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1.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 40-44, feb. 2020. tab, graf
Artigo em Espanhol | IBECS-Express | ID: ibc-ET2-3435

RESUMO

Objetivo. Determinar el impacto pronóstico de la enfermedad pulmonar obstructiva crónica (EPOC) en los pacientes diagnosticados de enfermedad tromboembólica venosa (ETV) en servicios de urgencias (SU) españoles. Método. Análisis secundario del registro ESPHERIA que incluyó pacientes consecutivos con ETV sintomática en 53 SU. Resultados. Se incluyeron 801 pacientes de los que 71 (9%) tenían EPOC, siendo la tromboembolia pulmonar la forma de presentación más frecuente de ETV en este subgrupo de pacientes (77,5% vs 47,1%, p < 0,001). Los pacientes con EPOC tuvieron con más frecuencia disfunción de ventrículo derecho en la angiotomografía pulmonar (18,2% vs 13,1%; p < 0,001) y necesidad de soporte ventilatorio (7% vs 0,5%; p < 0,001). Los pacientes con ETV y EPOC tuvieron mayor incidencia de reingreso o mortalidad en el seguimiento a 180 días [HR 1,52 (IC 95% 1,00-2,29; p = 0,048)], comparados con los pacientes con ETV sin EPOC. Conclusiones. La EPOC tiene impacto pronóstico en los pacientes diagnosticados de ETV en SU españoles, en términos de mortalidad y reingreso hospitalario


Objective. To determine the impact of chronic obstructive pulmonary disease (COPD) on prognosis in patients diagnosed with venous thromboembolic disease (VTED) in Spanish emergency departments. Methods. Secondary analysis of data from the ESPHERIA (Spanish acronym for Risk Profile of Patients VTED Attended in Spanish Emergency Departments) registry. Results. A total of 801 patients, 71 (9%) with COPD, were included. Pulmonary thromboembolism was recorded in 77.%% of the patients with COPD (vs in 47.1% of patients without COPD; P<.001). Patients with COPD had evidence of right ventricular dysfunction on computed tomography angiography more often than other VTED patients (18.2% vs 13.1%; P<.001) and more often required ventilatory support (7% vs 0.5%; P<.001). VTED patients with COPD also had a higher rate of readmission or mortality at 180 days (hazard ratio, 1.52; 95% CI, 1.00-2.29; P = .048)] than patients without COPD. Conclusions. COPD affects the prognosis of patients diagnosed with VTED in Spanish emergency departments as evidenced by hospital readmission and mortality

2.
Emergencias ; 32(1): 40-44, 2020 Feb.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31909911

RESUMO

OBJECTIVES: To determine the impact of chronic obstructive pulmonary disease (COPD) on prognosis in patients diagnosed with venous thromboembolic disease (VTED) in Spanish emergency departments. MATERIAL AND METHODS: Secondary analysis of data from the ESPHERIA (Spanish acronym for Risk Profile of Patients VTED Attended in Spanish Emergency Departments) registry. RESULTS: A total of 801 patients, 71 (9%) with COPD, were included. Pulmonary thromboembolism was recorded in 77.%% of the patients with COPD (vs in 47.1% of patients without COPD; P<.001). Patients with COPD had evidence of right ventricular dysfunction on computed tomography angiography more often than other VTED patients (18.2% vs 13.1%; P<.001) and more often required ventilatory support (7% vs 0.5%; P<.001). VTED patients with COPD also had a higher rate of readmission or mortality at 180 days (hazard ratio, 1.52; 95% CI, 1.00-2.29; P = .048)] than patients without COPD. CONCLUSION: COPD affects the prognosis of patients diagnosed with VTED in Spanish emergency departments as evidenced by hospital readmission and mortality.

5.
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.

