Validación del modelo predictivo de bacteriemia (5MPB-Toledo) en los pacientes atendidos en el servicio de urgencias por infección / Validation of a predictive model for bacteraemia (MPB5-Toledo) in the patients seen in emergency departments due to infections

ObjetivoValidar un modelo sencillo de riesgo para predecir bacteriemia (5MPB-Toledo) en los pacientes atendidos en los servicios de urgencias hospitalarios (SUH) por un episodio de infección.MétodosEstudio observacional de cohortes prospectivo y multicéntrico de los hemocultivos (HC) obtenidos en 74 SUH españoles en los pacientes adultos (≥18 años) atendidos por infección desde el 1 de octubre de 2019 hasta el 29 de febrero de 2020. Se analizó la capacidad predictiva del modelo con el área bajo la curva (ABC) de la característica operativa del receptor (COR) y se calculó el rendimiento diagnóstico de los puntos de corte (PC) del modelo elegidos con los cálculos de la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo.ResultadosSe incluyeron 3.843 episodios de HC extraídos. De ellos, se consideraron como bacteriemias verdaderas 839 (21,83%) y como HC negativos 3.004 (78,17%). Entre los negativos, 172 (4,47%) se consideraron contaminados. Se categorizó a los pacientes en bajo (0-2 puntos), moderado (3-5 puntos) y alto (6-8 puntos) riesgo, con una probabilidad de bacteriemia de 1,5, 16,8 y 81,6%, respectivamente. El ABC-COR del modelo tras remuestreo fue de 0,930 (IC 95%: 0,916-0,948). El rendimiento diagnóstico del modelo con un PC≥5 puntos consigue una sensibilidad del 94,76% (IC 95%: 92,97-96,12), especificidad del 81,56% (IC 95%: 80,11-82,92) y un valor predictivo negativo del 98,24% (IC 95%: 97,62-98,70).ConclusiónEl modelo 5MPB-Toledo es de utilidad para predecir bacteriemia en los pacientes atendidos en el SUH por un episodio de infección.

ObjectiveTo validate a simple risk score to predict bacteremia (MPB5-Toledo) in patients seen in the emergency departments (ED) due to infections.MethodsProspective and multicenter observational cohort study of the blood cultures (BC) ordered in 74 Spanish ED for adults (aged 18 or older) seen from from October 1, 2019, to February 29, 2020.The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the cut-off values chosen for getting the sensitivity, specificity, positive predictive value and negative predictive value.ResultsA total of 3.843 blood samples wered cultured. True cases of bacteremia were confirmed in 839 (21.83%). The remaining 3.004 cultures (78.17%) were negative. Among the negative, 172 (4.47%) were judged to be contaminated. Low risk for bacteremia was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 8 points. Bacteremia in these 3 risk groups was predicted for 1.5%, 16.8%, and 81.6%, respectively. The model's area under the receiver operating characteristic curve was 0.930 (95% CI, 0.916-0.948). The prognostic performance with a model's cut-off value of ≥ 5 points achieved 94.76% (95% CI: 92.97-96.12) sensitivity, 81.56% (95% CI: 80.11-82.92) specificity, and negative predictive value of 98.24% (95% CI: 97.62-98.70).ConclusionThe 5MPB-Toledo score is useful for predicting bacteremia in patients attended in hospital emergency departments for infection.

Validation of a predictive model for bacteraemia (MPB5-Toledo) in the patients seen in emergency departments due to infections.

