Riesgo de reconsulta al servicio de urgencias en pacientes COVID-19 leves con seguimiento ambulatorio mediante telemedicina
DOI:
https://doi.org/10.31053/1853.0605.v78.n3.32414Palabras clave:
servicios médicos de urgencia, infecciones por coronavirus, atención ambulatoria, telemedicina, readmisión del pacienteResumen
Introducción: Describir las características de los pacientes COVID-19 con síntomas leves dados de alta desde la Central de Emergencias de Adultos (CEA) y seguidos en forma ambulatoria mediante telemedicina. Estimar las tasas de re-consulta a CEA y hospitalización, y explorar los factores asociados a estos desenlaces.
Métodos: Cohorte retrospectiva de Junio a Agosto 2020 en el Hospital Italiano de Buenos Aires, que incluyó personas COVID-19 con síntomas leves. Se siguieron durante 14 días hasta la ocurrencia de re-consulta en CEA y/o hospitalización. Se utilizaron modelos de Kaplan-Meier y regresión logística.
Resultados: De un total de 1.239 pacientes, con una mediana de 41 años y 53,82% varones, 167 pacientes re-consultaron a CEA, con una tasa de incidencia global a los 14 días del 13,08% (IC del 95% 11,32 a 15,08). De estos, 83 requirieron hospitalización (media de 4,98 días), el 6% no se relaciona con COVID-19 y 5 pacientes fallecieron. Después del ajuste por factores confundidores (edad ≥65, sexo, diabetes, hipertensión, ex tabaquismo, tabaquismo activo, fiebre, diarrea y saturación de oxígeno), encontramos asociaciones significativas: tabaquismo anterior (ORa 2,09, IC95% 1,31-3,34, p0=0,002), fiebre (ORa 1,56, IC95% 1,07-2,28, p=0,002) y saturación de oxígeno (ORa 0,82, IC95% 0,71-0,95, p=0,009).
Conclusión: La tasa del 13% de re-consulta a CEA durante 14 días de seguimiento resultó muy significativa para la gestión hospitalaria, la calidad del desempeño y la seguridad del paciente.
Descargas
Citas
Blumenthal D, Fowler EJ, Abrams M, Collins SR. Covid-19 - Implications for the Health Care System. N Engl J Med. 2020 Oct 8;383(15):1483-1488. doi: 10.1056/NEJMsb2021088. Epub 2020 Jul 22. Erratum in: N Engl J Med. 2020 Jul 23
World Health Organization. Home care for patients with suspected or confirmed COVID-19 and management of their contacts: interim guidance, 12 August 2020. World Health Organization; 2020. Report No.: WHO/2019-nCoV/IPC/HomeCare/2020.4. Disponible en: https://apps.who.int/iris/handle/10665/333782
World Health Organization. Clinical management of COVID-19: interim guidance, 27 May 2020. World Health Organization; 2020. Report No.: WHO/2019-nCoV/clinical/2020.5. Disponible en: https://apps.who.int/iris/handle/10665/332196
Okereafor K. Adebola O. Djehaiche R. Exploring the potentials of telemedicine and other non-contact electronic health technologies in controlling the spread of the novel coronavirus disease (COVID-19). International Journal in IT & Engineering. 2020; Apr; 8(4)1-13. Disponible en: https://ijmr.net.in/current/2020/APRIL,-2020/jukkaE7cAjkaJnl.pdf
Qureshi RO, Kokkirala A, Wu WC. Review of Telehealth Solutions for Outpatient Heart Failure Care in a Veterans Health Affairs Hospital in the COVID-19 Era. R I Med J (2013). 2020 Nov 2;103(9):22-25.
Irarrázaval MJ, Inzunza M, Muñoz R, Quezada N, Brañes A, Gabrielli M, Soto P, Dib M, Urrejola G, Varas J, Valderrama S, Crovari F, Achurra P. Telemedicine for postoperative follow-up, virtual surgical clinics during COVID-19 pandemic. Surg Endosc. 2020 Nov 2:1–7. doi: 10.1007/s00464-020-08130-1.
Tenforde AS, Borgstrom H, Polich G, Steere H, Davis IS, Cotton K, O'Donnell M, Silver JK. Outpatient Physical, Occupational, and Speech Therapy Synchronous Telemedicine: A Survey Study of Patient Satisfaction with Virtual Visits During the COVID-19 Pandemic. Am J Phys Med Rehabil. 2020 Nov;99(11):977-981. doi: 10.1097/PHM.0000000000001571.
Shenoi S, Hayward K, Curran ML, Kessler E, Mehta JJ, Riebschleger MP, Foster HE. Telemedicine in pediatric rheumatology: this is the time for the community to embrace a new way of clinical practice. Pediatr Rheumatol Online J. 2020 Oct 31;18(1):85. doi: 10.1186/s12969-020-00476-z.
Gu L, Xiang L, Lipner SR. Analysis of availability of online dermatology appointments during the COVID-19 pandemic. J Am Acad Dermatol. 2021 Feb;84(2):517-520. doi: 10.1016/j.jaad.2020.10.069.
Keesara S, Jonas A, Schulman K. Covid-19 and Health Care's Digital Revolution. N Engl J Med. 2020 Jun 4;382(23):e82. doi: 10.1056/NEJMp2005835.
Schulman KA, Richman BD. Toward an Effective Innovation Agenda. N Engl J Med. 2019 Mar 7;380(10):900-901. doi: 10.1056/NEJMp1812460.
