Probable síndrome neurológico tardío tras intoxicación por monóxido de carbono. Caso clínico y revisión de la literatura / Probable delayed neurological syndrome after carbon monoxide poisoning: a clinical case and a review of the literature

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Eficiencia de las unidades de agudos de geriatría frente al resto de servicios hospitalarios. Análisis de la casuística de 5 años ajustada por GRD / Efficiency of the acute geriatric units compared to the rest of the hospital departments. A 5-year audit of the case-mix adjusted for diagnosis-related group

Introducción: La ocupación hospitalaria por pacientes mayores es elevada y lo será aún más en los próximos años. Sus estancias suelen ser más prolongadas, por lo que es importante que los hospitales desarrollen estructuras con la mayor eficiencia posible. Método: En un complejo hospitalario de 1.200 camas con dos unidades de geriatría de agudos (UGA), una en el hospital general (HG) y otra en un hospital de apoyo (HA), se analizaron las altas de los 15 grupos relacionados con el diagnóstico (GRD) más frecuentes en geriatría durante 5años y se compararon las estancias de los pacientes mayores de 75años en ambas UGA con las del resto de servicios de sus respectivos centros. Resultados: Se incluyeron 14.948 altas, cuyas estancias fueron 2,9días (25% de la estancia) inferiores en las UGA que en el resto de servicios. Las diferencias en la unidad del HG fueron del 22% (9,2 vs 11,7días) en 2011, del 16% (9,3 vs 11,1días) en 2012, del 21% (9,3 vs 11,1días) en 2013, del 34% (7,4 vs 11,1días) en 2014 y del 25% (8,3 vs 11días) en 2015. Las diferencias en la unidad del HA fueron del 18% (10,4 vs 12,7días) en 2011, del 19% (9,5 vs 11,7días) en 2012, del 25% (8,8 vs 11,7días) en 2013, del 24% (8,8 vs 11,6días) en 2014 y del 32% (9 vs 13,1días) en 2015, todas las diferencias con p<0,05. Conclusiones: Las UGA son un 25% más eficientes que el resto de servicios en el ingreso de pacientes mayores de 75años

Introduction: Hospital occupancy rate by older patients is high, and it will be even higher in the future. Their hospital stay is usually longer, making it important for hospitals to develop structures with the best efficiency possible. Method: Hospital discharges of patients older than 75years with the 15 most frequent Diagnosis-Related Groups (DRG) in Geriatrics were recorded during a 5-year period in a 1,200-bed hospital. Length of stay was compared between the two acute geriatric units (AGU), one in the general hospital (GH) and another in an affiliate hospital (AH), as well as with the rest of departments. Results: A total of 14,948 discharged patients were included. Length of stay was 2.9 (25%) days shorter in AGU units than in the rest of departments. Differences were 22% (9.2 vs 11.7days) in 2011, 16% (9.3 vs 11.1days) in 2012, 21% (9.3 vs 11.1days) in 2013, 34% (7.4 vs 11.1days) in 2014, and 25% (8.3 vs 11days) in 2015 in the GH. Differences were 18% (10.4 vs 12.7days) in 2011, 19% (9.5 vs 11.7days) in 2012, 25% (8.8 vs 11.7days) in 2013, 24% (8.8 vs 11.6days) in 2014, and 32% (9 vs 13.1days) in 2015 at the AH, all of them with a P<.05. Conclusions: AGU are 25% more efficient than the rest of hospital departments in managing hospital admissions of patients older than 75years

[Efficiency of the acute geriatric units compared to the rest of the hospital departments. A 5-year audit of the case-mix adjusted for diagnosis-related group]. / Eficiencia de las unidades de agudos de geriatría frente al resto de servicios hospitalarios. Análisis de la casuística de 5 años ajustada por GRD.

INTRODUCTION: Hospital occupancy rate by older patients is high, and it will be even higher in the future. Their hospital stay is usually longer, making it important for hospitals to develop structures with the best efficiency possible. METHOD: Hospital discharges of patients older than 75years with the 15 most frequent Diagnosis-Related Groups (DRG) in Geriatrics were recorded during a 5-year period in a 1,200-bed hospital. Length of stay was compared between the two acute geriatric units (AGU), one in the general hospital (GH) and another in an affiliate hospital (AH), as well as with the rest of departments. RESULTS: A total of 14,948 discharged patients were included. Length of stay was 2.9 (25%) days shorter in AGU units than in the rest of departments. Differences were 22% (9.2 vs 11.7days) in 2011, 16% (9.3 vs 11.1days) in 2012, 21% (9.3 vs 11.1days) in 2013, 34% (7.4 vs 11.1days) in 2014, and 25% (8.3 vs 11days) in 2015 in the GH. Differences were 18% (10.4 vs 12.7days) in 2011, 19% (9.5 vs 11.7days) in 2012, 25% (8.8 vs 11.7days) in 2013, 24% (8.8 vs 11.6days) in 2014, and 32% (9 vs 13.1days) in 2015 at the AH, all of them with a P<.05. CONCLUSIONS: AGU are 25% more efficient than the rest of hospital departments in managing hospital admissions of patients older than 75years.

