Triaging of acutely ill children transported by ambulance. / Hastegradsvurdering av akutt syke barn transportert i ambulanse.

BACKGROUND: The Western Norway Regional Health Authority uses SATS Norge (SATS-N), a modified version of the South African Triage Scale, in all accident and emergency departments (A&E) and ambulance services in the region. The purpose of the study was to examine the validity of the paediatric component of SATS-N used for children transported to hospital by ambulance for emergency medical assistance. MATERIAL AND METHOD: We conducted a retrospective observational study which included all children in the age group 0-14 years, admitted by ambulance to A&E at Haukeland University Hospital for emergency medical assistance in the period from January to June 2020. The five triage levels in SATS-N were dichotomised to high triage level (the two highest triage categories) or low triage level (the three lowest triage categories). Sensitivity was calculated as the proportion of patients assigned to the high triage level among those who were directly transferred from A&E to a high dependency unit, and specificity as the proportion of patients assigned to the low triage level among those who were not directly transferred to a high dependency unit. RESULTS: Of a total of 303 patient transports, 270 (89 %) were triaged in the ambulance and 243 (80 %) in the A&E. In the pre-hospital and A&E settings, the sensitivity of SATS-N was 96 % and 88 %, and specificity was 46 % and 60 %, respectively. INTERPRETATION: For children admitted to hospital by ambulance, SATS-N had high sensitivity and low specificity for identifying patients who needed to be directly transferred from A&E to a high dependency unit.

Admisiones en los servicios de urgencias y costes económicos relacionados con procesos susceptibles de atención ambulatoria en adultos mayores que viven en centros residenciales / Emergency department admissions and economic costs burden related to ambulatory care sensitive conditions in older adults living in care homes

Objetivos Evaluar la frecuencia de las admisiones en los servicios de urgencias (ASU) por ambulatory care sensitive conditions (ACSC) y no-ACSC de personas que viven en residencias; describir y comparar sus características, y analizar los costes asociados. Método Este estudio multicéntrico, retrospectivo y observacional evaluó 2.444ASU de personas ≥65 años que viven en residencias en 5 servicios de urgencias de Cataluña por ACSC y no-ACSC, en 2017. Se recogieron variables sociodemográficas, estado funcional y cognitivo, e información sobre diagnóstico y hospitalización. Se evaluaron los costes relacionados con ACSC-ASU y se efectuó un análisis de sensibilidad utilizando diferentes supuestos de disminución de ingresos por ACSC. Resultados La media de edad de la muestra del estudio fue de 85,9 años (desviación estándar: 7,2 años). La frecuencia de ACSC-ASU y no-ACSC-ASU fue del 56,6 y el 43,4%, respectivamente. El 56,6 y el 78% presentaban dependencia severa y deterioro cognitivo, respectivamente, sin observarse diferencias entre los 2 grupos. Las 3 ACSC más frecuentes fueron caídas/traumatismos (13,8%), enfermedad pulmonar obstructiva crónica/asma (11,4%) e infección urinaria (7,4%). El coste medio por ACSC-ASU fue de 1.408,24€. Suponiendo una reducción del 60% de las ACSC-ASU, el ahorro de costes estimado sería de 1,2 millones de euros. Conclusiones Las admisiones en urgencias por ACSC procedentes de entornos residenciales suponen un impacto significativo tanto en la frecuencia como en los costes. La disminución de estas enfermedades mediante la aplicación de intervenciones específicas podría redirigir los costes evitados hacia la mejora del apoyo asistencial en los entornos residenciales (AU)

Objectives To assess the frequency of emergency department admissions (EDAs) for ambulatory care sensitive conditions (ACSC) and non-ACSC among older adults living in care homes (CH), to describe and compare their demographic and clinical characteristics, the outcomes of the hospitalization process and the associated costs. Method This multicenter, retrospective and observational study evaluated 2444 EDAs of older adults ≥65 years old living in care homes in five emergency departments in Catalonia (Spain) by ACSC and non-ACSC, in 2017. Sociodemographic variables, prior functional and cognitive status, and information on diagnosis and hospitalization were collected. Additionally, the costs related with the EDAs were calculated, as well as a sensitivity analysis using different assumptions of decreased admissions due to ACSC Results A total of 2444 ED admissions were analyzed. The patients’ mean (SD) age was 85.9 (7.2) years. The frequency of ACSC-EDA and non-ACSC-EDA was 56.6% and 43.4%, respectively. Severe dependency and cognitive impairment were present in 56.6% and 78%, respectively, with no differences between the two groups. The three most frequent ACSC were falls/trauma (13.8%), chronic obstructive pulmonary disease/asthma (11.4%) and urinary tract infection (7.4%). The average cost per ACSC-EDA was €1408.24. Assuming a 60% reduction of ACSC-EDA, the estimated cost savings would be €1.2 million. Conclusions Emergency admissions for ACSC from care homes have a significant impact on both frequency and costs. Reducing these conditions through targeted interventions could redirect the avoided costs toward improving care support in residential settings (AU)

Race and Ethnicity and Prehospital Use of Opioid or Ketamine Analgesia in Acute Traumatic Injury.

Importance: Racial and ethnic disparities in pain management have been characterized in many hospital-based settings. Painful traumatic injuries are a common reason for 911 activations of the EMS (emergency medical services) system. Objective: To evaluate whether, among patients treated by EMS with traumatic injuries, race and ethnicity are associated with either disparate recording of pain scores or disparate administration of analgesia when a high pain score is recorded. Design, Settings, and Participants: This cohort study included interactions from 2019 to 2021 for US patients ages 14 to 99 years who had experienced painful acute traumatic injuries and were treated and transported by an advanced life support unit following the activation of the 911 EMS system. The data were analyzed in January 2023. Exposures: Acute painful traumatic injuries including burns. Main Outcomes and Measures: Outcomes were the recording of a pain score and the administration of a nonoral opioid or ketamine. Results: The study cohort included 4 781 396 EMS activations for acute traumatic injury, with a median (IQR) patient age of 59 (35-78) years (2 497 053 female [52.2%]; 31 266 American Indian or Alaskan Native [0.7%]; 59 713 Asian [1.2%]; 742 931 Black [15.5%], 411 934 Hispanic or Latino [8.6%], 10 747 Native Hawaiian or other Pacific Islander [0.2%]; 2 764 499 White [57.8%]; 16 161 multiple races [0.3%]). The analysis showed that race and ethnicity was associated with the likelihood of having a pain score recorded. Compared with White patients, American Indian and Alaskan Native patients had the lowest adjusted odds ratio (AOR) of having a pain score recorded (AOR, 0.74; 95% CI, 0.71-0.76). Among patients for whom a high pain score was recorded (between 7 and 10 out of 10), Black patients were about half as likely to receive opioid or ketamine analgesia as White patients (AOR, 0.53; 95% CI, 0.52-0.54) despite having a pain score recorded almost as frequently as White patients. Conclusions and Relevance: In this nationwide study of patients treated by EMS for acute traumatic injuries, patients from racial or ethnic minority groups were less likely to have a pain score recorded, with Native American and Alaskan Natives the least likely to have a pain score recorded. Among patients with a high pain score, patients from racial and ethnic minority groups were also significantly less likely to receive opioid or ketamine analgesia treatment, with Black patients having the lowest adjusted odds of receiving these treatments.

