aspects of the area of origin, activities they have carried out, their length of stay in the area and the onset of symptoms, will eventually help us, if not to make a definitive diagnosis, at least to exclude diseases that pose a threat to these patients. Malaria should be ruled out because of its frequency, without forgetting other common causes of fever familiar to emergency doctors.

4.
Emergencias (Sant Vicenç dels Horts) ; 31(1): 21-26, feb. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182432

RESUMO

Objetivo: Evaluar la utilidad del cuestionario COPD Asessment Test (CAT) para valorar la recuperación de la exacerbación de la enfermedad pulmonar obstructiva crónica (EA-EPOC). Evaluar si la puntuación CAT aumenta la capacidad predictiva de mala evolución de una escala de gravedad para EA-EPOC. Método: Estudio de cohortes prospectivo multicéntrico. Se reclutaron pacientes que consultaron en los servicios de urgencias hospitalarios (SUH) participantes con síntomas compatibles con EA-EPOC. Se recogieron variables sociodemográficas, datos clínicos, cuestionario CAT y escala de disnea modificada del Medical Research Council (mMRC). Las variables resultado fueron: puntuación CAT dos meses tras EA-EPOC y mala evolución durante el ingreso o una semana después en pacientes dados de alta directamente desde los SUH. Resultados: Se incluyeron 501 pacientes. La mediana (RIC) de la puntuación CAT fue de 13 (RIC 7-18) en el día previo a EA-EPOC, 25 (19-30) en el momento de la consulta por EA-EPOC, y 13 (7-18) a dos meses. La diferencia entre la puntuación CAT el día previo a EA-EPOC y 2 meses del cuestionario no fue estadísticamente significativa según la gravedad de la EPOC basal, leve, moderada y grave-muy grave (p = 0,585, p = 0,419 y p = 0,436). Presentaron una mala evolución a corto plazo 91 pacientes (18,2%). La escala de gravedad con el cuestionario CAT obtuvo un área bajo la curva de la característica operativa del receptor de 0,701 (IC 95% 0,640-0,762) y sin el cuestionario CAT de 0,667 (IC 95% 0,616-0,737), esta diferencia no fue estadísticamente significativa (p = 0,088). Conclusiones: La escala CAT puede ser una herramienta de utilidad a la hora de supervisar la recuperación de la EAEPOC. Su inclusión como variable predictora en una escala de gravedad podría ser de utilidad clínica


Objectives: To assess the usefulness of the chronic obstructive pulmonary disease (COPD) assessment test (CAT) for evaluating recovery from an acute exacerbation of chronic COPD. To assess whether the CAT score used along with a COPD exacerbation severity scale can better predict risk of a poor course of disease. Methods: Prospective multicenter cohort study enrolling patients who attended hospital emergency departments with symptoms of exacerbated COPD. We recorded sociodemographic and clinical data and information from 2 questionnaires: the CAT and the modified dyspnea scale of the Medical Research Council (mMRC). Measures of clinical outcome in this study were the CAT score 2 months after the COPD exacerbation and poor course of disease during the hospital stay or 1 week after discharge from the emergency department if patients were not hospitalized. Results: The cohort included 501 patients. The median (interquartile range) CAT score was 13 (7-18) on the day before the exacerbation, 25 (19-30) during emergency care for the exacerbation, and 13 (7-18) 2 months later. The difference between the CAT scores before the exacerbation and 2 months later was not statistically significant when the cohort was stratified by severity of baseline COPD (mild, moderate, and severe/very severe) (P=.585, P=.419, and P=.4357). The short-term course of disease was poor for 91 patients (18.16%). Combining the mMRC and the CAT scores to predict poor short-term outcome gave an area under the receiver operating characteristic curve (AUC) of 0.701 (95% CI, 0.640-0.762). The AUC for the mMRC score without the CAT score was 0.667 (95% CI, 0.616- 0.737). The difference between the AUCs was not statistically significant (P=.088). Conclusions: The CAT score may be useful for monitoring recovery from a COPD exacerbation. Combining the CAT score and a COPD severity score may be useful for predicting clinical course after an exacerbation


Assuntos
Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Índice de Gravidade de Doença , Serviço Hospitalar de Emergência , Progressão da Doença , Tempo de Internação , Prognóstico , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/reabilitação
5.
Emergencias ; 31(1): 21-26, 2019 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30656869