OBJECTIVE: To validate a simple risk score to predict bacteremia (MPB5-Toledo) in patients seen in the emergency departments (ED) due to infections. METHODS: Prospective and multicenter observational cohort study of the blood cultures (BC) ordered in 74 Spanish ED for adults (aged 18 or older) seen from October 1, 2019, to February 29, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the cut-off values chosen for getting the sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: A total of 3.843 blood samples wered cultured. True cases of bacteremia were confirmed in 839 (21.83%). The remaining 3.004 cultures (78.17%) were negative. Among the negative, 172 (4.47%) were judged to be contaminated. Low risk for bacteremia was indicated by a score of 0-2 points, intermediate risk by 3-5 points, and high risk by 6-8 points. Bacteremia in these 3 risk groups was predicted for 1.5%, 16.8%, and 81.6%, respectively. The model's area under the receiver operating characteristic curve was 0.930 (95% CI, 0.916-0.948). The prognostic performance with a model's cut-off value of ≥5 points achieved 94.76% (95% CI: 92.97-96.12) sensitivity, 81.56% (95% CI: 80.11-82.92) specificity, and negative predictive value of 98.24% (95% CI: 97.62-98.70). CONCLUSION: The 5MPB-Toledo score is useful for predicting bacteremia in patients attended in hospital emergency departments for infection.

Validation of a predictive model for bacteraemia (MPB5-Toledo) in the patients seen in emergency departments due to infections. / Validación del modelo predictivo de bacteriemia (5MPB-Toledo) en los pacientes atendidos en el servicio de urgencias por infección.

OBJECTIVE: To validate a simple risk score to predict bacteremia (MPB5-Toledo) in patients seen in the emergency departments (ED) due to infections. METHODS: Prospective and multicenter observational cohort study of the blood cultures (BC) ordered in 74 Spanish ED for adults (aged 18 or older) seen from from October 1, 2019, to February 29, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the cut-off values chosen for getting the sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: A total of 3.843 blood samples wered cultured. True cases of bacteremia were confirmed in 839 (21.83%). The remaining 3.004 cultures (78.17%) were negative. Among the negative, 172 (4.47%) were judged to be contaminated. Low risk for bacteremia was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 8 points. Bacteremia in these 3 risk groups was predicted for 1.5%, 16.8%, and 81.6%, respectively. The model's area under the receiver operating characteristic curve was 0.930 (95% CI, 0.916-0.948). The prognostic performance with a model's cut-off value of ≥ 5 points achieved 94.76% (95% CI: 92.97-96.12) sensitivity, 81.56% (95% CI: 80.11-82.92) specificity, and negative predictive value of 98.24% (95% CI: 97.62-98.70). CONCLUSION: The 5MPB-Toledo score is useful for predicting bacteremia in patients attended in hospital emergency departments for infection.

Predicting bacteremia in patients attended for infections in an emergency department: the 5MPB-Toledo model. / Modelo 5MPB-Toledo para predecir bacteriemia en los pacientes atendidos por infección en el servicio de urgencias.

OBJECTIVES: To develop a simple risk score to predict bacteremia in patients in our hospital emergency department for infection. MATERIAL AND METHODS: Retrospective observational cohort study of all blood cultures ordered in the emergency department for adults (aged 18 or older) from July 1, 2018, to March 31, 2019. We gathered data on 38 independent variables (demographic, comorbidity, functional status, and laboratory findings) that might predict bacteremia. Univariate and multiple logistic regression analyses were applied to the data and a risk scale was developed. RESULTS: A total of 2181 blood samples were cultured. True cases of bacteremia were confirmed in 262 (12%). The remaining 1919 cultures (88%) were negative. No growth was observed in 1755 (80.5%) of the negative cultures, and 164 (7.5%) were judged to be contaminated. The 5MPB-Toledo model identified 5 predictors of bacteremia: temperature higher than 38.3°C (1 point), a Charlson comorbidity index of 3 or more (1 point), respiratory frequency of at least 22 breaths/min (1 point), leukocyte count greater than 12 000/mm3 (1 point), and procalcitonin concentration of 0.51 ng/mL or higher (4 points). Low risk for bacteremia was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 8 points. Bacteremia in these 3 risk groups was predicted for 1.1%, 10.5%, and 77%, respectively. The model's area under the receiver operating characteristic curve was 0.946 (95% CI, 0.922-0.969). CONCLUSION: The 5MPB-Toledo score could be useful for predicting bacteremia in patients attended in hospital emergency departments for infection.

