93 results on '"Aguiló S"'
Search Results
2. Aspectos epidemiológicos, manejo clínico y resultados a corto plazo en pacientes mayores diagnosticados de insuficiencia cardiaca aguda en urgencias en España: resultados del estudio EDEN-34
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Miró, Ò., Llorens, P., Aguiló, S., Alquézar-Arbé, A., Fernández, C., Burillo-Putze, G., Canadell Marcos, N., Arce Marañón, A., Sánchez Oms, G., and González del Castillo, J.
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- 2024
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3. Epidemiological aspects, clinical management and short-term outcomes in elderly patients diagnosed with acute heart failure in the emergency department in Spain: results of the EDEN-34 study
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Miró, Ò., Llorens, P., Aguiló, S., Alquézar-Arbé, A., Fernández, C., Burillo-Putze, G., Marcos, N.C., Marañón, A.A., Oms, G.S., and del Castillo, J.G.
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- 2024
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4. Lysyl oxidase (LOX) in ectopic cardiovascular calcification: Impact on matrix mineralization and vascular calcification associated to atherosclerosis
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Ballester-Servera, C., primary, Cañes, L., additional, Alonso, J., additional, Puertas-Umbert, L., additional, Aguiló, S., additional, Taurón, M., additional, Rodríguez, C., additional, and Martínez-González, J., additional
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- 2023
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5. Activation of WNT/Β-catenin signaling in abdominal aortic aneurysm: Impact of porcupine inhibition and disruption of CBP/Β-catenin interaction in a murine experimental model
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Puertas-Umbert, L., primary, Varona, S., additional, Ballester-Servera, C., additional, Alonso, J., additional, Aguiló, S., additional, Orriols, M., additional, Martínez-Martínez, E., additional, Rodríguez-Sinovas, A., additional, Martínez-González, J., additional, and Rodríguez, C., additional
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- 2023
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6. The FAST-FURO study: effect of very early administration of intravenous furosemide in the prehospital setting to patients with acute heart failure attending the emergency department
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Miró Ò, Harjola P, Rossello X, Gil V, Jacob J, Llorens P, Martín-Sánchez FJ, Herrero P, Martínez-Nadal G, Aguiló S, López-Grima ML, Fuentes M, Álvarez Pérez JM, Rodríguez-Adrada E, Mir M, Tost J, Llauger L, Ruschitzka F, Harjola VP, Mullens W, Masip J, Chioncel O, Peacock WF, Müller C, Mebazaa A, ICA-SEMES Research Group, and University of Zurich
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medicine.medical_specialty ,Emergency Medical Services ,New York Heart Association Class ,610 Medicine & health ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Furosemide ,Internal medicine ,Epidemiology ,medicine ,Emergency medical services ,Humans ,030212 general & internal medicine ,Mortality ,Original Scientific Papers ,Diuretics ,Outcome ,Heart Failure ,business.industry ,Emergency department ,Acute heart failure ,Atrial fibrillation ,General Medicine ,Odds ratio ,medicine.disease ,3. Good health ,Heart failure ,Acute Disease ,10209 Clinic for Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Emergency Service, Hospital ,medicine.drug - Abstract
Aims The effect of early administration of intravenous (IV) furosemide in the emergency department (ED) on short-term outcomes of acute heart failure (AHF) patients remains controversial, with one recent Japanese study reporting a decrease of in-hospital mortality and one Korean study reporting a lack of clinical benefit. Both studies excluded patients receiving prehospital IV furosemide and only included patients requiring hospitalization. To assess the impact on short-term outcomes of early IV furosemide administration by emergency medical services (EMS) before patient arrival to the ED. Methods and results In a secondary analysis of the Epidemiology of Acute Heart Failure in Emergency Departments (EAHFE) registry of consecutive AHF patients admitted to Spanish EDs, patients treated with IV furosemide at the ED were classified according to whether they received IV furosemide from the EMS (FAST-FURO group) or not (CONTROL group). In-hospital all-cause mortality, 30-day all-cause mortality, and prolonged hospitalization (>10 days) were assessed. We included 12 595 patients (FAST-FURO = 683; CONTROL = 11 912): 968 died during index hospitalization [7.7%; FAST-FURO = 10.3% vs. CONTROL = 7.5%; odds ratio (OR) = 1.403, 95% confidence interval (95% CI) = 1.085–1.813; P = 0.009], 1269 died during the first 30 days (10.2%; FAST-FURO = 13.4% vs. CONTROL = 9.9%; OR = 1.403, 95% CI = 1.146–1.764; P = 0.004), and 2844 had prolonged hospitalization (22.8%; FAST-FURO = 25.8% vs. CONTROL = 22.6%; OR = 1.189, 95% CI = 0.995–1.419; P = 0.056). FAST-FURO group patients had more diabetes mellitus, ischaemic cardiomyopathy, peripheral artery disease, left ventricular systolic dysfunction, and severe decompensations, and had a better New York Heart Association class and had less atrial fibrillation. After adjusting for these significant differences, early IV furosemide resulted in no impact on short-term outcomes: OR = 1.080 (95% CI = 0.817–1.427) for in-hospital mortality, OR = 1.086 (95% CI = 0.845–1.396) for 30-day mortality, and OR = 1.095 (95% CI = 0.915–1.312) for prolonged hospitalization. Several sensitivity analyses, including analysis of 599 pairs of patients matched by propensity score, showed consistent findings. Conclusion Early IV furosemide during the prehospital phase was administered to the sickest patients, was not associated with changes in short-term mortality or length of hospitalization after adjustment for several confounders.
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- 2021
7. Profile of older patients attended in the emergency department after falls: a FALL-ER registry study of the magnitude of the problem and opportunities for improving hospital emergency care
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Miró Ò, Nayla Brizzi B, Aguiló S, Alemany X, Jacob J, Llorens P, Herrero Puente P, González Ramón B, Castro Jiménez V, Torres Machado V, Cenjor R, Gil A, Rico V, Martínez Nadal G, Lázaro Del Nogal M, and Martín-Sánchez FJ
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Emergency health services ,Geriatría ,Caída ,Servicios de urgencias ,Prevención ,Aged ,Geriatrics ,Falls ,Prevention ,Anciano - Abstract
OBJECTIVES: To profile patients aged 65 years or older who are attended in a hospital emergency department after falls. To describe the falls, their severity, and factors relevant to recommended preventive measures. MATERIAL AND METHODS: The FALL-ER is a multipurpose, multicenter prospective registry of a systematically described cohort of patients aged 65 years or older attended in 5 hospital emergency departments on 52 days of the same year. We collected data on 68 independent variables. Patients were classified according to whether they had received recommendations related to preventing falls in any of the following categories: exercise, education on fall prevention, referral to a specialist or changes in medication. RESULTS: . A total of 1507 patients or carers were interviewed (93.6% of the 1610 patients in the registry). The cohort was of advanced age and had high rates of comorbidity, polypharmacy, and history of geriatric syndromes. The majority of falls occurred during the day and in the patients home. Half the falls were not witnessed. Forty-eight percent of the patients reported fear of falling, 22% had acute functional impairment, 16% were admitted, and 0.6% died in the hospital. Recommendations directed to preventing falls were received by 509 (33.8%) cases. Loss of hearing acuity, self-reported cognitive impairment, emergency first aid at the site of the fall, fear of falling again, acute functional impairment, and hospitalization were associated with a greater likelihood of receiving recommendations for preventing falls. Loss of visual acuity was associated with a lower likelihood of receiving recommendations. CONCLUSION: Only a third of elderly patients attended in an emergency department after falls receive recommendations that target preventing further falls. Certain patient and fall characteristics are associated with a greater likelihood of receiving such recommendations.
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- 2018
8. Short-term reconsultation, hospitalisation, and death rates after discharge from the emergency department in patients with acute heart failure and analysis of the associated factors. The ALTUR-ICA Study
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Miró Ò, Gil V, Martín-Sánchez FJ, Herrero P, Jacob J, Sánchez C, Xipell C, Aguiló S, Llorens P, and en nombre del grupo de investigación ICA-SEMES
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Death ,Reconsultation ,Accident and emergency ,Hospitalisation ,Acute heart failure ,Accident and emergency, Acute heart failure, Death, Hospitalisation, Hospitalización, Insuficiencia cardiaca aguda, Mortalidad, Reconsulta, Reconsultation, Urgencias - Abstract
Background and objectives: The aim of this study was to define the following in patients with acute heart failure (AHF) discharged directly from accident and emergency (A&E): rates of reconsultation to A&E and hospitalisation for AHF, and all-cause death at 30 days, rate of combined event at 7 days and the factors associated with these rates. Patients and method: The study included patients consecutively diagnosed with AHF during 2 months in 27 Spanish A&E departments who were discharged from A&E without hospitalisation. We collected 43 independent variables, monitored patients for 30 days and evaluated predictive factors for adverse events using Cox regression analysis. Results: We evaluated 785 patients (78 +/- 9) years, 54.7% women). The rates of reconsultation, hospitalisation, and death at 30 days and the combined event at 7 days were: 26.1, 15.7, 1.7 and 10.6%, respectively. The independent factors associated with reconsultation were no endovenous diuretics administered in A&E (HR 2.86; 95% CI 2.01-4.04), glomerular filtration rate (GFR) < 60 ml/min/m(2) (1.94; 1.37-2.76) and previous AHF episodes (1.48; 1.02-2.13); for hospitalisation these factors were no endovenous diuretics in A&E (2.97; 1.96-4.48), having heart valve disease (1.61; 1.04-2.48), blood oxygen saturation at arrival to A&E < 95% (1.60; 1.06-2.42); and for the combined event no endovenous diuretics in A&E (3.65; 2.19-6.10), GFR < 60 ml/min/m(2) (2.22; 1.31-3.25), previous AHF episodes (1.95; 1.04-3.25), and use of endovenous nitrates (0.13; 0.02-0.99). Conclusion: This is the first study in Spain to describe the rates of adverse events in patients with AHF discharged directly from A&E and define the associated factors. These data should help establish the most adequate approaches to managing these patients. (C) 2017 Elsevier Espana, S.L.U. All rights reserved.
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- 2018
9. Lysyl oxidase overexpression accelerates cardiac remodeling and aggravates angiotensin II–induced hypertrophy
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Galán M., Varona S., Guadall A., Orriols M., Navas M., Aguiló S., De Diego A., Navarro M.A., García-Dorado D., Rodríguez-Sinovas A., Martínez-González J., and Rodriguez C.
