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OBJECTIVES: To develop a multidimensional score to assess risk of death for patients of advanced age 180 days after their admission to short-stay units (SSUs). MATERIAL AND METHODS: Prospective, multicenter, observational and analytical study of a cohort of patients aged 75 years or older who were admitted to 5 Spanish SSUs between February 1 and April 30, 2014. We recorded demographic and clinical data as well as geriatric assessment scores. A multilevel logistic regression model was developed to identify independent factors associated with 180-day mortality. The model was used to construct a scale for scoring risk. RESULTS: Data for 593 patients with a mean (SD) age of 83.4 (5.9) years entered the model; 359 (60.7%) were women. Ninety-two patients (15.5%) died within 180 days of SSU admission. Factors included in the final risk score were age over 85 years (1 point), male sex (1), loss of appetite or weight loss in the 3 months before admission (1), acute confusional state (2), functional dependence for basic activities of daily living at admission (2), and pressure ulcers (2). Low risk was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 9 points. Mortality rates at 180 days in these 3 risk groups were 5%, 18%, and 54%, respectively. The area under the receiver operating characteristic curve for the model after boots trapping was 0.72 (95% CI, 0.65-0.78). CONCLUSION: The SSU score could be useful for stratifying risk of death within 6 months of SSU admission of older patients, so that type of care can be tailored to risk.
OBJETIVO: Diseñar una escala de puntuación multidimensional con el fin de estratificar el riesgo de mortalidad a 180 días entre los ancianos ingresados en las unidades de corta estancia (UCE). METODO: Estudio analítico observacional de cohortes prospectivo multicéntrico que seleccionó todos los pacientes 75 años ingresados en 5 UCE españolas del 1 de febrero al 30 de abril de 2014. Se recogieron variables demográficas, clínicas y de la valoración geriátrica. Se derivó un modelo de regresión logística multinivel para identificar los factores independientemente asociados con la mortalidad a 180 días y después se construyó una escala de puntuación. RESULTADOS: Se incluyeron 593 pacientes (edad media 83,4 años, DE: 5,9; 359 mujeres, 60,7%), y 92 (15,5%) fallecieron a los 180 días. La escala de puntuación 6M UCE-SCORE incluyó la edad 85 años (1 punto), sexo varón (1 punto), presencia de pérdida de apetito o peso involuntaria en los últimos 3 meses (1 punto), síndrome confusional agudo (2 puntos), dependencia en las actividades básicas de la vida diaria al ingreso (2 puntos) y úlceras por presión (2 puntos). Se categorizó a los pacientes en bajo (0-2 puntos), intermedio (3-5 puntos) y alto (6-9 puntos) riesgo, con una mortalidad a 180 días de 5%, 18% y 54%, respectivamente. El ABC COR del modelo tras remuestreo fue de 0,72 (IC95%: 0,65-0,78). CONCLUSIONES: La escala de puntuación 6M UCE-SCORE podría ser de utilidad a la hora de estratificar el riesgo a 6 meses entre los ancianos ingresados en las UCE con el fin de diseñar un plan individualizado de cuidados.
