ABSTRACT
Objetivo: Analizar la frecuentación, el perfil clínico, manejo y los factores determinantes de su evolución de los pacientes con sospecha de gripe A atendidos en urgencias. Método: Estudio transversal y descriptivo de los pacientes que acudieron a urgencias de un hospital de área entre el 20 de junio y el 31 de julio de 2009 y cumplían criterios de caso sospechoso. Se registraron los datos clínicos, el manejo y la evolución. Resultados: Se incluyeron 211 pacientes con sospecha de gripe A (2,92%). El 47,9%no presentaba co-morbilidad y 87,1% eran menores de 50 años. Los síntomas más frecuentes de consulta fueron: fiebre (75,8%), tos (56,9%) y mialgias (40,8%). Al 82,9%se les realizó alguna exploración complementaria, y en el 30% de los pacientes se objetivaron infiltrados radiológicos. Se solicitaron test de diagnóstico microbiológico al43,1% de los pacientes (positivo en el 12%). El destino del 65,4% fue el alta domiciliaria, una paciente requirió ingreso en cuidados Intensivos, y fallecieron 2 pacientes, ninguno en relación con la gripe A. Un 7,1% de los pacientes consultaron de nuevo a urgencias por el mismo motivo, y 3 de ellos precisaron ingreso. Conclusiones: La pandemia por gripe A H1N1 afectó a pacientes jóvenes y sanos, y supuso una sobrecarga asistencial muy moderada en nuestra serie. El cuadro clínico es leve, con bajas morbilidad y mortalidad asociadas y escaso números de reingresos. Sin embargo, el manejo fue poco homogéneo y el uso de exploraciones complementarias muy elevado en relación con la gravedad clínica (AU)
Objective: To analyze use of the emergency department by patients suspected of having influenza A infection, their clinical characteristics, the management of cases, and variables related to clinical course. Methods: Cross-sectional, descriptive study of patients who sought emergency care at a referral hospital between June20 and July 31, 2009 and who were suspected of having influenza A infection. Data on clinical characteristics, management, and course were recorded. Results: A total of 211 patients (2.92%) met the criteria for clinical suspicion of influenza A infection. Co-morbidity was absent in 47.9%, and 87.1% were younger than 50 years of age. The most common complaints were fever (75.8%),cough (56.9%), and muscle aches (40.8%). Complementary tests were ordered for 82.9%. Thirty percent had infiltrates on radiographs. Microbiology was ordered for 43.1% of the patients and was positive for 12%. Patients were discharged home in 65.4% of the cases. One patient required admission to the intensive care unit. Two patients died, neither due to influenza A. Second visits to the emergency department were made by 7.1% of the patients; 3 of these patients requiredadmission. Conclusions: The influenza A (H1N1) pandemic mainly affects young, healthy patients. The burden of care was only moderate in this patient series. Symptoms are mild, morbidity and mortality low, and readmissions few. Management, however, is uneven and the use of complementary tests is very high in comparison with the level of seriousness of the illness (AU)
Subject(s)
Humans , Influenza A Virus, H1N1 Subtype/pathogenicity , Influenza, Human/epidemiology , Communicable Disease Control , Outcome and Process Assessment, Health Care , Emergency Medical Services/organization & administrationABSTRACT
INTRODUCTION: To identify factors influencing decisions in initial management of community-acquired pneumonia (CAP) admitted to hospital through Emergency departments. METHODS: Records of CAP adult patients admitted to 24 Spanish hospitals in January-March 2003 were reviewed. Patients sent for ambulatory treatment were excluded. RESULTS: 341 patients (67.0 +/- 24.6 years; 65.3% males) were included; 39% were taking antibiotics at attendance. PSI was (% patients): I-II (19.7%), III (14.7%), and IV-V (65.6%). Comorbidities were: COPD (37.2%), heart disease (24.6%), hypertension (17%), diabetes mellitus (10.8%), and malignancies (10%). Pneumococcal/Legionella urinary antigens were performed in 34.0%/42.2% patients. Fewer (p < or = 0.006) rapid tests were performed in class IV-V (p = 0.001), with higher (p < or = 0.01) pneumococcal positive results in class V. Initial treatment was fluoroquinolone (37.5%), beta-lactam + macrolide (26.4%), beta-lactam (22.9%), macrolide (4.7%), and others (8.5%). Patients referred to Internal Medicine had higher heart disease (p = 0.06) and hypertension (p = 0.001) as comorbidity than those at Short-Stay Units or Pneumology. COPD patients were equally distributed between Internal Medicine and Pneumology, with differences vs. Short-Stay Units. CONCLUSIONS: Rapid diagnostic tests were underused, maybe due to broad empirical treatments covering drug-resistant pneumococci and L. pneumophila (regardless PSI and comorbidity). Presence of comorbidities or positive results in rapid diagnostic tests seems to influence the medical ward to which the patient is referred to, but not initial treatment.
