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

{"title":"Influence of income on in-hospital mortality in older adults during the first wave of the COVID-19 pandemic: results from the EDEN-33 study.","authors":"Lourdes Artajona, Ana García-Martínez, Sira Aguiló, Guillermo Burillo-Putze, Aitor Alquézar-Arbé, Cesáreo Fernández, Amparo Fernández-Simón, María Fernández Cardona, María Teresa Maza Vera, Marta Iglesias Vela, Patricia Trenc Español, Manuel Salido Mota, Ángel García García, Carmen Lucena Aguilera, Ferran Llopis, Pablo Herrero, Adriana Laura Doi Grande, Leticia Serrano Lázaro, Ana Chacon García, José J Noceda Bermejo, Amanda Ibisate Cubillas, María José Hernández Martínez, Francesc Xavier Alemany González, Susana Sánchez Ramón, Begoña Espinosa Fernández, Juan González Del Castillo, Òscar Miró","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether income was associated with unexpected in-hospital mortality in older patients treated in Spanish public health system hospital emergency departments.</p><p><strong>Material and methods: </strong>Fifty-one public health system hospital emergency departments in Spain voluntarily participated in the study. Together the hospitals covered 25% of the population aged 65 years or older included in all patient registers during a week in the pre-pandemic period (April 1-7, 2019) and a week during the COVID-19 pandemic (March 30 to April 5, 2020). We estimated a patient's gross income as the amount published for the postal code of the patient's address. We then calculated the standardized gross income (SGI) by dividing the patient's estimated income by the mean for the corresponding territory (Spanish autonomous community). The existence and strength of an association between the SGI and in-hospital mortality was evaluated by means of restricted cubic spline (RCS) curves adjusted for 10 patient characteristics at baseline. Odds ratios (ORs) for each income level were expressed in relation to a reference SGI of 1 (the mean income for the corresponding autonomous community). We compared the COVID-19 and pre-pandemic periods by means of first-order interactions.</p><p><strong>Results: </strong>Of the 35 280 patients attended in the 2 periods, gross income could be ascertained for 21 180 (60%), 15437 in the pre-pandemic period and 5746 during the COVID-19 period. SGIs were slightly higher for patients included before the pandemic (1.006 vs 0.994; P = .012). In-hospital mortality was 5.6% overall and higher during the pandemic (2.8% pre-pandemic vs 13.1% during COVID-19; P .001). The adjusted RCS curves showed that associations between income and mortality differed between the 2 periods (interaction P = .004). Whereas there were no significant income-influenced differences in mortality before the pandemic, mortality increased during the pandemic in the lowest-income population (SGI 0.5 OR, 1.82; 95% CI, 1.32-3.37) and in higher-income populations (SGI 1.5 OR, 1.32; 95% CI, 1.04-1.68, and SGI 2 OR, 1.92; 95% CI, 1.14-3.23). We found no significant differences between patients with COVID-19 and those with other diagnoses (interaction P = .667).</p><p><strong>Conclusion: </strong>The gross income of patients attended in Spanish public health system hospital emergency departments, estimated according to a patient's address and postal code, was associated with in-hospital mortality, which was higher for patients with the lowest and 2 higher income levels. The reasons for these associations might be different for each income level and should be investigated in the future.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812268","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":"Patient transfers from emergency departments to other in-hospital areas: a failure mode and effects analysis.","authors":"Antonio Prieto-Molina, Marta Aranda-Gallardo, Ana Belén Moya-Suárez, Francisco Rivas-Ruiz, Joaquín Peláez-Cherino, José Carlos Canca-Sánchez","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To perform an in-depth analysis of the process of transferring patients from an emergency department (ED) to other areas inside a hospital and identify possible points of failure and risk so that strategies for improvement can be developed.</p><p><strong>Material and methods: </strong>We formed a multidisciplinary group of ED and other personnel working with hospitalized adults. The group applied failure mode and effects analysis (FMEA) to understand the in-hospital transfer processes. A risk priority scoring system was then established to assess the seriousness of each risk and the likelihood it would appear and be detected.</p><p><strong>Results: </strong>We identified 8 transfer subprocesses and 14 critical points at which failures could occur. Processes related to administering medications and identifying patients were the components that received the highest risk priority scores. Improvement strategies were established for all risks. The group created a specific protocol for in-hospital transfers and a checklist to use during handovers.</p><p><strong>Conclusion: </strong>The FMEA method helped the group to identify points when there is risk of failure during patient transfers and to define ways to improve patient safety.