Justificación bibliográfica del análisis de riesgos para los profesionales sanitarios en ambulancias de urgencia

Introducción. Esta revisión bibliográfica tiene como objetivo justificar y evidenciar la necesidad de un análisis de riesgos del transporte sanitario urgente español. Metodología. Se realizó una revisión sistemática usando como bases de datos: Medline, Cochrane, Pubmed, Biblioteca de la UPNA, Google académico y Scopus. Los descriptores de búsqueda han sido: Ambulance, Paramedic, Nurse in Emergency, EMS (Emergency Medical Services), EMT (Emergency Medical Technician), Workplace Safety, Mental Health, Emergency Medical Services, Técnico en Emergencias Sanitarias, Urgencias extrahospitalarias, riesgos en las ambulancias y prevención ambulancias. Los criterios de inclusión que se han utilizado son artículos publicados en revistas con alta evidencia científica en inglés o español a texto completo y los criterios de exclusión, artículos publicados con anterioridad a 1990. Resultados. Es inherente al personal del transporte sanitario urgente el manejo de cargas variables y pesadas durante su jornada laboral, adquiriendo posturas forzadas de rodillas y cuclillas cuando realizan una atención. También se encuentran expuestos a estresores psicológicos debidos de las atenciones urgentes, en las cuales en muchas ocasiones se encuentran rodeados de familiares y viandantes. Conclusiones. Gracias a la revisión bibliográfica, hemos llegado a la conclusión de la existencia de riesgos y que todos los estudios se han realizado en otros países, por lo que, se evidencia la necesidad de realizar un estudio integral de riesgos laborales del transporte urgente español.Introduction. This bibliographic review aims to justifyand evidence the need for a risk analysis of urgent medicaltransport. Methods. The methodology of this study has been systematic review of articles, using as databases: Medline, Cochrane, Pubmed, Google academic, UPNA librery and Scopus. The search engines have been: Ambulance, Pa-ramedic, Nurse in Emergency, EMS (Emergency Medical Technician), Workplace Safety, Mental Health, Emergency Medical Services, Emergency Medical Technician, Outpatient Emergencies, Risks in Ambulances and ambulance prevention. The inclusion criteria that have been used are articles published in journals with high scientific evidence in English or Spanish full text and exclusion criteria, articles published prior to 1990. Results. As results, we have obtained that is inherent to the staff of the urgent medical transport The handling of variable and heavy loads during their working day, acquiring forced positions of knees and squats when they pay attention. They are also exposed to psychological stressors due to urgent care, in which they are often surrounded by family members and by standers. Conclusions. Thanks to the bibliographical review we have concluded the existence of risks and that all studies have been carried out in other countries, thus evidencing the need to carry out an integral study of occupational risks of urgent transport

Influence of prehospital response times in the survival of trauma patients in Navarre

Réplica de los autores a la carta recibida en relación con el trabajo: Influencia de los tiempos de respuesta prehospitalarios en la supervivencia de los pacientes politraumatizados en Navarr

Variation of the characteristics and epidemiology of patients with pneumonia acquired in the community treated in hospital A and E services

Artículo de opinión sobre el siguiente artículo: Julián-Jiménez A, González del Castillo J, Martínez Ortíz de Zárate M, Candel González FJ, Piñera Salmerón P, Moya Mir MS (en representación del grupo INFURG-SEMES). Características y cambios epidemiológicos de los pacientes con neumonía adquirida en la comunidad en los servicios de urgencias hospitalarios

An evolutionary underbagging approach to tackle the survival prediction of trauma patients: a case study at the Hospital of Navarre