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collagen ,mitogen activated protein kinase p38 ,animal cell ,angiotensin II ,fibroblast ,Protein-Lysine 6-Oxidase ,Mice ,heart function ,oxidative stress ,animal ,genetics ,cardiac muscle cell ,heart ventricle hypertrophy ,adult ,transgenics ,gene expression regulation ,heart ventricle remodeling ,heart ventricle function ,enzyme activity ,priority journal ,cardiomegaly ,chemically induced ,signal transduction ,cross linking ,cardiac muscle ,inflammatory infiltrate ,phenotype ,gene overexpression ,enzymology ,animal experiment ,hydrogen peroxide ,Mice, Transgenic ,Article ,Gene Expression Regulation, Enzymologic ,heart protection ,Animals ,Humans ,human ,protein expression ,mouse ,Signal Tra ,Inflammation ,nonhuman ,animal model ,Myocardium ,transgene ,Fibroblasts ,heart fibroblast ,transgenic mouse ,physiology ,cytology ,AMPK signaling ,metabolism ,protein lysine 6 oxidase - Abstract
Lysyl oxidase (LOX) controls matrix remodeling, a key process that underlies cardiovascular diseases and heart failure; however, a lack of suitable animal models has limited our knowledge with regard to the contribution of LOX to cardiac dysfunction. Here, we assessed the impact of LOX overexpression on ventricular function and cardiac hypertrophy in a transgenic LOX (TgLOX) mouse model with a strong cardiac expression of human LOX. TgLOX mice exhibited high expression of the transgene in cardiomyocytes and cardiofibroblasts, which are associated with enhanced LOX activity and H2O2 production and with cardiofibroblast reprogramming. LOX overexpression promoted an age-associated concentric remodeling of the left ventricle and impaired diastolic function. Furthermore, LOX transgenesis aggravated angiotensin II (Ang II)–induced cardiac hypertrophy and dysfunction, which triggered a greater fibrotic response that was characterized by stronger collagen deposition and cross-linking and high expression of fibrotic markers. In addition, LOX transgenesis increased the Ang II–induced myocardial inflammatory infiltrate, exacerbated expression of proinflammatory markers, and decreased that of cardioprotective factors. Mechanistically, LOX overexpression enhanced oxidative stress and potentiated the Ang II–mediated cardiac activation of p38 MAPK while reducing AMPK activation. Our findings suggest that LOX induces an age-dependent disturbance of diastolic function and aggravates Ang II–induced hypertrophy, which provides novel insights into the role of LOX in cardiac performance. © FASEB.
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- 2017
10. Project E53: attempting to quantify and measure the level of stress
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Aguiló J, Ferrer-Salvans P, García-Rozo A, Armario A, Corbí Á, Cambra-Lasaosa FJ, Bailón R, González-Marcos A, Caja G, Aguiló S, López-Antón R, Arza-Valdés A, and Garzón-Rey JM
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- 2015
11. NOR-1 modulates the inflammatory response of vascular smooth muscle cells by preventing nfkb activation
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Martí Pàmies, I., primary, Rodriguez-Calvo, R., additional, Calvayrac, O., additional, Alonso, J., additional, Ferrán, B., additional, Aguiló, S., additional, Crespo, J., additional, Rodríguez-Sinovas, A., additional, Rodríguez, C., additional, and Martínez-González, J., additional
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- 2015
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12. PP.04.09
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Galan, M., primary, Varona, S., additional, Orriols, M., additional, Aguiló, S., additional, De Diego, A., additional, Navarro, M.A., additional, Osada, J., additional, Martinez-González, J., additional, and Rodriguez, C., additional
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- 2015
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13. Seizures after flumazenil administration in a case of combined benzodiazepine and tricyclic antidepressant overdose
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Melo O.L., Nogué S., Trullás J.C., Aguiló S., and Maciel A.
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Flumazenil ,Adult ,Tonic clonic seizure ,Tricyclic antidepressant ,Benzodiazepine ,Respiratory failure ,Article ,Tricyclic antidepressant agent ,Benzodiazepines ,Clinical feature ,Seizures ,Intensive care ,Case report ,Suicide attempt ,Female ,Risk factor ,Coma ,Disease course ,Human - Abstract
Flumazenil is a competitive inhibitor of the GABA receptor which effectively counteracts the effects of benzodiazepine overdose. It is considered to be safe, although infrequent adverse effects, including seizures, have been described. We present the case of a 30-year-old patient who was found in coma after taking an unknown amount of benzodiazepines and tricyclic antidepressants in an attempt to commit suicide After the administration of flumazenil, the patient suffered generalized tonic-clonic seizure. The patient was admitted to the ICU due to respiratory insufficiency secondary to broncoaspiration, with a satisfactory evolution after 48 hours. The risk factors for the development of seizure after flumazenil admisnistracion are discussed, recomendation for its safe use are suggested.
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- 2004
14. 404: Factors Related to Patients’ Acceptance of Hospital-at-Home Care from the Emergency Department: Is Their Clinical Condition Decisive?
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Sanchez, M., primary, Jiménez, S., additional, Prieto, S., additional, Aguiló, S., additional, Coll-Vinent, B., additional, Bragulat, E., additional, and Miró, O., additional
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- 2007
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15. Atypical autoantibodies in patients with primary Sjögren syndrome: clinical characteristics and follow-up of 82 cases.
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Ramos-Casals M, Nardi N, Brito-Zerón P, Aguiló S, Gil V, Delgado G, Bové A, and Font J
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OBJECTIVES: To analyze the clinical characteristics, follow-up, and fulfillment of classification criteria for other systemic autoimmune diseases (SAD) in patients with primary Sjögren syndrome (SS) and atypical autoantibodies. METHODS: We studied 402 patients diagnosed with primary SS seen consecutively in our Department since 1994. We considered anti-DNA, anti-Sm, anti-RNP, anti-topoisomerase1/Scl70, anticentromere (ACA), anti-Jo1, anti-neutrophil cytoplasmic antibodies (ANCA), anticardiolipin antibodies (aPL), and lupus anticoagulant as atypical autoantibodies. The patients were prospectively followed after inclusion into the protocol, focusing on the development of features that might lead to the fulfillment of classification criteria for additional SAD. As a control group, we selected an age-sex-matched subset of patients with primary SS without atypical autoantibodies. RESULTS: Eighty-two (20%) patients showed atypical autoantibodies (36 had aPL, 21 anti-DNA, 13 ANCA, 10 anti-RNP, 8 ACA, 6 anti-Sm, 2 anti-Scl70, and 1 anti-Jo-1 antibodies). There were 77 (94%) women and 5 (6%) men, with a mean age of 57 years. Patients with atypical autoantibodies had no statistical differences in the prevalence of the main sicca features, extraglandular manifestations (except for a higher prevalence of Raynaud's phenomenon, 28% versus 7%, P=0.001), immunological markers, and in the fulfillment of the 2002 classification criteria, compared with the control group. After a follow-up of 534 patient-years, 13 (16%) of the 82 patients with atypical autoantibodies developed an additional SAD (systemic lupus erythematosus in 5 cases, antiphospholipid syndrome in 4, limited scleroderma in 3, and microscopic polyangiitis in 1) compared with none in the control group (P<0.001). CONCLUSIONS: This study shows an immunological overlap (defined by the presence of autoantibodies considered typical of other SAD) in 20% of our patients with primary SS. However, the clinical significance of these atypical autoantibodies varies widely depending on the autoantibodies detected, with a broad spectrum of prevalence and clinical patterns of disease expression, and a specific predilection for association with some SAD in preference to others. Copyright © 2006 by Elsevier Inc. [ABSTRACT FROM AUTHOR]
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- 2006
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16. PROYECTO PARA CONTROL DE RIESGO NUTRICIONAL EN PACIENTES GERIÁTRICOS HOSPITALIZADOS.
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Rubio, M. P., Martí, M., Nadal, L., Benedi, J. M., Bosch, I., and Aguiló, S.
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- 2018
17. Thirty-day outcomes in frail older patients discharged home from the emergency department with acute heart failure: Effects of high-risk criteria identified by the DEED FRAIL-AHF trial,Resultados a 30 días en los pacientes mayores frágiles con insuficiencia cardiaca aguda dados de alta desde urgencias o sus unidades vinculadas que cumplen los criterios de alto riesgo del estudio DEED FRAIL-AHF
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Martín-Sánchez, F. J., Esquivel, García, G. L., Del Castillo, J. G., Adrada, E. R., Espinosa, B., Díez, M. P. L., Pareja, R. R., Bordigoni, M. A. R., Pérez-Durá, M. J., Bibiano, C., Ferrer, C., Aguiló, S., Mojarro, E. M., Aguirre, A., Piñera, P., López-Picado, A., Llorens, P., Javier Jacob, Gil, V., Herrero, P., Pérez, C. F., Gil, P., Calvo, E., Rosselló, X., Bueno, H., Burillo, G., and Miró, Ò
18. Project ES3: Attempting to quantify and measure the level of stress | Proyecto ES3: Intentando la cuantificación y medida del nivel de estrés
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Aguiló, J., Ferrer-Salvans, P., García-Rozo, A., Armario, A., Corbí, Á, Cambra, F. J., Bailón, R., González-Marcos, A., Gerardo Caja, Aguiló, S., López-Antón, R., Arza-Valdés, A., and Garzón-Rey, J. M.
19. Profile of older patients attended in the emergency department after falls: A FALL-ER registry study of the magnitude of the problem and opportunities for improving hospital emergency care,Perfil de los pacientes ancianos atendidos en urgencias por caídas (Registro FALL-ER): magnitud del problema y posibilidades de mejora en los servicios de urgencias hospitalarios
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Miró, Ò, Brizzi, B. N., Aguiló, S., Alemany, X., Javier Jacob, Llorens, P., Herrero Puente, P., González Ramón, B., Castro Jiménez, V., Torres Machado, V., Cenjor, R., Gil, A., Rico, V., Martínez Nadal, G., Lázaro Del Nogal, M., and Martín-Sánchez, F. J.
20. Prehospital emergency care of patients with acute heart failure in Spain: The semica study (Emergency medical response systems for patients with acute heart failure),Atención prehospitalaria a los pacientes con insuficiencia cardiaca aguda en España: Estudio SEMICA
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Miró, Ò, Llorens, P., Escalada, X., Herrero, P., Javier Jacob, Gil, V., Xipell, C., Sánchez, C., Aguiló, S., and Martín-Sánchez, F. J.
21. Catastrophic antiphospholipid syndrome presenting with renal thrombotic microangiopathy and diffuse proliferative glomerulonephritis [2]
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Gómez-Puerta, J. A., Salgado, E., Cervera, R., Aguiló, S., Manuel Ramos-Casals, Soler, M., Torras, A., and Font, J.
22. Influence of clinical and immunological parameters on the health-related quality of life of patients with primary Sjögren's syndrome
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Belenguer, B., Manuel Ramos-Casals, Brito-Zerón, P., Del Pino, J., Sentís, J., Aguiló, S., and Font, J.
23. Activation of Wnt/β-catenin signaling in abdominal aortic aneurysm: A potential therapeutic opportunity?
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Lídia Puertas-Umbert, Saray Varona, Carme Ballester-Servera, Judith Alonso, Silvia Aguiló, Mar Orriols, Ernesto Martínez-Martínez, Antonio Rodríguez-Sinovas, José Martínez-González, Cristina Rodríguez, Institut Català de la Salut, [Puertas-Umbert L, Aguiló S] Institut de Recerca Hospital de la Santa Creu i Sant Pau (IRHSCSP), Barcelona, Spain. Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain. [Varona S, Ballester-Servera C, Alonso J, Orriols M] Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain. CIBER de Enfermedades Cardiovasculares, ISCIII, Madrid, Spain. Instituto de Investigaciones Biomédicas de Barcelona-Consejo Superior de Investigaciones Científicas (IIBB-CSIC), Barcelona, Spain. [Rodríguez-Sinovas A] CIBER de Enfermedades Cardiovasculares, ISCIII, Madrid, Spain. Grup de Recerca de Malalties Cardiovasculars, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
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Cardiovascular Diseases::Vascular Diseases::Aneurysm::Aortic Aneurysm::Aortic Aneurysm, Abdominal [DISEASES] ,fenómenos químicos::fenómenos bioquímicos::transducción de señales::vía de señalización Wnt [FENÓMENOS Y PROCESOS] ,Chemical Phenomena::Biochemical Phenomena::Signal Transduction::Wnt Signaling Pathway [PHENOMENA AND PROCESSES] ,Other subheadings::/therapy [Other subheadings] ,Cell Biology ,enfermedades cardiovasculares::enfermedades vasculares::aneurisma::aneurisma de la aorta::aneurisma de la aorta abdominal [ENFERMEDADES] ,Molecular Biology ,Biochemistry ,Otros calificadores::/terapia [Otros calificadores] ,Genetics (clinical) ,Aneurisma abdominal - Tractament - Abstract
Abdominal aortic aneurysm Aneurisma aórtico abdominal Aneurisma aòrtic abdominal This work was supported by Instituto de Salud Carlos III (ISCIII) (No. PI21/01048, PI20/01649), the European Regional Development Fund (ERDF-FEDER, a way to build Europe), Ministerio de Ciencia e Innovación (No. RTI2018-094727-B-100), AGAUR (No. 2017-SGR-00333, 2017-SGR-1807) and Consejo Superior de Investigaciones Científicas (No. 2021AEP073). L. P. is supported by a PFIS contract (ISCIII), C.B–S by a FPU fellowship and A.R.-S. and M.G. were funded by the Miguel Servet Program.
