Aplicación de escala de Brighton y su asociación con las características clínicas y demográficas de pacientes con patologías respiratorias en un hospital de tercer nivel en Ciudad de Panamá, Panamá

Introducción: La escala de alerta temprana pediátrica (PEWS) es un conjunto de parámetros analizados en pacientes pediátricos, puntuados de forma aleatoria, que determinan la probabilidad de deterioro clínico. Material y métodos: Estudio de tipo observacional, retrospectivo, analítico en pacientes de 1 mes a 15 años de edad con patología respiratoria, trasladados de sala de hospitalización general a unidad de terapia intensiva en el Hospital del Niño Dr. José Renán Esquivel, del 1 de enero 2020 al 31 de diciembre 2021, para los cuales calculamos dos puntajes de la Escala de alerta temprana en pediatría (PEWS), con la información consignada en las dos notas de evolución, en el expediente clínico, previas al traslado. Resultados: De 75 pacientes trasladados, 61% correspondieron al sexo masculino; y 72% fueron lactantes. La media de edad de ingreso fue de 30.1 meses (2 años y 6 meses). El principal rango de PEWS encontrado fue de 3-4 para ambos sexos. La mayoría de los pacientes presentaron comorbilidades y la principal fue la cardiopatía congénita, en un 12% de éstos. Del total de patologías respiratorias estudiadas, 70% correspondieron a casos de Neumonía, con predominio de PEWS de 3-4. Se obtuvo medias de 8.2 días de estancia hospitalaria en sala, 10.8 días en unidad de terapia intensiva y 29.1 días de estancia hospitalaria total, sin existir asociación estadísticamente significativa entre éstos y los valores de PEWS obtenidos. Fallecieron 14% (n=11) de los pacientes admitidos en el lapso estudiado. Conclusiones: La principal patología respiratoria admitida a la unidad de terapia intensiva es la neumonía, el principal grupo etario y sexo son los lactantes masculinos. La principal comorbilidad encontrada fue la cardiopatía congénita. PEWS de 0-2 presentaron mayores medias de estancia en todas las salas. No encontramos asociación estadísticamente significativa entre las variables estudiadas y los valores de PEWS obtenidos. (provisto por Infomedic International)

Introduction: The Pediatric Early Warning Score (PEWS) is a set of parameters analyzed in pediatric patients that determine the probability of clinical deterioration. Material and methods: Observational, retrospective, analytical study in patients with respiratory disease from 1 month to 15 years of age, transferred from the general hospitalization ward to the intensive care unit at Hospital del Niño Dr. José Renán Esquivel, from January 1, 2020 to December 31, 2021, for which we calculated two Pediatric Early Warning Scale (PEWS) scores, with the information recorded in the two medical notes, prior to transfer. Results: 61% transferred patients were males; and 72% were infants. The mean age at admission was 30 months (2 years and 6 months). The main PEWS range found was 3-4 for both sexes. Most of the patients presented comorbidities and the main one was congenital heart disease (12%). 70.7% patients had pneumonia with a predominant PEWS of 3-4. Means of 8.2 days of hospital stay in the ward, 10.8 days in the intensive care unit, and 29.1 days of total hospital stay were obtained, with no statistically significant association between these and the PEWS values ​​obtained. 14% (n=11) of the patients died. Conclusions: The main respiratory pathology, sex, and age group transferred to the intensive care unit were pneumonia, males, and infants, respectively. The main comorbidity was congenital heart disease. A 0-2 PEWS range was associated with longer means of stay. We did not find a statistically significant association between the studied variables and the ​​obtained PEWS. (provided by Infomedic International)

COVID-19: Asociación entre la clasificación de riesgo y el Modified Early Warning Score y los resultados hospitalarios / COVID-19: Association of risk classification with the Modified Early Warning Score and hospital outcomes / COVID-19: Associação da classificação de risco com o Modified Early Warning Score e os desfechos hospitalares

Objetivo: evaluar la asociación entre las categorías de clasificación de riesgo y el Modified Early Warning Score y los resultados de los pacientes con COVID-19 en el servicio de emergencia Método: estudio transversal, realizado con 372 pacientes hospitalizados con diagnóstico de COVID-19 atendidos en la Recepción con Clasificación de Riesgo en Urgencias. En este estudio, el Modified Early Warning Score de los pacientes se clasificó como sin y con deterioro clínico, de 0 a 4 y de 5 a 9, respectivamente. Se consideró que había deterioro clínico cuando presentaban insuficiencia respiratoria aguda, shock y paro cardiorrespiratorio. Resultados: el Modified Early Warning Score promedio fue de 3,34. En cuanto al deterioro clínico de los pacientes, se observó que en el 43% de los casos el tiempo de deterioro fue menor a 24 horas y que el 65,9% ocurrió en urgencias. El deterioro más frecuente fue la insuficiencia respiratoria aguda (69,9%) y el resultado fue alta hospitalaria (70,3%). Conclusión: los pacientes con COVID-19 que presentaban Modified Early Warning Score 4 se asociaron a las categorías de clasificación de riesgo urgente, muy urgente y emergente y tuvieron más deterioro clínico, como insuficiencia respiratoria y shock, y murieron, lo que demuestra que el Protocolo de Clasificación de Riesgo priorizó correctamente a los pacientes con riesgo vital.

Objective: to evaluate the association of the risk classification categories with the Modified Early Warning Score and the outcomes of COVID-19 patients in the emergency service Method: a crosssectional study carried out with 372 patients hospitalized with a COVID-19 diagnosis and treated at the Risk Classification Welcoming area from the Emergency Room. In this study, the patients' Modified Early Warning Score was categorized into without and with clinical deterioration, from 0 to 4 and from 5 to 9, respectively. Clinical deterioration was considered to be acute respiratory failure, shock and cardiopulmonary arrest Results: the mean Modified Early Warning Score was 3.34. In relation to the patients' clinical deterioration, it was observed that, in 43%, the time for deterioration was less than 24 hours and that 65.9% occurred in the Emergency Room. The most frequent deterioration was acute respiratory failure (69.9%) and the outcome was hospital discharge (70.3%). Conclusion: COVID-19 patients who had a Modified Early Warning Scores > 4 were associated with the urgent, very urgent and emergency risk classification categories, had more clinical deterioration, such as respiratory failure and shock, and evolved more to death, which shows that the Risk Classification Protocol correctly prioritized patients at risk of life.

Objetivo: avaliar a associação das categorias de classificação de risco com o Modified Early Warning Score e os desfechos dos pacientes com COVID-19 no serviço de emergência Método: estudo transversal, realizado com 372 pacientes internados com diagnóstico de COVID-19 atendidos no Acolhimento com Classificação de Risco no Pronto-Atendimento. Neste estudo, o Modified Early Warning Score dos pacientes foi categorizado em sem e com deterioração clínica, de 0 a 4 e de 5 a 9, respectivamente. Foram consideradas deteriorações clínicas a insuficiência respiratória aguda, choque e parada cardiorrespiratória. Resultados: o Modified Early Warning Score médio foi de 3,34. Em relação à deterioração clínica dos pacientes, observou-se que em 43% o tempo para deterioração foi menor de 24 horas e que 65,9% delas ocorreu no pronto-socorro. A deterioração mais frequente foi a insuficiência respiratória aguda (69,9%) e o desfecho foi o de alta hospitalar (70,3%). Conclusão: pacientes com COVID-19 que tiveram Modified Early Warning Score 4 foram associados às categorias da classificação de risco urgente, muito urgente e emergente e tiveram mais deterioração clínica, como a insuficiência respiratória e o choque, e evoluíram mais a óbito, o que demonstra que o Protocolo de Classificação de Risco priorizou corretamente os pacientes com risco de vida.

