Encuesta a urgenciólogos sobre el papel del laboratorio en el manejo de las intoxicaciones agudas

espanolObjetivo: Evaluar mediante una encuesta la percepcion que los facultativos que atienden a pacientes intoxicados agudos tienen sobre el papel del laboratorio y conocer la importancia subjetiva que otorgan a determinadas pruebas para realizar el manejo clinico de las intoxicaciones agudas frecuentes. Metodo: La encuesta se dirigio a urgenciologos que trabajan en servicios de urgencias (SU) de dos hospitales con Unidades de Toxicologia Clinica (UTC) y medicos asistentes a cursos de formacion toxicologica. Se solicitaba: datos profesionales, grado de importancia atribuida a las pruebas del laboratorio para las diferentes etapas asistenciales, un maximo de tres pruebas fundamentales para el cuidado de 17 intoxicaciones agudas e indicar una determinacion de analitica basica y que no se realizase en su laboratorio. Resultados: Ochenta y ocho encuestas se consideraron validas, de las cuales 69 (78%) se recogieron en cursos y 19 (22%) en 2 SU. La etapa asistencial a la cual los facultativos encuestados otorgan una mayor importancia al laboratorio es la etapa diagnostica, independientemente del grupo al que pertenecen (62% si pertenecen a SU y 58% si asistieron a cursos). El papel del laboratorio es mas relevante (p En todas las demas intoxicaciones las pruebas analiticas son inespecificas. Conclusiones: Los medicos encuestados corroboran que la finalidad principal del laboratorio de toxicologia es la confirmacion de la impresion diagnostica en funcion de la clinica del paciente. EnglishObjective: To survey physicians who treat acute poisoning cases to determine their attitudes toward laboratory testing in these cases and also toward certain tests for the management of common poisonings. Methods: A questionnaire was sent to physicians working in the emergency departments of 2 hospitals with toxicology units and to physicians attending toxicology training courses. Survey items asked about professional data; the degree of importance the physicians attached to laboratory testing at different stages in the care process; which 3 tests the respondents considered important in 17 different acute poisoning scenarios; and which laboratory test they considered highly important was unavailable at the hospitals where the physicians worked. Results: Eighty-eight valid questionnaires were returned; 69 of them (78%) were from physicians attending toxicology courses and 19 (22%) were from emergency room physicians. The respondents in both groups believed that laboratory tests were most important when cases of acute poisoning were being diagnosed; 62% of the emergency department physicians and 58% of the trainee physicians expressed that opinion. More emergency department physicians at hospitals with toxicology units considered laboratory testing to be of great importance (52% of such physicians vs 26% of the trainees, P GHB [gamma-hydroxybutyrate]; and ecstasy). A specific quantitative test that could detect the cause of poisoning was named as first choice only for smoke inhalation, in which case the respondents would measure carboxyhemoglobin concentration. Tests named for other poisonings were nonspecific. Conclusions: The surveyed physicians confirmed that the purpose of laboratory testing in toxicology is to confirm the diagnosis suggested by the patient�s symptoms.