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- 2023
24. Factors associated with discharge home in older patients admitted to emergency department observation units: Looking for a predictive scale.
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Montero-Pérez FJ, Bajo-Fernández I, González-Del Castillo J, Burillo-Putze G, Jacob J, Aguiló S, Piñera-Salmerón P, Alquezar-Arbé A, Fernández-Alonso C, Llorens P, Cho JH, Casado-Ramón B, Gayoso-Martín S, Sánchez-Sindín G, Fernández-Álvarez ME, Gallardo-Vizcaíno P, Romero-Carrete C, Llauger L, Vázquez-Rey V, Calle-Fernández S, Cañete M, Ruescas E, Fernández-Salgado F, and Miró Ò
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Background: The selection of patients who are going to be admitted to an emergency department observation unit (EDOU) is essential for the good management of these units, intended fundamentally to avoid unnecessary hospitalization of patients. This is especially important when dealing with older patients. It would be important to know what factors are associated with discharge home and to have a clinical predictive scale that appropriately selects older patients who are going to be admitted to an EDOU., Methods: A retrospective cross-sectional study was conducted of all patients ≥65 years of age assisted in 48 Spanish Emergency Departments for 7 consecutive days and were admitted to the EDOU. Demographics-functional, vital signs data and initial laboratory results were analyzed to investigate its association with discharge home and develop and validate a prediction model for discharge home from EDOU. Multivariable logistic regression was performed to develop a prediction model, and a scoring system was created., Results: Among 5457 patients admitted to the EDOU from the emergency room, 2508 (46%) patients were discharged home, and 2949 (54%) were admitted to the hospital. Five variables were strongly associated with discharge home: the absence of fever (adjusted OR: 3.61, 95% CI:1.53-8.54), Glasgow Coma Scale score of 15 points (2.80, 1.63-4.82), absence of tachypnea (2.51, 1.74-3.64) or leukocytosis (2.07, 1.70-2.52) and oxygen saturation >94% (2.00, 1.64-2.43). The final model achieved an area under the receiver operating characteristic curve of 0.648 (IC95% = 0.627-0.668) in the development cohort and 0.635 (0.614-0.656) in the validation cohort., Conclusions: There are factors associated with a greater probability of discharge home of older patients admitted to EDOUs. Prediction at the individual level remains elusive, as the best model obtained in this study did not have sufficient validity to be applied in the clinical setting., (© 2024 John Wiley & Sons Ltd.)
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- 2024
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25. Use of diagnostic tests in elderly patients consulting the emergency department. Analysis of the emergency department and elder needs cohort (EDEN-8).
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Jacob J, Fuentes E, Del Castillo JG, Bajo-Fernández I, Alquezar-Arbé A, García-Lamberechts EJ, Aguiló S, Fernández-Alonso C, Burillo-Putze G, Piñera P, Llorens P, Jimenez S, Gil-Rodrigo A, Tembleque-Sánchez JS, López-Diez MP, Iglesias-Vela M, Pérez-Costa RA, López-Pardo M, González-González R, Carrión-Fernández M, Escudero-Sánchez C, Adroher-Muñoz M, Trenc-Español P, Gayoso-Martín S, Sánchez-Sindín G, Cirera-Lorenzo I, Pazos-González J, Rizzi M, Llauger L, and Miró Ò
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Objective: Analyse the association between the use of diagnostic tests and the characteristics of older patients 65 years of age or more who consult the emergency department (ED)., Methods: We performed an analysis of the EDEN cohort that includes patients who consulted 52 Spanish EDs. The association of age, sex, and ageing characteristics with the use of diagnostic tests (blood tests, electrocardiogram (ECG), microbiological cultures, X-ray, computed tomography, ultrasound, invasive techniques) was studied. The association was analysed by calculating the adjusted odds ratios (aOR) and their 95 % confidence intervals (CI) using a logistic regression model., Results: A total of 25,557 patients were analysed. There was an increase in the use of diagnostic tests based on age, with an aOR for blood test of 1.805 (95 %CI 1.671 - 1.950), ECG 1.793 (95 %CI 1.664 - 1.932) and X-ray 1.707 (95 %CI 1.583 - 1.840) in the group of 85 years or more. The use of diagnostic tests is lower in the female population. Most ageing characteristics (cognitive impairment, previous falls, polypharmacy, dependence, and comorbidity) were independently associated with increased use of diagnostic tests., Conclusions: Age, and the characteristics of ageing itself are generally associated with a greater use of diagnostic tests in the ED., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)
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- 2024
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26. Overnight stay in Spanish emergency departments and mortality in older patients.
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Miró Ò, Aguiló S, Alquézar-Arbé A, Fernández C, Burillo G, Martínez SG, Larrull MEM, Periago ABB, Molinas CLA, Falcón CR, Dacosta PB, Flores RCC, Calzada JN, Blesa EMF, Martín MÁP, Requena ÁC, Fuentes L, Cortizo IL, Garcinuño PG, García MB, Del Valle PR, Campos RB, Jiménez VC, Cuñado VA, Gutiérrez OT, Del Mar Sousa Reviriego M, Roussel M, and Del Castillo JG
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To assess whether older adults who spend a night in emergency departments (ED) awaiting admission are at increased risk of mortality. This was a retrospective review of a multipurpose cohort that recruited all patients ≥ 75 years who visited ED and were admitted to hospital on April 1 to 7, 2019, at 52 EDs across Spain. Study groups were: patients staying in ED from midnight until 8:00 a.m. (ED group) and patients admitted to a ward before midnight (ward group). The primary endpoint was in-hospital mortality, truncated at 30 days, and secondary outcomes assessed length of stay for the index episode. The sample comprised 3,243 patients (median [IQR] age, 85 [81-90] years; 53% women), with 1,096 (34%) in the ED group and 2,147 (66%) in the ward group. In-hospital mortality for patients spending the night in the ED the ED group was 10.7% and 9.5% for patients transferred to a ward bed before midnight the ward group (adjusted OR: 1.12, 95%CI: 0.80-1.58). Sensitivity analyses rendered similar results (ORs ranged 1.06-1.13). Interaction was only detected for academic/non-academic hospitals (p < 0.001), with increased mortality risk for the latter (1.01, 0.33-3.09 vs 2.86, 1.30-6.28). There were no differences in prolonged hospitalization (> 7 days), with adjusted OR of 1.16 (0.94-1.43) and 1.15 (0.94-1.42) depending on whether time spent in the ED was or was not taken into consideration. No increased risk of in-hospital mortality or prolonged hospitalization was found in older patients waiting overnight in the ED for admission. Nonetheless, all estimations suggest a potential harmful effect of staying overnight, especially if a proper bedroom and hospitalist ward bed and hospitalized care are not provided., (© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)
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- 2024
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27. Use of resources in elderly patients consulting the emergency department: analysis of the Emergency Department and Elder Needs Cohort (EDEN-21).
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Fuentes E, Jacob J, Del Castillo JG, Montero-Pérez FJ, Alquezar-Arbé A, García-Lamberechts EJ, Aguiló S, Fernández-Alonso C, Burillo-Putze G, Piñera P, Llauger L, Vázquez-Rey V, Carrasco-Fernández E, Juárez R, Blanco-Hoffman MJ, de Las Nieves Rodríguez E, Rios-Gallardo R, Berenguer-Diez MA, Guiu S, López-Laguna N, Delgado-Sardina V, Diego-Robledo FJ, Ezponda P, Martínez-Lorenzo A, Ortega-Liarte JV, García-Rupérez I, Borne-Jerez S, Gil-Rodrigo A, Llorens P, and Miró Ò
- Abstract
The elderly population frequently consults the emergency department (ED). This population could have greater use of EDs and hospital health resources. The EDEN cohort of patients aged 65 years or older visiting the ED allowed this association to be investigated. To analyse the association between healthcare resource use and the characteristics of patients over 65 years of age who consult hospital EDs. We performed an analysis of the EDEN cohort, a retrospective, analytical, and multipurpose registry that includes patients over 65 years of age who consulted in 52 Spanish EDs. The impact of age, sex, and characteristics of ageing on the following outcomes was studied: need for hospital admission (primary outcome) and need for observation, stay in the ED > 12 h, prolonged hospital stay > 7 days, need for intensive care unit (ICU) and return to the ED at 30 days related to the index visit (secondary outcomes). The association was analysed by calculating the adjusted odds ratios (aOR) and their 95% confidence intervals (CI), using a logistic regression model. A total of 25,557 patients with a mean age of 78.3 years were analysed, 45% were males. Of note was the presence of comorbidity, a Charlson index ≥ 3 (33%), and polypharmacy (66%). Observation in the ED was required by 26%, 25.4% were admitted to the hospital, and 0.9% were admitted to the ICU. The ED stay was > 12 h in 12.5% and hospital stay > 7 days in 13.5% of cases. There was a progressive increase in healthcare resource use based on age, with an aOR for the need for observation of 2.189 (95% CI 2.038-2.352), ED stay > 12 h 2.136 (95% CI 1.942-2.349) and hospital admission 2.579 (95% CI 2.399-2.772) in the group ≥ 85 years old. Most of the characteristics inherent to ageing (cognitive impairment, falls in the previous 6 months, polypharmacy, functional dependence, and comorbidity) were associated with significant increases in the use of healthcare resources, except for ICU admission, which was less in all the variables studied. Age and the characteristics inherent to ageing are associated with greater use of structural healthcare resources., (© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)
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- 2024
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28. Clinical course in older patients diagnosed with syncope treated in Spanish emergency departments: results from the Emergency Department and Elder Needs-17 study.
