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

{"title":"Acute colchicine poisoning: prediction of in-hospital mortality at hospital admission using a nomogram. A bicenter retrospective cohort study.","authors":"Azzurra Schicchi, Alberto L Malovini, Sebastian Voicu, Pietro Papa, Isabelle Malissin, Nicolas Deye, Valeria M Petrolini, Davide Lonati, Laurence Labat, Carlo A Locatelli, Bruno Mégarbane","doi":"10.55633/s3me/086.2026","DOIUrl":"10.55633/s3me/086.2026","url":null,"abstract":"<p><strong>Objective: </strong>Acute colchicine poisoning is associated with high mortality. Early identification of high-risk patients is crucial for timely intervention. The prognostic value of plasma colchicine concentration (ColC) has not been previously studied. The objective was to develop a nomogram for predicting in-hospital mortality in acute colchicine poisoning using admission ColC and time elapsed since ingestion.</p><p><strong>Methods: </strong>We conducted a bicenter retrospective cohort study (2000-2020). Patients with colchicine poisoning from a French toxicology critical care service and an Italian poison control center were included. Validation datasets included data from the registry itself and previously published cases. Logistic regression models were developed using admission ColC (ng/mL), time from ingestion to ColC measurement (h), and in-hospital mortality as the outcome variable.</p><p><strong>Results: </strong>A nomogram was developed using data from 52 patients (training cohort) and validated in 3 independent testing cohorts (n = 25, 13, and 16, respectively). In this retrospective study, the nomogram demonstrated potential for discriminating patients at greater risk.</p><p><strong>Conclusions: </strong>An exploratory nomogram for early risk stratification of mortality after colchicine poisoning is presented. Clinical implementation requires prospective multicenter validation with adequate statistical power.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 4","pages":"276-284"},"PeriodicalIF":6.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611302","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":"Consensus document on the management of patients with accidental hypothermia from the Spanish Society of Anesthesiology, Resuscitation and Pain Management (SEDAR), the Spanish Society of Intensive Care Medicine, Critical Care and Coronary Units (SEMICYUC), and the Spanish Society of Emergency Medicine (SEMES).","authors":"Robert Blasco Mariño, Eduard Argudo, Iñigo Soteras Martínez, Manuel Luis Avellanas Chavala, Manuel Pons Claramonte, Javier Rius, Laura Martín Sánchez, Asier Pinillos Alonso, Duilio González-Delgado, Jesús Abelardo Barea Mendoza, Carlos Pérez Fernandez, Michelle Laurens Acevedo","doi":"10.55633/s3me/070.2026","DOIUrl":"10.55633/s3me/070.2026","url":null,"abstract":"<p><strong>Objective: </strong>Accidental hypothermia is an underdiagnosed condition with a significant impact on public health. With the aim of providing the basis for a comprehensive care framework, 12 panelists from 3 Spanish scientific societies (SEDAR, SEMES and SEMICYUC) developed this multidisciplinary consensus document. Through a systematic search and the final synthesis of 281 articles including 1,704,632 patients, 37 recommendations were developed through a 2-round Delphi process, distributed across 8 application domains based on the organization of a rescue chain: prehospital prevention, initial evaluation, management and transport, hospital detection, care of the polytraumatized patient, hospital rewarming, cardiac arrest, and resuscitation. Robust consensus among panelists (>75% agreement) and excellent internal consistency (ω = 0.913) were achieved, providing a solid document that may serve as a basis for the implementation of standardized protocols.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 4","pages":"285-298"},"PeriodicalIF":6.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610604","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":"Caustic ingestion. Spanish multicenter study on prognostic severity factors and diagnostic test performance.","authors":"María Codinach-Martín, Antonio Francisco Caballero-Bermejo, María Teresa Maza-Vera, Valle Molina-Samper, Clara Serrano-Ferrer, Oriol Pallás-Villaronga, Antonio Dueñas-Ruiz, Belén Ruiz-Antoran, Pere Planellas-Giné, Antoni Codina-Cazador, Jordi Puiguriguer-Ferrando","doi":"10.55633/s3me/041.2026","DOIUrl":"10.55633/s3me/041.2026","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the clinical profile of patients treated for oral caustic injury, describe the use of diagnostic tests in emergency departments (EDs), and analyze factors associated with severity and prognosis.</p><p><strong>Methods: </strong>Multicenter, retrospective, observational study including patients treated in EDs for caustic substance ingestion over a 7-year period (2015-2021). Epidemiological, clinical, and diagnostic variables were analyzed, and the prognostic performance of esophagogastroduodenoscopy (EGD) and computed tomography (CT) was evaluated.