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1.
Can J Surg ; 63(5): E435-E441, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009902

RESUMO

BACKGROUND: Most of the literature on emergency general surgery (EGS) has investigated appendiceal and biliary disease; however, EGS surgeons manage many other complex conditions. This study aimed to describe the operative burden of these conditions throughout Canada. METHODS: This multicentre retrospective cohort study evaluated EGS patients at 7 centres across Canada in 2014. Adult patients (aged ≥ 18 yr) undergoing nonelective operative interventions for nonbiliary, nonappendiceal diseases were included. Data collected included information on patients' demographic characteristics, diagnosis, procedure details, complications and hospital length of stay. Logistic regression was used to identify predictors of morbidity and mortality. RESULTS: A total of 2595 patients were included, with a median age of 60 years (interquartile range 46-73 yr). The most common principal diagnoses were small bowel obstruction (16%), hernia (15%), malignancy (11%) and perianal disease (9%). The most commonly performed procedures were bowel resection (30%), hernia repair (15%), adhesiolysis (11%) and débridement of skin and soft tissue infections (10%). A total of 47% of cases were completed overnight (between 5 pm and 8 am). The overall inhospital mortality rate was 8%. Thirty-three percent of patients had a complication, with independent predictors including increasing age (p = 0.001), increasing American Society of Anesthesiologists score (p = 0.02) and transfer from another centre (p = 0.001). CONCLUSION: This study characterizes the epidemiology of nonbiliary, nonappendiceal EGS operative interventions across Canada. Canadian surgeons are performing a large volume of EGS, and conditions treated by EGS services are associated with a substantial risk of morbidity and mortality. Results of this study will be used to guide future research efforts and set benchmarks for quality improvement.


Assuntos
Tratamento de Emergência/estatística & dados numéricos , Cirurgia Geral/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Idoso , Benchmarking , Canadá , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/efeitos adversos , Feminino , Cirurgia Geral/organização & administração , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Padrões de Prática Médica/organização & administração , Melhoria de Qualidade , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Resultado do Tratamento
4.
Afr J Prim Health Care Fam Med ; 12(1): e1-e5, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-33054265

RESUMO

The COVID-19 global pandemic forced healthcare facilities to put special isolation measures in place to limit nosocomial transmission. Cohorting is such a measure and refers to placing infected patients (or under investigation) together in a designated area. This report describes the physical reorganisation of the emergency centre at Khayelitsha Hospital, a district level hospital in Cape Town, South Africa in preparation to the COVID-19 pandemic. The preparation included the identification of a person under investigation (PUI) room, converting short stay wards into COVID-19 isolation areas, and relocating the paediatric section to an area outside the emergency centre. Finally, we had to divide the emergency centre into a respiratory and non-respiratory side by utilising part of the hospital's main reception. We are positive that the preparation and reorganization of the emergency centre will limit nosocomial transmission during the expected COVID-19 surge. Our experience in adapting to COVID-19 may have useful implications for ECs throughout South Africa and in low-and-middle income countries that are preparing for this pandemic.


Assuntos
Infecções por Coronavirus , Serviço Hospitalar de Emergência/organização & administração , Instalações de Saúde , Hospitais de Distrito , Controle de Infecções/métodos , Pandemias , Pneumonia Viral , Betacoronavirus , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Emergências , Tratamento de Emergência , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , África do Sul
5.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(9): 1025-1028, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33081885

RESUMO

With the development of society and economy, the disease spectrum of Chinese residents has undergone a major change, and the public health emergencies have occasionally occurred. The new situation has put forward higher requirements on the emergency capacity, professional technical level and treatment quality of critical care treatment system. Combining with the advantages of hospital aviation, ground and Internet emergency, Henan Provincial People's Hospital established a new construction path of emergency and critical care treatment system, namely "trinity" rescue system of aviation, ground and Internet emergency treatment and the "five-ring" model of critical care treatment system in hospital. The purpose of this paper is to summarize the practical experience of the construction of emergency and critical care system in Henan Provincial People's Hospital, so as to provide reference for the management of emergency and critical care in China.


