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

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.

Objective: To describe and compare the diagnosis associated with medication-related problems (MRP) that lead to emergency departments visits based on sex and type of culprit drug.

Methods: We conducted a retrospective observational study included 1,611 adult patients who visited the emergency department of a tertiary referral center in Catalonia (Spain) from 2021 through 2022 for MRP. We collected sociodemographic and clinical baseline variables in addition to the diagnosis and drug associated with the MRP that caused the visit to the emergency department based on the medical history at discharge. Data analysis was performed using binomial distribution tests and binary logistic regression models.

Results: More than 50% of patients who visit the emergency department for MRP are women (95%CI, 55%-60%). Additionally, as age increases, the percentage of women visiting the emergency department rises significantly vs men (P .001). Significant differences by sex were found in the MRP-related diagnosis and the type of culprit drug. The frequency of women with MRP associated with diarrhea and decreased intestinal motility was higher (P .001), as well as unintentional drug poisonings (P = .001), hypertension (P = .010), hyponatremia (P .001), and hypokalemia (P = .001). Women visit the emergency department more than men do regarding MRP associated with drugs acting on the nervous, cardiovascular, and anti-infective systems (P .001).

Conclusions: Results highlight sex differences and justify the need to continue researching to minimize such differences.