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Stals MAM, Moumneh T, Ainle FN, Aujesky D, van Bemmel T, Bertoletti L, Bistervels IM, Chauleur C, Couturaud F, van Dooren YPA, Elias A, Faber LM, Le Gall C, Hofstee HMA, van der Hulle T, Kruip MJHA, Maignan M, Mairuhu ATA, Middeldorp S, Le Moigne E, Nijkeuter M, van der Pol LM, Robert-Ebadi H, Roy PM, Sanchez O, Schmidt J, van Smeden M, Tromeur C, Wolde MT, Righini M, Le Gal G, Huisman MV, Klok FA. Noninvasive diagnostic work-up for suspected acute pulmonary embolism during pregnancy: a systematic review and meta-analysis of individual patient data. J Thromb Haemost 2023; 21:606-615. [PMID: 36696189 DOI: 10.1016/j.jtha.2022.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Few studies evaluated the performance of noninvasive diagnostic strategies for suspected acute pulmonary embolism (PE) in pregnant women. OBJECTIVES The aim of this study was to establish the safety and efficiency of the Wells rule with fixed and adapted D-dimer threshold, and the YEARS algorithm, combined with compression ultrasonography (CUS), in pregnant women with suspected PE in an individual patient data meta-analysis. METHODS We performed a systematic review to identify prospective diagnostic management studies in pregnant women with suspected PE. Primary outcomes were safety, defined as the failure rate, ie, the 3-month venous thromboembolism (VTE) incidence after excluding PE without chest imaging, and efficiency, defined as the proportion of patients in whom chest imaging could be avoided. RESULTS We identified 2 relevant studies, of which individual patient-level data were analyzed in a fixed-effect meta-analysis, totaling 893 pregnant women. The Wells rule with fixed and adapted D-dimer threshold as well as the YEARS algorithm could safely rule out acute PE (failure rate, 0·37%-1·4%), but efficiency improved considerably when applying pretest probability-adapted D-dimer thresholds. The efficiency of bilateral CUS was limited (2·3% overall; number needed to test 43), especially in patients without symptoms of deep-vein thrombosis (efficiency 0·79%; number needed to test 127). CONCLUSION This study supports the latest guideline recommendations (European Society of Cardiology 2019) to apply pretest probability assessment and D-dimer tests to rule out PE in pregnant women. From an efficiency perspective, the use of a strategy with pretest probability-adapted D-dimer threshold is preferred. The yield of CUS was very limited in patients without concomitant symptoms of deep-vein thrombosis.
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Affiliation(s)
- Milou A M Stals
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Thomas Moumneh
- Department of Emergency Medicine, CHU Angers, University Hospital of Angers, UMR MitoVasc CNRS 6015 - INSERM 1083, Equipe CARME, Angers, France; F-CRIN INNOVTE research network, Saint-Etienne, France
| | - Fionnuala Ni Ainle
- Department of Hematology, Mater Misericordiae University Hospital, Dublin, and School of Medicine, University College Dublin, Ireland
| | - Drahomir Aujesky
- Division of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas van Bemmel
- Department of Internal Medicine, Gelre Ziekenhuizen Apeldoorn, Apeldoorn, the Netherlands
| | - Laurent Bertoletti
- F-CRIN INNOVTE research network, Saint-Etienne, France; Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France; CIC 1408 Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France University Jean Monnet, University Hospital of Saint-Etienne, Mines Saint-Etienne, INSERM U 1059, Saint-Etienne, France
| | - Ingrid M Bistervels
- Department of Internal Medicine, Flevo Hospital, Almere, the Netherlands; Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Céline Chauleur
- Department of Obstetrics and Gynaecology, CHU de St-Etienne, Saint-Etienne, France; CIC 1408 Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France University Jean Monnet, University Hospital of Saint-Etienne, Mines Saint-Etienne, INSERM U 1059, Saint-Etienne, France
| | - Francis Couturaud
- F-CRIN INNOVTE research network, Saint-Etienne, France; Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, INSERM UMR1304, University of Brest, Brest, France
| | | | - Antoine Elias
- F-CRIN INNOVTE research network, Saint-Etienne, France; Médecine Vasculaire, Centre Hospitalier de Toulon, Toulon, France
| | - Laura M Faber
- Department of Internal Medicine, Red Cross Hospital, Beverwijk, the Netherlands
| | - Catherine Le Gall
- F-CRIN INNOVTE research network, Saint-Etienne, France; Centre Hospitalier d'Argenteuil, Argenteuil, France
| | - Herman M A Hofstee
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, the Netherlands
| | - Tom van der Hulle
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Marieke J H A Kruip
- Department of Hematology Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Maxime Maignan
- Department of Emergency, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2, Grenoble, France
| | - Albert T A Mairuhu
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Emmanuelle Le Moigne
- F-CRIN INNOVTE research network, Saint-Etienne, France; Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, INSERM UMR1304, University of Brest, Brest, France
| | - Mathilde Nijkeuter
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Liselotte M van der Pol
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Helia Robert-Ebadi
- F-CRIN INNOVTE research network, Saint-Etienne, France; Department of Medicine, Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Pierre-Marie Roy
- Department of Emergency Medicine, CHU Angers, University Hospital of Angers, UMR MitoVasc CNRS 6015 - INSERM 1083, Equipe CARME, Angers, France; F-CRIN INNOVTE research network, Saint-Etienne, France
| | - Olivier Sanchez
- F-CRIN INNOVTE research network, Saint-Etienne, France; Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jeannot Schmidt
- F-CRIN INNOVTE research network, Saint-Etienne, France; Department of Emergency, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cecile Tromeur
- F-CRIN INNOVTE research network, Saint-Etienne, France; Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, INSERM UMR1304, University of Brest, Brest, France
| | - Marije Ten Wolde
- Department of Internal Medicine, Flevo Hospital, Almere, the Netherlands
| | - Marc Righini
- Department of Medicine, Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Grégoire Le Gal
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Thrombosis Research Group, Ottawa, Canada
| | - Menno V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
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Morel B, Bouleux G, Viallon A, Maignan M, Provoost L, Bernadac JC, Devidal S, Pillet S, Cantais A, Mory O. Evaluating the Increased Burden of Cardiorespiratory Illness Visits to Adult Emergency Departments During Flu and Bronchiolitis Outbreaks in the Pediatric Population: Retrospective Multicentric Time Series Analysis. JMIR Public Health Surveill 2022; 8:e25532. [PMID: 35266876 PMCID: PMC8949698 DOI: 10.2196/25532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 08/04/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiorespiratory decompensation (CRD) visits have a profound effect on adult emergency departments (EDs). Respiratory pathogens like respiratory syncytial virus (RSV) and influenza virus are common reasons for increased activity in pediatric EDs and are associated with CRD in the adult population. Given the seasonal aspects of such challenging pathology, it would be advantageous to predict their variations. OBJECTIVE The goal of this study was to evaluate the increased burden of CRD in adult EDs during flu and bronchiolitis outbreaks in the pediatric population. METHODS An ecological study was conducted, based on admissions to the adult ED of the Centre Hospitalier Universitaire (CHU) of Grenoble and Saint Etienne from June 29, 2015 to March 22, 2020. The outbreak periods for bronchiolitis and flu in the pediatric population were defined with a decision-making support tool, PREDAFLU, used in the pediatric ED. A Kruskal-Wallis variance analysis and a Spearman monotone dependency were performed in order to study the relationship between the number of adult ED admissions for the International Classification of Diseases (ICD)-10 codes related to cardiorespiratory diagnoses and the presence of an epidemic outbreak as defined with PREDAFLU. RESULTS The increase in visits to the adult ED for CRD and the bronchiolitis and flu outbreaks had a similar distribution pattern (CHU Saint Etienne: χ23=102.7, P<.001; CHU Grenoble: χ23=126.67, P<.001) and were quite dependent in both hospital settings (CHU Saint Etienne: Spearman ρ=0.64; CHU Grenoble: Spearman ρ=0.71). The increase in ED occupancy for these pathologies was also significantly related to the pediatric respiratory infection outbreaks. These 2 criteria gave an idea of the increased workload in the ED due to CRD during the bronchiolitis and flu outbreaks in the pediatric population. CONCLUSIONS This study established that CRD visits and bed occupancy for adult EDs were significantly increased during bronchiolitis and pediatric influenza outbreaks. Therefore, a prediction tool for these outbreaks such as PREDAFLU can be used to provide early warnings of increased activity in adult EDs for CRD visits.
