Factores asociados con la aspiración broncopulmonar: estudio de base nacional

estudio transversal y analítico, realizado a partir del análisis de notificaciones de incidentes relacionados con la aspiración broncopulmonar del Sistema de Notificación de Vigilancia Sanitaria, de enero de 2014 a diciembre de 2018.

Resultados:

de las 264.590 notificaciones, 553 se refirieron a aspiración, cuya tasa de prevalencia fue del 0,21%. Hubo asociación entre el evento y la edad, etnia, diagnóstico médico principal, región del país, tipo de servicio, unidad de salud y consecuencias para el paciente. Además, se encontraron cuatro variables predictoras independientes de muerte: vivir en la región Norte o Sur, ser anciano y recibir atención médica por la noche.

Conclusiones:

la tasa de prevalencia de aspiración broncopulmonar fue pequeña, pero con impacto negativo en los pacientes.

Descriptores:
Seguridad del Paciente; Gestión de Riesgos; Aspiración Respiratoria; Neumonía por Aspiración; Sistemas de Información en Salud

Sociodemographic variables	n	%
Sex
Female	241	43.6
Male	312	56.4
Age
< 28 days	16	2.9
29 days to 1 year	16	2.9
2 to 4 years	0	0.0
5 to 11 years	2	0.4
12 to 17 years	2	0.4
18 to 25 years	6	1.1
26 to 35 years	15	2.7
36 to 45 years	30	5.4
46 to 55 years	44	8.0
56 to 65 years	89	16.1
66 to 75 years	96	17.4
76 to 85 years	147	26.6
> 85 years	90	16.3
Ethnicity
White	166	30.0
Yellow	4	0.7
Brown	85	15.4
Indigenous	2	0.4
Black	6	1.1
Not reported	290	52.4

Incident variables	n	%
Care period
Daytime (7 a.m. to 7 p.m.)	326	58.3
Nighttime (7 p.m. to 7 a.m.)	121	21.6
Do not know how to inform	112	20.1
Care phase
Was not hospitalized	1	0.2
On admission	2	0.4
During care provision	552	98.6
In the moments of transfer	2	0.4
In post-discharge follow-up	2	0.4
Service type
Outpatient	9	1.6
Inpatient	547	97.8
Emergency	2	0.2
Other	1	0.4
Health unit
Radiology	1	0.2
Hospitalization Units	350	62.7
Intensive Care Units	164	29.3
Operating center	10	1.8
Emergency	18	3.2
Others	4	0.7
NA^* * NA - Not applicable, this option is checked when there is no specific “Unit”.	12	2.1
Consequences for patients
None	13	2.3
Mild	205	36.7
Moderate	224	40.1
Severe	76	13.6
Death	41	7.3

Explanatory variables	Bronchopulmonary aspiration						p value^†
	No		Yes		Total^* * Frequencies do not total 264,590 due to the number of missing data; †Chi-square test of a sample; ‡NA - Not Applicable, this option is checked when there is no specific “Unit”; §P<0.001 value.
	n	%	n	%	n	%
Sex
Female	125.436	47.5	241	43.6	125.677	47.5	0.065
Male	138.593	52.5	312	43.6	138.906	52.5	0.065
Age group
<18 years	33.976	12.9	36	6.5	34.013	12.9	<0.001
Adults	128.306	48.6	184	33.3	128.490	48.6
Elderly	101.747	38.5	333	60.2	102.080	38.6
Ethnicity
White	78.275	29.6	166	30.0	78.441	29.6	0.029
Indigenous	305	0.1	2	0.4	307	0.1
Black	7.505	2.8	6	1.1	7.511	2.8
Other	177.950	67.4	379	68.5	178.330	67.4
Main medical diagnosis
Diseases of the circulatory system	35.212	13.3	64	11.6	35.276	13.3	<0.001
Diseases of the digestive system	20.634	7.8	63	11.4	20.697	7.8
Diseases of the respiratory system	39.809	15.1	136	24.6	39.945	15.1
Diseases of the nervous system	25.778	9.8	80	14.5	25.858	9.8
Neoplasms (tumors)	19.697	7.5	58	10.5	19.755	7.5
Other	122.899	46.5	152	27.5	123.052	46.5
Country region
Center-West	32.898	12.5	106	19.2	33.004	12.5	<0.001
Northeast	46.142	17.5	96	17.4	46.238	17.5
North	11.125	4.2	19	3.4	11.144	4.2
Southeast	121.685	46.1	229	41.4	121.915	46.1
South	52.185	19.8	103	18.6	52.288	19.8
Service type
Inpatient	247.581	93.8	540	97.6	248.122	93.8	<0.001
Outpatient	2.595	1.0	10	1.8	2.605	1.0
Other	13.852	5.2	3	0.5	13.855	5.2
Health unit
Outpatient	2.194	0.8	0	0.0	2.194	0.8
Inpatient sectors	129.742	49.1	343	62.0	130.085	49.2
Intensive Care Unit	71.725	27.2	167	30.2	71.892	27.2	<0.001
Emergency	18.503	7.0	17	3.1	18.520	7.0
Other	21.125	8.0	13	2.4	21.139	8.0
NA^‡	20.746	7.9	13	2.4	20.759	7.8
Care period
Daytime (7 a.m. to 7 p.m.)	156.930	59.4	324	58.6	157.254	59.4	0.910
Nighttime/early morning (7 a.m. to 7 p.m.)	55.981	21.2	117	21.2	56.098	21.2
Did not know how to inform	51.117	19.4	112	20.3	51.230	19.4
Consequences for patients
None	83.843	31.7	14	0.01	83.857	31.7	<2.2e-16^§
Mild	138.740	52.4	197	0.07	138.937	52.5
Moderate	33.342	12.6	225	0.09	33.567	12.7
Severe	6.647	2.5	76	0.03	6.723	2.5
Death	1.455	0.5	41	0.02	1.496	0.6