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Moyano García R, Piñera-Salmerón P, Jacob J, González Del Castillo J, Montero-Pérez F, Alquézar-Arbé A, García-Lamberechts EJ, Aguiló S, Fernández-Alonso C, Burillo-Putze G, Gil-Rodrigo A, Llorens P, Salido Mota M, Beddar Chaib F, Pedraza García J, Bretones Baena S, Micheloud Giménez DE, López Díez MP, Moreno Martín M, Rodríguez Romero M, Benavent Company T, Valle Borrego B, Carrión Fernández M, Escudero Sánchez C, Adroher Muñoz M, and Miró Ò
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- Humans, Aged, Spain epidemiology, Female, Male, Aged, 80 and over, Patient Discharge statistics & numerical data, Comorbidity, Patient Readmission statistics & numerical data, Syncope etiology, Syncope epidemiology, Syncope therapy, Emergency Service, Hospital statistics & numerical data, Hospitalization statistics & numerical data, Length of Stay statistics & numerical data
- Abstract
Objective: To study factors associated with hospitalization in an unselected population of patients aged 65 years or older treated for syncope in Spanish hospital emergency departments (EDs). To determine the prevalence of adverse events at 30 days in patients discharged home and the factors associated with such events., Methods: We included all patients aged 65 years or older who were diagnosed with syncope during a single week in 52 Spanish EDs, recording patient clinical and ED case management data. We compared the findings between hospitalized patients and those discharged home, following the latter for 30 days. In discharged patients, we explored predictors of a composite adverse-event outcome (occurrence of any of the following: ED revisits, hospitalization related to the index visit, or any-cause death)., Results: A total of 477 patients with syncope were identified; 67 (14%) were admitted, and 5 (7.5%) died. The median (interquartile range) length of hospital stay was 6 days (3-11 days). Comorbidity increased the probability of hospitalization (odds ratio, 2.172; 95% CI, 1.013-4.655). Among the 410 patients (86%) discharged home from the ED, 9.2% experienced an adverse event within 30 days (ED revisits, 8.,1%; hospitalization, 2.2%; death, 1.5%). No factors were associated with the 30-day composite outcome., Conclusions: The majority of patients aged 65 years or older are discharged home from EDs, and 30-day adverse events, while infrequent, are difficult to predict. Hospitalization was related to comorbidity and an absence of cognitive decline.
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- 2024
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29. Sex- and age-related patterns in the use of analgesics in older patients in the emergency department.
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Miró Ò, Osorio GI, Alquézar-Arbé A, Aguiló S, Fernández C, Burillo G, Jacob J, Montero-Pérez FJ, García-Lamberechts EJ, Piñera P, Rodríguez Valles C, Carrasco Fernández E, Molina L, Ruescas E, Fernández Salgado F, Fernández-Simón Almela A, de Juan Gómez MÁ, Guiu Martí S, López-Laguna N, García Acosta J, Maza Vera MT, García García Á, Ezponda P, Martínez Lorenzo A, Ortega Liarte JV, Sánchez Ramón S, Ruiz Ramos J, and González Del Castillo J
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- Male, Humans, Female, Aged, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Acetaminophen therapeutic use, Emergency Service, Hospital, Analgesics, Opioid therapeutic use, Analgesics therapeutic use, Opiate Alkaloids
- Abstract
Background: Treatment of acute pain in older patients is a common challenge faced in emergency departments (EDs). Despite many studies that have investigated chronic analgesic use in the elderly, data on patterns of acute use, especially in EDs, of analgesics according to patient characteristics is scarce., Objective: To investigate sex- and age-related patterns of analgesic use in the Spanish EDs and determine differences in age-related patterns according to patient sex., Design: A secondary analysis of the Emergency Department and Elderly Needs (EDEN) multipurpose cohort., Setting: Fifty-two Spanish EDs (17% of Spanish EDs covering 25% of Spanish population)., Participants: All patients' ≥65 years attending ED during 1 week (April 1-7, 2019). Patient characteristics recorded included age, sex, chronic treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and opiates, comorbidity, dependence, dementia, depression, ability to walk and previous falls. Analgesics used in the ED were categorized in three groups: non-NSAID non-opioids (mainly paracetamol and metamizole, PM), NSAIDs, and opiates., Outcome Measures: Frequency of analgesic use was quantified, and the relationship between sex and age and analgesic use (in general and for each analgesic group) was assessed by unadjusted and adjusted logistic regression and restricted cubic spline models. Interaction between sex and age was explored., Main Results: We included 24 573 patients, and 6678 (27.2%) received analgesics in the ED: 5551 (22.6%) PM, 1661 (6.8%) NSAIDs and 937 (3.8%) opiates (1312 received combinations). Analgesics were more frequently used in women (adjusted OR = 1.076, 95%CI = 1.014-1.142), as well as with NSAID (1.205, 1.083-1.341). Analgesic use increased with age, increasing PM and decreasing NSAIDs use. Opiate use remained quite constant across age and sex. Interaction of sex with age was present for the use of analgesics in general ( P = 0.006), for PM ( P < 0.001) and for opiates ( P = 0.033), with higher use of all these analgesics in women., Conclusion: Use of analgesics in older individuals in EDs is mildly augmented in women and increases with age, with PM use increasing and NSAIDs decreasing with age. Conversely, opiate use is quite constant according to sex and age. Age-related patterns differ according to sex, with age-related curves of women showing higher probabilities than those of men to receive any analgesic, PM or opiates., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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30. Hyperactive delirium during emergency department stay: analysis of risk factors and association with short-term outcomes.
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Miró Ò, Osorio G, Alquézar-Arbé A, Aguiló S, Fernández C, Burillo G, Jacob J, Llorens P, Llauger L, Peláez González Á, Figuera Castro ER, Juarez González R, Blanco Hoffman MJ, Fernandez Salgado F, Pablos Pizarro T, Berenguer Díez MA, Truyol Más M, López-Laguna N, Garcia Acosta J, Fernandez Domato C, Diego Robledo FJ, Ezponda P, Martinez Lorenzo A, Ortega Liarte JV, García Rupérez I, Borne Jerez S, Corugedo Ovies C, Gallardo Sánchez BA, and Del Castillo JG
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- Humans, Aged, Length of Stay, Psychomotor Agitation complications, Aftercare, Patient Discharge, Emergency Service, Hospital, Risk Factors, Delirium epidemiology, Delirium etiology
- Abstract
To investigate factors related to the development of hyperactive delirium in patients during emergency department (ED) stay and the association with short-term outcomes. A secondary analysis of the EDEN (Emergency Department and Elderly Needs) multipurpose multicenter cohort was performed. Patients older than 65 years arriving to the ED in a calm state and who developed confusion and/or psychomotor agitation requiring intravenous/intramuscular treatment during their stay in ED were assigned to delirium group. Patients with psychiatric and epileptic disorders and intracranial hemorrhage were excluded. Thirty-four variables were compared in both groups and outcomes were adjusted for age, sex, Charlson Comorbidity Index, Barthel Index and polypharmacy. Hyperactive delirium that needed treatment were developed in 301 out of 18,730 patients (1.6%). Delirium was directly associated with previous episodes of delirium (OR: 2.44, 95% CI 1.24-4.82), transfer to the ED observation unit (1.62, 1.23-2.15), chronic treatment with opiates (1.51, 1.09-2.09) and length of ED stay longer than 12 h (1.41, 1.02-1.97) and was indirectly associated with chronic kidney disease (0.60, 0.37-0.97). The 30-day all-cause mortality was 4.0% in delirium group and 2.9% in non-delirium group (OR: 1.52, 95% CI 0.83-2.78), need for hospitalization 25.6% and 25% (1.09, 0.83-1.43), in-hospital mortality 16.4% and 7.3% (2.32, 1.24-4.35), prolonged hospitalization 54.5% and 48.6% (1.27, 0.80-2.00), respectively, and 90-day post-discharge combined adverse event 36.4% and 35.8%, respectively (1.06, 0.82-2.00). Patients with previous episodes of delirium, treatment with opioids and longer stay in ED more frequently develop delirium during ED stay and preventive measures should be taken to minimize the incidence. Delirium is associated with in-hospital mortality during the index event., (© 2023. The Author(s).)
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- 2024
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31. Older Adult Patients in the Emergency Department: Which Patients should be Selected for a Different Approach?
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Aguirre NL, Gutiérrez SG, Miro O, Aguiló S, Jacob J, Alquézar-Arbé A, Burillo G, Fernandez C, Llorens P, Alonso CR, Lopez IT, Cañete M, Asensio PR, Díaz BP, Pizarro TP, Navarro RJDR, Viola NP, Hernández-Castells L, Soler AC, Sánchez Fernández-Linares E, Serrano JÁS, Ezponda P, Lorenzo AM, Liarte JVO, Ramón SS, Aranda AR, Martín-Sánchez FJ, and Del Castillo JG
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- Humans, Female, Aged, Male, Aged, 80 and over, Spain epidemiology, Geriatric Assessment methods, Comorbidity, Emergency Service, Hospital statistics & numerical data, Patient Readmission statistics & numerical data
- Abstract
Background: While multidimensional and interdisciplinary assessment of older adult patients improves their short-term outcomes after evaluation in the emergency department (ED), this assessment is time-consuming and ill-suited for the busy environment. Thus, identifying patients who will benefit from this strategy is challenging. Therefore, this study aimed to identify older adult patients suitable for a different ED approach as well as independent variables associated with poor short-term clinical outcomes., Methods: We included all patients ≥65 years attending 52 EDs in Spain over 7 days. Sociodemographic, comorbidity, and baseline functional status data were collected. The outcomes were 30-day mortality, re-presentation, hospital readmission, and the composite of all outcomes., Results: During the study among 96,014 patients evaluated in the ED, we included 23,338 patients ≥65 years-mean age, 78.4±8.1 years; 12,626 (54.1%) women. During follow-up, 5,776 patients (24.75%) had poor outcomes after evaluation in the ED: 1,140 (4.88%) died, 4,640 (20.51) returned to the ED, and 1,739 (7.69%) were readmitted 30 days after discharge following the index visit. A model including male sex, age ≥75 years, arrival by ambulance, Charlson Comorbidity Index ≥3, and functional impairment had a C-index of 0.81 (95% confidence interval, 0.80-0.82) for 30-day mortality., Conclusion: Male sex, age ≥75 years, arrival by ambulance, functional impairment, or severe comorbidity are features of patients who could benefit from approaches in the ED different from the common triage to improve the poor short-term outcomes of this population.
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- 2024
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32. Epidemiological and clinical management aspects of pneumonias diagnosed in the emergency department in elderly patients in Spain: Results of the EDEN-29 study.
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Cuerpo S, Aguiló S, Poblete-Palacios MF, Burillo-Putze G, Alquézar-Arbé A, Jacob J, Fernández C, Llorens P, Montero-Pérez FJ, Iglesias-Frax C, Quero-Motto E, Escudero-Sánchez C, Poch-Ferrer EA, Hong-Cho JU, Casado-Ramón B, Gayoso-Martín S, Sánchez-Sindín G, Fernández-Álvarez ME, Puiggali-Ballard M, Trejo O, Llauger L, Garrido-Acosta L, Calle-Fernández S, Molina L, Martínez-Juan M, Gómez-García G, Rivas Del Valle P, López-Grima ML, Rull-Bertrán P, González Del Castillo J, and Miró Ò
- Abstract
Objectives: To estimate the incidence of pneumonia diagnosis in elderly patients in Spanish emergency departments (ED), need for hospitalization, adverse events and predictive capacity of biomarkers commonly used in the ED., Methods: Patients ≥65 years with pneumonia seen in 52 Spanish EDs were included. We recorded in-hospitaland 30-day mortality as adverse events, as well as intensive care unit (ICU) admission among hospitalizedpatients. Association of 10 predefined variables with adverse events was calculated and expressed as odds ratio (OR) with 95% confidence interval (CI), as well as predictive capacity of 5 commonly used biomarkers in the ED (leukocytes, hemoglobin, C-reactive protein, glucose, creatinine) was investigated using area under the receiver operating characteristic curve (AUC-ROC)., Results: 591 patients with pneumonia attended in the ED were included (annual incidence of 18,4 per 1000 inhabitants). A total of 78.0% were hospitalized. Overall, 30-day mortality was 14.2% and in-hospital mortality was 12.9%. Functional dependency was associated with both events (OR=4.453, 95%CI=2.361-8.400; and OR=3.497, 95%CI=1.578-7.750, respectively) as well as severe comorbidity (2.344, 1.363-4.030, and 2.463, 1.252-4.846, respectively). Admission to the ICU during hospitalization occurred in 3.5%, with no associated factors. The predictive capacity of biomarkers was only moderate for creatinine for ICU admission (AUC-ROC=0.702, 95% CI=0.536-0.869) and for leukocytes for post-discharge adverse event (0.669, 0.540-0.798)., Conclusions: Pneumonia is a frequent diagnosis in elderly patients consulting in the ED. Their functional dependence and comorbidity is the factor most associated with adverse events. The biomarkers analyzed do not have a good predictive capacity for adverse events., (Copyright © 2023 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2024
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33. Short-term prognosis of polypharmacy in elderly patients treated in emergency departments: results from the EDEN project.