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812631","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":"Amphetamine-positive urine screen in a patient treated with metoclopramide.","authors":"Verónica Martínez Pina, María Luisa Gil del Castillo, Iria Cebreiros López, Ana María Cerón Moreno, Pedro José Sánchez Carretero, José Antonio Noguera Velasco","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811330","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":"Anticoagulants for acute ischaemic stroke: a Cochrane review.","authors":"Xia Wang, Menglu Ouyang, Jie Yang, Lili Song, Min Yang, Craig S Anderson","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811350","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":"Bladder catheterization in the emergency department: Think twice before catheterizing?","authors":"Alberto Villamor Ordozgoiti, Emília Miró","doi":"10.55633/s3me/E02.2023","DOIUrl":"10.55633/s3me/E02.2023","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811696","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":"The patient's experience: a new view of the emergency department?","authors":"Lara Guillén García, Francisco José Chamorro Martín, Cristina Martín Tarapiella, Pierre Malchair","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813304","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":"Factors related to patients' perception of feeling safe in pre-hospital emergencies: a multicenter cross-sectional study.","authors":"Juan-Antonio Péculo-Carrasco, Hugo-José Rodríguez-Ruiz, Antonio Puerta-Córdoba, José-Manuel de la Fuente-Rodríguez, Mónica Rodríguez-Bouza, Inmaculada Failde","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To identify factors related to patients' feeling of safety during prehospital emergencies.</p><p><strong>Material and methods: </strong>Descriptive, multicenter cross-sectional study in the context of \"061\" emergency response services of Andalusia, Spain. Data were collected from April 2021 to March 2022. Patients attended and transported by emergency responders were eligible for inclusion. Patients were excluded if they were minors or in an altered state of consciousness, or had cognitive impairment or any barrier to communication. We calculated that a minimum sample size of 644 patients would be required. The outcome variable was the score on a 16-item scale of patient-perceived safety (ESP16, as abbreviated in Spanish). Sociodemographic, emergency service response, patient, and hospital transfer variables were studied in relation to ESP16 score. We also collected patient safety incident reports. Multivariate linear regression was used to analyze associations between the independent variables and the dependent outcome variable. Guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) were followed.</p><p><strong>Results: </strong>We received 1756 responses. The mean (SD) ESP16 score was 77.7 (5.6); the median score was 80. The β􀀃 coefficients derived from the linear regression model were as follows for the variables associated with the ESP16 score: 2.799 (P .001) for satisfaction; -6.097 (P .001) for incident reports of errors, falls, harm, or injury; -2.742 (P .001) for reports of any other incident during attendance; 2.538 (P = .001) for use of the transport protocol; 1.157 (P .001) for type of emergency transport used; 0.726 (P = .014) for a cardiology diagnosis; and 1.195 (P = .003) for pain intensity.</p><p><strong>Conclusion: </strong>Patients' perception of safety is very high, as reflected by level of satisfaction, incident reports, use of a transport protocol, means of transport used, diagnosis, and pain level.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811882","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":"Use of digoxin in the emergency department to treat patients with acute heart failure and its impact on short-term outcomes.","authors":"Enrique Martín Mojarro, Víctor Gil, Pere Llorens, Jesús Álvarez, Silvia Flores Quesada, Osvaldo J Troiano Ungerer, Aitor Alquézar-Arbé, Javier Jacob, Pablo Herrero-Puente, Begoña Espinosa, Carolina Sánchez, Lluis Llauger, Josep Tost, Leticia Serrano, Aitor Dávila, Raquel Torres Garate, María Luisa López-Grima, Francisco Javier Lucas-Imbernón, Héctor Alonso, Fran Pagán, José Manuel Garrido, Òscar Miró","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To analyze factors related to the use of digoxin to treat patients with acute heart failure (AHF) in emergency departments (EDs) and the impact of digoxin treatment on short-term outcomes.</p><p><strong>Material and methods: </strong>We included patients diagnosed with AHF in 45 Spanish EDs. The patients, who were not undergoing long-term treatment for heart failure, were classified according to whether or not they were given intravenous digoxin in the ED. Fifty-one patient or cardiac decompensation episode variables were recorded to profile ED patients treated with digoxin. Outcome variables studied were the need for hospital admission, prolonged stay in the ED (> 24 hours) for discharged patients, prolonged hospitalization (> 7 days) for admitted patients, and all-cause in-hospital or 30-day mortality. The associations between digoxin treatment and the outcomes were studied with odds ratios (ORs) adjusted for patient and AHF episode characteristics.