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Neuromuscular Scoliosis (NMS) causes severe deformity and operative correction for these patients carries high complication rates. We present a retrospective study comparing a series of consecutive patients who underwent posterior fusion via a single-surgeon (SS) approach with a consecutive series of patients treated via a dual-surgeon (DS) approach.Patients with NMS who underwent posterior fusion via a SS approach from 2019 to 2022 were analyzed and compared to a series of patients with NMS who underwent posterior fusion via a DS approach.In the SS group, the average estimated blood loss (EBL) was 675 mL, average length of stay (LOS) was 6.3 days, average operative time (OT) was 6.5 hours, average packed red blood cell transfusion was 1.5 units, with a complication rate of 30%. The DS group had an average EBL of 400 mL, a LOS of 4.8 days, an OT of 4.75 hours, an average packed red blood cell transfusion of 0.8 units, with a complication rate of 20%. The DS approach was significant for a lower EBL, OT (P0.001), and LOS (P0.03).This study suggests that for patients with NMS the DS approach decreases OT, EBL, complication rates, and LOS. This further supports that this approach may benefit outcomes in NMS patients.

Introducción. La permisividad ante la hiperglucemia es nociva para los pacientes ingresados. DIAGETHER es una aplicación que ayuda al médico en el tratamiento del paciente diabético. Objetivos. Determinar grado de usabilidad, nivel de confianza y valoración global de DIAGETHER empleada por médicos residentes en distintos escenarios clínicos. Método. Estudio descriptivo multicéntrico, basado en una encuesta de valoración sobre DIAGETHER, a 42 residentes de dos hospitales, valorando la toma de decisiones con respecto a la terapéutica de pacientes con alteraciones glucémicas en distintos escenarios clínicos. Resultados. DIAGETHER fue valorado positivamente respecto a usabilidad, confianza en resolución de casos, y tiempo empleado. La valoración global de la herramienta fue del 87,5. En el lado negativo, es necesario realizar estudios en terreno real para saber la adaptación real de la herramienta al trabajo médico. Conclusiones. La aplicación DIAGETHER® es una herramienta fácil de usar, rápida en la toma de decisiones y le da al médico seguridad en el tratamiento de pacientes con hiperglucemia, lo que hace que su valoración global sea alta. En el lado negativo, el estudio fue realizado en condiciones “no reales”, sería interesante desarrollar futuros estudio en varios servicios de urgencias.

Objectives Gastrointestinal (GI) bleeding is a common illness seen in the emergency department. The prognosis varies from self-limited to potentially life threatening. Currently available GI bleeding risk scores have only a modest predictive value, limiting their wide implementation. The aim of this study was to assess the association and capability of point-of-care ultrasound (POCUS) used by emergency physicians to improve common GI bleeding scores for predicting complications and long-term outcomes of patients with GI bleeding, which to our knowledge have never been studied. Methods Between August 2015 and April 2017, 203 hemodynamically stable patients with acute GI bleeding admitted to the emergency department were prospectively investigated. Using ultrasound, we measured the inferior vena cava diameter, cardiac output with surrogate markers such as the velocity time integral before and after the passive leg-raising test, and the presence of systolic obliteration of the left ventricle. The Rockall and Glasgow-Blatchford scores were calculated for patients with upper GI bleeding and the Velayos score for lower GI bleeding. The patients had follow-up during hospitalization and 30 days later to assess for early and late adverse events (AEs). Then we integrated the ultrasound findings of hypovolemia into the GI bleeding scores, assessing the capability to detect AEs. Results In our cohort, patients with upper GI bleeding who showed left ventricle kissing walls had a worse evolution, with a greater presence of late AEs (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.32-10.96; P = .01). Patients with lower GI bleeding who showed a collapse of the inferior vena cava (>50%) after passive leg raising had a greater presence of early AEs (OR, 3.6; 95% CI, 1.46-9.00; P = .004). The predictive performance of the Rockall score (receiver operating characteristic analysis: area under the curve [AUC], 77.6%; 95% CI, 66.3%-88.8%) increased with POCUS (AUC, 80.3%; 95% CI, 69.5%-91.1%); that of the Glasgow-Blatchford score (AUC, 72.5%; 95% CI, 59.9%-85.2%) increased with POCUS (AUC, 73.2%; 95% CI, 61.1%-85.4%); and that of Velayos score (AUC, 55.7%; 95% CI, 42.5%-69.0%) also increased with POCUS (AUC, 72.2%; 95% CI, 61.1%-83.3%). Conclusions The use of POCUS in GI bleeding is feasible and enhances common GI bleeding risk scores, showing better predictive performance in detecting AEs.

