Resultados a corto plazo de los pacientes con tiempo de estancia prolongada en un servicio de Medicina Interna / Short-term outcomes of patients with a long stay in an internal medicine service

Objetivo Describir las características y los factores pronósticos a corto plazo de los pacientes con estancia prolongada en Medicina Interna. Material y métodos Estudio retrospectivo de una serie de casos que incluyó pacientes ingresados en un servicio de Medicina Interna de un hospital universitario con tiempos de estancia mayor de 30 días durante cinco años. La información se obtuvo del Conjunto Mínimo Básico de Datos. Las variables de resultado fueron tiempo de estancia muy prolongada, mortalidad intrahospitalaria y resultados adversos en los primeros 30 días tras el alta. Resultados De un total de 11.948 pacientes, 335 (2,8%) tuvieron una estancia prolongada. El tiempo total de estancia fue de 15.271 días (15% del total de tiempo de estancia del servicio). La edad media fue de 74,5 (±13,9) años, siendo 180 (53,7%) varones. La mediana de tiempo de estancia fue de 39 (RIC 34-49) días. El ingreso en la Unidad de Cuidados Intensivos (UCI) (OR = 2,5; IC 95% 1,4-4,7; p = 0,003) y recibir una valoración geriátrica (OR = 0,3; IC 95% 0,8-0,9; p = 0,042) fueron factores independientes con efecto en el tiempo de estancia muy prolongado. Un ingreso hospitalario en año previo fue un factor independiente de un resultado adverso a los 30 días tras el alta (OR = 2,2; IC 95% 1,0-4,8). Conclusiones El porcentaje de pacientes con estancias prolongadas es menor de un 3%, pero tienen un alto impacto en la actividad de un servicio de Medicina Interna. Existen factores asociados con el tiempo de estancia muy prolongada y con la presencia de un resultado adverso precoz tras el alta (AU)

Objective To describe the characteristics and short-term prognostic factors of patients with prolonged stay in internal medicine. Material and methods Retrospective case series study including patients admitted to an Internal Medicine service of a university hospital with lengths of stay greater than 30 days during 5 years. Information was obtained from the Minimum Basic Data Set. Outcome variables were a very long length of stay, in-hospital mortality, and adverse outcomes in the first 30 days after discharge. Results Out of 11,948 patients, 335 (2.8%) cases had a prolonged stay. The total length of stay was 15,271 days (15% of the total length of stay of the service). The mean age was 74.5 (±13.9) years, 180 (53.7%) were male. The median length of stay was 39 (RIC 34-49) days. Intensive Care Unit admission (OR = 2.5; 95%CI 1.4-4.7; p = 0.003) and receiving a geriatric assessment (OR = 0.3; 95%CI 0.8-0.9; p = 0.042) were independent factors with an effect on very long length of stay. Having an admission in the previous year was an independent factor for an adverse outcome 30 days after discharge (OR = 2.2; 95%CI 1.0-4.8). Conclusions The percentage of patients with prolonged length of stay is less than 3%, but they have a high impact on the activity of an internal medicine service. There are factors associated with a very long length of stay and with the presence of an early adverse outcome after discharge (AU)

Short-term outcomes of patients with a long stay in an internal medicine service.

OBJECTIVE: To describe the characteristics and short-term prognostic factors of patients with prolonged stay in internal medicine. MATERIAL AND METHODS: Retrospective case series study including patients admitted to an Internal Medicine service of a university hospital with lengths of stay greater than 30 days during 5 years. Information was obtained from the Minimum Basic Data Set. Outcome variables were a very long length of stay, in-hospital mortality, and adverse outcomes in the first 30 days after discharge. RESULTS: Out of 11,948 patients, 335 (2.8%) cases had a prolonged stay. The total length of stay was 15,271 days (15% of the total length of stay of the service). The mean age was 74.5 (±13.9) years, 180 (53.7%) were male. The median length of stay was 39 (RIC 34-49) days. Intensive Care Unit admission (OR = 2.5; 95%CI 1.4-4.7; p = 0.003) and receiving a geriatric assessment (OR = 0.3; 95%CI 0.8-0.9; p = 0.042) were independent factors with an effect on very long length of stay. Having an admission in the previous year was an independent factor for an adverse outcome 30 days after discharge (OR = 2.2; 95%CI 1.0-4.8). CONCLUSIONS: The percentage of patients with prolonged length of stay is less than 3%, but they have a high impact on the activity of an internal medicine service. There are factors associated with a very long length of stay and with the presence of an early adverse outcome after discharge.

Infiltrados pulmonares alveolares difusos: un reto diagnóstico para el clínico / No disponible

La presencia de infiltrados pulmonares bilaterales es un hallazgo radiológico frecuente en la práctica clínica habitual. En un varón de edad media no siempre es indicativo de infección y hay que considerar otras entidades diagnósticas (procesos no infecciosos). La sospecha de metástasis pulmonares debe incluirse dentro de estas entidades, aunque se trate de un diagnóstico clínico poco frecuente. La clínica es variable y depende del tumor primario, la edad del paciente, la situación cardiorrespiratoria del mismo y del mecanismo de diseminación tumoral. La linfangitis carcinomatosa es un patrón poco frecuente de metástasis pulmonares y el diagnóstico diferencial se realiza con procesos infecciosos (como neumonías atípicas) e inflamatorios (neumonía intersticial, neumonitis por hipersensibilidad o eosinofilias pulmonares). El paciente que se presenta debutó con clínica respiratoria e infiltrados pulmonares bilaterales y fue diagnosticado de linfangitis carcinomatosa, cuyo origen era un adenocarcinoma gástrico

The presence of bilateral pulmonary infiltrates is a frequent radiological finding in routine clinical practice. In a middle-aged man is not always indicative of infection and you need to consider other diagnostic entities (non-infectious processes). Suspected pulmonary metastases should be included in these entities, although it is a rare clinical diagnosis. The clinical course is variable and depends on the primary tumor, the patient’s age, cardiopulmonary status thereof and the mechanism of tumor dissemination . Carcinomatous lymphangitis is a rare radiographic pattern of pulmonary metastases and the differential diagnosis includes infectious processes (such as atypical pneumonia) and inflammatory diseases (interstitial pneumonia, hypersensitivity pneumonitis or pulmonary eosinophilia). We report the case of a man with respiratory symptoms and bilateral pulmonary infiltrates who was diagnosed of carcinomatous lymphangitis, whose origin was a gastric adenocarcinoma

Tumor carcinoide bronquial en una mujer de 30 años con sibilancias, tratada inicialmente como asma bronquial / No disponible

Los tumores carcinoides constituyen menos del 5% de todas las neoplasias malignas de pulmón. La clínica asociada con este tumor depende de su localización. Cuando se localiza en la luz bronquial puede producir tos y sibilancias. Presentamos la imagen endoscópica de un tumor carcinoide en una mujer joven que fue diagnosticada inicialmente de asma bronquial con una espirometría con prueba broncodilatadora positiva sin respuesta al tratamiento (AU)

Pulmonary carcinoids represent less than 5% of primary lung tumors. The most common symptoms in bronchial carcinoids are cough and wheezing. We report the case of a young woman who was diagnosed in the first instance of bronchial asthma. The post-bronchodilator test was positive. She didn´t respond to treatment (AU)