Impact of emergency department management of isolated superficial vein thrombosis of the lower limbs: a secondary analysis of data from the ALTAMIRA study. / Impacto del manejo en urgencias en la evolución de los pacientes con trombosis venosa superficial aislada de miembros inferiores: subanálisis del estudio ALTAMIRA.

OBJECTIVES: To describe the management of superficial vein thrombosis (SVT) of the lower limbs in patients treated in Spanish hospital emergency departments (EDs). To evaluate the impact of ED management of venous thromboembolic complications on outcomes and to determine the characteristics of patients who develop complications. MATERIAL AND METHODS: The retrospective multicenter ALTAMIRA study (Spanish acronym for risk factors, complications, and assessment of Spanish ED management of SVT) used recorded data for consecutive patients with a diagnosis of isolated SVT treated in 18 EDs. We gathered data on symptomatic venous thromboembolic disease (deep vein thrombosis, pulmonary embolism, or the extension or recurrence of SVT), clinically significant bleeding, and 180-day mortality. Cox regression analysis was used to explore variables associated with complications. RESULTS: A total of 703 patients were included. Anticoagulation was prescribed for 84.1% of the patients for a median of 30 days (interquartile range, 15-42 days); 81.3% were treated with low molecular weight heparin. A prophylactic dose was prescribed for 48% and an intermediate therapeutic dose for 52%. Sixty-four patients (9.2%) developed symptomatic thromboembolic disease within 180 days, 12 (1.7%) experienced clinically significant bleeding, and 4 (0.6%) died. Complications developed later in patients receiving anticoagulant therapy than in those not taking an anticoagulant (66 vs 11 days , P=.009), and 76.6% of those developing complications were not on anticoagulant when symptoms appeared. A history of thromboembolic disease was associated with developing complications (adjusted hazard ratio, 2.20; 95% confidence interval, 1.34-3.62). CONCLUSION: ED treatment of SVT varies and is often suboptimal. The incidence of thromboembolic complications after SVT is high. Starting anticoagulation in the ED delays the development of complications. Patients with a history of thromboembolic disease are more at risk of complications.

OBJETIVO: Describir el manejo terapéutico de los pacientes con trombosis venosa superficial (TVS) aislada de miembros inferiores en servicios de urgencias hospitalarios (SUH) españoles. Evaluar el impacto del tratamiento instaurado en urgencias en la evolución, en términos de complicaciones de enfermedad tromboembólica venosa (ETV), y conocer las características de los pacientes que sufren complicaciones. METODO: El estudio multicentrico (18 SUH) ALTAMIRA (fActores de riesgo, compLicaciones y evaluación del manejo de la TVS de Miembros Inferiores en hospitales españoles atendidos en los seRvicios de urgenciAs) creó un cohorte retrospectivo de pacientes consecutivos con diagnóstico objetivo de TVS aislada. Se recogieron las complicaciones de ETV sintomáticas (trombosis venosa profunda, tromboembolia pulmonar y extensión o recurrencia de TVS), sangrados clínicamente relevantes y defunciones a 180 días. Se evaluaron las variables asociadas a las complicaciones mediante una regresión de Cox. RESULTADOS: Se incluyeron 703 pacientes. El 84,1% recibieron anticoagulación durante 30 días (rango intercuartil 15-42), 81,3% con heparina de bajo peso molecular (48% dosis profilácticas, 52% intermedias-terapéuticas). En 180 días, 64 pacientes (9,1%) tuvieron complicación de ETV, 12 (1,7%) tuvieron sangrado clínicamente relevante, y 4 fallecieron (0,6%). Los pacientes en que se instauró anticoagulación en urgencias tardaron más tiempo en desarrollar complicaciones (66 vs 11 días, p = 0,009). El 76,6% de los que se complicaron no estaban anticoagulados en ese momento. La ETV previa se asoció de forma independiente con el desarrollo de complicaciones (hazard ratio ajustada 2,20; intervalo de confianza del 95%: 1,34-3,62). CONCLUSIONES: El tratamiento en urgencias de la TVS aislada es heterogéneo y con frecuencia subóptimo. La incidencia de complicaciones de ETV es elevada. El tratamiento anticoagulante iniciado en urgencias supone un retraso en el desarrollo de complicaciones. Los pacientes con ETV previa tienen más riesgo de complicaciones.