Application of GIS and spatiotemporal analyses in viral infection modelling using multiple datasets - A case study on the SARS-CoV-2 epidemic.

INTRODUCTION/OBJECTIVE: Viral and infectious diseases such as COVID-19 continue to pose a significant public health threat. In order to create an early warning system for new pandemics or emerging versions of the virus, it is imperative to study its epidemiology. In this study, we created a geospatial model to predict the weekly contagion and lethality rates of COVID-19 in Ireland. METHODS: More than forty parameters including atmospheric pollutants, metrological variables, sociodemographic factors, and lockdown phases were introduced as input variables to the model. The significant parameters in predicting the number of new cases and the death toll were identified. QGIS software was employed to process input data, and a principal component regression (PCR) model was developed using the statistical add-on XLSTAT. RESULTS AND CONCLUSIONS: The developed models were able to predict more than half of the variations in contagion and lethality rates. This indicates that the proposed model can serve to help prediction systems for the identification of future high-risk conditions. Nevertheless, there are additional parameters that could be included in future models, such as the number of deaths in care homes, the percentage of contagion and mortality among health workers, and the degree of compliance with social distancing.

SmartLab 2.0 en prevención cardiovascular de dislipemia aterogénica / SmartLab 2.0 in cardiovascular prevention of atherogenic dyslipidemia

Objetivo: Implementación en el sistema informático de laboratorio (SIL) de un algoritmo bioquímico automatizado para la identificación en analíticas de rutina de pacientes con dislipemia aterogénica y derivación prioritaria a la unidad de día de diabetes. Material y métodos: Se diseñó en el SIL el algoritmo: HBA1c>9,3 +TG>150mg/dl +cHDL <40mg/dl +LDL/ApoB es<1,3. Se inserta un comentario alertando al médico peticionario del diagnóstico de dislipemia aterogénica y se procede a la derivación prioritaria desde el laboratorio a la unidad de día de diabetes en los casos necesarios. Resultados: En el periodo de un año se han identificado a un total de 899 pacientes con HBA1c>7 y criterio de dislipemia aterogénica. De ellos, 203 pacientes procedentes de atención primaria con HbA1c>9,3 se derivaron al hospital de día de diabetes. Conclusiones: El refuerzo de la prevención cardiovascular es necesario a todos los niveles. El laboratorio clínico debe jugar un papel fundamental en el diagnóstico de las dislipemias. La detección temprana de los pacientes con alto riesgo cardiovascular es primordial y la colaboración entre las distintas unidades clínicas es fundamental para garantizar la seguridad del paciente.(AU)

Introduction: SmartLab 2.0 is an innovative concept of multidisciplinary collaboration between the clinical laboratory and the diabetes day unit that was born with the aim of identifying patients at high cardiovascular risk who require priority attention, such as patients with atherogenic dyslipidemia, in order to create a cardiovascular prevention strategy. Objective: Implementation in the Laboratory Information System (LIS) of an automated biochemical algorithm for the identification of patients with atherogenic dyslipidemia in routine analyses and priority referral to the diabetes day unit. Material and methods: The algorithm designed in the SIL was: HBA1c>9.3 +TG>150mg/dl +HDLc<40mg/dl +LDL/ApoB<1.3. A comment was inserted alerting the requesting physician of the diagnosis of atherogenic dyslipidemia and priority referral was made from the laboratory to the diabetes day unit in the necessary cases. Results: In the 1-year period, a total of 899 patients with HBA1c>7 and atherogenic dyslipidemia criteria were identified. Of these, 203 patients from primary care with HbA1c>9.3 were referred to the diabetes day hospital. Conclusions: Reinforcement of cardiovascular prevention is necessary at all levels. The clinical laboratory should play a fundamental role in the diagnosis of dyslipidemias. Early detection of patients at high cardiovascular risk is essential and collaboration between the different clinical units is fundamental to guarantee patient safety.(AU)

The Guadalajara Declaration on sepsis: emergency physicians' constructive comments on the Surviving Sepsis Campaign's 2021 updated guidelines. / Declaración de Guadalajara: una visión constructiva desde el servicio de urgencias a partir de la Surviving Sepsis Campaign 2021.

TEXT: The Surviving Sepsis Campaign (SSC) published a 2021 update of its 2016 recommendations. The update was awaited with great anticipation the world over, especially by emergency physicians. Under the framework of the CIMU 2022 (33rd World Emergency Medicine Conference) in Guadalajara, Mexico in March, emergency physiciansreviewed and analyzed the 2021 SSC guidelines from our specialty's point of view. In this article, the expert reviewers present their consensus on certain key points of most interest in emergency settings at this time. The main aims of the review are to present constructive comments on 10 key points and/or recommendations in the SSC 2021 update and to offer emergency physicians' experience- and evidence-based proposals. Secondarily, the review's recommendations are a starting point for guidelines to detect severe sepsis in emergency department patients and prevent progression, which is ultimate goal of what has become known as the Guadalajara Declaration on sepsis.

TEXTO: En noviembre del año 2021, la Surviving Sepsis Campaign (SSC) publicó una actualización de sus recomendaciones y directrices de 2016. Estas fueron recibidas con una enorme expectativa en todo el mundo, especialmente entre los médicos de urgencias y emergencias (MUE). Recientemente, en el marco del CIMU 2022 (33 Congreso Mundial de Medicina de Urgencias celebrado en marzo de 2022 en Guadalajara ­ México) se ha revisado y analizado, desde la perspectiva del MUE, la Guía SSC de 2021. Los expertos que realizaron esa tarea y también consensuaron algunos de los puntos clave que más interesan y preocupan a los MUE en la actualidad han elaborado este documento. Su objetivo principal es analizar de forma constructiva diez de los puntos clave y recomendaciones de la SSC 2021 para complementarlas con argumentos y propuestas desde la experiencia, evidencia y perspectiva del urgenciólogo. Además, de forma secundaria, pretende ser el punto de partida de la elaboración de las guías para detectar, prevenir la progresión y atender a los pacientes con infección grave y sepsis en urgencias, que supone la meta final de lo que desde la MUE ya se conoce como "la Declaración de Guadalajara".

