[Prognostic factors of mortality in elderly patients in the emergency department]. / Factores pronósticos de mortalidad de los ancianos en un servicio de urgencias hospitalario.

BACKGROUND: Increasing attention has been given to the elderly patients in emergency departments. However, prevalence and predictive factors of mortality in geriatric patients in emergency rooms have not been stablished. This study was conducted to analyse predictive factors associated with mortality in patients aged more than 75 years-old. METHODS: Descriptive transversal study. Data from 1003 patients aged over 75 years were recorded: biographic data, past medical history, functional capacity, acute vs chronic diseases, discharge diagnosis, emergency room stay, mortality and their causes. Bivariant and multivariant (logistic regression) analysis were performed in an attempt to establish mortality associated factors. Prevalence odds ratio (OR) and 95% confidence intervals were estimated. RESULTS: 45 patients died (4.7% IC 95%: 3.2 a 5.7). In bivariant analysis age (p = 0.008), previous heart failure (p = 0.008) or renal failure (p = 0.05), functional disability (p < 0.001), mental disorders (p < 0.001), acute diseases (p = 0.01), and the following entities: politraumatism, sepsis, respiratory failure, pneumonia, ileus, acute abdomen, and coronary artery diseases, were associated with mortality. In multivariant analysis were detected as independent prognostic factors: circulatory disorders, coronary artery diseases, sepsis, respiratory failure, and functional disability. CONCLUSIONS: Over 75 years-old patients mortality in emergency departments is more frequently associated with diagnosis of coronary heart disease, respiratory failure, sepsis and functional disability.

[The efficacy of bronchoalveolar lavage in the diagnosis of pulmonary tuberculosis]. / Rentabilidad del lavado broncoalveolar en el diagnóstico de la tuberculosis pulmonar.

In order to analyze the usefulness of bronchoalveolar lavage (BAL) for conventional microbiological diagnosis of tuberculosis (TB) and other mycobacteria, and to assess the need to use it or not as a routine diagnostic technique in these diseases, we studied 30 patients with mycobacteria (26 TB and 4 Mycobacterium avium-intracellulare infections) by bronchoscopy, with BAL and bronchoaspirate (BAS) bacteriological analyses also available. The results were compared with those obtained for sputum taken before and after bronchoscopy when these specimens were available. The overall yield for BAL and BAS cultures was 90%, with BAL (83.3%) specimens being more productive than BAS (73.3%) specimens. Both performed far better than the 53.8% recorded for cultures of pre-bronchoscopy sputum and 60% for post-bronchoscopy sputum. BAL was the only diagnostic specimen from 7 patients, while BAS the only one from 4. Sensitivity was similar for the two mycobacteria studied. The results for direct bacilloscopy, however, at 30% for the two specimens, rose to 36.6% when they were analyzed together with BAS and BAL. We conclude that bronchoscopy should be performed on all patients suspected of mycobacterial infection when sputum bacilloscopy is negative and patients have no expectoration. Performance of BAL should be routine since this simple and usually uncomplicated technique produces the most productive specimens.