Impacto del manejo en urgencias en la evolución de los pacientes con trombosis venosa superficial aislada de miembros inferiores: subanálisis del estudio ALTAMIRA / Impact of emergency department management of isolated superficial vein thrombosis of the lower limbs: a secondary analysis of data from the ALTAMIRA study

Objetivos: Describir el manejo terapéutico de los pacientes con trombosis venosa superficial (TVS) aislada de miembros inferiores en servicios de urgencias hospitalarios (SUH) españoles. Evaluar el impacto del tratamiento instaurado en urgencias en la evolución, en términos de complicaciones de enfermedad tromboembólica venosa (ETV), y conocer las características de los pacientes que sufren complicaciones. Métodos: Estudio de cohorte retrospectivo, multicéntrico (18 SUH), que incluyó pacientes consecutivos con diagnóstico objetivo de TVS aislada. Se recogieron las complicaciones de ETV sintomáticas (trombosis venosa profunda, tromboembolia pulmonar y extensión o recurrencia de TVS), sangrados clínicamente relevantes y defunciones a 180 días. Se evaluaron las variables asociadas a las complicaciones mediante una regresión de Cox. Resultados: Se incluyeron 703 pacientes. El 84,1% recibieron anticoagulación durante 30 días (rango intercuartil 15-42), 81,3% con heparina de bajo peso molecular (48% dosis profilácticas, 52% intermedias-terapéuticas). En 180 días, 64 pacientes (9,1 %) tuvieron complicación de ETV, 12 (1,7%) tuvieron sangrado clínicamente relevante, y 4 fallecieron (0,6 %). Los pacientes en que se instauró anticoagulación en urgencias tardaron más tiempo en desarrollar complicaciones (66 vs 11 días, p = 0,009). El 76,6% de los que se complicaron no estaban anticoagulados en ese momento. La ETV previa se asoció de forma independiente con el desarrollo de complicaciones (hazard ratio ajustada 2,20; intervalo de confianza del 95%: 1,34-3,62). (AU)

Objectives: To describe the management of superficial vein thrombosis (SVT) of the lower limbs in patients treated in Spanish hospital emergency departments (EDs). To evaluate the impact of ED management of venous thromboembolic complications on outcomes and to determine the characteristics of patients who develop complications.Methods: The retrospective multicenter ALTAMIRA study (Spanish acronym for risk factors, complications, and assessment of Spanish ED management of SVT) used recorded data for consecutive patients with a diagnosis of isolated SVT treated in 18 EDs. We gathered data on symptomatic venous thromboembolic disease (deep vein thrombosis, pulmonary embolism, or the extension or recurrence of SVT), clinically significant bleeding, and 180-day mortality. Cox regression analysis was used to explore variables associated with complications. Results: A total of 703 patients were included. Anticoagulation was prescribed for 84.1% of the patients for a median of 30 days (interquartile range, 15-42 days); 81.3% were treated with low molecular weight heparin. A prophylactic dose was prescribed for 48% and an intermediate therapeutic dose for 52%. Sixty-four patients (9.2%) developed symptomatic thromboembolic disease within 180 days, 12 (1.7%) experienced clinically significant bleeding, and 4 (0.6%) died. Complications developed later in patients receiving anticoagulant therapy than in those not taking an anticoagulant (66 vs 11 days , P=.009), and 76.6% of those developing complications were not on anticoagulant when symptoms appeared. A history of thromboembolic disease was associated with developing complications (adjusted hazard ratio, 2.20; 95% confidence interval, 1.34-3.62). (AU)

Impacto de los ingresos urgentes innecesarios sobre las estancias hospitalarias en un hospital de asturias / Impact on hospital days of care due to unnecessary emergency admissions

Fundamento: Los ingresos innecesarios en los hospitales deagudos tienen importantes consecuencias sobre su eficiencia y organización.El objetivo de este estudio es identificar el grado de inadecuaciónde los ingresos realizados desde un servicio de urgenciashospitalario y sus causas, así como cuantificar las estancias inadecuadasgeneradas por estos ingresos.Método: Se evaluó la adecuación de 622 ingresos realizados enal año 2002 seleccionados aleatoriamente, y la del total de estanciasgeneradas por los ingresos inadecuados y una muestra representativade los ingresos adecuados de un hospital de segundo nivel de Asturias.El instrumento de revisión fue el Appropiateness EvaluationProtocol. Se realizó un análisis descriptivo de la muestra, un análisisbivariante y un análisis de regresión logística multivariante.Resultados: Se consideraron inadecuados 63 ingresos (10,1%).La principal causa de inadecuación fueron los ingresos para realizarpruebas diagnósticas y/o tratamientos que podrían realizarse de formaambulatoria. Los ingresos innecesarios generaron un 78,2% deestancias innecesarias y los necesarios un 24,8%. Incrementaron elriesgo de ingresos innecesarios la derivación a urgencias desde consultasexternas del propio hospital (OR:4,50, IC 95%: 1,59-12,76),ingresar en horario de mañana (OR: 13,97, IC 95%: 1,86-104,76) otarde (OR: 7,70, IC 95%: 1,01-58,72), ingresar en los servicios decardiología (OR: 3,93, IC 95%: 1,22-12,70) y neurología (OR: 5,86,IC 95%: 1,88-18,30) disminuyó el riesgo de ingreso innecesario laexperiencia de ingresos previos (OR: 0,34, IC 95%: 0,18-0,65).Conclusiones: Los ingresos innecesarios generan tres veces másestancias inadecuadas que los necesarios. Los problemas organizativosdel centro son la principal causa de ingresos inadecuados

