[Ability of qSOFA1-lactate to predict 30-day mortality in patients seen for infection in the Emergency Department]. / Capacidad del qSOFA1-lactato para predecir mortalidad a 30 días en los pacientes atendidos por infección en urgencias.

OBJECTIVE: To evaluate lactate and the Quick Sepsis-Related Organ Failure Assessment (qSOFA) and compare their ability to predict 30-day mortality in patients treated for infection in emergency departments (ED). METHODS: Prospective multicenter observational cohort study. We enrolled a convenience sample of patients aged 18 years or older attended in 71 Spanish ED from October 1, 2019, to March 31, 2020. Each model's predictive power was analyzed with the area under the receiver operating characteristic curve (AUC), and its values of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative (NPV). RESULTS: A total of 4439 patients with a mean (SD) age of 18 years were studied; 2648 (59.7%) were men and 459 (10.3%) died within 30 days. For 30-day mortality, the AUC-COR obtained with the qSOFA = 1 model plus 2 mmol/l lactate was 0.66 (95% CI, 0.63-0.69) with Se: 68%, Es: 70% and NPV:92%, while qSOFA = 1 obtained AUC-COR of 0.52 (95% CI, 0.49-0.55) with a Se:42%, Es:64% and NPV:90%. CONCLUSIONS: To predict 30-day mortality in patients presenting to the ED due to an episode of infection, the qSOFA =1 + lactate≥2 mmol/L model significantly improves the predictive power achieved individually by qSOFA1 and becomes very similar to qSOFA≥2.

Utilidad del modelo 5MPB-Toledo para predecir bacteriemia en el paciente con infección del tracto urinario en el servicio de urgencias / Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with urinary tract infections in the emergency department

Objetivo: Analizar la utilidad de un nuevo modelo predictivo de bacteriemia (5MPB-Toledo) en pacientes atendidos por infección del tracto urinario (ITU) en los servicios de urgencias (SU). Métodos: Estudio observacional, prospectivo y multicéntrico de los hemocultivos (HC) obtenidos en pacientes mayores de 18 años atendidos por ITU en 65SU desde el 1 de octubre de 2019 hasta el 30 de abril 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 del punto de corte elegido con su sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo. Resultados: Se incluyeron 1.499 episodios de HC extraídos. De ellos se consideraron como bacteriemias verdaderas 277 (18,5%) y como HC negativos 1.222 (81,5%). Entre los negativos 94 (6,3%) se consideraron contaminados. El ABC-COR del modelo fue de 0,937 (IC 95%: 0,926-0,949). El rendimiento diagnóstico del modelo con un PC≥5 puntos consigue una sensibilidad de 97,47% (IC 95%: 94,64-98,89), especificidad de 76,68% (IC 95%: 74,18-79,00), un valor predictivo positivo de 48,65% (IC 95%: 44,42-52,89) y un valor predictivo negativo de 99,26% (IC 95%: 98,41-99,67). Conclusión: El modelo 5MPB-Toledo podría ser útil para predecir bacteriemia en los pacientes adultos atendidos en el SU por un episodio de ITU (AU)

Objective: To analyze the usefulness of a new predictive model of bacteremia (5MPB-Toledo) in patients treated for urinary tract infection (UTI) in the emergency department (ED). Methods: Prospective and multicenter observational cohort study of the blood cultures (BC) ordered for patients with UTIs in 65 Spanish ED from October 1, 2019, to April 30, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The diagnostic performance was calculated with the chosen cut-off point for sensitivity, specificity, positive predictive value, and negative predictive value. Results A total of 1,499 blood cultures were evaluated. True cases of bacteremia were confirmed in 277 (18.5%). The remaining 1,222 cultures (81.5%) were negative. Ninety-four (6.3%) were considered contaminated. The model's area under the ROC curve was 0.937 (95% CI, 0.926-0.949). The prognostic performance with a model's cut-off value of≥5 points achieved 97.47% (95% CI, 94.64-98.89) sensitivity, 76.68% (95% CI, 74.18-79.00) specificity, 48.65% (95% CI, 44.42-52.89) positive predictive value and 99.26% (95% CI, 98.41-99.67) negative predictive value. Conclusion: The 5MPB-Toledo score is useful for predicting bacteremia in patients with UTIs who visit the ED (AU)

Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with urinary tract infections in the emergency department.