OBJETIVO: Diseñar un modelo sencillo de riesgo para predecir bacteriemia en los pacientes atendidos por un episodio de infección en el servicio de urgencias hospitalario (SUH). METODO: Estudio observacional, de cohortes retrospectivo, de todos los hemocultivos (HC) extraídos en un SUH en los pacientes adultos ($ 18 años) atendidos por infección desde el 1 de julio de 2018 hasta el 31 de marzo de 2019. Se analizaron 38 variables independientes (demográficas, comorbilidad, funcionales, clínicas y analíticas) que pudieran predecir la existencia de bacteriemia. Se realizó un estudio univariado y multivariable, mediante regresión logística, y después se construyó una escala de puntuación de riesgo. RESULTADOS: Se incluyeron 2.181 episodios de HC extraídos. De ellos se consideraron como bacteriemias verdaderas 262 (12%) y como HC negativos 1.919 (88%). Entre los negativos, 1.755 (80,5%) no tuvieron crecimiento y 164 (7,5%) se consideraron contaminados. Se definió un modelo predictivo de bacteriemia con 5 variables (5MPBToledo). El modelo incluyó la temperatura > 38,3°C (1 punto), un índice de Charlson $ 3 (1 punto), la frecuencia respiratoria $ 22 respiraciones por minuto (1 punto), leucocitos > 12.000/mm3 (1 punto) y procalcitonina $ 0,51 ng/ ml (4 puntos). Se categorizó a los pacientes en bajo (0-2 puntos), moderado (3-5 puntos) y alto (6-8 puntos) riesgo, con una probabilidad de bacteriemia de 1,1%, 10,5% y 77%, respectivamente. El ABC-COR del modelo tras remuestreo fue de 0,946 (IC 95%: 0,922-0,969). CONCLUSIONES: El Modelo 5MPB-Toledo podría ser de utilidad para predecir bacteriemia en los pacientes atendidos por un episodio de infección en los SUH.

Infection and systemic inflammatory response syndrome in older patients in the emergency department: a 30-day risk model. / Modelo de riesgo a 30 días en los pacientes ancianos con infección y síndrome de respuesta inflamatoria sistémica atendidos en los servicios de urgencias.

OBJECTIVES: To build a model to predict 30-day mortality and compare it to prediction based on the Mortality in Emergency Department Sepsis (MEDS) score in patients aged 75 years or older treated for infection and systemic inflammatory response syndrome (SIRS) in the emergency department. MATERIAL AND METHODS: Prospective analysis of a convenience cohort of patients aged 75 years or older treated for infection and SIRS in 13 Spanish emergency departments in 2013. We recorded demographic variables; comorbidity; risk factors for poor outcome; functional dependence at baseline; site of infection; and hemodynamic, clinical and laboratory findings on start of care.The main outcome variable was 30-day all-cause mortality. RESULTS: Three hundred seventy-nine patients with a mean (SD) age of 84 (5.8) years were included; 186 (49.,1%) were women, 150 (39.6%) had a high degree of comorbidity, and 113 (34.2%) had a high level of functional dependence. Seventy-nine (20.8%) died within 30 days. The model built by the infection working group (INFURG) of the Spanish Society of Emergency Medicine (SEMES) included the presence of metastasis from a solid tumor (odds ratio [OR], 5.4; 95% CI, 1.6-18.2; P=.006), respiratory insufficiency (OR, 3.02; 95% CI, 1.5-6.0; P=.002), renal insufficiency (OR, 2.4; 95% CI, 1.0-5.5; P=.045), arterial hypertension (OR, 2.4; 95% CI, 1.2-5.0; P=.015), and altered level of consciousness (OR, 2.9; 95% CI, 1.4-5.8; P=.003). The area under the receiver operating characteristic curve of the INFURG-OLDER model was 0.78 (95% CI, 0.72-0.84; P<.001) (vs 0.72 (95% CI, 0.64-0.80; P<.001 for the MEDS model). CONCLUSION: The INFURG-OLDER model has good predictive ability for 30-day mortality in patients aged 75 years or older who are treated in emergency departments for SIRS.