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Affiliation(s)
- Benoit Morel
- Department of Pediatric Emergency, University Hospital of Saint Etienne, Saint Etienne, France
| | - Guillaume Bouleux
- Décision et Information pour les Systèmes de Production EA4570, University of Lyon, Villeurbanne, France
| | - Alain Viallon
- Emergency Department and Intensive Care Unit, University Hospital, Saint Etienne, France
| | - Maxime Maignan
- Emergency Department and Mobile Intensive Care Unit, University Grenoble Alpes, La Tronche, France
| | - Luc Provoost
- Department of Pediatric Emergency, Hospital University, Grenoble, France
| | | | - Sarah Devidal
- Department of Information Technology, Hospital University, Saint Etienne, France
| | - Sylvie Pillet
- Laboratory of Infectious Agents and Hygiene, University Hospital of Saint Etienne, Saint Etienne, France.,Groupe sur l'Immunité des Muqueuses et Agents Pathogènes EA 3064, Saint Etienne, France
| | - Aymeric Cantais
- Department of Pediatric Emergency, University Hospital of Saint Etienne, Saint Etienne, France.,Groupe sur l'Immunité des Muqueuses et Agents Pathogènes EA 3064, Saint Etienne, France
| | - Olivier Mory
- Department of Pediatric Emergency, University Hospital of Saint Etienne, Saint Etienne, France
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Mégarbane B, Oberlin M, Alvarez JC, Balen F, Beaune S, Bédry R, Chauvin A, Claudet I, Danel V, Debaty G, Delahaye A, Deye N, Gaulier JM, Grossenbacher F, Hantson P, Jacobs F, Jaffal K, Labadie M, Labat L, Langrand J, Lapostolle F, Le Conte P, Maignan M, Nisse P, Sauder P, Tournoud C, Vodovar D, Voicu S, Claret PG, Cerf C. Management of pharmaceutical and recreational drug poisoning. Ann Intensive Care 2020; 10:157. [PMID: 33226502 PMCID: PMC7683636 DOI: 10.1186/s13613-020-00762-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/09/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Poisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis. METHODS A committee composed of 30 experts from five scientific societies, the Société de Réanimation de Langue Française (SRLF), the Société Française de Médecine d'Urgence (SFMU), the Société de Toxicologie Clinique (STC), the Société Française de Toxicologie Analytique (SFTA) and the Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to recreational drug poisoning; and (8) characteristics of cardiotoxicant poisoning. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology. RESULTS The SRLF-SFMU guideline panel provided 41 statements concerning the management of pharmaceutical and recreational drug poisoning. Ethanol and chemical poisoning were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for all recommendations. Six of these recommendations had a high level of evidence (GRADE 1±) and six had a low level of evidence (GRADE 2±). Twenty-nine recommendations were in the form of expert opinion recommendations due to the low evidences in the literature. CONCLUSIONS The experts reached a substantial consensus for several strong recommendations for optimal management of pharmaceutical and recreational drug poisoning, mainly regarding the conditions and effectiveness of naloxone and N-acetylcystein as antidotes to treat opioid and acetaminophen poisoning, respectively.
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Affiliation(s)
- Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM MURS-1144, University of Paris, 2 Rue Ambroise Paré, Paris, 75010 France
| | - Mathieu Oberlin
- Emergency Department, HuManiS Laboratory (EA7308), University Hospital, Strasbourg, France
| | - Jean-Claude Alvarez
- Department of Pharmacology and Toxicology, Inserm U-1173, FHU Sepsis, Raymond Poincaré Hospital, AP-HP, Paris-Saclay University, Garches, France
| | - Frederic Balen
- Emergency Department, Toulouse University Hospital, Toulouse, France
| | - Sébastien Beaune
- Department of Emergency Medicine, Ambroise Paré Hospital, AP-HP, INSERM UMRS-1144, Paris-Saclay University, Boulogne-Billancourt, France
| | - Régis Bédry
- Hospital Secure Unit, Pellegrin University Hospital, Bordeaux, France
| | - Anthony Chauvin
- Emergency Department, Hôpital Lariboisière, AP-HP, Paris, France
| | - Isabelle Claudet
- Pediatric Emergency Department Children’s Hospital CHU Toulouse, Toulouse, France
| | - Vincent Danel
- Department of Emergency Medicine, University Hospital of Grenoble, Grenoble, France
| | - Guillaume Debaty
- 5525, University Grenoble Alps/CNRS/CHU de Grenoble Alpes/TIMC-IMAG UMR, Grenoble, France
| | | | - Nicolas Deye
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM U942, University of Paris, Paris, France
| | - Jean-Michel Gaulier
- Laboratory of Toxicology, EA 4483 - IMPECS - IMPact de L’Environnement Chimique Sur La Santé Humaine, University of Lille, Lille, France
| | | | - Philippe Hantson
- Intensive Care Department, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Frédéric Jacobs
- Polyvalent Intensive Care Unit, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, Clamart, France
| | - Karim Jaffal
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM MURS-1144, University of Paris, 2 Rue Ambroise Paré, Paris, 75010 France
| | - Magali Labadie
- Poison Control Centre of Bordeaux, University Hospital of Bordeaux, Bordeaux, France
| | - Laurence Labat
- Laboratory of Toxicology, Federation of Toxicology APHP, Lariboisière Hospital, INSERM UMRS-1144, University of Paris, Paris, France
| | - Jérôme Langrand
- Poison Control Center of Paris, Federation of Toxicology, Fernand-Widal-Lariboisière Hospital, AP-HP, INSERM UMRS-1144, University of Paris, Paris, France
| | - Frédéric Lapostolle
- SAMU 93-UF Recherche-Enseignement-Qualité, Inserm, U942, Avicenne Hospital, AP-HP, Paris-13 University, Bobigny, France
| | - Philippe Le Conte
- Department of Emergency Medicine, University Hospital of Nantes, Nantes, France
| | - Maxime Maignan
- Emergency Department, Grenoble University Hospital, INSERM U1042, Grenoble Alpes University, Grenoble, France
| | - Patrick Nisse
- Poison Control Centre, University Hospital of Lille, Lille, France
| | - Philippe Sauder
- Intensive Care Unit, University Hospital of Strasbourg, Strasbourg, France
| | | | - Dominique Vodovar
- Poison Control Center of Paris, Federation of Toxicology, Fernand-Widal-Lariboisière Hospital, AP-HP, INSERM UMRS-1144, University of Paris, Paris, France
| | - Sebastian Voicu
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM MURS-1144, University of Paris, 2 Rue Ambroise Paré, Paris, 75010 France
| | - Pierre-Géraud Claret
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Charles Cerf
- Intensive Care Unit, Foch Hospital, Suresnes, France
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Bouget J, Balusson F, Maignan M, Pavageau L, Roy PM, Lacut K, Scailteux LM, Nowak E, Oger E. Major bleeding risk associated with oral anticoagulant in real clinical practice. A multicentre 3-year period population-based prospective cohort study. Br J Clin Pharmacol 2020; 86:2519-2529. [PMID: 32415705 DOI: 10.1111/bcp.14362] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 04/21/2020] [Accepted: 05/01/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS The objective was to compare major bleeding risk of direct oral anticoagulants (DOACs; per type and dose) with vitamin K antagonists (VKAs), irrespective of indication, using real-world data. METHODS A population-based prospective cohort study, using the French national health data system (SNIIRAM), identified 47 469 adults living within 5 well-defined geographical areas, who were new users of oral anticoagulants in the period 2013-2015: 20 205 VKA users, 19 579 rivaroxaban users, 4225 dabigatran users and 3460 apixaban users. From all emergency departments within these areas, clinical data for all adults referred for bleeding was collected and medically validated. The databases were linked for common key variables. The main outcome measure was major bleeding: intracranial haemorrhage, major gastrointestinal bleeding and other major bleeding events. Hazard ratios were derived from adjusted Cox proportional hazard models. We used propensity score weighting as a sensitivity analysis, with separate analyses according to indications (atrial fibrillation or venous thromboembolism). RESULTS Compared to VKAs, high and low-dose DOACs were associated with a reduced risk of intracranial haemorrhage (adjusted hazard ratio 0.55, 95% confidence interval 0.37-0.82 and 0.54, 0.26-1.12 respectively), and a reduced risk of other major bleeding events (0.41, 0.29-0.58 and 0.41, 0.22-0.79 respectively), irrespective of duration and indication. Neither DOAC dose evidenced any significant difference from VKAs in terms of risk of major gastrointestinal bleeding. CONCLUSION There is a clear benefit of using DOACs with regard to intracranial haemorrhage. The study provides new insight into major gastrointestinal and other major bleeding events.