6.
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
7.
Emergencias ; 29(2): 93-98, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-28825250

RESUMO

OBJECTIVES: To determine the prevalence of international normalized ratio (INR) findings outside the normal range in hospital emergency department patients on vitamin K antagonists (VKAs). To identify factors associated with abnormal anticoagulant levels in these patients. MATERIAL AND METHODS: Observational, cross-sectional, multicentric study in 4 hospital emergency departments. We included a convenience sample of patients on VKA treatment for whom INR levels were on record and who had sought emergency care for complications unrelated to anticoagulant treatment. RESULTS: We included 376 patients with a mean (SD) age of 76.8 (10.1) years; 50.3% were women and 86.7% had atrial fibrillation. We found that 60.4% (95% CI, 55.3%-65.2%) had INRs outside the reference range. Multivariate analysis showed that changes in the patients' other long-term medications were independently associated with nontherapeutic INR results (odds ratio, 1.6; 95% CI, 1.02-2.79; P=.035). CONCLUSION: Over 60% of patients on VKA treatment who come to hospital emergency departments with complaints unrelated to anticoagulant therapy have INR values outside the normal range. Changes in a patient's usual medications are significantly associated with nontherapeutic INR findings.


Assuntos
Anticoagulantes/farmacologia , Coeficiente Internacional Normatizado , Vitamina K/antagonistas & inibidores , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/sangue , Estudos Transversais , Emergências , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Polimedicação , Prevalência , Trombofilia/tratamento farmacológico
8.
Emergencias (St. Vicenç dels Horts) ; 29(2): 93-98, abr. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-161660

RESUMO

Objetivos. Determinar la prevalencia de un International Normalized Ratio (INR) fuera de rango entre los pacientes que acuden a los servicios de urgencias hospitalarios (SUH) y se encuentran en tratamiento con fármacos antivitamina K (AVK). Identificar los factores que se asocian con unos valores inadecuados de anticoagulación en estos pacientes. Método. Estudio multicéntrico, observacional y transversal en cuatro SUH. Se incluyeron pacientes en tratamiento con AVK a los que se les realizó una analítica con determinación de INR, que no acudían por complicaciones asociadas al tratamiento anticoagulante. La inclusión se realizó mediante un muestreo de oportunidad. Resultados. Se incluyeron en el estudio un total de 376 pacientes. Edad media de 76,8 (10,1) años, 50,3% fueron mujeres. El 86,7% de los pacientes presentaban fibrilación auricular. El 60,4% (IC 95%: 55,3%-65,2%) de los pacientes tuvieron un INR fuera de rango. El análisis multivariado demostró que los cambios en los medicamentos habituales con odss ratio (OR) de 1,6 (IC 95%: 1,02-2,79; p = 0,035) se asociaron de forma independiente a la presencia de un INR fuera de rango. Conclusiones. El 60,4% de los pacientes en tratamiento con AVK que acuden a un SUH sin complicaciones asociadas al tratamiento anticoagulante presenta un INR fuera de rango. Los cambios en el tratamiento habitual del paciente se relacionaron significativamente con un INR fuera de rango (AU)


Aims. To determine the prevalence of international normalized ratio (INR) findings outside the normal range in hospital emergency department patients on vitamin K antagonists (VKAs). To identify factors associated with abnormal anticoagulant levels in these patients. Methods. Observational, cross-sectional, multicentric study in 4 hospital emergency departments. We included a convenience sample of patients on VKA treatment for whom INR levels were on record and who had sought emergency care for complications unrelated to anticoagulant treatment. Results. We included 376 patients with a mean (SD) age of 76.8 (10.1) years; 50.3% were women and 86.7% had atrial fibrillation. We found that 60.4% (95% CI, 55.3%–65.2%) had INRs outside the reference range. Multivariate analysis showed that changes in the patients' other long-term medications were independently associated with nontherapeutic INR results (odds ratio, 1.6; 95% CI, 1.02–2.79; P=.035). Conclusions. Over 60% of patients on VKA treatment who come to hospital emergency departments with complaints unrelated to anticoagulant therapy have INR values outside the normal range. Changes in a patient's usual medications are significantly associated with nontherapeutic INR findings (AU)


Assuntos
Humanos , Vitamina K/antagonistas & inibidores , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Coeficiente Internacional Normatizado/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/métodos , Conduta do Tratamento Medicamentoso
9.
Emergencias (St. Vicenç dels Horts) ; 27(4): 236-240, ago. 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-139340

