Experiencia en el desarrollo e implementación de la metodología de grupos relacionados por diagnóstico en un hospital universitario chileno. Evaluación a diez años de funcionamiento / Implementation of diagnosis related groups methodology in a university hospital

Background The Diagnosis Related Groups (DRG) constitute a method of classifying hospital discharges. Aim To report its development and implementation in a Chilean University Hospital and global results of 10 years Material and Methods We included 231,600 discharges from 2007 to 2016. In the development we considered the physical plant, clinical record flow, progressively incorporated human resources and computer equipment for coding and analysis to obtain results. The parameters used were: average stay, average DRG weight, mean of diagnosis and codified procedures, behavior of upper outliers, hospital mortality, distribution by severity and its relationship with other variables. Results The global complexity index was 0.9929. The average of diagnoses coded was 4.35 and of procedures was 7.21. The average stay was 4.56 days, with a downward trend. The top outliers corresponded to 2.25%, with stable hospital days and average DRG weight. The median of hospital mortality was 1.65% with a tendency to decrease and stable DRG mean weight. Seventy two percent had a grade 1 severity, with low median hospital stay. They occupied 40% of bed days. Nine percent had a grade 3 severity with high median hospital stay and accounting for 31.5% of bed days. Conclusions DRG methodology is a valuable information tool for decision making and result assessment in hospital management.

Estudio epidemiológico descriptivo de pacientes hospitalizados en el Servicio de ORL del Hospital Clínico de la Universidad de Chile entre los años 2007 y 2014 / Descriptive epidemiological study of patients hospitalized in the ENT Department of the Hospital Clínico de la Universidad de Chile between the years 2007 and 2014

Introducción: Las enfermedades de origen otorrinolaringológico (ORL) tienen una elevada prevalencia en atención primaria de salud, sin embargo, la información epidemiológica en pacientes hospitalizados es bastante escasa. Objetivo: Obtener características demográficas y prevalencia de enfermedades en los pacientes hospitalizados del Servicio de ORL del Hospital Clínico de la Universidad de Chile (HCUCh). Material y método: Estudio de tipo descriptivo y retrospectivo, llevado a cabo en el Servicio de ORL del HCUCh, donde se revisaron los registros electrónicos, existentes de grupos relacionados a diagnóstico (GRD) de egresos, entre los años 2007 y 2014. Resultados: Se incluyeron 7.353 egresos, con un promedio de edad de los pacientes de 28,24 años. La causa de hospitalización más frecuente fue la patología de faringe. Del total de los egresos 87,88% presentaron una intervención quirúrgica donde la amigdalectomía con adenoidectomía alcanzó el 15,7% de las cirugías realizadas. Conclusión: Este estudio nos entrega información epidemiológica sobre los pacientes hospitalizados en un servicio de ORL de un hospital de referencia a nivel nacional.

Introduction: Diseases ofotolaryngology (ENT) origin have a high prevalence in primary health care, however, the epidemiological information on hospitalized patients is almost null. Aim: To obtain demographic and disease prevalence information in hospitalized patients of the ENT Department at the Hospital Clínico de la Universidad de Chile (HCUCh). Material and method: A descriptive and retrospective study, was carried out at the ENT department of the HCUCh, reviewing existing records of diagnostic related groups (GRD) for discharges between 2007 and 2014. Results: We review a total of 7353 discharges, with an average age of patients of 28.24 years. The most frequent cause of hospitalization was pharynx pathology. An 87.88% of discharges had surgery performed, where tonsillectomy with adenoidectomy reached 15,7% of the total. Conclusion: This study provides us with epidemiological information on patients hospitalized in an ENT department in a nationwide referral hospital.