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Affiliation(s)
- Jacques Bouget
- Univ Rennes, CHU Rennes, EA 7449 [Pharmacoepidemiology and Health Services Research] REPERES, Rennes, France
| | - Frédéric Balusson
- Univ Rennes, CHU Rennes, EA 7449 [Pharmacoepidemiology and Health Services Research] REPERES, Rennes, France
| | - Maxime Maignan
- Emergency Department, University Hospital, Grenoble, France
| | - Laure Pavageau
- Emergency Department, University hospital, Nantes, France
| | | | - Karine Lacut
- CIC 1412, Université de Bretagne Loire, Université de Brest, INSERM, CHRU de Brest, Brest, France
| | - Lucie-Marie Scailteux
- Univ Rennes, CHU Rennes, EA 7449 [Pharmacoepidemiology and Health Services Research] REPERES, Rennes, France
| | - Emmanuel Nowak
- CIC 1412, Université de Bretagne Loire, Université de Brest, INSERM, CHRU de Brest, Brest, France
| | - Emmanuel Oger
- Univ Rennes, CHU Rennes, EA 7449 [Pharmacoepidemiology and Health Services Research] REPERES, Rennes, France
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Viglino D, Maignan M. Aspects extrapulmonaires des exacerbations de bronchopneumopathie chronique obstructive. Ann Fr Med Urgence 2020. [DOI: 10.3166/afmu-2019-0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La bronchopneumopathie chronique obstructive (BPCO) est une maladie systémique aux multiples atteintes, émaillée d’exacerbations. L’inflammation, l’hypoxémie, les troubles de la coagulation et les perturbations des interactions coeur–poumon expliquent en partie les atteintes non pulmonaires observées notamment lors d’exacerbations aiguës. Les événements cardiovasculaires sont la première cause de mortalité des patients BPCO, et leur recrudescence est observée pendant plusieurs semaines après une exacerbation. Aux urgences, la prise en charge des patients en exacerbation de BPCO repose donc en plus du support ventilatoire sur une bonne évaluation des potentielles pathologies associées telles que l’insuffisance cardiaque, l’ischémie myocardique, l’insuffisance rénale ou encore la maladie thromboembolique. Cette évaluation globale permet d’adapter les thérapeutiques parfois délétères sur la fonction cardiaque ou l’équilibre acide−base et de prendre en compte le risque extrapulmonaire dans le choix du parcours de soins du patient. Dans cette mise au point, nous abordons quelques explications physiologiques des multiples perturbations observées au cours de l’exacerbation de BPCO, et proposons une vision globale de l’évaluation de ces patients admis pour une dyspnée ou un autre motif pouvant être en rapport avec la BPCO.
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Lvovschi VE, Maignan M, Tazarourte K, Diallo ML, Hadjadj-Baillot C, Pons-Kerjean N, Lapostolle F, Dussart C. Multiple criteria decision analysis approach to consider therapeutic innovations in the emergency department: The methoxyflurane organizational impact in acute trauma pain. PLoS One 2020; 15:e0231571. [PMID: 32294125 PMCID: PMC7159203 DOI: 10.1371/journal.pone.0231571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/21/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Acute trauma pain is poorly managed in the emergency department (ED). The reasons are partly organizational: ED crowding and rare trauma care pathways contribute to oligoanalgesia. Anticipating the organizational impact of an innovative care procedure might facilitate the decision-making process and help to optimize pain management. METHODS We used a multiple criteria decision analysis (MCDA) approach to consider the organizational impact of methoxyflurane (self-administered) in the ED, introduced alone or supported by a trauma care pathway. A MCDA experiment was designed for this specific context, 8 experts in emergency trauma care pathways (leading physicians and pharmacists working in French urban tertiary hospitals) were recruited. The study involved four steps: (i) Selection of organizational criteria for evaluating the innovation's impact; (ii) assessment of the relative weight of each criterion; (iii) choice of appropriate scenarios for exploring the organizational impact of MEOX under various contexts; and (iv) software-assisted simulation based on pairwise comparisons of the scenarios. The final outcome measure was the expected overall organizational impact of methoxyflurane on a 0-to-100 scale (score >50: positive impact). RESULTS Nine organizational criteria were selected. "Mean length of stay in the ED" was the most weighted. Methoxyflurane alone obtained 59 as a total score, with a putative positive impact for eight criteria, and a neutral effect on one. When a trauma care pathway was introduced concomitantly, the impact of methoxyflurane was greater overall (score: 75) and for each individual criterion. CONCLUSIONS Our model highlighted the putative positive organizational impact of methoxyflurane in the ED-particularly when supported by a trauma care pathway-and the relevance of expert consensus in this particular pharmacoeconomic context. The MCDA approach could be extended to other research fields and healthcare challenges in emergency medicine.
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Affiliation(s)
- Virginie Eve Lvovschi
- Emergency Department, Rouen University Hospital, Normandie Univ, UNIROUEN, INSERM U1073, Rouen, France
| | - Maxime Maignan
- Emergency Department, Grenoble University Hospital, Univ. Grenoble Alpes, INSERM U1042, CHU Grenoble Alpes, HP2, Grenoble Alps University, Grenoble, France
| | - Karim Tazarourte
- Emergency Department, Edouard Herriot Hospital, Lyon Public Hospices, Lyon, France; Health Services and Performance Research, HESPER, EA, Claude Bernard University, Lyon, France
| | | | | | | | - Frederic Lapostolle
- SAMU 93, Avicenne Hospital-APHP, Bobigny, France; INSERM U942, Paris 13 University, Paris, France
| | - Claude Dussart
- Lyon Public Hospices, Central Pharmacy, Lyon, France; EA, Systemic Health Pathway Laboratory, University Claude Bernard, Lyon, France
- * E-mail:
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7
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Belbézier A, Deroux A, Sarrot-Reynauld F, Colombe B, Bosseray A, Wintenberger C, Dumanoir P, Lugosi M, Boccon-Gibod I, Leroy V, Maignan M, Collomb-Muret R, Viglino D, Vaillant M, Minotti L, Lagrange E, Epaulard O, Dumestre-Perard C, Lhomme S, Lupo J, Larrat S, Morand P, Schwebel C, Vilotitch A, Bosson JL, Bouillet L. Screening of hepatitis E in patients presenting for acute neurological disorders. J Infect Public Health 2020; 13:1047-1050. [PMID: 32224109 DOI: 10.1016/j.jiph.2019.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/13/2019] [Accepted: 12/21/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Hepatitis E virus (HEV) infection has been reported to be associated with neurological disorders. However, the real prevalence of acute hepatitis E in those diseases is still unknown. We determined the prevalence of anti-HEV IgM antibody in a population with acute non-traumatic, non-metabolic, non-vascular neurological injury. METHOD A registry was created in Grenoble Hospital University from 2014 to 2018 to collect data on patients with acute (<3 months) non-traumatic, non-metabolic, non-vascular neurological injuries. Acute hepatitis E was defined as anti-HEV IgM-positive serum in immunocompetent patient, and as anti-HEV IgM-positive serum or HEV RNA-positive serum in immunocompromised patients. RESULTS One hundred fifty-nine patients were included. Anti-HEV IgM seroprevalence in our cohort of non-traumatic, non-metabolic, non-vascular neurological injuries was 6.9% (eleven patients, including 4 Parsonage-Turner syndrome (PTS) and 2 Guillain-Barré syndrome (GBS)). Elevated transaminases were observed in only 64% of hepatitis E patients and cholestasis in 64%. CONCLUSION In this study, 6·9% of patients with acute non-traumatic, non-metabolic, non-vascular neurological injuries had a probable recent HEV infection. HEV serology should be systematically performed in this population, even in patients with normal transaminase level.
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Affiliation(s)
- Aude Belbézier
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France.
| | - Alban Deroux
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France
| | | | - Barbara Colombe
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France
| | - Annick Bosseray
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France
| | - Claire Wintenberger
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France
| | - Perrine Dumanoir
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France
| | - Maxime Lugosi
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France
| | | | - Vincent Leroy
- Department of Hepatology, Grenoble University Hospital, Grenoble, France
| | - Maxime Maignan
- Department of Emergency, Grenoble University Hospital, Grenoble, France
| | | | - Damien Viglino
- Department of Emergency, Grenoble University Hospital, Grenoble, France
| | - Mathieu Vaillant
- Department of Neurology, Grenoble University Hospital, Grenoble, France
| | - Lorella Minotti
- Department of Neurology, Grenoble University Hospital, Grenoble, France
| | - Emeline Lagrange
- Department of Neurology, Grenoble University Hospital, Grenoble, France
| | - Olivier Epaulard
- Univ. Grenoble Alpes, Department of Infectious Disease, Grenoble University Hospital, Grenoble, France
| | - Chantal Dumestre-Perard
- Univ. Grenoble Alpes, CNRS, Laboratory of Immunology CHU Grenoble Alpes, TIMC-IMAG, 38000 Grenoble, France
| | - Sébastien Lhomme
- INSERM, U1043, Centre de Physiopathologie de Toulouse Purpan, Toulouse, F-31300, France; CHU Toulouse, Hôpital Purpan, Laboratoire de virologie, F-31300, France
| | - Julien Lupo
- Univ. Grenoble Alpes, CEA, CNRS, Virology Laboratory CHU Grenoble Alpes, IBS, 38000 Grenoble, France
| | - Sylvie Larrat
- Univ. Grenoble Alpes, CEA, CNRS, Virology Laboratory CHU Grenoble Alpes, IBS, 38000 Grenoble, France
| | - Patrice Morand
- Univ. Grenoble Alpes, CEA, CNRS, Virology Laboratory CHU Grenoble Alpes, IBS, 38000 Grenoble, France
| | - Carole Schwebel
- Univ. Grenoble Alpes, Laboratory of Bioclinical Pharmaceutic CHU Grenoble Alpes, INSERM U1039, 38000 Grenoble, France
| | - Antoine Vilotitch
- Department of Public Health, Grenoble University Hospital, Grenoble, France
| | - Jean-Luc Bosson
- Department of Public Health, Grenoble University Hospital, Grenoble, France; Univ. Grenoble Alpes, CNRS, Public Health Department CHU Grenoble Alpes, TIMC-IMAG, 38000 Grenoble, France
| | - Laurence Bouillet
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France; Univ. Grenoble Alpes, Department of Internal Medicine CHU Grenoble, Inserm (U1036), CEA, BIG-BCI, France
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Viglino D, Daoust R, Bailly S, Faivre-Pierret C, Charif I, Roustit M, Paquet J, Debaty G, Pépin JL, Maignan M, Chauny JM. Opioid drug use in emergency and adverse outcomes among patients with chronic obstructive pulmonary disease: a multicenter observational study. Sci Rep 2020; 10:5038. [PMID: 32193505 PMCID: PMC7081336 DOI: 10.1038/s41598-020-61887-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 03/03/2020] [Indexed: 11/09/2022] Open
Abstract
There is still debate as to the safety of non-palliative opioid administration to chronic obstructive pulmonary disease (COPD) patients punctually treated for an acute complaint. All patients over 40 presenting at two university hospital emergency departments (Montréal Qc, Grenoble Fr) from March 2008 to September 2014 with dyspnea, abdominal pain or trauma were retrieved, and COPD patients were selected. Our primary endpoint was a composite criterion including invasive ventilation and death. Comparisons between visits in which opioid drugs were prescribed and those without opioids were performed using an inverse probability of treatment and censoring weight (IPTCW) estimator to adjust for baseline confounders. A survival weighted Cox model was used. 7799 visits by COPD patients were identified, corresponding to 4173 unique patients. Opioid drug prescription was reported in 1317 (16.9%) visits. After applying IPCTW weighting, opioid prescription was found to be associated with the composite criterion of poor clinical outcomes (HR = 4.73 (2.94; 7.61), p < 0.01). When taken separately, this association remained significant for invasive ventilation and death, but not for NIV. All sensitivity analyses confirmed the association, except for patients with trauma or abdominal pain as the main complaint. This excess risk is observed whatever the route of administration.
