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

{"title":"Artificial intelligence and machine learning systems: fascination vs reality.","authors":"Federico Gordo-Vidal, Natalia Gordo-Herrera","doi":"10.55633/s3me/115.2024","DOIUrl":"https://doi.org/10.55633/s3me/115.2024","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 1","pages":"3-4"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082818","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":"Hidden HIV diagnostic opportunity: a link to community-acquired pneumonia.","authors":"Cristina Ramió Lluch, Neus Robert Boter, Mireia Saura Codina, Míriam Carbó Díez, Eduard Poch Ferret, Lucía Alejandra Manning","doi":"10.55633/s3me/066.2024","DOIUrl":"https://doi.org/10.55633/s3me/066.2024","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 1","pages":"74-75"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082899","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":"Authors' reply.","authors":"Cesáreo Fernández Alonso, Sara Vargas Lobé, Laura Fernández García, Manuel Fuentes Ferrer, Óscar Quintela Jorge, Begoña Bravo Serrano, Juan J González Armengol, Andrés Santiago Sáez","doi":"10.55633/s3me/106.2024","DOIUrl":"https://doi.org/10.55633/s3me/106.2024","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 1","pages":"78"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082824","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":"Early empirical antibiotherapy in patients attended for suspected sepsis in emergency departments: a systematic review.","authors":"Marcelo R Rodríguez, Ferran Llopis Roca, Rafael Rubio Díaz, Darío Eduardo García, Agustín Julián-Jiménez","doi":"10.55633/s3me/092.2024","DOIUrl":"10.55633/s3me/092.2024","url":null,"abstract":"<p><strong>Objective: </strong>Patients with suspected infections account for 15% to 35% of hospital emergency department (ED) caseloads in Spain and Latin America. The main objective of this systematic review was to compare evidence supporting the safety and efficacy of early (3 hours after triage) vs deferred ($ 3-6 hours) antibiotic therapy prescribed in EDs for adults with serious infections or sepsis. Efficacy and improved clinical course were defined by reduced progression to septic shock and short- and long-term mortality.</p><p><strong>Methods: </strong>The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). PubMed, the Web of Sciencie, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase, and ClinicalTrials.gov were searched for the period from January 1, 2010, to December 31, 2023. No language restrictions were set. We used the following Medical English Subject Headings and strings: \"Antibiotic OR Antibiotic Treatment OR Antibiotic Therapy OR Early Antibiotic Treatment OR Early Antibiotic Therapy,\" \"Infection OR Bacterial Infection OR Sepsis,\" \"Emergencies OR Emergency OR Emergency Department,\" \"Timing,\" \"Early,\" and \"Adults.\" Observational cohort studies were included. To evaluate quality of research design and risk of bias, we applied the Newcastle-Ottawa Scale. Case-control studies, narrative reviews and other types of articles were excluded. We completed a narrative review of the findings and did not undertake meta-analysis. The review was registered in the PROSPERO database (CRD42024520687).</p><p><strong>Results: </strong>The search yielded 1528 articles, of which 7 met the criteria for inclusion and analysis. The 7 studies comprised data for 118349 patients, 74141 of whom (62.6%) received early antibiotic treatment. Three studies were classified as high quality, 3 moderate, and 1 low. The 3 high-quality studies provided information on 2 aspects: 1) hospital and short-term mortality and 2) long-term mortality. One high-quality study showed a tendency for hospital and 30-day mortality to increase when antibiotics were administered more than 6 hours after triage vs within 1 hour of triage (hazard ratio, 2.25; 95% CI, 0.91-5.59; P = .08). Another reported an adjusted odds ratio of 1.09 (95% CI, 1.05-1.13; P = .024) for hospital mortality associated with each hour of therapeutic delay after triage. The third study reported that each additional hour of delay after triage was associated with a 10% increase (95% CI, 5%-14%; P .001) in the probability of 360-day mortality. Finally, the single low-quality study reported that each hour of delay in treatment was associated with an odds ratio of 1.08 (95% CI, 1.02-1.04; P .001) for increased risk of septic shock.</p><p><strong>Conclusions: </strong>Early initiation of antibiotic therapy, preferably within 3 hours of triage, can be recommended in cases of serious infection (sepsis or serious sepsis that do not meet the criteria for septic shoc","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 1","pages":"44-55"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082892","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":"Characteristics of emergency department patients with confirmed diagnoses of chronic obstructive pulmonary disease vs patients with respiratory symptoms and a suspected diagnosis.","authors":"Raúl Alonso Avilés, Carlos Del Pozo Vegas, Pedro Ángel de Santos Castro, Rosanna Guerrero Tejada, Ronald Paul Torres Gutiérrez, Raúl López Izquierdo","doi":"10.55633/s3me/110.2024","DOIUrl":"10.55633/s3me/110.2024","url":null,"abstract":"<p><strong>Objective: </strong>To describe differences in patient characteristics and case management between patients attended in emergency departments (EDs) with confirmed diagnoses of chronic obstructive pulmonary disease (COPD) vs those with respiratory symptoms in whom COPD is suspected.