To evaluate a fast-track pathway utilizing point-of-care (POC) testing and sonography as soon as uncomplicated renal or ureteral colic is suspected and to compare the POC clinical pathway to a standard one.Unblinded randomized controlled clinical trial in a hospital emergency department (ED). We enrolled patients with suspected uncomplicated renal or ureteral colic and randomized them to a POC or standard pathway (1:1 ratio). Duration of ED stay, treatments, the proportion of diagnoses other than uncomplicated colic, and 30-day complications were analyzed.One hundred forty patients were recruited between November 2018 and October 2019; data for 124 were analyzed. The mean (SD) total time in the ED was 112 (45) minutes in the POC arm and 244 (102) in the standard arm (P .001). Treatments, alternative diagnoses, and complication rates did not differ.The use of a fast-track POC pathway to manage uncomplicated colic in the ED is effective and safe. It also reduces the amount of time spent in the ED.Evaluar una vía de alta resolución (vía POC) que utiliza análisis en el punto de atención (point-of-care testing –POCT–) y ecografía en el punto de atención (point-of-care ultrasonography –POCUS–) en la sospecha del cólico renoureteral (CRU) no complicado y compararla con la vía estándar (vía STD).Ensayo clínico aleatorizado, controlado, no ciego, realizado en un servicio de urgencias hospitalario (SUH). Incluyó pacientes con sospecha clínica de CRU agudo y se aleatorizaron 1:1 a seguir vía POC o vía STD. Se analizó el tiempo de estancia en el SUH, el tratamiento administrado, la proporción de diagnósticos alternativos a CRU y las complicaciones a 30 días.Entre noviembre de 2018 y octubre de 2019, se reclutaron 140 pacientes de los que se analizaron 124. El tiempo de estancia total en el SUH de la vía POC fue de 112 minutos (DE 45) y en la vía STD 244 minutos (DE 102) (p 0,001). No hubo diferencias en el tratamiento administrado en urgencias, en el número de diagnósticos alternativos, ni en las complicaciones a 30 días.La utilización de una vía de alta resolución del manejo del CRU en un SUH es eficaz, segura y reduce el tiempo de estancia en urgencias.

Goals: To quantify the savings that could be made by the hospital implementation of a computer application (DIAGETHER®), which advises the treatment of hyperglycemia of the diabetic patient in the emergency department when this patient is admitted to a third level hospital. Methods: A multicenter interventional study was designed, including patients in two arms, one in the conventional treatment prescribed by the physician and the other applied the treatment indicated by the computer application DIAGETHER®. The days of hospitalization were collected in the two arms of intervention. Results: A total of 183 patients were included, 86 received treatment with the computer application, and 97 received conventional treatment. The mean blood glucose level on the first day of admission in the GLIKAL group was 178.56 (59.53), compared to 212.93 (62.23) in the conventional group (p

