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

Objective: The National Early Warning Score 2 (NEWS2) is a tool used internationally to detect risk of clinical deterioration and promote rapid intervention. Although it has been extensively validated in hospital settings, few prospective studies have sought evidence of the score's ability to identify patients at high risk during prehospital emergency care. This study aimed to assess the ability of the NEWS2 to predict high risk for poor outcomes in out-of-hospital emergencies.

Methods: Prospective cohort study of patients evaluated by emergency medical technicians before arrival for treatment at a tertiary care hospital. NEWS2 findings for all eligible patients were recorded and then analyzed according to patient survival or not.

Results: We included 1307 patients (mean age 64.5 years); 51% were males, 1268 were survivors, and 39 were nonsurvivors). The median (interquartile range) NEWS2 score for survivors (3 [1-6]) was significantly lower than the median for nonsurvivors (14 [11-17]) (P .001). The areas under the receiver operating characteristic curves (AUCs) demonstrated that the NEWS2 was a significant predictor of poor outcomes such as all-cause mortality (AUC, 0.95; 95% CI, 0.93-0.98), admission to the intensive care unit (AUC, 0.93; 95% CI, 0.91-0.94), and later in-hospital mortality (AUC, 0.83; 95% CI, 0.80-0.87). Multivariate logistic regression analysis identified significant associations between the NEWS2 assessment and mortality (adjusted odds ratio, 1.599; 95% CI, 1.447-1.766; P .001). A NEWS2 score greater than 4 reliably identified patients at high risk for both early death (P .001) and later in-hospital death (P .001).

Conclusions: The NEWS2 is useful for evaluating patients in prehospital emergency care, enabling responders to quickly recognize serious clinical scenarios and identify patients at high risk for early in-hospital mortality.

Objective: Objective. Adverse drug events (ADEs) are a well-known cause for emergency department visits. The objective of this study is to evaluate the prevalence of these adverse events through an annual multicentcer cross-sectional registry and identify factors associated with new emergency visits within 30 days following discharge.

Methods: We conducted a multicenter cross-sectional study in emergency departments of Spanish hospitals. The identification and registration of patients were obtained from the census of patients treated in emergency departments at the end of the of the 5-year registry period. We used a multivariate logistic regression model to evaluate possible risk factors for new emergency visits within 30 days of discharge.

Results: A total of 10,678 patients were evaluated in 53 centers, 785 of whom (7.35%) consulted due to ADEs. Prevalence ranged from 0% up to 14.3%. Antithrombotic drugs were the therapeutic group responsible for the highest number of events, causing 96 of them (25.9%). Regarding AEs, hemorrhagic events (n = 63; 8.1%), followed by episodes of confusion (n = 42; 5.4%), were the most common ones. A total of 86 (23.5%) evaluable patients returned to the emergency department within 30 days of discharge. Chronic prescription of > 10 drugs was associated with a higher risk of new consultations [OR, 1.65 (1.07-2.56)].

Conclusions: ADEs are a common reason for emergency department visits and are associated with a significant number of subsequent visits after discharge. Severe polypharmacy is a risk factor for new emergency visits within 30 days.

Objective: Too much controversy continues to surround the issue of ordering blood cultures in the emergency department (ED). The key question of which of our ED patients should have blood extracted remains unresolved. Nor is there clear consensus. Against this background it is still crucial to identify patients at risk of true bacteremia, as untreated bacteremia can lead to more serious life-threatening events such as septic shock. The main purpose of this narrative review was to look at the evidence on ED treatment of adults with suspected sepsis or serious infection in an attempt to define when cultures should be ordered, given that the results of microbiology can have an impact on prognosis, progression, and mortality. The authors report their consensus on recommendations for ordering cultures in cases of serious infection or sepsis attended in EDs.

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.