RESUMO
Objetivo: Evaluar la frecuencia y los factores asociados con la mortalidad a corto plazo de personas que viven en residencias tras ingreso en urgencias.Método: Análisis retrospectivo multicéntrico de una muestra aleatoria de admisiones de personas $ 65 años que viven en residencias en cinco servicios de urgencias de Cataluña, a lo largo de 2017. Se analizaron características sociodemográficas, el estado funcional y cognitivo previo, multimorbilidad, nivel de triaje de las urgencias, duración de la estancia en urgencias, hospitalización y mortalidad a corto plazo (en urgencias o en los 30 días posteriores al alta). Se utilizó un análisis de regresión multivariante para investigar los factores asociados con la mortalidad a corto plazo. Resultados: Se analizaron 2.444 admisiones en urgencias, con una edad media de 85,9 (DE 7,1) años, 67,7% mujeres. La mortalidad a corto plazo (15,5%) se asoció con una edad > 90 años (OR 1,50; IC 95%: 1,5-1,95), un índice de Charlson > 2 (OR 1,47; IC 95%: 1,14-1,90), y un grado de dependencia moderado (OR 1,50; IC 95%: 1,03-2,20) y grave (OR 2,56; IC 95%: 1,84-3,55). También se asoció con un mayor nivel de triaje de la urgencia, duración de la estancia en urgencias e ingreso en planta de hospitalización. Conclusiones: Los ancianos residentes con las características descritas podrían beneficiarse especialmente de intervenciones dirigidas a la prevención de traslados potencialmente innecesarios a urgencias y a la implementación de una atención integral geriátrica dentro de los servicios de urgencias, a fin de garantizar una buena calidad de los cuidados en fases finales de la vida. (AU)
Objectives: To evaluate short-term mortality in people transferred from aged care homes for treatment in a hospital emergency department (ED) and to analyze factors associated with mortality. Methods: Multicenter study of a random sample of retrospective data of patients treated in 5 EDs in Catalonia in 2017. The patients were over the age of 65 years and lived in residential care facilities. In addition to short-term mortality (in the ED or within 30 days of discharge), we analyzed sociodemographic characteristics, prior functional and cognitive status, multimorbidity, triage level on arrival, length of stay in the ED, and hospital admission. Odds ratios (ORs) for factors associated with short-term mortality were calculated by multivariate regression analysis. Results: A total of 2444 ED admissions were analyzed. The patients mean (SD) age was 85.9 (7.1) years, and 67.7% were women. Short-term mortality (in 15.5%) was associated with age >90 years (OR, 1.50; 95% CI, 1.5-1.95 years), a Charlson index >2 (OR, 1.47; 95% CI, 1.14-1.90), and dependency assessed as moderate (OR, 1.50; 95% CI, 1.03-2.20) or severe (OR, 2.56; 95% CI, 1.84-3.55). Other associated factors were a higher level of urgency on triage, duration of ED stay, and hospital admission. Conclusions: Aged residents with the characteristics associated with short-term mortality could benefit from interventions for potentially avoiding unnecessary transfers to an ED, and from the implementation of comprehensive geriatric care within the ED. This could be useful to support good quality of care at the end of life. (AU)
Assuntos
Humanos, Masculino, Feminino, Idoso, Idoso de 80 Anos ou mais, Instituição de Longa Permanência para Idosos, Serviços Médicos de Emergência, Estudos Retrospectivos, Mortalidade, HospitalizaçãoRESUMO
OBJECTIVES: To evaluate short-term mortality in people transferred from aged care homes for treatment in a hospital emergency department (ED) and to analyze factors associated with mortality. MATERIAL AND METHODS: Multicenter study of a random sample of retrospective data of patients treated in 5 EDs in Catalonia in 2017. The patients were over the age of 65 years and lived in residential care facilities. In addition to short-term mortality (in the ED or within 30 days of discharge), we analyzed sociodemographic characteristics, prior functional and cognitive status, multimorbidity, triage level on arrival, length of stay in the ED, and hospital admission. Odds ratios (ORs) for factors associated with short-term mortality were calculated by multivariate regression analysis. RESULTS: A total of 2444 ED admissions were analyzed. The patients' mean (SD) age was 85.9 (7.1) years, and 67.7% .were women. Short-term mortality (in 15.5%) was associated with age >90 years (OR, 1.50; 95% CI, 1.5-1.95 years), a Charlson index >2 (OR, 1.47; 95% CI, 1.14-1.90), and dependency assessed as moderate (OR, 1.50; 95% CI, 1.03- 2.20) or severe (OR, 2.56; 95% CI, 1.84-3.55). Other associated factors were a higher level of urgency on triage, duration of ED stay, and hospital admission. CONCLUSION: Aged residents with the characteristics associated with short-term mortality could benefit from interventions for potentially avoiding unnecessary transfers to an ED, and from the implementation of comprehensive geriatric care within the ED. This could be useful to support good quality of care at the end of life.