Evaluación de las visitas a urgencias previas a un diagnóstico de VIH: oportunidades perdidas / Evaluation of emergency department visits prior to an HIV diagnosis: Missed opportunities

Objetivo: Existe una elevada tasa de infección oculta y diagnóstico tardío en el VIH. Los servicios de urgencias hospitalarios (SUH) son un punto importante de atención sanitaria. El presente trabajo tiene el objetivo conocer el número de oportunidades perdidas para el diagnóstico de VIH que ocurren en los SUH. Método: Estudio multicéntrico de cohortes retrospectivo que incluyó a todos los pacientes diagnosticados de infección por el VIH en el año 2019 en 27 hospitales españoles de 7 comunidades autónomas diferentes. Se revisaron todos los episodios de consulta en los SUH en los 5años previos al diagnóstico para conocer el motivo de consulta y si este representaba una oportunidad perdida para el diagnóstico de VIH. Resultado: Se incluyeron 723 pacientes, y 352 de ellos (48,7%; IC95%: 45,1-52,3%) presentaron al menos una visita a un SUH durante los 5años anteriores al diagnóstico (mediana2; p25-p75: 1-4). Ciento dieciocho pacientes (16,3%; IC95%: 13,8-19,2%) presentaron oportunidad perdida de diagnóstico. Las principales consultas fueron consumo de drogas (145 [15%]), infecciones de transmisión sexual (91 [9,4%]) y solicitud de profilaxis de VIH postexposición (39 [4%]). Ciento cincuenta y cinco (42,9%) de los 352 tenían menos de 350CD4/mm3 cuando se estableció el diagnóstico de VIH. En los pacientes con visitas previas a urgencias, el tiempo medio hasta el diagnóstico desde esta visita fue de 580 (DE647) días. Conclusiones: El 16% de los pacientes diagnosticados de VIH perdieron la oportunidad de ser diagnosticados en los 5años previos al diagnóstico, lo que pone de manifiesto la necesidad de implementar medidas de cribado en los SUH diferentes a las actuales para mejorar estos resultados.(AU)

Objective: There is a high rate of occult infection and late diagnosis in HIV. Hospital emergency departments (ED) are an important point of health care. The present work aims to know the number of missed opportunities for HIV diagnosis occurring in the ED. Method: Retrospective multicenter cohort study that included all patients diagnosed with HIV infection in 2019 in 27 Spanish hospitals in 7 different autonomous communities. All ED consultation episodes in the 5years prior to diagnosis were reviewed to find out the reason for consultation and whether this represented a missed opportunity for HIV diagnosis. Result: Seven hundred twenty-three patients were included, and 352 (48.7%; 95%CI: 45.1%-52.3%) had at least one ED visit during the 5years prior to diagnosis (median2; p25-p75: 1-4). One hundred and eighteen patients (16.3%; 95%CI: 13.8%-19.2%) had a missed diagnostic opportunity. The main consultations were drug use (145 [15%]), sexually transmitted infections (91 [9.4%]) and request for post-exposure HIV prophylaxis (39 [4%]). One hundred and fifty-five (42.9%) of the 352 had less than 350CD4/mm3 when the HIV diagnosis was established. In patients with previous ED visits, the mean time to diagnosis from this visit was 580 (SD647) days. Conclusions: Sixteen percent of patients diagnosed with HIV missed the opportunity to be diagnosed in the 5years prior to diagnosis, highlighting the need to implement ED screening measures different from current ones to improve these outcomes.(AU)

Errores de medicación en niños que acuden a los servicios de urgencias pediátricas / Medication errors in children visiting pediatric emergency departments

Objetivos: la seguridad de los medicamentos en pediatría supone un verdadero reto. Se dispone de escasos estudios que hayan analizado los errores de medicación en los pacientes pediátricos que acuden a los servicios de urgencias. El objetivo de este estudio ha sido caracterizar los errores detectados en estos pacientes, determinando su gravedad, los procesos afectados, los medicamentos implicados y los tipos de errores y causas asociados. Métodos: estudio multicéntrico observacional prospectivo realizado en los servicios de urgencias de 8 hospitales públicos españoles durante 4 meses. Los errores de medicación detectados por los pediatras de urgencias en pacientes entre 0 y 16 años fueron evaluados por un farmacéutico y un pediatra. Los errores de medicación fueron analizados utilizando la Taxonomía Española de Errores de Medicación actualizada. Resultados: en 99.797 visitas a urgencias se detectaron 218 (0,2%) errores de medicación, de los cuales 74 (33,9%) causaron daños (eventos adversos por medicamentos). Los preescolares fueron el grupo poblacional con mayor número de errores de medicación (126/218). Los errores se originaron mayoritariamente en la prescripción (66,1%), por automedicación (16,5%) y por administración equivocada por parte de los familiares (15,6%). Los tipos de errores más frecuentes fueron: «dosis incorrectas» (51,4%) y «medicamento inapropiado» (46,8%). Los antiinfecciosos (63,5%) fueron los fármacos más comúnmente implicados en los errores con daño. Las causas subyacentes asociadas a una mayor proporción de errores de medicación fueron: «falta de conocimiento del medicamento» (63,8%), «falta de seguimiento de los procedimientos» (48,6%) y «falta de información del paciente» (30,3%). Conclusiones: los errores de medicación en la población pediátrica que acude a urgencias se producen en la prescripción, por automedicación y en la administración, provocando daños a los pacientes en un tercio de las ocasiones. ...(AU)

Objectives: Medication safety represents an important challenge in children. There are limited studies on medication errors in pediatric patients visiting emergency departments. To help bridge this gap, we characterized the medication errors detected in these patients, determining their severity, the stages of the medication process in which they occurred, the drugs involved, and the types and causes associated with the errors. Methods: We conducted a multicenter prospective observational study in the pediatric emergency departments of 8 Spanish public hospitals over a 4-month period. Medication errors detected by emergency pediatricians in patients between 0 and 16 years of age were evaluated by a clinical pharmacist and a pediatrician. Each medication error was analyzed according to the updated Spanish Taxonomy of Medication Errors. Results: In 99,797 visits to pediatric emergency departments, 218 (0.2%) medication errors were detected, of which 74 (33.9%) resulted in harm (adverse drug events). Preschoolers were the age group with the most medication errors (126/218). Errors originated mainly in the prescribing stage (66.1%), and also by self-medication (16.5%) and due to wrong administration of the medication by family members (15.6%). Dosing errors (51.4%) and wrong/improper drugs (46.8%) were the most frequent error types. Anti-infective drugs (63.5%) were the most common drugs implicated in medication errors with harm. Underlying causes associated with a higher proportion of medication errors were “medication knowledge deficit” (63.8%), “deviation from procedures/guidelines” (48.6%) and “lack of patient information” (30.3%). Conclusions: Medication errors presented by children attending emergency departments arise from prescriptions, self-medication, and administration, and lead to patient harm in one third of cases. Developing effective interventions based on the types of errors and the underlying causes identified will improve patient safety. (AU)

Qualitative study on the use of emergency services by people with serious mental disorder in Spain.

