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1.
Arch. pediatr. Urug ; 93(2): e205, dic. 2022. graf, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1383652

ABSTRACT

En marzo de 2020 se confirma el primer caso de enfermedad por coronavirus en Uruguay, recomendándose un confinamiento social. La atención sanitaria se redujo a servicios de urgencia y emergencia (SE). Objetivo: analizar las características de las consultas pediátricas en los SE del subsector público y privado en Uruguay, durante los primeros 4 meses de la pandemia por SARS-CoV-2. Metodología: estudio descriptivo, retrospectivo, multicéntrico. Resultados: participaron 23 SE de todas las regiones del país. Período 1 prepandemia: 14/03/19-29.07.19, período 2: 14/03/20-29/07/20 Consultas: período 1 n=121.116, período 2 n=33.099 (desciende 73%). Hospitalizaciones desde el SE: período 1 n= .6649 (tasa 5,5%). Período 2: n=2.948 (tasa 9,5%). Diagnósticos período 1: infección respiratoria aguda (IRA) alta 39.892 (33%), IRA baja 86.56 (7%), trauma menor 8.651 (7%), gastroenteritis 8.044 (6,6%), crisis asmática/CBO 7.974 (6,5%), lesiones 4.389 (3,6%), dolor abdominal 3.528 (3%), problemas de salud mental 859 (0,7%), convulsiones 758 (0,7%), patología social 678 (0,5%). Diagnósticos 2020: IRA alta 5.168 (16%), trauma menor 2.759 (8%), lesiones 2.652 (8%), dolor abdominal 1.494 (4,5%), gastroenteritis 1.296 (4%), asma/CBO 1.095 (3,3%), IRA baja 700 (2,1%), patología social 522 (1,6%), problemas de salud mental 471 (1,4%), convulsiones 408 (1,2%). Conclusiones: en los primeros meses de la pandemia hubo una reducción sostenida y significativo de consultas pediátricas en los SE. No hubo aumento en frecuencia absoluta de ninguno de los diagnósticos. Se registró un descenso histórico de las IRA bajas y las hospitalizaciones por esta causa en todo el país. Mantener una vigilancia de las consultas en los SE permitiría identificar e intervenir oportunamente si se produjeran cambios o situaciones de riesgo hasta el momento no detectadas.


In March 2020 the first case of coronavirus disease was confirmed in Uruguay, and lockdown was recommended. Health care services were reduced to Urgency and Emergency Services (ES). Objectives: to analyze the epidemiological characteristics of pediatric visits to the ES of the public and private subsector in Uruguay, during the first 4 months of the SARS-CoV-2 pandemic. Methods: descriptive, retrospective. Results: 23 institutions participated. 2 periods were considered: 1) pre-pandemic, 03/14/19 to 07/29/19, 2) 03/14/20 to 07/29/20. Visits: period 1: n=121,116 (< 15 years), period 2: n=33.099 (73% decrease). Hospital admissions: period 1: n=6,649 (rate 5.5). Period 2: n=2.948 (rate 9,5). Diagnoses period 1: High acute respiratory infection 39,892 (33%), low acute respiratory infection 8,656 (7%), minor trauma 8,651 (7%), gastroenteritis 8,044 (6,6%), asthmatic crisis/CBO 7.974 (6,5%), injuries 4,389 (3,6%), abdominal pain (3,528) 3%, mental health problems 859 (0.7%), seizures 758 (0.7%), social pathology 678 (0.5% ). 2020 diagnoses: high acute respiratory infection 5.168 (16%), minor trauma 2,759 (8%), injuries 2,652 (8%), abdominal pain 1,494 (4.5%), gastroenteritis 1,296 (4%), asthma/CBO 1,095 (3,3%), low acute respiratory infection 700 (2,1%), social pathology 522 (1,6%), mental health problems 471 (1,4%), seizures 408 (1,2%). Conclusions: in the first months of the pandemic there was a sustained and significant reduction in pediatric consultations in ES. There was no increase in absolute frequency of any of the diagnoses. There was a historical decrease in low respiratory infections and hospitalizations due to this cause in the whole country. Maintaining a surveillance of the visits in the ES would enable practitioners to identify and take action in case of changes or previously undetected risk situations.


Em março de 2020, foi confirmado o primeiro caso de doença por coronavírus no Uruguai, recomendando o confinamento. A assistência à saúde foi reduzida a serviços de urgência e emergência (SE). Objetivo: analisar as características das consultas pediátricas no SE do subsetor público e privado no Uruguai, durante os primeiros 4 meses da pandemia de SARS-CoV-2. Metodologia: estudo descritivo, retrospectivo, multicêntrico. Resultados: participaram 23 SEs de todas as regiões do país. Período pré-pandemia 1: 14/03/19-29/07/19, período 2: 14/03/20-29/07/20 Consultas: período 1 n=121.116, período 2 n=33.099 (redução de 73%) . Internações da SE: período 1 n= 0,6649 (taxa 5,5%). Período 2: n=2.948 (taxa de 9,5%). Diagnósticos do período 1: infecção respiratória aguda alta (IRA) 39.892 (33%), LRA baixa 86,56 (7%), trauma menor 8.651 (7%), gastroenterite 8.044 (6,6%), crise asmática/CBO 7.974 (6, 5% ), lesões 4.389 (3,6%), dor abdominal 3.528 (3%), problemas de saúde mental 859 (0,7%), convulsões 758 (0,7%), patologia social 678 (0,5%). Diagnósticos 2020: IRA alta 5.168 (16%), trauma leve 2.759 (8%), lesões 2.652 (8%), dor abdominal 1.494 (4,5%), gastroenterite 1.296 (4%), asma/CBO 1.095 (3, 3%), IRA baixa 700 (2,1%), patologia social 522 (1,6%), problemas de saúde mental 471 (1,4%), convulsões 408 (1,2%). Conclusões: nos primeiros meses da pandemia houve uma redução sustentada e significativa das consultas pediátricas no SE. Não houve aumento na frequência absoluta de nenhum dos diagnósticos. Foi registrado um decréscimo histórico de IRAs baixas e internações por essa causa em todo o país. A manutenção de uma vigilância das consultas no SE permitiria identificar e intervir atempadamente nos casos de alterações ou situações de risco que até agora não tinham sido detectadas.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Child Health/statistics & numerical data , Medical Care , Emergency Service, Hospital/statistics & numerical data , Pandemics , COVID-19/epidemiology , Uruguay/epidemiology , Retrospective Studies , Multicenter Study , Public Sector , Private Sector , Age and Sex Distribution
2.
Arch. pediatr. Urug ; 93(2): e222, dic. 2022. tab, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1411437

ABSTRACT

El Hospital Escuela del Litoral de Paysandú es un centro de referencia departamental y regional con un Servicio de Emergencia único. Asiste a 68.000 usuarios, 25% pediátrico. Objetivos: describir la epidemiología global de las consultas durante el año 2019 en el Servicio de Emergencia del Hospital Escuela del Litoral de Paysandú y las características de la población pediátrica que concurre al mismo. Analizar los principales motivos de consulta, demanda asistencial, nivel de gravedad, rol del médico que asiste al paciente pediátrico y destino del paciente. Material y métodos: estudio descriptivo retrospectivo de la demanda asistencial durante el año 2019. Descripción y análisis de las consultas pediátricas entre el 1 de enero y el 30 de junio de 2019. Resultados: 47.647 consultas, 11.411 pediátricas. Meses de mayor consulta: julio, agosto y octubre. N: 4.905, 34,4% preescolares. 89% de las consultas se clasificaron como nivel 4 y 5. La patología respiratoria predominó en todas las franjas etarias y meses del año. Los pacientes nivel 1 se derivaron a cuidados moderados o CTI, y uno falleció. Discusión y conclusiones: mayor demanda asistencial en los meses fríos por patologías respiratorias. 1 de cada 100 consultas corresponden a emergencia-urgencia y 1 de cada 5 menos urgentes. Inadecuado uso del Servicio de Emergencia con sobrecarga asistencial. Se confirma utilidad del triage como herramienta en un Servicio de Emergencia mixto