</p><p><strong>Methods: </strong>Prospective multicenter observational study of patients registered in a multipurpose database between November 14, 2022, and May 14, 2023, in 14 emergency departments in the public hospital system of Castile-Leon. We included patients aged 40 years or older with confirmed COPD or suspected COPD. Variables analyzed were patient characteristics, clinical presentation, and management of the emergency episode.</p><p><strong>Results: </strong>Of a total of 1179 patients, 931 (78.9%) had diagnosed COPD and 248 (21.1%) had suspected COPD. The median (interquartile range) age was 76 years (68-83 years) and 305 (25.87%) were women. Variables related to suspected COPD were age between 40 and 65 years (odds ratio [OR], 0.46; 95% CI, 0.26-0.65) and female sex (OR,0.57; 95% CI, 0.42-0.77). Patients with diagnosed COPD had higher Charlson comorbidity scores (OR, 1.93; 95% CI,1.42-2.63), and more of them were using inhalers (OR, 3.43; 95% CI, 2.57-4.61). Admission to a respiratory care ward (OR, 1.39; 95% CI, 1.97-3.01) and need for noninvasive mechanical ventilation (OR, 3.21; 95% CI, 1.27-10.71) were more common in patients with diagnosed COPD. However, no differences were observed in the frequency of hospitalization overall or 30-day mortality.</p><p><strong>Conclusions: </strong>Clinical characteristics and management of emergency care differ between patients with confirmed vs suspected COPD. Patients with suspected COPD had more limited access to certain diagnostic, therapeutic, and follow-up resources.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 1","pages":"31-38"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082830","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":"Clinical and sociodemographic factors associated with frequent use of emergency services by persons of advanced age in Paris: a nested case-control study.","authors":"Louise Reinhart, Agnes Dechartres, Sebastien Beaune, Dominique Bonnet-Zamponi, Anthony Chauvin, Youri Yordanov","doi":"10.55633/s3me/114.2024","DOIUrl":"https://doi.org/10.55633/s3me/114.2024","url":null,"abstract":"<p><strong>Objective: </strong>To identify clinical and sociodemographic characteristics of frequent use of emergency departments by persons of advanced age.</p><p><strong>Methods: </strong>Nested case-control study in a cohort of patients aged 75 years or older attending 3 hospital emergency departments (EDs) in Paris between January 1, 2018, and December 31, 2019. The index date was defined by the last visit during the study period. Frequency was defined as making 4 or more visits to an ED during the year prior to the index date. Controls were patients who visited an ED fewer than 4 times. We first analyzed sociodemographic factors related to frequent use and then randomly selected a convenience sample of 300 patients (150 frequent users and 150 in the non-frequent users) stratified by hospital. In this sample we analyzed clinical factors associated with frequent use. The statistical analysis included multivariate logistical regression models.</p><p><strong>Results: </strong>A total of 29 009 patients of advanced age visited the 3 EDs; 1241 (4.3%; 95% CI, 4.1%-4.5%) were frequent users in the year prior to their index date. Independent factors associated with frequent visiting were older age (odds ratio [OR], 1.03; 95% CI, 1.02-1.04); male sex (OR, 1.15; 95% CI, 1.02-1.29); the presence of comorbidities, eg, a history of falls (OR, 2.42; 95% CI, 1.27-4.70), stroke (OR, 4.07 (95% CI, 1.84-9.69), or cognitive decline (OR, 2.53; 95% CI, 1.20-5.45); loss of autonomy (OR, 2.70; 95% CI, 1.38-5.41); and medications, eg, diuretics (OR, 2.10; 95% CI, 1.09-4.11) or benzodiazepines (OR, 2.27; 95% CI, 1.07-5.00).</p><p><strong>Conclusions: </strong>Frail elderly patients with more comorbid conditions are at higher risk for frequent use of emergency departments. These patients should be identified early so that management of their conditions can be adjusted.