Declaración de Guadalajara: una visión constructiva desde el servicio de urgencias a partir de la Surviving Sepsis Campaign 2021 / The Guadalajara Declaration on sepsis: emergency physicians’ constructive comments on the Surviving Sepsis Campaign’s 2021 updated guidelines

En noviembre del año 2021, la Surviving Sepsis Campaign (SSC) publicó una actualización de sus recomendaciones y directrices de 2016. Estas fueron recibidas con una enorme expectativa en todo el mundo, especialmente entre los médicos de urgencias y emergencias (MUE). Recientemente, en el marco del CIMU 2022 (33 Congreso Mundial de Medicina de Urgencias celebrado en marzo de 2022 en Guadalajara – México) se ha revisado y analizado, desde la perspectiva del MUE, la Guía SSC de 2021. Los expertos que realizaron esa tarea y también consensuaron algunos de los puntos clave que más interesan y preocupan a los MUE en la actualidad han elaborado este documento. Su objetivo principal es analizar de forma constructiva diez de los puntos clave y recomendaciones de la SSC 2021 para complementarlas con argumentos y propuestas desde la experiencia, evidencia y perspectiva del urgenciólogo. Además, de forma secundaria, pretende ser el punto de partida de la elaboración de las guías para detectar, prevenir la progresión y atender a los pacientes con infección grave y sepsis en urgencias, que supone la meta final de lo que desde la MUE ya se conoce como “la Declaración de Guadalajara”. (AU)

The Surviving Sepsis Campaign (SSC) published a 2021 update of its 2016 recommendations. The update was awaited with great anticipation the world over, especially by emergency physicians. Under the framework of the CIMU 2022 (33rd World Emergency Medicine Conference) in Guadalajara, Mexico in March, emergency physicians reviewed and analyzed the 2021 SSC guidelines from our specialty’s point of view. In this article, the expert reviewers present their consensus on certain key points of most interest in emergency settings at this time. The main aims of the review are to present constructive comments on 10 key points and/or recommendations in the SSC 2021 update and to offer emergency physicians’ experience- and evidence-based proposals. Secondarily, the review’s recommendations are a starting point for guidelines to detect severe sepsis in emergency department patients and prevent progression, which is ultimate goal of what has become known as the Guadalajara Declaration on sepsis. (AU)

Multicenter validation of Early Warning Scores for detection of clinical deterioration in COVID-19 hospitalized patients / Validación multicéntrica de Sistemas de Alerta Temprana para la detección precoz de deterioro clínico en pacientes hospitalizados por COVID-19

Objective Investigate the predictive value of NEWS2, NEWS-C, and COVID-19 Severity Index for predicting intensive care unit (ICU) transfer in the next 24h. Design Retrospective multicenter study. Setting Two third-level hospitals in Argentina. Patients All adult patients with confirmed COVID-19, admitted on general wards, excluding patients with non-intubated orders. Interventions Patients were divided between those who were admitted to ICU and non-admitted. We calculated the three scores for each day of hospitalization. Variables We evaluate the calibration and discrimination of the three scores for the outcome ICU admission within 24, 48h, and at hospital admission. Result We evaluate 13,768 days of hospitalizations on general medical wards of 1318 patients. Among these, 126 (9.5%) were transferred to ICU. The AUROC of NEWS2 was 0.73 (95%CI 0.68–0.78) 24h before ICU admission, and 0.52 (95%CI 0.47–0.57) at hospital admission. The AUROC of NEWS-C was 0.73 (95%CI 0.68–0.78) and 0.52 (95%CI 0.47–0.57) respectively, and the AUROC of COVID-19 Severity Index was 0.80 (95%CI 0.77–0.84) and 0.61 (95%CI 0.58–0.66) respectively. COVID-19 Severity Index presented better calibration than NEWS2 and NEWS-C. Conclusion COVID-19 Severity index has better calibration and discrimination than NEWS2 and NEWS-C to predict ICU transfer during hospitalization (AU)

Objetivo Investigar el valor predictivo de los scores NEWS2, NEWS-C y COVID-19 Severity Index para predecir la transferencia de urgencia a la unidad de cuidados intensivos (UCI) en las próximas 24horas. Diseño Estudio multicéntrico retrospectivo. Ámbito Dos hospitales de tercer nivel en Argentina. Pacientes Pacientes adultos con COVID-19, ingresados en salas generales, excluyendo pacientes con órdenes de no intubar. Intervenciones Se dividió a los pacientes entre los que ingresaron en la UCI y los que no ingresaron. Calculamos las tres puntuaciones para cada día de hospitalización. Variables Evaluamos la calibración y discriminación de las tres puntuaciones para predecir el traslado de urgencia a UCI en las 24, 48h previas al pase a UCI y al ingreso hospitalario. Resultados Evaluamos 13.768 días de hospitalización en internación general de 1.318 pacientes, de los cuales 126 (9,5%) fueron trasladados a UCI. El AUROC del NEWS2 fue de 0,73 (IC 95% 0,68-0,78) 24h antes del ingreso en UCI y de 0,52 (IC 95% 0,47-0,57) al ingreso hospitalario. El AUROC de NEWS-C fue de 0,73 (IC 95% 0,68-0,78) y 0,52 (IC 95% 0,47-0,57) respectivamente, y el AUROC del COVID-19 Severity Index fue de 0,80 (IC 95% 0,77-0,84) y 0,61 (IC 95% 0,58-0,66) respectivamente. El COVID-19 Severity Index presentó una mejor calibración que NEWS2 y NEWS-C. Conclusión El COVID-19 Severity Index presentó una mejor calibración y discriminación que NEWS2 y NEWS-C para predecir la transferencia de la UCI durante la hospitalización (AU)

Tarjeta de emergencias médicas para la enfermedad de Steinert: una necesidad desatendida / Medical emergency card for Steinert’s disease: an unmet need

Introducción: La distrofia miotónica de tipo 1 (DM1), o enfermedad de Steinert (ORPHA 273; OMIM #160900), es un trastorno de origen genético poco frecuente con manifestaciones musculares (debilidad muscular y miotonía), cataratas de inicio temprano (antes de los 50 años) y manifestaciones sistémicas (cerebral, endocrina, cardíaca, del tubo digestivo, del útero, de la piel y del sistema inmunitario). Su expresividad clínica es muy variable y se extiende desde formas letales en la lactancia hasta una enfermedad leve de aparición tardía. Su baja frecuencia impide que los profesionales de urgencias médicas se familiaricen con las precauciones imprescindibles para su tratamiento. Con el propósito de paliar esta falta de información, los afectados por DM1 disponen, en los países de nuestro entorno, de una tarjeta de emergencia médica (TEM) que el paciente siempre debe llevar consigo y entregar al facultativo antes de recibir asistencia urgente. Objetivos: Definir la TEM, describir las TEM para la DM1 ya implantadas y enumerar las ventajas para pacientes y profesionales que supone su utilización. Material y métodos. Se describen algunas de las TEM para la DM1 actualmente en uso en Francia y el Reino Unido. Resultados: Se exponen pormenorizadamente los argumentos que justifican su implantación en nuestro medio.Conclusiones: La TEM para la DM1 gestionada por un facultativo puede mejorar la asistencia en emergencias médicas de los pacientes afectados por la enfermedad de Steinert.