Rabdomiólisis de inicio precoz e insuficiencia renal aguda asociadas a daptomicina. Caso clínico y revisión de la literatura / Early onset rhabdomyolysis and acute renal failure associated with the administration of daptomycin. A Case report and literature review

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Factores predictores de pérdida funcional al alta en ancianos hospitalizados por enfermedad aguda / Predictive factors of functional decline at hospital discharge in elderly patients hospitalised due to acute illness

Objetivo: Comparar las características basales y las encontradas durante la hospitalización como predictores de pérdida funcional al alta (PFa) en ancianos hospitalizados por enfermedad aguda. Material y métodos: Se revisaron los registros informatizados de los pacientes ingresados en una Unidad de Agudos de Geriatría de un hospital terciario durante 10 años. Se incluyeron variables demográficas, clínicas, funcionales y asistenciales. Se definió la PFa mediante la diferencia entre el índice de Barthel basal (IBp) y al alta (IBa). Se calculó el porcentaje de PFa (%PFa=(IBp−IBa/IBp)x100). Las variables asociadas a mayor %PFa en el análisis bivariante se incluyeron en modelos multivariantes de regresión logística. La capacidad predictiva de cada modelo se evaluó mediante el área bajo la curva ROC. Resultados: Los factores asociados a mayor %PFa fueron la edad avanzada, el sexo femenino, provenir de residencia, un mayor deterioro cognitivo previo y al ingreso, una mejor situación funcional previa, una peor situación funcional al ingreso, un mayor número de diagnósticos y una estancia prolongada. El área bajo la curva para los modelos predictivos de %PFa fue 0,638 (IC 95%: 0,615-0,662) en el basado en la situación previa; 0,756 (IC 95%: 0,736-0,776) en el basado en la situación durante el ingreso; y 0,952 (IC 95%: 0,944-0,959) en el basado en una combinación de ambas. Conclusiones: La valoración global de las características del paciente tanto basales como durante el ingreso tiene mayor valor en la predicción de PFa que el análisis de los factores por separado en ancianos hospitalizados por enfermedad aguda (AU)

Objective: To compare baseline characteristics and those found during hospitalisation as predictors of functional decline at discharge (FDd) in elderly patients hospitalised due to acute illness. Material and method: A review was made of the computerized records of patients admitted to a Geriatric Acute Unit of a tertiary hospital over a 10 year period. A record was made of demographic, clinical, functional and health-care variables. Functional decline at discharge (FDd) was defined by the difference between the previous Barthel Index (pBI) and the discharge Barthel Index (dBI). The percentage of FDd (%FDd=(pBI−dBI/pBI)×100) was calculated. The variables associated with greater %FDd in the bivariate analysis were included in multivariate logistic regression models. The predictive capacity of each model was assessed using the area under the ROC curve. Results: The factors associated with greater %FDd were advanced age, female gender, to live in a nursing home, cognitive impairment, better baseline functional status and worse functional status at admission, number of diagnoses, and prolonged stay. The area under the ROC curve for the predictive models of %FDd was 0.638 (95% CI: 0.615-0.662) based on the previous situation, 0.756 (95% CI: 0.736-0.776) based on the situation during admission, and 0.952 (95% CI: 0.944-0.959) based on a combination of these factors. Conclusions: The overall assessment of patient characteristics, both during admission and baseline, may have greater value in prediction of FDd than analysis of factors separately in elderly patients hospitalised due to acute illness (AU)

[Predictive factors of functional decline at hospital discharge in elderly patients hospitalised due to acute illness]. / Factores predictores de pérdida funcional al alta en ancianos hospitalizados por enfermedad aguda.

OBJECTIVE: To compare baseline characteristics and those found during hospitalisation as predictors of functional decline at discharge (FDd) in elderly patients hospitalised due to acute illness. MATERIAL AND METHOD: A review was made of the computerized records of patients admitted to a Geriatric Acute Unit of a tertiary hospital over a 10 year period. A record was made of demographic, clinical, functional and health-care variables. Functional decline at discharge (FDd) was defined by the difference between the previous Barthel Index (pBI) and the discharge Barthel Index (dBI). The percentage of FDd (%FDd=(pBI-dBI/pBI)×100) was calculated. The variables associated with greater %FDd in the bivariate analysis were included in multivariate logistic regression models. The predictive capacity of each model was assessed using the area under the ROC curve. RESULTS: The factors associated with greater %FDd were advanced age, female gender, to live in a nursing home, cognitive impairment, better baseline functional status and worse functional status at admission, number of diagnoses, and prolonged stay. The area under the ROC curve for the predictive models of %FDd was 0.638 (95% CI: 0.615-0.662) based on the previous situation, 0.756 (95% CI: 0.736-0.776) based on the situation during admission, and 0.952 (95% CI: 0.944-0.959) based on a combination of these factors. CONCLUSIONS: The overall assessment of patient characteristics, both during admission and baseline, may have greater value in prediction of FDd than analysis of factors separately in elderly patients hospitalised due to acute illness.