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Ruiz Ramos J, Alquézar-Arbé A, Juanes Borrego A, Burillo Putze G, Aguiló S, Jacob J, Fernández C, Llorens P, Quero Espinosa FB, Gordo Remartinez S, Hernando González R, Moreno Martín M, Sánchez Aroca S, Sara Knabe A, González González R, Carrión Fernández M, Artieda Larrañaga A, Adroher Muñoz M, Hong Cho JU, Escolar Martínez Berganza MT, Gayoso Martín S, Sánchez Sindín G, Silva Penas M, Gómez Y Gómez B, Arenos Sambro R, González Del Castillo J, and Miró Ò
- Abstract
Background: Polypharmacy is a growing phenomenon among elderly individuals. However, there is little information about the frequency of polypharmacy among the elderly population treated in emergency departments (EDs) and its prognostic effect. This study aims to determine the prevalence and short-term prognostic effect of polypharmacy in elderly patients treated in EDs., Methods: A retrospective analysis of the Emergency Department Elderly in Needs (EDEN) project's cohort was performed. This registry included all elderly patients who attended 52 Spanish EDs for any condition. Mild and severe polypharmacy was defined as the use of 5-9 drugs and ⩾10 drugs, respectively. The assessed outcomes were ED revisits, hospital readmissions, and mortality 30 days after discharge. Crude and adjusted logistic regression analyses, including the patient's comorbidities, were performed., Results: A total of 25,557 patients were evaluated [mean age: 78 (IQR: 71-84) years]; 10,534 (41.2%) and 5678 (22.2%) patients presented with mild and severe polypharmacy, respectively. In the adjusted analysis, mild polypharmacy and severe polypharmacy were associated with an increase in ED revisits [odds ratio (OR) 1.13 (95% confidence interval (CI): 1.04-1.23) and 1.38 (95% CI: 1.24-1.51)] and hospital readmissions [OR 1.18 (95% CI: 1.04-1.35) and 1.36 (95% CI: 1.16-1.60)], respectively, compared to non-polypharmacy. Mild and severe polypharmacy were not associated with increased 30-day mortality [OR 1.05 (95% CI: 0.89-2.26) and OR 0.89 (95% CI: 0.72-1.12)], respectively., Conclusion: Polypharmacy was common among the elderly treated in EDs and associated with increased risks of ED revisits and hospital readmissions ⩽30 days but not with an increased risk of 30-day mortality. Patients with polypharmacy had a higher risk of ED revisits and hospital readmissions ⩽30 days after discharge., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2024.)
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- 2024
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34. Predictive usefulness of qSOFA, NEWS and GYM scores in the elderly patient: EDEN-5 study.
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García-Lamberechts EJ, Fuentes Ferrer M, Fernández-Alonso C, Burillo-Putze G, Aguiló S, Alquezar-Arbé A, Montero-Pérez FJ, Jacob J, Piñera Salmerón P, Salido Mota M, Marchena MJ, Martínez Alonso A, Chacón García A, Güemes de la Iglesia C, Troiano Ungerer OJ, Eiroa-Hernández P, Parra-Esquivel P, Lázaro Aragüés P, Gantes Nieto P, Cuerpo Cardeñosa S, Chacón García C, Serrano Lázaro L, Caballero Martínez M, Guillen L, Muñoz Martos R, González Del Castillo J, and Miró Ò
- Abstract
Objective: To analyze the prognostic accuracy of the scores NEWS, qSOFA, GYM used in hospital emergency department (ED) in the assessment of elderly patients who consult for an infectious disease., Methods: Data from the EDEN (Emergency Department and Elderly Need) cohort were used. This retrospective cohort included all patients aged ≥65 years seen in 52 Spanish EDs during two weeks (from 1-4-2019 to 7-4-2019 and 30/3/2020 to 5/4/2020) with an infectious disease diagnosis in the emergency department. Demographic variables, demographic variables, comorbidities, Charlson and Barthel index and needed scores parameters were recorded. The predictive capacity for 30-day mortality of each scale was estimated by calculating the area under the receiver operating characteristic (ROC) curve, and sensitivity and specificity were calculated for different cut-off points. The primary outcome variable was 30-day mortality., Results: 6054 patients were analyzed. Median age was 80 years (IQR 73-87) and 45.3% women. 993 (16,4%) patients died. NEWS score had better AUC than qSOFA (0.765, 95CI: 0.725-0.806, versus 0.700, 95%CI: 0.653-0.746; P < .001) and GYM (0.716, 95%CI: 0.675-0.758; P = .024), and there was no difference between qSOFA and GYM (P = .345). The highest sensitivity scores for 30-day mortality were GYM ≥ 1 point (85.4%) while the qSOFA score ≥2 points showed high specificity. In the case of the NEWS scale, the cut-off point ≥4 showed high sensitivity, while the cut-off point NEWS ≥ 8 showed high specificity., Conclusion: NEWS score showed the highest predictive capacity for 30-day mortality. GYM score ≥1 showed a great sensitivity, while qSOFA ≥2 scores provide the highest specificity but lower sensitivity., (Copyright © 2024. Published by Elsevier España, S.L.U.)
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- 2024
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35. Impact of First Wave of COVID-19 Pandemic on Mortality at Emergency Department in Older Patients with COVID and Non-COVID Diagnoses.
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Fernández Alonso C, Fuentes Ferrer M, Llorens P, Burillo G, Alquézar-Arbé A, Jacob J, Montero-Pérez FJ, Aguiló S, Abad Cuñado V, Amer Al Arud L, Escudero Sánchez C, Poch Ferret EA, Hong Cho JU, Escolar Martínez-Berganza MT, Gayoso Martín S, Sánchez Sindín G, Prieto Zapico A, Petrus Rivas MC, Doi Grande AL, Llauger L, Rodríguez Valles C, Marquez Quero L, Juárez González R, Ruescas E, Fernández Salgado F, Ríos Gallardo R, de Juan Gómez MÁ, Masid Barco M, González Del Castillo J, and Miró Ò
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- Aged, Humans, Male, Retrospective Studies, Hospitalization, Emergency Service, Hospital, Pandemics, COVID-19 epidemiology
- Abstract
Introduction: Mortality in emergency departments (EDs) is not well known. This study aimed to assess the impact of the first-wave pandemic on deaths accounted in the ED of older patients with COVID and non-COVID diseases., Methods: We used data from the Emergency Department and Elderly Needs (EDEN) cohort (pre-COVID period) and from the EDEN-COVID cohort (COVID period) that included all patients ≥65 years seen in 52 Spanish EDs from April 1 to 7, 2019, and March 30 to April 5, 2020, respectively. We recorded patient characteristics and final destination at ED. We compared older patients in the pre-COVID period, with older patients with non-COVID and with COVID-19. ED-mortality (before discharge or hospitalization) is the prior outcome and is expressed as an adjusted odds ratio (aOR) with 95% interval confidence., Results: We included 23,338 older patients from the pre-COVID period (aged 78.3 [8.1] years), 6,715 patients with non-COVID conditions (aged 78.9 [8.2] years) and 3,055 with COVID (aged 78.3 [8.3] years) from the COVID period. Compared to the older patients, pre-COVID period, patients with non-COVID and with COVID-19 were more often male, referred by a doctor and by ambulance, with more comorbidity and disability, dementia, nursing home, and more risk according to qSOFA, respectively (p < 0.001). Compared to the pre-COVID period, patients with non-COVID and with COVID-19 were more often to be hospitalized from ED (24.8% vs. 44.3% vs. 79.1%) and were more often to die in ED (0.6% vs. 1.2% vs. 2.2%), respectively (p < 0.001). Compared to the pre-COVID period, aOR for age, sex, comorbidity and disability, ED mortality in elderly patients cared in ED during the COVID period was 2.31 (95% confidence interval [CI]: 1.76-3.06), and 3.75 (95% CI: 2.77-5.07) for patients with COVID. By adding the variable qSOFA to the model, such OR were 1.59 (95% CI: 1.11-2.30) and 2.16 (95% CI: 1.47-3.17), respectively., Conclusions: During the early first pandemic wave of COVID-19, more complex and life-threatening older with COVID and non-COVID diseases were seen compared to the pre-COVID period. In addition, the need for hospitalization and the ED mortality doubled in non-COVID and tripled in COVID diagnosis. This increase in ED mortality is not only explained by the complexity or severity of the elderly patients but also because of the system's overload., (© 2023 S. Karger AG, Basel.)
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- 2024
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36. Identifying needs of older patients at the emergency department.
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García-Martínez A, Artajona L, and Aguiló S
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- Humans, Qualitative Research, Attitude of Health Personnel, Emergency Service, Hospital
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- 2023
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37. Factors related to bladder catheterization in older patients and its possible association with prognosis: results of the EDEN-30 study.
