Acute pulmonary embolism: Appropriateness of emergency department management according to clinical guidelines.

BACKGROUND AND AIMS: To evaluate the frequency of acute pulmonary embolism, the use of clinical probability scores, and the appropriateness of the management of patients for whom computed tomography angiography (CTA) was requested from the emergency department for suspected acute pulmonary embolism. MATERIALS AND METHODS: This was a retrospective observational study of CTA studies requested from the emergency department to rule out acute pulmonary embolism. We analyzed clinical variables and the explicit use of clinical probability scores. We determined the appropriateness of management according to the Wells Score and Geneva Score and the simplified versions of these two scores, calculated retrospectively. RESULTS: We included 534 patients (52.8% women; mean age, 73 years). The frequency of acute pulmonary embolism was 23.0% and the Wells Score was explicitly used in 15.2%. The appropriateness of the management varied depending on the clinical probability score used to assess it (54.5%-75.8%) and on whether the standard d-dimer or age-adjusted d-dimer was used. CONCLUSIONS: The failure to use the Wells Scores in all cases does not necessarily imply inappropriate management, and the performance of global clinical judgment can be similar to that of clinical probability scores; however, specific studies are necessary to confirm this hypothesis.

Tromboembolismo pulmonar agudo: adecuación del manejo de pacientes según las guías de práctica clínica en el servicio de urgencias / Acute pulmonary embolism: appropriateness of emergency department management according to clinical guidelines

Antecedentes y objetivo: Evaluar la frecuencia de tromboembolismo pulmonar agudo (TEPA), el uso de escalas de probabilidad clínica (EPC) y la adecuación del manejo de los pacientes a los que se solicitó angiografía pulmonar por tomografía computarizada (angio-TC) por sospecha de TEPA desde el servicio de urgencias. Materiales y métodos: Estudio observacional retrospectivo de las angio-TC solicitadas desde el servicio de urgencias para descartar TEPA. Se analizaron variables clínicas y el uso explícito de EPC. Se determinó la adecuación del manejo en función de las escalas de Wells (EW) y Ginebra (EG) y sus versiones simplificadas (EWs y EGs), calculadas retrospectivamente. Resultados: Se incluyeron 534 pacientes (52,8% mujeres, mediana de edad: 73 años). La frecuencia de TEPA fue del 23,0% y el uso explícito de la EW, del 15,2%. La adecuación del manejo fue variable dependiendo de la EPC (54,5-75,8%) y del dímero D estándar o ajustado por edad. Conclusiones: La baja utilización explícita de la EW no conlleva un manejo inadecuado, y el juicio clínico global puede ofrecer un rendimiento similar a las EPC, pero es necesario realizar estudios específicos para comprobar esta hipótesis.(AU)

Background and aims: To evaluate the frequency of acute pulmonary embolism, the use of clinical probability scores, and the appropriateness of the management of patients for whom computed tomography angiography (CTA) was requested from the emergency department for suspected acute pulmonary embolism. Materials and methods: This was a retrospective observational study of CTA studies requested from the emergency department to rule out acute pulmonary embolism. We analyzed clinical variables and the explicit use of clinical probability scores. We determined the appropriateness of management according to the Wells Score and Geneva Score and the simplified versions of these two scores, calculated retrospectively. Results: We included 534 patients (52.8% women; mean age, 73 years). The frequency of acute pulmonary embolism was 23.0% and the Wells Score was explicitly used in 15.2%. The appropriateness of the management varied depending on the clinical probability score used to assess it (54.5%-75.8%) and on whether the standard D-dimer or age-adjusted D-dimer was used. Conclusions: The failure to use the Wells Scores in all cases does not necessarily imply inappropriate management, and the performance of global clinical judgment can be similar to that of clinical probability scores; however, specific studies are necessary to confirm this hypothesis.(AU)

Acute pulmonary embolism: appropriateness of emergency department management according to clinical guidelines. / Tromboembolismo pulmonar agudo: adecuación del manejo de pacientes según las guías de práctica clínica en el servicio de urgencias.

BACKGROUND AND AIMS: To evaluate the frequency of acute pulmonary embolism, the use of clinical probability scores, and the appropriateness of the management of patients for whom computed tomography angiography (CTA) was requested from the emergency department for suspected acute pulmonary embolism. MATERIALS AND METHODS: This was a retrospective observational study of CTA studies requested from the emergency department to rule out acute pulmonary embolism. We analyzed clinical variables and the explicit use of clinical probability scores. We determined the appropriateness of management according to the Wells Score and Geneva Score and the simplified versions of these two scores, calculated retrospectively. RESULTS: We included 534 patients (52.8% women; mean age, 73 years). The frequency of acute pulmonary embolism was 23.0% and the Wells Score was explicitly used in 15.2%. The appropriateness of the management varied depending on the clinical probability score used to assess it (54.5%-75.8%) and on whether the standard D-dimer or age-adjusted D-dimer was used. CONCLUSIONS: The failure to use the Wells Scores in all cases does not necessarily imply inappropriate management, and the performance of global clinical judgment can be similar to that of clinical probability scores; however, specific studies are necessary to confirm this hypothesis.

