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

Objective: To evaluate the association between particulate matter concentration (PM10 and PM2.5) and the number of emergency department visits for exacerbation of chronic obstructive pulmonary disease (COPD) in a low-pollution area.

Methods: We conducted an ecological study based on emergency department visits for COPD exacerbations. A generalized additive model was used to estimate the relative risk and attributable fraction (AF), adjusting for weather variables. Pollution levels on the day of the visit and the 5 preceding days were considered to assess potential delayed effects of exposure.

Results: A total of 2,045 patients with 5,233 emergency department visits were included. A total of 79.1% of the patients were men. The mean age was 79.5 years (SD, 10.1). The mean concentration of PM2.5 and PM10 was 11.5 µg/m³ and 17.3 µg/m³, respectively. Both emergency visits and particulate matter concentrations showed a seasonalpattern. A significant association was found with exposure occurring 3 days prior (lag -3), with a 5.8% increase in visits for every 10 µg/m³ increase in PM2.5 (AF 5.45%) and a 3.3% increase for PM10 (AF 3.15%). Men and patients older than 75 years showed greater sensitivity to exposure. The impact of particulate matter was more pronounced during the summer months.

Conclusions: Exposure to PM2.5 and PM10 is associated with an increase in emergency department visits for COPD exacerbations, with a particular impact among men, patients older than 75 years, and during the summer season.

Objective: Design a risk model to predict adverse outcome (AO) 30 days after discharge in adult patients treated for acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) in emergency departments (EDs).

Methods: PREURG was a prospective, observational, multi-purpose, multicenter cohort registry. Phone calls were made as part of a 30-day follow-up. The main variable was the presence of any AO (recurrence of COPD AE, ED revisit, hospitalization, institutionalization, or death) 30 days after being discharge from the ED.

Results: The study included a total of 931 patients with COPD AE (23.4% women and 76.6% men) discharged from the ED with follow-up data; 322 (34.6%) had an AO 30 days after being discharge from the ED. The REPOCUR model included the variable sex (OR for men of 1.50 [95%CI, 1.06-2.15]), severe COPD AE type (OR, 3.15 [95%CI, 2.02-5.04]), $ 2 COPD AE/year (OR, 1.64 [95%CI, 1.20-2.24]), and $ 4 ED visits/year (OR, 2.15 [95%CI, 1.52-3.04]). Each item is worth 1 point. The risk of experiencing an AO at 30 days with a score of 1 is 22.5%; 35.0% with a score of 2; 50.0% with a score of 3; and 65.1% with a score of 4. The area under the curve is 0.67 (95%CI, 0.64-0.71).

Conclusions: The REPOCUR model could be a useful prognostic tool to identify adult patients with COPD AE and a high risk of exhibing AO at 30 days after being discharged from the emergency department.

Objective: To describe the microbiological isolates obtained from hematologic patients seen in the emergency department (ED) who had blood cultures requested and identify the risk factors associated with the isolation of multidrug-resistant bacteria (MDR).

Methods: We conducted a retrospective, observational, and descriptive study of all consecutive patients with hematologic malignancies who presented to the ED and had, at least, 1 blood culture requested within the first 72 hours following admission from January 2020 through March 2022. The decision on the number of blood cultures and other requested samples was made by the attending physician. A descriptive analysis was performed on the microbiological isolates from blood cultures and, when applicable, from other requested samples. A multivariate analysis was conducted to determine the variables associated with MDR isolation.

Results: A total of 679 ED visits were included. The median patient age was 66 years (IQR, 52-76), with lymphoma being the most prevalent hematologic disease (35.6%). A significant proportion of patients had prior hospitalizations (47%), were colonized by multidrug-resistant gram-negative bacilli (MDR-GNB) (14%), and/or were neutropenic (27%). In addition to blood cultures, at least, 1 more culture was requested in 556 visits, 202 of which had > 1 blood culture, resulting in a total of 1,751 microbiological cultures in the ED. Most samples came from blood (936; 53.5%), followed by urine (567; 32.4%), respiratory tract (88; 5%), and stool (88; 5%). A total of 211 (12.1%) cultures tested positive in 179 ED visits (26.4%). Of these, 99 (10.6%) blood cultures tested positive in 88 (13%) visits. Among patients with bacteremia, gram-negative bacilli (GNB) were the most common microorganisms (48%), with 12 (25%) categorized as MDR-GNB. Gram-positive microorganisms were documented in 47 (47%) episodes of bacteremia. MDR bacteria were isolated in 40 (5.9%) visits. A past medical history of MDR was associated with MDR isolation in the ED [OR, 4.13; 95%CI, 1.99-8.50].

Conclusions: The proportion of positive cultures and MDR isolates is relatively high in patients with hematologic malignancies presenting to the ED. A past medical history of MDR is an independent risk factor for MDR isolation.