Assuntos
Aviação , Tratamento de Emergência , China , Emergências , Humanos , Internet
6.
Discov Med ; 29(158): 201-209, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33007195

RESUMO

Sepsis is an important disorder in intensive care medicine, and the emphasis is not on infections but the imbalance in body reactions and life-threatening organ dysfunction. The infection, the imbalance in the body's reaction, and the deadly organ dysfunction are three aspects of sepsis. Currently, there is still a debate on suitable criteria for the diagnosis of patients with sepsis with continuing changes in the guidelines on sepsis management. Here we summarize recent advances on the definitions, diagnosis, and treatment in the clinical practice of sepsis management in the emergency department. We also highlight future research directions on sepsis. In particular, given the global outbreak of coronavirus disease 2019 (COVID-19), we briefly describe the relationship between COVID-19 and sepsis. How to manage sepsis caused by emerging pathogens such as COVID-19 is a new challenge for care professionals in the emergency department.


Assuntos
Betacoronavirus/patogenicidade , Doenças Transmissíveis Emergentes/terapia , Infecções por Coronavirus/terapia , Tratamento de Emergência/métodos , Pneumonia Viral/terapia , Sepse/terapia , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Doenças Transmissíveis Emergentes/complicações , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/organização & administração , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Sepse/diagnóstico , Sepse/virologia , Índice de Gravidade de Doença
7.
Indian J Ophthalmol ; 68(11): 2483-2485, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33120648

RESUMO

As the COVID-19 pandemic rages on, India is recording a very high number of new cases daily; even as the country prepares to gradually "unlock", after months of lockdown. While elective eye surgeries such as uncomplicated cataract surgeries, blepharoplasty and eyelid procedures and refractive surgeries can be planned at a later date; emergency cases pertaining to ocular trauma cannot be deferred. This manuscript gives a brief overview of the general guidelines for the management of ocular trauma during the COVID-19 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Traumatismos Oculares/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/normas , Pandemias , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/transmissão , Tratamento de Emergência , Humanos , Índia/epidemiologia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/transmissão , Dispositivos de Proteção Respiratória , Ferimentos não Penetrantes/cirurgia
9.
G Ital Med Lav Ergon ; 42(3): 187-194, 2020 09.
Artigo em Italiano | MEDLINE | ID: mdl-33119979

RESUMO

SUMMARY: Background. In December 2019, a Coronavirus 2019 epidemic (COVID-19) was reported, caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which occurred in the city of Wuhan, Hubei province, China. Perceived risk of contracting diseases has led many Governments and Healthcare Organizations to implement a variety of control and protection measures for the population, in particular for health professionals who have made contact with positive Covid-19 patients. In this publication, we have carried out a review of the information available, in order to share the prevention and protection measures for health and safety at work, which a University Hospital of Pavia, in Northern Italy, has remodulated, according to the changed scenario in which professionals finds themselves carrying out their profession in the post lockdown, in account to the specificity of processes and methods of work organizing, which overall, they serve to characterize risks, in order to be able to prevent them in the best possible way for patients, visitors and healthcare professionals.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Tratamento de Emergência , Pessoal de Saúde , Hospitais Universitários , Doenças Profissionais/prevenção & controle , Doenças Profissionais/virologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/terapia , Humanos , Itália , Pneumonia Viral/terapia
10.
Ann Surg ; 272(4): 548-553, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32932304

RESUMO

OBJECTIVE: Patients may call urgent care centers (UCCs) with urgent surgical conditions but may not be properly referred to a higher level of care. This study aims to characterize how UCCs manage Medicaid and privately insured patients who present with an emergent condition. METHODS: Using a standardized script, we called 1245 randomly selected UCCs in 50 states on 2 occasions. Investigators posed as either a Medicaid or a privately-insured patient with symptoms of an incarcerated inguinal hernia. Rates of direct emergency department (ED) referral were compared between insurance types. RESULTS: A total of 1223 (98.2%) UCCs accepted private insurance and 981 (78.8%) accepted Medicaid. At the 971 (78.0%) UCCs that accepted both insurance types, direct-to-ED referral rates for private and Medicaid patients were 27.9% and 33.8%, respectively. Medicaid patients were significantly more likely than private patients to be referred to the ED [odds ratio (OR) 1.32, 95% confidence interval (CI) 1.09-1.60]. Private patients who were triaged by a clinician compared to nonclinician staff were over 6 times more likely to be referred to the ED (OR 6.46, 95% CI 4.63-9.01). Medicaid patients were nearly 9 times more likely to have an ED referral when triaged by a clinician (OR 8.72, 95% CI 6.19-12.29). CONCLUSIONS: Only one-third of UCCs across the United States referred an apparent emergent surgical case to the ED, potentially delaying care. Medicaid patients were more likely to be referred directly to the ED versus privately insured patients. All patients triaged by clinicians were significantly more likely to be referred to the ED; however, the disparity between private and Medicaid patients remained.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Cobertura do Seguro , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Humanos , Medicaid , Estados Unidos
11.
J Hand Surg Am ; 45(9): 869-875, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32888437