The School Hospital Hospital Escuela del Litoral de Paysandú is a departmental and regional reference center with a unique Emergency Service. It serves 68,000 users, 25% of which are pediatric users. Objectives: to describe the total epidemiology consultations in 2019 at the Emergency Service of the Hospital Escuela del Litoral de Paysandú and the characteristics of its emergency pediatric population. Analyze the key reasons for consultation, care demand, level of severity, the role of doctors who receive pediatric patients and patients' referral. Material and methods: retrospective descriptive study of the demand for care in 2019. Description and analysis of pediatric consultations between January 1 and June 30, 2019. Results: 47,647 consultations, 11,411 pediatric. Months of greater consultation: July, August and October. N: 4905. 34.4% preschool. 89% of the consultations were classified as level 4 and 5. Respiratory pathology prevailed in all age groups and months of the year. Level 1 patients were referred to moderate care or ICU and one died. Discussion and conclusions: higher demand for care in Winter months due to respiratory pathologies. 1 out of every 100 consultations belonged to Emergency-Urgency Services and 1 out of 5 were less urgent. Inadequate use of the Emergency Service with care overload. We confirm the effectiveness of Triage as a tool in a mixed Emergency Services patients' referral process.


O Hospital Escola do Litoral de Paysandú é um centro de referência departamental e regional com um Serviço de Emergência único. Atende 68.000 usuários, 25% pediátricos. Objetivos: descrever a epidemiologia geral das consultas durante o ano de 2019 no Serviço de Emergência do Hospital Escola de Paysandú e as características da população pediátrica que atende o Serviço de Emergência. Analisar os principais motivos de consulta, demanda de atendimento, grau de gravidade, atuação dos médicos que atendem os pacientes pediátricos e destino do paciente. Material e métodos: estudo descritivo retrospectivo da demanda de atendimento durante o ano de 2019. Descrição e análise das consultas pediátricas entre 1º de janeiro e 30 de junho. de 2019 Resultados: 47.647 consultas, 11.411 pediátricas. Meses de maior consulta: julho, agosto e outubro. N: 4.905. 34,4% pré-escolar. 89% das consultas foram classificadas como nível 4 e 5. A patologia respiratória prevaleceu em todas as faixas etárias e meses do ano. Pacientes nível 1 foram encaminhados para cuidados moderados ou UTI e um faleceu. Discussão e conclusões: maior procura de cuidados nos meses frios devido a patologias respiratórias. 1 em cada 100 consultas corresponde a Urgência-Emergência e 1 em cada 5 corresponde a consultas menos urgentes. Uso inadequado do Serviço de Emergência com sobrecarga de atendimento. Confirma-se a utilidade da Triagem como ferramenta em um Serviço de Emergência misto.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Physician's Role , Medical Care Statistics , Emergency Service, Hospital/statistics & numerical data , Pediatric Emergency Medicine/statistics & numerical data , Uruguay/epidemiology , Retrospective Studies , Age Distribution , Temporal Distribution
3.
Rev. cir. (Impr.) ; 74(1): 41-47, feb. 2022. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388917

ABSTRACT

Resumen Introducción: Las consultas en el servicio de urgencia (CU) y el reingreso (RI) hospitalario después de una cirugía bariátrica (CB) son importantes indicadores de calidad y seguridad. Sin embargo, existe escasa información de estos indicadores en nuestro medio nacional. En este trabajo analizamos las CU y RI de pacientes sometidos a una CB primaria en un centro universitario de alto volumen, y buscamos variables asociadas a estos indicadores. Materiales y Método: Estudio observacional retrospectivo que incluyó a todos los pacientes sometidos a bypass gástrico (BPG) o gastrectomía en manga (GM) laparoscópica primaria realizados de forma consecutiva en nuestra institución durante el período 2006-2007 y 2012-2013. Utilizando nuestros registros clínicos y base de seguimiento prospectivo, identificamos aquellos pacientes con CU o RI en nuestro hospital durante los primeros 30 días después del alta. Resultados: Se incluyeron 1.146 CB primarias, 53% (n = 613) fueron BPG y 47% (n = 533) GM. Un 8,03% (n = 92) de los pacientes tuvo al menos una CU y un 3,7% (n = 42) un RI. Las variables independientes asociadas tanto a CU como RI fueron el tiempo operatorio e índice de masa corporal (IMC) preoperatorio. No se encontró asociación estadística, en el periodo estudiado, para el tipo de CB realizada con la CU ni con el RI. Conclusión: Existe una baja proporción de pacientes que requieren CU y RI posterior a la CB, lo que demuestra la seguridad de estas intervenciones.


Introduction: Emergency department visits (EDV) and hospital readmission (HR) after bariatric surgery (BS) are important indicators of quality and safety in surgery, however there is little information on their characteristics in our national environment. Aim: In this work we analyze EDV and HR in patients undergoing a primary BS in a high-volume university center, and identify variables that could be associated with these indicators. Materials and Method: A retrospective observational study where we identified all patients undergoing Roux-in-Y gastric bypass (RYGBP) or primary laparoscopic sleeve gastrectomy (SG) performed consecutively at our institution during the period 2006-2007 and 2012-2013. Using our clinical records and prospective follow-up database, we identify those patients with EDV and/or HR in our hospital during the first 30 days after discharge. Results: 1146 primary BS were included, of these 53% (n = 613) were RYGBP and 47% (n = 533) SG. 8,03% (n = 92) of the patients had at least one EDV, of these 3,7% (n = 42) had an HR. The independent variables associated with EDV and HR were the operative time and preoperative body mass index (BMI). No statistical association was found, in the period studied, for the type of BS performed with EDV or HR. Conclusion: There is a low proportion of patients who require EDV and HR after BS, which demonstrates the safety of these interventions.


Subject(s)
Humans , Male , Female , Child , Adult , Gastric Bypass/methods , Bariatric Surgery/statistics & numerical data , Patient Readmission , Postoperative Complications , Multivariate Analysis , Risk Factors , Emergency Service, Hospital/statistics & numerical data , Gastrectomy
4.
Ciênc. cuid. saúde ; 21: e57088, 2022. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1384520

ABSTRACT

RESUMO Objetivo: descrever o perfil dos pacientes com crise hipertensiva atendidos em uma Unidade de Pronto Atendimento. Método: estudo transversal descritivo, realizado por meio da análise de 80 prontuários de pacientes com quadro de crise hipertensiva, atendidos em uma unidade de pronto atendimento, entre o período de março de 2018 a fevereiro de 2019. Os dados foram coletados por meio de roteiro estruturado e receberam tratamento estatístico descritivo. Resultados: Após a análise dos 80 prontuários, constatou-se que a média de idade entre os pacientes atendidos foi de 58,03, sendo a faixa etária adulta a mais prevalente (53,8%). Constatou-se que a média da pressão arterial sistólica foi significativamente maior em homens em relação às mulheres (p=0,013). Quanto à sintomatologia, a cefaleia foi a mais prevalente, com 35,0%. Verificou-se que durante o atendimento da crise hipertensiva, a maioria dos pacientes fez uso de apenas uma droga para redução da PA, sendo o inibidor adrenérgico de ação central o mais citado. Quanto ao desfecho, grande parte dos pacientes recebeu alta (93,8%) logo após o atendimento, porém, 6,3% permaneceram em internamento de curta permanência até a estabilização do quadro. Considerações finais: Este estudo possibilitou a caracterização da população com crise hipertensiva atendida em um pronto atendimento, a qual evidencia uma possível fragilidade existente entre a articulação dos níveis de atenção à saúde.