Goal: to evaluate the adherence of Emergency Physicians to clinical guidelines for medical treatment in in-hospital patients, evaluated by using a specific computing tool (GLIKAL©) in patients with hyperglycemia and/or diabetes mellitus. Methodology: An observational study with descriptive cases was designed, with no intervention, including patients from an urban, tertiary university hospital. Patients pending admittance were recruited, starting at the very first hours of the day, any day of the week. Inclusion criteria were age above 18 years old, with glycaemia >150 mg/dl upon admittance to hospital (with a known diabetes or not) who were admitted to hospital from the Emergency Department. The study period included was from June to October 2012. The independent variables were age, sex, previous treatment for diabetes, type of diet prescribed upon admittance, corticosteroid treatment, serum creatinine and glycaemia upon admittance to the Emergency Department. The outcome variable was the treatment suggested by the software program, which was evaluated with 11 items gathered by the specific computing tool (GLIKAL©). Results: 125 patients were gathered, amongst which eight were discarded due to mistakes in the initial data collected. Of the remaining 117 patients, the mean age was of 78.1 years old, with 61% males. Among these 117 patients, 74 of them (63.4%) were being treated with oral antidiabetic drugs alone or in combination with insulin, of which 13 cases (17.5%) continued having it prescribed by the physician even when it was not suitable, while no mistake was detected in the treatment specified by GLIKAL© (p

Study objective The objective of the InMEDIATE study was to evaluate the change in intensity of traumatic pain over the first 20 min in adult patients treated with methoxyflurane versus standard analgesic treatment in Spain. This the first randomized, active-controlled, multicenter trial of methoxyflurane in the emergency setting in Europe. Methods This was a randomized, controlled study that enrolled adult patients with acute moderate to severe (score ≥4 on the 11-point Numeric Rating Scale) trauma-associated pain in 14 Spanish emergency departments. Patients were randomized 1:1 to methoxyflurane (up to 2×3 mL) or standard analgesic treatment. Coprimary endpoints were the change from baseline in Numeric Rating Scale pain intensity score during the first 20 minutes of treatment and time to first pain relief. Results Three hundred five patients were randomized (methoxyflurane 156; standard analgesic treatment 149). Most patients in the standard analgesic treatment group (70%) received intravenous first-step analgesics and 9.4% of patients were treated with opioids. Mean decrease from baseline in Numeric Rating Scale pain intensity score was greater for methoxyflurane than standard analgesic treatment at all points, with a significant treatment difference overall up to 20 minutes (repeated-measures model 2.47 versus 1.39; treatment difference 1.00; 95% confidence interval 0.84 to 1.32). Median time to first pain relief was significantly shorter for methoxyflurane than standard analgesic treatment (3 versus 10 minutes). Methoxyflurane achieved better patient and clinician ratings for pain control and comfort of treatment than standard analgesic treatment and exceeded patient and clinician expectations of treatment in, respectively, 77% and 72% of cases compared with 38% and 19% for standard analgesic treatment. Conclusion These results support consideration of methoxyflurane as a nonnarcotic, easy-to-administer, rapid-acting, first-line alternative to currently available analgesic treatments for trauma pain.