OBJETIVO: Evaluar la frecuencia y los factores asociados con la mortalidad a corto plazo de personas que viven en residencias tras ingreso en urgencias. METODO: Análisis retrospectivo multicéntrico de una muestra aleatoria de admisiones de personas $ 65 años que viven en residencias en cinco servicios de urgencias de Cataluña, a lo largo de 2017. Se analizaron características sociodemográficas, el estado funcional y cognitivo previo, multimorbilidad, nivel de triaje de las urgencias, duración de la estancia en urgencias, hospitalización y mortalidad a corto plazo (en urgencias o en los 30 días posteriores al alta). Se utilizó un análisis de regresión multivariante para investigar los factores asociados con la mortalidad a corto plazo. RESULTADOS: Se analizaron 2.444 admisiones en urgencias, con una edad media de 85,9 (DE 7,1) años, 67,7% mujeres. La mortalidad a corto plazo (15,5%) se asoció con una edad > 90 años (OR 1,50; IC 95%: 1,5-1,95), un índice de Charlson > 2 (OR 1,47; IC 95%: 1,14-1,90), y un grado de dependencia moderado (OR 1,50; IC 95%: 1,03-2,20) y grave (OR 2,56; IC 95%: 1,84-3,55). También se asoció con un mayor nivel de triaje de la urgencia, duración de la estancia en urgencias e ingreso en planta de hospitalización. CONCLUSIONES: Los ancianos residentes con las características descritas podrían beneficiarse especialmente de intervenciones dirigidas a la prevención de traslados potencialmente innecesarios a urgencias y a la implementación de una atención integral geriátrica dentro de los servicios de urgencias, a fin de garantizar una buena calidad de los cuidados en fases finales de la vida.
Assuntos
Serviços Médicos de Emergência, Hospitalização, Humanos, Feminino, Masculino, Estudos Retrospectivos, Serviço Hospitalar de Emergência, Alta do PacienteRESUMO
OBJECTIVE: The birth rate in Spain has increased due to the continuous rise in the number of immigrants. Ethnic origin and socioeconomic position can be determining factors in differences in maternal and child health. The aim of the present study was to determine the possible existence of differences in neonatal diagnoses according to parental ethnic origin. METHODS: We performed a retrospective, cross-sectional study of all live newborns delivered in Hospital del Mar (Barcelona) between 2003 and 2005. The variables studied were risk of admission, diagnostic classes, and parental ethnic group. RESULTS: Of the 2118 newborns included in this study, 46.7% were of immigrant origin (mainly from Central and South America) and 6.4% were gypsies. More than 60% of the 1445 admitted newborns were included in the diagnostic class of risk or suspicion of infection. The risk of pregnancy with little or no prenatal care was higher in non-native and gypsy newborns (OR = 2.58; 95%CI: 1.76-3.77, and OR = 5.84; 95%CI: 3.45-9.90, respectively). The risk of low birth weight and maternal drug use were lower in non-native newborns (OR = 0.17; 95%CI: 0.03-0.90, and OR = 0.12; 95%CI: 0.03-0.44, respectively). CONCLUSIONS: Differences in non-native and gypsy newborns compared with native newborns are not due to imported or genetic diseases but are probably due to differences in the social and cultural environment during pregnancy. Preventive measures should be promoted and reinforced and access to and the quality of primary care should be improved in these mothers and their infants.