RESUMO

The case spectrum in hand surgery is one of extremes-purely elective day surgery cases under local anesthesia to mangling limb injuries that require immediate, and frequently, lengthy, surgery. Despite the cancellation of most elective orthopedic and plastic surgical procedures, hand surgeons around the world continue to see a steady stream of limb-threatening cases such as severe trauma and infections that require emergent surgical care. With the increase in community-spread, an increasing number of COVID-19-infected patients may be asymptomatic or have mild, nonspecific or atypical symptoms. Some of them may already have an ongoing, severe infection. The time-sensitive nature of some of these cases means that hand surgeons may need to operate urgently on patients who may be suspected of COVID-19 infections, often before confirmatory test results are available. General guidelines for perioperative care of the COVID-19-positive patient have been published. However, our practices differ from those of general orthopedic and plastic surgery, primarily because of the focus on trauma. This article discusses the perioperative and technical considerations that are essential to manage the COVID-19 patient requiring emergency care, without compromising clinical outcomes and while ensuring the safety of the attending staff.


Assuntos
Amputação Traumática/cirurgia , Betacoronavirus , Infecções por Coronavirus , Traumatismos dos Dedos/cirurgia , Microcirurgia/métodos , Pandemias , Pneumonia Viral , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Tratamento de Emergência , Humanos , Masculino
12.
Hand Surg Rehabil ; 39(5): 459-461, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32777488

RESUMO

The recent coronavirus outbreak has tested the adaptability, cooperation and organizational capabilities of our healthcare systems. Restrictions were implemented in several countries to reduce virus transmission whilst emergency departments (ED) were overwhelmed and there was shortage of healthcare providers. Given this situation and the consequences of hand injuries, we studied the epidemiology of hand injuries in an accredited FESSH emergency center during the lockdown in France (March 17 to May 10, 2020) due to the coronavirus outbreak. During this period, 1947 patients consulted for a hand injury. We found high percentages of men (63%), open wounds (70%), domestic accidents (88%) and surgical treatment being required (76%). There was a significant decrease in admissions and consultations relative to the same period in 2019. This reference data can help healthcare systems prepare for future outbreaks and similar restrictions.


Assuntos
Infecções por Coronavirus/epidemiologia , Tratamento de Emergência/estatística & dados numéricos , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/cirurgia , Pneumonia Viral/epidemiologia , Quarentena , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Espanha/epidemiologia , Adulto Jovem
13.
Aging (Albany NY) ; 12(15): 15771-15783, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32805726

RESUMO

During the COVID-19 outbreak, some patients with COVID-19 pneumonia also suffered from acute abdomen requiring surgical treatment; however, there is no consensus for the treatment of such patients. In this study, we retrospectively reviewed 34 patients with acute abdomen who underwent emergency surgery during the COVID-19 outbreak. Among the 34 patients with acute abdomen, a total of six cases were found with COVID-19 pneumonia (clinical classification for COVID-19 pneumonia: all were the common type). On the premise of similar demographics between both groups, patients with COVID-19 pneumonia had worse indicators of liver and coagulation function. Compared with acute abdomen patients without COVID-19, patients with COVID-19 pneumonia had a longer hospital stay, but there were no significant differences in postsurgical complications (P = 0.58) or clinical outcomes (P = 0.56). In addition, an obvious resolution of lung inflammation after surgery was observed in five COVID-19 patients (83.3%). No new COVID-19 cases occurred during the patients' hospital stays. Therefore, for the common type of COVID-19 pneumonia, emergency surgery could not only improve the outcomes of COVID-19 pneumonia patients with acute abdomen, but also benefit the resolution of pulmonary inflammation.


