Validez y utilidad del RAE-CMBD en el estudio de los pacientes hospitalizados con gripe / Validity and usefulness of the RAE-CMBD studying patients hospitalised with influenza

Background: Understanding the hospital impact of influenza requires enriching epidemiological surveillance registries with other sources of information. The aim of this study was to determine the validity of the Hospital Care Activity Record – Minimum Basic Data Set (RAE-CMBD) in the analysis of the outcomes of patients hospitalised with this infection. Methods: Observational and retrospective study of adults admitted with influenza in a tertiary hospital during the 2017/2018 and 2018/2019 seasons. We calculated the concordance of the RAE-CMBD with the influenza epidemiological surveillance registry (gold standard), as well as the main parameters of internal and external validity. Logistic regression models were used for risk adjustment of in-hospital mortality and length of stay. Results: A total of 907 (97.74%) unique matches were achieved, with high inter-observer agreement (ƙ=0.828). The RAE-CMBD showed a 79.87% sensitivity, 99.72% specificity, 86.71% positive predictive value and 99.54% negative predictive value. The risk-adjusted mortality ratio of patients with influenza was lower than that of patients without influenza: 0.667 (0.53-0.82) vs. 1.008 (0.98-1.04) and the risk-adjusted length of stay ratio was higher: 1.15 (1.12-1.18) vs. 1.00 (0.996-1.001). Conclusion: The RAE-CMBD is a valid source of information for the study of the impact of influenza on hospital care. The lower risk-adjusted mortality of patients admitted with influenza compared to other inpatients seems to point to the effectiveness of the main clinical and organisational measures adopted. (AU)

Objetivos: Conocer el impacto hospitalario de la gripe requiere enriquecer los registros de vigilancia epidemiológicos con otras fuentes de información. El objetivo de este estudio fue determinar la validez del Registro de Actividad de Atención Especializada – Conjunto Mínimo Básico de Datos (RAE-CMBD) en el análisis de los resultados asistenciales de los pacientes hospitalizados con esta infección. Métodos: Estudio observacional retrospectivo de los adultos ingresados con gripe en un hospital terciario durante las temporadas 2017/2018 y 2018/2019. Se calculó la concor-dancia del RAE-CMBD con el registro de vigilancia epidemiológica de gripe (estándar de referencia), así como los principales parámetros de validez interna y externa. Se utilizaron modelos de regresión logística para el ajuste por riesgo de la mortalidad intrahospitalaria y duración de la estancia. Resultados: Se lograron 907 (97,74%) emparejamientos únicos, con una concordancia interobservadores elevada (ƙ=0,828). El RAE-CMBD mostró una sensibilidad del 79,87%, especificidad del 99,72%, valor predictivo positivo del 86,71% y negativo del 99,54%. La razón de mortalidad ajustada por riesgo de los pacientes con gripe fue menor que la de los pacientes sin gripe: 0,667 (0,53–0,82) vs. 1,008 (0,98–1,04) y la razón de duración de la estancia ajustada por riesgo, mayor: 1,15 (1,12–1,18) vs. 1,00 (0,996–1,001). Conclusiones: El RAE-CMBD es una fuente de información válida para el estudio del impacto de la gripe en la atención hospitalaria. La menor mortalidad ajustada por riesgo de los pacientes ingresados con gripe respecto de los demás ingresados, parece apuntar a la efectividad de las principales medidas clínicas y organizativas adoptadas. (AU)

Los ingresos ectópicos y su relación con la aparición de complicaciones y estancias prolongadas / Outlier patient admissions and their relationship with the emergence of clinical complications and prolonged hospital stays

Objetivo: Analizar la relación entre el tipo de ingreso (ectópico y no ectópico) y la aparición de complicaciones clínicas y la estancia media. Métodos: Mediante un estudio epidemiológico retrospectivo de cohorte de pacientes ingresados durante un periodo de 6 meses en el Hospital Complejo Asistencial Universitario de Salamanca se identificaron los pacientes ectópicos y no ectópicos. Se utilizaron las bases de datos del servicio de admisión, el conjunto mínimo básico de datos de hospitalización, el agrupador de pacientes por grupos relacionados por el diagnóstico (GRD) y el analizador estadístico clínico-asistencial ALCOR. El análisis se amplió detallando los resultados para los cinco GRD más frecuentes en el periodo. Resultados: De un total de 11.842 ingresos, el 8,4% fueron ingresos ectópicos. En el estudio global, la estancia media fue mayor en los ectópicos (8,11 días) que en los no ectópicos (7,15 días). La mortalidad también fue superior en los ectópicos, pero aparecieron menos complicaciones (7,6% en ectópicos frente a 8,4% en no ectópicos). El análisis por GRD mantuvo estos resultados en tres de los cinco grupos analizados, con mayor estancia media, pero menos complicaciones, en los casos ectópicos. Conclusiones: Un determinado porcentaje de pacientes ingresaron ectópicos. Fueron más frecuentes los pacientes de especialidades médicas ubicados en plantas quirúrgicas. Estos pacientes ectópicos presentaron una estancia media mayor respecto a los no ectópicos. No hubo diferencias significativas en la aparición de complicaciones