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Affiliation(s)
- Damien Viglino
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France. .,INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France.
| | - Raoul Daoust
- Department of Emergency Medicine, Research Centre, Sacré-Coeur Hospital of Montreal, Montreal, Quebec, Canada
| | - Sebastien Bailly
- INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France.,Department of Physiology and Sleep, Grenoble Alpes University Hospital, Grenoble, France
| | - Caroline Faivre-Pierret
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Isma Charif
- INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France
| | - Matthieu Roustit
- INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France.,Clinical Pharmacology Department, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean Paquet
- Department of Emergency Medicine, Research Centre, Sacré-Coeur Hospital of Montreal, Montreal, Quebec, Canada
| | - Guillaume Debaty
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France.,Department of Physiology and Sleep, Grenoble Alpes University Hospital, Grenoble, France
| | - Maxime Maignan
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France.,INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France
| | - Jean-Marc Chauny
- Department of Emergency Medicine, Research Centre, Sacré-Coeur Hospital of Montreal, Montreal, Quebec, Canada
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Viglino D, L'her E, Maltais F, Maignan M, Lellouche F. Evaluation of a new respiratory monitoring tool "Early Warning ScoreO 2" for patients admitted at the emergency department with dyspnea. Resuscitation 2020; 148:59-65. [PMID: 31945431 DOI: 10.1016/j.resuscitation.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/10/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Many scores derived from Early Warning Scores have been developed to detect patients at risk of poor outcome. Few of these scores incorporate the oxygen flow rate while this is a major marker in patients with respiratory complaint. We developed and evaluated a new automatable monitoring tool (Early Warning Score O2: EWS.O2) that incorporates cardio-respiratory parameters (Respiratory rate, Heart rate, SpO2, and FiO2 derived from oxygen flow rate), aiming to achieve early detection of poor outcome among patients with dyspnea. METHODS All patients presenting at an emergency department for dyspnea from June 2011 to June 2018 with available initial value (nurse triage) of respiratory parameters were included. Our primary endpoint was a composite criterion including the use of non-invasive ventilation, ICU admission and death. The Area under the Receiver Operating Characteristic curve (AUROC) of the SpO2/FiO2 index, NEWS, NEWS2, and the EWS.O2 were compared, including in subgroup analysis by final diagnosis or oxygen supplementation. RESULTS Among the 1729 patients retrieved, the composite outcome was observed in 288 (16.7%). The EWS.O2 displayed better or comparable predictive accuracy at triage (AUROC: 0.704, 95% CI 0.672-0.736) compared to NEWS (0.662, p < 0.01), NEWS2 (0.672, p = 0.02) and SpO2/FiO2 (0.695, p = 0.46). CONCLUSIONS This new ScoreO2 is equivalent or superior to common early warning scores and index to predict poor outcome at first medical contact. This score may be automatically and continuously recorded with new closed-loop devices to titrate oxygen flow. Further prospective studies will allow to verify its accuracy at multiple time points of the patient's journey.
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Affiliation(s)
- Damien Viglino
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada; Grenoble-Alpes University Hospital, HP2 Laboratory INSERM U1042, Grenoble, France
| | - Erwan L'her
- Medical Intensive Care, CHRU de Brest-La Cavale Blanche, Brest, France; LATIM INSERM UMR 1101, FHU Techsan, Université de Bretagne Occidentale, Brest, France
| | - François Maltais
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Maxime Maignan
- Grenoble-Alpes University Hospital, HP2 Laboratory INSERM U1042, Grenoble, France
| | - François Lellouche
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada.
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Viglino D, Collomb-Muret R, Mabiala-Makele P, Clape C, Gros R, Maignan M. Adequacy of oral information given to research participants regarding the Declaration of Helsinki. Eur J Emerg Med 2019; 27:65-66. [PMID: 31876609 DOI: 10.1097/mej.0000000000000618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Damien Viglino
- Emergency Department, Grenoble Alps University Hospital, INSERM U1042, Grenoble, France
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11
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Jouffroy R, Bloch-Laine E, Maignan M, Le Borgne P, Marjanovic N, Lafon T, Dehdar S, Thomas L, Michelet P, Vivien B. Contribution of Capillary Refilling Time and Skin Mottling Score to Predict ICU Admission of Patients with Septic or haemorrhagic Shock Admitted to the Emergency Department: A TRCMARBSAU Study. Turk J Anaesthesiol Reanim 2019; 47:492-495. [PMID: 31828247 DOI: 10.5152/tjar.2019.28459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/07/2019] [Indexed: 11/22/2022] Open
Abstract
Objective In the emergency department (ED), the severity assessment of shock is a fundamental step prior to the admission in the intensive care unit (ICU). As biomarkers are time consuming to evaluate the severity of micro- and macro-circulation alteration, capillary refill time and skin mottling score are two simple, available clinical criteria validated to predict mortality in the ICU. The aim of the present study is to provide clinical evidence that capillary refill time and skin mottling score assessed in the ED also predict ICU admission of patients with septic or haemorrhagic shock. Methods This trial is an observational, non-randomised controlled study. A total of 1500 patients admitted to the ED for septic or haemorrhagic shock will be enrolled into the study. The primary outcome is the admission to the ICU. Results The study will not impact the treatments provided to each patient. Capillary refill time and skin mottling score will not be taken into account to decide patient's treatments and/or ICU admission. Patients will be followed up during their hospital stay to determine their precise destination after the ED (home, ICU or ward) and the 28- and 90-day mortality after hospital admission. Conclusion The results from the present study will provide clinical evidence on the correlation between the ICU admission and the capillary refill time and the skin mottling score in septic or haemorrhagic shock admitted to the ED. The aim of the present study is to provide two simple, reliable and non-invasive tools for the triage and early orientation of these patients.
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Affiliation(s)
- Romain Jouffroy
- Intensive Care Unit, Anaesthesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Emmanuel Bloch-Laine
- Department of Emergency, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Maxime Maignan
- Department of Emergency and SAMU, Grenoble Alps University Hospital, Grenoble; Department of Emergency, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Pierrick Le Borgne
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, Strasbourg, France
| | - Nicolas Marjanovic
- Department of Emergency and SAMU, Poitiers University Hospital, Poitiers, France
| | - Thomas Lafon
- Department of Emergency, SAMU, Inserm CIC 1435, Limoges University Hospital Center, Limoges, France
| | - Scarlett Dehdar
- Department of Emergency, Argenteuil Hospital, Argenteuil, France
| | - Lea Thomas
- Department of Emergency, Begin Military Hospital, Clamart, France
| | - Pierre Michelet
- Department of Emergency, Timone Hospital, Aix-Marseille University - CV2N, INSERM, INRA, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Benoit Vivien
- Intensive Care Unit, Anaesthesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
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Viglino D, Termoz Masson N, Verdetti A, Champel F, Falcon C, Mouthon A, Mabiala Makele P, Collomb Muret R, Maindet Dominici C, Maignan M. Multimodal oral analgesia for non-severe trauma patients: evaluation of a triage-nurse directed protocol combining methoxyflurane, paracetamol and oxycodone. Intern Emerg Med 2019; 14:1139-1145. [PMID: 31290084 DOI: 10.1007/s11739-019-02147-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/03/2019] [Indexed: 01/03/2023]
Abstract
Insufficient analgesia affects around 50% of emergency department patients. The use of a protocol helps to reduce the risk of oligoanalgesia in this context. Our objective was to describe the feasibility and efficacy of a multimodal analgesia protocol (combining paracetamol, oxycodone, and inhaled methoxyflurane) initiated by triage nurse. We performed a prospective, observational study in an emergency department (Grenoble Alpes University Hospital, France) between December 2017 and April 2018. Adult non-severe trauma patients with a numerical pain rating scale (NRS) score ≥ 4 were included. The primary efficacy criterion was the proportion of patients with an NRS score ≤ 3 at 15 min. Pain intensity was measured for 60 min and during radiography. Data on adverse events and satisfaction were recorded. A total of 200 adult patients were included (median [interquartile range (IQR)] age: 32 [23-49] years; 126 men (63%)). Sixty-six patients (33%) reported an NRS score ≤ 3 at 15 min. The time required to achieve a decrease of at least 2 points in the NRS score was 10 (5-20) min. The median [IQR] pain intensity was 4 [2-5] before radiography and 4 [2-6] during radiography. Adverse events were frequent (n = 128, 64%). No serious adverse events were reported. The patients and caregivers reported good levels of satisfaction. The administration of a nurse-driven multimodal analgesia protocol (combining paracetamol, oxycodone, and methoxyflurane) was feasible on admission to the emergency department. It rapidly produced long-lasting analgesia in adult trauma patients.Trial registration: NCT03380247.