Survival prediction systems are used among emergency services at hospitals in order to measure their quality objectively. In order to do so, the estimated mortality rate given by a prediction model is compared with the real rate of the hospital. Hence, the accuracy of the prediction system is a key factor as more reliable estimations can be obtained. Survival prediction systems are aimed at scoring the severity of patients' injuries. Afterward, this score is used to estimate whether the patient will survive or not. Luckily, the number of patients who survive their injuries is greater than that of those who die. However, this degree of imbalance implies a greater difficulty in learning the prediction models. The aim of this paper is to develop a new prediction system for the Hospital of Navarre with the goal of improving the prediction capabilities of the currently used models since it would imply having a more reliable measurement of its quality. In order to do so, we propose a new strategy to conform an ensemble of classifiers using an evolutionary under sampling process in the bagging methodology. The experimental study is carried out over 462 patients who were treated at the Hospital of Navarre. Our new ensemble approach is an appropriate tool to deal with this problem as it is able to outperform the currently used models by the staff of the hospital as well as several state-of-the-art ensemble approaches designed for imbalanced domains.This work was supported in part by the Spanish Ministry of Science and Technology under Project TIN2016-77356-P (AEI/FEDER, UE), in part by the Network Project under Grant TIN2014-56381-REDT, and in part by the Health Department of the Government of Navarre under Project PI-019/11

Emergency ambulance professionals in spain, is the working clothes washing appropriate?

Introducción: según el estudio EPINE-EPPS del 9 de Noviembre de 2017 realizado en 313 hospitales españoles y estudiado a 61.673 pacientes, de ellos 1493 ya la tenían antes del ingreso. Objetivo: valorar si el personal de urgencias extrahospitalarias limpia correctamente su uniforme ya que es muy común que laven esta ropa en sus domicilios. Material y Métodos: consistió en estudio descriptivo de las variables cerradas, con una población de estudio de 126 profesionales. Se les encuestó a través de una aplicación de formulario Google. El tiempo que permaneció abierto el acceso a la encuesta fue de Junio a Noviembre de 2017. Los datos se analizaron con el programa informático R y ha consistido en la obtención de tablas de frecuencias absolutas y relativas. También para cada par de variables, se han realizado los contrastes de independencia exactos de Fisher y para todas aquellas tablas de contingencia 2x2, se ha calculado el Odds Ratio junto a su intervalo de confianza a nivel 95%. Resultados: tipo de servicio en el que se trabaja y cuestión sobre si la empresa lava la ropa (p-valor = 0.00). El Odds Ratio muestra que la razón de encuestados cuya empresa lava la ropa en el tipo de servicio público es 17,53 veces la razón en el servicio privado. Conclusiones: más de la mitad de los encuestados lava la ropa laboral en su domicilio todos los días que trabaja con el consiguiente riesgo que eso genera de que los microorganismos se queden en su lavadora. Además, desconocer también qué tipo de lavado es el adecuado disminuye su vida útil.Introduction: according to the EPINE-EPPS study of November 9, 2017 carried out in 313 Spanish hospitals and studied 61,673 patients, 1493 of them had already it before admission. Objective: to evaluate if the outpatient emergency staff clean their uniform correctly, since it is very common to wash these clothes at home. Material and Methods: consisted in a descriptive study of closed variables, with a study population of 126 professionals. They were surveyed through a Google Form application. The time for getting access to the survey remained open from June to November 2017. The data was analyzed with the computer program R obtaining tables of absolute and relative frequencies. Also for each pair of variables, the contrasts of Fisher’s exact test of independence have been made, and for all those 2x2 contingency tables the Odds Ratio has been calculated together with its 95% confidence interval.Results: type of service in which it is being worked and the question about whether the company washes clothing (p-value = 0.00). The Odds Ratio shows that the ratio of respondents whose company washes clothes in the public service type is 17.53 times the ratio in the private service. Conclusions: More than half of the respondents wash their working clothes at home every day they work, causing the consequent risk that the microorganisms can remain in their washing machine. In addition, not knowing what type of washing is also the most appropriate will decrease its useful life

Epidemiological comparison between the Navarra Major Trauma Registry and the German Trauma Registry (TR-DGU®)

