Pileflebitis o trombosis séptica portal persistente en paciente nonagenaria / Persistent septic portal vein thrombosis in a nonagenarian patient

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Octogenaria con artritis reumatoide, febrícula, derrame pericárdico severo y esplenomegalia / Octogenarian with rheumatoid arthritis, low-grade fever, severe pericardial effusion, and splenomegaly

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Development and validation of a prognostic index for 6- and 12-month mortality in hospitalized older adults.

BACKGROUND/AIM: Estimation of mortality in elderly patients is difficult yet very important when planning care. Previous tools are complicated or do no take into account some major determinants of mortality (i.e., frailty). We designed a simple, accurate, and non-disease-specific tool to predict individual mortality risk after hospital discharge in older adults. METHODS: Patients admitted to the Acute Geriatric Unit were assessed at adission and at discharge and contacted 6 and 12 months later. Determinants of mortality were obtained. Using multivariable analysis, beta coeffcicients were calculated to build 2 scores able to predict mortality at 6 and 12 months after discharge. The scores were tested on a sample comprising 75% of the patients, who were randomly selected; they were validated using the remaining 25%. Discrimination was assessed using ROC curves. Scores were calculated for each patient and divided into tertiles. Survival analysis was performed. RESULTS: Determinants of mortality at 6 months were dependent ambulation at baseline, full dependence at discharge, length of stay, pluripatology, pressure ulcers, low grip strength, malignacy, and male gender. At 12 months the determinants were: dependent amblation at baseline, full dependence at discharge, pluripatology, low BMI, low grip strength, heart failure, malignacy, and male gender. Discrimination and calibration were excellent. Survival analysis demonstrated different survival trajectories (p<0.001) for each tertile in both scores. CONCLUSIONS: Our incices provide accurate prognostic information in elderly patients after discharge. They can be calculated easily, quickly and do not require technical or laboratory support, thus endorsing their value in dalily clinical practice.

[Medical-surgical emergency department]. / Departamento de urgencias médico-quirúrgicas.

We describe and analyze the response of the emergency department (ED) to the events of 11 March, 2004. The ED played a major role in the care of victims who survived the initial explosions. Of the 976 victims transferred to hospital that day, 325 (32%) were attended in the ED of the Gregorio Maranon University Hospital. Nine percent were critically ill and only 5 died. The first step was to evaluate and transfer the 123 patients who were already in the ED when the explosions took place, thus freeing the emergency area. Victim triage was organized in three stages: external triage, triage in the ED, and a third triage in the critical care unit. The emergency areas were reclassified into resuscitation, major trauma and minor trauma. There were no staff shortages as personnel spontaneously volunteered. Finally, the main factors related to the success of the interventions, as well as the deficiencies found, are discussed.

Departamento de Urgencias Médico-Quirúrgicas / Medical-Surgical Emergency Department

Describimos y analizamos la respuesta del Departamento de Urgencias a los acontecimientos del 11 de marzo de 2004. Dicho departamento desempeñó un papel fundamental en la asistencia a las víctimas que sobrevivieron a las explosiones iniciales. De las 976 víctimas trasladadas a los hospitales ese día, en el Departamento de Urgencias del Hospital Gregrorio Marañón se atendió a 325 (32%). El 9% eran pacientes críticos y sólo 5 fallecieron. La primera acción fue evaluar y reubicar a los 123 pacientes ordinarios que permanecían en el Departamento de Urgencias al inicio de las explosiones y así liberar el área de urgencias. El triage de las víctimas se organizó a 3 niveles: uno externo y otro interno en urgencias, y un tercer triage posterior en las Unidades de Cuidados Críticos. Las áreas de urgencias se reclasificaron en resucitación, traumatismo mayor y traumatismo menor. La espontaneidad y el voluntarismo de los trabajadores hicieron que no faltara personal. Finalmente, se discuten los principales factores relacionados con el éxito en la asistencia, así como las debilidades y fallos encontrados (AU)

We describe and analyze the response of the emergency department (ED) to the events of 11 March, 2004. The ED played a major role in the care of victims who survived the initial explosions. Of the 976 victims transferred to hospital that day, 325 (32%) were attended in the ED of the Gregorio Marañón University Hospital. Nine percent were critically ill and only 5 died. The first step was to evaluate and transfer the 123 patients who were already in the ED when the explosions took place, thus freeing the emergency area. Victim triage was organized in three stages: external triage, triage in the ED, and a third triage in the critical care unit. The emergency areas were reclassified into resuscitation, major trauma and minor trauma. There were no staff shortages as personnel spontaneously volunteered. Finally, the main factors related to the success of the interventions, as well as the deficiencies found, are discussed (AU)