BACKGROUND: The population with severe mental disorders (SMD) is a frequent user of emergency services. Situations of psychiatric decompensation can have devastating consequence and can cause problems in getting urgent medical care. The objective was to study the experiences and needs of these patients and their caregivers regarding the demand for emergency care in Spain. METHODS: Qualitative methodology involving patients with SMD and their informal caregivers. Purposive sampling by key informants in urban and rural areas. Paired interviews were carried out until data saturation. A discourse analysis was conducted, obtaining a codification in categories by means of triangulation. RESULTS: Forty-two participants in twenty-one paired interviews (19 ± 7.2 min as mean duration). Three categories were identified. 1º Reasons for urgent care: poor self-care and lack of social support, as well as difficulties in accessibility and continuity of care in other healthcare settings. 2º Urgent care provision: trust in the healthcare professional and the information patients receive from the healthcare system is crucial, telephone assistance can be a very useful resource. 3º Satisfaction with the urgent care received: they request priority care without delays and in areas separated from the other patients, as well as the genuine interest of the professional who attends them. CONCLUSIONS: The request for urgent care in patients with SMD depends on different psychosocial determinants and not only on the severity of the symptoms. There is a demand for care that is differentiated from the other patients in the emergency department. The increase in social networks and alternative systems of care would avoid overuse of the emergency departments.

Racial differences in healthcare utilization among patients with suspected or diagnosed preeclampsia: A retrospective cohort study.

OBJECTIVES: To analyze healthcare resource utilization and severe maternal morbidity (SMM) in Black and White patients with preeclampsia diagnosis versus signs/symptoms. STUDY DESIGN: This was a retrospective cohort study analyzing data from the IBM® Explorys Database between 7/31/2012-12/31/2020. Demographic, clinical, and laboratory data were extracted. Healthcare utilization and SMM were analyzed during the antepartum period (20 weeks of gestation until delivery) among Black and White patients with signs/symptoms of preeclampsia, with a diagnosis of preeclampsia, or neither (control). MAIN OUTCOME MEASURES: Healthcare utilization and SMM in those with a preeclampsia diagnosis or signs/symptoms of preeclampsia only were compared with a control group (White patients with no preeclampsia diagnosis or signs/symptoms). RESULTS: Data from 38,190 Black and 248,568 White patients were analyzed. Patients with preeclampsia diagnosis or signs/symptoms were more likely to visit the emergency room compared to those without diagnosis or signs/symptoms. Black patients with signs/symptoms of preeclampsia had the highest elevated risk (odds ratio [OR] = 3.4), followed by Black patients with a preeclampsia diagnosis (OR = 3.2), White patients with signs/symptoms (OR = 2.2), and White patients with a preeclampsia diagnosis (OR = 1.8). More Black patients experienced SMM (SMM rate 6.1% [Black with preeclampsia diagnosis] and 2.6% [Black with signs/symptoms]) than White patients (5.0% [White with preeclampsia diagnosis] and 2.0% [White with signs/symptoms]). SMM rates were higher for Black preeclampsia patients with severe features than for White preeclampsia patients with severe features (8.9% vs 7.3%). CONCLUSIONS: Compared with White patients, Black patients had higher rates of antepartum emergency care and antepartum SMM.

A face vitimada: morbidade entre mulheres atendidas em serviços sentinelas no brasil / The face victimized: morbidity between women incoming in sentinel service in Brazil / El rostro victimizado: morbilidad entre mujeres atendidas en servicios de centinela en Brasil

Introdução:Mulheres têm sido subjugadas pela violência em prol da identidade machista e domínio viril do homem. Objetivo: analisar os atendimentos de emergência em mulheres vítimas de violência na região de cabeça e pescoço. Metodologia:Análise de dados do inquérito de Vigilância e Acidentes em 25 capitais e no Distrito Federal no ano de 2011 por meio de amostra de 351 atendimentos de mulheres entre 15 e 49 anos em relação à ocorrência de violência na região de cabeça e pescoço. Resultados:A ocorrência da violência foi predominante em mulheres pretas (70,8%),jovens (68,3% 20-29 anos)e com pouca escolaridade (< 8 anos de estudo), sendo mais frequentes no domicílio (45,5%), cometida de forma intencional (86,9%) por um agressor do sexo masculino (77,4%), identificado como parceiro ou ex-parceiro íntimo (44,5%), sendo aface (87,0%) a região de cabeça/pescoço mais atingida. Conclusões:A violência contra a mulher perpassa a discussão das desigualdades de gênero, interseccionalidade e capital social. O importante não é o gênero em si, mas a junção do gênero, raça e classe socioeconômica. Isto requer políticas públicas intersetoriais e mobilização social em prol do capital social. Para tanto, o modelo de Redes de Atenção, com a consequente multiprofissionalidade, intersetorialidade e transdisciplinaridadeé fundamental. Isto pressupõe, inclusive, a maior inserção do cirurgião-dentista na identificação e acolhimento das vítimas para posteriores encaminhamentos (AU).

Introduction:Women have been subjugated by violence in favor of the male identity and virile dominance of men. Objective:to analyze emergency care for women victims of violence in the head and neck region. Methodology:Analysis of data from the Surveillance and Accident Survey in 25 state capitals and the Federal District in 2011 througha sample of 351 visits to women between 15 and 49 years old regarding the occurrence of violence in the head and neck region. Results:The occurrence of violence was predominant in black women (70.8%), young (68.3% 20-29 years) and with little schooling (< 8 years of study), being more frequent at home (45.5 %), committed intentionally (86.9%) by a male aggressor (77.4%), identified as a partner or former intimate partner (44.5%), with the face (87.0%) the most affected head/neck region. Conclusions:Violence against women permeates the discussion of gender inequalities, intersectionality and social capital. What is important is not gender per se, but the combination of gender, race and socioeconomic class. This requires intersectoral public policies and social mobilization in favor of social capital. Therefore, the model of Care Networks, with the consequent multiprofessionality, intersectoriality and transdisciplinarity is fundamental. This presupposes, including, greater involvement of the dental surgeon in the identification and reception of victims for subsequent referrals (AU).

