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

Objective: To analyze the scientific output of professionals working in emergency medicine in Spain during the 2015-2019 vs the previous 5 years (2010-2014).

Methods: We included documents authored by professionals affiliated with emergency and urgency medicine in a Spanish center, indexed in the Science Citation Index (SCI)-Expanded, excluding conference communications. These documents were analyzed by publication year, authors (number, affiliation, and order of authorship), journal, document type, and research areas. Some output markers were analyzed by autonomous community and hospital based on the affiliation of the lead author from the emergency settins.

Results: During the 2015-2019 5-year period, a total of 1,906 documents were published (64% original articles, 33% more vs 2010-2014), with a higher proportion of articles being published in Spanish (55%) vs English (45%). However, there was a significant increase in English articles vs the previous period (32%, p .001). Although most research activity came from hospital emergency departments (85%), the production from emergency medical services (EMS) professionals went up from 8.7% to 11.5%; p .001. First authorship went down from 67% to 50%; p .001, while university affiliation went up from 16% to 33%, p .001, as well as collaborative articles with other hospital and EDs, and other hospitals, including international collaborations (20% of international documents) (p .001 forall comparisons). Research areas with the most documents being published were cardiovascular (17.6%), infectious diseases (11.9%), pediatrics (10.7%), toxicology/pharmacology (8.0%), neurology (5.5%), and pulmonology (5.2%). Catalonia produced the most documents (510; 26.9%), followed by Madrid (419; 22.1%) and Andalusia (281; 14.8%). The regions with the largest relative increase in their share of Spanish output vs the previous 5-year period were Murcia (+71%), the Balearic Islands (+60%), Madrid (+40%), Castile-León (+37%), the Basque Country (+28%), and Asturias (+27%). Hospital Clínic led hospital production (199 out of 1,612 documents; 12%) while the Andalusian EMS led the out-of-hospital production (41 out of 219; 19%).

Conclusions: The scientific oyutput of emergency professionals in Spain grew steadily during the 2015-2019 period, with significant positive changes in many qualitative aspects of this production vs the previous 5 years. Some significant changes were also detected regarding the relative weight of certain centers and autonomous communities in this production.

Objective: To analyze the prescription of antiviral therapy for mild to moderate COVID-19 in Spanish emergency departments, the incidence of missed opportunities to prescribe, and associated factors.

Methods: Retrospective cross-sectional study in 16 hospital emergency departments. We collected data for adults with mild to moderate COVID-19 confirmed within 7 days of first symptoms. The patients studied were at risk for progression and were treated as outpatients during the first 8 months of 2022. We estimated the incidence of missed opportunities and evaluated associated factors with a Bayesian statistical approach assuming noninformative prior distributions.

Results: The overall incidence of missed opportunities to prescribe was 33.5% (95% probability interval [PI], 31.7%- 35.3%). Incidences in the 16 hospitals ranged from 17.8% to 50.6%. Adjusted odds ratios (aORs) showed that factors associated with more missed opportunities were age (aOR, 1.021; 95% PI, 1.013-1.029); widening of recommended indications relative to the first period (aOR third period, 2.641 [95% PI, 1.844-3.783]; aOR fourth period, 7.440 [95% PI, 5.352-10.343]; and aOR fifth period, 17.743 [95% PI, 10.821-29.105]); immunosuppression (aOR, 2.698; 95% PI, 2.115-3.443); and fewer vaccine doses relative to no vaccination (aOR 3 doses, 0.287 [95% PI, 0.197-0-417] and aOR 4 doses, 0.115 [95% PI, 0.074-0.179]). Factors associated with increased antiviral prescription were obesity (aOR, 0.735, 95% PI, 0.567-0.952) and the existence of automated clinical pathway alerts (aOR, 0.287; 95% PI, 0.114-0.721).

Conclusions: The incidence of missed opportunities to prescribe antiviral therapy is high. Incidences vary across hospitals and more often involve the most vulnerable patients.

Objective: To identify hemodynamic changes in helitransported patients and how they are affected by meteorological factors and transport characteristics.

Methods: A longitudinal study was conducted using the Canary Islands Emergency Service medical records database, from January 1, 2022, to December 31, 2022. Data from patients without mechanical ventilation or administration of vasoactive drugs were used. Systolic and diastolic blood pressure (BP), oxygen saturation, and heart rate (HR) variables were collected before, during, and at the end of the transfer, were collected. Meteorological variables during the flight, as well as sociodemographic variables, were taken into account. For bivariate analyses, Student's t-tests and ANOVA were used to assess the relationship between the variables described above. Mixed linear regression models were used to assess factors associated with hemodynamic changes.

Results: The 383 patients experienced changes in HR, oxygen saturation, and BP. These changes are due to altitude, exposure to wind and temperature variations. The study also shows that the duration of the flight and the speed of the helicopter affect hemodynamic stability.

Conclusions: Significant changes in HR, oxygen saturation and systolic BP during flights, which are restored after landing. The climatic conditions in the islands and altitude characteristic of this area influence the patient's physiology.

Objective: To study whether chronic constipation (CC) in patients hospitalized for acute heart failure (AHF) is associated with short-term prognosis.

Methods: Baseline and clinical data were prospectively collected for a cohort of patients consecutively admitted for AHF. CC was diagnosed if a patient reported having at least 2 of the following symptoms lasting at least 3 months within the past year: a) straining when emptying bowels, b) hard or lumpy stool, c) a feeling that bowels have not been fully emptied, d) a feeling of anorectal blockage, and e) fewer than 3 spontaneous bowel movements per week. We estimated crude and adjusted associations between CC and a composite outcome of 30-day mortality or readmission for AHF.

Results: A total of 492 patients hospitalized for AHF were studied; 116 (23.6%) were diagnosed with CC on admission. The mean (SD) age was 64 (11) years for patients without CC and 65 (10) years for patients with CC. Patients with CC had higher prevalences of chronic kidney insufficiency, valvular heart disease, atrial fibrillation, and need for mechanical ventilation on admission. The Kaplan-Meier analyses before and after propensity score matching showed that risk for 30-day mortality or readmission for AHF was significantly greater in patients with CC (before, log-rank P .001); after, log-rank P = .046).

Conclusions: Poorer clinical outcomes were associated with CC in this cohort of patients with AHF.