RESUMO
Fundamento y objetivo: Conocer mejor las características de las interconsultas solicitadas por el servicio de Cirugía General a un servicio de Medicina Interna, valorar los resultados y la experiencia desde la visión del internista. Pacientes y método: Estudio prospectivo de las 129 interconsultas de pacientes ingresados en el servicio de Cirugía General solicitadas durante el año 2005 al servicio de Medicina Interna. Resultados: Equivalen al 4% de todos los ingresos del servicio de Cirugía General (el 6,5% de los pacientes ingresados desde urgencias y el 2% de los ingresados de forma programada). La media de edad de los pacientes fue de 74 años. Los pacientes fueron visitados una media de 3,3 días. Las causas más frecuentes que motivaron la solicitud fueron la disnea (29%), la fiebre (21%), la tos (11%) y las arritmias (8%). Los diagnósticos más frecuentemente realizados fueron la insuficiencia cardiaca (17%), la enfermedad pulmonar obstructiva crónica (15%), la sobre infección respiratoria y/o acumulación de secreciones bronquiales (13%), la neumonía (9%) y la fibrilación auricular (7%). El 31% de los diagnósticos ha correspondido a agudización de enfermedad crónica previamente conocida. Los fallecimientos han sido 19 (15%), porcentaje mayor al global en el servicio de Cirugía General (2%). La media de edad de los fallecidos fue de 82 años. La mortalidad fue mayor cuando el ingreso se realizó desde urgencias (17 de 91) que cuando se realizó de forma programada (2 de 38). La causa más frecuente ha sido el fallo de sutura con peritonitis y sepsis en 5 pacientes. Conclusiones: La labor del internista no sólo se ha dirigido al tratamiento de las enfermedades crónicas, sino que también ha ayudado en el diagnóstico y tratamiento de procesos agudos relacionados o no con el motivo inicial de ingreso. A destacar la nula especificidad de la tos como síntoma guía en el diagnóstico de pacientes previamente intervenidos. Las causas del fallecimiento se han relacionado casi exclusivamente con el proceso que requirió el ingreso en Cirugía General o las complicaciones de éste (17 de 19)
Rational and aim: to better understand the nature of the consults solicited by the Department of General Surgery to the Department of Internal Medicine and to examine the results and the experience from the point of view of an Internal Medicine specialist. Patients and methods: Prospective analysis of the 129 consults from patients admitted in General Surgery to the Department of Internal Medicine during 2005. Results: The number of consults was 4% of all patients admitted in General Surgery (6,5% of de admitted patients were from the emergency service and 2% from the planning programme). The median age was 74 years. The patients were visited a mean of 3.3 days. The most frequent reasons for consultation were dyspnea (29%), fever (21%), cough (11%) and dysrhythmias (8%). The most frequent diagnosis were cardiac failure (17%), chronic obstructive pulmonary disease (15%), respiratory infection and/or accumulation of bronchial secretions (13%), pneumonia (9%) and a trial fibrillation (7%). In 31% of cases the diagnosis was decompensation of previously diagnosed chronic disease. Nineteen patients died (15%), higher than the global average admitted in General Surgery (2%). The average age of these patients was 82 years. The mortality was higher when the admission was from the emergency service (17 of 91) than when it was from the planning programme. The most frequent cause of death was suture failure and peritonitis with secondary septicemia in 5 patients. Conclusions: The task of the Internal Medicine specialist was not only the treatment of chronic diseases, but also to assist in the diagnosis and treatment of acute diseases related or unrelated to the cause of the admission. To point up the invalid specificity of cough as a guide symptomin the diagnosis of previously operated patients. The causes of death were almost exclusively related to the disease that resulted in the admission to the Department of Surgery or with its complications (17 of 19)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Encaminhamento e Consulta/estatística & dados numéricos , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Estudos Prospectivos , Médicos de Família , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estatísticas HospitalaresRESUMO
UNLABELLED: RATIONAL AND AIM: to better understand the nature of the consults solicited by the Department of General Surgery to the Department of Internal Medicine and to examine the results and the experience from the point of view of an Internal Medicine specialist. PATIENTS AND METHODS: Prospective analysis of the 129 consults from patients admitted in General Surgery to the Department of Internal Medi-cine during 2005. RESULTS: The number of consults was 4% of all patients admitted in General Surgery (6,5% of de admitted patients were from the emergency service and 2% from the planning programme). The median age was 74 years. The patients were visited a mean of 3.3 days. The most frequent reasons for consultation were dyspnea (29%), fever (21%), cough (11%) and dysrhythmias (8%). The most frequent diagnosis were cardiac failure (17%), chronic obstructive pulmonary disease (15%), respiratory infection and/or accumulation of bronchial secretions (13%), pneumonia (9%) and atrial fibrillation (7%). In 31% of cases the diagnosis was decompensation of previously diagnosed chronic disease. Nineteen patients died (15%), higher than the global average admitted in General Surgery (2%). The average age of these patients was 82 years. The mortality was higher when the admission was from the emergency service (17 of 91) than when it was from the planning programme. The most frequent cause of death was suture failure and peritonitis with secondary septicemia in 5 patients. CONCLUSIONS: The task of the Internal Medicine specialist was not only the treatment of chronic diseases, but also to assist in the diagnosis and treatment of acute diseases related or unrelated to the cause of the admission. To point up the invalid specificity of cough as a guide symptom in the diagnosis of previously operated patients. The causes of death were almost exclusively related to the disease that resulted in the admission to the Department of Surgery or with its complications (17 of 19).