Wosik J, Fudim M, Cameron B, Gellad ZF, Cho A, Phinney D, Curtis S, Roman M, Poon EG, Ferranti J, Katz JN, Tcheng J. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc. 2020 Jun 1;27(6):957-962. doi: 10.1093/jamia/ocaa067.
Frid SA, Ratti MFG, Pedretti A, Pollan J, Martínez B, Abreu AL, Diodati G, López G, Sommer J, Luna D, Plazzotta F. Telemedicine for Upper Respiratory Tract Infections During 2018 Epidemiological Outbreak in South America. Stud Health Technol Inform. 2019 Aug 21;264:586-590. doi: 10.3233/SHTI190290.
Frid AS, Ratti MFG, Pedretti A, Valinoti M, Martínez B, Sommer J, Luna D, Plazzotta F. Teletriage Pilot Study (Strategy for Unscheduled Teleconsultations): Results, Patient Acceptance and Satisfaction. Stud Health Technol Inform. 2020 Jun 16;270:776-780. doi: 10.3233/SHTI200266.
Petrilli CM, Jones SA, Yang J, Rajagopalan H, O'Donnell L, Chernyak Y, Tobin KA, Cerfolio RJ, Francois F, Horwitz LI. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020 May 22;369:m1966. doi: 10.1136/bmj.m1966.
Kilaru AS, Lee K, Snider CK, Meisel ZF, Asch DA, Mitra N, Delgado MK. Return Hospital Admissions Among 1419 COVID-19 Patients Discharged from Five U.S. Emergency Departments. Acad Emerg Med. 2020 Oct;27(10):1039-1042. doi: 10.1111/acem.14117.
Korean Society of Infectious Diseases and Korea Centers for Disease Control and Prevention. Analysis on 54 Mortality Cases of Coronavirus Disease 2019 in the Republic of Korea from January 19 to March 10, 2020. J Korean Med Sci. 2020 Mar 30;35(12):e132. doi: 10.3346/jkms.2020.35.e132.
Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, Greninger AL, Pipavath S, Wurfel MM, Evans L, Kritek PA, West TE, Luks A, Gerbino A, Dale CR, Goldman JD, O'Mahony S, Mikacenic C. Covid-19 in Critically Ill Patients in the Seattle Region - Case Series. N Engl J Med. 2020 May 21;382(21):2012-2022. doi: 10.1056/NEJMoa2004500.
Plazzotta F, Sommer JA, Marquez Fosser SN, Luna DR. Asynchronous Dermatology Teleconsultations Using a Personal Health Record. Stud Health Technol Inform. 2018;247:690-694.
Mehraeen E, Hayati B, Saeidi S, Heydari M, Seyedalinaghi S. Self-Care Instructions for People Not Requiring Hospitalization for Coronavirus Disease 2019 (COVID-19). Arch Clin Infect Dis. 2020;15 (COVID-19); e102978. doi: 10.5812/archcid.102978.
World Health Organization. Weekly Epidemiological Update - 24 November 2020 World Health Organization; 2020. Report No.: WHO/2019-nCoV/IPC/HomeCare/2020.4. Disponible en: https://www.who.int/publications/m/item/weekly-epidemiological-update---24-november-2020
Weber E, Miller SJ, Astha V, Janevic T, Benn E. Characteristics of telehealth users in NYC for COVID-related care during the coronavirus pandemic. J Am Med Inform Assoc. 2020 Dec 9;27(12):1949-1954. doi: 10.1093/jamia/ocaa216.
Reeves JJ, Hollandsworth HM, Torriani FJ, Taplitz R, Abeles S, Tai-Seale M, Millen M, Clay BJ, Longhurst CA. Rapid response to COVID-19: health informatics support for outbreak management in an academic health system. J Am Med Inform Assoc. 2020 Jun 1;27(6):853-859. doi: 10.1093/jamia/ocaa037.
Childs AW, Unger A, Li L. Rapid design and deployment of intensive outpatient, group-based psychiatric care using telehealth during coronavirus disease 2019 (COVID-19). J Am Med Inform Assoc. 2020 Jul 1;27(9):1420-1424. doi: 10.1093/jamia/ocaa138.
Rodriguez-Santos F, Loson V, Plazzotta F, Martinez H. Argentine experience with telemedicine for venous care during the COVID-19 pandemic. J Vasc Surg Venous Lymphat Disord. 2020 Nov;8(6):1121-1122. doi: 10.1016/j.jvsv.2020.08.021.
Burgos LM. Benzadón M. Candiello A. Cabral MH. Conde D. de Lima AA. Belardi J. Diez M. Telehealth in Heart Failure Care during COVID-19 Pandemic Lockdown in Argentina. Int J Heart Fail. 2020 Oct;2(4):247-253. doi: 10.36628/ijhf.2020.0025.
Fraiche AM, Eapen ZJ, McClellan MB. Moving Beyond the Walls of the Clinic: Opportunities and Challenges to the Future of Telehealth in Heart Failure. JACC Heart Fail. 2017 Apr;5(4):297-304. doi: 10.1016/j.jchf.2016.11.013.
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2021 Universidad Nacional de Córdoba
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
La Revista de la Facultad de Ciencias Médicas de Córdoba (RFCM) adhiere a la política de Acceso Abierto y no cobra cargos a los autores para publicar, ni tampoco a lectores para acceder a los artículos publicados.
