Emergencias
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Although many health care quality indicators have been defined for establishing a common, homogeneous, and reliable system for assessing emergency department care, less information is available on the use of indicators of quality in attending emergencies outside the hospital. We aimed to identify and analyze quality indicators that have appeared in the literature on out-of-hospital emergencies. This systematic review of the literature followed the ations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). ⋯ The indicators were classified as clinical or nonclinical; within each of these 2 sets, we also identified domains, or subcategories. As nonclinical quality identifiers were more numerous in the literature, it seems that they are the ones most often used to assess out-of-hospital emergency care at this time. This finding leaves the door open to designing and implementing new indicators able to measure quality of care in this clinical setting.
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Uncontrolled bleeding from serious injuries continues to be one of the main causes of preventable deaths outside hospitals. Tourniquets could be useful for quickly stemming blood flow and prevent exsanguination, although evidence supporting their use and effectiveness in civilian accidents is limited. To analyze the effectiveness of tourniquets for stopping bleeding in out-of-hospital emergencies and to explore factors associated with effectiveness. ⋯ Tourniquets are effective for stopping massive blood loss. There are few complications, most of which are attributable to the critical state of patients rather than to application of the tourniquet. A tourniquet should be applied in major trauma cases in civilian settings if massive, life-threatening bleeding cannot be stopped with direct pressure.
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We reviewed the literature on mass gatherings published worldwide to determine event types and topics or epidemiologic aspects covered. Articles using the term mass gatherings indexed in the Scopus database between 2000 and 2015 were reviewed. Of the 518 returned, we selected 96 with relevant information. ⋯ The main topics studied were models of health care (n=55), health care evaluation by means of rates of patients presenting for care or transferred to hospitals (n=21), respiratory pathogens (n=18), syndromic surveillance (n=10), and the global spread of diseases (n=10). Mass gatherings are an emerging area of study addressed by various medical specialties that have focused on studying the health care models used at such events. Emergency medicine is particularly involved with this research topic.
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Acute heart failure (AHF) has become a public health problem of the first magnitude: it is the main cause of emergencies and hospitalization in patients over the age of 65. Various guidelines for managing AHF have been drafted in recent years, yet we continue to see high readmission and mortality rates. ⋯ Few studies have analyzed precipitating factors in AHF and their role in prognosis. This review analyzes the prevalence of precipitating factors and their relation to readmission and mortality.
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Review Meta Analysis
[Usefulness of scoring risk for adverse outcomes in older patients with the Identification of Seniors at Risk scale and the Triage Risk Screening Tool: a meta-analysis].
A considerable proportion of the geriatric population experiences unfavorable outcomes of hospital emergency department care. An assessment of risk for adverse outcomes would facilitate making changes in clinical management by adjusting available resources to needs according to an individual patient's risk. Risk assessment tools are available, but their prognostic precision varies. ⋯ The sensitivity of the ISAR scoring system as a whole ranged between 67% and 99%; specificity fell between 21% and 41%. TRST sensitivity ranged between 52% and 75% and specificity between 39% and 51%. We conclude that the tools currently used to assess risk of adverse outcomes in patients of advanced age attended in hospital emergency departments do not have adequate prognostic precision to be clinically useful.