Introducción:Las mujeres han sido subyugadas por la violencia a favor de la identidad masculina y el dominio viril de los hombres. Objetivo:analizar la atención de emergencia a mujeres víctimas de violencia en la región de cabeza y cuello. Metodología:Análisis de datos de la Encuesta de Vigilancia y Accidentalidad en 25 capitales de estado y Distrito Federal en 2011 a través de una muestra de 351 visitas a mujeres entre 15 y 49 años sobre la ocurrencia de violencia en la región de cabeza y cuello. Resultados: Predominó la ocurrencia de violencia en mujeres negras (70,8 %), jóvenes (68,3 % 20-29 años) y con poca educación(< 8 años de estudio), siendo más frecuente en el hogar (45,5 %), cometida intencionalmente (86,9%) por un agresor masculino (77,4%), identificado como pareja o ex pareja íntima (44,5%), siendo el rostro (87,0%) la región de cabeza/cuello más afectada. Conclusiones:La violencia contra las mujeres permea la discusión sobre las desigualdades de género, la interseccionalidad y el capital social. Lo importante no es el género per se, sino la combinación de género, raza y clase socioeconómica. Esto requiere políticas públicas intersectoriales y movilización social a favor del capital social. Por ello, es fundamental el modelo de Redes de Atención, con la consiguiente multiprofesionalidad, intersectorialidad y transdisciplinariedad. Esto presupone incluso una mayor inserción del cirujano dentista en la identificación y recepción de las víctimas para su posterior derivación (AU).

Lecciones aprendidas sobre el manejo de la urolitiasis tras los perjuicios causados por la COVID-19: un ejemplo de adaptación en un centro de alto volumen / Lessons learned after the disruption caused by COVID-19 in the management of urolithiasis: An example of adaptation in a high-volume center

Introducción El objetivo del estudio fue analizar el impacto de la pandemia por COVID-19 en la presentación y el manejo de la enfermedad litiásica. Métodos Estudio retrospectivo comparativo de los procedimientos (urgentes y electivos) por litiasis durante los primeros 8 meses de la pandemia (01/03/2020 al 31/10/2020), comparándose con el mismo periodo de 2019, y entre olas. Las pruebas utilizadas fueron la prueba exacta de Fisher, la t de Student, la chi-cuadrado y la U de Mann-Whitney. Resultados Se analizaron 530 procedimientos. El número total de procedimientos quirúrgicos por enfermedad litiásica fue similar entre los 2 periodos. En cuanto a la cirugía electiva, se identificó un aumento en la tasa de complicaciones en el periodo de pandemia, pero no se observaron diferencias estadísticamente significativas en cuanto a tipos de procedimientos realizados y necesidad de tratamientos complementarios. El patrón de presentación del cólico renoureteral complicado fue diferente durante la pandemia, con un mayor número de días desde el inicio de los síntomas hasta la consulta y una mayor proporción de pacientes con fracaso renal agudo. Asimismo, se detectó un aumento significativo de los niveles de creatinina en la primera ola, así como un incremento en el número de procedimientos urgentes tras la primera ola debido al retraso en el tratamiento y diagnóstico de la enfermedad litiásica. Conclusiones La pandemia por COVID-19 ha impactado negativamente en el tratamiento urgente y electivo de la litiasis. Se deben aprender lecciones sobre el manejo de la litiasis en este contexto para evitar complicaciones graves y mejorar los estándares de atención (AU)

Introduction The aim was to determine the impact of COVID-19 pandemic on urolithiasis presentation and management. Methods In this retrospective study, we comparatively evaluated urgent and elective procedures due to urolithiasis during the early 8 months of the COVID-19 pandemic (March 1, 2020, to October 31, 2020) compared to the same period a year before, and between waves. Fisher's exact test, Student's t-test, chi-square test and Mann-Whitney U test were used to compare the patients’ characteristics and outcomes between the 2 periods and waves. Results Five hundred and thirty procedures were included. The overall numbers of surgical procedures due to urolithiasis were similar between pre-pandemic and pandemic periods. Regarding elective surgery, our data draw attention to the increased complication rate in the pandemic times, but no statistically significant differences in terms of types of procedures and need for complementary treatments were observed. We noted that patterns of presentation of complicated renal colic were different during COVID-19 pandemic, with a higher number of days after the onset of symptoms and a higher proportion of patients presenting acute kidney injury. Furthermore, a significant increase of creatinine levels at presentation in first wave was detected, and a growth in the number of urgent procedures after the first wave was noted, owing to the delay in urolithiasis treatment and diagnosis. Conclusions The COVID-19 pandemic has negatively affected both urgent and elective management of urolithiasis. Lessons about the management of urolithiasis in this context should be learned to avoid fatal complications and improve standards of care (AU)

Intoxicación por monóxido de carbono: estudio observacional de pacientes que acudieron a Urgencias durante 2020 / Carbon monoxide poisoning: an observational study of patients admitted to Emergency Department during 2020

El objetivo fue describir las intoxicaciones monóxido de carbono. Se diseñó un corte transversal que incluyó una muestra consecutiva de mediciones de carboxihemoglobina (COHb), realizadas Enero y Diciembre 2020 en la Central de Emergencias del Hospital Italiano de Buenos Aires. Se utilizaron bases secundarias y revisión manual de historias clínicas para recolección de varia-bles de interés. Durante el período de estudio hubo 20 pacientes confirmados, con media de 50 años (DE 20), 55% sexo masculino, 20% tabaquistas, y una única embarazada. El 70% correspondieron al trimestre Junio-Julio-Agosto. La fuente de intoxicación más frecuente se debió a accidentes domésticos (calefón, estufa, brasero, hornalla, salamandra) que representaron el 50% de los casos, 30% por incendios, y el 20% restante explicado por tabaco o factor desconocido. Los estudios de laboratorio más solicitados fueron: 95% recuento de glóbulos blancos, 85% glucemia, 70% CPK, y 55% troponina. Los hallazgos relevantes fueron COHb con mediana de 7.15%, CPK con mediana de 89 U/mL, y troponina con mediana de 8.5 pg/mL. La totalidad se realizó electrocardiograma: 15% presentaron arritmia como hallazgo patológico, y ninguno isquemia. En cuanto la presentación clínica: 30% presentó cefalea, 15% síncope, 15% coma, 10% mareos y 10% convulsiones. Sólo 25% tuvieron tomografía y 15% resonancia de cerebro, sin hallazgos críticos. Sin embargo, 15% fueron derivados para trata-miento con cámara hiperbárica. La mayoría ocurrieron en invierno y explicados por accidentes domésticos. Será necesario un fortalecimiento del rol preventivo que apunte al control de la instalación y el buen funcionamiento de artefactos, como mantener los ambientes bien ventilados (AU)

