[Spontaneous visits to the emergency service and hepatology day hospital by patients with liver cirrhosis]. / Análisis de las consultas espontáneas de enfermos cirróticos a urgencias y hospital de día de hepatología.

INTRODUCTION: Because of the current overload of emergency services, new units, such as day units, have had to be created. Liver cirrhosis (LC) is a chronic disease with frequent decompensations requiring medical attention. The aim of this study was to compare differences between emergency consultations in a hepatology day hospital (HDH) and in an emergency service (ES) among patients with LC. METHODS AND MATERIAL: We performed an observational prospective study. All patients with LC attending the HDH or ES from September 2007 to August 2008 were asked to complete a questionnaire. Demographic, clinical, and radiological variables were collected. RESULTS: There were 743 consultations, of which 62% involved the HDH. The mean age was 65±12 years, and the male/female ratio was 2:3. The most frequent diagnosis in the ES was hepatic encephalopathy (26.2% ES versus 6% HDH, p<0.001) followed by upper gastrointestinal hemorrhage (17.7% ES versus 0.6% HDH, p<0.001), while the most frequent diagnosis in the HDH was ascites (66.2% HDH versus 22.7% ES, p<0.001). The tests performed were as follows: blood analysis: 95% ES versus 60% HDH (p<0.01); radiology: 71% ES versus 11% HDH (p<0.01) and paracentesis: 51% ES versus 74% HDH (p<0.01). The mean length of stay in the ES was 21.3±121.5 hours compared with 3.3±2.4 hours in the HDH (p<0.001). A total of 53% of patients attended in the ES were hospitalized compared with 12% of those attended in the HDH (p<0.05). CONCLUSION: Patients with LC preferentially attend the HDH, where fewer tests are performed and the length of stay is shorter. The care provided in the HDH is appropriate and efficient.

Análisis de las consultas espontáneas de enfermos cirróticos a urgencias y hospital de día de hepatología / Spontaneous visits to the emergency service and hepatology day hospital by patients with liver cirrhosis

Introducción El colapso actual de los servicios de urgencias ha originado el desarrollo de otros ámbitos de atención como los hospitales de día. La cirrosis hepática (CH) es una enfermedad crónica que presenta descompensaciones que requieren atención. El objetivo es comparar las diferencias entre las visitas urgentes de los pacientes con CH al hospital de día de hepatología (HDH) o al servicio de urgencias (URG).Material y métodos Estudio prospectivo observacional, mediante la complementación de un cuestionario de los pacientes que acudieron al HDH y a URG entre 9/2007 y 8/2008. Se recogieron variables demográficas, clínicas y exploraciones complementarias realizadas. Resultados Hubo 743 consultas, 62% al HDH. La edad media fue de 65±12 años, ratio hombre/mujer 2,3. El diagnóstico más frecuente en URG fue la encefalopatía (26,2% URG versus 6% HDH, p<0,001) seguido de la hemorragia digestiva alta (17,7% URG versus 0,6% HDH, p<0,001). La ascitis fue el más frecuente en HDH (66,2% HDH versus 22,7% URG, p<0,001). Las exploraciones realizadas fueron, análisis: 95% URG versus 60% HDH (p<0,01); radiología: 71% URG versus 11% HDH (p<0,01), y paracentesis: 51% URG versus 74% HDH (p<0,01). El tiempo de estancia en URG fue de 21,3±121,5 h respecto a 3,3±2,4 h en HDH (p<0,001). Se hospitalizaron el 53% de los visitados en URG y el 12% de los visitados en HDH (p<0,05).Conclusión los pacientes acuden mayoritariamente al HDH, realizándose menos pruebas y presentando un tiempo de estancia menor. La atención continuada de pacientes con CH en el HDH es adecuada y eficiente (AU)

Introduction Because of the current overload of emergency services, new units, such as day units, have had to be created. Liver cirrhosis (LC) is a chronic disease with frequent decompensations requiring medical attention. The aim of this study was to compare differences between emergency consultations in a hepatology day hospital (HDH) and in an emergency service (ES) among patients with LC. Methods and material We performed an observational prospective study. All patients with LC attending the HDH or ES from September 2007 to August 2008 were asked to complete a questionnaire. Demographic, clinical, and radiological variables were collected. Results There were 743 consultations, of which 62% involved the HDH. The mean age was 65±12 years, and the male/female ratio was 2:3. The most frequent diagnosis in the ES was hepatic encephalopathy (26.2% ES versus 6% HDH, p<0.001) followed by upper gastrointestinal hemorrhage (17.7% ES versus 0.6% HDH, p<0.001), while the most frequent diagnosis in the HDH was ascites (66.2% HDH versus 22.7% ES, p<0.001). The tests performed were as follows: blood analysis: 95% ES versus 60% HDH (p<0.01); radiology: 71% ES versus 11% HDH (p<0.01) and paracentesis: 51% ES versus 74% HDH (p<0.01). The mean length of stay in the ES was 21.3±121.5hours compared with 3.3±2.4hours in the HDH (p<0.001). A total of 53% of patients attended in the ES were hospitalized compared with 12% of those attended in the HDH (p<0.05).Conclusion Patients with LC preferentially attend the HDH, where fewer tests are performed and the length of stay is shorter. The care provided in the HDH is appropriate and efficient (AU)