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Eiroa-Hernández P, Matos S, Aguiló S, Alquézar-Arbé A, Jacob J, Fernández C, Llorens P, Moreno Ruíz S, Cuevas Jiménez L, Vaswani-Bulchand A, Rodríguez-Cabrera M, Suárez Pineda MC, Alegre Fresno S, Gina Osorio I, Puche Alcaraz AM, Mansilla Collado J, Veguillas Benito M, Chamorro F, Álvarez Rocío L, Toro Gallardo V, Beddar Chaib F, Pedraza García J, Quero Espinosa FB, Jiménez Lucena M, Yepez León G, González Revuelta E, Sánchez Aroca S, González Del Castillo J, Burillo-Putze G, and Miró Ò
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- Humans, Male, Female, Aged, Hospital Mortality, Hospitalization, Urinary Catheterization, Dehydration, Urinary Bladder
- Abstract
Objectives: The aims of this study in the Emergency Department and Elder Needs (EDEN) series were to explore associations between clinical variables on arrival at the ED (baseline) and the insertion of a bladder catheter, and the relation between catheterization and deterioration to a more complex or serious clinical state., Material and Methods: Included were all patients aged 65 years or older attended during 1 week in 52 Spanish EDs. Patients were grouped according to whether a bladder catheter was or was not inserted in the ED. We used multivariable logistical regression to explore associations between catheterization and patient age, sex, 10 comorbidities, 7 baseline status variables, and 6 clinical variables. Progression was considered serious or complex if the patient died or required hospitalization, a prolonged hospital stay, or discharge to a care facility. We also explored the association between age and catheterization using adjusted restricted cubic spline (RCS) curves with a cutoff value of 65 years., Results: Participating hospitals enrolled 24 573 patients; bladder catheters were inserted in 976 (4%). Of these, 44.3% were discharged from the ED. Fifteen of the 24 variables were independently associated with bladder catheterization. Factors with the strongest associations according to odds ratios (ORs) were impaired consciousness (OR, 2.50; 95% CI, 1.90-3.30), dehydration (OR, 2.24; 95% CI, 1.85-2.72), and male sex (OR, 2.12; 95% CI, 1.84- 2.44). Age 80 years or older was also associated with bladder catheterization (OR, 1.17; 95% CI, 1.01-1.358). The adjusted RCS curves showed a progressive linear increase in the probability of catheterization with age. The increase was constant in men and stabilized after the age of 85 years in women (P-interaction .001). Bladder catheterization was associated with hospitalization (OR, 2.31; 95% CI, 1.99-2.68), intensive care unit admission (OR, 4.64; 95% CI, 3.04-7.09), prolonged stay in the ED for discharged patients (OR, 2.28; 95% CI, 1.75-2.96), in-hospital death (OR, 1.99; 95% CI, 1.54-2.57), and 30-day death (OR, 1.66; 95% CI, 1.33-2.08). No associations were found between catheterization and prolonged hospital stay (OR, 1.11; 95% CI, 0.92-1.34) or need for a care facility on discharge (OR, 1.50; 95% CI, 0.98-2.29)., Conclusion: Certain patient characteristics and baseline clinical conditions are associated with bladder catheterization in patients of advanced age. The main factors were decreased consciousness, dehydration, and male sex. Even after adjustment for related factors, catheterization is independently associated with progression to more complex or serious clinical states.
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- 2023
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38. Influence of type of household on prognosis at one year in patients ≥65 years attending hospital emergency departments in Spain. The EDEN-6 study.
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Alquézar-Arbé A, Osorio GI, Jacob J, García-Lamberechts EJ, Piñera Salmerón P, Llorens P, Burillo-Putze G, Requena AC, Gil A, Fernández C, Aguiló S, Jiménez S, Escudero Blázquez B, Rosendo Mesino D, Mojarro EM, Vaswani-Bulchand A, Rodríguez-Cabrera M, Alarcón Martínez P, Gioya GD, Alemany González FX, González Tejera M, Bóveda García M, Espinosa Fernández B, Llopis F, Suero Méndez C, González Del Castillo J, and Miró Ò
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- Humans, Female, Aged, Male, Retrospective Studies, Spain epidemiology, Prognosis, Hospitals, Hospitalization, Emergency Service, Hospital
- Abstract
Objective: To investigate whether the type of household is associated with prognosis at one year in patients ≥65 years of age discharged after medical consultation requiring emergency department care., Methods: Data from the Emergency Department and Elder Needs (EDEN) cohort were used. This retrospective cohort included all patients ≥65 years of age seen in 52 Spanish emergency departments over one week (April 1-7, 2019) in whom the type of household was recorded and categorized as living at home alone, with relatives, with professional caregivers, or in a nursing home. Patient demographic and other baseline characteristics and management during the index emergency department episode were recorded and used to adjust the following 1-year outcomes: all-cause mortality, hospitalization and emergency department revisit. Associations between type of household and outcomes are expressed as adjusted hazard ratios with 95% confidence intervals using living alone as the reference category., Results: 13,442 patients with a median age of 79 years (interquartile range 72-86) were included; 56% were women, 12.2% of patients lived alone, 74.9% with relatives, 3.9% with a professional caregiver, and 9.1% in a nursing home. During the year following discharge, the mortality rate was 14.0%, the hospitalization rate 29.7%, and the emergency department revisit rate 59.3%. In the fully adjusted model, the risk of death was associated only with living in a nursing home (hazard ratio 1.366 (1.101-1.695)). On the other hand, the risk of hospitalization was lower in individuals living in nursing homes (hazard ratio 0.783 [0.676-0.907]) and at home with relatives (hazard ratio 0.897 [0.810-0.992]), while the risk of emergency department revisit was lower in individuals living in nursing homes (hazard ratio 0.826 [0.742-0.920]) or at home with caregivers (hazard ratio 0.856 [0.750-0.976])., Conclusion: The type of household was modestly associated with the one-year prognosis of patients ≥65 years of age discharged after attendance at an emergency department. Living in a nursing home is associated with an increased risk of death but a decreased risk of rehospitalization or emergency department revisit, while living at home with relatives or professional caregivers is associated only with a decreased risk of hospitalization and emergency department revisit, respectively., Competing Interests: Declaration of competing interest The authors declare that they have no competing interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)
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- 2023
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39. Influence of income on in-hospital mortality in older adults during the first wave of the COVID-19 pandemic: results from the EDEN-33 study.
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Artajona L, García-Martínez A, Aguiló S, Burillo-Putze G, Alquézar-Arbé A, Fernández C, Fernández-Simón A, Fernández Cardona M, Maza Vera MT, Iglesias Vela M, Trenc Español P, Salido Mota M, García García Á, Lucena Aguilera C, Llopis F, Herrero P, Doi Grande AL, Serrano Lázaro L, Chacon García A, Noceda Bermejo JJ, Ibisate Cubillas A, Hernández Martínez MJ, Alemany González FX, Sánchez Ramón S, Espinosa Fernández B, González Del Castillo J, and Miró Ò
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- Humans, Aged, Pandemics, SARS-CoV-2, Hospital Mortality, Spain epidemiology, COVID-19 epidemiology
- Abstract
Objectives: To determine whether income was associated with unexpected in-hospital mortality in older patients treated in Spanish public health system hospital emergency departments., Material and Methods: Fifty-one public health system hospital emergency departments in Spain voluntarily participated in the study. Together the hospitals covered 25% of the population aged 65 years or older included in all patient registers during a week in the pre-pandemic period (April 1-7, 2019) and a week during the COVID-19 pandemic (March 30 to April 5, 2020). We estimated a patient's gross income as the amount published for the postal code of the patient's address. We then calculated the standardized gross income (SGI) by dividing the patient's estimated income by the mean for the corresponding territory (Spanish autonomous community). The existence and strength of an association between the SGI and in-hospital mortality was evaluated by means of restricted cubic spline (RCS) curves adjusted for 10 patient characteristics at baseline. Odds ratios (ORs) for each income level were expressed in relation to a reference SGI of 1 (the mean income for the corresponding autonomous community). We compared the COVID-19 and pre-pandemic periods by means of first-order interactions., Results: Of the 35 280 patients attended in the 2 periods, gross income could be ascertained for 21 180 (60%), 15437 in the pre-pandemic period and 5746 during the COVID-19 period. SGIs were slightly higher for patients included before the pandemic (1.006 vs 0.994; P = .012). In-hospital mortality was 5.6% overall and higher during the pandemic (2.8% pre-pandemic vs 13.1% during COVID-19; P .001). The adjusted RCS curves showed that associations between income and mortality differed between the 2 periods (interaction P = .004). Whereas there were no significant income-influenced differences in mortality before the pandemic, mortality increased during the pandemic in the lowest-income population (SGI 0.5 OR, 1.82; 95% CI, 1.32-3.37) and in higher-income populations (SGI 1.5 OR, 1.32; 95% CI, 1.04-1.68, and SGI 2 OR, 1.92; 95% CI, 1.14-3.23). We found no significant differences between patients with COVID-19 and those with other diagnoses (interaction P = .667)., Conclusion: The gross income of patients attended in Spanish public health system hospital emergency departments, estimated according to a patient's address and postal code, was associated with in-hospital mortality, which was higher for patients with the lowest and 2 higher income levels. The reasons for these associations might be different for each income level and should be investigated in the future.
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- 2023
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40. Study EDEN-12: Analysis of access to intensive care units of patients older than 65 years requiring emergency hospitalization.
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Burillo-Putze G, Parra-Esquivel P, Aguiló S, Jiménez S, Jacob J, Piñera Salmerón P, Llorens P, García-Lamberechts EJ, Montero-Pérez FJ, Muñoz-Triano E, Gil-Rodrigo A, Fernández-Alonso C, Alquezar-Arbé A, Salido Mota M, Gil Hernández RJ, Pedraza García J, Cobos Requena A, Gargallo Garcia E, de Diego Arnaiz M, Iglesias Vela M, Pérez-Costa RA, Pérez Peñalva SDM, Valle Borrego B, Quero Motto E, Morales Franco B, Adroher Muñoz M, González Del Castillo J, and Miró Ò
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- Humans, Aged, Male, Female, Retrospective Studies, Aged, 80 and over, Spain epidemiology, Age Factors, Patient Admission statistics & numerical data, Comorbidity, Cognitive Dysfunction epidemiology, Intensive Care Units statistics & numerical data, Emergency Service, Hospital statistics & numerical data, Hospitalization statistics & numerical data
- Abstract
Objective: To investigate the relationship between the age of an urgently hospitalized patient and his or her probability of admission to an intensive care unit (ICU)., Design: Observational, retrospective, multicenter study., Setting: 42 Emergency Departments from Spain., Time-Period: April 1-7, 2019., Patients: Patients aged ≥65 years hospitalized from Spanish emergency departments., Interventions: None., Main Variables of Interest: ICU admission, age sex, comorbidity, functional dependence and cognitive impairment., Results: 6120 patients were analyzed (median age: 76 years; males: 52%. 309 (5%) were admitted to ICU (186 from ED, 123 from hospitalization). Patients admitted to the ICU were younger, male, and with less comorbidity, dependence and cognitive impairment, but there were no differences between those admitted from the ED and from hospitalization. The OR for ICU-admission adjusted by sex, comorbidity, dependence and dementia reached statistical significance >83 years (OR: 0.67; 95%CI: 0.45-0.49). In patients admitted to the ICU from ED, the OR did not begin to decrease until 79 years, and was significant >85 years (OR: 0.56, 95%CI: 0.34-0.92); while in those admitted to ICU from hospitalization, the decrease began 65 years of age, and were significant from 85 years (OR: 0.55, 95%CI: 0.30-0.99). Sex, comorbidity, dependency and cognitive deterioration of the patient did not modify the association between age and ICU-admission (overall, from the ED or hospitalization)., Conclusions: After taking into account other factors that influence admission to the ICU (comorbidity, dependence, dementia), the chances of admission to the ICU of older patients hospitalized on an emergency basis begin to decrease significantly after 83 years of age. There may be differences in the probability of admission to the ICU from the ED or from hospitalization according to age., (Copyright © 2023 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.)
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- 2023
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41. [Importance of outpatient medical consultation prior to going to the hospital emergency department in patients over 65 years of age: Impact on hospitalization results].
