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Figura 1. Flujograma de revisión de historias.
Figura 2. Efectos adversos en pacientes con estancia de hasta 4 días o de más de 4 días.
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Objetivos: Los pacientes críticos tienen un riesgo especialmente alto de presentar efectos adversos (EA). En este trabajo estudiamos la incidencia de EA en una unidad de cuidados intensivos (UCI) para identificar los factores que incrementan el riesgo de presentarlos, los clasificamos según su gravedad y medimos su influencia en la estancia en UCI. Material y método: Estudio prospectivo de cohortes realizado en los pacientes ingresados en una UCI de un hospital pequeño en 1 año. La revisión se llevó a cabo en dos fases: primero se utilizó una guía de cribado y en segundo lugar se revisaron las historias seleccionadas mediante un cuestionario de confirmación para identificar los EA. Se analizó la influencia de la edad, el sexo, el diagnóstico, la puntuación APACHE y la estancia en la aparición de EA. Se determinó la repercusión de los EA en la estancia del paciente en la unidad. Se clasificaron los EA en tres grupos: graves, moderados y leves. Resultados: Se revisaron 416 historias clínicas y la guía de cribado seleccionó 259. El 29% de los pacientes (121) presentaron 172 EA. La edad y el sexo no demostraron influencia. Los pacientes con estancias prolongadas presentaron EA con mayor frecu encia (49%) que los que tuvieron estancias cortas (24%). La puntuación APACHE fue más elevada en los pacientes que presentaron EA. El grupo diagnóstico que con mayor frecuencia presentó EA fue el de pacientes sépticos. Ocurrieron un 59,3% de EA graves, un 14% de EA moderados y un 26,7% de EA leves. Los EA motivaron 323 estancias, es decir, el 22,5% del total de las estancias en UCI. Conclusiones: Los EA son frecuentes entre los pacientes críticos. La mayor gravedad y la estancia prolongada incrementaron el riesgo de EA. Los EA fueron graves y prolongaron la estancia de los pacientes en la UCI.
Palabras clave:
Efectos adversos
Seguridad
Evaluación del riesgo
Objectives: Critically ill patients have an especially high risk of adverse events (AE). We sought to study the incidence of AE in an intensive care unit (ICU) to identify which factors could increase the risk of AE, determine their severity, and evaluate their influence on length of stay. Material and method: We performed a prospective 1-year cohort study in patients admitted to the ICU of a small hospital. The study was carried out in two phases: in the first phase, a screening guide was used and in the second phase, positively screened records were reviewed to identify AEs. The influence of age, sex, diagnosis, APACHE score and length of stay on the occurrence of AE were analyzed and the effect of these events on the patient's length of stay in the unit was determined. AE were classified in three groups: serious, moderate and minor. Results: We reviewed 416 records and screened 259. One hundred twenty-one (29%) patients had 172 AE. Age and sex had no influence. AE were more frequent in patients with longer stays (49%) than in those with shorter stays (24%). The APACHE score was higher in patients with AE. The most frequent diagnosis in the AE group was sepsis. A total of 59.3% AE were serious, 14% were moderate and 26.7% were minor. AE prolonged ICU stay by 323 patient-days, representing 22.5% of ICU time. Conclusions: AE were frequent in critically ill patients. Greater severity and prolonged stay increased the risk of AE. AE were serious and prolonged ICU stay.
Keywords:
Adverse events
Safety
Risk assessment
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