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

Objective: To describe the clinical characteristics and interventions performed on critically ill patients admitted to pediatric emergency departments (PED) in Spain.

Methods: Study based on a prospective multicenter registry of 19 PED included in the critical patient working group of the Spanish Society of Pediatric Emergencies. We included critical patients under 18 years of age admitted to those PEDs on the 4th, 14th, and 24th of each month between February 2020 and January 2022 (2 years). Critical patient was defined as one who met at least one of the following criteria: admission to a pediatric intensive care unit, stabilization procedures of the airway or circulatory system in the PED.

Results: During the study period, 116,138 episodes were registered in the PEDs, and 255 (0.2%) were critically ill patients (median age 15 months; medical conditions 232, 91.0%). Of these, 145 (56.9%) required airway stabilization and 19 (7.5%) circulatory procedures. Eighty-four (32.9%) received prehospital care, 9 requiring airway stabilization and 6 circulatory procedures (5 cardiac massage). In the PEDs, 233 patients (91.4%) required interventions, of which 15 (5.9%) were airway stabilization, 1 (0.4%) circulatory and 8 (3.1%) both. Ten patients died (3.9%).

Conclusions: Critically ill patients are infrequent in Spanish PEDs. The high rate of procedures performed emphasizes the importance of adequate training of healthcare pre-hospital and in-hospital professionals.

Objective: To study factors associated with prehospital orotracheal intubation and the association between intubation and survival in polytrauma patients.

Methods: Retrospective observational cohort study. Cases were entered into the Major Trauma Registry of the Spanish autonomous community of Navarre between January 1, 2010, and December 31, 2019. We analyzed associations between clinical and demographic variables and the performance of prehospital intubation and survival. Multivariate logistic regression was used with mortality adjusted by inverse probability of treatment to control forconfounding factors.

Results: Of the 1909 patients attended, responders performed prehospital orotracheal intubations in 212 patients (11.1%). Intubation was associated with more severe trauma (Injury Severity Score, 35.9 vs 25.6 for patients not intubated and New Injury Severity Score [NISS], 43.8 vs 32.3) (P .001, both scores). Survival was lower in patients who were intubated before adjustment for other factors; however, after adjustment, intubation was not significantly associated with survival. Odds ratios (OR) showed that the factors most strongly associated with poor survival were advanced age , base excess, and 2 trauma scales, as follows: age OR, 1.06 (95%CI, 1.04-1.09); base excess OR, 0.92 (95% CI, 0.86-0.98); Revised Trauma Score (RTS) OR, 0.52 (95% CI, 0.39-0.67); and NISS OR, 1.04 (95% CI, 1.02-1.06).

Conclusions: Prehospital orotracheal intubation is associated with greater injury severity but not with survival. Predictors of mortality were advanced age, base excess, and trauma severity (RTS and NISS scores).

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.