Assuntos
Abdome Agudo , Infecções por Coronavirus , Tratamento de Emergência , Gastroenteropatias , Pandemias , Pneumonia Viral , Procedimentos Cirúrgicos Operatórios , Abdome Agudo/diagnóstico , Abdome Agudo/epidemiologia , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Idoso , Betacoronavirus/isolamento & purificação , Testes de Coagulação Sanguínea/métodos , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Tratamento de Emergência/métodos , Tratamento de Emergência/estatística & dados numéricos , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/fisiopatologia , Humanos , Tempo de Internação/estatística & dados numéricos , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/tendências
14.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(4): 715-718, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32773808

RESUMO

OBJECTIVE: To select and define the clinical questions and outcomes of Guideline for the Emergency Treatment of Anaphylaxis. METHODS: A draft including clinical questions, which could be divided into foreground questions and background questions, and outcomes was drawn and revised by the secretary group for the guideline referring to the present guidelines with the guidance of a panel consisting of 7 experienced clinical medicine, pharmacy and nursing experts. Foreground questions and outcomes of the draft were voted into a final version after three rounds of counsels of 22 experienced medicine, pharmacy and nursing clinical experts using Delphi method including 3 rounds of inquiry. And the background questions were directly included in the guideline after the 22 experts' thorough revising. The research was carried out under the supervision of method ologists. Active coefficient, coefficient of variation and the frequencies of each score were calculated for quality control. RESULTS: The draft of 34 foreground questions, 6 background questions and 6 outcomes was finally drawn up after thorough selecting and consulting. The 6 background questions revised by the clinical experts were all included. After three rounds of Delphi method, 28 pivotal clinical questions covering the diagnosis, preparation for the treatment, treatment and administration after the treatment, and 6 outcomes were defined and included for the guideline. The rest of the foreground questions, 4 of which were recognized as essential and 2 as important, were excluded from the guideline and left for further revising or updating. As for the outcomes, 4 of them were recognized as critical and the rest as important. The experts contributing to the research were active as the active coefficient reached 100%, and the degree of consensus was fine as the frequencies of the feedback scoring equal to or greater than 4 for all the 28 foreground questions included were greater than 75% and the result was settled in the first round. And 2 outcomes, fatality rate and severity, reached a higher degree of consensus with coefficient of variation less than 15%. CONCLUSION: After thorough and rigorous selecting, the clinical questions and outcomes to be included in the Guideline for the Emergency Treatment of Anaphylaxis were finally selected and defined via Delphi method, guiding the future development of the guidelines.


Assuntos
Anafilaxia , Anafilaxia/terapia , Consenso , Técnica Delfos , Tratamento de Emergência , Humanos , Projetos de Pesquisa
15.
PLoS One ; 15(8): e0237604, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790732

RESUMO

This study investigated the efficiency of a portable nitric oxide (NO) inhalation device through optimizing its design and structure. The portable rescue device could be used in clinical applications in outbreaks of viral pneumonia such as SARS. To reduce energy consumption for battery-powered portable usage, NO micro-channel plasma reactions induced by a continuous discharge arc were employed. A single-use airway tube could be combined with an intubation tube in clinical applications. In the experiment, a switching transistor controlled high frequency DC (12.5 kHz) was used to create a continuous discharge arc between two stainless steel electrodes (1-mm separation) after high-voltage breakthrough. A rotate instrument was employed to change the direction angle between the airflow and discharge arc, tube filled with Calcium hydroxide connected with gas outlet for reducing NO2, gas flow rate and input voltage were evaluated separately with concentration of NO and NO2/NO ratio. Results showed that a 2 L/min air flow direction from the cathode to the anode of electrodes (direction angle was zero) under 4 V input voltages produced 32.5±3.8 ppm NO, and the NO2/NO ratio reduced to less than 10%, stable output of nitric oxide might be convenient and effective for NO inhalation therapy. Modularization of the design produced a portable NO inhalation device that has potential for use in clinical applications as it is low cost, easy to disinfect, consumes low levels of energy and is ready to use.


Assuntos
Tratamento de Emergência/instrumentação , Desenho de Equipamento , Óxido Nítrico/metabolismo , Gases em Plasma/química , Pneumonia Viral/terapia , Terapia Respiratória/instrumentação , Ventiladores Mecânicos , Administração por Inalação , Tratamento de Emergência/métodos , Humanos , Óxido Nítrico/administração & dosagem , Terapia Respiratória/métodos
16.
J Obstet Gynaecol Can ; 42(8): 1017-1020, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32736852

