Factores relacionados con la revisita y el ingreso de los pacientes que consultan a urgencias por fiebre

Fundamento y objetivo: Identificar los factores predictores de revisita e ingreso de los pacientes que consultan por fiebre a urgencias y son dados de alta. Pacientes y método: Se incluyó a 300 pacientes que entre septiembre de 2003 y abril de 2004 acudieron a urgencias por fiebre y fueron dados de alta. Se cuantificaron los porcentajes de revisitas y de ingresos. Se realizó un estudio estadístico univariable y multivariable. Resultados: El 17% (n = 51) de los pacientes incluidos fueron revisitados por persistencia de la fiebre y el 9% (n = 26) requirió ingreso hospitalario. Los factores independientes relacionados con la revisita fueron la edad mayor de 65 años (odds ratio [OR] = 1,96; p = 0,01), las comorbilidades (OR = 3,23; p = 0,01) y la proteína C reactiva > 15 mg/dl (OR = 6,67; p = 0,02). Los factores independientes relacionados con el ingreso tras la revisita fueron la edad mayor de 65 años (OR = 4,51; p = 0,03) y las comorbilidades (OR = 3,31; p = 0,01). Conclusiones: Entre los pacientes que acuden a urgencias por fiebre y son dados de alta, una sexta parte consultará de nuevo a urgencias. Si el paciente es mayor de 65 años y con morbilidad concomitante, es más probable que precise ingreso tras la revisita.

Background and objective: To identify factors associated with both emergency department (ED) revisit, and hospital admission of patients complaining of fever that have previously been seen and discharged from the ED. Patients and method: From September, 2003 to April, 2004, 300 patients complaining of fever were discharged from the ED. Revisit rate and admission rate were calculated. Factors from the first visit associated with revisit, and revisit and admission were assessed by univariate and multivariate regression analysis. Results: Fifty-one (17%) patients were revisit, 26 (9%) of whom were finally admitted. The independent factors associated with revisit were: age greater than 65 (OR = 1.96; p = 0.01), presence of comorbidity (OR = 3.23; p = 0.01), and C-reactive protein higher than 15 mg/dl (OR = 6.67; p = 0.02). The independent factors associated with revisit and admission were: age greater than 65 (OR = 4.51; p = 0.03), and presence of comorbidity (OR = 3.31; p = 0.01). Conclusions: One-sixth of patients complaining of fever that are discharged from an ED will be seen again. These patients are also more likely to be admitted if they are older than 65 and have any comorbidity present.