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

{"title":"Probability of new falls and factors associated with them in aged patients treated in emergency departments after falling: data from the FALL-ER registry.","authors":"Ana García-Martínez,&nbsp;Adriana Gil-Rodrigo,&nbsp;Arrate Placer,&nbsp;Xavier Alemany,&nbsp;Sira Aguiló,&nbsp;Victoria Torres-Machado,&nbsp;Javier Jacob,&nbsp;Pablo Herrero,&nbsp;Pere Llorens,&nbsp;Francisco Javier Martín-Sánchez,&nbsp;Òscar Miró","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To identify characteristics associated with a new fall in a patient who received emergency department care after an accidental fall and to develop a risk model to predict repeated falls.</p><p><strong>Material and methods: </strong>The FALL-ER registry included accidental falls in patients over the age of 65 years treated in 5 Spanish emergency departments. Independent variables analyzed were patient characteristics at baseline, fall characteristics, immediate consequences, and functional status on discharge. Patients were followed with telephone interviews for 6 months to record the occurrence of new falls. Multivariate regression analysis was used to identify variables associated with falling again and to develop a risk model. We identified 3 levels of risk for new falls (low, intermediate, and high).</p><p><strong>Results: </strong>A total of 1313 patients were studied; 147 patients (11.2%) reported having another fall. Variables associated with risk of falling again were having had a fall in the 12 months before the index fall, neurological disease, anemia, use of non-opioid analgesics, falling at home, falling at night, head injury on falling, and need for help when rising from a chair. The probability of falling again was 3.5%, 10.5%, and 23.3%, respectively, in patients at low, intermediate, and high risk. The model's ability to discriminate was moderate: the area under the receiver operating characteristic curve was 0.688 (95% CI, 0.640-0.736).</p><p><strong>Conclusion: </strong>One in 9 older adults treated in an emergency department for an accidental fall will fall again within 6 months. It is possible to identify patients at higher risk for whom preventive measures should be implemented.</p>","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"34 6","pages":"444-451"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9091273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine laboratory testing to determine if a patient has COVID-19.","authors":"Inge Stegeman, Eleanor A Ochodo, Fatuma Guleid, Gea A Holtman, Bada Yang, Clare Davenport, Jonathan J Deeks, Jacqueline Dinnes, Sabine Dittrich, Devy Emperador, Lotty Hoo, René Spijker, Yemisi Takwoingi, Ann Van den Bruel, Junfeng Wang, Miranda Langendam, Jan Y Verbakel, Mariska M G Leeflang","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"34 6","pages":"465-467"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9091276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Main causes of accidental deaths due to avalanches in the Catalan Pyrenees: a review of 50 years.","authors":"Íñigo Soteras Martínez,&nbsp;Marc Ayala,&nbsp;Josep Maria Casadesús,&nbsp;Glòria Martí Domènech,&nbsp;Joan Carles Trullàs,&nbsp;Robert Blasco Mariño","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"34 6","pages":"483-485"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9460209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency department observation of patients with acute heart failure prior to hospital admission: impact on short-term prognosis.","authors":"María Pilar López Díez,&nbsp;Pere Llorens,&nbsp;Francisco Javier Martín-Sánchez,&nbsp;Víctor Gil,&nbsp;Javier Jacob,&nbsp;Pablo Herrero,&nbsp;Lluís Llauger,&nbsp;Josep Tost,&nbsp;Alfons Aguirre,&nbsp;José Manuel Garrido,&nbsp;Juan Antonio Vega,&nbsp;Marta Fuentes,&nbsp;María Isabel Alonso,&nbsp;María Luisa López Grima,&nbsp;Pascual Piñera,&nbsp;Rodolfo Romero,&nbsp;Francisco Javier Lucas-Imbernón,&nbsp;Juan Antonio Andueza,&nbsp;Javier Povar,&nbsp;Fernando Richard,&nbsp;Carolina Sánchez,&nbsp;Òscar Miró","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To analyze whether short-term outcomes are affected when patients diagnosed with acute heart failure (AHF) spend time in an emergency department observation unit (EDOU) before hospital admission.</p><p><strong>Material and methods: </strong>Baseline and emergency episode data were collected for patients diagnosed with AHF in the EDs of 15 Spanish hospitals. We analyzed crude and adjusted associations between EDOU stay and 30-day mortality (primary outcome) and in-hospital mortality and a prolonged hospital stay of more than 7 days (secondary outcomes).