Defectos de la pared abdominal. Estudio comparativo entre onfalocele y gastrosquisis / Abdominal wall defects. A Comparative investigation between omphalocele and gastroschisis

Introducción: Onfalocele y gastrosquisis son los defectos de la pared abdominal (DPA) más frecuentes, que por su importancia y las diferencias entre ellos merecen ser estudiados en forma especial. Objetivos: Establecer las tasas de prevalencia de onfalocele y gastroaquisis al nacimiento. Verificar variaciones de ellas en distintos períodos. Estudiar la morbimortalidad asociada y su sobrevida. Pacientes y Método: Se revisó la base de datos ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congênitas) para el período 1996-2010. Resultados: Se pesquizarón 33 recién nacidos (RN) con DPA. (11,6 por 10.000 nacimientos). De ellos 19 fueron onfalocele (6,7 por 10.000) y 14 (4,9 por 10.000) gastrosquisis. Los niños con onfalocele tenían significativamente mayor asociación con otras malformaciones, su frecuencia en el sexo masculino fue mayor y mostró mayor letalidad que la gastrosquisis. Todos los niños con gastrosquisis nacieron vivos, con predominio del sexo femenino, sus madres eran significativamente más jóvenes. Conclusión: Onfalocele y gastros-quisis presentaron una prevalencia al nacimiento mayor que lo publicado, probablemente por ser el HCUCH un Centro de Referencia. Ambas anomalías mostraron un aumento significativo en sus tasas de prevalencia al nacimiento al compararlas con las obtenidas anteriormente por nosotros en el mismo hospital. Se demostró diferencias significativas entre estas dos entidades: Onfalocele tiene mayor mortinatalidad, mortalidad y letalidad, mayor frecuencia de malformaciones asociadas y mayor promedio de edad materna.

Introduction: Omphalocele and Gastroschisis are the two most common congenital abdominal wall (AWD) defects. Objectives: To determine birth prevalence of Omphalocele and Gastroaquisis; to verify variations in different periods and to study the associated morbidity, mortality and survival. Patients and Method: The database of the Latin American Collaborative Study of Congenital Malformations (ECLAMC) was searched between the years 1996 and 2010. Results: 33 newborns (NB) with AWD were investigated (11.6 per 10,000 births). 19 of the cases corresponded to omphalocele (6.7 per 10,000 births) and 14 to gastroschisis (4.9 per 10,000 births). Children with omphalocele had significantly greater association with other malformations and the frequency in males was higher and showed higher mortality rates than gastroschisis. All children with gas-troschisis were born alive; they were predominantly female infants whose mothers were significantly younger. Conclusion: Birth omphalocele and gastroschisis prevalence were higher than published information, perhaps due to the fact that the HCUCH (Clinical Hospital of Universidad de Chile) is a reference center. Both anomalies showed a significant increase in their birth prevalence rates when compared with those previously obtained by us in the same hospital. Significant differences between these two entities were described. Omphalocele presented higher stillbirth, mortality and fatality rates; higher frequency of associated malformations and higher average maternal age.

Cambios en la distribución etaria de las madres en Chile y en el Hospital Clínico de la Universidad de Chile y su influencia en la morbimortalidad neonatal / Change in the age distribution of mothers in Chile and its influence on neonatal morbidity

Antecedentes: En las últimas décadas en Chile y otros países Sudamericanos se ha producido un cambio en la distribución etaria de las madres. Objetivos: Obtener la distribución de los nacimientos por grupos de edades maternas en el Hospital Clínico de la Universidad de Chile (HCUCH) y compararlos con iguales grupos en todo Chile. Comprobar que los grupos de edades extremas están aumentando. Estudiar la relación entre estos cambios con algunas patologías del recién nacido, como prematuridad, recién nacidos pequeños para su edad gestacional (PEG) y malformaciones congénitas. Método: Datos de la maternidad del HCUCH (1982-2010) y del Ministerio de Salud (1990-2008). Se distribuye a las madres en 3 grupos: <20, >35 y 20-34 años. Las comparaciones se hicieron con prueba de Chi Cuadrado. Resultados: En Chile el grupo de madres >35 años aumentó en más del 50 por ciento al comparar los años 1990 (10,2 por ciento del total) y 2008 por ciento(15,8 por ciento) (p<10-8). Las madres adolescentes en Chile aumentaron de 13,8 por ciento en 1990 a 16,6 por ciento en 1998 (p<10-8). En el HCUCH las adolescentes disminuyeron de 16,08 por ciento en 1982 a 9,09 por ciento en 2010 (p<10-8). Las >35 años aumentaron significativamente, al igual que en Chile, de 9,8 por ciento en 1982 a 22,17 por ciento en el año 2010 (p<10-8). Esta distribución etaria en el HCUCH (1996-2010) se asoció con otros cambios significativos: disminuyeron los RN PEG (p=0,02) y los prematuros (<37 semanas) aumentaron significativamente (p<0,00001). El grupo de mujeres >35 años se asocia con mayor cantidad de RN femeninos, malformaciones congénitas, síndrome de Down y partos por cesárea.