Introduction: Myotonic dystrophy type 1 (DM1) or Steinert’s disease (ORPHA 273; OMIM #160900) is a rare disorder of genetic origin with muscular manifestations (muscle weakness and myotonia), early-onset cataracts (before 50 years of age) and systemic manifestations (cerebral, endocrine, cardiac, gastrointestinal tract, uterus, skin and immune system). Its clinical expressivity is highly variable and ranges from lethal forms in infancy to mild late-onset disease. Its low frequency prevents emergency medical professionals from becoming familiar with the essential precautions for its treatment. In order to alleviate this lack of information, those affected by DM1 have, in the countries of our environment, a medical emergency card (Tarjeta de Emergencias Médicas, TEM) that the patient should always carry with him/her and give to the physician before receiving emergency care. Objectives: To define the TEM. To describe the TEM for DM1 already implemented. To list the advantages for patients and professionals of their use. Material and methods: Some of the TEM for DM1 currently in use in France and the United Kingdom are described. Results: The arguments justifying their implantation in our setting are presented in detail. Conclusions: The TEM for DM1 managed by a physician can improve the emergency medical care of patients affected by Steinert’s disease.(AU)

Multicenter validation of Early Warning Scores for detection of clinical deterioration in COVID-19 hospitalized patients.

OBJECTIVE: Investigate the predictive value of NEWS2, NEWS-C, and COVID-19 Severity Index for predicting intensive care unit (ICU) transfer in the next 24h. DESIGN: Retrospective multicenter study. SETTING: Two third-level hospitals in Argentina. PATIENTS: All adult patients with confirmed COVID-19, admitted on general wards, excluding patients with non-intubated orders. INTERVENTIONS: Patients were divided between those who were admitted to ICU and non-admitted. We calculated the three scores for each day of hospitalization. VARIABLES: We evaluate the calibration and discrimination of the three scores for the outcome ICU admission within 24, 48h, and at hospital admission. RESULTS: We evaluate 13,768 days of hospitalizations on general medical wards of 1318 patients. Among these, 126 (9.5%) were transferred to ICU. The AUROC of NEWS2 was 0.73 (95%CI 0.68-0.78) 24h before ICU admission, and 0.52 (95%CI 0.47-0.57) at hospital admission. The AUROC of NEWS-C was 0.73 (95%CI 0.68-0.78) and 0.52 (95%CI 0.47-0.57) respectively, and the AUROC of COVID-19 Severity Index was 0.80 (95%CI 0.77-0.84) and 0.61 (95%CI 0.58-0.66) respectively. COVID-19 Severity Index presented better calibration than NEWS2 and NEWS-C. CONCLUSION: COVID-19 Severity index has better calibration and discrimination than NEWS2 and NEWS-C to predict ICU transfer during hospitalization.

SmartLab 2.0 in cardiovascular prevention of atherogenic dyslipidemia. / SmartLab 2.0 en prevención cardiovascular de dislipemia aterogénica.

INTRODUCTION: SmartLab 2.0 is an innovative concept of multidisciplinary collaboration between the clinical laboratory and the diabetes day unit that was born with the aim of identifying patients at high cardiovascular risk who require priority attention, such as patients with atherogenic dyslipidemia, in order to create a cardiovascular prevention strategy. OBJECTIVE: Implementation in the Laboratory Information System (LIS) of an automated biochemical algorithm for the identification of patients with atherogenic dyslipidemia in routine analyses and priority referral to the diabetes day unit. MATERIAL AND METHODS: The algorithm designed in the SIL was: HBA1c>9.3 +TG>150mg/dl +HDLc<40mg/dl +LDL/ApoB<1.3. A comment was inserted alerting the requesting physician of the diagnosis of atherogenic dyslipidemia and priority referral was made from the laboratory to the diabetes day unit in the necessary cases. RESULTS: In the 1-year period, a total of 899 patients with HBA1c>7 and atherogenic dyslipidemia criteria were identified. Of these, 203 patients from primary care with HbA1c>9.3 were referred to the diabetes day hospital. CONCLUSIONS: Reinforcement of cardiovascular prevention is necessary at all levels. The clinical laboratory should play a fundamental role in the diagnosis of dyslipidemias. Early detection of patients at high cardiovascular risk is essential and collaboration between the different clinical units is fundamental to guarantee patient safety.

Migraine with aura and stroke - the role of warning signs in the context of secondary headaches: case report / Enxaqueca com aura e acidente vascular cerebral ­ o papel dos sinais de alerta no contexto das cefaleias secundárias: relato de caso

Introduction: Headache is a very common complaint in doctors' offices, with primary causes being the majority in relation to secondary ones. Despite this, the identification of secondary headaches is very relevant in clinical practice, since these can be a life-threatening condition, functionality or even a reversible cause. However, imaging screening for all individuals with headache is costly and unrewarding. Therefore, it is important to know the warning signs that, together with the clinical context, lead to a more precise indication of these exams and early and well-targeted therapeutic interventions. Clinical case: This is a 60-year-old man, previously dyslipidemic and smoker, with migraine with aura reported since childhood, who underwent treatment with sodium valproate, with headache attack suppression. About 4 months before admission, he presented with an alteration in the pain pattern, amaurosis fugax in the right eye, dizziness and mild paresis and hypoesthesia in the left side of the body, primarily treated by him as migraine crises, without improvement with the use of triptans. A new outpatient investigation was carried out, which showed multiple small infarcts in the right hemisphere secondary to atheromatous plaque in the right carotid bulb with an obstruction of approximately 85%. Diagnostic and therapeutic arteriography was performed, with stent implantation, uneventfully. Conclusion: The differential diagnosis between migraine with aura and a cerebrovascular event has already been widely reported in the literature and constitutes a pitfall in the routine of headaches, since a serious and potentially disabling condition can be overlooked. The joint evaluation of the alarm signs with the global context becomes an important tool in the propaedeutics of these patients, with knowledge of this casuistry being something relevant within clinical practice.

Introdução: A cefaleia é uma queixa muito comum nos consultórios médicos, sendo as causas primárias majoritárias em relação às secundárias. Apesar disso, a identificação de cefaleias secundárias é muito relevante na prática clínica, uma vez que estas podem ser uma condição potencialmente fatal, funcional ou mesmo uma causa reversível. No entanto, o rastreio imagiológico para todos os indivíduos com cefaleias é dispendioso e pouco recompensador. Portanto, é importante conhecer os sinais de alerta que, juntamente com o contexto clínico, levam a uma indicação mais precisa destes exames e a intervenções terapêuticas precoces e bem direcionadas. Caso clínico: Trata-se de um homem de 60 anos, previamente dislipidémico e fumador, com queixa de enxaqueca com aura desde a infância, que realizou tratamento com valproato de sódio, com supressão das crises de cefaleia. Cerca de 4 meses antes da internação apresentou alteração do padrão álgico, amaurose fugaz em olho direito, tontura e leve paresia e hipoestesia no lado esquerdo do corpo, tratada por ele primariamente como crises de enxaqueca, sem melhora com o uso de triptanos. Foi realizada nova investigação ambulatorial que evidenciou múltiplos pequenos infartos no hemisfério direito secundários a placa de ateroma no bulbo carotídeo direito com obstrução de aproximadamente 85%. Foi realizada arteriografia diagnóstica e terapêutica, com implante de stent, sem intercorrências. Conclusão: O diagnóstico diferencial entre enxaqueca com aura e evento cerebrovascular já foi amplamente relatado na literatura e constitui uma armadilha na rotina das cefaleias, uma vez que uma condição grave e potencialmente incapacitante pode ser negligenciada. A avaliação conjunta dos sinais de alarme com o contexto global torna-se uma ferramenta importante na propedêutica destes pacientes, sendo o conhecimento desta casuística algo relevante dentro da prática clínica.