OBJETIVO: . Diseñar un modelo de riesgo para predecir la mortalidad a los 30 días, y compararlo con la escala MEDS (Mortality in Emergency Department), en pacientes 75 años atendidos por infección con síndrome de respuesta inflamatoria sistémica (SIRS) en los servicios de urgencias (SU). METODO: Estudio analítico de cohortes prospectivo que incluyó por oportunidad a pacientes 75 años atendidos por infección con SIRS en 13 SU españoles durante el año 2013. Se recogieron variables demográficas, comorbilidad, factores de riesgo de mala evolución, situación funcional basal, modelo de infección, y parámetros hemodinámicos, clínicos y analíticos en el momento de la primera atención. La variable de resultado principal fue mortalidad por cualquier causa a los 30 días. RESULTADOS: Se incluyeron 379 pacientes con edad media de 84 (DE 5,8) años, 186 (49,1%) fueron mujeres, 150 (39,6%) tenían alto grado de comorbilidad y 113 (34,2%) dependencia funcional grave. Setenta y nueve pacientes (20,8%) fallecieron a los 30 días. El modelo INFURG-OLDER incluyó la presencia de tumor sólido con metástasis (OR = 5,4; IC95% 1,6- 18,2; p = 0,006), la insuficiencia respiratoria (OR = 3,02; IC95% 1,5-6,0; p = 0,002), la insuficiencia renal (OR = 2,4; IC95% 1,0-5,5; p = 0,045), la hipotensión arterial (OR = 2,4; IC95% 1,2-5,0; p = 0,015) y la disminución del nivel de consciencia (OR = 2,9; IC95% 1,4-5,8; p = 0,003). El área bajo la curva (ABC) del modelo INFURG-OLDER fue de 0,78 (IC95% 0,72- 0,84; p < 0,001) y el ABC de la escala MEDS fue de 0,72 (IC95% 0,64-0,80; p < 0,001). CONCLUSIONES: El modelo INFURG-OLDER tiene buena capacidad para predecir la mortalidad a los 30 días en los pacientes 75 años atendidos por infección con SIRS en los SU.

APACHE II score for critically ill patients with a solid tumor: A reclassification study. / Escala APACHE II para pacientes críticos con cáncer sólido. Estudio de reclasificación.

OBJECTIVE: To improve the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE) II model for predicting hospital mortality in critically ill cancer patients. MATERIALS AND METHODS: This was a prospective cohort study of 522 patients admitted to ICU with a solid tumor. We developed the "APACHE II score for critically ill patients with a solid tumor" (APACHE IICCP score), in which typical variables of critically ill cancer patients were added to general APACHE II score. Calibration and discrimination were evaluated by Hosmer-Lemeshow test (H-L) and area under receiver operating characteristic curve (AROC), respectively. The improvement in predicting hospital mortality with the new model was assessed using a reclassification analysis by integrated discrimination improvement (IDI), net reclassification improvement (NRI; cut-off point of 20% in risk of death) and quantitative NRI (qNRI). RESULTS: The hospital mortality rate was 13%. Discrimination was superior for APACHE IICCP score (AROC=0.91 [95% CI 0.87-0.94; P<.0001]) compared to general APACHE II score (AROC=0.62 [95% CI 0.54-0.70; P=.002]). Calibration was better using APACHE IICCP score (H-L; P=.267 vs. P=.001). In reclassification analysis, an improved mortality prediction was observed with APACHE IICCP score (IDI=0.2994 [P<.0001]; total qNRI=134.3% [95% CI 108.8-159.8%; P<.0001]; total NRI=41.5% [95% CI 23.7-59.3%; P<.0001]). CONCLUSIONS: The performance of APACHE IICCP score was superior to that observed for general APACHE II score in predicting mortality in critically ill patients with a solid tumor. Other studies validating this new predictive model are required.

Predicting short-term mortality in patients with acute exacerbation of chronic heart failure: The EAHFE-3D scale. / Predicción de la mortalidad a muy corto plazo de los pacientes con insuficiencia cardiaca crónica agudizada: escala EAHFE-3D.