Background: International benchmarking can help identify trauma system performance issues and determine the extent to which other countries also experience these. When problems are identified, countries can look to high performers for insight into possible responses. The objective of this study was to compare the treatment and outcome of severely injured patients in Germany and Navarra, Spain. Methods: Data collected, from 2010 to 2013, in the Navarra Major Trauma Registry (NMTR) and the TraumaRegister DGU® (TR-DGU) were compared. Both registries followed the Utstein Trauma Template (European Core Dataset) for documentation of trauma patients. Adult patients (≥ 16 years) with New Injury Severity Score (NISS) being >15 points were included in this study. Patients who had been admitted to the hospital later than 24 h after the trauma, had been pronounced dead before hospital arrival, or had been injured by hanging, drowning or burns, were excluded. Demographic data, injury data, prehospital data, hospital treatment data, time intervals, and outcome were compared. The expected mortality was calculated using the Revised Injury Severity Classification score II (RISC II). Results: A total of 646 and 43,110 patients were included in the outcome analysis from NMTR and TR-DGU, respectively. The difference between observed and expected mortality was −0.4% (standardized mortality ratio [SMR] 0.97; 95% CI 0.93–1.04) in Germany and 1.6% (SMR 1.08; 95% CI: 1.02–1.14) in Navarra. Differences in the characteristics of trauma patients and trauma systems between the regions were noted. Conclusion: The higher observed mortality in Navarra is consistent with the epidemiological characteristics of its population. However, to improve the quality of trauma care in the Navarra trauma system, certain improvements are necessary. There were less young adults with severe injuries in Navarra than in Germany. It is possible to compare data of severely injured patients from different countries if standardized registries are used

Epidemiology of severe trauma in Navarra for 10 years: out-of-hospital/ in-hospital deaths and survivors

Background Major trauma is a leading cause of death. Due to the difficulties to keep a registry of these cases, few studies include all subjects, because they exclude out-of-hospital deaths. The purpose of this work was to compare the epidemiological profiles of out-of-hospital deaths, in-hospital deaths, and survivors over a 10-year period (2010– 2019) of patients who had been treated by Navarre´s Health Service (Spain). Methods Retrospective longitudinal cohort study using data of patients injured by an external physical force of any intentionality and with a New Injury Severity Score above 15. Hangings, drownings, burns, and chokings were excluded. Intergroup differences of demographic and clinical variables were analysed using the Kruskal Wallis test, chi-squared test, or Fisher´s exact test. Results Data from 2,610 patients were analysed; 624 died out-of-hospital, 439 in-hospital, and 1,547 survived. Trauma incidences remained moderately stable over the 10-year period analysed, with a slight decrease in out-of-hospital deaths and a slight increase in in-hospital deaths. Patients of the out-of-hospital deaths group were younger (50.9 years) in comparison to in-hospital deaths and survivors. Death victims were predominantly male in all study groups. Intergroup differences regarding prior comorbidities and predominant type of injury were observed. Conclusions There are significant differences among the three study groups. More than half of the deaths occur out-of-hospital and the causative mechanisms differ in each of them. Thus, when designing strategies, preventive measures were considered for each group on a case-by-case basis.Open Access funding provided by Universidad Pública de Navarra

A decision tree based approach with sampling techniques to predict the survival status of poly-trauma patients

Survival prediction of poly-trauma patients measure the quality of emergency services by comparing their predictions with the real outcomes. The aim of this paper is to tackle this problem applying C4.5 since it achieves accurate results and it provides interpretable models. Furthermore, we use sampling techniques because, among the 378 patients treated at the Hospital of Navarre, the number of survivals excels that of deaths. Logistic regressions are used in the comparison, since they are an standard in this domain.This work was supported in part by the Spanish Ministry of Science and Technology under Projects TIN2016-77356-P and by the Health Department of the Navarre Government under Project PI-019/11