The objective was to describe carbon monoxide poisoning. A cross sectional was designed, which included a consecutive sample of carboxyhemoglobin (COHb) measurements, carried from January to December 2020 at the Emergency Department of tHospital Italiano de Buenos Aires. Secondary databases and manual review of medical records were used to collect variables of interest. During the study period there were 20 confirmed patients, with a mean age of 50 (SD 20), mostly male (55%), 20% smokers, and only one pregnant woman, 70% corresponded to June-July-August. The most frequent source of poisoning was explained to domestic accidents (water heater, stove, brazier, stove, salamander) which represented 50% of cases, 30% due to fires, and the remaining 20% by tobacco or unknown factor. The most laboratory studies were: 95% white blood cell count, 85% glycemia, 70% CPK, and 55% troponin. Meanwhile, relevant findings were carboxyhemoglobin with a median of 7.15%, CPK with a median of 89 U/mL, and troponin with a median of 8.5 pg/mL. All underwent an electrocardiogram: 15% presented arrhythmia as a pathological finding, and none ischemia. Regarding the clinical presentation: 30% presented headache, 15% syncope, 15% coma, 10% dizziness and 10% seizures. Only 25% had brain tomography and 15% MRI, without pathological findings. However, 15% were referred for treatment with a hyperbaric chamber. Most of the cases occurred in winter and explained by domestic accidents. It will be necessary to strengthen the preventive role that aims to control the installation and the proper functioning of devices, such as keeping rooms well ventilated (AU)

Ondansetrón para el control de vómitos asociados a gastritis y gastroenteritis aguda en urgencias de Pediatría: uso, abuso y buen uso / Ondansetron for the control of vomiting associated with acute gastritis/gastroenteritis in Pediatric Emergencies: use, abuse and appropriate use

Introducción: el ondansetrón es un antiemético ampliamente utilizado en la práctica clínica para el control de vómitos asociados a gastritis y/o gastroenteritis aguda en niños. Sin embargo, la evidencia disponible es controvertida, sus indicaciones no están claramente definidas y no existe una unanimidad de uso en las guías de práctica clínica. Material y métodos: se realizó un estudio de cohortes retrospectivo en el que se incluyó un total de 825 niños entre 0 y 14 años con vómitos asociados a gastritis y/o gastroenteritis aguda que acudieron a Urgencias de Pediatría de un hospital terciario durante el año 2019. Se analizó la asociación entre el uso de ondansetrón y la necesidad de rehidratación intravenosa, las hospitalizaciones, el tiempo de permanencia en Urgencias y las nuevas consultas a Urgencias dentro de las 72 horas posteriores. Resultados: de la muestra estudiada, el 38,8% de los pacientes recibieron ondansetrón. La administración de ondansetrón redujo el riesgo de ingreso (OR 0,19; IC 95%: 0,04-0,84) y disminuyó el tiempo de permanencia en Urgencias (p = 0,000). No se encontraron diferencias significativas en la reducción de la necesidad de rehidratación intravenosa (OR 0,65; IC 95%: 0,40-1,05) ni en las nuevas visitas a Urgencias dentro de las 72 horas siguientes (OR 1,38; IC 95%: 0,82-2,31). Conclusiones: nuestros resultados sugieren que el uso de ondansetrón podría ser beneficioso en niños mayores de 6 meses con vómitos asociados a gastritis y/o gastroenteritis aguda y que presenten deshidratación de leve a moderada (AU)

Background: ondansetron is an antiemetic widely used in clinical practice for the control of vomiting associated with gastritis and/or acute gastroenteritis in children. However, the available evidence about its use is controversial, its directions for use are not clearly defined and there is no unanimity on its use in clinical practice guidelines.Methodology: we performed a retrospective cohort study which included a total of 825 children between 0 and 14 years, who presented symptoms of vomiting associated with gastritis and/or acute gastroenteritis and attended the Pediatric Emergency Department of a tertiary hospital in 2019. The association between the use of ondansetron and the need for intravenous rehydration, hospitalization, length of stay in the Pediatric Emergency Department and return visits to the emergency department within 72 hours was analysed.Results: of the sample studied, 38.7% of the patients received ondansetron. The administration of ondansetron reduced the risk of hospital admission (OR 0.19; 95% CI 0.04 to 0.84) and decreased the length of stay in the emergency department (p = 0.000). No significant differences were found in reducing the need for intravenous rehydration (OR 0.65; 95% CI 0.40 to 1.05) or in return visits to emergency department within 3 days (OR 1.38; 95% CI 0.82-2.31).Conclusions: our results suggest that the use of ondansetron could be beneficial in children older than 6 months with vomiting associated with gastritis and/or acute gastroenteritis and with mild-to-moderate dehydration. (AU)

Racial and Ethnic Differences in Bystander CPR for Witnessed Cardiac Arrest.

BACKGROUND: Differences in the incidence of cardiopulmonary resuscitation (CPR) provided by bystanders contribute to survival disparities among persons with out-of-hospital cardiac arrest. It is critical to understand whether the incidence of bystander CPR in witnessed out-of-hospital cardiac arrests at home and in public settings differs according to the race or ethnic group of the person with cardiac arrest in order to inform interventions. METHODS: Within a large U.S. registry, we identified 110,054 witnessed out-of-hospital cardiac arrests during the period from 2013 through 2019. We used a hierarchical logistic regression model to analyze the incidence of bystander CPR in Black or Hispanic persons as compared with White persons with witnessed cardiac arrests at home and in public locations. We analyzed the overall incidence as well as the incidence according to neighborhood racial or ethnic makeup and income strata. Neighborhoods were classified as predominantly White (>80% of residents), majority Black or Hispanic (>50% of residents), or integrated, and as high income (an annual median household income of >$80,000), middle income ($40,000-$80,000), or low income (<$40,000). RESULTS: Overall, 35,469 of the witnessed out-of-hospital cardiac arrests (32.2%) occurred in Black or Hispanic persons. Black and Hispanic persons were less likely to receive bystander CPR at home (38.5%) than White persons (47.4%) (adjusted odds ratio, 0.74; 95% confidence interval [CI], 0.72 to 0.76) and less likely to receive bystander CPR in public locations than White persons (45.6% vs. 60.0%) (adjusted odds ratio, 0.63; 95% CI, 0.60 to 0.66). The incidence of bystander CPR among Black and Hispanic persons was less than that among White persons not only in predominantly White neighborhoods at home (adjusted odds ratio, 0.82; 95% CI, 0.74 to 0.90) and in public locations (adjusted odds ratio, 0.68; 95% CI, 0.60 to 0.75) but also in majority Black or Hispanic neighborhoods at home (adjusted odds ratio, 0.79; 95% CI, 0.75 to 0.83) and in public locations (adjusted odds ratio, 0.63; 95% CI, 0.59 to 0.68) and in integrated neighborhoods at home (adjusted odds ratio, 0.78; 95% CI, 0.74 to 0.81) and in public locations (adjusted odds ratio, 0.73; 95% CI, 0.68 to 0.77). Similarly, across all neighborhood income strata, the frequency of bystander CPR at home and in public locations was lower among Black and Hispanic persons with out-of-hospital cardiac arrest than among White persons. CONCLUSIONS: In witnessed out-of-hospital cardiac arrest, Black and Hispanic persons were less likely than White persons to receive potentially lifesaving bystander CPR at home and in public locations, regardless of the racial or ethnic makeup or income level of the neighborhood where the cardiac arrest occurred. (Funded by the National Heart, Lung, and Blood Institute.).