RESUMEN Objetivo: describir el perfil de los pacientes con crisis hipertensiva atendidos en una Unidad de Pronta Atención. Método: estudio transversal descriptivo, realizado por medio del análisis de 80 registros médicos de pacientes con cuadro de crisis hipertensiva, atendidos en una unidad de pronta atención, entre el período de marzo de 2018 a febrero de 2019. Los datos fueron recogidos por medio de guion estructurado y recibieron tratamiento estadístico descriptivo. Resultados: después del análisis de los 80 registros médicos, se constató que el promedio de edad entre los pacientes atendidos fue de 58,03, siendo la franja etaria adulta la más prevalente (53,8%). Se constató que el promedio de la presión arterial sistólica fue significativamente mayor en hombres que en las mujeres (p=0,013). En cuanto a la sintomatología, la cefalea fue la más prevalente, con 35,0%. Se verificó que, durante la atención de la crisis hipertensiva, la mayoría de los pacientes hizo uso de solo una droga para reducción de la PA, siendo el inhibidor adrenérgico de acción central el más relatado. Respecto al resultado, gran parte de los pacientes recibió el alta (93,8%) inmediatamente después de la atención, sin embargo, el 6,3% permaneció en internamiento de corta estancia hasta la estabilización del cuadro. Consideraciones finales: este estudio posibilitó la caracterización de la población con crisis hipertensiva atendida en una pronta atención, la cual evidencia una posible fragilidad existente entre la articulación de los niveles de atención a la salud.


ABSTRACT Objective: to describe the profile of patients with hypertensive crisis treated at an Emergency Care Unit. Method: descriptive cross-sectional study carried out through the analysis of 80 medical records of patients with hypertensive crisis, treated at an emergency care unit, between March 2018 and February 2019. Data were collected using a structured script and were subjected to descriptive statistical treatment. Results: after analyzing the 80 medical records, it was found that the mean age of the treated patients was 58.03, with the adult age group being the most prevalent (53.8%). It was found that the mean systolic blood pressure was significantly higher in men than in women (p=0.013). As for symptoms, headache was the most prevalent, with 35.0%. It was found that during the treatment of the hypertensive crisis, most patients used only one drug to reduce BP, with centrally acting antiadrenergic drugs being the most cited. Regarding the outcome, most of the patients were discharged (93.8%) soon after treatment; however, 6.3% remained in short-term hospitalization until their condition stabilized. Final considerations: this study made it possible to characterize the population with hypertensive crisis treated in an emergency room, showing a possible fragility in the articulation between health care levell


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Patients/psychology , Health Profile , Emergency Medical Services/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Hypertension/diagnosis , Hypertension/drug therapy , Medical Records/statistics & numerical data , Cross-Sectional Studies/methods , Nursing/statistics & numerical data , Delivery of Health Care/statistics & numerical data , Emergency Service, Hospital/standards , Arterial Pressure , Arterial Pressure/drug effects , Clinical Study , Hospitals, Packaged/statistics & numerical data , Hypertension/nursing , Hypertension/epidemiology
5.
Arch. pediatr. Urug ; 93(nspe1): e211, 2022.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1393871

ABSTRACT

Introducción: la Organización Mundial de la Salud declaró la pandemia por SARS-CoV-2 COVID-19 el 11 de marzo de 2020.En Uruguay se declaró estado de emergencia sanitaria y desde el 13 de marzo de 2020 se adoptaron medidas para evitar la propagación del virus, incluyendo reducción de la movilidad. Esto condicionó, entre otras cosas, la disminución de la concurrencia a centros de salud incluidas las consultas en emergencia pediátrica. Objetivo: describir las características de las consultas en el Servicio de Emergencia del Hospital Policial durante el período 14/3/2020-14/07/2020 en el contexto epidemiológico y compararla con el mismo período del 2019. Metodología: se realizó un estudio observacional descriptivo retrospectivo. Período considerado: desde el 14 de marzo al 14 de julio de 2019 y 2020. Se incluyeron todos los niños y adolescentes de 0 a 14 años inclusive que consultaron en el Servicio de Emergencia del Hospital Policial. Se consideraron variables epidemiológicas, clínicas y evolutivas. Fuente de datos: historias clínicas. Análisis estadístico: distribución de frecuencias, medidas de resumen y significancia. Resultados: la frecuencia absoluta de consultas en el período analizado fue de 2.765 en 2019 y de 576 en 2020. Se identificó 79% de reducción de consultas en 2020 con respecto a 2019. Las infecciones respiratorias disminuyeron un 53%; no así las crisis broncoobstructivas. Por otro lado, se vio un aumento de 87,5% en las lesiones por traumatismos/heridas cortantes. Se destaca el aumento de 427% de las consultas por escabiosis. No se identificó aumento significativo en las consultas por maltrato/abuso. Conclusiones: las consultas en emergencia pediátrica disminuyeron con respecto al año anterior, lo que se corresponde con comunicaciones internacionales. Las infecciones respiratorias continúan siendo el principal motivo de consulta. Existió un aumento significativo tanto en las lesiones como en la escabiosis lo que se puede relacionar con las medidas de confinamiento.


Summary: Introduction: the WHO declared the SARS-CoV-2 COVID-19 pandemic on 3/11/2020. A Public Health Emergency was declared in Uruguay and as of 3/13/2020 and different measures were adopted to prevent the spread of the virus, including the establishment of reduced mobility measures. This led, among other things, to a decrease in attendance levels at all health centers, including pediatric emergency consultations. Objective: to describe the characteristics of the consultations in the Emergency Service of the Police Hospital during 3/14/20-07/14/20 within an epidemiological context and to compare it with the same period in 2019. Methodology: we carried out a retrospective descriptive observational study from March 14 to July 14, 2019 and 2020. We included all children and adolescents from 0 to 14 years old including those who consulted in the Emergency Service of the Police Hospital. We considered epidemiological, clinical and evolutionary variables. Data source: medical records. Statistical analysis: frequency distribution, summary measures and significance. Results: the absolute frequency of consultations in the period analyzed was 2,765 in 2019 compared to 576 in 2020. A 79% reduction in consultations was identified in 2020 compared to 2019. Respiratory infections decreased by 53%, even though obstructive bronchial crises did not. On the other hand, we recorded a significant increase 87.5% in trauma/cutting injuries. A significant rise of 427% in consultations for scabies was observed. No significant growth in consultations for mistreatment/abuse was identified. Conclusions: pediatric emergency consultations decreased compared to the previous year, which matches the international literature. Respiratory infections continue to be the main reason for consultation. There was a significant increase in both lesions and scabies, which can be linked to the confinement measures.


Introdução: a OMS declarou a pandemia de SARS-CoV2 COVID 19 em 11/03/2020. O estado de emergência sanitária foi declarado no Uruguai e desde 13/03/2020 foram adotadas medidas para evitar a propagação do vírus, incluindo mobilidade reduzida. Isso ocasionou, entre outras coisas, uma diminuição do atendimento nos centros de saúde, incluindo as consultas de emergência pediátrica. Objetivo: descrever as características dos atendimentos no Serviço de Emergência do Hospital Policial durante o período de 14/03/20-14/07/20 no contexto epidemiológico e compará-lo com o mesmo período de 2019. Metodologia: foi realizado um estudo observacional descritivo retrospectivo. Período considerado de 14 de março a 14 de julho de 2019 e 2020. Foram incluídas todas as crianças e adolescentes de 0 a 14 anos inclusive aquelas que consultaram no Serviço de Emergência do Hospital Policial. Foram consideradas variáveis epidemiológicas, clínicas e evolutivas. Fonte de dados: prontuários médicos. Análise estatística: distribuição de frequência, medidas sumárias e significância. Resultados: a frequência absoluta de consultas no período analisado foi de 2.765 em 2019 e 576 em 2020. Identificou-se uma redução de 79% nas consultas em 2020 em relação a 2019. As infecções respiratórias diminuíram 53%; não assim as crises brônquicas obstrutivas. Por outro lado, observou-se um aumento significativo de 87,5% nos traumas/lesões cortantes. Destaca-se o aumento de consultas por sarna de 427%. Não foi identificado aumento significativo de consultas por maus-tratos/abuso. Conclusões: as consultas de urgência pediátrica diminuíram comparadas ao ano anterior, o que concorda com a literatura internacional. As infecções respiratórias continuam a ser o principal motivo de consulta. Houve aumento significativo tanto das lesões quanto da sarna, o que pode estar relacionado às medidas de confinamento.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Emergencies/epidemiology , Emergency Service, Hospital/statistics & numerical data , Uruguay/epidemiology , Retrospective Studies , Age and Sex Distribution , Pandemics , Observational Study , COVID-19/epidemiology
6.
Rev. pediatr. electrón ; 18(4): 7-15, dic. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1371044