To evaluate 5 diagnostic-therapeutic strategies for suspected acute paracetamol poisoning in terms of cost-effectiveness in a tertiary university hospital with an active, validated poisoning surveillance program (SAT-HULP).Cost-effectiveness analysis of the 5 diagnostic-therapeutic alternatives considered when attending patients with suspected paracetamol poisoning. The alternatives were chosen by means of a decision tree. We studied patients detected by the SAT-HULP program between April 1, 2011, and January 31, 2015. The diagnostic-therapeutic alternatives were as follows: 1) systematic treatment of all patients with N-acetylcysteine (NAC), 2) NAC treatment according to the reported dose; 3) NAC treatment according to a Rümack-Matthew nomogram; 4) NAC treatment according to urine test results confirmed by a blood test, and 5) treatment according to elimination half-life calculation. Probability data were obtained from the SAT-HULP program and validation studies corresponding to the diagnostic tests. Deterministic and probabilistic sensitivity analyses were performed.The approaches that were most cost-effective were those guided by reported doses and nomograms. The incremental cost-effectiveness of treatment according to reported dose was €5985.37. The sensitivity analysis showed that the model was highly dependent on variations in the main variables; the probabilistic sensitivity analysis indicated an incremental cost-effectiveness of €25 111.06 (SD, €1 534 420.16; range, €42 136.03-€92 358.75) between the first approach (treat all cases) and last (calculate elimination half-life); half-life calculation was the more efficient.Treating according to nomogram was the most efficient diagnostic-therapeutic approach to treating paracetamol poisoning in our hospital. However, when the prevalence of paracetamol poisoning is higher and uncertainty is greater, it would be more efficient to treat based on calculating the half-life.Evaluar la eficiencia de cinco estrategias diagnóstico-terapéuticas posibles ante la sospecha de intoxicación aguda (IA) por paracetamol (PCT) a través de un análisis coste-efectividad, según la perspectiva del financiador en un hospital universitario terciario dotado de un programa de toxicovigilancia activa validado (SAT-HULP).Estudio de análisis de coste-efectividad (ACE) de cinco alternativas diagnóstico-terapéuticas consideradas en el abordaje de los pacientes atendidos en el servicio de urgencias hospitalario (SUH) con intoxicación por PCT mediante un modelo de árbol de decisión. La población estudiada fueron los pacientes atendidos en un SUH detectados por el SAT-HULP, entre el 1/04/2011 y el 31/01/2015. Las alternativas diagnóstico-terapéuticas consideradas fueron: 1) administración sistemática de Nacetilcisteína; 2) administración del tratamiento según la dosis confirmada; 3) tratamiento según el nomograma de Rümack- Matthew; 4) tratamiento según test de orina confirmado con posterior test en sangre; y 5) tratamiento según el cálculo de la semivida. Los datos correspondientes a probabilidades fueron obtenidos del programa SAT-HULP y publicaciones sobre la validación de las pruebas diagnósticas. Se realizaron análisis de sensibilidad determinístico y probabilístico.Las opciones “Tratar según dosis comunicada” y “Tratar según el nomograma” son las que muestran mejor coste-efectividad. Al compararlas, la razón coste-efectividad incremental es de 5.985,37 € para la primera. El análisis de sensibilidad mostró una importante dependencia del modelo a la variación de las variables principales. En el análisis de sensibilidad probabilístico la estrategia “Tratar a todos los casos” respecto a “Cálculo de semivida” obtuvo una razón coste-efectividad incremental de unos 25.111,06 € (DE: 1.534.420,16; intervalo: –42.136,03 a 92.358,75), resultando esta última la más eficiente.La estrategia “Tratar según el nomograma” es la alternativa más eficiente en el diagnóstico y tratamiento de la intoxicacióna aguda por Paracetamol en nuestro medio, no así para un escenario de mayor prevalencia e incertidumbre, donde la opción “Cálculo de semivida” se muestra como la más eficiente.

La artritis infecciosa es una urgencia medica de cuyo rapido diagnostico depende el pronostico a corto y medio plazo del estado general del paciente y de la funcionalidad final de la articulacion. La articulacion esternoclavicular es una region de baja prevalencia de este tipo de artritis, aunque su frecuencia se suele concentrar en pacientes inmunosuprimidos, usuarios de drogas parenterales o tras procedimientos traumaticos. Presentamos una serie de 5 casos microbiologicamente documentados de artritis infecciosa esternoclavicular, 3 de los cuales se presentaron en pacientes inmunocompetentes, y una revision de esta peculiar enfermedad

