Emergencias
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Observational Study
Diagnosis of pulmonary embolism in the elderly: adherence to guidelines and age-adjusted D-dimer concentration values.
. The main purpose was to assess our emergency department's level of adherence to clinical practice guidelines (CPGs) for the diagnosis of pulmonary embolism in different age groups. The secondary aims were to study the utility and estimated the number of avoidable CT angiography with this approach of age-adjusted D-dimer concentrations in combination with the Wells score in the diagnosis of pulmonary embolism. ⋯ We observed different degrees of age-related adherence to CPGs in cases in which pulmonary embolism was suspected. Using the simplified Wells score combined with an age-adjusted cut-point for D-dimer assay positivity improved the specificity and positive predictive value of the D-dimer assessment in comparison with standard practice. Using age-adjusted D-dimer cut-points could decrease the number of pulmonary artery CT angiograms required.
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To gain greater understanding of the development of emergency medicine in Spain by analyzing the presentations at conferences of the Spanish Society of Emergency Medicine (SEMES) over the past 30 years (1988-2017). ⋯ SEMES conference programs have attracted significantly more presentations and presenters over the years. We also detected changes in descriptive characteristics. The analysis of those characteristics can help future SEMES conference planners to plan ways to correct aspects such as scarce geographic diversity, low international participation, and few women among presenters.
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Observational Study
Emerging and imported diseases diagnosed in the emergency department of a hospital in Madrid.
To describe the clinical and epidemiologic characteristics of patients diagnosed with malaria, dengue fever, and Zika or chikungunya virus infections in a hospital emergency department. To describe the usefulness of the department's diagnostic resources. ⋯ Most patients with these infections were males and natives of areas where the diseases were endemic. Even when malaria is diagnosed early, the possibility of concomitant infection by other arboviruses must be ruled out. Serology is necessary to rule out Zika virus infection; polymerase chain reaction testing of urine and serum should be included.
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Analysis of quality antimicrobial agent use in the emergency department of a tertiary care hospital.
To describe modifiable factors related to inappropriate antimicrobial treatment in the observation area of an emergency department to explore practices that can be targeted for change through a program to improve emergency use of antimicrobial agents, the PROA program in its spanish observations. ⋯ Fewer than half the antimicrobial treatments were appropriate as prescribed. Signs of serious infection, specification of the focus of infection in the patient's records, and the analysis of biologic samples were independent predictors of quality care (appropriate antimicrobial prescription). These factors can be targeted for training in the development of a specific emergency department program to improve this aspect of care.