INTRODUCTION AND OBJECTIVES: Prognostic scales are needed in acute exacerbation of chronic heart failure to detect early mortality. The objective of this study is to create a prognostic scale (scale EAHFE-3D) to stratify the risk of death the very short term. PATIENTS AND METHOD: We used the EAHFE database, a multipurpose, multicenter registry with prospective follow-up currently including 6,597 patients with acute heart failure attended at 34 Spanish Emergency Departments from 2007 to 2014. The following variables were collected: demographic, personal history, data of acute episode and 3-day mortality. The derivation cohort included patients recruited during 2009 and 2011 EAHFE registry spots (n=3,640). The classifying variable was all-cause 3-day mortality. A prognostic scale (3D-EAHFE scale) with the results of the multivariate analysis based on the weight of the OR was created. The 3D-EAHFE scale was validated using the cohort of patients included in 2014 spot (n=2,957). RESULTS: A total of 3,640 patients were used in the derivation cohort and 102 (2.8%) died at 3 days. The final scale contained the following variables (maximum 165 points): age≥75 years (30 points), baseline NYHA III-IV (15 points), systolic blood pressure<110mmHg (20 points), room-air oxygen saturation<90% (30 points), hyponatremia (20 points), inotropic or vasopressor treatment (30 points) and need for noninvasive mechanical ventilation (20 points); with a ROC curve of 0.80 (95% CI 0.76-0.84; P<.001). The validation cohort included 2,957 patients (66 died at 3 days, 2.2%), and the scale obtained a ROC curve of 0.76 (95% CI 0.70-0.82; P<.001). The risk groups consisted of very low risk (0-20 points), low risk (21-40 points), intermediate risk (41-60 points), high risk (61-80 points) and very high risk (>80 points), with a mortality (derivation/validation cohorts) of 0/0.5, 0.8/1.0, 2.9/2.8, 5.5/5.8 and 12.7/22.4%, respectively. CONCLUSIONS: EAHFE-3D scale may help to predict the very short term prognosis of patients with acute heart failure in 5 risk groups.

Escala de Blatchford modificada en la hemorragia digestiva alta no varicosa / Modified Blatchford Scale for non-variceal upper gastrointestinal bleeding

Introducción: las escalas pronósticas tienen una amplia utilización en el diagnóstico, tratamiento y seguimiento del paciente con hemorragia digestiva alta no varicosa. Objetivo: determinar la capacidad predictiva de los elementos clínicos componentes de la escala de Blatchford modificada para identificar a los pacientes con mayor probabilidad de presentar estigmas de sangrado activo o reciente, durante la endoscopia urgente.Métodos: estudio observacional, analítico y prospectivo. Se incluyeron todos los pacientes, 188, atendidos en el Centro de Urgencias del Hospital Militar Central Dr. Luis Díaz Soto, desde el 1ro. de enero al 31 de diciembre de 2012. Se realizó una estimación del riesgo por cada uno de los componentes de la escala. Se calculó el valor predictivo mediante curva ROC. Se determinaron la sensibilidad y especificidad del punto de corte igual a 1. Resultados: de los pacientes estudiados, 61 (32,4 por ciento) presentaron estigmas de sangrado activo o reciente. La mayor probabilidad de estigmas se encontró en casos con tensión arterial sistólica ≤ 90 mmHg (RR: 7,53; IC 95 por ciento 2,31-24,48; p= 0,001), frecuencia cardiaca ≥ 100 lat/min (RR: 5,49; IC 95 por ciento 2,78-10,83; p= 0,001) y hemoglobina ≤ 10 g/dL (RR: 4,39; IC 95 por ciento 2,17-8,89; p= 0,001). La capacidad predictiva de la escala de Blatchford fue buena (c= 0,729; IC 95 por ciento 0,652-0,807; p= 001). El punto de corte 1 mostró una sensibilidad de 11,81 por ciento y una especificidad de 98,36 por ciento. Conclusiones: se confirma el valor de la escala de Blatchford abreviada para predecir la presencia de estigmas de sangrado activo o reciente durante el estudio endoscópico en pacientes con sangrado digestivo alto no varicoso(AU)