</p><p><strong>Results: </strong>Data for 15 549 patients (median age, 83 years; 55% women) were analyzed; 1430 (9.2%) were treated with digoxin. Digoxin was used more often in women, young patients, and those with better New York Heart Association (NYHA) classifications but more severe cardiac decompensation, especially if the trigger was atrial fibrillation with rapid ventricular response. Admissions were ordered for 75.4% of the patients overall (81.6% of digoxin-treated patients vs 74.8% of nontreated patients; P .001). The ED stay was prolonged in 38.3% of patients discharged from the ED (52.9% of digoxin-treated patients vs 37.2% of nontreated patients; P .001). The duration of hospital stay was prolonged in 48.1% (digoxin-treated, 49.3% vs 47.9%; P = .385). In-hospital mortality was 7.2% overall (6.9% vs 7.2%, P= .712), and 30-day mortality was 9.7% (9.3% vs 9.7%, P = .625). ED use of digoxin was associated with a prolonged stay in the department (adjusted OR, 1.883; 95% CI, 1.359-2.608) but not with hospitalization or mortality.</p><p><strong>Conclusion: </strong>Digoxin continues to be used in one out of ten ED patients who are not already on long-term treatment with the drug. Digoxin use is associated with cardiac decompensation triggered by atrial fibrillation with rapid ventricular response, younger age, women, and patients with better initial NYHA function status but possibly more severe decompensation. Digoxin use leads to a longer ED stay but is safe, as it is not associated with need for admission, prolonged hospitalization, or short-term mortality.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813315","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":"Factors related to bladder catheterization in older patients and its possible association with prognosis: results of the EDEN-30 study.","authors":"Patricia Eiroa-Hernández, Sebastián Matos, Sira Aguiló, Aitor Alquézar-Arbé, Javier Jacob, Cesáreo Fernández, Pere Llorens, Sandra Moreno Ruíz, Lidia Cuevas Jiménez, Aarati Vaswani-Bulchand, Montserrat Rodríguez-Cabrera, Maribel Coromoto Suárez Pineda, Sara Alegre Fresno, Ivet Gina Osorio, Ana María Puche Alcaraz, Jésica Mansilla Collado, Mónica Veguillas Benito, Francisco Chamorro, Lorenzo Álvarez Rocío, Valle Toro Gallardo, Fahd Beddar Chaib, Jorge Pedraza García, Francisco de Borja Quero Espinosa, Montserrat Jiménez Lucena, Gabriel Yepez León, Enrique González Revuelta, Sara Sánchez Aroca, Juan González Del Castillo, Guillermo Burillo-Putze, Òscar Miró","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>The aims of this study in the Emergency Department and Elder Needs (EDEN) series were to explore associations between clinical variables on arrival at the ED (baseline) and the insertion of a bladder catheter, and the relation between catheterization and deterioration to a more complex or serious clinical state.</p><p><strong>Material and methods: </strong>Included were all patients aged 65 years or older attended during 1 week in 52 Spanish EDs. Patients were grouped according to whether a bladder catheter was or was not inserted in the ED. We used multivariable logistical regression to explore associations between catheterization and patient age, sex, 10 comorbidities, 7 baseline status variables, and 6 clinical variables. Progression was considered serious or complex if the patient died or required hospitalization, a prolonged hospital stay, or discharge to a care facility. We also explored the association between age and catheterization using adjusted restricted cubic spline (RCS) curves with a cutoff value of 65 years.</p><p><strong>Results: </strong>Participating hospitals enrolled 24 573 patients; bladder catheters were inserted in 976 (4%). Of these, 44.3% were discharged from the ED. Fifteen of the 24 variables were independently associated with bladder catheterization. Factors with the strongest associations according to odds ratios (ORs) were impaired consciousness (OR, 2.50; 95% CI, 1.90-3.30), dehydration (OR, 2.24; 95% CI, 1.85-2.72), and male sex (OR, 2.12; 95% CI, 1.84- 2.44). Age 80 years or older was also associated with bladder catheterization (OR, 1.17; 95% CI, 1.01-1.358). The adjusted RCS curves showed a progressive linear increase in the probability of catheterization with age. The increase was constant in men and stabilized after the age of 85 years in women (P-interaction .001). Bladder catheterization was associated with hospitalization (OR, 2.31; 95% CI, 1.99-2.68), intensive care unit admission (OR, 4.64; 95% CI, 3.04-7.09), prolonged stay in the ED for discharged patients (OR, 2.28; 95% CI, 1.75-2.96), in-hospital death (OR, 1.99; 95% CI, 1.54-2.57), and 30-day death (OR, 1.66; 95% CI, 1.33-2.08). No associations were found between catheterization and prolonged hospital stay (OR, 1.11; 95% CI, 0.92-1.34) or need for a care facility on discharge (OR, 1.50; 95% CI, 0.98-2.29).</p><p><strong>Conclusion: </strong>Certain patient characteristics and baseline clinical conditions are associated with bladder catheterization in patients of advanced age. The main factors were decreased consciousness, dehydration, and male sex. Even after adjustment for related factors, catheterization is independently associated with progression to more complex or serious clinical states.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811766","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 intentional and unintentional injury and the average income in a patient's area of residence.","authors":"Hugo Fernández-Hervás, Carlos García Fuentes, Jesús Abelardo Barea-Mendoza, Pedro Gullón Tosio, Alejandro Caballo Manuel, Mario Chico-Fernández","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811677","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}