RESUMO

OBJECTIVES: To assess the usefulness of the chronic obstructive pulmonary disease (COPD) assessment test (CAT) for evaluating recovery from an acute exacerbation of chronic COPD. To assess whether the CAT score used along with a COPD exacerbation severity scale can better predict risk of a poor course of disease. METHODS: Prospective multicenter cohort study enrolling patients who attended hospital emergency departments with symptoms of exacerbated COPD. We recorded sociodemographic and clinical data and information from 2 questionnaires: the CAT and the modified dyspnea scale of the Medical Research Council (mMRC). Measures of clinical outcome in this study were the CAT score 2 months after the COPD exacerbation and poor course of disease during the hospital stay or 1 week after discharge from the emergency department if patients were not hospitalized. RESULTS: The cohort included 501 patients. The median (interquartile range) CAT score was 13 (7-18) on the day before the exacerbation, 25 (19-30) during emergency care for the exacerbation, and 13 (7-18) 2 months later. The difference between the CAT scores before the exacerbation and 2 months later was not statistically significant when the cohort was stratified by severity of baseline COPD (mild, moderate, and severe/very severe) (P=.585, P=.419, and P=.4357). The short-term course of disease was poor for 91 patients (18.16%). Combining the mMRC and the CAT scores to predict poor short-term outcome gave an area under the receiver operating characteristic curve (AUC) of 0.701 (95% CI, 0.640-0.762). The AUC for the mMRC score without the CAT score was 0.667 (95% CI, 0.616- 0.737). The difference between the AUCs was not statistically significant (P=.088). CONCLUSION: The CAT score may be useful for monitoring recovery from a COPD exacerbation. Combining the CAT score and a COPD severity score may be useful for predicting clinical course after an exacerbation.


Assuntos
Doença Pulmonar Obstrutiva Crônica/diagnóstico , Índice de Gravidade de Doença , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Serviço Hospitalar de Emergência , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/reabilitação
6.
Emergencias (Sant Vicenç dels Horts) ; 30(4): 241-246, ago. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-180058

RESUMO

Objetivo: Diseñar un modelo de riesgo para predecir la mortalidad a los 30 días, y compararlo con la escala MEDS (Mortality in Emergency Department), en pacientes >= 75 años atendidos por infección con síndrome de respuesta inflamatoria sistémica (SIRS) en los servicios de urgencias (SU). Método: Estudio analítico de cohortes prospectivo que incluyó por oportunidad a pacientes >= 75 años atendidos por infección con SIRS en 13 SU españoles durante el año 2013. Se recogieron variables demográficas, comorbilidad, factores de riesgo de mala evolución, situación funcional basal, modelo de infección, y parámetros hemodinámicos, clínicos y analíticos en el momento de la primera atención. La variable de resultado principal fue mortalidad por cualquier causa a los 30 días. Resultados: Se incluyeron 379 pacientes con edad media de 84 (DE 5,8) años, 186 (49,1%) fueron mujeres, 150 (39,6%) tenían alto grado de comorbilidad y 113 (34,2%) dependencia funcional grave. Setenta y nueve pacientes (20,8%) fallecieron a los 30 días. El modelo INFURG-OLDER incluyó la presencia de tumor sólido con metástasis (OR=5,4; IC95% 1,618,2; p=0,006), la insuficiencia respiratoria (OR=3,02; IC95% 1,5-6,0; p=0,002), la insuficiencia renal (OR=2,4; IC95% 1,0-5,5; p=0,045), la hipotensión arterial (OR=2,4; IC95% 1,2-5,0; p=0,015) y la disminución del nivel de consciencia (OR=2,9; IC95% 1,4-5,8; p=0,003). El área bajo la curva (ABC) del modelo INFURG-OLDER fue de 0,78 (IC95% 0,720,84; p<0,001) y el ABC de la escala MEDS fue de 0,72 (IC95% 0,64-0,80; p<0,001). Conclusiones: El modelo INFURG-OLDER tiene buena capacidad para predecir la mortalidad a los 30 días en los pacientes >= 75 años atendidos por infección con SIRS en los SU