Assistência de urgência e emergência: desafios no atendimento a múltiplas vítimas / Urgency and emergency assistance: challenges in caring for multiple victims / Urgencias y emergencias: retos en la atención a múltiples víctimas

A urgência e emergência, por sua vez, se faz como ocorrência imprevista com ou sem risco potencial à vida, onde o indivíduo necessita de assistência e pressupõem atendimento rápido, proporcional a sua gravidade. O presente trabalho tem o objetivo de promover reflexões acerca dos desafios que surgem diante do atendimento a múltiplas vítimas nos serviços médicos de urgência e emergência. Trata-se de uma revisão integrativa da literatura. Realizou-se uma análise de materiais já publicados na literatura e artigos científicos divulgados em bases de dados: Scientific Eletronic Library Online, Medical Literature Analysis and Retrieval System Online e Localizador de informação em Saúde. Foram encontradas nas bases de dados, 25 estudos completos, após a leitura dos resumos, 21 artigos foram selecionados para análise na íntegra, sendo 17 eleitos para integrar a revisão integrativa. Diante dos resultados obtidos, observou que as equipes de atendimento pré- hospitalar vivenciam desafios para atender múltiplas vítimas, e dentro desse paradigma existem várias etapas que devem ser seguidas, que envolvem comunicação desde um protocolo de atendimento inicial ao transporte final. Portanto, observa-se a necessidade de maiores estudos e desenvolvimento de novas tecnologias que auxiliam na assistência a múltiplas vítimas, como também o prepara e atualização dos profissionais.

Urgency and emergency, in turn, is made as an unforeseen occurrence with or without potential risk to life, where the individual needs assistance and quick care, in turn, proportional to its severity. The work of emergency care and the need to respond to problems presented in urgent and emergency services. This is an integrative literature review. An analysis was performed of materials already published in the literature and articles published in databases: Scientific Electronic Library Online, Medical Literature Analysis and Retrieval System Online and Health Information Locator. All studies were complete, after reading the studies,21 articles were selected for full analysis, with 17 studies elected to integrate the integrative review. Results obtained, observed that pre care teams experience challenges to support various hospital communication protocols, and within these paradigms from initial care to transport. Therefore, there is a need for studies and development of technologies that assist in the installation of larger and more up-to-date devices, there is a need for studies and development of new technologies, as well as preparation.

La atención de urgencia y emergencia es un suceso imprevisto con o sin riesgo potencial para la vida, en el que el individuo necesita asistencia y requiere una atención rápida, proporcional a su gravedad. Este documento pretende promover la reflexión sobre los retos que surgen al tratar con múltiples víctimas en los servicios médicos de urgencia y emergencia. Se trata de una revisión bibliográfica integradora. Se ha realizado un análisis de los materiales publicados en la literatura y los artículos científicos divulgados en las bases de datos: Scientific Eletronic Library Online, Medical Literature Analysis and Retrieval System Online y Localizador de información en Salud. Se encontraron en las bases de datos, 25 estudios completos, después de leer los resúmenes, se seleccionaron 21 artículos para el análisis en su totalidad, siendo 17 elegidos para integrar la revisión integradora. A partir de los resultados obtenidos, se observa que los equipos de atención prehospitalaria viven desafíos para atender a múltiples víctimas, y dentro de este paradigma existen varias etapas que deben seguirse, que implican la comunicación desde un protocolo de atención inicial hasta el transporte final. Por lo tanto, se observa la necesidad de realizar más estudios y desarrollar nuevas tecnologías que ayuden en la asistencia a las múltiples víctimas, así como la preparación y actualización de los profesionales.

O papel da estratégia da saúde da família e comunidade na rede de urgências e emergências / The role of the family and community health strategy in the urgency and emergency care network

Introdução: A Estratégia de Saúde da Família e Comunidade (ESFC) é parte da Rede de Atenção às Urgências e Emergências (RAUE). Embora a ESFC seja um ponto da RAUE, essa temática é pouco estudada, mesmo com a atenção a casos de urgência e emergência (U/E) estando cada vez mais presente em seu cotidiano. Isso aponta para a importância em investigá-la. Objetivo: Analisar o papel da ESFC na atenção a usuários em situações de U/E. Metodologia: trata-se aqui, de estudo de caso, qualitativo, exploratório, desenvolvido nas sete unidades de ESFC de um município do centro-oeste paulista, Brasil. Foram realizadas entrevistas semiestruturadas com 38 profissionais, analisadas segundo descrição temática. Resultados: Os dados foram agrupados em três núcleos temáticos: estrutura, processo de trabalho e articulação da ESFC com a RAUE. A estrutura mostrou-se deficiente, em relação à capacitação profissional e à disponibilidade de medicamentos, materiais e insumos. A ESFC tem importante papel no atendimento a casos de U/E, entretanto o processo de trabalho não está organizado para abordar adequadamente esses casos, e a articulação com a RAUE é deficiente. Os resultados apontam para questões que representam um desafio ao aprimoramento da ESFC em contextos semelhantes e servem como embasamento preliminar para pesquisas futuras.

Introduction: The Family and Community Health Strategy (ESFC, in Portuguese) is part of the Emergency Care Network (RAUE). Although it is part of RAUE and the attention to emergency cases is increasingly present in the daily routine of the ESFC, this themeis little studied, which points out the importance of investigating it. Objective: To analyze the role of ESFC in the care of users in emergency situations. Methodology: Qualitative and exploratory case study, developed in the seven ESFC units of a municipality in the Midwest of São Paulo, Brazil. Semi-structured interviews were conducted with 38 professionals and analyzed according to the thematic description. Results: The data were grouped into three thematic nuclei: structure, work process, and ESFC articulation with RAUE. The structure was deficient in relation to professional training and the availability of medicines, materials, and supplies.ESFC plays an important role in the care of emergency cases. However, the work process is not organized to adequately address these cases and the articulation with RAUE is deficient. The results point to issues that represent a challenge for the improvement of ESFC in similar contexts and serve as a preliminary basis for future research.