Introduction: prognostic scales have a wide use in the diagnosis, treatment and monitoring patients with non-variceal upper gastrointestinal bleeding. Objective: determine the predictive ability of clinical component elements of Blatchford modified scale to identify patients most likely to have stigmata of active or recent bleeding during emergency endoscopy. Methods: observational, analytical and prospective study. All patients were included, 188, assisted in the emergency unit at Dr. Luis Díaz Soto Central Military Hospital, from January 1 to December 31, 2012. An estimate risk for each scale components was performed. The predictive value using ROC curve was calculated. The sensitivity and specificity of cut off 1 was determined. Results: 61 (32.4 percent) out of the patients studied had scars of active or recent bleeding. Stigmas are more likely found in cases with systolic blood pressure ≤ 90 mmHg (RR 7.53; 95 percent CI 2.31 to 24.48; p= 0.001), heart rate ≥ 100 beats min (RR 5.49; 95 percent CI 2.78 to 10.83; p= 0.001) and hemoglobin ≤ 10 g/dL (RR 4.39; 95 percent CI 2.17 to 8.89; p = 0.001). The predictive capacity of Blatchford scale was good (c= 0.729; 95 percent CI: 0.652 to 0.807; p= .001). The cut point 1 showed a sensitivity of 11.81 percent and a specificity of 98.36 percent. Conclusions: the value of the Blatchford scale is confirmed abbreviated to predict the presence of stigmata of active or recent bleeding during endoscopic study in patients with non-variceal upper gastrointestinal bleeding(AU)

Escala de blatchford modificada en la hemorragia digestiva alta no varicosa / Modified Blatchford Scale for non-variceal upper gastrointestinal bleeding

INTRODUCCIÓN: las escalas pronósticas tienen una amplia utilización en el diagnóstico, tratamiento y seguimiento del paciente con hemorragia digestiva alta no varicosa. OBJETIVO: determinar la capacidad predictiva de los elementos clínicos componentes de la escala de Blatchford modificada para identificar a los pacientes con mayor probabilidad de presentar estigmas de sangrado activo o reciente, durante la endoscopia urgente. MÉTODOS: estudio observacional, analítico y prospectivo. Se incluyeron todos los pacientes, 188, atendidos en el Centro de Urgencias del Hospital Militar Central "Dr. Luis Díaz Soto", desde el 1ro. de enero al 31 de diciembre de 2012. Se realizó una estimación del riesgo por cada uno de los componentes de la escala. Se calculó el valor predictivo mediante curva ROC. Se determinaron la sensibilidad y especificidad del punto de corte igual a 1. RESULTADOS: de los pacientes estudiados, 61 (32,4 %) presentaron estigmas de sangrado activo o reciente. La mayor probabilidad de estigmas se encontró en casos con tensión arterial sistólica ≤ 90 mmHg (RR: 7,53; IC 95 % 2,31-24,48; p= 0,001), frecuencia cardiaca ≥ 100 lat/min (RR: 5,49; IC 95 % 2,78-10,83; p= 0,001) y hemoglobina ≤ 10 g/dL (RR: 4,39; IC 95 % 2,17-8,89; p= 0,001). La capacidad predictiva de la escala de Blatchford fue buena (c= 0,729; IC 95 % 0,652-0,807; p= 001). El punto de corte 1 mostró una sensibilidad de 11,81 % y una especificidad de 98,36 %. CONCLUSIONES: se confirma el valor de la escala de Blatchford abreviada para predecir la presencia de estigmas de sangrado activo o reciente durante el estudio endoscópico en pacientes con sangrado digestivo alto no varicoso.