Objectives: To build a model to predict 30-day mortality and compare it to prediction based on the Mortality in Emergency Department Sepsis (MEDS) score in patients aged 75 years or older treated for infection and systemic inflammatory response syndrome (SIRS) in the emergency department. Material and methods: Prospective analysis of a convenience cohort of patients aged 75 years or older treated for infection and SIRS in 13 Spanish emergency departments in 2013. We recorded demographic variables; comorbidity; risk factors for poor outcome; functional dependence at baseline; site of infection; and hemodynamic, clinical and laboratory findings on start of care.The main outcome variable was 30-day all-cause mortality. Results: Three hundred seventy-nine patients with a mean (SD) age of 84 (5.8) years were included; 186 (49.,1%) were women, 150 (39.6%) had a high degree of comorbidity, and 113 (34.2%) had a high level of functional dependence. Seventy-nine (20.8%) died within 30 days. The model built by the infection working group (INFURG) of the Spanish Society of Emergency Medicine (SEMES) included the presence of metastasis from a solid tumor (odds ratio [OR], 5.4; 95% CI, 1.6–18.2; P=.006), respiratory insufficiency (OR, 3.02; 95% CI, 1.5–6.0; P=.002), renal insufficiency (OR, 2.4; 95% CI, 1.0–5.5; P=.045), arterial hypertension (OR, 2.4; 95% CI, 1.2–5.0; P=.015), and altered level of consciousness (OR, 2.9; 95% CI, 1.4–5.8; P=.003). The area under the receiver operating characteristic curve of the INFURG-OLDER model was 0.78 (95% CI, 0.72–0.84; P<.001) (vs 0.72 (95% CI, 0.64–0.80; P<.001 for the MEDS model). Conclusion: The INFURG-OLDER model has good predictive ability for 30-day mortality in patients aged 75 years or older who are treated in emergency departments for SIRS


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Técnicas de Apoio para a Decisão , Prognóstico , Índice de Gravidade de Doença , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Serviço Hospitalar de Emergência , Estudos Prospectivos , Curva ROC , Fatores de Risco , Medição de Risco , Sepse/diagnóstico , Sepse/mortalidade , Espanha/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
7.
Emergencias ; 30(4): 241-246, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30033697

RESUMO

OBJECTIVES: To build a model to predict 30-day mortality and compare it to prediction based on the Mortality in Emergency Department Sepsis (MEDS) score in patients aged 75 years or older treated for infection and systemic inflammatory response syndrome (SIRS) in the emergency department. MATERIAL AND METHODS: Prospective analysis of a convenience cohort of patients aged 75 years or older treated for infection and SIRS in 13 Spanish emergency departments in 2013. We recorded demographic variables; comorbidity; risk factors for poor outcome; functional dependence at baseline; site of infection; and hemodynamic, clinical and laboratory findings on start of care.The main outcome variable was 30-day all-cause mortality. RESULTS: Three hundred seventy-nine patients with a mean (SD) age of 84 (5.8) years were included; 186 (49.,1%) were women, 150 (39.6%) had a high degree of comorbidity, and 113 (34.2%) had a high level of functional dependence. Seventy-nine (20.8%) died within 30 days. The model built by the infection working group (INFURG) of the Spanish Society of Emergency Medicine (SEMES) included the presence of metastasis from a solid tumor (odds ratio [OR], 5.4; 95% CI, 1.6-18.2; P=.006), respiratory insufficiency (OR, 3.02; 95% CI, 1.5-6.0; P=.002), renal insufficiency (OR, 2.4; 95% CI, 1.0-5.5; P=.045), arterial hypertension (OR, 2.4; 95% CI, 1.2-5.0; P=.015), and altered level of consciousness (OR, 2.9; 95% CI, 1.4-5.8; P=.003). The area under the receiver operating characteristic curve of the INFURG-OLDER model was 0.78 (95% CI, 0.72-0.84; P<.001) (vs 0.72 (95% CI, 0.64-0.80; P<.001 for the MEDS model). CONCLUSION: The INFURG-OLDER model has good predictive ability for 30-day mortality in patients aged 75 years or older who are treated in emergency departments for SIRS.