Performance of risk scores in patients with acute exacerbations of COPD / Desempenho de escores de risco em pacientes com exacerbações agudas da DPOC

ABSTRACT Objective: Acute exacerbations of COPD (AECOPD) are common causes of hospitalization. Various scoring systems have been proposed to classify the risk of clinical deterioration or mortality in hospitalized patients with AECOPD. We sought to investigate whether clinical deterioration and mortality scores at admission can predict adverse events occurring during hospitalization and after discharge of patients with AECOPD. Methods: We performed a retrospective study of patients admitted with AECOPD. The National Early Warning Score 2 (NEWS2), the NEWS288-92%, the Dyspnea, Eosinopenia, Consolidation, Acidemia, and atrial Fibrillation (DECAF) score, and the modified DECAF (mDECAF) score were calculated at admission. We assessed the sensitivity, specificity, and overall performance of the scores for the following outcomes: in-hospital mortality; need for invasive mechanical ventilation or noninvasive ventilation (NIV); long hospital stays; hospital readmissions; and future AECOPD. Results: We included 119 patients admitted with AECOPD. The median age was 75 years, and 87.9% were male. The NEWS288-92% was associated with an 8.9% reduction in the number of individuals classified as requiring close, continuous observation, without an increased risk of death in the group of individuals classified as being low-risk patients. The NEWS288-92% and NEWS2 scores were found to be adequate in predicting the need for acute NIV and longer hospital stays. The DECAF and mDECAF scores were found to be better at predicting in-hospital mortality than the NEWS2 and NEWS288-92%. Conclusions: The NEWS288-92% safely reduces the need for clinical monitoring in patients with AECOPD when compared with the NEWS2. The NEWS2 and NEWS288-92% appear to be good predictors of the length of hospital stay and need for NIV, but they do not replace the DECAF and mDECAF scores as predictors of mortality.

RESUMO Objetivo: As exacerbações agudas da DPOC (EADPOC) são causas comuns de hospitalização. Vários escores foram propostos para classificar o risco de deterioração clínica ou mortalidade em pacientes hospitalizados com EADPOC. Buscamos investigar se escores de deterioração clínica e mortalidade no momento da admissão podem prever eventos adversos durante a hospitalização e após a alta de pacientes com EADPOC. Métodos: Realizamos um estudo retrospectivo a respeito de pacientes admitidos com EADPOC. O National Early Warning Score 2 (NEWS2), o NEWS288-92%, o escore Dyspnea, Eosinopenia, Consolidation, Acidemia, and atrial Fibrillation (DECAF, Dispneia, Eosinopenia, Consolidação, Acidemia e Fibrilação atrial) e o escore DECAF modificado (DECAFm) foram calculados no momento da admissão. Avaliamos a sensibilidade, a especificidade e o desempenho geral dos escores quanto aos seguintes desfechos: mortalidade hospitalar; necessidade de ventilação mecânica invasiva ou ventilação não invasiva (VNI); longas internações hospitalares; readmissões hospitalares e futuras AECOPD. Resultados: Incluímos 119 pacientes admitidos com EADPOC. A mediana da idade foi de 75 anos, e 87,9% eram do sexo masculino. O NEWS288-92% associou-se a uma redução de 8,9% no número de indivíduos classificados em pacientes com necessidade de observação atenta e contínua, sem aumento do risco de morte no grupo de indivíduos classificados em pacientes de baixo risco. O NEWS288-92% e o NEWS2 foram considerados adequados para prever a necessidade de VNI aguda e internações hospitalares mais longas. O DECAF e o DECAFm foram considerados melhores em prever a mortalidade hospitalar do que o NEWS2 e o NEWS288-92%. Conclusões: Em comparação com o NEWS2, o NEWS288-92% reduz com segurança a necessidade de monitoramento clínico em pacientes com EADPOC. O NEWS2 e o NEWS288-92% aparentemente são bons preditores do tempo de internação hospitalar e da necessidade de VNI, mas não substituem o DECAF e o DECAFm como preditores de mortalidade.

A comparative study of telephone and face-to-face use of phone screening interview for autistic spectrum disorder symptoms (PSI-ASD) / Estudo comparativo da aplicação por telefone e presencial da entrevista de triagem por telefone de sintomas do espectro autista (PSI-TEA)

ABSTRACT Objective: Describe reliabilities evidence of the Phone Screening Interview (PSI), a telephone screening interview for autism spectrum disorder (ASD) symptoms, capable of investigating mild to moderate ASD symptoms. Moreover, the PSI also works for verbal and non-verbal children and is consistent with the DSM-5 diagnostic criteria. Methods: An interview was performed with sixty-eight parents of children between 2 and 15 years old attended by the Psychiatry Ambulatory of Santa Casa de Misericórdia do Rio de Janeiro through the PSI in person and by telephone. Results: No significant differences in comparison between averages of the total score of the face-to-face and telephone applications were observed. The agreement analysis between the items indicated three items with lower values, leading to the modification of some questions, culminating in a new interview version for further studies. Given the disagreement in the values found, the order of application of the interviews seems to not impact the results, demonstrating strong correlations between both interviews, even with a different order of application. Aiming to facilitate the use of the scale by different examiners, the interobserver reliability was investigated, which did not show significant differences in the means. Conclusion: The study suggests that the telephone interview can be used similarly to the face-to-face interview, by different evaluators, with no impact on its efficiency in detecting ASD symptoms.

RESUMO Objetivo: Descrever evidências de confiabilidade da Phone Screening Interview (PSI), uma entrevista para rastreio telefônico de sintomas do Transtorno do Espectro Autista (TEA) de fácil aplicação, capaz de investigar sintomas de TEA leve a moderado, aplicável a crianças verbais e não verbais e consistente com os critérios diagnósticos do DSM-5. Métodos: Sessenta e oito pais de crianças com idade entre 2 e 15 anos atendidas pelo Ambulatório de Psiquiatria da Santa Casa de Misericórdia do Rio de Janeiro foram entrevistados por meio da PSI, tanto de maneira presencial quanto telefônica. Resultados: As médias da pontuação total da aplicação presencial e telefônica foram comparadas, não sendo obtidas diferenças significativas. A análise de concordância entre os itens apontou três itens com valores muito baixos, levando à modificação de algumas perguntas, culminando em uma nova versão, para estudos posteriores. Diante da discordância de valores encontrada, foi verificado que a ordem de aplicação das entrevistas não impactaria os resultados, demonstrando fortes correlações entre as entrevistas, mesmo com ordem de aplicação diferente. Para viabilizar o uso da escala por diferentes examinadores, investigou-se a confiabilidade interobservadores, que não mostrou diferenças significativas nas médias. Conclusão: O estudo sugere que a entrevista telefônica pode ser utilizada de forma semelhante à presencial, por diferentes avaliadores, sem impacto em sua eficiência na detecção de sintomas de TEA.