Introduction: In recent decades, both in Chile and other South American countries there has been a change in the age distribution of mothers. Objectives: To obtain the distribution of births by maternal age groups in the Hospital Clinic of the University of Chile (HCUCH) and compare them with similar groups throughout Chile. Check that the extreme age groups are increasing. To study the relationship between these changes and some diseases of the newborn, such as prematurity, infants small for gestational age (SGA) and birth defects. Methods: We reviewed the database of the Maternity HCUCH (1982-2010) and of the Ministry of Health (19902008). The mothers are distributed in 3 groups: <20, >35 and between 20-34 years. Comparisons were made with chi square test. Results: In Chile, the group of mothers >35 years old has increased by over 50 percent when comparing the 1990 (10.2 percent of total) and 2008 15.8 percent (p<10-8). Teenager mothers in Chile increased from 13.8 percent in 1990 to 16.6 percent in 1998 (p<10-8). In the HCUCH variations were different, adolescents decreased 16.08 percent in 1982 to 9.09 percent in 2010 (p<10-8). The >35 years increased significantly, as in all of Chile, 9.8 percent in 1982 to 22.17 percent in 2010 (p<10-8). The live birth age distribution in the HCUCH (1996-2010) led to significant changes: reducing SGA (p=0.02), the premature (<37 weeks) increased significantly (p<0.00001). The group of women >35 years is associated with increased number of children women, congenital malformations, Down syndrome and cesarean deliveries.

Restricción del crecimiento intrauterino como factor de riesgo para malformaciones congénitas / Fetal growth restriction as a risk factor for congenital malformations

Antecedentes: La restricción del crecimiento intrauterino (RCIU) se estima que está presente en el 5 por ciento de los nacimientos y es la manifestación de procesos aberrantes que impiden el desarrollo normal del feto. Objetivos: Estimar la frecuencia de esta patología en la maternidad del Hospital Clínico de la Universidad de Chile. Obtener la tasa prevalencia al nacimiento de malformaciones congénitas (MFC) y comparar la frecuencia en recién nacidos pequeños (PEG) con los adecuados (AEG) y grandes (GEG) para la edad gestacional. Método: Se estudian todos los nacimientos, vivos y mortinatos, ocurridos entre enero de 1997 a diciembre de 2008, contenidos en la base de datos del ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congénitas) desde 1969 a la fecha. Se excluyen los recién nacidos con malformaciones como hidrocefalia, anencefalia e hidrops, que por sus características dificultan la posibilidad de clasificación en PEG, AEG o GEG. Resultados: 10,1 por ciento de los nacimientos del período eran PEG. Entre los nacidos vivos 10 por ciento fueron PEG, mientras que 33,5 por ciento de los mortinatos eran PEG (p<0,05). Eran malformados el 12,9 por ciento de los PEG, 8,5 por ciento de los AEG y 9,3 por ciento de los GEG (p<0,05). La tasa global de malformaciones fue de 9,5 por ciento; en NV el 9,4 por ciento y en mortinatos el 33 por ciento. Conclusión: El RCIU es un factor que aumenta el riesgo de mortalidad fetal tardía y de presentar malformaciones congénitas.

Background: Fetal growth restriction (FGR) is the result of anomalies that prevent the normal development of the fetus, it is present in about the 5 percent of births. Objectives: To estimate the frequency of FGR in the Clinical Hospital of the University of Chile. To estimate the congenital malformation prevalence rate at birth and compare it among small (SGE), adequate (AGE) and large (LGE) newborns according their gestational age. Methods: All live births and stillbirths included in the ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congénitas) registered from January 1997 and December 2008 were considered. Newborns with congenital malformations that modified per se the size of the child, like hydrocephaly anencephaly and hydrops were excluded. Results: 10.1 percent of newborns were SGE. Among live births 10 percent were SGE instead of the 33.5 percent found in stillbirths (p<0.05). Congenital malformation rate at birth was 12.9 percent in SGE, 8.5 percent in AGE and 9.3 percent in LGE newborns (p<0.05). The global congenital malformation prevalence rate at birth was 9.5 percent; 9.4 percent in live newborns and 33 percent in stillbirth. Conclusion: The FGR increase the risk of late fetal mortality and congenital anomalies.

