RESUMO
Oncology patients do not form a large proportion within the overall figures of an emergency service, but their clinical characteristics mean that attending to them is often complex. The elaboration of a complete clinical history, specifying the characteristics and stage of the tumoural disease, is a basic weapon for taking decisions when an emergency arises. According to the data from our centre, oncology patients account for 5% of the total of emergency cases. The most frequent type of tumour that we deal with is pulmonary, followed by breast and colon. It is often the case that these patients come to the emergency department several times in the same month and pain is the most frequent reason for consultation, although it is normal for them to mention several causes on each occasion. In a high percentage of cases the reason for the consultation is related to the disease itself, but on as many as 35% of occasions it is an intercurrent pathology. The index of admissions is high (around 50%), especially if the patient has come for a reason related to the disease. In global terms, they account for 14% of total admissions from emergencies.
Assuntos
Neoplasias/epidemiologia , Emergências , Humanos , Espanha/epidemiologiaRESUMO
Los pacientes oncológicos no representan un gran volumen dentro del global de un servicio de urgencias, pero sus características clínicas hacen que su atención sea a menudo compleja. La realización de una historia clínica completa, en la que se especifiquen las características y estadio de la enfermedad tumoral, es un arma fundamental para la toma de decisiones en el momento urgente. Según datos de nuestro centro, los enfermos oncológicos representan un 5% del total de las urgencias. El tipo de tumor que más frecuentemente atendemos es el pulmonar, seguido del de mama y colon. Es frecuente que estos enfermos acudan a urgencias varias veces en un mismo mes y el motivo de consulta más frecuente es el dolor, aunque es habitual que comenten varias causas en cada ocasión. En un alto porcentaje de casos la causa de su consulta está relacionada con la propia enfermedad pero hasta en un 35% de las ocasiones es una patología intercurrente. El índice de ingresos es elevado (alrededor del 50%) y especialmente si el paciente ha acudido por un motivo relacionado con la enfermedad. En global suponen un 14% del total de ingresos desde urgencias (AU)
Oncology patients do not form a large proportion within the overall figures of an emergency service, but their clinical characteristics mean that attending to them is often complex. The elaboration of a complete clinical history, specifying the characteristics and stage of the tumoural disease, is a basic weapon for taking decisions when an emergency arises. According to the data from our centre, oncology patients account for 5% of the total of emergency cases. The most frequent type of tumour that we deal with is pulmonary, followed by breast and colon. It is often the case that these patients come to the emergency department several times in the same month and pain is the most frequent reason for consultation, although it is normal for them to mention several causes on each occasion. In a high percentage of cases the reason for the consultation is related to the disease itself, but on as many as 35% of occasions it is an intercurrent pathology. The index of admissions is high (around 50%), especially if the patient has come for a reason related to the disease. In global terms, they account for 14% of total admissions from emergencies (AU)
Assuntos
Humanos , Neoplasias/epidemiologia , Emergências , Espanha/epidemiologiaRESUMO
We carried out a prospective evaluation of 172 patients using our own risk score for patients transferred from the emergency department of a community hospital in Tudela, Spain, to main centres, during 1988. Although the data go back almost 10 years, this scoring has not been internationally published and is at present widely applied in Spain. Patients scoring less than 7 points were transferred under specialized nursing supervision (Group I), and those scoring equal to or over 7 points were transferred in a specially equipped intensive care unit surface ambulance and supervised by a physician and a nurse (Group II). There were 102 patients in Group I and 70 in Group II. Complications arising during transfer were defined as minor or serious. A low overall incidence of complications was recorded--a total of 29 cases (16.9% of all transfers). The incidence of complications was significantly higher in Group II patients (p < 0.005). One patient from Group II died during transport. All patients from Group II were admitted to the ICUs compared with only 20 (18.6%) from Group I (p < 0.001). Of a total of 23 deaths in hospital, nine were from Group I and 14 from Group II. During the first 24 hours after admission, six patients died from Group II and none from Group I. The application of risk scores has permitted to assign effectively technical and human resources for a safe interhospital transfer of critically ill patients.