Assuntos
Técnicas de Apoio para a Decisão , Índice de Gravidade de Doença , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Curva ROC , Medição de Risco , Fatores de Risco , Sepse/diagnóstico , Sepse/mortalidade , Espanha/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
8.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 35(4): 214-219, abr. 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-162741

RESUMO

Objetivos: Analizar los factores asociados a la mortalidad a corto plazo en los pacientes ancianos que acuden al servicio de urgencias (SU) por un episodio de infección. Material y métodos: Estudio observacional, prospectivo, multicéntrico y analítico. Se incluyó consecutivamente a pacientes de 75 o más años atendidos en 8 servicios de SU por un proceso infeccioso. Se analizaron 26 variables independientes (epidemiológicas, de comorbilidad, funcionales, clínicas y analíticas) que pudieran influir en la mortalidad a corto plazo (30 días). Se realizó un estudio multivariable mediante regresión logística. Resultados: Se incluyó a 488 pacientes, de los que 92 (18,9%) habían fallecido a los 30 días tras su consulta en el SU. Tres variables se asociaron de forma significativa con la mortalidad: la dependencia funcional basal grave con índice de Barthel ≤60 (odds ratio [OR] 8,92; intervalo de confianza [IC] del 95%: 4,98-15,98, p=0,003), la existencia de una presión arterial sistólica (PAS)<90mmHg (OR 7,34; IC95%: 4,39-12,26, p=0,005) y lactato sérico >4mmol/l (OR 21,14; IC95%: 8,94-49,97, p=0,001). El área bajo la curva-ROC del modelo fue 0,971 (IC95%: 0,951-0,991; p<0,001). Conclusiones: Existen varios factores disponibles tras una primera atención en el SU —entre ellos la valoración funcional, la PAS y, el más importante, el lactato sérico— que determinan un mal pronóstico a corto plazo del paciente anciano que consulta por un proceso infeccioso (AU)


Objectives: To analyse factors associated with short-term mortality in elderly patients seen in emergency departments (ED) for an episode of infectious disease. Materials and methods: A prospective, observational, multicentre, analytical study was carried out on patients aged 75 years and older who were treated in the ED of one of the eight participating hospitals. An assessment was made of 26 independent variables that could influence mortality at 30 days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Multivariate logistic regression analysis was performed. Results: The study included 488 consecutive patients, 92 (18.9%) of whom died within 30 days of visiting the ED. Three variables were significantly associated with higher mortality: severe functional dependence, with Barthel index ≤60 [odds ratio (OR) 8,92; 95% confidence interval (CI): 4.98-15.98, P=.003], systolic blood pressure <90mmHg [OR 7.34; 95%CI: 4.39-12.26, P=.005] and serum lactate >4mmol/l [OR 21.14; 95%CI: 8.94-49.97, P=.001]. The area under the curve for the model was 0.971 (95%CI: 0.951-0.991; P<.001). Conclusions: Several factors evaluated in an initial assessment in the ED, including the level of functional dependence, systolic blood pressure and, especially, serum lactate, were found to determine a poor short-term prognosis in the elderly patients who presented with an episode of an infectious disease (AU)


Assuntos
Humanos , Idoso , Doenças Transmissíveis/epidemiologia , Tratamento de Emergência/estatística & dados numéricos , Antibacterianos/uso terapêutico , Estudos Prospectivos , Resultado do Tratamento , Mortalidade , Ácido Láctico/sangue , Biomarcadores/análise , Prognóstico
9.
Enferm Infecc Microbiol Clin ; 35(4): 214-219, 2017 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-26702902

RESUMO

OBJECTIVES: To analyse factors associated with short-term mortality in elderly patients seen in emergency departments (ED) for an episode of infectious disease. MATERIALS AND METHODS: A prospective, observational, multicentre, analytical study was carried out on patients aged 75years and older who were treated in the ED of one of the eight participating hospitals. An assessment was made of 26 independent variables that could influence mortality at 30days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Multivariate logistic regression analysis was performed. RESULTS: The study included 488 consecutive patients, 92 (18.9%) of whom died within 30days of visiting the ED. Three variables were significantly associated with higher mortality: severe functional dependence, with Barthel index ≤60 [odds ratio (OR) 8,92; 95% confidence interval (CI): 4.98-15.98, P=.003], systolic blood pressure <90mmHg [OR 7.34; 95%CI: 4.39-12.26, P=.005] and serum lactate >4mmol/l [OR 21.14; 95%CI: 8.94-49.97, P=.001]. The area under the curve for the model was 0.971 (95%CI: 0.951-0.991; P<.001). CONCLUSIONS: Several factors evaluated in an initial assessment in the ED, including the level of functional dependence, systolic blood pressure and, especially, serum lactate, were found to determine a poor short-term prognosis in the elderly patients who presented with an episode of an infectious disease.