Focalidad de Aedes aegypti e indicadores climáticos en Nueva Gerona Cuba (2006-2022)

Introducción: Las enfermedades transmitidas por mosquitos resultan particularmente sensibles a las condiciones meteorológicas. Objetivo: Modelar la focalidad de Aedes aegypti e indicadores climáticos en Nueva Gerona, Cuba. Métodos: Estudio descriptivo de corte transversal realizado en el período de 2006 a 2022 en Nueva Gerona, Isla de la Juventud. Se empleó una curva de expectativa según meses y análisis de indicadores climáticos para establecer el momento más oportuno para acometer acciones de supresión vectorial. Una vez identificado, se procedió a la modelación espacial y al análisis del clima para el mismo período. Resultados: La curva de expectativa facilitó muestras de mayor focalidad de Aedes aegypti a partir del mes de junio, por lo que se definió el período de marzo a junio como el más oportuno para intensificar las acciones de supresión de la población vectorial. Los mapas mostraron varias zonas calientes en las que se encuentran involucrados con mayor riesgo los consejos populares de Pueblo Nuevo, Abel Santamaría, 26 de Julio y la localidad de Nazareno. Las precipitaciones acumuladas comenzaron en marzo (24,3 mm), abril (55,4 mm), mayo (163,4 mm) y junio (393,8 mm). Las temperaturas y la humedad relativa incrementaron de un mes a otro. Predominaron los vientos del Este. Conclusiones: La modelación de la focalidad de Aedes aegypti definió temporo-espacialmente y como sistema de alerta temprana que el período entre marzo y junio constituía el más oportuno para la realización de las acciones que llevarían hacia la supresión vectorial, a tenor del comportamiento de indicadores climáticos que ejercieron efectos favorecedores sobre la infestación.

Introduction: Mosquito-borne diseases are particularly sensitive to weather conditions. Objective: To model Aedes aegypti focality and climate indicators in Nueva Gerona, Cuba. Methods: A descriptive cross-sectional study was conducted from 2006 to 2022 in Nueva Gerona, Isla de la Juventud. An expectation curve by months and analysis of climate indicators was used to decide on the most appropriate moment to undertake vector suppression actions. Once identified, spatial modeling and weather analysis were carried out for the same period. Results: The expectation curve provided evidence of greater Aedes aegypti focality from June onwards; therefore, the period from March to June was defined as the most appropriate to intensify vector population suppression actions. The maps showed several hot spots with the highest risk that include the people's councils of Pueblo Nuevo, Abel Santamaría, 26 de Julio and the locality of Nazareno. Cumulative rainfall began in March (24.3 mm), April (55.4 mm), May (163.4 mm) and June (393.8 mm). Temperatures and relative humidity increased by month. Easterly winds predominated. Conclusions: Modeling Aedes aegypti focality defined temporo-spatially and as an early warning system that the period between March and June were the most appropriate for conducting vector suppression actions, based on climate indicators that exerted favoring effects on infestation.

National Early Warning Score 2 ­ versão brasileira: validade preditiva para adultos com COVID-19* / National Early Warning Score 2 ­ versión brasileña: validez predictiva para adultos con COVID-19 / National Early Warning Score 2 ­ Brazilian version: predictive validity for adults with COVID-19

Objetivo: realizar a validade preditiva do National Early Warning Score 2 ­ versão brasileira (NEWS 2 ­ BR) nos desfechos alta e óbito em pacientes com COVID-19. Método: estudo transversal com análise de validade preditiva. Variáveis sociodemográficas, clínicas, desfechos e os componentes do escore foram coletados em prontuário eletrônico e analisados por meio da estatística descritiva e inferencial. Resultados: incluíram-se 400 pacientes, com mediana de idade de 61 anos. O escore na admissão teve mediana de 5 pontos, com amplitude de 0 a 21. Houve associação entre escores mais altos com o desfecho óbito e escores mais baixos com a alta. A validade preditiva do NEWS 2 ­ BR para o óbito foi realizada pela análise de curva ROC e o ponto de corte de maior acurácia foi de seis pontos. Conclusão: a versão brasileira do NEWS 2 é um escore válido para avaliação de pacientes com COVID-19.

Objective: perform the predictive validity of National Early Warning Score 2 ­ Brazilian version (NEWS 2 ­ BR) in discharge and death outcomes in patients with COVID-19. Method: cross-sectional study with predictive validity analysis. Social-demographical and clinical variables, outcomes and the score components were collected with an electronic health record and analyzed through descriptive and inferential statistics. Outcomes: 400 patients were included, with median age of 61 years. The score, at the moment of admission, had a median of 5 points, with a range from 0 to 21. There is an association between the highest scores and the death outcome and the lowest scores and the discharge outcome. The predictive validity of NEWS 2 ­ BRfor death was established by the analysis of the ROC curve and the most accurate cut-off point was six points. Conclusion: The Brazilian version of NEWS 2 is a valid score to assess patients with COVID-19.

Objetivo: realizar la validez predictiva del National Early Warning Score 2 ­ versión brasileña (NEWS 2 ­ BR) en los resultados alta y fallecimiento en pacientes con COVID-19. Método: estudio transversal con análisis de validez predictiva. Variables sociodemográficas, clínicas, resultados y los componentes del score fueron recolectados en prontuario electrónico y analizados por medio de la estadística descriptiva e inferencial. Resultados: se incluyeron 400 pacientes, con mediana de edad de 61 años. El score en la admisión tuvo mediana de 5 puntos, con amplitud de 0 a 21. Hubo asociación entre scores más altos con el resultado fallecimiento y scores más bajos con el alta. La validez predictiva del NEWS 2 ­ BR para el fallecimiento fue realizada por el análisis de curva ROC y el punto de corte de mayor precisión fue de seis puntos. Conclusión: la versión brasileña del NEWS 2 es un score válido para la evaluación de pacientes con COVID-19.

Desempenho do Escore Pediátrico de Alerta (EPA) de deterioração clínica / Desempeño del Sistema de Alerta Precoz Infantil (SAPI) de deterioración clínica / Pediatric Alert Score (EPA) performance in clinical deterioration

Resumo Objetivo Avaliar a acurácia, utilidade, reprodutibilidade e aplicabilidade do Escore Pediátrico de Alerta (EPA) na identificação da deterioração clínica em crianças e adolescentes hospitalizados. Métodos Estudo de teste diagnóstico, prospectivo, realizado entre outubro/2018 a outubro/2019, para medir a acurácia diagnóstica do EPA em uma amostra de 240 crianças, e sua reprodutibilidade e aplicabilidade em uma amostra de 60 crianças. Os dados foram processados e analisados no MedCalc e VassarStats.net. Resultados No ponto de corte ≥ 3, o escore apresentou sensibilidade de 73,6%, especificidade de 95,7%, valor preditivo positivo de 83%, valor preditivo negativo de 92,7, área sob a curva ROC de 93,6%, prevalência estimada pelo teste de 19,6%, razão de probabilidade positiva 17,1, probabilidade pós-teste positivo de 77,8%, kappa simples de 0,946. Conclusão O estudo fornece evidências sobre a elevada acurácia, utilidade e reprodutibilidade do EPA na identificação da deterioração clínica em um cenário hospitalar pediátrico brasileiro, e considerou o instrumento aplicável no contexto da pesquisa.