</p><p><strong>Results: </strong>A total of 6597 patients with a median (interquartile range) age of 83 (76-88 years) were studied. Fifty-five percent were women. All were hospitalized for AHF (50% in internal medicine wards, 23% in cardiology, 11% in geriatrics, and 16 in other specialties. Of these patients, 3241 (49%) had had EDOU stays and 3350 (51%) had been admitted immediately, with no EDOU stay. Having an EDOU stay was associated with female sex, dementia or chronic obstructive pulmonary disease, long-term treatment with certain drugs for heart failure, greater baseline deterioration in function, and a higher degree of decompensation. Patients in the EDOU group were more often admitted to an internal medicine ward and had shorter stays; cardiology, geriatric, and intensive care admissions were less likely to have had an EDOU stay. Overall, 30-day mortality was 12.6% (13.7% in the EDOU group and 11.4% in the no-EDOU group; P = .004). In-hospital mortality was 10.4% overall (EDOU, 11.1% and no-EDOU, 9.6%; P = .044). Prolonged hospitalization occurred in 50.0% (EDOU, 48.7% and no-EDOU, 51.2%; P = .046). After adjusting for between-group differences, the EDOU stay was not associated with 30-day mortality (hazard ratio, 1.14; 95% CI, 0.99-1.31). Odds ratios for associations between EDOU stay and in-hospital mortality and prolonged hospital stay, respectively, were 1.09 (95% CI, 0.92-1.29) and 0.91 (95% CI, 0.82-1.01).</p><p><strong>Conclusion: </strong>Although mortality higher in patients hospitalized for AHF who spend time in an EDO, the association seems to be accounted for by their worse baseline situation and the greater seriousness of the decompensation episode, not by time spent in the EDOU.</p>","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":" ","pages":"345-351"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33498112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in clinical signs and severity of intoxication due to street drugs in adolescents and young adults treated in emergency departments.","authors":"Guillermo Burillo-Putze,&nbsp;Dima Ibrahim-Achi,&nbsp;Lidia Martínez-Sánchez,&nbsp;Miguel Galicia,&nbsp;August Supervía,&nbsp;Jordi Puiguriguer Ferrando,&nbsp;Sebastián Matos Castro,&nbsp;María Ángeles Leciñena,&nbsp;M ª José Venegas de L'Hotellerie,&nbsp;Belén Rodríguez Miranda,&nbsp;Ángel Bajo Bajo,&nbsp;Beatriz Martín-Pérez,&nbsp;Antonio Dueñas-Laita,&nbsp;Ana Ferrer Dufol,&nbsp;Francisco Callado-Moro,&nbsp;Santiago Nogué-Xarau,&nbsp;Òscar Miró","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether symptoms and levels of severity of intoxication from street drugs differ between adolescents and young adults who come to hospital emergency departments for treatment.</p><p><strong>Material and methods: </strong>We studied a consecutive cohort of adolescents (aged 12-17 years) and young adults (aged 18-30 years) who were treated in 11 hospital emergency departments belonging to the Drug Abuse Network of Spanish Hospital Emergency Departments (REDURHE). Sociodemographic and clinical characteristics and level of severity were recorded for comparison between between adolescents and young adults, adjusted for sex, alcohol co-ingestion, and type of drug used. An intoxication was recorded as severe if at least 1 of the following indicators was present: cardiac arrest, tracheal intubation, intensive care unit admission, and in-hospital death.</p><p><strong>Results: </strong>We included a total of 2181 patients: 249 adolescents (11.4%) and 1932 young adults (88.6%). Alcohol coingestion and use of multiple drugs were less common in adolescents, who had significantly more events related to cannabis (in 81.1% vs 49.0% of young adults) and benzodiazepines (13.3% vs 5.5%). The adolescents had significantly fewer intoxications from the use of cocaine (10.8% vs 45.1%), amphetamines (17.3% vs 32.3%), ketamine (0.4% vs 6.0%) and gamma-hydroxybutyrate (0.4% vs 4.0%). A higher proportion of adolescents than young adults presented with diminished consciousness (23.0% vs 16.9%), but fewer manifested anxiety (15.9% vs 26.3%), palpitations (11.0% vs 19.5%), or chest pain (2.8% vs 9.2%). The pattern of associations was similar in the subgroup of intoxications due to cannabis. The adjusted model confirmed that the adolescents were more likely to have diminished consciousness, with an odds ratio (OR) of 1.851 (95% CI, 1.204-2.844) and less likely to have anxiety (OR, 0.529 (95% CI, 0.347-0.807). Intoxication was severe in 46 patients overall (2.1%); in adolescents and young adults the proportions were 0.8% and 2.3%, respectively (P = 0.129). In adolescents, the OR was 0.568 (95% CI, 0.131-2.468) for severity; for component indicators, the ORs were 0.494 (95% CI, 0.063-3.892) for intubation and 0.780 (95% CI, 0.175-3.475) for intensive care unit admission. No deaths occurred.</p><p><strong>Conclusion: </strong>Adolescents requiring emergency care for street drug intoxication had co-ingested alcohol or taken multiple drugs less often than young adults. Cannabis was the drug most often used by adolescents, who presented more often with diminished consciousness but less often with anxiety. We detected no differences related to event severity.