Assuntos
/mortalidade , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Fatores de Tempo
10.
Rev. esp. quimioter ; 29(6): 318-327, dic. 2016. tab, graf
Artigo em Inglês | IBECS | ID: ibc-158226

RESUMO

Objective. To develop a set of recommendations, by consensus of Emergency Medicine experts, on key aspects related to the care of adult patients with acute infection attended in Spanish emergency departments (ED). Methodology. The study was divided into three phases: 1) To design a questionnaire by a coordinating group; 2) To conduct a survey in ED physicians in order to know their opinion on the issues raised by the coordinating group; 3) To develop a number of recommendations based on the responses to the questionnaire and their subsequent discussion. Results. A group of 28 experts from different Spanish ED, as well as 5 members of the coordinating group, with knowledge and experience in the management of infectious diseases in ED, conducted a round of voting to a questionnaire of 18 issues grouped into three sections: 1) identification and stratification of the severity; 2) diagnosis and treatment; 3) management. Conclusions. A monitoring system and proper training of the entire healthcare team are required, as well as extensive knowledge on these issues, to ensure adequate and effective care for these patients. It is essential to educate and train all health staff, especially in the ED, because it is the initial point of contact for most patients with an infection. The experts established proposals based on survey questions and the discussion (AU)


Objetivo. Elaborar un conjunto de recomendaciones basadas en la opinión de expertos en medicina de urgencias sobre aspectos claves relacionados con la atención del paciente con sospecha de infección en los servicios de urgencias. Metodología. El estudio se desarrolló en tres fases: 1) Diseño de un cuestionario por un grupo coordinador; 2) Realización de una encuesta para conocer la opinión de los profesionales en urgencias y emergencias sobre las cuestiones formuladas por el grupo coordinador; 3) Elaboración de una serie de recomendaciones basadas en las respuestas al cuestionario y su posterior discusión. Resultados. Un grupo de 28 expertos procedentes de distintos servicio de urgencias hospitalarios españoles, así como 5 miembros del grupo coordinador, formado por médicos con experiencia en urgencias y patología infecciosa, realizaron una ronda de votación a un cuestionario de 18 preguntas clasificadas en tres bloques: identificación y estratificación del paciente infectado, diagnóstico y tratamiento, y gestión hospitalaria. Conclusiones. Para garantizar una atención adecuada y eficaz de estos pacientes se requiere una atención estructurada y un entrenamiento adecuado de todo el equipo sanitario, así como un amplio conocimiento en estos temas. Resulta fundamental educar y concienciar a todo el personal sanitario especialmente en los servicios de urgencias, punto de contacto inicial de la mayoría de los pacientes que padecen una infección. En base a las preguntas y su discusión, se consensuaron una serie de propuestas (AU)


Assuntos
Humanos , Masculino , Feminino , Serviços Médicos de Emergência/métodos , Medicina de Emergência/métodos , Infecção/complicações , Infecção/epidemiologia , Sepse/complicações , Sepse/diagnóstico , Diagnóstico Precoce , Assistência ao Paciente/economia , Assistência ao Paciente/métodos , Inquéritos e Questionários , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/normas , Eficácia/métodos , Resultado do Tratamento
11.
Rev. calid. asist ; 31(6): 322-328, nov.-dic. 2016.
Artigo em Espanhol | IBECS | ID: ibc-157209

RESUMO

Objetivo. Describir las características clínicas y evolución de los pacientes ancianos (≥75 años) con sospecha de infección atendidos en los servicios de urgencias (SU) y comparar los que ingresan en una unidad de corta estancia (UCE) respecto las unidades de hospitalización convencional (UHC). Material y métodos. Estudio de cohortes prospectivo que incluyó, mediante muestreo por oportunidad, a los pacientes ≥75 años atendidos por infección en los SU de 3 hospitales universitarios españoles (año 2013). Se analizaron variables demográficas, comorbilidad, situación funcional basal, existencia de sepsis, tipo de infección, destino y mortalidad a 30 días. Resultados. Se identificaron 330 pacientes ≥75 años (edad media: 83,8±7,3). Ingresaron 306 (93%), 175 en UHC (53%) y 87 (26%) en UCE. Los principales antecedentes fueron HTA (74,5%), arritmia cardíaca (30%), enfermedad pulmonar obstructiva crónica (28%) y diabetes mellitus (26%), y como factores de multirresistencia el tratamiento antibiótico los 3 meses previos (48%) y la institucionalización (26%). El 53% presentó síndrome séptico clásico y la infección respiratoria fue la más prevalente (50%). Al comparar el ingreso en UCE o UHC se observaron diferencias estadísticamente significativas (p<0,05) en el índice de Charlson (1,95 vs. 2,51), escala de Glasgow (14,6 vs. 14,3), síndrome séptico (67% vs. 53%), sepsis grave (2,3% vs. 18%), estancia hospitalaria (4,2 días vs. 10,4) y mortalidad a 30 días (3,4% vs. 18%) respectivamente. onclusiones. Las UCE suponen una alternativa a las UHC para enfermos ancianos con sospecha de infección que requieren ingreso (AU)