To compare the general, structural, and organizational characteristics of public hospital emergency departments in the Spanish autonomous communities of Madrid and Catalonia.Descriptive survey-based study covering 3 areas of inquiry: general hospital features (18 questions), structural features of the emergency department (14 questions), and organizational and work-related policies of the emergency department (30 questions). Hospitals were grouped according to complexity: local hospitals (level 1), high-technology or referral hospitals (levels 2-3).We studied 26 hospital departments in Madrid (21, levels 2-3; 5, level 1) and 55 in Catalonia (24, levels 2-3; 31, level 1). Hospitals in Madrid are in newer buildings (P=.002), have more beds on conventional wards and in critical care units (P.001, both comparisons), are more often affiliated with a university (P.001), and serve larger populations (P=.027). The emergency departments in Madrid have larger surface areas available for clinical care and more cubicles for preliminary evaluations and observation beds (P=.001, all comparisons). Hospitals in Madrid also attended a larger median number of emergencies (P.001). More physicians were employed in Catalonia overall, but the numbers of physician- and nurse-hours per hospital were higher in Madrid, where it was more usual for physicians to work exclusively in the emergency department (92.5% in Madrid vs 56.8% in Catalonia, P.001). However, fewer of the employed physicians had permanent contracts in Madrid (30.5% vs 75.1% in Catalonia, P.001). The ratio of resident physicians to staff physicians differs between the 2 communities on afternoon/evening, night, and holiday shifts (3:1 in Madrid; 1:1 in Catalonia).The physical and functional structures of hospital emergency departments in the communities of Madrid and Catalonia differ significantly. The differences cannot be attributed exclusively to geographic location.Comparar las características generales, estructurales y organizativas de los servicios de urgencias de hospitales públicos (SUHP) de la Comunidad de Madrid con los de Cataluña.Estudio descriptivo tipo encuesta estructurada con 3 apartados: aspectos generales del hospital (18 preguntas), aspectos generales y estructurales de urgencias (14 preguntas), y aspectos organizativos y laborales de urgencias (30 preguntas). Los centros se agruparon según complejidad: niveles I-hospital comarcal y niveles II y III-hospital de alta tecnología o de referencia.Se incluyeron los 26 SUHP de la Comunidad de Madrid (21 nivel II-III y 5 nivel I), y 55 de Cataluña (24 nivel II- III y 31 nivel I). En Madrid, comparada con Cataluña: los hospitales son de construcción más reciente (p = 0,002); tienen mayor número de camas de hospitalización (p0,001) y de cuidados críticos (p0,001); están más frecuentemente vinculados a la universidad (p0,001) y cubren mayor población (p = 0,027). Los servicios de urgencias: tienen mayor superficie para la actividad clínica (p0,001) y la primera asistencia (p0,001); mayor número de puestos de primera asistencia (p0,001) y camas de observación (p = 0,001) y la mediana del número de atenciones urgentes es mayor (p0,001). De forma global, hay más facultativos contratados en Cataluña, pero el número de horas de médico y enfermera contratadas por centro es mayor en Madrid, donde los médicos suelen realizar su actividad exclusivamente en urgencias (92,5% frente a 56,8%; p0,001), muy pocos con contrato fijo indefinido (30,5% frente a 75,1%; p0,001) con relación médico residente/adjunto diferente en turnos de tarde, noche y días festivos en comparación con los SUHP catalanes (3:1 frente a 1:1).La estructura física y funcional de los SUHP madrileños y catalanes difiere de forma significativa sin que pueda explicarse, exclusivamente, por los aspectos geográficos.