Background: Unnecessary admissions of acute cases havemajor impacts on hospital efficiency and organization. This study isaimed to identify percentage of unnecessary admissions from a hospitalemergency department and the reasons why, as well as toquantify the unnecessary hospital days of care generated by theseadmissions.Methods: It has been analyzed the appropriateness of 622admissions made in 2002, selected at random, all of the hospital staysgenerated by the inappropriate admissions and a representative sampleof the appropriate admissions of a second-level hospital in Asturias.The review tool was the Appropriateness Evaluation Protocol.A descriptive analysis, a bivariate analysis and a multivariate logicregression analysis were made.Results: A total of 63 admissions (10.1%) were judged inappropriate.The main cause of inappropriateness were admissions for performingdiagnostic tests and/or treatments, which could be carried outon an outpatient basis. These unnecessary admissions generated78.2% of unnecessary stays, and the appropriate admissions generated24.8% of unnecessary stays. Referrals to hospital emergency roomsfrom physicians outside of the hospital proper heightened the risk ofunnecessary admissions (OR:4.50, 95% CI: 1.59-12.76), daytimeadmissions (OR: 13.97, 95% CI: 1.86-104.76) or evening admissions(OR: 7.70, 95% CI: 1.01-58.72), admissions to cardiology wards (OR:3.93, 95% CI: 1.22-12.70) and neurology wards (OR: 5.86, 95% CI:1.88-18.30), the experience of prior admissions having lowered therisk of unnecessary admission (OR: 0.34, 95% CI: 0.18-0.65).Conclusions: Unnecessary admissions generate three timesmore inappropriate stays than the necessary admissions. Hospitalorganization-related problems are the main cause of inappropriateadmissions

[Impact on hospital days of care due to unnecessary emergency admissions]. / Impacto de los ingresos urgentes innecesarios sobre las estancias hospitalarias en un hospital de asturias.

BACKGROUND: Unnecessary admissions of acute cases have major impacts on hospital efficiency and organization. This study is aimed to identify percentage of unnecessary admissions from a hospital emergency department and the reasons why, as well as to quantify the unnecessary hospital days of care generated by these admissions. METHODS: It has been analyzed the appropriateness of 622 admissions made in 2002, selected at random, all of the hospital stays generated by the inappropriate admissions and a representative sample of the appropriate admissions of a second-level hospital in Asturias. The review tool was the Appropriateness Evaluation Protocol. A descriptive analysis, a bivariate analysis and a multivariate logic regression analysis were made. RESULTS: A total of 63 admissions (10.1%) were judged inappropriate. The main cause of inappropriateness were admissions for performing diagnostic tests and/or treatments, which could be carried out on an outpatient basis. These unnecessary admissions generated 78.2% of unnecessary stays, and the appropriate admissions generated 24.8% of unnecessary stays. Referrals to hospital emergency rooms from physicians outside of the hospital proper heightened the risk of unnecessary admissions (OR:4.50, 95% CI: 1.59-12.76), daytime admissions (OR: 13.97, 95% CI: 1.86-104.76) or evening admissions (OR: 7.70, 95% CI: 1.01-58.72), admissions to cardiology wards (OR: 3.93, 95% CI: 1.22-12.70) and neurology wards (OR: 5.86, 95% CI: 1.88-18.30), the experience of prior admissions having lowered the risk of unnecessary admission (OR: 0.34, 95% CI: 0.18-0.65). CONCLUSIONS: Unnecessary admissions generate three times more inappropriate stays than the necessary admissions. Hospital organization-related problems are the main cause of inappropriate admissions.