Resumen de Estudio de las consultas repetidas por cólicos nefríticos en un servicio de urgencias hospitalario

José Luis Bauset Navarro, César Cinesi Gómez, Rosario Izquierdo Barnés, María Victoria Pérez López, Daniela Rosillo Castro, Francisco Miguel González Valverde

• español

  Objetivo: Describir las características de los pacientes reatendidos en las primeras 72 horas por cólico renoureteral (CR) en el servicio de urgencias (SUH).

  Método: Estudio epidemiológico unicéntrico descriptivo mediante revisión de historias de pacientes con CR atendidos el año 2009. Se comparó el grupo de readmitidos en las 72 horas siguientes frente a aquéllos que no volvieron a consultar. Se estudiaron los datos demográficos, los antecedentes de CR, el método diagnóstico y el tratamiento. Resultados: Se realizaron 1.386 asistencias a 1.256 pacientes: 1.150 (91,6%) enfermos consultaron en una ocasión, mientras 106 (8,4%) realizaron al menos 2 consultas (total: 236 asistencias). Los varones presentaron una mayor frecuencia de reconsulta (OR 3,14; IC 95% 1,92-5,17; P < 0,001). Como también se observó en los pacientes con antece­dentes con urolitiais el 57,54% reconsultaron (OR 1,89; IC 95% 1,24-2,89; P = 0,0017). Se realizaron 756 (65,7%) radiografías simples en primera visita y 57 (53,8%) en reconsultas (OR 0,61; IC 95% 0,40-0,93; P < 0,001). Se realizó ecografía abdominal inicial a 155 (13,4%) pacientes y en visitas posteriores a 29 (27,5%) (OR 2,18; IC 95% 1,50­3,16; P < 0,001). La analgesia incluyó más frecuentemente dexketoprofeno (OR 1,44; IC 95% 1,05-1,96; P = 0,016). En readmitidos se empleó más tramadol (OR 1,75; IC 95% 1,05-2,88; P = 0,002) Y benzodiacepinas (OR 2,01; IC 95% 1,32-3,07; P < 0,001). Conclusiones: Las reconsultas por CR es elevado, mayoritaria mente varones y con an­tecedentes de CR. La ecografía se reservó para pacientes con dolor persistente. El uso de dexketoprofeno resultó beneficioso. Los escalones terapéuticos de analgesia estuvieron presentes al prescribir tramadol como analgésico y las benzodiacepinas como adyuvantes y fueron fármacos eficaces.

• English

  Objective: To describe the characteristics of patients seeking retreatment for renal or ureteral colic within 72 hours of a first visit to the emergency department.

  Material and methods: Descriptive single center epidemiologic study based on records for patients with nephritic colic treated in the emergency department of Hospital General Reina Sofía in Murcia, Spain, in 2009. Data for patients who were readmitted to the emergency department were compared with data for patients who did not return. We studied demographic variables, history of emergency visits, diagnostic workup, and treatment.

  Results: A total of 1386 emergency department visits for nephritic colic by 1256 patients were studied; 1150 (91.56%) patients carne to the emergency department once and 106 (8.44%) sought emergency care at least twice (236 visits). Men revisited more frequently than women (odds ratio [OR], 3.14; 95% confidence intervai [CI], 1.92-5.17; P<.001). As well as those patients with a history of urinary tract stones, 57.54% came more than once to the emergency room (OR, 1.89; 95% CI, 1.24-2.89; P=.0017). Plain radiographs were ordered during 756 (65.7%) first visits and 57 (53.8%) subsequent visits (OR, 0.61; 95% CI, 0.40-0.93; P<.001). Abdominal sonograms were done on the first visits of 155 (13.4%) patients and on 29 (27.45%) subsequent visits (OR, 2.18, 95% CI, 1.5-3.16; P<.OOl). Analgesics prescribed included dexketoprofen (OR, 1.44, 95% CI, 105.1-96; P=.016). On subsequent visits to the emergency department tramadol (OR, 1.75; 95% CI, 1.05-2.88; P=.002) and benzodiazepines (OR, 2.01; 95% CI, 1.32-3.07; P<.OOl) were prescribed more often.

  Conclusions: The number of emergency department visits for nephritic colic is high; most patients are men with a history of colie. Ultrasonography is used mainly for patients with persistent pain. Dexketoprofen alleviated pain. In the prescription of analgesics, it was clear that levels of severity were being considered. Tramadol as an analgesic and benzodiazepines as adjuvant medication were efficacious.