Resumen Objetivo Evaluar la precisión, utilidad, reproducibilidad y aplicabilidad del Sistema de Alerta Precoz Infantil (SAPI) en la identificación del deterioro clínico en niños y adolescentes hospitalizados. Métodos Estudio de prueba diagnóstica, prospectiva, realizada entre octubre de 2018 y octubre de 2019, para medir la precisión diagnóstica del SAPI en una muestra de 240 niños y su reproducibilidad y aplicabilidad en una muestra de 60 niños. Los datos fueron procesados y analizados en MedCalc y VassarStats.net. Resultados En el punto de corte ≥ 3, el puntaje presentó una sensibilidad del 73,6 %, especificidad del 95,7 %, valor predictivo positivo del 83 %, valor predictivo negativo de 92,7, área bajo la curva ROC del 93,6 %, prevalencia estimada por la prueba del 19,6 %, razón de probabilidad positiva 17,1, probabilidad posprueba positiva del 77,8 %, kappa simple de 0,946. Conclusión El estudio presenta evidencias sobre la elevada precisión, utilidad y reproducibilidad del SAPI en la identificación del deterioro clínico en un escenario hospitalario pediátrico brasileño, por lo que el instrumento se consideró aplicable en el contexto de la investigación.

Abstract Objective To assess the Pediatric Alert Score (EPA) accuracy, usefulness, reproducibility and applicability in identifying clinical deterioration in hospitalized children and adolescents. Methods This is a prospective diagnostic test study, carried out between October/2018 and October/2019, to measure EPA diagnostic accuracy in a sample of 240 children, and its reproducibility and applicability in a sample of 60 children. Data were processed and analyzed on MedCalc and VassarStats.net. Results At cut-off point ≥ 3, the score had a sensitivity of 73.6%, specificity of 95.7%, positive predictive value of 83%, negative predictive value of 92.7, area under the ROC curve of 93.6%, estimated prevalence of 19.6%, positive probability ratio of 17.1, positive post-test probability of 77.8%, simple Kappa of 0.946. Conclusion The study provides evidence on EPA high accuracy, usefulness and reproducibility in identifying clinical deterioration in a Brazilian pediatric hospital setting, and considered the instrument applicable in the context of the research.

Design of early warning system for mental health problems based on data mining and database / Projeto de sistema de alerta precoce para problemas de saúde mental com base na mineração de dados e banco de dados / Diseño de un sistema de alerta temprana de problemas de salud mental basado en la minería de datos y en la base de datos

ABSTRACT Introduction: Data mining technology is mainly employed in the era of big data to evaluate the acquired information. Subsequently, reasoning about the data inductively is fully automated to discover possible patterns. Objective: Recently, data mining technology in the national mental health database has deepened and can be effectively used to solve various mental health early warning problems. Methods: For example, it can be applied to mine psychological data and extract the most important features and information. Results: This paper presents the design of an early warning system for mental health problems based on data mining techniques to offer some thoughts on early warning of mental health problems, including data preparation, data mining, results in analysis, and decision tree algorithm. Conclusion: The experimental results indicate that the results of the early warning system in this paper can achieve an accuracy rate of more than 96% with a high accuracy rate. Level of evidence II; Therapeutic studies - investigating treatment outcomes.

RESUMO Introdução: A tecnologia de mineração de dados é empregada principalmente na era da big data para avaliar as informações adquiridas. Posteriormente, raciocinar indutivamente sobre os dados de forma totalmente automatizada para descobrir possíveis padrões. Objetivo: Recentemente, a tecnologia de mineração de dados no banco de dados nacional de saúde mental tem se aprofundado e pode ser efetivamente utilizada para resolver vários problemas de alerta precoce da saúde mental. Métodos: Por exemplo, ela pode ser aplicada para a mineração de dados psicológicos e extrair as características e informações mais importantes. Resultados: Este documento apresenta o projeto de um sistema de alerta precoce para problemas de saúde mental baseado em técnicas de mineração de dados, com o objetivo de oferecer algumas reflexões sobre alerta precoce de problemas de saúde mental, incluindo preparação de dados, mineração de dados, análise de resultados e algoritmo de árvore de decisão. Conclusão: Os resultados experimentais indicam que os resultados do sistema de alerta precoce neste trabalho podem alcançar uma taxa de precisão de mais de 96% com uma alta taxa de precisão. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

Resumen Introducción: La tecnología de minería de datos se emplea principalmente en la era de la big data para evaluar la información adquirida. Posteriormente, razonar inductivamente sobre los datos de forma totalmente automatizada para descubrir posibles patrones. Objetivo: Recientemente, la tecnología de minería de datos en la base de datos nacional de salud mental se ha profundizado y puede ser utilizada eficazmente para resolver varios problemas de alerta temprana de salud mental. Métodos: Por ejemplo, puede aplicarse para minar datos psicológicos y extraer las características e información más importantes. Resultados: Este trabajo presenta el diseño de un sistema de alerta temprana de problemas de salud mental basado en técnicas de minería de datos, con el objetivo de ofrecer algunas reflexiones sobre la alerta temprana de problemas de salud mental, incluyendo la preparación de los datos, la minería de datos, el análisis de los resultados y el algoritmo de árbol de decisión. Conclusión: Los resultados experimentales indican que los resultados del sistema de alerta temprana de este documento pueden alcanzar un índice de precisión superior al 96% con un alto índice de precisión. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Factores asociados a malestar psicológico durante la pandemia de COVID-19 en personal de salud de un hospital público de Ecuador / Related factors to psychological distress during the COVID-19 pandemic in the health staff of a public hospital in Ecuador

Fundamento: La pandemia por el coronavirus SARS-CoV-2, genera afectaciones en las esferas social, económica y sanitaria de un país, y de manera particular, consecuencias psicológicas negativas en el personal sanitario de hospitales públicos, considerados como la primera línea de atención a pacientes con esta enfermedad. Objetivo: Describir factores asociados a la presencia de malestar psicológico en el personal sanitario de un hospital general público en Ecuador, durante la pandemia de COVID-19. Metodología: Estudio no experimental, de corte transversal, con alcance descriptivo-correlacional. Los datos correspondieron a 276 funcionarios de la salud que respondieron un instrumento online, con un módulo de datos sociodemográficos y una escala de tamizaje de malestar psicológico, estos se aplicaron después de una intervención en salud dirigida al personal de salud realizada al inicio de la pandemia, en mayo del año 2020. Se realizaron análisis descriptivos y de asociación, mediante el software SPSS 25.0. Resultados: La muestra estuvo compuesta por 76.1 % de mujeres, 23.9 % de hombres, con una media de edad de 36 años, en mayor cantidad con profesionales de Enfermería (33.7 %), seguido de Medicina (24.3 %). El 70.7 % del personal de salud presentó malestar psicológico, de estos, el 26.1 % con indicativo de trastorno mental. Se encontraron tres variables asociadas a la presencia de malestar psicológico: clima laboral, teletrabajo y convivir con grupos de riesgo. Conclusiones: El personal de Salud ha presentado afectación en su salud mental asociado a las condiciones sociolaborales durante la pandemia.