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Aguiló S, Osorio G, Comas Diaz B, López-Laguna N, González Del Castillo J, Montero Pérez FJ, and Miró Ò
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- Humans, Male, Hospitalization, Emergency Service, Hospital, Referral and Consultation, Hospitals, Retrospective Studies, Outpatients, Pro-Opiomelanocortin
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Objective: Investigate factors associated with a previous outpatient medical consultation (POMC), to the health center or another physician, before attending a hospital emergency department (ED), in patients aged >65 and its impact on the hospitalization rate and variables related to ED stay. SITE: Fifty-two Spanish EDs., Participants: Patients over 65 years consulting an ED., Main Measurements and Design: A cohort (n=24645) of patients aged >65 attended for one week in 52 ED. We recorded five sociodemographic variables, six functional, three episode-related severity and analyzed their crude and adjusted association with the existence of a POMC at ED consultation. The primary outcome variable was the need for admission and the secondary variables were complementary examinations and ED stay length. We analyzed whether the POMC influenced these outcomes., Results: 28.5% of the patients had performed a POMC prior to their visit to the ED. Living in a residence, NEWS-2 score ≥5, aged ≥80, dependency functions, severe comorbidity, living alone, cognitive impairment, male gender and depression were independently associated with a POMC. Also was associated with a greater need for hospitalization and shorter length of stay in the ED. No minor consumption of diagnostic resources in patients with POMC., Conclusion: Patients presenting to the ED following POMC are admitted more frequently, suggesting that they are appropriately referred and that minor emergencies are probably effectively resolved in the POMC. Their stay in the ED prior to hospitalization is shorter, so the POMC would facilitate clinical resolution in the ED., (Copyright © 2023 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)
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- 2023
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42. Sex differences in mortality of older adults with falls after emergency department consultation: FALL-ER registry.
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Miró Ò, Gil-Rodrigo A, García-Martínez A, Aguiló S, Alemany X, Nickel CH, Jacob J, Llorens P, Herrero P, Torres-Machado V, Cenjor R, Coll-Vinent B, Martínez-Nadal G, Del Nogal ML, Peacock F, and Martín-Sánchez FJ
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- Humans, Male, Female, Aged, Aged, 80 and over, Risk Factors, Registries, Sex Characteristics, Emergency Service, Hospital
- Abstract
Background: To investigate if sex is a risk factor for mortality in patients consulting at the emergency department (ED) for an unintentional fall., Methods: This was a secondary analysis of the FALL-ER registry, a cohort of patients ≥65 years with an unintentional fall presenting to one of 5 Spanish EDs during 52 predefined days (one per week during one year). We collected 18 independent patient baseline and fall-related variables. Patients were followed for 6 months and all-cause mortality recorded. The association between biological sex and mortality was expressed as unadjusted and adjusted hazard ratios (HR) with the 95% confidence interval (95% CI), and subgroup analyses were performed by assessing the interaction of sex with all baseline and fall-related mortality risk variables., Results: Of 1315 enrolled patients (median age 81 years), 411 were men (31%) and 904 women (69%). The 6-month mortality was higher in men (12.4% vs. 5.2%, HR = 2.48, 95% CI = 1.65-3.71), although age was similar between sexes. Men had more comorbidity, previous hospitalizations, loss of consciousness, and an intrinsic cause for falling. Women more frequently lived alone, with self-reported depression, and the fall results in a fracture and immobilization. Nonetheless, after adjustment for age and these eight divergent variables, older men aged 65 and over still showed a significantly higher mortality (HR = 2.19, 95% CI = 1.39-3.45), with the highest risk observed during the first month after ED presentation (HR = 4.18, 95% CI = 1.31-13.3). We found no interaction between sex and any patient-related or fall-related variables with respect to mortality (p > 0.05 in all comparisons)., Conclusions: Male sex is a risk factor for death following ED presentation for a fall in the older population adults aged 65 and over. The causes for this risk should be investigated in future studies., (© 2023 The American Geriatrics Society.)
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- 2023
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43. Impact of the COVID-19 pandemic on demand for emergency department care for older patients: the EDEN-7 COVID cohort study.
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Montero-Pérez FJ, Cobos Requena ÁM, González Del Castillo J, Jacob J, García-Lamberechts EJ, Piñera Salmerón P, Alquézar-Arbé A, Aguiló S, Fernández Alonso C, Burillo-Putze G, Calderón Caro M, Díaz Salado ÁI, Martín Mojarro E, Eiroa-Hernández P, Parra-Esquivel P, López Pérez JJ, Ruiz Grinspan M, Osorio Quispe IG, González Tejera M, Serrano Lázaro L, Espinosa Fernández B, Fuentes L, Suero Méndez C, Del Valle Toro-Gallardo M, Beddar Chaib F, Pedraza Ramírez P, and Miró Ò
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- Male, Humans, Aged, Cohort Studies, Retrospective Studies, Cross-Sectional Studies, Emergencies, Emergency Service, Hospital, Pandemics, COVID-19 epidemiology, COVID-19 therapy
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Objectives: To analyze the impact of the COVID-19 pandemic on Spanish emergency department (ED) care for patients aged 65 years or older during the first wave vs. a pre-pandemic period., Material and Methods: Retrospective cross-sectional study of a COVID-19 portion of the EDEN project (Emergency Department and Elder Needs). The EDEN-COVID cohort included all patients aged 65 years or more who were treated in 52 EDs on 7 consecutive days early in the pandemic. We analyzed care variables, discharge diagnoses, use of diagnostic and therapeutic resources, use of observation units, need for hospitalization, rehospitalization, and mortality. These data were compared with data for an EDEN cohort in the same age group recruited during a similar period the year before the pandemic., Results: The 52 participating hospital EDs attended 33 711 emergencies during the pandemic vs. 96 173 emergencies in the pre-COVID period, representing a 61.7% reduction during the pandemic. Patients aged 65 years or older accounted for 28.8% of the caseload during the COVID-19 period and 26.4% of the earlier cohort (P .001). The COVID-19 caseload included more men (51.0%). Comorbidity and polypharmacy were more prevalent in the pandemic cohort than in the earlier one (comorbidity, 92.6% vs. 91.6%; polypharmacy, 65.2% vs. 63.6%). More esturesources (analgesics, antibiotics, heparins, bronchodilators, and corticosteroids) were applied in the pandemic period, and common diagnoses were made less often. Observation wards were used more often (for 37.8% vs. 26.2% in the earlier period), and hospital admissions were more frequent (in 56.0% vs. 25.3% before the pandemic). Mortality was higher during the pandemic than in the earlier cohort either in ED (1.8% vs 0.5%) and during hospitalization (11.5 vs 2.9%)., Conclusion: The proportion of patients aged 65 years or older decreased in the participating Spanish EDs. However, more resources were required and the pattern of diagnoses changed. Observation ward stays were longer, and admissions and mortality increased over the numbers seen in the reference period.
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- 2023
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44. Plasma sodium concentration in older patients as an indicator of severity in emergencies: Results from the Emergency Department and Elder Needs-16 study.
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Llorens P, Miró Ò, Veguillas Benito M, Fernández C, Jacob J, Burillo-Putze G, Alquézar A, Aguiló S, Puiggali Ballard M, Bretones Baena S, Hong Cho JU, San Julián Romero M, Rodríguez Palma ME, Álvarez Madrigal A, Rodríguez Romero M, Lozano López MI, González González R, Carrión Fernández M, Morales Franco B, Poch Ferrer EA, González Guillén V, Gayoso Martín S, Sánchez Sindín G, Prieto Zapico A, Ponte Márquez P, Espinosa B, and González del Castillo J
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- Humans, Aged, Sodium, Emergencies, Hospital Mortality, Emergency Service, Hospital, Hypernatremia diagnosis, Hypernatremia epidemiology, Hyponatremia diagnosis, Hyponatremia epidemiology, Dementia
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Objectives: To study baseline factors associated with hypo- and hypernatremia in older patients attended in emergency departments (EDs) and explore the association between these dysnatremias and indicators of severity in an emergency., Material and Methods: We included patients attended in 52 Spanish hospital EDs aged 65 years or older during a designated week. All included patients had to have a plasma sodium concentration on record. Patients were distributed in 3 groups according to sodium levels: normal, 135-145 mmol/L; hyponatremia, 135 mmol/L; or hypernatremia > 145 mmol/L. We analyzed associations between sodium concentration and 24 variables (sociodemographic information, measures of comorbidity and baseline functional status, and ongoing treatment for hypo- or hypernatremia). Indicators of the severity in emergencies were need for hospitalization, in-hospital mortality, prolonged ED stay (> 12 hours) in discharged patients, and prolonged hospital stay (> 7 days) in admitted patients. We used restricted cubic spline curves to analyze the associations between sodium concentration and severity indicators, using 140 mmol/L as the reference., Results: A total of 13 368 patients were included. Hyponatremia was diagnosed in 13.5% and hypernatremia in 2.9%. Hyponatremia was associated with age ($ 80 years), hypertension, diabetes mellitus, an active neoplasm, chronic liver disease, dementia, chemotherapy, and needing help to walk. Hypernatremia was associated with needing help to walk and dementia. The percentages of cases with severity indicators were as follows: hospital admission, 40.8%; in-hospital mortality, 4.3%; prolonged ED stay, 15.9%; and prolonged hospital stay, 49.8%. Odds ratios revealed associations between lower sodium concentration cut points in patients with hyponatremia and increasing need for hospitalization (130 mmol/L, 2.24 [IC 95%, 2.00-2.52]; 120 mmol/L, 4.13 [3.08-5.56]; and 110 mmol/L, 7.61 [4.53-12.8]); risk for in-hospital death (130 mmol/L, 3.07 [2.40-3.92]; 120 mmol/L, 6.34 [4.22- 9.53]; and 110 mmol/L, 13.1 [6.53-26.3]); and risk for prolonged ED stay (130 mmol/L, 1.59 [1.30-1.95]; 120 mmol/L, 2.77 [1.69-4.56]; and 110 mmol/L, 4.83 [2.03-11.5]). Higher sodium levels in patients with hypernatremia were associated with increasing need for hospitalization (150 mmol/L, 1.94 [1.61-2.34]; 160 mmol/L, 4.45 [2.88-6.87]; 170 mmol/L, 10.2 [5.1-20.3]; and 180 mmol/L, 23.3 [9.03-60.3]); risk for in-hospital death (150 mmol/L, 2.77 [2.16-3.55]; 160 mmol/L, 6.33 [4.11-9.75]; 170 mmol/L, 14.5 [7.45-28.1]; and 180 mmol/L, 33.1 [13.3-82.3]); and risk for prolonged ED stay (150 mmol/L, 2.03 [1.48-2.79]; 160 mmol/L, 4.23 [2.03-8.84]; 170 mmol/L, 8.83 [2.74-28.4]; and 180 mmol/L, 18.4 [3.69-91.7]). We found no association between either type of dysnatremia and prolonged hospital stay., Conclusion: Measurement of sodium plasma concentration in older patients in the ED can identify hypo- and hypernatremia, which are associated with higher risk for hospitalization, death, and prolonged ED stays regardless of the condition that gave rise to the dysnatremia.
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- 2023
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45. Assessing effectiveness of heart rate variability biofeedback to mitigate mental health symptoms: a pilot study.