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Affiliation(s)
- Damien Viglino
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Nicolas Termoz Masson
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Agnès Verdetti
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Flore Champel
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Cédric Falcon
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Alexis Mouthon
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Prudence Mabiala Makele
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Roselyne Collomb Muret
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | | | - Maxime Maignan
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France.
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Maignan M, Viglino D, Collomb Muret R, Vejux N, Wiel E, Jacquin L, Laribi S, N-Gueye P, Joly LM, Dumas F, Beaune S. Intensity of care delivered by prehospital emergency medical service physicians to patients with deliberate self-poisoning: results from a 2-day cross-sectional study in France. Intern Emerg Med 2019; 14:981-988. [PMID: 31104303 DOI: 10.1007/s11739-019-02108-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
Emergency management of deliberate self-poisoning (DSP) by drug overdose is common in emergency medicine. There is a paucity of data about the prehospital care of these patients. The principal aim was to describe the intensity of care received by patients with DSP who were managed by prehospital emergency medical service (EMS) physicians. A 48-h cross-sectional study was conducted in 319 EMS and emergency units in France. Patient and poisoning characteristics and treatments administered were recorded. Complications of poisoning, hospitalization, intensive care unit admission and death were recorded until day 30. The primary endpoint was the probability of receiving prehospital intensive care, including fluid resuscitation, vasopressor therapy, invasive ventilation, or antidotal treatments, depending whether prehospital treatment was carried out by an EMS physician or not. Data from 703 patients (median age was 43 [30-52] years, 288 (40%) men) were analyzed. One hundred and fifteen (16%) patients were attended by an EMS physician. Patients attended by EMS physicians were more likely to receive intensive treatment in the prehospital setting [odds ratio (OR) 7.4, 95% confidence interval 4.3-12.9]. These patients had more severe poisoning as suggested mainly by a lower Glasgow Coma Score (13 [8-15] vs. 15 [15-15]; p < 0.001) and a higher rate of admission to an intensive care unit [29 (25%) vs. 15 (2%), p < 0.001]. Patients with DSP attended by prehospital EMS physicians frequently received intensive care. The level of care seemed appropriate for the severity of the poisoning.
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Affiliation(s)
- Maxime Maignan
- Emergency Department, CHU Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble cedex 9, France.
| | - Damien Viglino
- Emergency Department, CHU Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble cedex 9, France
| | - Roselyne Collomb Muret
- Emergency Department, CHU Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble cedex 9, France
| | - Nathan Vejux
- Emergency Department, CHU Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble cedex 9, France
| | - Eric Wiel
- Emergency Department and SAMU 59, Lille University Hospital, Inserm UMR1011 and UDSL, Institut Pasteur de Lille, EGID, Lille, France
| | - Laurent Jacquin
- Emergency Department, Hospices Civiles de Lyon, Lyon, France
| | - Said Laribi
- Emergency Department, Tours University Hospital, 37044, Tours, France
- INSERM, U942, BIOmarkers in CArdioNeuroVAScular Diseases, Paris, France
| | - Papa N-Gueye
- Emergency Department, APHP Hôpital Lariboisière, Paris, France
| | - Luc-Marie Joly
- Emergency Department, Charles Nicolle Hospital, Rouen, France
| | - Florence Dumas
- Emergency Department, APHP Hôpital Cochin, Sudden Death Expertise Center, Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France
| | - Sebastien Beaune
- Department of Emergency Medicine, Ambroise Paré Hospital, APHP, University Paris Diderot, INSERM UMR-S 1144, Paris, France
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Javaud N, Soria A, Maignan M, Martin L, Descamps V, Fain O, Bouillet L, Berard F, Tazarourte K, Roy PM, Fontaine JP, Bagot M, Khellaf M, Goulet H, Lapostolle F, Casalino E, Doutre MS, Gil-Jardine C, Caux F, Chosidow O, Pateron D, Vicaut E, Adnet F. Glucocorticoids for acute urticaria: study protocol for a double-blind non-inferiority randomised controlled trial. BMJ Open 2019; 9:e027431. [PMID: 31439599 PMCID: PMC6707704 DOI: 10.1136/bmjopen-2018-027431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This study protocol describes a trial designed to investigate whether antihistamine alone in patients with acute urticaria does not increase the 7-day Urticaria Activity Score (UAS7) in comparison with an association of antihistamine and glucocorticoids and reduces short-term relapses and chronic-induced urticaria. METHODS AND ANALYSIS This is a prospective, double-blind, parallel-group, multicentre non-inferiority randomised controlled trial. Two-hundred and forty patients with acute urticaria admitted to emergency department will be randomised in a 1:1 ratio to receive levocetirizine or an association of levocetirizine and prednisone. Randomisation will be stratified by centre. The primary outcome will be the UAS7 at day 7. The secondary outcomes will encompass recurrence of hives and/or itch at day 7; occurrence of spontaneous hives or itch for >6 weeks; patients with angioedema at day 7, and 2, 6, 12 and 24 weeks; new emergency visits for acute urticaria recurrences at days 7 and 14, and 3 months; Dermatology Life Quality Index at days 7 and 14, and 3 and 6 months; and Chronic Urticaria Quality of Life Questionnaire at 6 weeks. ETHICS AND DISSEMINATION The protocol has been approved by the Comité de Protection des PersonnesSud-Méditerranée II and will be carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. A steering committee will oversee the progress of the study. Findings will be disseminated through national and international scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03545464.
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Affiliation(s)
- Nicolas Javaud
- Emergency Department, Hopital Louis-Mourier, Colombes, France
| | | | - Maxime Maignan
- Emergency Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Ludovic Martin
- Service de Dermatologie, Centre Hospitalier Universitaire d'Angers, Angers, France
| | | | - Olivier Fain
- Internal Medicine, Hopital Saint-Antoine, Paris, France
| | - Laurence Bouillet
- National Reference Centre for Angioedema, Grenoble University Hospital, Grenoble, France
| | | | - Karim Tazarourte
- Emergency Medicine, University Hospital, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory (EA 7425), University Lyon 1, Lyon, France
| | - Pierre-Marie Roy
- Emergency Medicine, University Hospital of Angers, Angers, France
- Institut MITOVASC, Université d'Angers, UFR Santé, Angers, France
| | | | | | | | | | - Frederic Lapostolle
- Urgences-SAMU 93-Unité Recherche-Enseignement-Qualité, APHP, Hôpital Avicenne, Bobigny, France
| | | | - Marie-Sylvie Doutre
- Dermatology, Centre Hospitalier Universitaire de Bordeaux, Groupe Hospitalier Pellegrin, Bordeaux, France
| | - Cedric Gil-Jardine
- Emergency, Centre Hospitalier Universitaire de Bordeaux, Groupe Hospitalier Pellegrin, Bordeaux, France
| | | | | | - Dominique Pateron
- Emergency, AP-HP, Hôpital Saint-Antoine, Service d'Accueil des Urgences, Paris, France
| | - Eric Vicaut
- Clinical Research Department, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Frederic Adnet
- Urgences-SAMU 93-Unité Recherche-Enseignement-Qualité, APHP, Hôpital Avicenne, Bobigny, France
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Blancher M, Repellin M, Maignan M, Clapé C, Perrin A, Labarère J, Debaty G, Viglino D. Accuracy of low-weight versus standard syringe infusion pump devices depending on altitude. Scand J Trauma Resusc Emerg Med 2019; 27:65. [PMID: 31296248 PMCID: PMC6621955 DOI: 10.1186/s13049-019-0643-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background Intravenous drug infusions in critically ill patients require accurate syringe infusion pumps (SIPs). This is particularly important during transportation of critically ill patients by helicopter emergency medical services (HEMS), where altitude may influence device performance. Because weight is a real concern in HEMS, new low-weight devices are very appealing. The aim of this study was to compare infusion flow rates delivered by low-weight versus standard SIP devices, in the prehospital emergency medicine setting, at different altitudes. Methods We conducted a comparative bench study involving five SIP devices (two standard and three low-weight models) at 300, 1700 and 3000 m altitude. The primary endpoint was the flow rate delivered by SIPs for prespecified values. We used two methods to measure flow. The normative method consisted in measuring weight (method A) and the alternate method consisted in measuring instantaneous flow (method B). Results Using method A, no significant differences were found in median flow rates and interquartile range depending on device and altitude for a prespecified 10-mL/h flow. However, method B showed that low-weight SIPs delivered multiple sequential boluses with substantial variations (1.2–15.8 mL/h) rather than a prespecified continuous 5-mL/h flow. At 1700 m altitude, the interquartile range of delivered flows increased only for low-weight devices (p for interaction< 0.001). Conclusions Despite satisfactory normative tests, low-weight SIPs deliver discontinuous flow with potential clinical implications for critically ill patients receiving vasoactive drugs. This study also highlights a thus far unknown negative impact of altitude on SIP function. We believe that normative requirements for SIP approval should be revised accordingly.