Urgencia odontológica ambulatoria en la población de la red pública de salud en Chile, 2017-2020 / Outpatient dental emergency in the population of the public health network in Chile, 2017-2020

OBJETIVO Describir la tendencia de las consultas de urgencia odontológica ambulatoria registrada en la población atendida en la red pública de salud en Chile entre los años 2017 y 2020. MATERIALES Y METODOS Diseño de estudio ecológico. Se evaluaron las consultas de urgencia odontológica ambulatoria obtenidas del Registro Estadístico Mensual (REM) del Ministerio de Salud de Chile entre los años 2017 y 2020. Se calculó la tasa de consulta por urgencia odontológica ambulatoria (UOA) considerando el total de consultas de urgencias con Garantía explícitas en salud en el numerador y la población beneficiaria registrada por el Fondo Nacional de salud en el denominador, amplificado por 1000 para cada año de estudio. Las tasas se especificaron por sexo, grupo etario (<20 años; 20 a 64 años y 65 y más años), y zona geográfica de Chile (zona norte, centro y sur). RESULTADOS Se registraron un total de 27.639.889 consultas odontológicas en la red pública de atención de salud en el país, de estas, 1.345.390 corresponden a consultas por UOA. Se observó una disminución de la tasa de consulta por urgencia odontológica ambulatoria hacia el año 2020 (variación porcentual de -17,93%). La tasa de consultas es levemente mayor en mujeres, en edades entre 20 a 64 años y en la zona norte y sur del país. CONCLUSION Se observa una disminución sostenida en la tasa de consultas por UOA en la red pública de salud del país, lo que podría reflejar la existencia de un mayor acceso de la población a resolver los problemas de salud bucal en el nivel primario de atención asociado al desarrollo de diferentes programas de alud bucal. Sin embargo hay que ser cautelosos con la interpretación considerando que durante el periodo Chile vivió un estallido social e hizo frente a la pandemia por COVID-19

AIM To describe the trend of outpatient dental emergency registered in the population attended in the public health system in Chile between 2017 and 2020. MATERIALS AND METODOS Ecological study design. Outpatient dental emergency obtained from the Statistical Registry (REM) of the Ministry of Health of Chile between 2017 and 2020 were evaluated. The consultation rate for outpatient dental emergency (OUA) was calculated considering the total number of emergency consultations with Explicit health guarantees in the numerator and the beneficiary population registered by the National Health Fund in the denominator, amplified by 1,000 for each year of study. The rates were specified by sex, age group (<20 years; 20 to 64 years and 65 years and over), and geographical area of Chile (north, center and south). RESULTS A total of 27,639,889 dental consultations were registered in the public health care network in the country, of these, 1,345,390 correspond to consultations by UOA. A decrease in the outpatient dental emergency consultation rate was observed towards the year 2020 (percentage variation of -17.93%). The consultation rate is slightly higher in omen, between the ages of 20 and 64, and in the north and south of the ountry.CONCLUSION A sustained decrease in the consultation rate for UOA in the country's public health system is observed, which could reflect the existence of a greater access of the population to solve oral health problems at the primary level of care associated to the development of different oral health programs. However, one must be cautious with the interpretation considering that during the period Chile experienced a social explosion and faced the COVID-19 pandemic

Categorización y revisión de reevaluaciones en tomografía computada en una unidad de telerradiología de urgencia / Categorization and review of reevaluations in computed tomography in an emergency teleradiology unit

INTRODUCCIÓN La telerradiología se basa en el despliegue de radiólogos a distancia para evaluar estudios de dicha especialidad. Actualmente hay evidencia limitada sobre las tasas de error de evaluaciones en telerradiología. Este estudio corresponde a una revisión de las discrepancias entre los informes preliminares y finales de tomografía computada (TC) de una unidad de urgencia telerradiológica. OBJETIVO Determinar las discrepancias de las reevaluaciones (addendum) en los informes radiológicos de TC en una unidad de telerradiología de urgencia. MATERIALES Y MÉTODOS La recolección de datos se planificó a modo de tabla de cotejo, en la cual se tabularon casos de reevaluaciones de urgencia desde el mes de enero hasta mayo del año 2021, en base a la categorización Agrawal. RESULTADOS De una total de 111.599, 836 informes presentaron addendum, que corresponden al 0,74% del total informado, La categoría Agrawal 0 agrupó la mayor cantidad de casos y los exámenes de TC especialidad de cuerpo se encuentran los segmentos con mayores requerimientos de reevaluación. Discusión: Los valores obtenidos permiten establecer una baja incidencia de reevaluaciones y de la gravedad de estas, apuntando a errores asociados a canales de comunicación, redacción y elaboración de informes con especial énfasis en estudios TC Tórax y Abdomen/Pelvis. CONCLUSIÓN El porcentaje de cumplimiento de un 99,26% de exactitud en los informes permite concluir la alta confiabilidad y la calidad del servicio de telerradiología de la empresa en cuestión durante el periodo evaluado y el empleo de medidas correctivas basadas en organización, gestión e instrumentalización tecnológica

[Descriptive analysis of triggers, outcomes and the response of the health systems of child drowning in Galicia (Spain). A 17-year retrospective study.] / Análisis descriptivo de las causas, consecuencias y respuesta de los sistemas de Salud Pública en los ahogamientos pediátricos en Galicia. Un estudio retrospectivo de 17 años.

OBJECTIVE: Drowning is one of major public health problem in childhood. The aim of this paper was to describe the characteristics, locations, interventions and outcomes of child drowning in Galicia over 17 years. METHODS: Retrospective study of 100% of data of drowning amongst children aged 0-14 in the 2004-2020 period who were attended by the 061 emergency services in Galicia (Spain) was made. The characteristics of the incident, the victim's profile, location, type of medical care given and whether the victim survived or died were analysed using the Chi Square test to compare relative frequencies, and Odds Ratio to estimate the risk. RESULTS: During the period under study, 100 child drownings were recorded. In 55%, the main cause was lack of supervision. Young children (aged 0-4) primarily drowned in pools, and pre-teens and teenagers (aged 10-14) in the sea. In 42% of the incidents, bystanders performed CPR (37% included ventilation). Emergency services took 12 minutes on average to arrive at the scene. 6% died in situ and of the rest, were taken to hospital and admitted in 47% PICU, 26% ward, 8% discharged from Accident and Emergency (43% with pulmonary oedema, 41% with supplemental oxygen, 13% with IMV/NIMV [invasive mechanical ventilation/non-invasive]). Pneumonia was the most common complication and survival to discharge was 77%. CONCLUSIONS: Small children usually drown in pools and water facilities because of lack of supervision, whereas adolescents usually drown in the sea. CPR started by bystanders and the fast response of emergency services contributed to a high rate of survival. A large amount of data was lost during the process: accurate, standardized coding of drowning is necessary.