Objective: To analyze the relationship between the type of hospital admission (outlier and non-outlier admissions) and the appearance of clinical complications and the average stay. Methods: From a retrospective epidemiological study of a cohort of patients admitted to the Hospital Complejo Asistencial Universitario de Salamanca (Salamanca, Spain) over a six-month period, outlier and non-outlier patients were identified. This project had access to the admissions department database, the hospital's CMBD (in Spanish, Conjunto Mínimo Básico de Datos) for hospitalisation, the AP-DRG (All Patient-Diagnosis Related Groups) and ALCOR (a clinical-statistics analytics tool). It then proceeded to break down the results by DRG, looking at the five most common DRGs in that period. Results: 8.4% of the total 11,842 admissions were medical outliers. In the overall study, the average stay was longer for outlier patients (8. 11 days) than for other patients (7.15 days). The mortality rate was, likewise, higher for outlier patients, although there was a reduced incidence of complications (7.6% for outlier patients as opposed to 8.4% for others). The analysis by DRG corroborated these results in three of the five cases investigated, showing longer average stays but fewer clinical complications in the case of outlier patients. Conclusions: On admission to hospital, a significant proportion of patients were allocated beds on inappropriate wards (outlier patients). It was more common to find medical patients placed on surgical wards than vice versa. The average stay of outlier patients was longer than that of patients admitted to the correct ward. The study found no significant difference between the two groupś in terms of clinical complication rates

[Outlier patient admissions and their relationship with the emergence of clinical complications and prolonged hospital stays]. / Los ingresos ectópicos y su relación con la aparición de complicaciones y estancias prolongadas.

OBJECTIVE: To analyze the relationship between the type of hospital admission (outlier and non-outlier admissions) and the appearance of clinical complications and the average stay. METHODS: From a retrospective epidemiological study of a cohort of patients admitted to the Hospital Complejo Asistencial Universitario de Salamanca (Salamanca, Spain) over a six-month period, outlier and non-outlier patients were identified. This project had access to the admissions department database, the hospital's CMBD (in Spanish, Conjunto Mínimo Básico de Datos) for hospitalisation, the AP-DRG (All Patient-Diagnosis Related Groups) and ALCOR (a clinical-statistics analytics tool). It then proceeded to break down the results by DRG, looking at the five most common DRGs in that period. RESULTS: 8.4% of the total 11,842 admissions were medical outliers. In the overall study, the average stay was longer for outlier patients (8. 11 days) than for other patients (7.15 days). The mortality rate was, likewise, higher for outlier patients, although there was a reduced incidence of complications (7.6% for outlier patients as opposed to 8.4% for others). The analysis by DRG corroborated these results in three of the five cases investigated, showing longer average stays but fewer clinical complications in the case of outlier patients. CONCLUSIONS: On admission to hospital, a significant proportion of patients were allocated beds on inappropriate wards (outlier patients). It was more common to find medical patients placed on surgical wards than vice versa. The average stay of outlier patients was longer than that of patients admitted to the correct ward. The study found no significant difference between the two groups in terms of clinical complication rates.

[Rhabdomyolysis. A descriptive study of 449 patients]. / Rabdomiólisis. Estudio descriptivo de 449 pacientes.

BACKGROUND AND OBJECTIVES: Rhabdomyolysis is a clinical syndrome characterized by acute necrosis of skeletal muscles along with the release of breakdown products into the bloodstream. Rhabdomyolysis is potentially lethal and its most serious complication is acute renal failure (ARF). Diagnosis is established by the 5-times elevation (975 UI/l) over the upper limit of creatine-kinase (CK). PATIENTS AND METHODS: We performed a retrospective study on Salamanca University Hospital for the period 1999-2010. There were 449 patients diagnosed with rhabdomyolysis over which we tested demographic, etiologic, analytic, complication and mortality variables. RESULTS: Out of 449 patients, 69% were male. Average age was 66.5 ± 21 years. Most frequent etiologies were trauma, sepsis and immobility/crushing (24, 19 and 17% respectively). Maximum levels of CK were 343,170 ng/ml and its increase did not show significant association with mortality or ARF. This was found in 54% of patients (mean creatinine 3.03 mg/dl) and it was significantly associated with mortality (P <. 001). Global mortality was 18.7%. There were no significant associations between mortality and unique or multiple causes. However, there were significant associations between mortality and age (P <. 001) and 90% of deaths occurred among patients over 60 years old. CONCLUSION: Rhabdomyolysis prevails in elder males. Trauma, sepsis and immobility/crushing are the most frequent etiologies. CK values are not related with ARF or mortality. Mortality is associated with most frequent causes, old age and ARF.