ABSTRACT

Objetivos El objetivo de este estudio es determinar a qué tipo de patologías nos enfrentamos. Utilizamos la Clasificación Internacional de Atención Primaria para asegurar una nomenclatura objetiva y comparable. Métodos Se realizó un estudio descriptivo, observacional y retrospectivo de una muestra de 108102 consultas de atención primaria de pacientes que acudieron a Urgencias de nuestro hospital para evaluar la epidemiología de la atención pediátrica brindada entre 2011 y 2019. Utilizamos el sistema de clasificación diagnóstica ICPC-2. Resultados El número de asistencias fue mayor en enero, febrero y marzo, así como los fines de semana. Tras ser atendidos, el 6,7% de los pacientes ingresaron en nuestro hospital. Las patologías más frecuentes fueron las infecciones del tracto respiratorio superior, gastroenteritis, fiebre y traumatismos / lesiones. Las patologías que con mayor frecuencia dieron lugar a ingresos hospitalarios fueron fiebre, bronquitis, gastroenteritis y vómitos (p> 0,001). En los ingresos hospitalarios de menores de 1 año, la bronquitis fue la patología más frecuente, mientras que entre los de 1 a 6 años fue la gastroenteritis y entre los de 7 a 14 años fue la apendicitis aguda (p <0,001). Conclusiones Las patologías pediátricas suponen un porcentaje importante de las visitas a urgencias, destacando las infecciones del tracto respiratorio superior, las infecciones intestinales y la fiebre. Sería aconsejable incrementar los recursos de personal en los fines de semana. Es necesario enfatizar en la educación sanitaria de la población para ajustar la demanda de asistencia en los servicios públicos. Se requiere más investigación para adaptar mejor la terminología ICPC-2.


Objectives The aim of this study is to determine what type of pathologies we are facing. We use the International Classification of Primary Care to ensure an objective and comparable nomenclature. Methods We carried out a descriptive, observational, and retrospective study of a sample comprising 108102 primary care encounters of patients presenting at our hospital's Emergency Room to assess the epidemiology of the pediatric care provided between 2011 and 2019. We used the ICPC-2 diagnosis classification system. Results The number of attendances was higher in January, February, and March, as well as at weekends. After being seen, 6.7% of patients were admitted to our hospital. The most frequent pathologies were upper respiratory tract infections, gastroenteritis, fever and trauma/injury. Pathologies most frequently resulting in hospital admissions were fever, bronchitis, gastroenteritis and vomiting (p>0.001). In hospital admissions involving patients under 1 year of age, bronchitis was the most frequent pathology, while among those aged between 1 and 6 years, it was gastroenteritis and among those aged between 7 and 14 years it was acute appendicitis (p<0.001). Conclusions Pediatric pathologies account for a significant percentage of visits to the emergency room, highlighting infections of the upper respiratory tract, intestinal infections, and fever. It would be necessary to increase staff resources on the weekends. It is highly recommended to emphasize the health education of the population to adjust the demand for assistance in public services. More research is required to better adapt the ICPC-2 terminology.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Pediatrics , Pediatric Emergency Medicine/statistics & numerical data , Hospitals, General/statistics & numerical data , Respiratory Tract Infections/epidemiology , Wounds and Injuries/epidemiology , Retrospective Studies , Emergency Service, Hospital/statistics & numerical data , Fever/epidemiology , Gastroenteritis/epidemiology
7.
Rev. méd. Maule ; 36(2): 42-48, dic. 2021. graf, tab
Article in Spanish | LILACS | ID: biblio-1378497

ABSTRACT

Infection by SARS-COV-2, was first described in November 2019 in Wuhan, China. First chilean cases where reported in March 2020.Our objective was to identify epidemiological changes in the pediatric population in the emergency service of the Hospital Regional de Talca (HRT). We carried out an observational and retrospective study. The reason and number of consultations in pediatric patients in the emergency room was analyzed during the periods defined as "Pre-pandemic" and "Pandemic". The target population was all consulting patients between 0-15 years of age. We separated the cases according to the reason of consultation. We obtained the data from the HRT statistics department. The number of consultations decreased by 67.6% per month, while the number of patients who consulted in pediatric emergencies for respiratory symptoms decreased by 75.4% per month. Within the pandemic period, 15,101 COVID PCR samples were performed in pediatric patients, with 13.7% positivity. This allows us to see the epidemiological impact that this new disease has had on pediatric patients in the Maule región


Subject(s)
Humans , Child , Adolescent , Pediatrics , Pandemics , COVID-19/epidemiology , Hospitals, Public/statistics & numerical data , Epidemiology, Descriptive , Retrospective Studies , Emergency Service, Hospital/statistics & numerical data , Epidemiological Monitoring , COVID-19 Nucleic Acid Testing
8.
Rev. chil. obstet. ginecol. (En línea) ; 86(4): 347-352, ago. 2021. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388669

ABSTRACT

INTRODUCCIÓN: La pandemia de COVID-19 ha comportado una disminución de la consulta ginecológica al servicio de urgencia. OBJETIVO: Caracterizar las consultas en el servicio de urgencia ginecológica, evaluando la cantidad de hospitalizaciones, la necesidad de intervención quirúrgica y los factores de morbilidad, entre otros, comparado a la situación con la previa a la pandemia. MÉTODO: Se realizó un estudio de cohorte no concurrente de pacientes hospitalizadas tras una consulta espontánea al servicio de urgencia ginecológica entre las semanas 12 y 28 de 2019 y 2020 en el Hospital Clínico de la Pontificia Universidad Católica, en Santiago (Chile). Se determinaron distintos factores de morbilidad: diagnóstico de ingreso, intervención quirúrgica, complicación operatoria, días de hospitalización, hemoglobina/hematocrito de ingreso y necesidad de transfusión de unidades sanguíneas. RESULTADOS: Hubo 511 consultas al servicio de urgencia entre las semanas 12 y 28 del año 2019, en comparación con 196 el año 2020. En 2019 fueron hospitalizadas 103 mujeres, y en 2020 ingresaron 72 (odds ratio [OR]: 2.3). Disminuyó el ingreso por aborto retenido (24 vs. 12; p = 0.01), mientras que aumentó el ingreso por metrorragia posmenopáusica (9 vs 22; p = 0.01). No hubo cambio en las intervenciones quirúrgicas realizadas (86.4% vs. 84.7%; p = 0.7). Aumentaron los días de hospitalización (2.3 vs. 3.1; p < 0.0001) y la necesidad de transfusión sanguínea (2 vs. 7; p = 0.02; OR: 5.4; intervalo de confianza: 1.09-26). CONCLUSIONES: La pandemia de COVID-19 provocó una disminución en la consulta espontánea por patología ginecológica al servicio de urgencia, provocando un aumento en la relación consulta/ingreso y una mayor morbilidad en las pacientes hospitalizadas, caracterizada por una mayor necesidad de transfusión sanguínea y un aumento de los días de hospitalización.


