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

Objective: To evaluate agreement between risk-assessment models for venous thromboembolism (VTE) in patients hospitalized for medical conditions and to analyze variables associated with the decision to prescribe pharmacological thromboprophylaxis in hospital emergency departments (EDs). Conclusions.

Methods: Prospective observational multicenter cohort study. We included adults attended in 15 hospital EDs who were hospitalized for medical conditions, calculating VTE risk according to the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score, the Padua Prediction Score (PPS), and the National Institute for Health and Care Excellence (NICE) score. In addition to assessing interscore concordance, we analyzed variables associated with the prescription of thromboprophylaxis in the ED.

Results: A total of 1203 patients were included. The PADUA, IMPROVE, and NICE scales assigned high risk scores for 68.7%, 47.4%, and 69.5% of the patients, respectively. The κ statistic for agreement between the PADUA and NICE scores was 0.80 (95% CI, 0.76-0.84); 102 patients (8.5%) had discordant scores. The κ statistics for agreement between the IMPROVE score and the PADUA and NICE classifications were 0.47 (95% CI, 0.43-0.52) and 0.37 (95% CI, 0.33-0.42), respectively; 322 (26.8%) and 384 patients (31.9%), respectively, had discordant scores. Variables associated with starting thromboprophylaxis in the ED were a diagnosis of acute myocardial infarction or stroke (adjusted odds ratio [aOR], 4.26), immobility in the last 2 months (aOR, 2.19), chronic obstructive pulmonary disease (aOR, 1.97), ischemic heart disease (aOR, 1.51), reduced mobility of 3 days or longer (aOR, 1.14), body mass index (aOR, 1.04), age (aOR, 1.02), recent trauma or surgery (aOR, 0.40), and risk for bleeding (aOR, 0.56).

Conclusions: There is disagreement among the recommended models for predicting risk for VTE in patients hospitalized for medical conditions. The basis for emergency physicians' clinical judgment regarding thromboprophylaxis extends beyond risk scales to include multiple risk factors for VTE and bleeding.

Objective: Objectives. To assess the impact of training for emergency department (ED) nurses on adequate thromboprophylaxis for patients admitted to hospital from the ED for medical conditions. Methods. Multicenter quasiexperimental pre-post study of an ED nurse training intervention in 8 hospitals. Patients were recruited from January 2022 through May 2023 in 3 phases: before nurse training, in the first month after training, and in the sixth month after training. Included were patients attended in the ED for medical conditions. Adequate thromboprophylaxis was defined as 1) use of prophylactic drugs in patients at high risk for venousthromboembolism according to the Padua Prediction Score (PPS), and 2) nonuse in patients at low risk. We compared the percentage of adequate prophylaxis in the first phase to the percentages in the second and third phases. Results. A total of 928 patients were included (326 in phase 1, 295 in phase 2, and 307 in phase 3). PPS scores indicated that 238 (73%) of the patients were at high risk in phase 1 vs 189 (64.1%, P = .016) in phase 2 and 207 (67.4%, P = .125) in phase 3. A total of 187 patients (57.4%, 95% CI, 51.8%-62.8%) were adequatelythromboprophylaxed in phase 1 vs 178 (60.%, 95% CI, 54.5%-66%) in phase 2 (absolute difference in proportions, 3.0% (95% CI, -4.8% to 10.6%; P = .462)]. In phase 3, 166 patients (54.1%, 95% CI, 48.3%-59.7%) received adequate prophylaxis (difference, -3.3% (95% CI, -11.0% to 4.4%; P = .405). Conclusions. A training intervention for ED nurses, implemented as an isolated strategy, had no impact on the adequacy of thromboprophylaxis in patients admitted from the ED for medical conditions.

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Objective: To present questions about poisoning to 4 artificial intelligence (AI) systems and 4 clinical toxicologists and determine whether readers can identify the source of the answers. To evaluate and compare text quality and level of knowledge found in the AI and toxicologists' responses.