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Castro Ribeiro T, Sobregrau Sangrà P, García Pagès E, Badiella L, López-Barbeito B, Aguiló S, and Aguiló J
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Introduction: The increasing burden on mental health has become a worldwide concern especially due to its substantial negative social and economic impact. The implementation of prevention actions and psychological interventions is crucial to mitigate these consequences, and evidence supporting its effectiveness would facilitate a more assertive response. Heart rate variability biofeedback (HRV-BF) has been proposed as a potential intervention to improve mental wellbeing through mechanisms in autonomic functioning. The aim of this study is to propose and evaluate the validity of an objective procedure to assess the effectiveness of a HRV-BF protocol in mitigating mental health symptoms in a sample of frontline HCWs (healthcare workers) who worked in the COVID-19 pandemic. Methods: A prospective experimental study applying a HRV-BF protocol was conducted with 21 frontline healthcare workers in 5 weekly sessions. For PRE-POST intervention comparisons, two different approaches were used to evaluate mental health status: applying (a) gold-standard psychometric questionnaires and (b) electrophysiological multiparametric models for chronic and acute stress assessment. Results: After HRV-BF intervention, psychometric questionnaires showed a reduction in mental health symptoms and stress perception. The electrophysiological multiparametric also showed a reduction in chronic stress levels, while the acute stress levels were similar in PRE and POST conditions. A significant reduction in respiratory rate and an increase in some heart rate variability parameters, such as SDNN, LFn, and LF/HF ratio, were also observed after intervention. Conclusion: Our findings suggest that a 5-session HRV-BF protocol is an effective intervention for reducing stress and other mental health symptoms among frontline HCWs who worked during the COVID-19 pandemic. The electrophysiological multiparametric models provide relevant information about the current mental health state, being useful for objectively evaluating the effectiveness of stress-reducing interventions. Further research could replicate the proposed procedure to confirm its feasibility for different samples and specific interventions., Competing Interests: Since 16th June 2022, the co-author PSS has been employed by Frontiers Media SA. PSS declared his/her affiliation with Frontiers, and the handling Editor states that the process nevertheless met the standards of a fair and objective review. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Castro Ribeiro, Sobregrau Sangrà, García Pagès, Badiella, López-Barbeito, Aguiló and Aguiló.)
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- 2023
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46. Sociodemographic characteristics, comorbidity, and baseline functional status of older patients treated in emergency departments during the COVID-19 pandemic and associations with mortality: an analysis based on the EDENCOVID cohort.
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González Del Castillo J, Jacob J, García-Lamberechts EJ, Piñera Salmerón P, Alquézar-Arbé A, Llorens P, Jiménez S, Quero Espinosa FB, Aguiló S, Gil-Rodrigo A, Fernández Alonso C, Burillo-Putze G, Espinosa Fernández B, Suero Méndez C, Iglesias Vela M, Quero Motto E, Hong Cho JU, Llopis F, Marrón R, Gayoso Martín S, Lucena Aguilera C, Alemany González X, Rizzi MA, Llauger L, Murcia Olagüenaga A, Vaswani-Bulchand A, Parra Esquivel P, Sánchez Nicolás JA, Carrasco Fernández E, Ruescas Escolano E, Chacón García A, Fernández Salgado F, and Miró Ò
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- Humans, Male, Female, Aged, Pandemics, Functional Status, Comorbidity, Emergency Service, Hospital, COVID-19 therapy
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Objectives: To describe the sociodemographic characteristics, comorbidity, and baseline functional status of patients aged 65 or older who came to hospital emergency departments (EDs) during the first wave of the COVID-19 pandemic, and to compare them with the findings for an earlier period to analyze factors of the index episode that were related to mortality., Material and Methods: We studied data from the EDEN-COVID cohort (Emergency Department and Elder Needs During COVID-19) of patients aged 65 years or older treated in 40 Spanish EDs on 7 consecutive days. Nine sociodemographic variables, 18 comorbidities, and 7 function variables were registered and compared with the findings for the EDEN cohort of patients included with the same criteria and treated a year earlier in the same EDs. In-hospital mortality was calculated in the 2 cohorts and a multivariable logistic regression model was used to explore associated factors., Results: The EDEN-COVID cohort included 6806 patients with a median age of 78 years; 49% were women. The pandemic cohort had a higher proportion of men, patients covered by the national health care system, patients brought from residential facilities, and patients who arrived in an ambulance equipped for advanced life support. Pandemic-cohort patients more often had diabetes mellitus, chronic kidney disease, and dementia; they less often had connective tissue and thromboembolic diseases. The Barthel and Charlson indices were worse in this period, and cognitive decline was more common. Fewer patients had a history of depression or falls. Eight hundred ninety these patients (13.1%) died, 122 of them in the ED (1.8%); these percentages were lower in the earlier EDEN cohort, at 3.1% and 0.5%, respectively. Independent sociodemographic factors associated with higher mortality were transport by ambulance, older age, male sex, and living in a residential facility. Mortalityassociated comorbidities were neoplasms, chronic kidney disease, and heart failure. The only function variable associated with mortality was the inability to walk independently. A history of falls in the past 6 months was a protective factor., Conclusion: The sociodemographic characteristics, comorbidity, and functional status of patients aged 65 years or older who were treated in hospital EDs during the pandemic differed in many ways from those usually seen in this older-age population. Mortality was higher than in the prepandemic period. Certain sociodemographic, comorbidity, and function variables were associated with in-hospital mortality.
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- 2022
47. Probability of new falls and factors associated with them in aged patients treated in emergency departments after falling: data from the FALL-ER registry.
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García-Martínez A, Gil-Rodrigo A, Placer A, Alemany X, Aguiló S, Torres-Machado V, Jacob J, Herrero P, Llorens P, Martín-Sánchez FJ, and Miró Ò
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- Humans, Aged, Patient Discharge, Registries, Probability, Accidental Falls prevention & control, Emergency Service, Hospital
- Abstract
Objectives: To identify characteristics associated with a new fall in a patient who received emergency department care after an accidental fall and to develop a risk model to predict repeated falls., Material and Methods: The FALL-ER registry included accidental falls in patients over the age of 65 years treated in 5 Spanish emergency departments. Independent variables analyzed were patient characteristics at baseline, fall characteristics, immediate consequences, and functional status on discharge. Patients were followed with telephone interviews for 6 months to record the occurrence of new falls. Multivariate regression analysis was used to identify variables associated with falling again and to develop a risk model. We identified 3 levels of risk for new falls (low, intermediate, and high)., Results: A total of 1313 patients were studied; 147 patients (11.2%) reported having another fall. Variables associated with risk of falling again were having had a fall in the 12 months before the index fall, neurological disease, anemia, use of non-opioid analgesics, falling at home, falling at night, head injury on falling, and need for help when rising from a chair. The probability of falling again was 3.5%, 10.5%, and 23.3%, respectively, in patients at low, intermediate, and high risk. The model's ability to discriminate was moderate: the area under the receiver operating characteristic curve was 0.688 (95% CI, 0.640-0.736)., Conclusion: One in 9 older adults treated in an emergency department for an accidental fall will fall again within 6 months. It is possible to identify patients at higher risk for whom preventive measures should be implemented.
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- 2022
48. Sociodemographic characteristics, functional status, and health resource use of older patients treated in Spanish emergency departments: a description of the EDEN cohort.
- Author
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Miró Ò, Jacob J, García-Lamberechts EJ, Piñera Salmerón P, Llorens P, Jiménez S, Burillo-Putze G, Montero-Pérez FJ, Aguiló S, Gil-Rodrigo A, Fernández Alonso C, Alquézar-Arbé A, Parra-Esquivel P, Fortuny Bayarri MJ, González Tejera M, Millán Soria J, Cirera I, Adroher M, Martín Mojarro E, Gargallo García E, Valle B, Díaz Salado Á, Ruiz Grispán M, López Díez MP, Beddar Chaib F, Salido Mota M, Pedraza García J, Sánchez Sindín G, Juárez González R, Pérez Costa RA, Escudero Sánchez C, Prieto Zapico A, and González Del Castillo J
- Subjects
- Humans, Female, Aged, Male, Hospitalization, Length of Stay, Health Resources, Functional Status, Emergency Service, Hospital
- Abstract
Objectives: To describe the sociodemographic characteristics of and the health care resources used to treat patients aged 65 years or older who come to hospital emergency departments (EDs) in Spain, according to age groups., Material and Methods: We studied the phase-1 data for the EDEN cohort (Emergency Department and Elder Needs). Forty Spanish EDs collected data on all patients aged 65 years or older who were treated on the first 7 days in April 2019. We registered information on 6 sociodemographic and 5 function variables for all patients. For health resource use we used 6 diagnostic, 13 therapeutic, and 5 physical structural variables, for a total of 24 variables. Differences were analyzed according to age in blocks of 5 years., Results: A total of 18 374 patients with a median age of 78 years were included; 55% were women. Twenty-seven percent arrived by ambulance, 71% had not previously been seen by a physician, and 13% lived alone without assistance. Ten percent had a high level of functional dependence, and 14% had serious comorbidity. Resources used most often were blood analysis (in 60%) and radiology (59%), analgesics (25%), intravenous fluids (21%), antibiotics (14%), oxygen (13%), and bronchodilators (11%). Twenty-six percent were kept under observation in the ED, 26% were admitted to wards, and 2% were admitted to intensive care units (ICUs). The median stay in the ED was 3.5 hours, and the median hospital stay was 7 days. Sociodemographic characteristics changed according to age. Functional dependence worsened with age, and resource requirements increased in general. However, benzodiazepine use was unaffected, while the use of nonsteroidal anti-inflammatory drugs and ICU admission decreased., Conclusion: The functional dependence of older patients coming to EDs increases with age and is associated with a high level of health care resource use, which also increases with age. Planners should take into consideration the characteristics of the older patients and the proportion of the caseload they represent when arranging physical spaces and designing processes for a specific ED.
- Published
- 2022
49. Activation of Wnt/β-catenin signaling in abdominal aortic aneurysm: A potential therapeutic opportunity?
- Author
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Puertas-Umbert L, Varona S, Ballester-Servera C, Alonso J, Aguiló S, Orriols M, Martínez-Martínez E, Rodríguez-Sinovas A, Martínez-González J, and Rodríguez C
- Published
- 2022
- Full Text
- View/download PDF
50. Factors associated with late presentation to the emergency department in patients complaining of chest pain.
- Author
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Miró Ò, Troester V, García-Martínez A, Martínez-Nadal G, Coll-Vinent B, Lopez-Ayala P, Gil V, Aguiló S, Galicia M, Jiménez S, Moll C, Sánchez C, Cardozo C, López-Sobrino T, Strebel I, Boeddinghaus J, Nestelberger T, Bragulat E, Sánchez M, Müller C, and López-Barbeito B
- Subjects
- Cohort Studies, Emergency Service, Hospital, Humans, Time Factors, Acute Coronary Syndrome therapy, Chest Pain diagnosis, Chest Pain etiology
- Abstract
Objective: We investigated which factors predict late presentation (LP) to the emergency department (ED) in patients with non-traumatic chest pain (CP)., Methods: All CP cases attended at a single ED (2008-2017) were included. LP was considered if time from CP onset to ED arrival was>6 h. We analyzed associations between 42 patient/CP-related characteristics and LP in the whole cohort and in patients with CP due to acute coronary syndrome (ACS)., Results: The cohort included 25,693 cases (LP=50.6%; ACS=19.0%). Twenty factors were associated with LP, and 8 were also found in patients with ACS: CP of short-duration, aggravated by exertion or breathing/movement, undulating or recurrent CP increased the risk of LP, whereas CP accompanied by diaphoresis, irradiated to the throat, and chronic treatment with nitrates decreased the risk of LP. Exertional and recurrent CP were associated with both, LP and ACS., Conclusion: Some characteristics, mainly CP-related, may lead to LP to the ED. CP aggravated by exercise and recurrent CP were associated with both LP and a final diagnosis of ACS., Practice Implications: Patient educational initiatives should consider these two features as potential warnings for ACS and thereby encourage patients to seek early medical consultation., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
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