Persons with diabetes make up a large percentage of patients attended in the emergency department. Most will be discharged, but patients who remain under observation in wards managed by the emergency department or who wait are waiting to be admitted to a conventional ward must receive appropriate, protocol-guided treatment for their diabetes. Situations of hyper- or hypoglycemia must be avoided because both worsen prognosis. Emergency physicians must correctly and efficiently prevent, diagnose, and manage acute metabolic complications of diabetes such as simple hyperglycemia, diabetic ketoacidosis, and hyperosmolar hyperglycemic state. They must also be ready to prescribe and properly administer intravenous insulin to critically ill patients. Hyperglycemia induced by treatment with steroids deserves special mention. If this complication develops, the hyperglycemia is intense, influenced by increased insulin resistance and gluconeogenesis in the liver. Thus, it usually appears after meals and is dependent on steroid dose, duration of treatment, and individual predisposition. The recommendations in this paper elaborated by consensus of the Spanish Society of Emergency Medicine (SEMES) experts, are the first to be written specifically for use in emergency departments in Spain. They give a detailed, in-depth overview of emergencies related to diabetes and diabetic complications.Un alto porcentaje de los pacientes atendidos en urgencias son diabéticos. La mayoría serán dados de alta. Sin embargo, los que se quedan en observación, ingresados en unidades dependientes de urgencias o los que quedan pendientes de ingreso en hospitalización convencional deben recibir un tratamiento correcto y protocolizado en cuanto a su diabetes, que evite tanto la hiper como la hipoglucemia, ya que ambas son situaciones que empeorarán el pronóstico del paciente. Por otro lado, los urgenciólogos deben prevenir, diagnosticar y manejar de una manera correcta y eficiente las complicaciones metabólicas agudas de la diabetes como son la hiperglucemia simple, la cetoacidosis diabética, la situación hiperosmolar y la hipoglucemia, así como las indicaciones y la forma de administración de insulina intravenosa en los pacientes críticos. Una mención aparte requiere también la hiperglucemia reactiva al tratamiento corticoideo. Esta hiperglucemia, en el caso de aparecer, es intensa y está influenciada por el aumento de la resistencia a la insulina y de la neoglucegénesis hepática que provocan los corticoides, por lo que será de predominio postprandial. Depende de la dosis y duración del tratamiento corticoideo además de una predisposición individual. Las recomendaciones que aquí se exponen, procedentes del consenso alcanzado por el grupo de expertos de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), son las primeras redactadas en España dirigidas exclusivamente a los servicios de urgencias y que hacen una revisión pormenorizada y profunda sobre todas las situaciones que pueden encontrarse en cuanto a la diabetes y sus complicaciones.

To compare the results of emergency department management of spinal pain from vertebral fractures (in terms of revisits, adverse effects at 90 days, or need for hospitalization because of poor pain control at 6 months) in patients treated with transdermal buprenorphine or another analgesic.Retrospective observational study of cohorts in an emergency department database compiled prospectively over a period of 18 months. We included all patients over the age of 60 with a radiologic diagnosis of vertebral fracture or compression causing pain for more than 3 months. Records were stratified according to the World Health Organization (WHO) analgesic scale, which was used when the patients were treated. Variables related to effectiveness were revisits at 1 month, time between visits in days, and the need for hospitalization.A total of 180 patients were included; 39 were treated with drugs on the first step of the WHO's analgesic ladder, 74 with second-step drugs (mainly tramadol), and 67 with transdermal buprenorphine, a third-step drug. Half the patients treated with buprenorphine had revisited at 50 days or later (interquartile range [IQR, 41-60 days); half those treated with first-step analgesics had revisited by 19 days IQR, 10-37 days), and half those on second-step drugs had revisited by 28 days (IQR, 21-53 days) (P.001). After adjustment for other variables, patients treated with first-step drugs revisited 4.19-fold more (95% CI, 2.57-6.80; P.001) and those treated with second-step drugs revisited 1.91-fold more (95% CI, 1.22-2.99; P=.005) more than patients treated with transdermal buprenorphine.Transdermal buprenorphine used to manage spinal pain seems to significantly reduce the need for revisits in comparison with treatments with first- or second-step analgesics.Comparar los resultados del manejo del dolor axial en pacientes con fracturas vertebrales, atendidos en un servicio de urgencias (SU) según hayan sido tratados con buprenorfina transdérmica u otro tratamiento analgésico, en términos de necesidad de nuevas consultas, aparición de efectos adversos a los 90 días o de necesidad de hospitalización por mal control analgésico a los 6 meses de la primera consulta.Estudio observacional de cohortes retrospectivo desde en una base de datos prospectiva de 18 meses, en un SU. Se incluyeron todos los pacientes mayores de 60 años, con diagnóstico radiológico de fractura/aplastamiento vertebral de más de 3 meses de evolución. Los registros fueron agrupados según el escalón analgésico de la OMS (Organización Mundial de la Salud) con el que fueron tratados los pacientes. Las variables de efectividad fueron: reconsulta al mes, tiempo de reconsulta en días y necesidad de hospitalización.Se incluyeron 180 pacientes, 39 tratados con fármacos del primer escalón analgésico de la OMS, 74 con fármacos del segundo escalón (fundamentalmente tramadol) y 67 con buprenorfina transdérmica (tercer escalón). El 50% de los pacientes tratados con buprenorfina reconsultaron a los 50 días o más (rango intercuartílico –RIC–: 41- 60), mientras que en el grupo tratado con primer escalón a los 19 (RIC 10-37) y con el segundo escalón a los 28 (RIC 21-53) (p0,001). Al ajustar el tratamiento por el resto de las variables se determinó que los pacientes tratados con el primer escalón incrementaban la tasa de reconsulta en 4,19 veces (IC95%: 2,57-6,80; p0,001) y en los tratados con el segundo escalón 1,91 veces (IC95%: 1,22-2,99; p = 0,005) frente a los pacientes tratados con buprenorfina transdérmica.La administración de buprenorfina transdérmica en el control sintomático del dolor axial parece disminuir significativamente la necesidad de nuevas consultas repetidas comparada con terapias de primer y segundo escalón analgésico.