RESUMO

Objetivo. Determinar la aplicabilidad y valorar la idoneidad de los componentes de la escala de Wells para la estimación de la probabilidad clínica de trombosis venosa profunda (TVP) en pacientes atendidos en los servicios de urgencias hospitalarios (SUH). Métodos. Estudio multicéntrico prospectivo de cohortes, con inclusión de pacientes consecutivos atendidos en los SUH con sospecha de TVP. Se realizó una ecografía de compresión con Doppler de toda la extremidad a todos los pacientes. Se recogió la existencia de variables relacionadas con el riesgo de desarrollo de TVP y los componentes de las escalas de probabilidad. Finalmente se calculó la probabilidad clínica mediante las escalas de Wells y Oudega. Resultados. Se incluyeron 362 pacientes de 23 SUH (edad media 65 (DE 18) años, 52,8% mujeres). Se diagnosticó TVP a un total de 254 pacientes (70,16%), de los que 171 (47,2%) fueron TVP proximales (TVPP). La distribución de los pacientes según las categorías de probabilidad de la escala de Wells y la prevalencia de TVPP fue: 57 pacientes con probabilidad baja (14 casos con TVP, 24,6%), 124 con probabilidad intermedia (43 casos con TVP, 34,7%) y 181 con probabilidad alta (114 casos con TVP, 63%). Sólo cinco de los componentes de la escala de Wells se asociaron a la presencia de TVPP. Conclusiones. La prevalencia de TVP en las diferentes categorías de probabilidad de la escala de Wells es muy elevada y no corresponde a la señalada en las series de validación. Parece necesario desarrollar escalas adecuadas a la población con sospecha de TVP que acude a los SUH (AU)


Objectives. To determine the applicability of the Wells clinical prediction criteria for deep vein thrombosis (DVT) in patients in hospital emergency departments and to evaluate the relevance of the score’s components. Methods. Prospective multicenter cohort study in consecutive hospital emergency department patients suspected of having DVT. Full-leg Doppler compression ultrasound imaging was performed on all patients. We recorded information on variables related to risk for DVT and the components of clinical prediction scales. Wells and Oudega clinical prediction scores were calculated. Results. We studied 362 patients in 23 hospital emergency departments; the mean (SD) age was 65 (18) years and 52.8% were women. DVT was diagnosed in 254 patients (70.16%); 171 (47.2%) had proximal DVT. The clinical probability of DVT according to the Wells scale and the prevalence of proximal DVT were as follows: low probability, 57 patients (14 with DVT, 24.6%); intermediate probability, 124 (43 with DVT, 34.7%), and high probability, 181 (114 with DVT, 63%). Only 5 of the components of the Wells scale were associated with the presence of proximal DVT. Conclusions. The prevalence of DVT is very high in the 3 categories of clinical probability indicated by the Wells score. The prevalences do not correspond to those of the cohort used to validate the scale. It appears to be necessary to develop scales adjusted for use in hospital emergency departments when DVT is suspected (AU)


Assuntos
Feminino , Humanos , Masculino , Probabilidade , Trombose Venosa/epidemiologia , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência , Medicina de Emergência/tendências , Previsões/métodos , Trombose Venosa , Estudos Prospectivos , Estudos de Coortes
11.
Emergencias ; 27(1): 68, 2015 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-29077341
12.
Emergencias ; 27(4): 236-340, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-29087080