INTRODUCTION: The COVID-19 pandemic has meant a decrease in gynecological visits to the emergency department. OBJECTIVE: To characterize the attending in the gynecological emergency service, evaluating the amount of admissions, hospitalizations, need for surgical intervention, morbidity factors, among others, compared to the pre-pandemic situation. METHOD: A non-concurrent cohort study of hospitalized patients was carried out through a spontaneous attending to the gynecological emergency service between weeks 12 and 28 of 2019 and 2020 at the Hospital Clínico of the Pontificia Universidad Católica, in Santiago (Chile). Different morbidity factors were measured: admission diagnosis, surgical intervention, surgical complication, hospital stay, admission hemoglobin, and need for transfusion of blood units. RESULTS: A total of 511 visitors to the emergency service were registered between weeks 12 and 28 of 2019, compared to 196 in 2020. In 2019 and 2020, 103 and 72 women were hospitalized respectively (odds ratio [OR]: 2.3). Admission for pregnancy loss decreased (24 vs. 12; p = 0.01), while admission for postmenopausal bleeding increased (9 vs. 22; p = 0.01). There was no change in the surgical interventions performed (86.4% vs. 84.7%; p = 0.7). The hospital stays increased (2.3 vs. 3.1; p < 0.0001) and the need for blood transfusion (2 vs. 7; p = 0.02; OR: 5.4; confidence interval: 1.09-26). CONCLUSIONS: The COVID-19 pandemic caused a decrease in spontaneous attending for gynecological pathology at the emergency service, causing an increase in the attend/admission ratio and greater morbidity in hospitalized patients characterized by a greater need for blood transfusion and an increase on the hospital stay.


Subject(s)
Humans , Female , Adult , Emergency Service, Hospital/statistics & numerical data , COVID-19 , Gynecology/statistics & numerical data , Gynecologic Surgical Procedures/statistics & numerical data , Obstetrics and Gynecology Department, Hospital/statistics & numerical data , Blood Transfusion , Confidence Intervals , Chile , Cohort Studies , Pandemics , SARS-CoV-2 , Hospitalization/statistics & numerical data , Length of Stay
9.
Säo Paulo med. j ; 139(2): 170-177, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1181006

ABSTRACT

ABSTRACT BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Pneumonia/diagnosis , Pneumonia/epidemiology , Triage/methods , Risk Assessment/methods , Emergency Service, Hospital/statistics & numerical data , Early Warning Score , COVID-19/therapy , Turkey , Uremia/etiology , Uremia/epidemiology , Blood Pressure , Retrospective Studies , Respiratory Rate/physiology , Pandemics , SARS-CoV-2 , COVID-19/diagnosis , COVID-19/epidemiology
10.
Rev. chil. obstet. ginecol. (En línea) ; 86(2): 152-162, abr. 2021. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388646

ABSTRACT

INTRODUCCIÓN: La red de atención de urgencia es fundamental en la salud de cualquier país. En Chile, los servicios de urgencia periódicamente están saturados por usuarios con patologías de carácter leve; lo mismo ocurre en las atenciones de urgencias gineco-obstétricas (UGO) en los centros de mediana y alta complejidad. OBJETIVO: Describir la categorización de las consultas de urgencias gineco-obstétricas en un hospital público de Chile, atendidas durante el año 2018. METODOLOGÍA: Estudio descriptivo y transversal que abarcó 3.077 consultas obtenidas de datos estadísticos anonimizados. RESULTADOS: De las UGO, el 58,3% fueron consultas obstétricas, el 36,9% ginecológicas y 4.8% neonatológicas; el 96% fueron consultantes mujeres; el 80,3% eran adultos y el 11,6% adolescentes; el 92,5% eran usuarios pertenecientes a la comuna de Penco; el mes más consultado fue mayo con 292 atenciones y el 71,5% de las consultas fueron atendidas en horario diurno. Los principales motivos de consulta obstétrica y ginecológica fueron el dolor y el sangramiento genital; en las urgencias neonatológicas, la ictericia fue el principal motivo de consulta. El diagnóstico más frecuente en las consultas obstétricas según clasificación CIE _10 fue la supervisión de embarazo normal, en las ginecológicas fue el dolor abdomino-pélvico y en las consultas neonatológicas, la ictericia; del total de consultas UGO un 91,1% fueron resueltas a nivel local. El 0,1% de las UGO fueron categorizadas como c1 y el 0,3% como c2, siendo la gran mayoría, consultas de baja complejidad. CONCLUSIONES: Existe un gran porcentaje de consultas de baja complejidad que sobrecargan el servicio de urgencia, afectando la calidad de la atención del hospital.


INTRODUCTION: the urgent care network is fundamental in the health of any country. In Chile, the emergency services are periodically saturated with users with mild pathologies; the same occurs in gynecological-obstetric emergency care (UGO) in more complex centers. OBJECTIVE: to describe the categorization of gynecological-obstetric emergency consultations in a public hospital in Chile, attended in 2018. METHODOLOGY: descriptive and cross-sectional study; covered 3,077 queries of anonymized statistical data. RESULTS: of the UGO, 58.3% were obstetric consultations, 36.9% gynecological and 4.8% neonatological; 96% were women; 80.3% were adults and 11.6% adolescents; 92.5% were from Penco; the month most consulted was may with 292 visits and 71.5% of the consultations were during daytime hours. The main reasons for obstetric and gynecological consultation were pain and genital bleeding; in neonatal emergencies, jaundice was the main reason for consultation. The most repeated diagnosis in obstetric consultations was the supervision of normal pregnancy; in gynecological cases, it was abdominal-pelvic pain and in neonatological consultations, jaundice; there was 91.1% local resolution. 0.1% of the UGO were categorized as c1 and 0.3% as c2, the vast majority being low complexity queries. CONCLUSIONS: there is a large percentage of low complexity consultations that overload the emergency service, affecting the quality of hospital care.


Subject(s)
Humans , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Obstetrics and Gynecology Department, Hospital/statistics & numerical data , Triage/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Pregnancy Complications , Obstetrics and Gynecology Department, Hospital/organization & administration , Chile , Cross-Sectional Studies , Triage/methods , Emergencies , Emergency Service, Hospital/organization & administration , Hospital Care , Genital Diseases, Female , Hospitals, Public/statistics & numerical data
11.
Rev. chil. neuro-psiquiatr ; 59(1): 27-37, mar. 2021. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388375

ABSTRACT

INTRODUCCIÓN: El objetivo consiste en analizar el impacto del COVID-19 en la demanda asistencial de las urgencias y en los ingresos psiquiátricos durante el primer mes de la pandemia. MÉTODOS: Realizamos un estudio transversal observacional retrospectivo en pacientes que acuden a urgencias psiquiátricas entre el 11 de marzo y el 11 de abril de 2019 y 2020 respectivamente. Se incluyeron variables sociodemográficas y clínicas en el estudio. Se realizaron las pruebas de Chi Cuadrado o Test exacto de Fisher para el contraste de hipótesis de variables categóricas y la prueba U Mann-Whitney para el contraste de variables cuantitativas. El nivel de significación estadística se estableció en p<0.05. Los análisis se realizaron con IBM SPSS Statistics. RESULTADOS: Se observa un descenso significativo de la media de pacientes atendidos al día en urgencias entre ambos periodos, siendo esta de 5,91 (±2,53) en 2019 y de 2,41 (±1,81) en 2020 (p<0.001). Se ha visto una disminución significativa de la ocupación media de camas en la UHB, ocupándose un 91,84% (±7,72) de camas en 2019 y un 58,85% (±13,81) en 2020 (p<0,001). En cuanto a la proporción de ingresos de los pacientes que acuden a urgencias, se ha visto un aumento significativo en el año 2020 respecto al año anterior. CONCLUSIONES: La demanda en la urgencia de pacientes psiquiátricos y la ocupación media de camas se ha reducido durante el primer mes tras la declaración de la pandemia. El miedo al contagio puede actuar como modulador de la demanda psiquiátrica.


INTRODUCTION: The aim is to analyze the impact of COVID-19 on the demand for emergency care and psychiatric admissions during the first month of the pandemic. METHODS: We conducted a retrospective, observational and cross-sectional study. We reviewed the clinical records of all patients attending the psychiatric emergency room (ER) between March 11th and April 11th, of both 2019 and 2020. Sociodemographic and clinical variables were included in the study. Chi-square test or Fisher's exact test were performed to compare categorical variables, while U Mann-Whitney U test was used for quantitative variables. The level of statistical significance was set at p<0.05. Analysis were conducted using IBM SPSS Statistics. RESULTS: The was a significant decrease in the number of patients attended in the ER. An average of 5.91 (±2.53) patients were treated per day in 2019 compared to 2.41 (±1.81) in 2020 (p<0.001). There was also a significant decrease in the occupancy rate at the inpatient psychiatric unit, with a 91.84% (±7.72) of beds occupied in 2019 and only 58.85% (±13.81) in 2020 (p<0.001). Regarding the percentage of patients admitted after assessment in the ER, there was a significant increase in 2020 compared to the previous year. CONCLUSIONS: The demand for care in the psychiatric emergency room and the average bed occupancy have decreased during the first month after the declaration of the pandemic. Fear of contagion may act as a modulator of psychiatric demand.