Scales for predicting outcome after severe trauma

En este artículo se ha hecho una revisión sobre el desarrollo de las escalas más utilizadas en los pacientes con traumatismo grave desde hace 40 años. Es sabido que, las escalas anatómicas son eficaces, tanto para medir la gravedad de las lesiones, como para predecir resultados. Las escalas fisiológicas miden el componente dinámico tras el trauma, con gran influencia en el pronóstico de los traumatizados. Los índices metabólicos, tanto lactato como el déficit de bases, son reflejo de un estado de hipoperfusión tisular, y por tanto de shock. Las escalas combinadas sirven para la predicción y comparación evaluativa de los resultados. La incorporación de factores que influyen en el pronóstico de los traumatizados ha conllevado al desarrollo de nuevas escalas. Sin embargo, hay carencia de estudios de validación externa para su uso generalizado. Hasta que estos estudios se lleven a cabo, estas escalas deben usarse con precauciónIn this article we review the development of the mostused scales for severe trauma patients over the past 40 years. It is well known that anatomical scales are effective for measuring the severity of injuries and for predicting results. Physiological scales measure the dynamic component after trauma, with a great influence on the prognosis of injured patients. Metabolic scales, both lactate and base deficit, are reflections of tissue hypoperfusion states and therefore shock. The combined scales are used for prediction and comparative assessment of results. The inclusion of factors that influence the prognosis of trauma patients has led to the development of new scales. However, they lack external validation studies for their widespread use. Until these validation studies are conducted caution should be taken with the use of existing scale

Gender differences in the treatment and outcome of patients with acute coronary syndrome

Fundamento. La perspectiva de género en salud nos alerta de la diferente prevalencia, incidencia, evolución y letalidad de las patologías coronarias agudas según sexo. Este estudio pretende conocer la diferencia en el tratamiento y la evolución de los pacientes afectos de Síndrome Coronario Agudo (SCA) según sexos en Navarra. Métodos. Se analizaron 35 variables de 130 usuarios que acudieron consecutivamente al servicio de Urgencias (SU) del Complejo Hospitalario de Navarra (CHN) con patología coronaria aguda desde enero hasta abril de 2012. La variable dependiente fue el sexo y las independientes los tiempos, tratamientos y evolución final del proceso. Resultados. Un 74,6% de la muestra fueron varones con una edad media de 67 años, inferior a los 72 años de la muestra femenina (p=0,043). Se obtuvo una mediana de 3 factores de riesgo cardiovascular (FRC) en los hombres y de dos en las mujeres (p=0,026). El tiempo de demora generado por los pacientes fue de 161 minutos en varones vs 266 minutos en féminas (p=0,006). El tratamiento llevado a cabo mediante revascularización por angioplastia primaria (AP) o fibrinolisis se realizó en un 71,6% de los hombres y un 41,2% de las mujeres (p=0,002). Se registró un 5,9% de muertes en mujeres, sin hallarse casos de fallecimiento en varones (p=0,017). Conclusiones. En Navarra, los procesos coronarios siguen siendo una patología de predominio masculino pero de mayor gravedad en mujeres. El tratamiento se realizó de forma distinta según sexo. Se observó un mayor retraso en la solicitud de atención sanitaria en las mujeres así como la presencia de alta voluntaria en ellas, lo que puede influir en la peor evolución de las mismasBackground. Gender-based approaches have revealed the differing prevalence, incidence, progression and mortality of acute coronary disease by sex. This study aims to determine the difference by sex in the treatment and outcomes of patients with acute coronary syndrome (ACS) in Navarre. Methods. Thirty-five variables were analysed from 130 users with acute coronary disease who attended the Navarre Hospital (CHN) emergency department consecutively from January to April 2012. The dependent variable was sex and independent variables were time, treatments and final outcome of the process. Results. Males accounted for 74.6% of the sample, with a mean age of 67, which was less than the mean age of 72 for the female patients (p = 0.043). The median for cardiovascular risk factors was three in men and two in women (p = 0.026). The patient delay in seeking health care was 161 minutes in men compared to 266 minutes in women (p = 0.006). Treatment via revascularization by primary angioplasty or fibrinolysis was performed in 71.6% of men and 41.2% of women (p = 0.002). A 5.9% death rate was registered for women, with no deaths among the men (p = 0.017). Conclusions. In Navarre, acute coronary syndrome remains more prevalent among men yet more severe in women. Treatment differs according to gender. Greater delay in seeking health care is observed among women, as is self-discharge from hospital, which may contribute to their less favourable outcome