Objective: To describe differences in patient characteristics and case management between patients attended in emergency departments (EDs) with confirmed diagnoses of chronic obstructive pulmonary disease (COPD) vs those with respiratory symptoms in whom COPD is suspected.
Methods: Prospective multicenter observational study of patients registered in a multipurpose database between November 14, 2022, and May 14, 2023, in 14 emergency departments in the public hospital system of Castile-Leon. We included patients aged 40 years or older with confirmed COPD or suspected COPD. Variables analyzed were patient characteristics, clinical presentation, and management of the emergency episode.
Results: Of a total of 1179 patients, 931 (78.9%) had diagnosed COPD and 248 (21.1%) had suspected COPD. The median (interquartile range) age was 76 years (68-83 years) and 305 (25.87%) were women. Variables related to suspected COPD were age between 40 and 65 years (odds ratio [OR], 0.46; 95% CI, 0.26-0.65) and female sex (OR,0.57; 95% CI, 0.42-0.77). Patients with diagnosed COPD had higher Charlson comorbidity scores (OR, 1.93; 95% CI,1.42-2.63), and more of them were using inhalers (OR, 3.43; 95% CI, 2.57-4.61). Admission to a respiratory care ward (OR, 1.39; 95% CI, 1.97-3.01) and need for noninvasive mechanical ventilation (OR, 3.21; 95% CI, 1.27-10.71) were more common in patients with diagnosed COPD. However, no differences were observed in the frequency of hospitalization overall or 30-day mortality.
Conclusions: Clinical characteristics and management of emergency care differ between patients with confirmed vs suspected COPD. Patients with suspected COPD had more limited access to certain diagnostic, therapeutic, and follow-up resources.
Objective: To identify clinical and sociodemographic characteristics of frequent use of emergency departments by persons of advanced age.
Methods: Nested case-control study in a cohort of patients aged 75 years or older attending 3 hospital emergency departments (EDs) in Paris between January 1, 2018, and December 31, 2019. The index date was defined by the last visit during the study period. Frequency was defined as making 4 or more visits to an ED during the year prior to the index date. Controls were patients who visited an ED fewer than 4 times. We first analyzed sociodemographic factors related to frequent use and then randomly selected a convenience sample of 300 patients (150 frequent users and 150 in the non-frequent users) stratified by hospital. In this sample we analyzed clinical factors associated with frequent use. The statistical analysis included multivariate logistical regression models.
Results: A total of 29 009 patients of advanced age visited the 3 EDs; 1241 (4.3%; 95% CI, 4.1%-4.5%) were frequent users in the year prior to their index date. Independent factors associated with frequent visiting were older age (odds ratio [OR], 1.03; 95% CI, 1.02-1.04); male sex (OR, 1.15; 95% CI, 1.02-1.29); the presence of comorbidities, eg, a history of falls (OR, 2.42; 95% CI, 1.27-4.70), stroke (OR, 4.07 (95% CI, 1.84-9.69), or cognitive decline (OR, 2.53; 95% CI, 1.20-5.45); loss of autonomy (OR, 2.70; 95% CI, 1.38-5.41); and medications, eg, diuretics (OR, 2.10; 95% CI, 1.09-4.11) or benzodiazepines (OR, 2.27; 95% CI, 1.07-5.00).
Conclusions: Frail elderly patients with more comorbid conditions are at higher risk for frequent use of emergency departments. These patients should be identified early so that management of their conditions can be adjusted.
Objective: Paracetamol poisoning can be serious and require treatment with N-acetylcysteine (NAC). A dose of 300 mg/kg is usually given in 3 fractions over 21 hours. An alternative regimen, the Scottish and Newcastle Acetylcysteine Protocol (SNAP), specifies the same total dose given in 2 intravenous injections over 12 hours. This study aimed to compare the 2 regimens in terms of effectiveness, adverse events, and lengths of emergency department (ED) and hospital stays.
Methods: Prospective multicenter study to compare outcomes associated with the traditional NAC regimen vs SNAP. We enrolled all patients with paracetamol poisoning requiring NAC treatment in the participating hospital EDs from 2021 through 2023. Data related to referrals, poisoning episodes, and discharge destinations were collected. Patients were studied in 2 groups according to the protocol assigned in the EDs.
Results: A total of 165 patients were treated (SNAP, 103; traditional protocol, 62). The mean (SD) age was 28.1 (19.7) years, and most were female (70.5%). No differences in peak transaminase levels were observed. SNAP-treated patients had significantly fewer adverse effects as well as shorter stays both in the ED (17.8 [15.2] hours vs 25.9 [17.1] hours; P = .001) and on the ward (2.6 [2.3] days vs 4.4 [3.6] days; P = .019).
Conclusions: Fewer adverse events occurred with the SNAP approach. The 2 protocols were similarly effective. The SNAP-treated patients spent less time in the ED, and those who were admitted to hospital had shorter stays.
Objective: To develop a scale to predict refractory septic shock (SS) based on clinical variables recorded during initial evaluations of patients.
Methods: Multicenter retrospective study of data for patients with suspected infection registered in the Marketplace for Medical Information in Intensive Care (MIMIC-IV). These data were used for the development and internal validation of the refractory SS scale (RSSS). For external validation, we used retrospective data for 2 cohorts: 1) patients diagnosed with SS in an emergency department (ED cohort) whose data were registered in a Korean SS registry, and 2) patients diagnosed with SS in 6 hospital intensive care units (ICU cohort). A machine-learning automatic clinical scoring system (AutoScore) was used in the development phase. The performance of the RSSS in the validation cohorts was assessed with the area under the receiver operating characteristic curve (AUROC) for each. The primary outcome was the development of refractory SS within 24 hours of ICU admission. Refractory SS was defined by the need for a norepinephrine-equivalent dose greater than 0.5 µg/kg/min.
Results: We collected data for 29 618 patients from the MIMIC-IV registry, 3113 patients for the ED cohort, and 1015 for the ICU cohort. The RSSS had 6 predictors: serum lactate level, systolic blood pressure, heart rate, temperature, arterial pH, and leukocyte count. The scale's AUROCs were as follows: 0.873 (95% CI, 0.846-0.900) in the internal validation, 0.705 (95% CI, 0.678-0.733) in the ED cohort on arrival, 0.781 (95% CI, 0.757-0.805) in the ED cohort at the moment of diagnosing hypoperfusion or hypotension, and 0.822 (95% CI, 0.787-0.857) in the ICU cohort. Calibration was acceptable in all the cohorts.
Conclusions: The RSSS had adequate diagnostic accuracy in multiple cohorts of patients diagnosed in the ED and ICU.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：