OBJETIVO: El ahogamiento es un importante problema de Salud Pública en la etapa infantil. El objetivo de este trabajo fue describir las características, localizaciones, intervenciones y resultados del ahogamiento pediátrico en Galicia durante 17 años. METODOS: Se realizó un estudio retrospectivo del 100% de los datos de ahogamiento de personas entre 0 y 14 años de edad del año 2004 a 2020, que fueran atendidos por los servicios de emergencias de Galicia 061. Se analizaron las características del incidente, perfil de la víctima, localización, tipo de asistencia sanitaria recibida y supervivencia respecto a muerte mediante el test Chi Cuadrado para comparar frecuencias relativas, y Odds Ratio para estimar el riesgo. RESULTADOS: Se registraron 100 ahogamientos pediátricos. En el 55% la principal causa fue la falta de supervisión. Los niños y niñas de 0-4 años se ahogaban mayoritariamente en piscinas, mientras que los/las adolescentes (10-14 años) en playas. En el 42% de los incidentes el testigo hizo reanimación cardiopulmonar (un 37% incluyó ventilaciones). Los servicios de emergencia tardaron 12 minutos de media en llegar. Un 6% falleció in situ y el resto fueron trasladados al hospital e ingresaron el 47% en UCI, 26% en planta, y 8% cursaron alta en Urgencias (43% con edema pulmonar, 41% con oxígeno suplementario, 13% con VMI/VMNI [ventilación mecánica invasiva/no invasiva]). La neumonía fue una complicación habitual y la supervivencia al alta fue del 77%. CONCLUSIONES: Los niños/as más pequeños se ahogan habitualmente en instalaciones acuáticas por falta de supervisión mientras que los/las adolescentes se suelen ahogar en playas marítimas. El inicio de la reanimación por parte de testigos y la rápida respuesta de los servicios de emergencias se asocia a una alta tasa de supervivencia. Numerosos datos fueron perdidos durante el proceso por lo que es necesaria una correcta y unificada codificación del ahogamiento.

Atendimento pré-hospitalar às tentativas de suicídio: um estudo transversal / Prehospital care for suicide attempts: a cross-sectional study

OBJETIVO: Caracterizar o atendimento pré-hospitalar às vítimas de tentativa de suicídio. MÉTODOS: Estudo transversal com dados de atendimento pré-hospitalar realizado pelo Serviço de Atendimento Móvel de Urgência (SAMU), em Teresina, Piauí, no período de julho/2015 a dezembro/2018. Foram realizadas análise descritiva com o teste Qui-quadrado de Pearson ou teste exato de Fisher e análise da densidade das tentativas de suicídio pela estimativa de Kernel. RESULTADOS: Os atendimentos às tentativas de suicídio predominaram em mulheres (60,9%), adultos de 20 a 29 anos (28,4%), residentes na Região Centro/Norte (35,9%), aos domingos (16,5%) e nos turnos da tarde (32,9%) e noite (34,9%). Foram relatados reincidências de tentativas (9,2%), histórico de atendimento psiquiátrico (14,1%), uso abusivo de álcool (17,5%) e outras drogas (4,6%). O atendimento em ambulâncias de suporte avançado e maior mortalidade antes do socorro foram mais frequentes em vítimas do sexo masculino (40,8% e 5,8%, respectivamente). A Zona Centro/Norte da cidade concentrou as ocorrências para ambos os sexos. CONCLUSÃO: Os atendimentos pré-hospitalares às tentativas de suicídio em Teresina demonstraram grande demanda por vítimas do sexo feminino e jovens e maior densidade de ocorrência na Zona Centro/Norte da cidade. O uso de bebida alcoólica, os meios de autolesão mais letais e a mortalidade foram associados ao sexo masculino. Faz-se necessário divulgar essas informações, capacitar os profissionais sobre a prevenção e abordagem às tentativas de suicídio, além de promover políticas públicas capazes de reduzir as tentativas de suicídio.

OBJECTIVE: To characterize pre-hospital care for victims of attempted suicide. METHODS: Cross-sectional study with pre-hospital care data conducted by the Mobile Emergency Care Service (SAMU), in Teresina, Piauí, from July/2015 to December/2018. Descriptive analysis was performed using Pearson's chi-square test or Fisher's exact test and analysis of the density of suicide attempts using the Kernel estimate. RESULTS: Attendance to suicide attempts predominated in women (60,9%), adults aged 30 to 59 years (46,8%), residing in the Center/North Region (35,9%), on Sundays (16,5%), in the afternoon (32,9%) and night (34,9%) shifts. Recurrence of attempts (9,2%), history of psychiatric care (14,1%), alcohol abuse (17,5%) and other drugs (4,6%) were reported. The attendance in ambulances of advanced support and higher mortality before the rescue were more frequent in male victims (40,8% and 5,8%, respectively). The Center/North zone of the city concentrated the occurrences for both sexes. CONCLUSION: Pre-hospital care for suicide attempts in Teresina showed great demand for female victims, young people and a higher density of occurrence in the Center/North zone of the city. Alcohol use, more lethal means of self-harm and mortality were associated with males. It is necessary to disseminate this information and train professionals on the prevention and approach to suicide attempts, in addition to promoting public policies capable of reducing suicide attempts.

Activation of Citizen Responders to Out-of-Hospital Cardiac Arrest During the COVID-19 Outbreak in Denmark 2020.

Background Little is known about how COVID-19 influenced engagement of citizen responders dispatched to out-of-hospital cardiac arrest (OHCA) by a smartphone application. The objective was to describe and analyze the Danish Citizen Responder Program and bystander interventions (both citizen responders and nondispatched bystanders) during the first COVID-19 lockdown in 2020. Methods and Results All OHCAs from January 1, 2020, to June 30, 2020, with citizen responder activation in 2 regions of Denmark were included. We compared citizen responder engagement for OHCA in the nonlockdown period (January 1, 2020, to March 10, 2020, and April 21, 2020, to June 30, 2020) with the lockdown period (March 11, 2020, to April 20, 2020). Data are displayed in the order lockdown versus nonlockdown period. Bystander cardiopulmonary resuscitation rates did not differ in the 2 periods (99% versus 92%; P=0.07). Bystander defibrillation (9% versus 14%; P=0.4) or return-of-spontaneous circulation (23% versus 23%; P=1.0) also did not differ. A similar amount of citizen responders accepted alarms during the lockdown (6 per alarm; interquartile range, 6) compared with the nonlockdown period (5 per alarm; interquartile range, 5) (P=0.05). More citizen responders reported performing chest-compression-only cardiopulmonary resuscitation during lockdown compared with nonlockdown (79% versus 59%; P=0.0029), whereas fewer performed standardized cardiopulmonary resuscitation, including ventilations (19% versus 38%; P=0.0061). Finally, during lockdown, more citizen responders reported being not psychologically affected by attending an OHCA compared with nonlockdown period (68% versus 56%; P<0.0001). Likewise, fewer reported being mildly affected during lockdown (26%) compared with nonlockdown (35%) (P=0.003). Conclusions The COVID-19 lockdown in Denmark was not associated with decreased bystander-initiated resuscitation in OHCAs attended by citizen responders.