Background: The SARS-CoV-2 coronavirus pandemic affects the social, economic and health spheres of a country, especially negative psychological consequences to the health staff of public hospitals, considered as the first line of care for patients with this disease. Objective: To describe factors related to the presence of psychological distress in the health personnel of a public general hospital in Ecuador, during the COVID-19 pandemic. Methodology: Non-experimental, cross-sectional study with a descriptive-correlational scope. The data corresponded to 276 health officials who answered to an online instrument, with a sociodemographic data module and a psychological distress screening scale, these were applied after a health intervention aimed at health personnel conducted at the beginning of the pandemic, in May 2020. Descriptive and association analyzes were performed using SPSS 25.0 software. Results: The sample was made up of 76.1 % women, 23.9 % men, mean age of 36 years, with a greater number of Nursing professionals (33.7 %), followed by Medicine (24.3 %). 70.7 % of the health personnel presented psychological distress, out of these, 26.1 % showed mental disorder. Three variables related to the presence of psychological distress were found: work environment, teleworking and living with risk groups. Conclusions: Health staff has presented mental health distress related to socio-labor conditions during the pandemic.

Escores de alerta precoce em pacientes com suspeita ou diagnóstico de sepse: uma revisão integrativa / Early warning scores in patients with suspected or diagnosed sepsis: an integrative review / Puntuaciones de alerta temprana en pacientes con sospecha o diagnóstico de sepsis: una revisión integradora

Objetivo: analisar publicações científicas sobre a utilização de escores de alerta precoce, nos serviços terciários, como ferramentas de detecção da deterioração clínica em paciente com suspeita ou diagnóstico de sepse. Método: revisão integrativa realizada na PubMed, Scopus, Web of Science e Biblioteca Virtual em Saúde entre fevereiro e março de 2021. Incluídos artigos em inglês, espanhol e português, sem delimitação de tempo na busca. Resultados: identificou-se diferentes escores para detecção precoce da deterioração clínica em pacientes com suspeita ou diagnóstico de sepse. As ferramentas mais frequentes nos serviços terciários foram: National Early Warning Score, Sequential Organ Failure Assessment Score e Systemic Inflammatory Response Syndrome (n=6) (50%), sendo a maioria nos Departamentos de Emergências (n=5) (41,6%). Considerações finais: National Early Warning Score foi o escore mais utilizado para pacientes com suspeita ou diagnóstico de sepse com maior acurácia para a predição de mortalidade hospitalar e admissão em Unidade de Terapia Intensiva.

Objective: to examine scientific publications on the use of early warning scores in tertiary services as tools for detecting clinical deterioration in patients with suspected or diagnosed sepsis. Method: this integrative review was conducted in PubMed, Scopus, Web of Science and the Virtual Health Library between February and March 2021. Articles in English, Spanish, and Portuguese were included with no time limits on the search. Results: different scores were found for early detection of clinical deterioration in patients with suspected or diagnosed sepsis. The most frequent tools in tertiary services were the National Early Warning Score, Sequential Organ Failure Assessment Score and Systemic Inflammatory Response Syndrome (n = 6) (50%), most of them in Emergency Departments (n = 5) (41.6 %). Final remarks: the National Early Warning Score was the most used for patients with suspected or diagnosed sepsis and was the most accurate in predicting hospital mortality and admission to the Intensive Care Unit.

Objetivo: analizar publicaciones científicas sobre la utilización de puntuaciones de alerta temprana, en servicios terciarios, como herramientas para detección de deterioro clínico en pacientes con sospecha o diagnóstico de sepsis. Método: revisión integradora en PubMed, Scopus, Web of Science y Biblioteca Virtual en Salud entre febrero y marzo de 2021. Fueron incluidos artículos en inglés, español y portugués, sin límite de tiempo en la búsqueda. Resultados: se identificaron diferentes puntuaciones para detección temprana de deterioro clínico en pacientes con sospecha o diagnóstico de sepsis. Las herramientas frecuentes en los servicios terciarios fueron: National Early Warning Score, Sequential Organ Failure Assessment Score y Systemic Inflammatory Response Syndrome (n=6) (50%), la mayoría en Servicios de Emergencia (n=5) (41,6 %). Consideraciones finales: National Early Warning Score fue la puntuación más utilizada para pacientes con sospecha o diagnóstico de sepsis con mejor precisión para predecir la mortalidad hospitalaria e ingreso a la Unidad de Cuidados Intensivos.

Validación en España de la escala National Early Warning Score 2 (NEWS-2) para la detección precoz en urgencias de pacientes en riesgo de deterioro / Early detection of risk for clinical deterioration in emergency department patients: validation of a version of the National Early Warning Score 2 for use in Spain

Objetivo: Conocer la capacidad predictiva en términos de ingresos hospitalarios y de aparición de eventos adversos de la escala de alerta temprana National Early Warning Score 2 (NEWS-2) en la consulta de triaje de los servicios de urgencias hospitalarios (SUH).Método: Estudio observacional prospectivo dividido en dos fases: Fase I (octubre-noviembre 2019) y Fase II (enero-febrero 2020). En la Fase I se llevó a cabo un proceso de traducción-retrotraducción, se formó al personal de Enfermería en el manejo de la escala NEWS-2 adaptada al español, y se realizó un pilotaje de la escala. En la Fase II se procedió a la validación de la escala analizando sus propiedades psicométricas y predictivas en términos de aparición de eventos adversos e ingresos hospitalarios. Se incluyeron consecutivamente a los usuarios adultos (mayores de 18 años) de un SUH en España.Resultados: Se valoraron 523 pacientes, 81 en la fase I y 442 en la fase II. La versión de la escala NEWS-2 en español obtenida tras el proceso de validación mostró un valor de alfa Cronbach de 0,70. El coeficiente de correlación intraclase para la fiabilidad intra e interobservador fue de 0,996 (IC 95%: 0,995-0,997) y 1 (IC 95%: 0,999-1), respectivamente. El área bajo la curva de la característica operativa del receptor fue de 0,969 (IC 95%: 0,938-1) para eventos adversos y de 0,881 (IC 95%: 0,819-0,943) para ingreso hospitalario.Conclusiones. La escala NEWS-2 tiene alta capacidad predictiva de ingresos hospitalarios y eventos adversos cuando se aplica en la consulta de triaje de los SUH. (AU)

Objective: To determine the ability of a Spanish translation of the National Early Warning Score 2 (NEWS2) to predict hospitalizations and adverse events during triage in hospital emergency departments. Methods: Prospective observational study in 2 phases. Phase 1 took place in October and November 2019 and phase 2 in January and February 2020. Phase 1 involved the translation and back translation process to produce an adapted Spanish version of the NEWS2 tool, the piloting of the adapted tool, and training sessions for nurses on how to use the scale. Phase 2 was a validation study of the translated scale for use in Spain. We analyzed its psychometric properties and capacity to predict adverse events and hospital admissions. Adult patients (over the age of 18 years) were recruited consecutively in a hospital emergency department in Spain.Results: We evaluated 523 patients, 81 in phase 1 and 442 in phase 2. The validated Spanish language version of the NEWS2 tool achieved a Cronbach α score of 0.70. The intraclass correlation coefficients for intra- and inter-observer reliability, respectively, were 0.996 (95% CI, 0.995–0.997) and approaching 1 (95% CI, 0.999-1). The area under the receiver operating characteristic curve was 0.969 (95% CI, 0.938-1) for adverse events and 0.881 (95% CI, 0.819-0.943) for hospitalization. Conclusion: The ability of the Spanish version of the NEWS2 scale to predict hospital admissions and adverse events is high when used during hospital emergency department triage. (AU)