Assuntos
Doenças do Recém-Nascido/epidemiologia, Pais, Admissão do Paciente/estatística & dados numéricos, Migrantes, Estudos Transversais, Humanos, Recém-Nascido, Doenças do Recém-Nascido/classificação, Estudos Retrospectivos, Espanha, População UrbanaRESUMO
Objetivo: El aumento continuado de la inmigración ha ocasionadoun incremento de la natalidad a expensas de este grupode población. El origen étnico y el nivel socioeconómico puedenser factores que condicionen las diferencias de salud maternoinfantil.El objetivo fue conocer si hay diferencias en los diagnósticosneonatales según el origen étnico de los progenitores.Métodos: Estudio transversal retrospectivo de los recién nacidosvivos en el Hospital del Mar (Barcelona) entre 2003 y2005. Las variables estudiadas fueron: riesgo de ingresar, categoríasdiagnósticas y grupo étnico de los progenitores.Resultados: El 46,7% de los 2.118 recién nacidos eran inmigrantes(mayoritariamente de Centroamérica y Sudamérica)y el 6,4% gitanos. En más del 60% de los 1.445 reciénnacidos ingresados, la categoría diagnóstica más frecuentefue el riesgo o la sospecha de infección. Los recién nacidosno autóctonos y gitanos tuvieron más riesgo de embarazo pocoo no controlado (odds ratio [OR] = 2,58; intervalo de confianzadel 95% [IC95%]: 1,76-3,77, y OR = 5,84; IC95%: 3,45-9,90,respectivamente). Los recién nacidos no autóctonos tuvieronmenos riesgo de bajo peso al nacimiento (OR = 0,17;IC95%: 0,03-0,90) y consumo materno de tóxicos (OR= 0,12; IC95%: 0,03-0,44).Conclusiones: Las diferencias en las categorías diagnósticasen los recién nacidos no autóctonos y gitanos, comparadoscon los autóctonos, no se deben a enfermedades importadaso a diferente carga genética, sino que posiblementeson consecuencia del entorno social y cultural de la gestante.Sería necesario reforzar y promover el uso de medidas preventivasde salud, así como mejorar el acceso y la calidad dela asistencia a estas mujeres y sus hijos(AU)
Objective: The birth rate in Spain has increased due to thecontinuous rise in the number of immigrants. Ethnic origin andsocioeconomic position can be determining factors in differencesin maternal and child health. The aim of the presentstudy was to determine the possible existence of differencesin neonatal diagnoses according to parental ethnic origin.Methods: We performed a retrospective, cross-sectional studyof all live newborns delivered in Hospital del Mar (Barcelona)between 2003 and 2005. The variables studied were risk ofadmission, diagnostic classes, and parental ethnic group.Results: Of the 2118 newborns included in this study, 46.7%were of immigrant origin (mainly from Central and South America)and 6.4% were gypsies. More than 60% of the 1445 admittednewborns were included in the diagnostic class of riskor suspicion of infection. The risk of pregnancy with little orno prenatal care was higher in non-native and gypsy newborns(OR = 2.58; 95%CI: 1.76-3.77, and OR = 5.84; 95%CI: 3.45-9.90, respectively). The risk of low birth weight and maternaldrug use were lower in non-native newborns (OR = 0.17;95%CI: 0.03-0.90, and OR = 0.12; 95%CI: 0.03-0.44, respectively).Conclusions: Differences in non-native and gypsy newbornscompared with native newborns are not due to imported orgenetic diseases but are probably due to differences in thesocial and cultural environment during pregnancy. Preventivemeasures should be promoted and reinforced and accessto and the quality of primary care should be improved in thesemothers and their infants(AU)
