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

{"title":"Exploring the triage accuracy of the Manchester Triage System and the Emergency Severity Index in emergency department patients with sepsis: A secondary retrospective analysis.","authors":"Philipp Schondelmaier, Anna Slagman, Martin Möckel, Antje Fischer-Rosinský, Konrad Reinhart, Catalina De La Cruz Macias, Angelika Stacke, Johannes Winning, Michael Bauer, Myrto Bolanaki","doi":"10.55633/s3me/074.2026","DOIUrl":"10.55633/s3me/074.2026","url":null,"abstract":"<p><strong>Objective: </strong>To meet the requirement of the Sepsis-3 guidelines for rapid initiation of treatment, emergency department (ED) triage systems must assign patients with suspected sepsis to the highest-priority triage categories. Our aim was to explore how effectively the Manchester Triage System (MTS) and the Emergency Severity Index (ESI) assign these patients to appropriate urgency categories and avoid undertriage.</p><p><strong>Methods: </strong>A secondary analysis was conducted from a prospective, multicenter observational study (LIFE-POC), which included patients presenting with suspected organ dysfunction in 1 of 3 participant EDs (2 using MTS and 1 using ESI). The primary endpoint was a diagnosis of sepsis within 24 hours of ED presentation. Patients diagnosed with sepsis who were assigned to urgent triage categories 1, 2, or 3 were classified as accurately triaged. Ethical approval was granted by the committees of the participating centers.</p><p><strong>Results: </strong>A total of 388 out of 1,424 patients were diagnosed with sepsis within 24 hours of ED presentation. MTS showed a sensitivity rate of 88.2% (undertriage, 11.8%), while ESI reached 99.0% (undertriage, 1.0%). Both triage tools demonstrated low specificity: 17.5% (MTS) and 2.7% (ESI). Binary logistic regression analysis indicated that the probability of sepsis increased with higher urgency triage categories and decreased in lower urgency categories.</p><p><strong>Conclusions: </strong>Both ESI and MTS demonstrated high sensitivity in assigning septic patients to higher urgency categories, with better performance by ESI. However, MTS showed superior discrimination between urgency levels and may therefore be more compatible with the resource limitations typically encountered in EDs.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 5","pages":"339-346"},"PeriodicalIF":6.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198464","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":"How can sepsis be suspected at triage?","authors":"Juan González Del Castillo","doi":"10.55633/s3me/106.2026","DOIUrl":"https://doi.org/10.55633/s3me/106.2026","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 5","pages":"323-324"},"PeriodicalIF":6.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198452","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":"Association between the emergency department length of stay in patients requiring hospitalization and in-hospital mortality: a systematic review and meta-analysis.","authors":"Christian Luis Di Paolo, Carla Boixeda, Carolina Rangel, Montserrat Rodríguez-Cabrera, Guillermo Burillo, Òscar Miró","doi":"10.55633/s3me/107.2026","DOIUrl":"10.55633/s3me/107.2026","url":null,"abstract":"<p><strong>Objective: </strong>To assess the association between the emergency department length of stay (EDLOS) and in-hospital mortality through an updated systematic review and meta-analysis.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 recommendations to identify studies published between January 2022 and December 2025 evaluating the association between EDLOS and in-hospital mortality. The identified studies were combined with those included in a former systematic review covering the period up to January 15, 2022. Searches were conducted across PubMed, MEDLINE, Web of Science, EMBASE, and Cochrane using the same search strategy. Studies including exclusively patients admitted to intensive care units (ICUs) were excluded. Separate meta-analyses were performed for each cutoff used to define prolonged EDLOS, along with an over all meta-analysis including all studies using a cutoff $ 6 hours; when the same study reported several cutoffs, only the longest cutoff was considered.</p><p><strong>Results: </strong>A total of 6,982 records were identified, and 16 new studies were included (9 suitable for meta-analysis).Together with the 20 studies from the former review (13 included in the meta-analysis), 36 studies were analyzed, 22 of which (9.3 million patients) were included in the quantitative synthesis. No statistically significant association was observed between prolonged EDLOS and in-hospital mortality for any of the cutoffs analyzed: < 4 hours (OR, 0.83; 95% CI, 0.29-2.35), $ 4 hours (OR, 0.82; 95% CI, 0.46-1.46), $ 5 hours (OR, 0.60; 95% CI, 0.21-1.70), $ 6 hours (OR, 0.95; 95% CI, 0.75-1.21), $ 8 hours (OR, 1.10; 95% CI, 0.73-1.65), and $ 24 hours (OR, 0.78; 95% CI, 0.56-1.08). Similarly, the overall meta-analysis showed no association (OR, 1.02; 95% CI, 0.85-1.23). Heterogeneity was high (I² = 80-98%; I² = 97% in the overall analysis), and no relevant publication bias was detected. Studies analyzing EDLOS as a continuous variable suggested increasing mortality with progressively longer stays. Some studies identified associations between prolonged EDLOS and longer hospitalizations, greater resource use, higher hospital costs, specific complications, and a greater need for ICU admission.</p><p><strong>Conclusions: </strong>The available evidence does not confirm an association between prolonged EDLOS and in-hospital mortality among hospitalized patients. The high degree of heterogeneity limits interpretation of the findings and highlights the need for studies using more homogeneous methodologies and definitions of EDLOS. Moreover, interpretation is limited by the inability to consistently distinguish care time from boarding time across the primary studies.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 5","pages":"359-375"},"PeriodicalIF":6.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198182","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":"In search of areté.","authors":"Miguel Castro Neira","doi":"10.55633/s3me/054.2026","DOIUrl":"https://doi.org/10.55633/s3me/054.2026","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 5","pages":"384-385"},"PeriodicalIF":6.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198526","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":"Meropenem as an antidote in severe valproic acid poisoning.","authors":"Diego Ángeles-Sistac, Edurne Fernández de Gamarra-Martínez, Nuria Rodríguez-Farré, María Estela Moreno-Martínez, Indalecio Morán-Chorro","doi":"10.55633/s3me/076.2026","DOIUrl":"https://doi.org/10.55633/s3me/076.2026","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 5","pages":"394-397"},"PeriodicalIF":6.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198572","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":"Common bile duct dilatation probably due to chronic tusi use.","authors":"Carla Boixeda, Javier Felipe Del Barrio, Miguel Ángel Galicia, Òscar Miró","doi":"10.55633/s3me/089.2026","DOIUrl":"https://doi.org/10.55633/s3me/089.2026","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 5","pages":"398-399"},"PeriodicalIF":6.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198448","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":"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}