RESUMO

Health care team training and simulation-based education are important for preparing obstetrical services to meet the challenges of the COVID-19 pandemic. Priorities for training are identified in two key areas. First, the impact of infection prevention and control protocols on processes of care (e.g., appropriate and correct use of personal protective equipment, patient transport, preparation for emergency cesarean delivery with the potential for emergency intubation, management of simultaneous obstetric emergencies, delivery in alternate locations in the hospital, potential for increased decision-to-delivery intervals, and communication with patients). And second, the effects of COVID-19 pathophysiology on obstetrical patients (e.g., testing and diagnosis, best use of modified obstetric early warning systems, approach to maternal respiratory compromise, collaboration with critical care teams, and potential need for cardiopulmonary resuscitation). However, such training is more challenging during the COVID-19 pandemic because of the requirements for social distancing. This article outlines strategies (spatial, temporal, video-recording, video-conferencing, and virtual) to effectively engage in health care team training and simulation-based education while maintaining social distancing during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Parto Obstétrico , Controle de Infecções/métodos , Obstetrícia , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Treinamento por Simulação , Desenvolvimento de Pessoal/métodos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Parto Obstétrico/educação , Parto Obstétrico/métodos , Tratamento de Emergência/métodos , Feminino , Humanos , Práticas Interdisciplinares/métodos , Obstetrícia/educação , Obstetrícia/métodos , Pandemias/prevenção & controle , Simulação de Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração
18.
Rev. esp. quimioter ; 33(4): 267-273, ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192949

RESUMO

OBJETIVO: Identificar qué biomarcadores realizados en la primera analítica de urgencias ayudan a estratificar según riesgo de mortalidad a pacientes COVID 19. MÉTODO: Estudio observacional descriptivo y transversal realizado con datos recogidos de los pacientes con sospecha de COVID-19 en el Servicio de Urgencias del 24 de febrero al 16 de marzo del 2020. Se realizó el estudio univariante y multivariante para encontrar los marcadores independientes de mortalidad y calcular el riesgo mediante la construcción de una escala de gravedad. RESULTADOS: Se incluyeron 163 pacientes de los que fallecieron 33 y 29 de ellos resultaron positivos para la prueba PCR COVID-19. Obtuvimos como posibles factores para conformar el score de riesgo de mortalidad edad>75 años ((OR ajustada=12,347, IC95%: 4,138-36,845 p = 0.001), leucocitos totales> 11.000 cel/mm3 (OR ajustada=2,649, IC95%: 0,879-7,981 p = 0,083), glucosa> 126 mg/dL (OR ajustada=3,716, IC95%: 1,247-11,074 p = 0,018) y creatinina>1,1 mg/dL (OR ajustada= 2,566, IC95%: 0,889-7,403, p = 0,081). Este score se denominó COVEB (COVID, Edad, perfil Básico analítico) con un AUC 0,874 (IC95%: 0,816-0,933, p < 0.001; punto de corte= 1 (sensibilidad= 89,66% (IC95%: 72,6%-97,8%), especificidad= 75,59% (IC95%: 67,2%-82,8%). Un score < 1 posee un valor predictivo negativo = 100% (IC95%: 93,51%-100%) y un valor predictivo positivo = 18,59% (IC95%: 12,82%-25,59%). CONCLUSIONES: Las escalas clínicas de gravedad, los biomarcadores de función renal, los parámetros del recuento leucocitario, el ratio neutrófilos totales/linfocitos y procalcitonina son factores de riesgo tempranos de mortalidad. Destacan las variables edad, glucosa, creatinina y leucocitos totales como mejores predictores de mortalidad. Un score COVEB< 1 indica con un 100% de probabilidad, que el paciente con sospecha de COVID-19 no va a fallecer en los próximos 30 días