La edad paterna como factor de riesgo para malformaciones congénitas / Paternal age as a risk factor for congenital malformations

The role of advanced maternal age as a risk factor for congenital malformations in offspring is known. However, the influence of paternal age is not clear. Aim: To evaluate the association between advanced paternal age and the risk for congenital malformations. Patients and Methods: Analysis of maternal and paternal age of cases (malformed newborns) and controls from ECLAMC Database (Latin American Collaborative Study of Congenital Malformations) registered at the University of Chile Clinical Hospital during the decade from Jan 1 1997 to Dec 31 2006. Newborns and stillborns were grouped according to maternal age into 6 intervals. In each interval, paternal ages of cases and controls were compared. The inverse procedure was performed to assess maternal age effect. Other variables as gestational age and birth weight were analyzed for the intervals of maternal and paternal ages. Results: No significant differences were observed in paternal age between cases and controls in any of the intervals of maternal age. However, mean maternal age was higher for cases than for controls (p =0,0149). Gestational age and birth weight depend more on being case or control than on the age of parents. Conclusions: No differences in paternal age were observed between cases and controls in this series of newborns.

Edad materna y malformaciones congénitas: Un registro de 35 años: 1970-2005: [revisión] / The association between maternal age and congenital malformations: [review]

Background: There is an association between extreme maternal ages and the risk of congenital malformations. This is specially true for chromosomal abnormalities among women of advanced ages and disruptive malformation among teenage mothers. Aim: To determine the association between maternal ages and incidence of congenital malformations at the obstetric ward of a clinical hospital. To compare these figures with those of Chile. Material and methods: The hospital registries of the Latin American Collaborative Study of Congenital Malformations (ECLAMC) between 1996 and 2005, were consulted. This is a database of all marformations detected in newborns at the hospital. Results: An overall prevalence of malformations of8,4 percent was detected at the hospital. There is a significantly lower frequency of mothers aged less than 20 years than in the rest of Chile. Mothers aged between 20 and 29 years have the lower frequency of malformed children. Women aged íess than 20 years and over 39 years of age, account for 56 percent of malformed children. Maternal ages and the rates of malformations, increased in a parallel fashion at a rate of 0.2 years and 2.2 malformed children per 1,000 born alive, per calendar year, respectively. Conclusions: The association between prevalence rates of congenital malformations and maternal age is U chaped with a higher proportion of malformed children among women aged íess than 20 years or more than 39 years.

Efecto de la fortificación de la harina con ácido fólico sobre la evolución de las tasas de prevalencia al nacimiento de malformaciones congénitas en los hospitales chilenos del ECLAMC / Effects of folic acid fortification in the rates of malformations at birth in Chile

Background: The effects of folic acid fortification on neural tube defects is well known. Other reports show a beneficial effect of the fortification on orofacial clefts, urinary malformations and defects caused by limb reduction. Aim: To determine the changes in prevalence of congenital malformations after the start of flour folic acid fortification in Chile. Material and methods: The rates of 22 malformations occurring in the maternity of the University of Chile Clinical Hospital and other Chilean hospitals participating in the Latin American Collaborative Study of Congenital Malformations (ECLAMC) were compared before and after the start of flour folic acid fortification. Results: After the start of folic acid fortification a significant reduction in the rates of anencephalia, spina bifida and diaphragmatic hernia, was observed. The rates of all other malformations remained stable or increased. The rates of all malformations at the University of Chile Clinical Hospital had a steady increase until 2005 and were significantly higher than in the rest of hospitals participating in ECLAMC. Conclusions: Folic acid fortification was associated with an expected reduction in rates of spina bifida and anencephalia and an unexpected reduction in the rates of diaphragmatic hernia.

