Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias最新文献

Objective: To evaluate the diagnostic performance of two commercial artificial intelligence (AI) systems-ChestView for chest radiographs (CXR) and BoneView for bone radiographs (BXR)-in an emergency department (ED), and compare their validity with that of observers with different professional profiles and levels of experience: emergency physicians, radiology trainees, and expert radiologists.

Methods: We conducted a diagnostic test evaluation study on a random selection of 346 CXRs and 261 BXRs requested in the ED. Examinations were independently analysed by the AI systems and the various observers. The reference diagnosis (gold standard) was established by consensus among 3 radiologists, resorting to additional imaging tests or clinical information when necessary. Sensitivity, specificity, and positive and negative (NPV) predictive values were then calculated and compared.

Results: For CXRs, AI (ChestView) showed overall sensitivity (64.4%) significantly higher than that of emergency physicians (49.2%; P = .018), although lower than that of the expert radiologist (83.9%; P .001). Performance was notable for the detection of nodules/masses (sensitivity 80.0%) and pneumothorax (NPV, 99.7%), but lower for consolidations (sensitivity, 40.4%). For BXRs, AI (BoneView) achieved sensitivity for fracture detection (87.5%) higher than that of the expert radiologist (77.1%), with an NPV of 96.9%. However, its performance was lower for detecting dislocations (sensitivity 60.0%) and joint effusions (25.0%).

Conclusions: The evaluated AI systems demonstrate clinically relevant performance in the emergency setting, significantly enhancing the diagnostic capacity of emergency physicians. Their high sensitivity for fracture detection and high NPV for pulmonary nodules, pneumothorax, and fractures establish them as a high-impact safety tool.

Objective: Home hospitalization (HH) directly from the emergency department (ED) in patients requiring admission is, overall, a safe and effective alternative. However, in some cases, HH requires escalation of care, and the patient must be transferred to the hospital to complete treatment under conventional inpatient care. This study analyzes the factors associated with the need for such escalation in patients with acute heart failure (AHF).

Methods: Two hospitals reviewed patients with AHF admitted to HH over a 3-year period. Escalation of care was defined as transfer from HH to the hospital to complete inpatient treatment, regardless of cause. The association between escalation need and 24 baseline variables as well as 24 variables from the decompensation episode was evaluated, both crudely and in adjusted analyses. Variables significant in both models were included in a final global multivariable model.

Results: A total of 367 patients admitted to HH from the ED for AHF were analyzed (median age, 86 years; 53% women). Escalation of care occurred in 52 cases (14%). The only baseline variable independently and inversely associated with the need for escalation was admission to an HH unit where joint evaluation between HH and emergency professionals was conducted to assess HH eligibility. Among the decompensation episode variables, hyponatremia and creatinine > 1.3 mg/dL were directly associated with escalation. These three variables remained significant in the final global model, with adjusted ORs of 0.373 (95% CI, 0.193-0.731), 2.634 (95% CI, 1.196-5.798), and 3.507 (95% CI, 1.80-6.835), respectively.

Conclusions: The need for escalation in patients with AHF admitted to HH directly from the ED occurs in a moderate percentage of cases and is associated with renal impairment and hyponatremia at admission. Joint participation of HH and emergency professionals in the decision-making process for HH admission reduces the risk of treatment failure in these patients.

Objective: In 2022, a retrospective analysis was conducted in public hospitals in the Community of Madrid (Spain) without transplant programs. The aim was to evaluate the loss of potential donors with catastrophic brain injury.

Methods: We used clinical and administrative databases (CMBD, CORE-ONT, and HORUS). Deceased patients with compatible diagnoses according to ICD-10 were included, excluding those with active tumor disease. Relevant clinical variables were analyzed, and patients were categorized into 3 groups: evaluated as donors, ineligible as donors, and potential donors not evaluated. Statistical analysis included univariate techniques and a multivariate analysis using categorical principal components analysis (CATPCA).

Results: Out of 1,429 deceased patients, 12 evaluated donors, 39 ineligible donors due to medical criteria, and 33 potential donors who were not evaluated were identified. This last group represents a significant loss in donation potential. Most effective donors were patients younger than 70 years admitted to hospitals with neurosurgery, in intensive care units, with prolonged mechanical ventilation, and without severe organ failure. In contrast, non-donors presented higher rates of comorbidities such as septic shock or renal failure. Multivariate analysis via CATPCA identified a total of 3 patient patterns and highlighted a significant group of missed potential donors.

Conclusions: These findings reinforce the need to implement strategies to improve early donor detection, such as emergency department staff training, inter-hospital collaboration, and use of technological tools. The study concludes that a structured intervention could significantly reduce donor loss in non-transplant centers.

Text: For Emergency and Urgent Care Medicine (MUYE), July 2nd, 2024, will forever be remembered in Spanish health care as the date when the most anticipated and significant milestone was finally achieved-after an exceedingly long and arduous journey-with the publication of Royal Decree 610/2024, which established the title of Specialist Physician in Emergency and Urgent Care Medicine (MUYE). Currently, the specialty of MUYE is on the verge of the publication of an "SND Order" (a regulation issued by the Spanish Ministry of Health) that will define the final structure of the official training program (OTP) for MUYE, the evaluation criteria for physicians in training, and the accreditation requirements for the MUYE teaching units (TUs). In 2025, the National Commission for the Specialty (CNE) of MUYE prepared the OTP, which must be ratified by the Consejo Nacional de Especialidades en Ciencias de la Salud (CNECS). Without a doubt, this OTP represents an unprecedented, innovative, and highly significant framework, with distinctive features that set it apart from other specialty programs within the CNECS. The MUYE OTP must serve as the fundamental tool for training both competent and compassionate specialists, integrating professionalism, humanism, and excellence through the acquisition of the competencies, skills, knowledge, and experience necessary to complete the 4 years of specialized medical training. The objectives of this article are to present the most relevant, distinctive, and innovative aspects of the MUYE OTP (recently published as a Draft Order for public consultation by the Spanish Ministry of Health), including its competency areas-"transversal" (shared with all other specialties in Health Sciences), "common" (developed jointly by the Delegated Commission on Immediate Care for both Family and Community Medicine (MFyC) and MUYE), and "specific" (unique to MUYE); and the accreditation requirements for the TUs, which will comprise 3 key training settings representing the essential environments for the learning and professional development of MUYE specialists: the emergency department of the teaching reference hospital, the Emergency Medical Services (EMS), and the emergency department of the teaching hospital.