OBJECTIVE: Identify which biomarkers performed in the first emergency analysis help to stratify COVID-19 patients according to mortality risk. METHOD: Observational, descriptive and cross-sectional study performed with data collected from patients with suspected COVID-19 in the Emergency Department from February 24 to March 16, 2020. The univariate and multivariate study was performed to find independent mortality markers and calculate risk by building a severity score. RESULTS: A total of 163 patients were included, of whom 33 died and 29 of them were positive for the COVID-19 PCR test. We obtained as possible factors to conform the Mortality Risk Score age> 75 years ((adjusted OR = 12,347, 95% CI: 4,138-36,845 p = 0.001), total leukocytes> 11,000 cells / mm3 (adjusted OR = 2,649, 95% CI: 0.879-7.981 p = 0.083), glucose> 126 mg / dL (adjusted OR = 3.716, 95% CI: 1.247-11.074 p = 0.018) and creatinine> 1.1 mg / dL (adjusted OR = 2.566, 95% CI: 0.889- 7.403, p = 0.081) This score was called COVEB (COVID, Age, Basic analytical profile) with an AUC 0.874 (95% CI: 0.816-0.933, p <0.001; Cut-off point = 1 (sensitivity = 89.66 % (95% CI: 72.6% -97.8%), specificity = 75.59% (95% CI: 67.2% -82.8%). A score <1 has a negative predictive value = 100% (95% CI: 93.51% -100%) and a positive predictive value = 18.59% (95% CI: 12.82% -25.59%). CONCLUSIONS: Clinical severity scales, kidney function biomarkers, white blood cell count parameters, the total neutrophils / total lymphocytes ratio and procalcitonin are early risk factors for mortality. The variables age, glucose, creatinine and total leukocytes stand out as the best predictors of mortality. A COVEB score <1 indicates with a 100% probability that the patient with suspected COVID-19 will not die in the next 30 days


Assuntos
Humanos , Infecções por Coronavirus/mortalidade , Biomarcadores/análise , Tratamento de Emergência/métodos , Risco Ajustado/métodos , Indicadores de Morbimortalidade , Infecções por Coronavirus/diagnóstico , Prognóstico , Índice de Gravidade de Doença , Estudos Transversais , Testes de Função Renal/estatística & dados numéricos , Fatores de Risco , Reação em Cadeia da Polimerase/estatística & dados numéricos
19.
Rev. esp. quimioter ; 33(4): 274-277, ago. 2020. graf
Artigo em Inglês | IBECS | ID: ibc-192950

RESUMO

INTRODUCTION: Changes in Public Health recommendations may have changed the number of emergency visits and COVID-19 diagnosed cases in an Emergency Department in Madrid. MATERIAL AND METHODS: This retrospective case series study included all consecutive patients in a tertiary and urban ED in Madrid from 1st to 31st March. The sample was divided: NonCOVID-19, Non-investigated COVID-19, Possible COVID-19, Probable COVID-19, Confirmed COVID-19. Differences between public health periods were tested by ANOVA for each cohort, and by ANCOVA including the number of PCR tests (%) as covariate. RESULTS: A total of 7,163 (4,071 Non-COVID-19, 563 Non-investigated COVID-19, 870 Possible, 648 Probable and 1,011 Confirmed COVID-19) cases were included. Public Health measurements applied during each period showed a clear effect on the case proportion for the five cohorts. CONCLUSION: The variability of case definitions and diagnostic test criteria may have impact on the number of emergency visits and COVID-19 diagnosed cases in Emergency Department


INTRODUCCIÓN: Los cambios en las recomendaciones de Salud Pública pueden haber modificado la cantidad de visitas y los casos diagnosticados por COVID-19 en un servicio de urgencias de Madrid. MATERIAL Y MÉTODOS: Estudio retrospectivo de series de casos que incluyó a todos los pacientes atendidos de manera consecutiva en un servicio de urgencias terciario y urbano en Madrid, del 1 al 31 de marzo. La muestra se dividió: no COVID-19, COVID-19 no investigado, COVID-19 posible, COVID-19 probable, COVID-19 confirmado. Las diferencias entre los diferentes periodos establecidos por Salud Pública se evaluaron por el test de ANOVA para cada cohorte, incluyendo el número porcentual de test de PCR como covariable. RESULTADOS: Se incluyeron un total de 7.163 casos (4.071 no COVID-19, 563 COVID-19 no investigados, 870 posibles, 648 probables y 1.011 confirmados COVID-19). Las medidas de Salud Pública aplicadas durante cada período mostraron un claro efecto en la proporción de casos para las cinco cohortes. CONCLUSIÓN: La variabilidad de las definiciones de casos y los criterios de las pruebas de diagnóstico pueden tener un impacto en la cantidad de visitas a urgencias y en los casos diagnosticados de COVID-19 en el servicio de Urgencias


Assuntos
Humanos , Atenção à Saúde , Pacotes de Assistência ao Paciente/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Síndrome Respiratória Aguda Grave/diagnóstico , Vírus da SARS/isolamento & purificação , Espanha/epidemiologia , Avaliação do Impacto na Saúde/métodos , Vírus da SARS/patogenicidade , Tratamento de Emergência/métodos , Estudos Retrospectivos , Reação em Cadeia da Polimerase/estatística & dados numéricos
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