Resumen El proposito del presente estudio es determinar la tasa de complicaciones por sangrado en pacientes anticoagulados con acenocumarol en funcion del indice normalizado internacional (INR) de coagulacion. Se realizo un estudio retrospectivo con 901 registros de pacientes a quienes se les practico una artrocentesis o infiltracion articular entre 2009 y 2013, se agruparon los registros en funcion de tener un INR superior o inferior a 2,0 (268 y 633 registros, respectivamente) y se compararon las tasas de complicaciones por sangrado. Se observo una tasa de 0,37% de complicaciones por sangrado tempranas (

El recidivismo en urgencias es la demanda asistencial generada por pacientes que ya han sido valorados previamente por el mismo motivo o por un motivo derivado por el tratamiento indicado. El propA³sito del presente estudio es determinar en quA© medida influye el tipo de tratamiento analgA©sico pautado en los procesos dolorosos axiales dorsales y lumbalgia en el recidivismo. Se realizA³ un estudio retrospectivo sobre 24490 registros de pacientes que consultaron por estos motivos en urgencias entre 2010 y 2015. Se identificaron la existencia de consultas posteriores hasta cumplidos 30 dA­as y el tipo de tratamiento analgA©sico pautado. En general el 18.02% de los pacientes consultaron nuevamente antes del primer mes. A los 30 dA­as la proporciA³n de pacientes que no habA­an reconsultado fue 67.4%, 78.6% y 91.7%, segAon fueron tratados con medicamentos del primer, segundo o tercer escalA³n analgA©sico. En todos los periodos de observaciA³n, el mal control analgA©sico fue el principal motivo de reconsulta. La identificaciA³n de eventos adversos como causa de consulta repetida se presentA³ mayoritariamente en pacientes que recibieron fAirmacos del segundo escalA³n analgA©sico.Aunque se requiere estudios prospectivos y controlados para validar el valor protector de ciertas prescripciones contra el recidivismo en urgencias, nuestros resultados sugieren intensamente que el uso de fAirmacos del tercer escalA³n puede tener un impacto positivo en este indicador. Urgency recidivism is defined as further need of medical assessment after a initial consultation due to the same chief complain or to an adverse effect caused by the original prescription. Aim of this study is to determine in what extent, the kind of analgesic treatment influences recidivism in patients who consulted by axial pain. A retrospective study based on 24490 records from 2010 to 2015 was performed. A survival curve was performed for each group of treatments. Globally, 18.02% of patients consulted before the first month. At the thirtieth day the proportion of patients who did not consulted again was 67.4%, 78.6% and 91.7%, according to have been treated with medications of the first, second or third analgesic step, respectively. In all periods of follow up, pain control failure was the most frequent chief complain, however, adverse effects of prescription were identified as major cause of consultation among patients who were treated with medications of the second analgesic step. Further prospective controlled studied should be performed to validate the protector value of certain prescriptions against urgency recidivism, however, our results strongly suggest that the use of medications of the third analgesic step could have a positive effect in this measure.Â

Infectious arthritis is a medical emergency whose prognosis, in terms of general morbidity and the final functionality of the joint, depends on rapid diagnosis and treatment. The sternoclavicular joint is an area of low prevalence of this type of arthritis, although its frequency is often concentrated in immunosuppressed patients, users of parenteral drugs or after traumatic events. We present a series of 5 microbiologically documented cases of sternoclavicular septic arthritis, 3 of which occurred in immunocompetent patients, and a short review of this pathology.

