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

{"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}

{"title":"Heterogeneity of regional protocols for the management of suicide attempts in emergency departments in Spain: The need for a unified framework.","authors":"Sonia Muñoz Carrasco, Ángel Vicario-Merino","doi":"10.55633/s3me/047.2026","DOIUrl":"https://doi.org/10.55633/s3me/047.2026","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 3","pages":"221-223"},"PeriodicalIF":6.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321329","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":"Effect of beta-blockers on the diagnosis of pulmonary embolism in the emergency department.","authors":"Laura Lozano Polo, Jesús Ruiz Ramos, Pedro C Ruiz Artacho, Sonia Jiménez Hernández, Adrián Plaza Díaz","doi":"10.55633/s3me/060.2026","DOIUrl":"10.55633/s3me/060.2026","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 3","pages":"237"},"PeriodicalIF":6.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321313","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":"Renal replacement therapies and adherence to EXTRIP consensus criteria in lithium poisoning: the multicenter SILITOX study.","authors":"Álvaro Pineda-Torcuato, Antonio F Caballero-Bermejo, August Supervía, Emilio Salgado, Ruadhan O'Laoi, Carolina Sánchez, Francisca Córdoba, Neus Rodríguez Farré, Natalia Sanz-López, Héctor Hernández Ontiveros, Blanca Andrea Gallardo Sánchez, Paula Romero Gallardo, Victoria Lobo-Antuña, Benjamín Climent, Sandra Mora, Alberto Cózar-Llistó, Marina Vergara Ortiz, Mikel Urroz, Valle Molina Samper, Pablo Navarro Román, Xavier Canseco Suárez, Francisco J Callado Moro, Cormack Kennedy, María Del Pilar Gómez Jiménez, Mª Angels Gispert, Macarena Mínguez, Isabel Llopis Sanmillán, Luca Cioccari, Beatriz Martín Pérez, Susanna Vert García, Jaime Laureiro Gonzalo, Guillermo Burillo, Edith Gutiérrez, Santiago Nogué-Xarau, Jordi Puiguriguer-Ferrando, Belén Ruiz-Antorán","doi":"10.55633/s3me/040.2026","DOIUrl":"10.55633/s3me/040.2026","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate adherence to the recommendations of the EXTRIP (Extracorporeal Treatments In Poisoning) group for the indication of renal replacement therapy (RRT) in patients with lithium poisoning, determine factors associated with the use of this therapeutic method, and analyze its impact on clinical outcomes.</p><p><strong>Methods: </strong>Multicenter international observational study including all episodes of lithium poisoning treated from 2015 through 2022 in emergency departments (ED) and clinical toxicology units (CTU) of 23 tertiary referral centers in Spain, Ireland, and Switzerland. Events were retrospectively classified according to EXTRIP criteria as RRT recommended, suggested, or not recommended. Adherence to these recommendations and their association with clinical outcomes were analyzed using uni- and multivariate analyses.</p><p><strong>Results: </strong>A total of 548 episodes of lithium poisoning were analyzed, of which 119 (21.7%) received RRT. According to EXTRIP criteria, RRT was recommended in 161 episodes (29.4%), suggested in 137 (25%), and not recommended in 250 (45.6%). Overall adherence to EXTRIP was 77.2%, and 69.6% when considering only strict indications. No significant differences were observed between adherent and non-adherent groups in the incidence of SILENT (Syndrome of Irreversible Lithium-Effectuated Neurotoxicity) at 60 days (7.1% vs 5.6%), need for critical care admission (16.8% vs 16.1%), or in-hospital mortality (3.3% vs 5.6%). Peak lithium concentration [3.45 (SD, 1.53) vs 2.05 (SD, 0.71) mEq/L; P < .001], decreased level of consciousness [49 (41.2%) vs 92 (21.4%); P < .001], and presence of atrioventricular block [6 (5.0%) vs 5 (1.2%); P = .008] were independent predictors for performing RRT.</p><p><strong>Conclusions: </strong>Adherence to EXTRIP recommendations was moderate to high but was not associated with improved clinical outcomes. These findings support an individualized approach based on clinical assessment when indicating RRT and suggest the need to refine EXTRIP criteria to improve applicability in real-world practice.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 3","pages":"186-194"},"PeriodicalIF":6.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321269","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":"Feasibility, safety and efficacy of a care model based on multidimensional frailty assessment (3D/3D+), implemented in a hospital emergency department.","authors":"Dolors García-Pérez, Laura Robles-Perea, Ana Belén Vena-Martínez, Rosa Bononad-Compte, Joan Espaulella-Panicot, Anna Arnau","doi":"10.55633/s3me/044.2026","DOIUrl":"10.55633/s3me/044.2026","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility, safety and efficacy of a care model based on multidimensional frailty assessment (3D/3D+), progressively implemented in a hospital emergency department (ED) for patients aged 75 years or older.</p><p><strong>Methods: </strong>A type 1 hybrid effectiveness-implementation study. All medical emergency episodes involving patients aged 75 years or older attended from January 1st, 2018 through December 31st, 2023, were included. Multivariable autoregressive moving average (ARMA) time-series models were used to estimate the impact on hospital admission conversion rate, length of hospital stay, discharge destination from the ED, and revisits at 72 hours and 30 days.</p><p><strong>Results: </strong>A total of 66,422 episodes were included, with a median age of 83.9 years (IQR, 79.4-88.3); 58.1% were women, and 61.5% had Model Andorrà de Triatge (MAT-SET) triage levels I-III. The multivariable time-series model adjusted for age and sex showed a 5-percentage point reduction in the proportion of hospital admissions in 2023 (β = -0.055; 95% CI, from -0.090 to -0.020) among high-priority episodes. In addition, there was a reduction in hospital stays > 2 days, an increase in referrals to intermediate care hospitalization, and a decrease in 30-day revisits, in both low- and high-priority episodes.</p><p><strong>Conclusions: </strong>The study demonstrates the feasibility and effectiveness of transforming emergency care toward integrated, value-based practices centered on frailty using 3D/3D+ multidimensional assessment.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"38 3","pages":"163-172"},"PeriodicalIF":6.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321340","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}