Vigilancia epidemiológica del síndrome de Down en Chile, 1972 a 2005 / Increasing rates of Down syndrome among newborns in Chile from 1972 to 2005

Background:There are some records shrowing that the frequency of Down syndrome is experiencing an increase over time. Aim: To verify whether the frequency of Down syndrome is increasing in the maternity of the University of Chile Clinical Hospital, or in other Chilean hospitals participating in the Latin American Collaborative Study of Congenital Malformations (ECLAMC) and compare the rates with other world registries of congenital malformations. Material and methods: The information was obtained from the ECLAMC databases of the maternity. The Down syndrome incidence rates were calculated from 1997 to 2005 and rate curves were constructed. Results: The overall rate of Down syndrome was 3.36 per 10,000 born alive. This rate experienced a significant increase in the study period. These rates differ in the different Chilean regions, being higher in Santiago and lower in the Southern regions of the country. The mean age of mothers of newborns with or without Down syndrome was 36±6 and 29±6 years, respectively, p >0.001. Conclusions: The rates of newborns with Down syndrome increased in the period 1972-2005, bearing a close relationship with the increase in maternal ages/.

La frecuencia de nacimientos de gemelos aumentó en un hospital chileno coincidiendo con el consumo periconcepcional de harina fortificada con ácido fólico / The frequency of twin pregnancies increased in a Chilean hospital associated with periconceptional flour folic acid supplementation

Background: A significant increase in the frequency of twins has been described in the literature as a secondary effect of perinatal supplementation with folic acid. Aim: To verify if the frequency of twins increased in a Chilean hospital, after the start of flour folic acid supplementation. Material and methods: The frequency of twins was compared in the University of Chile Clinical Hospital, before and after the start of flour fortification with folic acid. Results: There was a 34% increase in the frequency of twins during the post fortification period (2001-2004) as compared with the previous period (1998-2000). A decrease in the frequency of male twins, when compared with single newborns, was also observed in the post fortification period. There was a higher frequency of stillborns among twins, when compared with single newborns. Conclusions: The frequency of twin pregnancies increased after flour folic acid supplementation in sample of Chilean population.

Experiencia del registro electrónico de pacientes en un Servicio Universitario de Neonatología / Experience with electronic files in a University Neonatology Unit

The electronic file is a reality in medical practice nowadays. We have a decade of experience with electronic files in a neonatology unit. We use a local network that consists in one server and 8 connected computers, distributed in the hospital. Filemaker Pro® is used as database administrator and access to data is protected with passwords. Data entry is made by health care professionals in charge of the patients. Patient's reports and statistical information are based on data entered to the system. This methodology allows to have update clinical data, indexing of information, to maintain track of pharmacological indications, prescribe parenteral nutrition and obtain information for research purpose. It is possible therefore, with a minimal computing expertise, to devise electronic files that can improve the quality of health care.

Contacto perinatal con sarampión materno aparente / Perinatal contact with aparent maternal measles

Se comunican dos casos de recién nacidos de término, de madres con evidencia de sarampión perinatal. La madre de 24 años de edad, del primer niño, tuvo fiebre y signos respiratorios catarrales, seguidos de erupción cutánea morbiliforme días y horas antes, respectivamente, del parto. El recién nacido fue aislado de inmediato y recibió gamaglobulina intramuscular en las primeras horas de vida, evolucionando posteriormente sin evidencia de enfermedad. El segundo paciente permaneció con su madre, aparentemente sana durante el trabajo de parto, las primeras 24 horas de vida, al término de las cuales ella presentó el exantema característico. El paciente fue aislado, pero no recibió gamaglobulina. A los 8 días de edad mostró signos catarrales respiratorios, altos y bajos y a los 10 días dificultad respiratoria, hipoxemia, erupción cutánea morbiliforme y signos radiológicos de condensación pulmonar. Los cultivos de secreción nasal dieron desarrollo de Stafilococcus aureus. Fue tratado con oxígeno, F 102 50%, mediante capota, cloxacilina y ampicilina endovenosas, mejorando sus manifestaciones clínicas hacia los 15 días de edad, siendo dado de alta en buenas condiciones algunos días después