Subject(s)
Emergency Treatment , Hospitalization , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/drug therapy , Adolescent , Adult , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Emergency Service, Hospital , Female , Humans , Male , Middle Aged , Young AdultABSTRACT
Introduction. To identify factors influencing decisions ininitial management of community-acquired pneumonia(CAP) admitted to hospital through Emergency departments.Methods. Records of CAP adult patients admitted to 24Spanish hospitals in January-Mars 2003 were reviewed. Patientssent for ambulatory treatment were excluded.Results. 341 patients (67.0 ± 24.6 years; 65.3 % males)were included; 39 % were taking antibiotics at attendance.PSI was (% patients): I-II (19.7 %), III (14.7 %), and IV-V(65.6 %). Comorbidities were: COPD (37.2 %), heart disease(24.6 %), hypertension (17 %), diabetes mellitus (10.8 %),and malignancies (10 %). Pneumococcal/Legionella urinaryantigens were performed in 34.0 %/42.2 % patients. Fewer(p ≤ 0.006) rapid tests were performed in class IV-V(p = 0.001), with higher (p ≤ 0.01) pneumococcal positiveresults in class V. Initial treatment was fluoroquinolone(37.5 %), beta-lactam + macrolide (26.4 %), beta-lactam(22.9 %), macrolide (4.7 %), and others (8.5 %). Patients referredto Internal Medicine had higher heart disease(p = 0.06) and hypertension (p = 0.001) as comorbidity thanthose at Short-Stay Units or Pneumology. COPD patientswere equally distributed between Internal Medicine andPneumology, with differences vs. Short-Stay Units.Conclusions. Rapid diagnostic tests were underused,maybe due to broad empirical treatments covering drug-resistantpneumococci and L. pneumophila (regardless PSI andcomorbidity). Presence of comorbidities or positive resultsin rapid diagnostic tests seems to influence the medicalward to which the patient is referred to, but not initialtreatment (AU)
Introducción. Identificación de los factores que influyenen el manejo inicial de los pacientes con neumoníaadquirida en la comunidad (NAC) ingresados en el hospitala través de los Servicios de Urgencias.Material y métodos. Se revisaron los registros de pacientesadultos con NAC admitidos en 24 hospitales españolesen el período comprendido entre los meses deenero-marzo de 2003. Los pacientes remitidos para tratamientoambulatorio fueron excluidos.Resultados. Se incluyeron 341 pacientes (67,0 ± 24,6años; 65,3 % varones). El 39 % estaba tomando antibióticosen el momento de atención en Urgencias. El grado deFine de los pacientes fue (% pacientes): I-II (19,7 %),III (14,7 %), y IV-V (65,6 %). Las comorbilidades fueron:EPOC (37,2 %), enfermedad coronaria (24,6 %), hipertensión(17 %), diabetes mellitus (10,8 %) y neoplasia (10 %). Lostests de antígenos urinarios de neumococo y Legionellafueron realizados en 34,0 % y 42,2 % pacientes respectivamente.En las clases IV-V (p ≤ 0,006) se realizaron menostests rápidos, con mayor número de resultados positivospara neumococos (p ≤ 0,01) en la clase V. El tratamientoinicial fue fluoroquinolonas (37,5 %), betalactámico +macrólido(26,4 %), betalactámico (22,9 %), macrólido (4,7 %),y otros (8,5 %). Los pacientes ingresados en Medicina Internatenían una mayor incidencia de enfermedad cardiaca(p = 0,06) e hipertensión (p = 0,001) como comorbilidadque aquellos ingresados en Neumología o en Unidades deCorta Estancia. Los pacientes con EPOC fueron igualmentedistribuidos entre Medicina Interna y Neumología, con diferenciasrespecto a las Unidades de Corta Estancia.Conclusiones. Los tests diagnósticos rápidos fueron infrautilizados,debido posiblemente a la amplia cobertura delos tratamientos empíricos cubriendo neumococo resistente yL. pneumophila (independientemente del Fine y la comorbilidad) (AU)