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Affiliation(s)
- Marc Blancher
- Grenoble-Alps University - Emergency Department and Mobile Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France.
| | - Maxence Repellin
- Grenoble-Alps University - Emergency Department and Mobile Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France
| | - Maxime Maignan
- Grenoble-Alps University - Emergency Department and Mobile Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France.,INSERM U1042, HP2 Laboratory, Grenoble-Alps University, Grenoble, France
| | - Cyrielle Clapé
- Grenoble-Alps University - Emergency Department and Mobile Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France
| | - Arnaud Perrin
- Grenoble-Alps University - Emergency Department and Mobile Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France
| | - José Labarère
- Quality of Care Unit, Grenoble-Alps University Hospital, Grenoble, France
| | - Guillaume Debaty
- Grenoble-Alps University - Emergency Department and Mobile Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France.,Grenoble-Alps University, CNRS UMR 5525, TIMC-IMAG Laboratory, PRETA Team, Grenoble, France
| | - Damien Viglino
- Grenoble-Alps University - Emergency Department and Mobile Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France.,INSERM U1042, HP2 Laboratory, Grenoble-Alps University, Grenoble, France
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Blancher M, Maignan M, Clapé C, Quesada JL, Collomb-Muret R, Albasini F, Ageron FX, Fey S, Wuyts A, Banihachemi JJ, Bertrand B, Lehmann A, Bollart C, Debaty G, Briot R, Viglino D. Intranasal sufentanil versus intravenous morphine for acute severe trauma pain: A double-blind randomized non-inferiority study. PLoS Med 2019; 16:e1002849. [PMID: 31310600 PMCID: PMC6634380 DOI: 10.1371/journal.pmed.1002849] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/07/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intravenous morphine (IVM) is the most common strong analgesic used in trauma, but is associated with a clear time limitation related to the need to obtain an access route. The intranasal (IN) route provides easy administration with a fast peak action time due to high vascularization and the absence of first-pass metabolism. We aimed to determine whether IN sufentanil (INS) for patients presenting to an emergency department with acute severe traumatic pain results in a reduction in pain intensity non-inferior to IVM. METHODS AND FINDINGS In a prospective, randomized, multicenter non-inferiority trial conducted in the emergency departments of 6 hospitals across France, patients were randomized 1:1 to INS titration (0.3 μg/kg and additional doses of 0.15 μg/kg at 10 minutes and 20 minutes if numerical pain rating scale [NRS] > 3) and intravenous placebo, or to IVM (0.1 mg/kg and additional doses of 0.05 mg/kg at 10 minutes and 20 minutes if NRS > 3) and IN placebo. Patients, clinical staff, and research staff were blinded to the treatment allocation. The primary endpoint was the total decrease on NRS at 30 minutes after first administration. The prespecified non-inferiority margin was -1.3 on the NRS. The primary outcome was analyzed per protocol. Adverse events were prospectively recorded during 4 hours. Among the 194 patients enrolled in the emergency department cohort between November 4, 2013, and April 10, 2016, 157 were randomized, and the protocol was correctly administered in 136 (69 IVM group, 67 INS group, per protocol population, 76% men, median age 40 [IQR 29 to 54] years). The mean difference between NRS at first administration and NRS at 30 minutes was -4.1 (97.5% CI -4.6 to -3.6) in the IVM group and -5.2 (97.5% CI -5.7 to -4.6) in the INS group. Non-inferiority was demonstrated (p < 0.001 with 1-sided mean-equivalence t test), as the lower 97.5% confidence interval of 0.29 (97.5% CI 0.29 to 1.93) was above the prespecified margin of -1.3. INS was superior to IVM (intention to treat analysis: p = 0.034), but without a clinically significant difference in mean NRS between groups. Six severe adverse events were observed in the INS group and 2 in the IVM group (number needed to harm: 17), including an apparent imbalance for hypoxemia (3 in the INS group versus 1 in the IVM group) and for bradypnea (2 in the INS group versus 0 in the IVM group). The main limitation of the study was that the choice of concomitant analgesics, when they were used, was left to the discretion of the physician in charge, and co-analgesia was more often used in the IVM group. Moreover, the size of the study did not allow us to conclude with certainty about the safety of INS in emergency settings. CONCLUSIONS We confirm the non-inferiority of INS compared to IVM for pain reduction at 30 minutes after administration in patients with severe traumatic pain presenting to an emergency department. The IN route, with no need to obtain a venous route, may allow early and effective analgesia in emergency settings and in difficult situations. Confirmation of the safety profile of INS will require further larger studies. TRIAL REGISTRATION ClinicalTrials.gov NCT02095366. EudraCT 2013-001665-16.
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Affiliation(s)
- Marc Blancher
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- * E-mail:
| | - Maxime Maignan
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Cyrielle Clapé
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Roselyne Collomb-Muret
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - François Albasini
- Emergency Department and Mobile Intensive Care Unit, Saint-Jean-de-Maurienne Hospital, Saint-Jean-de-Maurienne France
| | | | - Stephanie Fey
- Emergency Department and Mobile Intensive Care Unit, Metropole Savoie Hospital, Chambery, France
| | - Audrey Wuyts
- Emergency Department, Albertville–Moutiers Hospital, Moutiers, France
| | - Jean-Jacques Banihachemi
- Emergency Trauma Unit, Department of Orthopedic Surgery and Sport Traumatology, Hôpital Sud, Grenoble Alpes University Hospital, Grenoble, France
| | - Barthelemy Bertrand
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Audrey Lehmann
- Pharmacy Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Claire Bollart
- Clinical and Innovation Research Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Guillaume Debaty
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- CNRS TIMC-IMAG Laboratory, UMR 5525, University Grenoble Alpes, Grenoble, France
| | - Raphaël Briot
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- CNRS TIMC-IMAG Laboratory, UMR 5525, University Grenoble Alpes, Grenoble, France
| | - Damien Viglino
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
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17
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Collart C, Moro-Sibilot D, Maignan M, Schwebel C, Giaj Levra M, Ferrer L, Paquier C, Viglino D, Toffart AC. [Emergency room management of patients with lung cancer and organ failure]. Rev Mal Respir 2019; 36:672-678. [PMID: 31255316 DOI: 10.1016/j.rmr.2019.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/23/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND When patients with lung cancer present to the emergency department with organ failure the question of admission to intensive care has to be considered. Our aim is to describe the process leading to the proposed management. METHODS Retrospectively, all patients admitted to the emergency room between December 2010 and January 2015 with a diagnosis of ICD-10 C34.9 (lung cancer) were reviewed. Those with at least one organ failure were included. RESULTS The records of 561 patients were reviewed, 79 (14%) had at least one organ failure. The majority of these patients received maximal medical care (59%), 25% exclusive palliative care, and 15% intensive care. Performance status, metastatic status and efficacy of anti-tumor treatment were recorded in the emergency medical record in 20%, 66% and 74% of cases, respectively. An opinion was obtained from the oncologist in 44% of cases and from the intensivist in 41% of cases. No external advice was provided in 27% of cases. CONCLUSION In the majority of cases, the decision on the intensity of care to be provided to patients with lung cancer and organ failure was made in a collective manner.
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Affiliation(s)
- C Collart
- Service d'accueil des urgences, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - D Moro-Sibilot
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - M Maignan
- Service d'accueil des urgences, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France; Inserm U1042, laboratoire hypoxie physiopathologie, université Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - C Schwebel
- Clinique universitaire de médecine intensive et réanimation, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France; Inserm U1039, biocliniques radiopharmaceutiques, université Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - M Giaj Levra
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - L Ferrer
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - C Paquier
- Service d'accueil des urgences, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - D Viglino
- Service d'accueil des urgences, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France; Inserm U1042, laboratoire hypoxie physiopathologie, université Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - A-C Toffart
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France; Inserm U 1209, CNRS UMR 5309, centre de recherche UGA, institut pour l'avancée des biosciences, 38700 La Tronche, France.