Methods: Ten questions about toxicology were presented to the following AI systems: Copilot, Bard, Luzia, and ChatGPT. Four clinical toxicologists were asked to answer the same questions. Twenty-four recruited experts in toxicology were sent a pair of answers (1 from an AI system and one from a toxicologist) for each of the 10 questions. For each answer, the experts had to identify the source, evaluate text quality, and assess level of knowledge reflected. Quantitative variables were described as mean (SD) and qualitative ones as absolute frequency and proportion. A value of P .05 was considered significant in all comparisons.

Results: Of the 240 evaluated AI answers, the expert evaluators thought that 21 (8.8%) and 38 (15.8%), respectively, were certainly or probably written by a toxicologist. The experts were unable to guess the source of 13 (5.4%) AI answers. Luzia and ChatGPT were better able to mislead the experts than Bard (P = .036 and P = .041, respectively). Text quality was judged excellent in 38.8% of the AI answers. ChatGPT text quality was rated highest (61.3% excellent) vs Bard (34.4%), Luzia (31.7%), and Copilot (26.3%) (P .001, all comparisons). The average score for the level of knowledge perceived in the AI answers was 7.23 (1.57) out of 10. The highest average score was achieved by ChatGPT at 8.03 (1.26) vs Luzia (7.02 [1,63]), Bard (6.91 [1.64]), and Copilot (6.91 [1.46]) (P .001, all comparisons).

Conclusions: Luzia and ChatGPT answers to the toxicology questions were often thought to resemble those of clinical toxicologists. ChatGPT answers were judged to be very well-written and reflect a very high level of knowledge.

Objective: To estimate the association between disability and the demand for medical emergency care by citizens of Peru over the age of 18 years in 2019.

Methods: Cross-sectional analysis of secondary data from the national survey of budgeted programs (ENAPRES, in its Peruvian abbreviation) of 2019. Disabilities were surveyed based on the criteria of the Washington Group on Disability Statistics. Medical emergencies were queried using 2 questions referring to life-threatening situations. Sociodemographic covariables and variables related to certain medical emergencies were also analyzed as possible confounders. Poisson regression analysis was carried out and crude and adjusted prevalence ratios calculated. Calculations were performed on a complex sample of data from the ENAPRES 2019 survey.

Results: Data for 62 959 persons over the age of 18 years were included. Some type of disability was reported by 4.3% of the sample, and 8.7% reported a medical emergency during the past year. Persons with 3 or more disabilities were 2.97-fold more likely to have a medical emergency than persons without disabilities (prevalence ratio, 2.97 (95% CI, 2.28-3.87) after adjustment for multiple confounding variables.

Conclusions: Disabled persons were more likely to have medical emergencies than persons without disabilities in Peru in 2019. The likelihood of medical emergencies was slightly higher in those with 3 or more disabilities.

Text: The prevalence of active hepatitis C virus (HCV) infection is higher in hospital emergency departments (EDs) than in the general population. Numerous patients who seek emergency care are unaware that they have detectable viremia, yet they fall outside established ED protocols for HCV screening. Often they belong to groups with difficult access to health care who use the ED as their point of entry to the system. The aim of this consensus paper was to develop an approach to guide ED detection of HCV infection in all Spanish hospitals. Experts from the Spanish Society of Emergency Medicine (SEMES), the Spanish Association for Study of the Liver (AEEH), and the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) met to establish criteria to guide health care professionals' decisions. The experts' review of the literature and discussion in consensus-building meetings resulted in evidence-based recommendations that consider the following aspects: 1) the population to target for HCV screening in the ED, 2) how to inform patients of the process, 3) how to carry out HCV screening, 4) how to order an HCV test, and 5) additional issues such as bundling HCV with other viral tests for comprehensive diagnosis, recording results in medical records, and implementing ways to retain and follow all patients with positive results. This consensus report provides guidelines and tools to facilitate emergency physicians' work and ensure effective detection of HCV infections and subsequent incorporation of patients into the health care system.