Subject(s)
Humans , Male , Female , Adult , Emergency Service, Hospital/statistics & numerical data , COVID-19 , Health Services Needs and Demand , Bed Occupancy/statistics & numerical data , Chi-Square Distribution , Mental Health , Cross-Sectional Studies , Retrospective Studies , Emergency Medical Services/statistics & numerical data , Pandemics , Hospitalization/statistics & numerical data , Hospitals, Psychiatric/statistics & numerical data
12.
Säo Paulo med. j ; 139(1): 53-57, Jan.-Feb. 2021. tab
Article in English | LILACS | ID: biblio-1156968

ABSTRACT

ABSTRACT BACKGROUND: The COVID-19 pandemic has affected healthcare systems worldwide. The effect of the pandemic on emergency general surgery patients remains unknown. OBJECTIVE: To reveal the effects of the COVID-19 pandemic on mortality and morbidity among emergency general surgery cases. DESIGN AND SETTING: Data on patients who were admitted to the emergency department of a tertiary hospital in Samsun, Turkey, and had consultations at the general surgery clinic were analyzed retrospectively. METHODS: Our study included comparative analysis on two groups of patients who received emergency general surgery consultations in our hospital: during the COVID-19 pandemic period (Group 2); and on the same dates one year previously (Group 1). RESULTS: There were 195 patients in Group 1 and 132 in Group 2 (P < 0.001). While 113 (58%) of the patients in Group 1 were women, only 58 (44%) were women in Group 2 (P = 0.013). Considering all types of diagnosis, there was no significant difference between the two groups (P = 0.261). The rates of abscess and delayed abdominal emergency diseases were higher in Group 2: one case (0.5%) versus ten cases (8%); P < 0.001. The morbidity rate was higher in Group 2 than in Group 1: three cases (1.5%) versus nine cases (7%); P = 0.016. CONCLUSIONS: The COVID-19 pandemic has decreased the number of unnecessary nonemergency admissions to the emergency department, but has not delayed patients' urgent consultations. The pandemic has led surgeons to deal with more complicated cases and greater numbers of complications.


Subject(s)
Humans , Male , Female , General Surgery/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Pandemics , COVID-19 , Turkey/epidemiology , Retrospective Studies
13.
Rev. chil. salud pública ; 25(2): 248-254, 2021.
Article in Spanish | LILACS | ID: biblio-1370774

ABSTRACT

INTRODUCCIÓN. El sistema de salud chileno se basa en el modelo de atención primaria. En este contexto, la demanda generada por la atención de usuarios policonsultantes constituye una problemática universal. Surge entonces la necesidad de identificar a esta población para implementar medidas. El objetivo de este estudio es caracterizar el perfil de usuarios policonsultantes en el servicio de urgencia del Hospital San Camilo, pertenecientes al CESFAM San Felipe El Real, entre junio 2018-mayo 2019. MATERIALES Y MÉTODOS. Estudio observacional, retrospectivo y descriptivo. Los datos fueron obtenidos desde base de datos anonimizada de usuarios atendidos en el servicio de salud; se seleccionaron pacientes pertenecientes al Centro con 7 o más consultas anuales en urgencia del Hospital San Camilo y se analizaron variables como sexo, edad, previsión y patologías consultadas. RESULTADOS. De 128 pacientes pertenecientes al CESFAM catalogados como policonsultantes, dos tercios del total son del sexo femenino, con un claro predominio de los primeros dos tramos de FONASA. En ambos sexos la población es mayormente pediátrica y le sigue a esto la población femenina de edad media. DISCUSIÓN. Con estos resultados se caracteriza a los usuarios policonsultantes del centro estudiado, lo que permite focalizar planes para estas personas implementando mejoras en resolutividad.


INTRODUCTION. The Chilean health system is based on the primary care model. In this context, the demand generated by the attention of polyconsultant users constitutes a universal problem. Is necessary to identify this population to implement measures. The objective of this study is to characterize the profile of polyconsultant users in the emergency department of San Camilo Hospital, belonging to the CESFAM San Felipe El Real, between June 2018-May 2019. MATERIALS AND METHODS. Observational, retrospective and descriptive study. From an anonymized database that collects information from users treated in the health service, patients belonging to the Center were selected if they had 7 or more annual consultations in the emergency care of the San Camilo Hospital. Variables such as sex, age, prevention and pathologies were analyzed. RESULTS. Of 128 patients belonging to CESFAM cataloged as polyconsultant, two thirds of the total are female, with a clear predominance of the first two sections of FONASA. In both sexes the population is mostly pediatric, and this is followed by the middle-aged female population. DISCUSSION. With these results, the polyconsultant users of the center studied are characterized, which allows to focus plans on these people and improve the resolution in these areas.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Primary Health Care/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Chile , Retrospective Studies , Delivery of Health Care/statistics & numerical data
14.
Article in Portuguese | LILACS | ID: biblio-1284362

ABSTRACT

Introdução: O trauma decorrente de causas externas é um problema de saúde em várias regiões do mundo. Além de altos índices de mortalidade e morbidade, os traumas de face resultam em impactos estéticos, estruturais e psicológicos na vida do indivíduo e na sociedade, gerando, também, um alto custo com gastos hospitalares. Objetivo: Relatar o caso de um paciente com trauma de face por acidente ciclístico, com alterações na funcionalidade do sistema estomatognático. Metodologia: Foi realizada avaliação fonoaudiológica por meio do Protocolo de Avaliação Preliminar (PAP), para observação do aspecto das estruturas orais, funções do sistema estomatognático, voz e reflexos protetivos de vias aéreas superiores. Na sequência, foi aplicado o Protocolo de Avaliação do Risco para Disfagia (PARD), para avaliação direta da deglutição. Resultados: Na avaliação dos órgãos fonoarticulatórios foi observado alterações de sensibilidade, mobilidade e redução significativa de força. Na avaliação direta da deglutição foi observada dificuldade na captação do alimento, escape anterior de alimento, elevação laríngea reduzida e múltiplas deglutições. Conclusão: O paciente foi classificado com Disfagia Orofaríngea leve a moderada, mantendo dieta via oral com consistência adaptada e orientação para continuidade de terapia fonoaudiológica. Devido ao alto número de casos semelhantes ao relatado nos hospitais de urgência e emergência, constata-se a necessidade de avaliação do sistema estomatognático para promover a melhor abordagem aos pacientes com trauma de face


Introduction: Trauma due to external causes is a health problem in several regions of the world. In addition to high rates of mortality and morbidity, facial traumas result in aesthetic, structural and psychological impacts on the individual's life and on society, also generating a high cost of hospital expenses. Objective: Report the case of a patient with facial trauma due to a cycling accident, with changes in the functionality of the stomatognathic system. Methodology: Speech therapy evaluation was carried out through the Preliminary Evaluation Protocol, to observe the appearance of oral structures, functions of the stomatognathic system, voice and protective reflexes of the upper airways. Then, the Risk Assessment Protocol for Dysphagia was applied, for direct swallowing assessment. Results: In the evaluation of Organs phonoarticulatory organs, changes in sensitivity, mobility and significant reduction in strength were observed. In the direct evaluation of swallowing, difficulty in capturing food, previous escape of food, reduced laryngeal elevation and multiple swallowing were observed. Conclusion: The patient was classified with Mild to Moderate Oropharyngeal Dysphagia, maintaining an oral diet with consistency adapted and guidance for continuing speech therapy. Due to the high number of cases similar to that reported in urgent and emergency hospitals, there is a need to evaluate the stomatognathic system to promote the best approach to patients with facial trauma.