</p>","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":" ","pages":"352-360"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33498113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Description of basic competencies in clinical ultrasound imaging for emergency departments.","authors":"Tomás Villén Villegas,&nbsp;Ricardo Campo Linares,&nbsp;José Ramón Alonso Viladot,&nbsp;Roser Martínez Mas,&nbsp;María José Luque Hernández,&nbsp;Miriam Ruiz Durán,&nbsp;Alberto Oviedo García,&nbsp;Joaquín Antonio Álvarez Gregori,&nbsp;Mariano Aguilar Mulet,&nbsp;Luis Campos Caubet,&nbsp;Linder Cárdenas Bravo,&nbsp;David Chaparro Pardo,&nbsp;Jaldún Chehayeb Morán,&nbsp;José Vicente Esteban Velasco,&nbsp;Manuel Ferreiro Gómez,&nbsp;Daniel García Martín,&nbsp;Iván García Suárez,&nbsp;Adrián Martínez Hernández,&nbsp;Ángel Hernández Galán,&nbsp;Javier Millán Soria,&nbsp;José Félix Martínez López,&nbsp;José Francisco Rodríguez García,&nbsp;Inés Ruano Peña,&nbsp;Francisco José Salvador Suárez,&nbsp;Susana Simó Meléndez,&nbsp;Juan José Zafra Sánchez,&nbsp;Ramón Nogué Bou","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Text: </strong>Recent years have seen great advances in the use of clinical ultrasound imaging in both hospital emergency departments and out-of-hospital settings. However, all new techniques require up-to-date definitions of competencies relevant to the clinical realities of different specialties and the geographic settings in which specialists work. To that end, a group of experts in clinical ultrasound reviewed the evidence available in the literature and strictly applied the Delphi method to define the competencies relevant to emergency physicians. The group worked with the starting premise that clinical ultrasound imaging should be a common competency across the specialty.</p>","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":" ","pages":"377-387"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33498115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change of pace.","authors":"Isabel Luque","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":" ","pages":"396-397"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33498117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is spontaneous pneumomediastinum really spontaneous?","authors":"Sebastián Campbell-Quintero,&nbsp;Santiago Campbell-Quintero,&nbsp;Santiago Campbell-Silva","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":" ","pages":"407-408"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33498124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Derivation and validation of new prehospital phenotypes for adults with COVID-19.","authors":"Ana Alberdi-Iglesias,&nbsp;Raúl López-Izquierdo,&nbsp;Guillermo J Ortega,&nbsp;Ancor Sanz-García,&nbsp;Carlos Del Pozo Vegas,&nbsp;Juan F Delgado Benito,&nbsp;Francisco Martín-Rodríguez","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize phenotypes of prehospital patients with COVID-19 to facilitate early identification of at-risk groups.</p><p><strong>Material and methods: </strong>Multicenter observational noninterventional study of a retrospective cohort of 3789 patients, analyzing 52 prehospital variables. The main outcomes were 4 clusters of prehospital variables describing the phenotypes. Secondary outcomes were hospitalization, mechanical ventilation, admission to an intensive care unit, and cumulative mortality inside or outside the hospital on days 1, 2, 3, 7, 14, 21, and 28 after hospitalization and after start of prehospital care.</p><p><strong>Results: </strong>We used a principal components multiple correspondence analysis (factor analysis) followed by decomposition into 4 clusters as follows: cluster 1, 1090 patients (28.7%); cluster 2, 1420 (37.4%); cluster 3, 250 (6.6%), and cluster 4, 1029 (27.1%). Cluster 4 was comprised of the oldest patients and had the highest frequencies of residence in group facilities and low arterial oxygen saturation. This group also had the highest mortality (44.8% at 28 days). Cluster 1 was comprised of the youngest patients and had the highest frequencies of smoking, fever, and requirement for mechanical ventilation. This group had the most favorable prognosis and the lowest mortality.</p><p><strong>Conclusion: </strong>Patients with COVID-19 evaluated by emergency medical responders and transferred to hospital emergency departments can be classified into 4 phenotypes with different clinical, therapeutic, and prognostic characteristics. The phenotypes can help health care professionals to quickly assess a patient's future risk, thus informing clinical decisions.</p>","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"34 5","pages":"361-368"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9459681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal blood pressure thresholds during vasopressors weaning: The U-Shaped pattern.","authors":"Ovidiu Chioncel,&nbsp;Laura Antohi,&nbsp;Serban Bubenek","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"34 5","pages":"329-330"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9459684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}