INTRODUCTION: prognostic scales have a wide use in the diagnosis, treatment and monitoring patients with non-variceal upper gastrointestinal bleeding. OBJECTIVE: determine the predictive ability of clinical component elements of Blatchford modified scale to identify patients most likely to have stigmata of active or recent bleeding during emergency endoscopy. METHODS: observational, analytical and prospective study. All patients were included, 188, assisted in the emergency unit at "Dr. Luis Díaz Soto" Central Military Hospital, from January 1 to December 31, 2012. An estimate risk for each scale components was performed. The predictive value using ROC curve was calculated. The sensitivity and specificity of cut off 1 was determined. RESULTS: 61 (32.4 %) out of the patients studied had scars of active or recent bleeding. Stigmas are more likely found in cases with systolic blood pressure ≤ 90 mmHg (RR 7.53; 95 % CI 2.31 to 24.48; p= 0.001), heart rate ≥ 100 beats min (RR 5.49; 95 % CI 2.78 to 10.83; p= 0.001) and hemoglobin ≤ 10 g/dL (RR 4.39; 95% CI 2.17 to 8.89; p = 0.001). The predictive capacity of Blatchford scale was good (c= 0.729; 95 % CI: 0.652 to 0.807; p= .001). The cut point 1 showed a sensitivity of 11.81 % and a specificity of 98.36 %. CONCLUSIONS: the value of the Blatchford scale is confirmed abbreviated to predict the presence of stigmata of active or recent bleeding during endoscopic study in patients with non-variceal upper gastrointestinal bleeding.

Terapéutica antimicrobiana en la neumonía adquirida en la comunidad / Antibiotic treatment in community acquired pneumonia

Introducción: la neumonía adquirida en la comunidad constituye una infección frecuente en nuestro medio, con elevada mortalidad en pacientes ancianos. Objetivo: determinar la efectividad de los tratamientos antimicrobianos utilizados en los pacientes con neumonía adquirida en la comunidad. Material y Métodos: estudio observacional, descriptivo, retrospectivo, en pacientes hospitalizados en el Hospital «Comandante Manuel Fajardo¼ con neumonía adquirida en la comunidad, durante los primeros 3 trimestres del año 2008. Las variables utilizadas fueron: los parámetros del score CRB-65, los esquemas de tratamiento utilizados y la evolución final del paciente. Resultados: el 88% de los pacientes tenían más de 65 años. La mortalidad general fue de 39.44%, independientemente del esquema de tratamiento utilizado. En los grupos de III y IV del CRB-65 la mortalidad fue de 70.6%. Conclusiones: la efectividad de los esquemas terapéuticos utilizados fue similar. La mortalidad fue mayor en los grupos III y IV del CRB-65.

Introduction: the Community-Acquired Pneumonia is one of the most frequents infections in our environment, with high mortality in patient of the third age. Objective: to determine the effectiveness of the antibiotics treatments used in the patients with Community-Acquired Pneumonia. Methods: Observational, retrospective and descriptive study was conducted in in 208 patients admitted at Internal Medicine service of Manuel Fajardo Hospital, during the first 3 trimesters of 2008. The variables studied were the parameters of CRB-65 score, the patients´s final evolution and the antimicrobial regimen used. Results: the 88% of patients were more than 65 years old. The global mortality was 39.44%, independently of the antimicrobial regimen used. The mortality in the III and IV groups of CRB-65 was 70.6%. Conclusions: the effectiveness of the three antimicrobial regimens was similar. The mortality was bigger in the patients of the groups III and IV of the CRB-65.

Terapéutica antimicrobiana en la neumonía adquirida en la comunidad / Antibiotic treatment in community acquired pneumonia

Introducción: la neumonía adquirida en la comunidad constituye una infección frecuente en nuestro medio, con elevada mortalidad en pacientes ancianos. Objetivo: determinar la efectividad de los tratamientos antimicrobianos utilizados en los pacientes con neumonía adquirida en la comunidad. Material y Métodos: estudio observacional, descriptivo, retrospectivo, en pacientes hospitalizados en el Hospital Comandante Manuel Fajardo con neumonía adquirida en la comunidad, durante los primeros 3 trimestres del año 2008. Las variables utilizadas fueron: los parámetros del score CRB-65, los esquemas de tratamiento utilizados y la evolución final del paciente. Resultados: el 88 por ciento de los pacientes tenían más de 65 años. La mortalidad general fue de 39.44 por ciento, independientemente del esquema de tratamiento utilizado. En los grupos de III y IV del CRB-65 la mortalidad fue de 70.6 por ciento. Conclusiones: la efectividad de los esquemas terapéuticos utilizados fue similar. La mortalidad fue mayor en los grupos III y IV del CRB-65(AU)