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 1","pages":"7-14"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082864","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":"Improvements in the treatment of paracetamol poisoning.","authors":"Guillermo Burillo-Putze","doi":"10.55633/s3me/002.2025","DOIUrl":"https://doi.org/10.55633/s3me/002.2025","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 1","pages":"5-6"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082909","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":"Paracetamol poisoning: a prospective comparison of 2 protocols for N-acetylcysteine treatment.","authors":"August Supervía, M ª Àngels Gispert, Jordi Puiguriguer, Pablo Borja Álvarez Zabala, Lidia Martínez Sánchez, Samuel Olmos, Beatriz Calderón, Rocío de Paz Picornell, Santiago Nogué, Francisca Córdoba","doi":"10.55633/s3me/100.2024","DOIUrl":"10.55633/s3me/100.2024","url":null,"abstract":"<p><strong>Objective: </strong>Paracetamol poisoning can be serious and require treatment with N-acetylcysteine (NAC). A dose of 300 mg/kg is usually given in 3 fractions over 21 hours. An alternative regimen, the Scottish and Newcastle Acetylcysteine Protocol (SNAP), specifies the same total dose given in 2 intravenous injections over 12 hours. This study aimed to compare the 2 regimens in terms of effectiveness, adverse events, and lengths of emergency department (ED) and hospital stays.</p><p><strong>Methods: </strong>Prospective multicenter study to compare outcomes associated with the traditional NAC regimen vs SNAP. We enrolled all patients with paracetamol poisoning requiring NAC treatment in the participating hospital EDs from 2021 through 2023. Data related to referrals, poisoning episodes, and discharge destinations were collected. Patients were studied in 2 groups according to the protocol assigned in the EDs.</p><p><strong>Results: </strong>A total of 165 patients were treated (SNAP, 103; traditional protocol, 62). The mean (SD) age was 28.1 (19.7) years, and most were female (70.5%). No differences in peak transaminase levels were observed. SNAP-treated patients had significantly fewer adverse effects as well as shorter stays both in the ED (17.8 [15.2] hours vs 25.9 [17.1] hours; P = .001) and on the ward (2.6 [2.3] days vs 4.4 [3.6] days; P = .019).</p><p><strong>Conclusions: </strong>Fewer adverse events occurred with the SNAP approach. The 2 protocols were similarly effective. The SNAP-treated patients spent less time in the ED, and those who were admitted to hospital had shorter stays.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 1","pages":"39-43"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082879","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":"Artificial intelligence as a diagnostic support tool in emergency departments.","authors":"Daniel Sáenz-Abad, Mónica Sachi Martínez-Mihara, María Del Carmen Lahoza-Pérez","doi":"10.55633/s3me/089.2024","DOIUrl":"10.55633/s3me/089.2024","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 1","pages":"78-79"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082820","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":"Scale to predict risk for refractory septic shock based on a hybrid approach using machine learning and regression modeling.","authors":"Sejin Heo, Daun Jeong, Minyoung Choi, Inkyu Kim, Minha Kim, Ye Rim Lee, Byuk Sung Ko, Seung Mok Ryoo, Eunah Han, Hyunglan Chang, Chang June Yune, Hui Jai Lee, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Tae Ho Lim, Won Young Kim, Kyuseok Kim, Sung Yeon Hwang, Jong Eun Park, Gun Tak Lee, Tae Gun Shin","doi":"10.55633/s3me/108.2024","DOIUrl":"https://doi.org/10.55633/s3me/108.2024","url":null,"abstract":"<p><strong>Objective: </strong>To develop a scale to predict refractory septic shock (SS) based on clinical variables recorded during initial evaluations of patients.</p><p><strong>Methods: </strong>Multicenter retrospective study of data for patients with suspected infection registered in the Marketplace for Medical Information in Intensive Care (MIMIC-IV). These data were used for the development and internal validation of the refractory SS scale (RSSS). For external validation, we used retrospective data for 2 cohorts: 1) patients diagnosed with SS in an emergency department (ED cohort) whose data were registered in a Korean SS registry, and 2) patients diagnosed with SS in 6 hospital intensive care units (ICU cohort). A machine-learning automatic clinical scoring system (AutoScore) was used in the development phase. The performance of the RSSS in the validation cohorts was assessed with the area under the receiver operating characteristic curve (AUROC) for each. The primary outcome was the development of refractory SS within 24 hours of ICU admission. Refractory SS was defined by the need for a norepinephrine-equivalent dose greater than 0.5 µg/kg/min.</p><p><strong>Results: </strong>We collected data for 29 618 patients from the MIMIC-IV registry, 3113 patients for the ED cohort, and 1015 for the ICU cohort. The RSSS had 6 predictors: serum lactate level, systolic blood pressure, heart rate, temperature, arterial pH, and leukocyte count. The scale's AUROCs were as follows: 0.873 (95% CI, 0.846-0.900) in the internal validation, 0.705 (95% CI, 0.678-0.733) in the ED cohort on arrival, 0.781 (95% CI, 0.757-0.805) in the ED cohort at the moment of diagnosing hypoperfusion or hypotension, and 0.822 (95% CI, 0.787-0.857) in the ICU cohort. Calibration was acceptable in all the cohorts.</p><p><strong>Conclusions: </strong>The RSSS had adequate diagnostic accuracy in multiple cohorts of patients diagnosed in the ED and ICU.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 1","pages":"15-22"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082961","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}