Burnout en médicos residentes que realizan guardias en un servicio de urgencias / Burnout syndrome among resident physicians performing shift work in the Emergency Department

Objetivo: Conocer el grado de desgaste profesional en médicos residentes de un hospital general que realizan guardias de urgencias. Metodos: Diseño: Estudio descriptivo transversal. Sujetos: Los 92 residentes que realizan guardias de policlínica. Mediciones: Cuestionario anónimo autoadministrado con variables sociodemográficas, laborales, sugerencias y el Maslach Burnout Inventory (22 ítems), que valora: cansancio emocional, despersonalización y realización personal en el trabajo. Análisis estadístico mediante t de Student y χ2. Resultados: 58 cuestionarios válidos (tasa de respuesta del 63,0%). La edad media fue 26 años. 72,4% mujeres. El 48,3% residentes de primer año, el 36,2% residentes de segundo año, y el 15,5% residentes de tercer año. El 50% eran residentes de medicina de familia. El 95% libraban las guardias. Los residentes de primer año realizaban 5 guardias de policlínica al mes, los residentes de segundo año 2 guardias, y los residentes de tercer año 3. Los valores medios obtenidos fueron: despersonalización: 11,0 ± 5,4 (IC del 95% 9,6-12,5); cansancio emocional: 34,0 ± 10,1 (IC del 95% 31,7-36,8); realización personal en el trabajo: 30,2 ± 7,6 (IC 95% 28,0-31,9). El 60% presentó puntaciones medias altas para despersonalización, el 74% para cansancio emocional y el 70% bajas para realización personal en el trabajo. Los residentes que no libraban las guardias registraron puntuaciones medias significativamente más altas de despersonalización. El 93% presentan burnout (moderado 50%, alto 43%). Se encontró un alto burnout en todos los residentes que no libraban las guardias (p < 0,05). No hay diferencias estadísticamente significativas en el nivel de burnout en relación al sexo, edad, año de residencia, especialidad ni número de guardias. Como sugerencias para mitigar el burnout destaca la petición de mejoras en las condiciones laborales. Conclusiones: El grado de burnout es muy alto entre los residentes de nuestro hospital que realizan guardias en urgencias (AU)

Background and aims: To assess the degree of professional and/or occupational burnout among resident physicians at a General Hospital performing Emergency Department (ED) shift duty. Methods: Design: Cross-sectional descriptive study. Study population: the 92 Resident Physicians performing shift duty in the ED. Measures: Anonymous self-administered questionnaire with socio-demographic and occupational variables, suggestions, and the 22-item MASLACH BURNOUT INVENTORY assessing emotional exhaustion, depersonalisation and professional accomplishment. Statistical analysis using the Student’s t-test and the χ2 test. Results: Material: Number of validly answered questionnaires, 58 (response rate, 63.0%). Mean age of the responders 26 years (72.4% women). Among the responder population, 48.3% were first-year, 36.2% secondyear and 15.5% third-year resident physicians; 50% of the responding population were resident physicians in the Community and Family Medicine speciality. Ninety-five per cent of the studied population were dutyfree after ED duty. The first-year Resident Physicians performed an average 5 ED duty shifts per month, the 2nd-year ones an average 2, and the 3rd year ones an average 3. The mean assessment values were: depersonalisation 11.0 ± 5.4 (95% CI, 9.6-12.5), emotional exhaustion 34.0 ± 10.1 (95% CI, 31.7-36.8), professional accomplishment 30.2 ± 7.6 (95% CI, 28.0-31.9). Mean-high scores were recorded for depersonalisation in 60% and for emotional exhaustion in 74%, and low scores for professional accomplishment in 70%. Those Resident Physicians who were not duty-free after ED shift duty showed significantly higher average depersonalisation scores. Ninety-three per cent evidenced some level of burnout (50% moderate, 43% high). High burnout levels were observed in all those resident physicians who were not duty-free after ED shift duty (p<0.05). There were no statistically significant differences in burnout level related to gender, age, residency year, speciality or ED duty shift numbers. As suggestions for mitigating the burnout incidence, the request for improvement in labour conditions may be stressed. Conclusions: The burnout degree is very high among the resident physicians in our hospital performing ED shift work (AU)