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Revista EMERGENCIAS




  REVISTA EMERGENCIAS SEMES > ARTÍCULOS

Emergencias 2012; 24: 19-27

Emergency department use of thromboprophylaxis in patients not requiring admission: results from the URGENTV study

SÒNIA JIMÉNEZ HERNÁNDEZ , SEBASTIÁN MARTÍNEZ FERNÁNDEZ , MARTA MERLO LORANCA , JUAN MARÍA FERNÁNDEZ NÚÑEZ , FRANCISCO RUIZ ROMERO , PEDRO GARCÍA BERMEJO

Sección de Urgencias Medicina, Área de Urgencias, Hospital Clínic, Barcelona. Grupo de Investigación Urgencias: Procesos y Patologías, Institut d��Investigacions Biomédiques Agustí Pi i Sunyer (IDIBAPS). Barcelona, Spain. Servicio de Urgenci

Objectives: To determine the number of patients at moderate to high risk for thromboembolism who are discharged from hospital emergency departments without appropriate treatment to prevent thrombosis. To analyze the factors associated with not starting thromboprophylaxis. Methods: This multicenter, retrospective, observational, epidemiologic study included patients who came to a hospital emergency department with an acute medical emergency or an exacerbation of a chronic disease and who did not require admission. The dependent variable was failure to prescribe thromboprophylaxis on discharge. Independent variables assessed were demographic characteristics, medical specialty, general medical history, characteristics related to the emergency department visit, and foreseen mobility at discharge. The PRETEMED scale to quantify the need for prophylaxis was used. Results: We assessed a total of 2280 patients; 1850 (81.1%) were at moderate to high risk. Of these, 42.1% were discharged without thromboprophylaxis. The variables independently associated with not starting such treatment were bed rest not foreseen on discharge (odds ratio [OR], 19.67; 95% confidence interval [CI], 13.83-27.99; P<.0005), reduced mobility not foreseen on discharge (OR, 6.8; 95% CI, 5.2-8.9; P<.0005), history of neurodegenerative disease (OR, 1.7; 95% CI, 1.2-2.5; P=.003), emergency department stay longer than 12 hours (OR, 1.3; 95% CI, 1.1-1.8; P=.007), and advanced age (OR, 1.03; 95% CI, 1.02-1.04; P<.005). Conclusions: A large percentage of hospital emergency department patients at high to moderate risk of thromboembolism are discharged without prophylaxis.


Texto Completo: http://www.semes.org/revista/vol24_1/6_ing.pdf


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