</p><p><strong>Results: </strong>A total of 225 patients were included, with a mean age of 44 (SD, 24) years; 52.4% were women. Intentional ingestion accounted for 49.3% of cases. The most prevalent caustic agents were sodium hypochlorite (48.9%) and hydrochloric acid (16.4%). EGD was performed in 84.4% of patients, CT in 24.9%, and both in 20.4%. In the final predictive model, prognostic factors associated with severe injury (Zargar $ IIb and/or Ryu > 2) were: intentional ingestion with OR, 4.19 ( 95% CI 1.71-10.26; P = .002), ammonia with OR, 11.39 ( 95% CI 2.07-62.65; P = .005), and the initial presence of digestive and/or respiratory symptoms. CT showed acceptable performance for detecting initial severe lesions, with a negative predictive value of 75% and a negative likelihood ratio of 0.28; however, it does not definitively replace EGD in less severe cases.</p><p><strong>Conclusions: </strong>Suicidal intent and the use of highly corrosive caustic agents, together with initial clinical findings, are associated with worse prognosis. CT is useful but does not replace EGD in mild or moderate cases.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 4","pages":"269-275"},"PeriodicalIF":6.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611335","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":"Implementation of shock teams and impact on the therapeutic approach and prognosis of cardiogenic shock in Spain.","authors":"Marta Marcos-Mangas, Pablo Jorge-Pérez, Josep Comin-Colet, Náyade Del Prado, Cristina Fernández, Ana Viana Tejedor, José Luis Bernal, Rut Andrea, Alessandro Sionis, Javier Segovia-Cubero, Jordi Bañeras, M Isabel Barrionuevo Sánchez, José C Sánchez-Salado, José González-Costello, Oriol Alegre, Manuel Martínez-Sellés, Roberto Martín-Asenjo, María Generosa Crespo-Leiro, Joan Antoni Gómez-Hospital, Javier Elola, Albert Ariza-Solé","doi":"10.55633/s3me/052.2026","DOIUrl":"10.55633/s3me/052.2026","url":null,"abstract":"<p><strong>Objective: </strong>There are no data on the implementation of shock teams (ST) or their impact on cardiogenic shock (CS) in Spain.</p><p><strong>Methods: </strong>We conducted a retrospective observational study including episodes of CS (2016-2022) from hospitals within the Spanish National Health System with availability of an Interventional Cardiology Unit. The population was divided into a) patients hospitalized in centers with ST (CS-ST) and b) patients hospitalized in centers without ST (CSNST). Furthermore, the availability of a cardiac intensive care unit (CICU), cardiac surgery, heart transplant program, and volume of CS cases at each center were recorded. The outcome variable was the in-hospital mortality rate.</p><p><strong>Results: </strong>A total of 15,879 episodes were analyzed, 32% (5,095) of which corresponded to the CS-ST group. The proportion of  enters with ST availability increased progressively from 7% in 2016 to 39% in 2022. Patients from the CS-ST group were younger (68 vs 71 years, P < .001) and more frequently underwent mechanical ventilation, renal replacement therapy, and circulatory support (P < .001), showing a higher rate of acute kidney failure and stroke and longer lengths of stay (12 days vs 9 days, P < .001). Care in centers with ST (OR, 0.86; 95% CI, 0.77-0.96; P = .005) and CICU (OR, 0.82; 95% CI, 0.69-0.98; P < .033) was significantly associated with a lower mortality rate.</p><p><strong>Conclusions: </strong>The availability of ST has expanded in our setting. Patients admitted to centers with ST are managed more invasively, with a lower in-hospital mortality rate despite a higher rate of complications.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 4","pages":"261-268"},"PeriodicalIF":6.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611110","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":"Critical risk mapping in emergency departments: key activities for patient safety with transforming teams.","authors":"Sonia Jiménez Hernández, Ana García Pavesio, Susana Barberá Ruiz, Mónica Suñen, Gemma Gallardo González, Miquel Sánchez Sánchez","doi":"10.55633/s3me/056.2026","DOIUrl":"10.55633/s3me/056.2026","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 3","pages":"234"},"PeriodicalIF":6.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321246","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":"Management of status epilepticus in the emergency department: Systematic review and clinical update.","authors":"Raúl Alonso Avilés, Cesáreo Fernández Alonso, Félix González Martínez, Manuel Liñán López","doi":"10.55633/s3me/045.2026","DOIUrl":"10.55633/s3me/045.2026","url":null,"abstract":"<p><strong>Objective: </strong>To update the available evidence on the management of all types of status epilepticus (SE) in hospital emergency departments (EDs) and prehospital emergency medical services (EMS).