¿Son las unidades de corta estancia médica un lugar adecuado para tratar la neumonía adquirida en la comunidad? / Are short stay medical units an appropiate place to manage community acquired pneumonia?

RESUMEN

Introducción: Evaluar los pacientes ingresados por neumonía adquirida en la comunidad (NAC) en una unidad de corta estancia médica (UCEM) para determinar, mediante los criterios de Fine para, si la reducción de la estancia en los grupos de máximo riesgo (grupos IV y V) lleva asociada una disminución de la calidad asistencial en forma de mortalidad y reingresos. Pacientes y métodos: Se incluyeron todos los pacientes con NAC ingresados en la UCEM en un periodo de 18 meses. Se realizó un estudio univariante contrastando cada variable con la variable resultado (estancia > o 250 mg/l, se relacionaron con una estancia mayor de 5 días y de ellas únicamente las 3 últimas permanecieron en el modelo final en el análisis multivariante. Conclusiones: La NAC se puede tratar de forma eficiente en una UCEM incluso en pacientes incluidos en los grupos IV y V de Fine, apoyados en una consulta externa ágil y precoz que permita una revisión temprana

ABSTRACT

Introduction: Evaluate patients with community acquired pneumonia (CAP) admitted to our Short Stay Medical Unit (SSMU) in order to establish, using Fines’s criteria, whether reducing the length of stay of maximum risk groups (IV and V) is associated with reduction of quality with either an increase of mortality or readmissions. A further objective was to pinpoint the variables associated with a prolongation of hospital stay. Patients and methods: All CAP patients admitted to our unit over a eighteen-month period were included in the study. We conducted an univariate analysis and a step wise multivariate analysis of all the variables in the univariate analysis showing a significant statistical relation. Results: 182 patients with a mean age of 73 years were studied. The length of hospital stay was 4.3 days. Stratified by Fines’s criteria, 91.2% were included in the groups of maximum risk: 12.1% in group III, 60.4% IV and 18.7% in V. The medium length of stay for each category was 4.3, 4.1 y 5.3 days respectively. The mortality rate was 2.7% and only 5 patients required readmission within one month alter the discharge. Of the variables analyzed only Fine’s group V, chronic liver disease and/or renal insufficiency as comorbidities, a pulse rate over 125 per minute and blood glucose level > 250 mg/l showed a significant relation with more than five days hospitalization, and out of them, only the three latter stayed in the multivariate analysis. Conclusions: All CAP patients, including those in Fine’s groups IV and V, can be treated safely and efficiently in a SSMU, providing there is an outpatient clinic for inmmediate consultation available