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18
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Maignan M, Viglino D, Hablot M, Termoz Masson N, Lebeugle A, Collomb Muret R, Mabiala Makele P, Guglielmetti V, Morand P, Lupo J, Forget V, Landelle C, Larrat S. Diagnostic accuracy of a rapid RT-PCR assay for point-of-care detection of influenza A/B virus at emergency department admission: A prospective evaluation during the 2017/2018 influenza season. PLoS One 2019; 14:e0216308. [PMID: 31063477 PMCID: PMC6504036 DOI: 10.1371/journal.pone.0216308] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/17/2019] [Indexed: 01/13/2023] Open
Abstract
STUDY OBJECTIVE To investigate the performance of a rapid RT-PCR assay to detect influenza A/B at emergency department admission. METHODS This single-center prospective study recruited adult patients attending the emergency department for influenza-like illness. Triage nurses performed nasopharyngeal swab samples and ran rapid RT-PCR assays using a dedicated device (cobas Liat, Roche Diagnostics, Meylan, France) located at triage. The same swab sample was also analyzed in the department of virology using conventional RT-PCR techniques. Patients were included 24 hours-a-day, 7 days-a-week. The primary outcome was the diagnostic accuracy of the rapid RT-PCR assay performed at triage. RESULTS A total of 187 patients were included over 11 days in January 2018. Median age was 70 years (interquartile range 44 to 84) and 95 (51%) were male. Nine (5%) assays had to be repeated due to failure of the first assay. The sensitivity of the rapid RT-PCR assay performed at triage was 0.98 (95% confidence interval (CI): 0.91-1.00) and the specificity was 0.99 (95% CI: 0.94-1.00). A total of 92 (49%) assays were performed at night-time or during the weekend. The median time from patient entry to rapid RT-PCR assay results was 46 [interquartile range 36-55] minutes. CONCLUSION Rapid RT-PCR assay performed by nurses at triage to detect influenza A/B is feasible and highly accurate.
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Affiliation(s)
- Maxime Maignan
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
- * E-mail:
| | - Damien Viglino
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
| | - Maud Hablot
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
| | - Nicolas Termoz Masson
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
| | - Anne Lebeugle
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
| | - Roselyne Collomb Muret
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
| | - Prudence Mabiala Makele
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
| | - Valérie Guglielmetti
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
| | - Patrice Morand
- Institut de Biologie Structurale (IBS), CEA, CNRS, University Grenoble Alpes, Laboratoire de Virologie, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Lupo
- Institut de Biologie Structurale (IBS), CEA, CNRS, University Grenoble Alpes, Laboratoire de Virologie, Grenoble Alpes University Hospital, Grenoble, France
| | - Virginie Forget
- TIMC-IMAG, CNRS, Grenoble INP, University Grenoble Alpes, Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Caroline Landelle
- TIMC-IMAG, CNRS, Grenoble INP, University Grenoble Alpes, Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Sylvie Larrat
- Institut de Biologie Structurale (IBS), CEA, CNRS, University Grenoble Alpes, Laboratoire de Virologie, Grenoble Alpes University Hospital, Grenoble, France
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19
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Freund Y, Claret PG, Maignan M, Tazarourte K, Ricard-Hibon A. Les réserves de la Société française de médecine d’urgence sur les recommandations 2018 de la Surviving Sepsis Campaign. Ann Fr Med Urgence 2019. [DOI: 10.3166/afmu-2019-0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Montassier E, Javaudin F, Moustafa F, Nandjou D, Maignan M, Hardouin JB, Annoot C, Ogielska M, Orer PL, Schotté T, Bouget J, Agha Babaei S, Raynal PA, Eche A, Duc AT, Cojocaru RA, Benaouicha N, Potel G, Batard E, Talan DA. Guideline-Based Clinical Assessment Versus Procalcitonin-Guided Antibiotic Use in Pneumonia: A Pragmatic Randomized Trial. Ann Emerg Med 2019; 74:580-591. [PMID: 30982631 DOI: 10.1016/j.annemergmed.2019.02.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/05/2019] [Accepted: 02/19/2019] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Efforts to reduce unnecessary and unnecessarily long antibiotic treatment for community-acquired pneumonia have been attempted through use of procalcitonin and through guidelines based on serial clinical assessment. Our aim is to compare guideline-based clinical assessment- and procalcitonin algorithm-guided antibiotic use among patients with community-acquired pneumonia. METHODS We performed a pragmatic, randomized, multicenter trial from November 2012 to April 2015 at 12 French hospitals. We included emergency department (ED) patients older than 18 years with community-acquired pneumonia. Patients were randomly assigned to either the procalcitonin-guided or clinical assessment group. In accordance with past studies, we hypothesized that serial clinical assessment would be superior to procalcitonin-guided care. The primary outcome was antibiotic duration, and secondary outcomes included rates of antibiotic duration less than or equal to 5 days, and clinical success and combined serious adverse outcomes at 30 days in the intention-to-treat population. RESULTS Of 370 eligible patients, 285 (77%) were randomly assigned to either clinical assessment- (n=143) or procalcitonin-guided care (n=142). Median age was 67 years (range 18 to 93 years) and 40% of patients were deemed to have Pneumonia Severity Index class IV or V. Procalcitonin algorithm adherence was 76%. Antibiotic duration was not significantly different between clinical assessment- and procalcitonin-guided groups (median 9 versus 10 days, respectively). Clinical success rate was 92% in each group and serious adverse outcome rates were similar (15% versus 20%, respectively). CONCLUSION Guideline-based serial clinical assessment did not reduce antibiotic exposure compared with procalcitonin-guided care among ED patients with community-acquired pneumonia. The strategies were similar in terms of duration of antibiotic use and clinical outcomes.
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Affiliation(s)
- Emmanuel Montassier
- Department of Emergency Medicine, Centre Hospitalier Universitaire, Nantes University Hospital, Nantes, France.
| | - François Javaudin
- Department of Emergency Medicine, Centre Hospitalier Universitaire, Nantes University Hospital, Nantes, France
| | - Farès Moustafa
- Department of Emergency Medicine, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Demeno Nandjou
- Department of Emergency Medicine, Centre Hospitalier Agen Agen, France
| | - Maxime Maignan
- University Grenoble Alps, Emergency Department and Mobile Intensive Care Unit, Centre Hospitalier UniversitaireGrenoble Alps, Grenoble, France
| | | | - Caroline Annoot
- Department of Emergency Medicine, Centre Hospitalier la Roche sur Yon, la Roche sur Yon, France
| | - Maja Ogielska
- Service de maladies infectieuses, Centre Hospitalier Universitaire Tours, Tours, France
| | - Pascal-Louis Orer
- Department of Emergency Medicine, Assistance Publique Hopitaux de Paris, Hôpital Avicenne, Bobigny, France
| | - Thibault Schotté
- Department of Emergency Medicine, Centre Hospitalier Universitaire Angers, Institut Mitovasc, Université d'Angers, Angers, France
| | - Jacques Bouget
- Department of Emergency Medicine, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Syamak Agha Babaei
- Department of Emergency Medicine, Centre Hospitalier Universitaire Strasbourg, Strasbourg, France
| | - Pierre-Alexis Raynal
- Department of Emergency Medicine, Assistance Publique Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France
| | - Antoine Eche
- Department of Emergency Medicine, Assistance Publique Hôpitaux de Paris, Hôpital Hôtel Dieu, Paris, France
| | - Albert Trinh Duc
- Department of Emergency Medicine, Centre Hospitalier Agen Agen, France
| | - Ruxandra-Aimée Cojocaru
- Department of Emergency Medicine, Centre Hospitalier Universitaire Strasbourg, Strasbourg, France
| | - Nesrine Benaouicha
- Department of Emergency Medicine, Centre Hospitalier Universitaire, Nantes University Hospital, Nantes, France
| | - Gilles Potel
- Department of Emergency Medicine, Centre Hospitalier Universitaire, Nantes University Hospital, Nantes, France
| | - Eric Batard
- Department of Emergency Medicine, Centre Hospitalier Universitaire, Nantes University Hospital, Nantes, France
| | - David A Talan
- Department of Emergency Medicine and Department of Medicine, Division of Infectious Diseases, Olive View-University of California, Los Angeles Medical Center, Sylmar, California; David Geffen School of Medicine at University of California, Los Angeles.