Assuntos
Técnicas de Apoio para a Decisão , Mortalidade Hospitalar , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Unidades Hospitalares , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Estudos Prospectivos , Curva ROC , Medição de Risco , Fatores de Risco , EspanhaRESUMO
OBJECTIVES: To compare the efficiency of short-stay units (SSUs) managed by different departments within hospitals. MATERIAL AND METHODS: Cross-sectional study in 40 hospitals with SSUs. From June 1 to December 31, 2012,we gathered data on clinical caseloads and management. Variables directly related to efficiency were mean length of stay, bed rotation index, and weekend discharge rate. RESULTS: Forty SSUs were studied; 25 (62.5%) were managed by the hospital's emergency department (ED), 9 (22.5%) were managed by the internal medicine department (IMD), 5 (12.5%) were independent, and 1 was jointly managed by the hospital's ED and the IMD. A total of 45 140 patients were discharged from the SSUs. The most common diagnoses were exacerbation of chronic heart or respiratory disease, urinary tract infection, and respiratory infection. Age was the only variable that was related to the hospital department designated to manage these SSUs. The mean ages by management type were as follows: independent SSUs (75.6 years) vs ED-managed SSUs (67.2 years) vs IMD-managed SSUs (57.8 years) (P=.02). Group-by-group comparisons showed that the mean length of stay was shorter in ED-managed SSUs than in IMD-managed units (2.65 vs 3.73 respectively; P=.047), and overall mortality was lower in IMD-managed SSUs than in ED-managed SSUs (0.64% vs 3%; P=.033). However, unforeseen mortality (after excluding patients under palliative care or judged to be in the final hours of life) did not differ significantly between groups. CONCLUSION: We did not detect important differences between SSUs managed by different departments in the hospitals in this series. However, mean length of stay was found to be shorter in ED-managed SSUs than in IMD-managed units.
OBJETIVO: Comparar los resultados de gestión clínica de las unidades de corta estancia (UCE) según su dependencia funcional. METODO: Estudio de análisis transversal realizado en 40 hospitales con UCE (1 junio-31 diciembre 2012). Se recogieron datos de actividad y gestión clínica, considerando como variables directamente relacionadas con la eficiencia la estancia media, el índice de rotación por cama y el porcentaje de altas en fin de semana. RESULTADOS: Se analizaron 40 UCE, 25 (62,5%) dependientes del servicio de urgencias (UCEU), 9 (22,5%) de medicina interna (UCEMI), 5 (12,5%) independientes (UCEI) y 1 con dependencia mixta (UCEU + UCEMI). El número total de altas fue de 45.140. Los diagnósticos más frecuentes fueron la exacerbación de la patología crónica cardiaca y respiratoria, la infección urinaria y la respiratoria. En relación a su dependencia funcional no se observaron diferencias en los parámetros analizados intergrupos salvo en la edad media (UCEI 75,6 años vs UCEU 67,2 vs UCEMI 57,8; p = 0,02). Al realizar la comparación intragrupos, la estancia media fue menor en las UCEU que las UCEMI (2,65 días vs 3,73; p = 0,047) y la mortalidad global menor en las UCEMI que las UCEU (0,64% vs 3%; p = 0,033), pero sin diferencias al comparar la mortalidad no esperada una vez excluidos los pacientes paliativos y/o en situación de últimas horas. CONCLUSIONES: En la serie analizada no se observan diferencias destacables al comparar las UCE en conjunto según dependencia funcional. Sin embargo, en el análisis intragrupos las UCEU lograron menor estancia media que las UCEMI.
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INTRODUCTION: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in elderly patients. The short stay units can be an alternative for patients who need admission with acute illness. MATERIAL AND METHODS: Descriptive and retrospective study in an Short-Stay Unit (SSU) of a 900-bed tertiary-care teaching hospital in the metropolitan area of Barcelona, Spain. PERIOD: a total of 22 months from January 2004 to December 2006. PATIENTS: all patients ≥ 75 years admitted to EDSSU with a diagnosis of CAP. Data were collected for demographic variables, Pneumonia Severity Index score (PSI), microbiological findings, antibiotic treatment, length of stay, mortality rates and new admissions during the 30 days following discharge. RESULTS: 175 consecutive patients ≥ 75 years with pneumonia were admitted to the EDSSU. Mean age was 84.31 years (range 75-100, SD ± 5.76), 92 (52,5%) were men, with 24 being nursing home residents. According to the PSI, 64 cases (36.6%) were scored as III, 97 (55.4%) as IV and 14 (8%) as V. A positive microbiological result was obtained in 46 cases (26.2%). Length of stay on average was 3.29 days (range 1-10, SD ± 1.56) and 19 patients died (10.8%). Six (3.8%) attended the ED in the 30 days following discharge. CONCLUSIONS: In view of our experience, the EDSSU can be an alternative to standard inpatient for elderly patients with pneumonia in PSI risk class III and IV.