Subject(s)
Humans , Adult , Young Adult , Stomatognathic System/injuries , Deglutition Disorders , Facial Injuries , Deglutition Disorders/rehabilitation , Glasgow Coma Scale , Emergency Service, Hospital/statistics & numerical data , Mandibular Fractures
15.
Rev. ANACEM (Impresa) ; 15(1): 33-39, 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1281420

ABSTRACT

INTRODUCCIÓN: El cólico renal es una condición médica común en los servicios de urgencia. Representa la manifestación clínica más frecuente de urolitiasis, cuya patogenia es multifactorial, con tasas de prevalencia varía de 1% a 20% y una recurrencia a 10 años del 42% al 50%. OBJETIVO: Establecer el perfil clínico-epidemiológico, como también el diagnóstico y manejo de los pacientes hospitalizados por cólico renal en el Hospital Clínico Herminda Martín (HCHCM). MATERIAL Y MÉTODO: Estudio descriptivo retrospectivo en pacientes hospitalizados con diagnóstico de cólico renal en el HCHM de Chillán en el período marzo 2014-marzo 2019. Se estudiaron las variables: sexo, edad, presentación clínica de ingreso, factores de riesgo asociados, motivo de hospitalización, resultados imagenológicos y manejo clínico. Resultados. El 52,45% correspondió a pacientes de sexo masculino, encontrándose la mayor cantidad de pacientes en el intervalo de 40-49 años. La obesidad, antecedente de urolitiasis e hipertensión arterial fueron las patologías asociadas más frecuentes. En la mayoría de los pacientes, el motivo de la hospitalización fue la refractariedad al tratamiento analgésico, alcanzando un 86,76%. El 56,37% de los pacientes recibió manejo médico expulsivo y a un 19,11% de los pacientes se le realizó una intervención quirúrgica durante la hospitalización. CONCLUSIÓN: El perfil de éstos pacientes no sólo permite establecer medidas que podrían evitar un evento litiásico, sino que además se demuestra la necesidad de realizar un manejo óptimo que puede evitar reconsultas, sobrecarga de los servicios de urgencia, aumento de días cama y complicaciones.


INTRODUCTION: Renal colic is a common condition in the emergency department. It represents the most frequent clinical manifestation of urolithiasis, whose prevalence rate varies between 1% to 20%. Its pathogenesis is multifactorial, with a recurrence of 10 years from 42-50%. OBJECTIVE: Establish the clinical-epidemiological profile, as well as the diagnosis and management of patients hospitalized for renal colic at the Herminda Martín Clinical Hospital(HCHM). MATERIALS AND METHODS: A retrospective descriptive study of hospitalized patients diagnosed with renal colic at the HCHM, March 2014-March 2019, the variables were studied: sex, age, the clinical presentation of admission, associated risk factors, the reason for hospitalization, imaging results, and management. Results: 52.45% were male patients, with the highest number of patients in the range of 40-49 years. Obesity, a history of urolithiasis and hypertension, occurred more frequently within the associated pathologies. In most patients, refractable to analgesic treatment was the reason for hospitalization, reaching 86.76%. 56.37% of patients received expulsion medical management, and 19.11% of patientshad surgeryduring hospitalization. CONCLUSION: The profile of these patients not only allows them to establish measures that could prevent a lithiasis event but also shows the need for effective management of patients who can avoid reconsults, an overload of emergency services, increasedbed days and complications


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Renal Colic/diagnosis , Hospitalization , Kidney Diseases/diagnosis , Epidemiology, Descriptive , Retrospective Studies , Emergency Service, Hospital/statistics & numerical data , Renal Colic/surgery , Renal Colic/epidemiology , Renal Colic/diagnostic imaging
16.
Rev. Col. Bras. Cir ; 48: e20202769, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155366

ABSTRACT

ABSTRACT Purpose: to analyze the relation between Trauma Quality Indicators (QI) and death, as well as clinical adverse events in severe trauma patients. Methods: analysis of data collected in the Trauma Register between 2014-2015, including patients with Injury Severity Score (ISS) > 16, reviewing the QI: (F1) Acute subdural hematoma drainage > 4 hours with Glasgow Coma Scale (GCS) <9; (F2) emergency room transference without definitive airway and GCS <9; (F3) Re-intubation within 48 hours; (F4) Admission-laparotomy time greater than 60 min in hemodynamically instable patients with abdominal bleeding; (F5) Unprogrammed reoperation; (F6) Laparotomy after 4 hours; (F7) Unfixed femur diaphyseal fracture; (F8) Non-operative treatment for abdominal gunshot; (F9) Admission-tibial exposure fracture treatment time > 6 hours; (F10) Surgery > 24 hours. T the chi-squared and Fisher tests were used to calculate statistical relevance, considering p<0.05 as relevant. Results: 127 patients were included, whose ISS ranged from 17 to 75 (28.8 + 11.5). There were adverse events in 80 cases (63%) and 29 died (22.8%). Twenty-six patients had some QI compromised (20.6%). From the 101 patients with no QI, 22% died, and 7 of 26 patients with compromised QI (26.9%) (p=0.595). From the patients with no compromised QI, 62% presented some adverse event. From the patients with any compromised QI, 18 (65.4%) had some adverse event on clinical evolution (p=0.751). Conclusion: the QI should not be used as death or adverse events predictors in severe trauma patients.


RESUMO Objetivo: analisar relação entre comprometimento de Filtros de Qualidade (FQ) com complicações e mortalidade entre vítimas de trauma grave. Métodos: análise dos dados coletados para o Registro de Trauma entre 2014 e 2015, sendo incluídos os traumatizados com Injury Severity Score (ISS) > 16 e analisados os FQ: (F1) drenagem de Hematoma Subdural Agudo (HSA) > 4 horas com Escala de Coma de Glasgow (ECG) <9, (F2) transferência da sala de emergência sem via aérea definitiva e com ECG<9, (F3) reintubação traqueal em até 48 horas, (F4) tempo entre admissão e laparotomia exploradora maior que 60 minutos em pacientes instáveis com foco abdominal, (F5) reoperação não programada, (F6) laparotomia > 4 horas, (F7) fratura de diáfise de fêmur não fixada, (F8) tratamento não operatório em Ferimento por Arma de Fogo (FAF) abdominal, (F9) tempo entre admissão e tratamento de fraturas expostas de tíbia > 6 horas, (F10) operação > 24 horas. Testes de Chi quadrado e Fisher para a análise estatística, considerando significativo p<0,05, foram usados. Resultado: foram incluídos 127 pacientes com ISS entre 17 a 75 (28,8 + 11,5). As complicações ocorreram em 80 casos (63%) e 29 morreram (22,8%). Vinte e seis pacientes apresentaram algum FQ comprometido (20,6%). Dos 101 doentes sem FQ comprometido, 22% faleceram, o que ocorreu em 7 dos 26 doentes com comprometimento dos FQ (26,9%) (p=0,595). Dos doentes sem FQ comprometido, 62% tiveram alguma complicação. Entre os pacientes com FQ comprometido, 18 (65,4%) tiveram complicações (p=0,751). Conclusão: os FQs não devem ser utilizados como preditor de mortes ou complicações evitáveis nas vítimas de traumas graves.