</p><p><strong>Methods: </strong>We conducted a systematic review following PRISMA 2020 methodology. A comprehensive search was conducted across biomedical databases (PubMed, Embase, Cochrane, Web of Science, and Spanish databases) from January 2015 through October 2025. Studies on treatment, validated prognostic scales, and multicenter registries of convulsive and nonconvulsive SE were included. Quality assessment was performed using GRADE and the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>A total of 47 studies were included. Benzodiazepines remain the first-line therapy (high certainty of evidence, GRADE). As second-line therapy, levetiracetam, phenytoin, and valproate showed comparable efficacy (50-60%; moderate certainty). The ESETT trial demonstrated no superiority among second-line antiseizure drugs. Spanish evidence includes the ACESUR Registry (664 patients) and the validated RACESUR (AUC 0.72) and ADAN scales (predictive accuracy 90.9%; 95% CI, 88.4-93.4), providing context-specific evidence for the Spanish healthcare system.</p><p><strong>Conclusions: </strong>SE management requires rapid sequential treatment with benzodiazepines followed by second-line antiseizure drugs. Comparable efficacy among second-line options allows individualized treatment. The Spanish RACESUR and ADAN scales are validated tools that facilitate risk stratification in emergency settings.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 3","pages":"200-208"},"PeriodicalIF":6.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321293","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":"Comparison of strategies for the use of brain injury biomarkers in mild traumatic brain injury.","authors":"Pedro Ángel de Santos Castro, Carlos Del Pozo Vegas, Wysali Trapiello Fernández, Inés Anibarro Miralles, Guillermo Velasco de Cos, David de Santos Sánchez","doi":"10.55633/s3me/055.2026","DOIUrl":"https://doi.org/10.55633/s3me/055.2026","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 3","pages":"233"},"PeriodicalIF":6.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321228","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":"Complexity of maintenance treatment as a predictor of 30-day deterioration in chronic obstrutive pulmonary disease (COPD) exacerbations in the emergency department.","authors":"Raúl Alonso Avilés, Carlos Del Pozo Vegas, José Eugenio Lozano Alonso, Marina Jimeno Asensio, Alberto Gómez de Diego, Alberto Caballero García, José Ramón Casal Codesido, Ramón Rodríguez Borrego, Carmen Peñalver Barrios, Mónica De Diego Arnáiz, Raúl López Izquierdo","doi":"10.55633/s3me/037.2026","DOIUrl":"10.55633/s3me/037.2026","url":null,"abstract":"<p><strong>Objective: </strong>Maintenance treatment patterns in chronic obstructive pulmonary disease (COPD) may reflect disease severity beyond the usual indicators used in emergency departments (EDs). The objective of this study was to evaluate whether treatment complexity predicts 30-day clinical deterioration.</p><p><strong>Methods: </strong>We conducted a prospective multicenter cohort study including patients aged $ 40 years presenting to 14 EDs with acute exacerbation of COPD confirmed by spirometry (post-bronchodilator FEV1/FVC < 0.7) or clinically suspected COPD (sCOPD: $ 10 pack-years with chronic respiratory symptoms). Treatment intensity was categorized as none, monotherapy, dual therapy, triple therapy, or multiple therapy ($ 4 drugs). The primary endpoint was a 30- day composite of therapeutic intensification, ED revisit, hospitalization, or death. Multivariable mixed-effects logistic regression was performed, adjusting for age, sex, comorbidity (Charlson Comorbidity Index), functional status (Barthel Index), and exacerbation severity, with a random intercept for hospital.</p><p><strong>Results: </strong>The median age was 75 years (IQR, 67-81). The composite endpoint occurred in 381 of the 1179 patients included (32.3%). After adjustment for age, sex, comorbidity, functional status, exacerbation severity, and hospital center, triple therapy (adjusted odds ratio [aOR], 2.20; 95% CI, 1.24-4.08; P = .009) and multiple therapy (aOR, 2.34; 95% CI, 1.32-4.34; P = .005) were associated with an increased risk of deterioration. The multivariable model showed adequate discriminative ability (C statistic = 0.71; 95% CI, 0.67-0.75).</p><p><strong>Conclusions: </strong>Treatment complexity predicted 30-day deterioration, likely reflecting underlying disease severity not captured by conventional measures rather than a causal effect of treatment.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 3","pages":"179-185"},"PeriodicalIF":6.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321214","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":"Chemical submission: an unresolved issue in emergency departments.","authors":"Blanca Rodríguez-Gamella, Miguel Galicia-Paredes, Guillermo Burillo-Putze, Jordi Puiguriguer-Ferrando","doi":"10.55633/s3me/033.2026","DOIUrl":"https://doi.org/10.55633/s3me/033.2026","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 3","pages":"218-220"},"PeriodicalIF":6.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321164","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":"Intestinal migration of a low-energy projectile after penetrating abdominal injury with gastric perforation.","authors":"María Mellado-García, Jesús Sandoval-Marín, Francisco Miguel González-Valverde","doi":"10.55633/s3me/039.2026","DOIUrl":"https://doi.org/10.55633/s3me/039.2026","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 3","pages":"231-232"},"PeriodicalIF":6.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321275","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}