Objective. To describe the clinical characteristics and outcomes of elderly patients (≥ 75 years) with suspected infection attending the emergency department (ED) and to compare patients admitted to a short-stay unit (SSU) with those admitted to a conventional hospital unit (CHU). Material and methods. Prospective cohort study including, using opportunity sampling, patients ≥75 years treated for infection in the ED of 3 Spanish university hospitals (2013). Demographic variables, comorbidity, baseline performance status, presence of sepsis, infection type, destination on discharge, and mortality at 30 days were collected. Results. During the study period, 330 patients ≥75 years (mean age 83.8±7.3) were evaluated for a suspected infection in the ED, and 306 (93%) were admitted to the hospital, 175 (53%) to the CHU and 87 (26%) to the SSU. Medical history included hypertension (74.5%), arrhythmia (30%), chronic obstructive pulmonary disease (28%), and diabetes mellitus (26%), and risk factors for multidrug resistance, such as antibiotic treatment in 3 months prior to admission (48%), and institutionalisation (26%). A classic sepsis syndrome was found to be the source of infection in 53%, and was respiratory in half of patients. When comparing patients admitted to SSU and CHU, statistically significant differences (p<.05) were found in the Charlson index (1.95 vs. 2.51), Glasgow coma scale (14.6 vs. 14.3), classic sepsis syndrome (67% vs. 53%), severe sepsis (2.3% vs. 18%), length of stay (4.2 vs. 10.4 days), and mortality within 30 days (3.4% vs. 18%), respectively. Conclusions. SSU may be an adequate alternative to CHU for elderly patients requiring admission with suspected infection (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Tempo de Internação/economia , Tempo de Internação/tendências , Infecção/complicações , Infecção/epidemiologia , Saúde do Idoso , Idoso Fragilizado/estatística & dados numéricos , Serviços de Saúde para Idosos/organização & administração , Serviços de Saúde para Idosos/normas , Serviços de Saúde para Idosos , Estudos Prospectivos
13.
Rev Calid Asist ; 31(6): 322-328, 2016.
Artigo em Espanhol | MEDLINE | ID: mdl-27211492

RESUMO

OBJECTIVE: To describe the clinical characteristics and outcomes of elderly patients (≥ 75 years) with suspected infection attending the emergency department (ED) and to compare patients admitted to a short-stay unit (SSU) with those admitted to a conventional hospital unit (CHU). MATERIAL AND METHODS: Prospective cohort study including, using opportunity sampling, patients ≥75 years treated for infection in the ED of 3 Spanish university hospitals (2013). Demographic variables, comorbidity, baseline performance status, presence of sepsis, infection type, destination on discharge, and mortality at 30 days were collected. RESULTS: During the study period, 330 patients ≥75 years (mean age 83.8±7.3) were evaluated for a suspected infection in the ED, and 306 (93%) were admitted to the hospital, 175 (53%) to the CHU and 87 (26%) to the SSU. Medical history included hypertension (74.5%), arrhythmia (30%), chronic obstructive pulmonary disease (28%), and diabetes mellitus (26%), and risk factors for multidrug resistance, such as antibiotic treatment in 3 months prior to admission (48%), and institutionalisation (26%). A classic sepsis syndrome was found to be the source of infection in 53%, and was respiratory in half of patients. When comparing patients admitted to SSU and CHU, statistically significant differences (p<.05) were found in the Charlson index (1.95 vs. 2.51), Glasgow coma scale (14.6 vs. 14.3), classic sepsis syndrome (67% vs. 53%), severe sepsis (2.3% vs. 18%), length of stay (4.2 vs. 10.4 days), and mortality within 30 days (3.4% vs. 18%), respectively. CONCLUSIONS: SSU may be an adequate alternative to CHU for elderly patients requiring admission with suspected infection.


Assuntos
Serviço Hospitalar de Emergência , Recursos em Saúde , Tempo de Internação , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Prospectivos , Sepse
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