Subject(s)
Humans , Adolescent , Adult , Aged , Young Adult , Quality Indicators, Health Care , Emergency Service, Hospital/statistics & numerical data , Hemorrhage , Glasgow Coma Scale , Injury Severity Score , Trauma Severity Indices , Retrospective Studies , Middle Aged
17.
Article in English | WPRIM | ID: wpr-880371

ABSTRACT

BACKGROUND@#An acute upper respiratory tract infection (URI) is the most common disease worldwide, irrespective of age or sex. This study aimed to evaluate the short-term effect of diurnal temperature range (DTR) on emergency room (ER) visits for URI in Seoul, Korea, between 2009 and 2013.@*METHODS@#Daily ER visits for URI were selected from the National Emergency Department Information System, which is a nationwide daily reporting system for ER visits in Korea. URI cases were defined according to International Classification of Diseases, 10@*RESULTS@#There were 529,527 ER visits for URI during the study period, with a daily mean of 290 visits (range, 74-1942 visits). The mean daily DTR was 8.05 °C (range, 1.1-17.6 °C). The cumulative day (lag 02) effect of DTR above 6.57 °C per 1 °C increment was associated with a 1.42% (95% confidence interval [CI] 0.04-2.82) increase in total URI. Children (≤ 5 years of age) were affected by DTR above 6.57 °C per 1 °C, with 1.45% (95% CI 0.32-2.60) at lag 02, adults (19-64 years) with 2.77% (95% CI 0.39-5.20) at lag 07. When the DTR (lag02) was 6.57 °C to 11.03 °C, the relative risk was significant at 6.01% (95% CI 2.45-9.69) for every 1 °C increase in youth subjects aged for 6 to 18 years.@*CONCLUSIONS@#DTR was associated with a higher risk for ER visits for URI. In addition, the results suggested that the lag effects and relative risks of DTR on URI were quite different according to age.


Subject(s)
Acute Disease/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cold Temperature/adverse effects , Emergency Service, Hospital/statistics & numerical data , Female , Hot Temperature/adverse effects , Humans , Infant , Infant, Newborn , Male , Middle Aged , Republic of Korea/epidemiology , Respiratory Tract Infections/etiology , Young Adult
19.
Med. infant ; 27(2): 125-132, Diciembre 2020. Tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1148374

ABSTRACT

Introducción. Conocer las características epidemiológicas (CE) de una población resulta primordial para la definición de estrategias sanitarias. Nuestro objetivo es describir las características de pacientes críticos ingresados al sector reanimación (SR). Materiales y métodos. Estudio descriptivo y retrospectivo realizado en un servicio de urgencias de un hospital de tercer nivel entre 2/7/2018 y 1/7/2019. Se incluyeron todos los pacientes ingresados a SR. Se registró edad, sexo, motivo de ingreso, condición crónica, procedimientos diagnósticos y terapéuticos efectuados. Los datos fueron obtenidos del libro de registro y la historia clínica informatizada, y analizados con software Redcap Versión 8.9.2. Las variables categóricas se expresaron como frecuencias y porcentajes y las continuas con mediana y rango intercuartílico. Resultados. Ingresaron 2292 pacientes. El 94% fueron menores de 16 años. El 56,5% presentaba condiciones crónicas (CC), siendo más frecuentes las enfermedades neurológicas (29%), endocrino/metabólicas (15,5%) y cardiovasculares (11%). Los motivos de ingreso más habituales: enfermedad respiratoria aguda baja (31%), estado epiléptico (13%), sepsis (13%) y deshidratación grave (7%). Estudios complementarios más utilizados: laboratorio (54%), radiografía (28%), hemocultivos (23%). Los procedimientos realizados con más frecuencia fueron la colocación de acceso venoso periférico (67%), cánula nasal de alto flujo (6%) y ventilación mecánica (5%). Las drogas más indicadas: oxígeno (42%), fluidos (34%), antibióticos (22%). El 14% ingresó a cuidados intensivos. Hubo 11 paros cardiorrespiratorios y 6 óbitos. Conclusiones. En el SR se asisten pacientes críticos con patologías de alta prevalencia como también pacientes con enfermedades crónicas complejas. La evaluación periódica de CE resulta una herramienta fundamental para detectar dificultades y elaborar estrategias de mejora (AU)


Introduction. Knowledge on the epidemiological characteristics (EC) of a population is essential to define healthcare strategies. Our aim was to describe the characteristics of critical patients admitted to the resuscitation unit (RU). Materials and methods. A descriptive and retrospective study was conducted at an emergency department of a third-level hospital between 2/7/2018 and 1/7/2019. All patients admitted to the RU were included. Age, sex, reason for admission, underlying disease, and diagnostic and therapeutic procedures performed were recorded. The data were obtained from the logbook and electronic records, and analyzed using Redcap software Version 8.9.2. Categorical variables were expressed as frequencies and percentages and continuous variables as median and interquartile range. Results. 2292 patients were admitted; 94% were younger than 16 years of age. Overall, 56.5% had underlying diseases (UD), the most common of which were neurological (29%), endocrine/metabolic (15.5%), and cardiovascular (11%) disorders. The most common reasons for admission were acute lower respiratory tract disease (31%), status epilepticus (13%), sepsis (13%), and severe dehydration (7%). The most frequently used complementary studies were laboratory tests (54%), x-rays (28%), and hemocultures (23%). The most frequently performed procedures were peripheral venous line (67%), high-flow nasal cannula (6%), and mechanical ventilation (5%) placement. The most frequently indicated medications were oxygen (42%), fluids (34%), and antibiotics (22%). Overall, 14% required admission to the intensive care unit. There were 11 cardiorespiratory arrests and six deaths. Conclusions. Critical patients with highly prevalent diseases as well as patients with complex underlying diseases are seen at the RU. Periodic EC evaluation is a key tool for detecting difficulties and developing improvement strategies (AU)


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Adult , Chronic Disease/epidemiology , Critical Illness/epidemiology , Emergency Service, Hospital/statistics & numerical data , Hospital Rapid Response Team/trends , Hospital Rapid Response Team/statistics & numerical data , Time Factors , Retrospective Studies , Treatment Outcome
20.
Gac. méd. Méx ; 156(6): 495-501, nov.-dic. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1249958

ABSTRACT

Resumen Introducción: La sepsis es una de las principales causas de consulta en los servicios de urgencias médicas. Objetivo: Identificar la prevalencia de la sepsis en servicios de urgencias médicas de México. Método: Estudio transversal con seguimiento a 30 días de los pacientes con diagnóstico de sepsis o choque séptico; se analizaron las variables demográficas, el manejo y los desenlaces. Resultados: En 68 servicios de urgencias médicas analizados se atendió a 2379 pacientes, de los cuales 307 presentaron sepsis. La prevalencia de la sepsis fue de 12.9 %, con mortalidad global de 16.93 %, que en los casos de sepsis fue de 9.39 % y en los de choque séptico, de 65.85 %; no se identificaron diferencias significativas en las variables demográficas o tipo de hospital. Se observó balance hídrico alto en las primeras tres horas y falta de apego a las recomendaciones internacionales de reanimación superior en los pacientes que fallecieron. Conclusiones: Se encontró alta prevalencia de la sepsis en los servicios de urgencias médicas mexicanos. La mortalidad de los pacientes con choque séptico fue similar e, incluso, mayor a la reportada internacionalmente.


Abstract Introduction: Sepsis is one of the main reasons for consultation at emergency departments. Objective: To identify the prevalence of sepsis in emergency departments of Mexico. Method: Cross-sectional study with a 30-day follow-up of patients diagnosed with sepsis or septic shock; demographic variables, management and outcomes were analyzed. Results: In 68 emergency departments analyzed, 2379 patients were attended to, out of whom 307 had sepsis. The prevalence of sepsis was 12.9 %, and overall mortality was 16.93 %, which in the cases of sepsis was 9.39 %, and in those of septic shock, 65.85 %; no significant differences were identified in demographic variables or type of hospital. A significantly higher fluid balance was observed within the first three hours in those patients who died, as well as a lack of adherence to international resuscitation recommendations. Conclusions: A high prevalence of sepsis was found in Mexican emergency departments. Mortality of patients with septic shock was similar and even higher than that internationally reported.


Subject(s)
Humans , Male , Female , Middle Aged , Sepsis/epidemiology , Emergency Service, Hospital/statistics & numerical data , Resuscitation , Shock, Septic/mortality , Shock, Septic/therapy , Shock, Septic/epidemiology , Severity of Illness Index , Prevalence , Cross-Sectional Studies , Follow-Up Studies , Sepsis/mortality , Sepsis/therapy , Guideline Adherence , Mexico/epidemiology
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