Introduction: the Community-Acquired Pneumonia is one of the most frequents infections in our environment, with high mortality in patient of the third age. Objective: to determine the effectiveness of the antibiotics treatments used in the patients with Community-Acquired Pneumonia. Methods: Observational, retrospective and descriptive study was conducted in in 208 patients admitted at Internal Medicine service of Manuel Fajardo Hospital, during the first 3 trimesters of 2008. The variables studied were the parameters of CRB-65 score, the patients´s final evolution and the antimicrobial regimen used. Results: the 88 percent of patients were more than 65 years old. The global mortality was 39.44 percent, independently of the antimicrobial regimen used. The mortality in the III and IV groups of CRB-65 was 70.6 percent. Conclusions: the effectiveness of the three antimicrobial regimens was similar. The mortality was bigger in the patients of the groups III and IV of the CRB-65(AU)

Evaluación funcional de pacientes con accidente cerebrovascular en el Hospital Dr. Gustavo Fricke / Funcional evaluation of cerebrovascular, patients at Hospital Dr. Gustavo Fricke

El accidente cerebrovascular (ACV) es una enfermedad prevalente, correspondiendo a una de las principales causas de incapacidad. Uno de los métodos usados para evaluar la capacidad funcional de los pacientes es la Escala pronóstica de Orpington (EPO). Este es un estudio prospectivo que evalúa la capacidad funcional de pacientes con ACV. Se incluyeron 41 pacientes con ACV hospitalizados en el Servicio de Medicina del Hospital Dr. Gustavo Fricke durante el período del 2 de septiembre y 2 de noviembre de 2007. Se obtuvo que: 26 ACV fueron en hombres y 15 en mujeres, con una edad promedio de 75 años (rango 47 a 94 años); 37 presentaban alguna comorbilidad asociada y 26 de éstos más de una comorbilidad; en 32 de los casos el déficit se manifestó como una parálisis faciobraquiocrural. Al aplicar la EPO se obtuvo que 6 casos tenían buen pronóstico, 23 moderado y 12 mal pronóstico funcional, siendo el equilibrio (33 casos) y el déficit motor (34 casos) los parámetros que más se afectaron. Así mismo, se obtuvo que el antecedente de ACV previo tiene un riesgo individual del 100 por ciento de tener un ACV de mal pronóstico (p<0,05), con un riesgo atribuible de un 76,32 por ciento. Por lo anterior, se entiende que debido a la gran prevalencia de comorbilidades asociadas, sumado al déficit inherente de esta patología, los convierten en pacientes muy demandantes de cuidados, tanto hospitalizados como en sus hogares, dificultando su traslado. Cabe destacar la importancia de la prevención secundaria de los ACV, debido al incremento del riesgo que tienen estos pacientes de que este evento sea de mal pronóstico funcional.

Stroke is a prevalent disease, corresponding to one of the leading causes of disability. One of the methods used to assess the functional status of patients is the Orpington Prognostic Scale (OPS). This is a prospective study that assesses the functional ability of stroke patients. Forty-one stroke patients admitted to Hospital Dr. Gustavo Fricke's medicine service between September 2nd and November 2nd 2007, were included. The following results were obtained; 26 cases were male and 15 cases were female, with a mean age of 75 years (range, 47 to 94); 37 had comorbidities and 26 of them had more than one. In 32 cases the deficit presented as faciobrachiocrural paresis. The OPS was administered to patients, obtaining a good prognostic score in 6 cases, intermediate score in 23 cases, and a poor prognosis in 12 cases. The most affected parameters were balance (33 cases) and motor function (34 cases). It was also found that a history of prior stroke has an individual risk of 100 per cent for having a stroke with poor prognosis (P<0.05), with an attributable risk of 76.32 per cent. Therefore, due to the high prevalence of associated comorbidities, and the inherent deficiency of stroke, this patients have high needs of care both in the hospital and their homes, difficulting their transport. The importance of secondary prevention in stroke patients is to be emphasized, considering their increased risk of having a new event with bad functional prognosis.