OBJECTIVE: To analyze the usefulness of a new predictive model of bacteremia (5MPB-Toledo) in patients treated for urinary tract infection (UTI) in the emergency department (ED). METHODS: Prospective and multicenter observational cohort study of the blood cultures (BC) ordered for patients with UTIs in 65 Spanish ED from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The diagnostic performance was calculated with the chosen cut-off point for sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: A total of 1,499 blood cultures were evaluated. True cases of bacteremia were confirmed in 277 (18.5%). The remaining 1,222 cultures (81.5%) were negative. Ninety-four (6.3%) were considered contaminated. The model's area under the ROC curve was 0.937 (95% CI, 0.926-0.949). The prognostic performance with a model's cut-off value of ≥5 points achieved 97.47% (95% CI, 94.64-98.89) sensitivity, 76.68% (95% CI, 74.18-79.00) specificity, 48.65% (95% CI, 44.42-52.89) positive predictive value and 99.26% (95% CI, 98.41-99.67) negative predictive value. CONCLUSION: The 5MPB-Toledo score is useful for predicting bacteremia in patients with UTIs who visit the ED.

[Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with community-acquired pneumonia in the Emergency Department]. / Utilidad del modelo 5MPB-Toledo para predecir bacteriemia en el paciente con neumonía adquirida en la comunidad en el Servicio de Urgencias.

OBJECTIVE: To analyse a new risk score to predict bacteremia in the patients with Community-acquired Pneumonia (CAP) in the emergency departments. METHODS: Prospective and multicenter observational cohort study of the blood cultures ordered in 74 Spanish emergency departments for patients with CAP seen from November 1, 2019, to March 31, 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 chosen cut-off for getting the sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: A total of 1,020 blood samples wered cultured. True cases of bacteremia were confirmed in 162 (15.9%). The remaining 858 cultures (84.1%) wered negative. And, 59 (5.8%) were judged to be contaminated. The model´s area under the receiver operating characteristic curve was 0.915 (95% CI, 0.898-0.933). The prognostic performance with a model´s cut-off value of ≥ 5 points achieved 97.5% (95% CI, 95.1-99.9) sensitivity, 73.2% (95% CI, 70.2-76.2) specificity, 40.9% (95% CI, 36.4-45.1) positive predictive value and 99.4% (95% CI, 99.1-99.8) negative predictive value. CONCLUSIONS: The 5MPB-Toledo score is useful for predicting bacteremia in the patients with CAP seen in the emergency departments.

[Validation of the Ottawa ankle rules for the efficient utilization of radiographies in acute lesions of the ankle]. / Validación de las reglas del tobillo de Ottawa para el uso eficiente de radiografías en las lesiones agudas de tobillo.

OBJECTIVE: To test the validity of Ottawa ankle rules (OAR) in our field. To test the agreement physician/nurse in the assessment of the patient with acute ankle injuries. DESIGN: Observational, with application of rules and prospective outcome measurement. SETTING: Hospital emergency departments. PARTICIPANTS: Adults who attended at the emergency department, suffering from a secondary ankle pain to a traumatic injury, from 1st March to 30th September, 1997. MEASUREMENTS AND MAIN RESULTS: Physicians who participated applied the OAR to the patients and asked for a control radiograph, independently from the result of rules application. 100 patients were valued by a physician and a nurse in order to measure the agreement level. Data from 564 patients were recorded, getting a global sensitivity of the OAR of 97.3% (95% CI 89.7-99.5); specificity of 33.3% (95% CI 29.5-37.3). The positive predictive value was of 15.6 (95% CI 12.4-19.3). Thanks to the application of the rules radiography would reduce by 29.5%. 74 (13.1%) patients suffered form fracture: 48 (8.5%), of the maleolar zone and 26 (4.6%) of the midfoot zone. Attending to the OAR criteria, radiographs wouldn't be necessary in two cases of fracture. CONCLUSIONS: We consider the OAR clinically valuable and useful in our field. They can help to work on the basis of uniform criteria when decisions must be taken and to use properly sanitary resources. Triage nurses can apply them.