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

Objective: The use of early warning scores and prehospital blood testing is a current reality in prehospital emergency medical systems. However, there is limited evidence regarding the benefit of incorporating point-of-care biomarkers alongside these scores. The aim of this study was to compare the predictive capacity of scores that include biomarkers with those based solely on vital signs.

Methods: We conducted a systematic search across Medline (via PubMed), Web of Science, Cochrane Library, and Scopus databases for studies evaluating the ability of early warning scores and blood biomarkers to predict short-term mortality. A subsequent meta-analysis was performed to compare the effectiveness of scores based solely on physiological parameters with those incorporating analytical parameters.

Results: A total of 9 studies were selected from the systematic review and included in the meta-analysis for meeting the predefined inclusion criteria. The pooled mean sensitivity was 0.619 (0.489-0.734) with biomarkers and 0.627 (0.538-0.708) without them; specificity was 0.809 (0.763-0.848) and 0.699 (0.653-0.742), and the diagnostic odds ratio was 6.839 (2.617-17.872) and 3.928 (2.811-5.491), respectively, for the scores with and without biomarkers. Significant differences were found for specificity (P .001), but not for sensitivity (P = .917) or the odds ratio (P = .285).

Conclusions: The inclusion of parameters derived from prehospital point-of-care testing in early warning scores provides a benefit to prehospital care, as it improves the identification of patients who will not experience short-termmortality by increasing specificity.

Objective: To assess, from a sex/gender perspective, the incidence bof atrial fibrillation (AF) in older patients in Spanish hospital emergency departments (EDs), their clinical characteristics, need for hospitalization, short-term follow-up consultations, long-term readmissions and mortality, and associated factors.

Methods: We included all patients aged $ 65 years diagnosed with AF in 52 Spanish EDs over a 1-week period. The outcome variables were the need for hospitalization, all-cause follow-up consultations within 30 days following discharge, and long-term readmissions and mortality. A total of 29 sociodemographic and clinical variables associated with these outcomes were analyzed using adjusted models, both overall and sex-disaggregated.

Results: A total of 676 patients with AF were identified, 55% of whom were women (annual incidence rate: 15.5 per 1,000 inhabitants aged $ 65 years (95%CI, 15.5-15.7; no differences were reported between sexes). Women were older. Overall comorbidity was high and more common in men. Hospitalization was required in 45.5% of cases, more frequently in men (51.1% vs 41.3%; p = .013 in the multivariable analysis). Within the first 30 days, 22.7% of patients had a follow-up consultation, with no differences between sexes. After a median follow-up of 1,186 days, a total of 346 patients (52.7%) were admitted at least once and 224 (34.1%) died with no significant sex differences in either event. Most factors associated with the 4 outcome variables varied by sex.

Conclusions: AF is a common diagnosis among older patients attending EDs, with equal incidence rates in men and women. Sex differences were found in hospitalization, but not early reconsultation, or long-term admission, or mortality, although the associated factors did vary by sex.