Explanatory variables	Death by bronchopulmonary aspiration						p value
	Yes		No		Total^* * Frequencies do not total 264,590 due to the number of missing data; †Chi-square test of a sample; ‡Fisher’s exact test.
	n	%	n	%	n	%
Sex
Female	16	39.0	224	43.2	240	42.9%	0.541^†
Male	25	61.0	294	56.8	319	57.1%	0.541^†
Age group
Adult	6	14.6	178	34.8	184	33.3	0.008^†
Elderly	34	82.9	299	58.4	333	60.2
Less than 18	1	2.4	35	6.8	36	6.5
Ethnicity
White	14	34.1	152	29.7	166	30.0	0.210^‡
Indigenous	1	2.4	1	0.2	2	0.4
Black	0	0.0	6	1.2	6	1.1
Other
Main medical diagnosis
II - Neoplasms	0	0.0	58	11.3	58	10.5%	0.043^‡
VI - Diseases of the nervous system	7	17.1	73	14.3	80	14.5%
IX - Diseases of the circulatory system	4	9.8	60	11.7	64	11.6
X - Diseases of the respiratory system	7	17.1	129	25.2	136	24.6
XI - Diseases of the digestive system	8	19.5	55	10.7	63	11.4
Others	15	36.6	137	26.8	152	27.5
Country region
Center-West	10	24.4	96	18.8	106	19.2	0.002^†
Northeast	8	19.5	88	17.2	96	17.4
North	5	12.2	14	12.2	19	3.4
Southeast	17	41.5	212	41.4	229	41.4
South	1	2.4	102	19.9	103	18.6
Service type
Inpatient	40	97.6	500	97.7	540	97.6	0.232^‡
Outpatient	0	0.0	10	2.0	10	1.8
Other	1	2.4	2	0.4	3	0.5
Health unit
Inpatient sectors	25	61.0	318	62.1	343	62.0	0.699^‡
Intensive Care Unit	12	29.3	155	30.3	167	30.2
Emergency	1	2.4	16	3.1	17	3.1
Other	2	4.9	11	2.1	13	2.4
NA^‡	1	2.4	12	2.3	13	2.4
Care period
Daytime (7 a.m. to 7 p.m.)	18	43.9	306	59.8	324	58.9	0.014^†
Nighttime (7 p.m. to 7 a.m.)	16	39.0	101	19.7	117	21.2
Did not know how to inform	7	17.1	105	20.5	112	20.2

Variables	Estimate	SD^* * SD - Standard Deviation; OR - Odds Ratio; 95%CI - 95% Confidence Interval.	z value	Pr(>\|z\|)	RC^†	95%CI^‡	Pr(>\|Z\|)
Intercept	-3.8026	0.5026	7.5665	0.0000
Country region
Center-West	0.3529	0.4297	0.8214	0.4114	1.4232	0.6131-3.3037	0.4114
Northeast	0.3574	0.4631	0.7718	0.4403	1.4296	0.5768-3.5435	0.4403
North	1.5711	0.6050	2.5967	0.0094	4.8119	1.4700-15.7512	0.0094
South	-2.1222	1.0404	2.0397	0.0414	0.1198	0.0156-0.9204	0.0414
Age group
Elderly	1.2689	0.4609	2.7534	0.0059	3.5570	1.4415-8.7775	0.0059
Less than 18 years	-0.4526	1.1163	0.4054	0.6852	0.6360	0.0713-5.6707	0.6852
Care period
Daytime (7 a.m. to 7 p.m.)
Nighttime (7 p.m. to 7 a.m.)	1.0261	0.3772	2.7202	0.0065	2.7902	1.3321-5.8443	0.0065
Did not know how to inform	0.1550	0.4725	0.3280	0.7429	1.1676	0.4625-2.9477	0.7429

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[1] Corresponding author: Fernanda Raphael Escobar Gimenes E-mail: fregimenes@eerp.usp.br