The purpose of this study is to determine the rate of bleeding complications in patient's anticoagulated with acenocoumarol according to the international normalized ratio (INR) coagulation index. A cross-sectional study was performed with 901 charts of patients who underwent arthrocentesis or joint infiltration between 2009 and 2013; the charts were grouped on the basis of having an INR higher or lower than 2.0 (268 and 633, respectively). Comparisons were performed in terms of rates of early or late bleeding complications. A 0.37% rate of early bleeding complications (< 24hours) was observed in the group of patients with INR

espanolIntroduccion. La adecuacion de ingresos hospitalarios garantiza la sostenibilidad del sistema sanitario y contribuye a incrementar la seguridad de los pacientes. Los hospitales universitarios deben tener como prioridad que el ejercicio de la docencia no repercuta en detrimento de la adecuacion de los ingresos hospitalarios. Objetivo. Determinar si nuestro modelo de supervision de residentes, conocido como no piramidal, garantiza una homogenea proporcion de ingresos hospitalarios adecuados desde el servicio de urgencias con independencia de la situacion de supervision que tenga el medico responsable del ingreso. Sujetos y metodos. Se aplico el protocolo de adecuacion de ingresos hospitalarios a un registro aleatorizado obtenido para un estudio previamente realizado sobre prevalencia de adecuacion de los ingresos hospitalarios. La proporcion de ingresos hospitalarios adecuados se comparo en funcion de quien habia realizado la indicacion del ingreso: un facultativo especialista, un residente de primer ano bajo supervision facultativa o un residente de segundo o tercer ano. Resultados. Los ingresos hospitalarios indicados por un facultativo especialista, por un residente de primer ano bajo supervision de un facultativo especialista y por un residente de segundo o tercer ano fueron 125, 93 y 78, respectivamente. En estos tres grupos, los ingresos hospitalarios considerados inadecuados fueron 4 (3,2%), 5 (5,4%), y 4 (5,1%), respectivamente, sin identifi carse diferencias estadisticamente signifi cativas. Conclusiones. En todos los grupos, la proporcion de ingresos inadecuados fue inferior a la comunicada en estudios nacionales previos. Creemos que nuestro modelo de supervision no piramidal garantiza una sostenibilidad del sistema sanitario al ahorrar costes de ingresos inadecuados y contribuye a aumentar la seguridad de los pacientes. EnglishIntroduction. A hospital admission adequacy warrants sustainability of a healthcare system and contributes increasing patients’ safety. Teaching hospitals must assure that pedagogic exercise with residents do not affect the adequacy of hospital admissions. Aim. To determine if our resident supervision model, known as non-pyramidal, warrants and homogeneous proportion of hospital admissions from the emergency department with independence of the different kind of physician who performs the instruction of hospital admission. Subjects and methods. A validated international protocol of hospital admission adequacy was applied to a randomized group of registries of hospital admissions which was used in a study of prevalence of adequate hospital admissions performed previously. The proportion of adequate hospital admission was compared according to who was who ordered the admission: a urgency physician staff, a first year resident under staff supervision and a second or third year resident. Results. The hospital admissions from the emergency department ordered by a staff physician, a first year resident and a second or third year resident were 125, 93 and 78 respectively. In those three groups, hospital admissions considered inadequate were 4 (3.2%), 5 (5.4%) and 4 (5.1%), respectively. There was no statistically signifi cant diff erence among those proportions. Conclusions. In all groups, proportion of inadequate hospital admissions was less than those found in national reports. We believe that our non-pyramidal supervision model assures sustainability of the healthcare system saving costs of inadequate hospital admissions and contributes to warrant patients’ safety.