RESUMO

OBJECTIVES: To determine the applicability of the Wells clinical prediction criteria for deep vein thrombosis (DVT) in patients in hospital emergency departments and to evaluate the relevance of the score's components. MATERIAL AND METHODS: Prospective multicenter cohort study in consecutive hospital emergency department patients suspected of having DVT. Full-leg Doppler compression ultrasound imaging was performed on all patients. We recorded information on variables related to risk for DVT and the components of clinical prediction scales. Wells and Oudega clinical prediction scores were calculated. RESULTS: We studied 362 patients in 23 hospital emergency departments; the mean (SD) age was 65 (18) years and 52.8% were women. DVT was diagnosed in 254 patients (70.16%); 171 (47.2%) had proximal DVT. The clinical probability of DVT according to the Wells scale and the prevalence of proximal DVT were as follows: low probability, 57 patients (14 with DVT, 24.6%); intermediate probability, 124 (43 with DVT, 34.7%), and high probability, 181 (114 with DVT, 63%). Only 5 of the components of the Wells scale were associated with the presence of proximal DVT. CONCLUSION: The prevalence of DVT is very high in the 3 categories of clinical probability indicated by the Wells score. The prevalences do not correspond to those of the cohort used to validate the scale. It appears to be necessary to develop scales adjusted for use in hospital emergency departments when DVT is suspected.

13.
Emergencias (Sant Vicenç dels Horts) ; 26(5): 349-353, oct. 2014. tab
Artigo em Espanhol | IBECS | ID: ibc-181350

RESUMO

Objetivos: Existen pocos datos sobre las diferencias entre las escalas utilizadas, en los servicios de urgencias hospitalarios (SUH), para la valoración del riesgo de enfermedad tromboembólica venosa (ETV) en pacientes que ingresan por patología médica. El objetivo fue analizar la concordancia entre la guía PRETEMED y el Padua Prediction Score (PPS). Método: Estudio de cohortes prospectivo multicéntrico, realizado en seis SUH españoles. Se incluyeron pacientes con patología médica que requirieron ingreso hospitalario entre diciembre de 2011 y julio de 2012. Se evaluó la concordancia de ambas escalas para clasificar a los pacientes en las diferentes categorías de riesgo. Además, se recogieron los acontecimientos tromboembólicos durante 90 días. Resultados: Se reclutaron 610 pacientes, de los que 580 fueron evaluables (edad media 70,1 (16,9) años, 45,3% mujeres). Los pacientes clasificados como de riesgo moderado o alto según PRETEMED fueron 256 (44,1%) y según PPS 368 (63,4%). Al evaluar la concordancia entre ambas escalas, se observó un índice kappa de 0,39 (IC95%: 0,32-0.46), con una discordancia del 31,3%. La incidencia de ETV en los 129 pacientes sin tromboprofilaxis clasificados de moderado o alto riesgo, según PRETEMED, fue de 2,3% y en los 201 pacientes de alto riesgo, según PPS, fue del 3,5%. Conclusiones: Existe discordancia significativa entre las escalas utilizadas (PRETEMED y PPS) para valorar el riesgo de ETV en los pacientes hospitalizados por patología médica. PPS fue la que más pacientes clasificó de alto riesgo, y lo hizo mejor, en base al desarrollo posterior de ETV


Background and objective: Little information is available on differences between scales used to assess risk for venous thromboembolism (VTE) in patients with medical conditions admitted from hospital emergency departments. We aimed to evaluate the agreement between 2 risk prediction tools: a scale based on the PRETEMED guideline and the Padua Prediction Score (PPS). Methods: Prospective multicenter cohort study in 6 Spanish hospital emergency departments. Patients with medical conditions requiring hospital admission were included between December 2011 and July 2012. The concordance correlation between the 2 scales was calculated. The development of VTE was registered for 90 days. Results: Of 610 patients recruited, data for 580 patients (mean [SD] age, 70.1 [16.9] years; 45.3% women) were valid for assessment. Patients classified as having moderate or high risk numbered 256 (44.1%) with the PRETEMED scale and 368 (63.4%) with the PPS. The κ index of concordance between the 2 scales was 0.39 (95% CI, 0.32-0.46) (discordance, 31.3%). Among patients who did not receive thromboprophylaxis, the incidence of VTE was 2.3% among the 129 patients the PRETEMED scale classified as being at moderate or high risk and 3.5% among patients at high risk according to the PPS. Conclusions: There is disagreement between PRETEMED and PPS scale assessments of risk for VTE in patients with medical conditions. The PPS classified more patients as being at high risk, and the predictions were more accurate based on their later development of VTE


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Índice de Gravidade de Doença , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/terapia , Estudos Prospectivos , Estudos de Coortes , Medição de Risco
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