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21
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Lvovschi VE, Joly J, Lemaire N, Maignan M, Canavaggio P, Leroi AM, Tavolacci MP, Joly LM. Nebulized versus intravenous morphine titration for the initial treatment of severe acute pain in the emergency department: study protocol for a multicenter, prospective randomized and controlled trial, CLIN-AEROMORPH. Trials 2019; 20:209. [PMID: 30975187 PMCID: PMC6458825 DOI: 10.1186/s13063-019-3326-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/25/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intravenous morphine titration (IVMT) is the French gold standard for opioid treatment in the emergency department (ED). Nebulized morphine titration (NMT) may represent an alternative without venous access, but it has not been adequately studied in adults. We test the hypothesis that NMT is at least as effective as IVMT to initially manage severe acute pain in the ED. METHODS/DESIGN We designed a multicenter (10 French EDs), single-blind, randomized and controlled trial. Adults between 18 and 75 years with visual analog scale (VAS) ≥ 70/100 or numeric rating scale (NRS) ≥ 7/10 will be enrolled. We will randomize 850 patients into two groups to compare two routes of MT as long as VAS > 30 or NRS > 3. In group A (425), patients will receive an initial NMT for 5-25 min associated with titration of an intravenously (IV) administered placebo of physiologic serum (PS). In group B (425), patients will receive IVMT plus nebulized PS placebo. NMT is defined as a minimum of 1 and a maximum of 3 5-min nebulized boluses of 10 mg or 15 mg (weight ≥ 60 kg), at 10-min fixed intervals. IVMT is defined as a minimum of 1 and a maximum of 6 boluses of 2 mg or 3 mg (weight ≥ 60 kg), at 5-min fixed intervals. Nebulized placebo titration will be performed every 10 min. IV titration of PS will be performed every 5 min. In both groups, after 25 min, if VAS > 30/100 or NRS > 3/10, routine IVMT will be continued until pain relief. Pain severity, vital signs, bronchospasm, and Ramsay score will be recorded every 5 min. The primary outcome is the rate of relief obtained 1 h from the start of drug administration. Complete pain relief in both groups will be compared with a non-inferiority design. Secondary outcomes are pain relief at 30 min (the end of NMT) and at 2 h and median pain relief. We will compare final doses, and study the feasibility and tolerance of NMT (protocol deviations, respiratory or hemodynamic depression, sedation, and minor vegetative side effects). Co-analgesia will be recorded. Discharge criteria from the ED and hospital are defined. DISCUSSION This trial is the first multicenter randomized and controlled NMT protocol for severe pain in the ED using the titration concept. We propose an original approach of combined titration with an endpoint at 1 h and a non-inferiority design. TRIAL REGISTRATION ClinicalTrials.gov, NCT03257319 . Registered on 22 August 2017.
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Affiliation(s)
- Virginie Eve Lvovschi
- Emergency Department, Rouen University Hospital, 76031 Rouen, France
- Normandie Univ, UNIROUEN, INSERM U1073, Rouen, France
| | - Justine Joly
- Emergency Department, Rouen University Hospital, 76031 Rouen, France
| | - Nicolas Lemaire
- Emergency Department, Rouen University Hospital, 76031 Rouen, France
| | - Maxime Maignan
- Emergency Department, Grenoble University Hospital, Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble Alps University, 38000 Grenoble, France
| | - Pauline Canavaggio
- Emergency Department, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | | | | | - Luc-Marie Joly
- Emergency Department, Rouen University Hospital, 76031 Rouen, France
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22
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van der Pol LM, Tromeur C, Bistervels IM, Ni Ainle F, van Bemmel T, Bertoletti L, Couturaud F, van Dooren YPA, Elias A, Faber LM, Hofstee HMA, van der Hulle T, Kruip MJHA, Maignan M, Mairuhu ATA, Middeldorp S, Nijkeuter M, Roy PM, Sanchez O, Schmidt J, Ten Wolde M, Klok FA, Huisman MV. Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. N Engl J Med 2019; 380:1139-1149. [PMID: 30893534 DOI: 10.1056/nejmoa1813865] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pulmonary embolism is one of the leading causes of maternal death in the Western world. Because of the low specificity and sensitivity of the d-dimer test, all pregnant women with suspected pulmonary embolism undergo computed tomographic (CT) pulmonary angiography or ventilation-perfusion scanning, both of which involve radiation exposure to the mother and fetus. Whether a pregnancy-adapted algorithm could be used to safely avoid diagnostic imaging in pregnant women with suspected pulmonary embolism is unknown. METHODS In a prospective study involving pregnant women with suspected pulmonary embolism, we assessed three criteria from the YEARS algorithm (clinical signs of deep-vein thrombosis, hemoptysis, and pulmonary embolism as the most likely diagnosis) and measured the d-dimer level. Pulmonary embolism was ruled out if none of the three criteria were met and the d-dimer level was less than 1000 ng per milliliter or if one or more of the three criteria were met and the d-dimer level was less than 500 ng per milliliter. Adaptation of the YEARS algorithm for pregnant women involved compression ultrasonography for women with symptoms of deep-vein thrombosis; if the results were positive (i.e., a clot was present), CT pulmonary angiography was not performed. All patients in whom pulmonary embolism had not been ruled out underwent CT pulmonary angiography. The primary outcome was the incidence of venous thromboembolism at 3 months. The secondary outcome was the proportion of patients in whom CT pulmonary angiography was not indicated to safely rule out pulmonary embolism. RESULTS A total of 510 women were screened, of whom 12 (2.4%) were excluded. Pulmonary embolism was diagnosed in 20 patients (4.0%) at baseline. During follow-up, popliteal deep-vein thrombosis was diagnosed in 1 patient (0.21%; 95% confidence interval [CI], 0.04 to 1.2); no patient had pulmonary embolism. CT pulmonary angiography was not indicated, and thus was avoided, in 195 patients (39%; 95% CI, 35 to 44). The efficiency of the algorithm was highest during the first trimester of pregnancy and lowest during the third trimester; CT pulmonary angiography was avoided in 65% of patients who began the study in the first trimester and in 32% who began the study in the third trimester. CONCLUSIONS Pulmonary embolism was safely ruled out by the pregnancy-adapted YEARS diagnostic algorithm across all trimesters of pregnancy. CT pulmonary angiography was avoided in 32 to 65% of patients. (Funded by Leiden University Medical Center and 17 other participating hospitals; Artemis Netherlands Trial Register number, NL5726.).
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Affiliation(s)
- Liselotte M van der Pol
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Cecile Tromeur
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Ingrid M Bistervels
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Fionnuala Ni Ainle
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Thomas van Bemmel
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Laurent Bertoletti
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Francis Couturaud
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Yordi P A van Dooren
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Antoine Elias
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Laura M Faber
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Herman M A Hofstee
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Tom van der Hulle
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Marieke J H A Kruip
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Maxime Maignan
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Albert T A Mairuhu
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Saskia Middeldorp
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Mathilde Nijkeuter
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Pierre-Marie Roy
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Olivier Sanchez
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Jeannot Schmidt
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Marije Ten Wolde
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Frederikus A Klok
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
| | - Menno V Huisman
- From the Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden (L.M.P., T.H., F.A.K., M.V.H.), the Department of Internal Medicine, Haga Teaching Hospital (L.M.P., A.T.A.M.), and the Department of Internal Medicine, Haaglanden Medical Center (H.M.A.H.), the Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam (I.M.B., S.M.), the Department of Internal Medicine, Flevo Hospital, Almere (I.M.B., M.W.), the Department of Internal Medicine, Gelre Hospital, Apeldoorn (T.B.), the Department of Pulmonology, Groene Hart Hospital, Gouda (Y.P.A.D.), the Department of Internal Medicine, Red Cross Hospital, Beverwijk (L.M.F.), the Department of Hematology, Erasmus University Medical Center, Rotterdam (M.J.H.A.K.), and the Department of Internal Medicine, University Medical Center Utrecht, Utrecht (M.N.), all of which are part of the Dutch Thrombosis Network (DTN) - all in the Netherlands; the Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, University of Brest, EA 3878, CIC-INSERM 1412, University of Brest, Brest (C.T., F.C.), Service de médecine vasculaire et thérapeutique, Centre Hospitalier Universitaire (CHU) Saint Etienne, INSERM CIC-1408, INSERM Unité 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne (L.B.), the Department of Vascular Medicine, Sainte Musse Hospital, Toulon (A.E.), the Emergency Department, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2 INSERM 1042, Grenoble (M.M.), the Emergency Department, CHU d'Angers, UFR Santé, Université d'Angers, Institut Mitovasc, UMR CNRS 6015 UMR INSERM 1083, Angers (P.-M.R.), the Department of Pulmonary Disease and Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Université Sorbonne Paris Cité, INSERM UMR S 1140, Paris (O.S.), and the Emergency Department, CHU de Clermont-Ferrand, Clermont-Ferrand (J.S.), all of which are part of the French Clinical Research Infrastructure Network-Investigation Network on Venous Thrombo-Embolism (F-CRIN INNOVTE Network, Saint Etienne) - all in France; and the School of Medicine, University College Dublin, and the Department of Haematology, Rotunda Hospital Dublin, INViTE Network, Dublin (F.N.A.)
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Bouget J, Balusson F, Scailteux LM, Maignan M, Roy PM, L'her E, Pavageau L, Nowak E. Major bleeding with antithrombotic agents: a 2012-2015 study using the French nationwide Health Insurance database linked to emergency department records within five areas - rationale and design of SACHA study. Fundam Clin Pharmacol 2019; 33:443-462. [PMID: 30537335 DOI: 10.1111/fcp.12444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/27/2018] [Accepted: 12/06/2018] [Indexed: 12/29/2022]
Abstract
Bleeding represents the most recognized and feared complications of antithrombotic drugs including oral anticoagulants. Previous studies showed inconsistent results on the safety profile. Among explanations, bleeding definition could vary and classification bias exists related to the lack of medical evaluation. To quantify the risk of major haemorrhagic event and event-free survival associated with antithrombotic drugs (vitamin K antagonist [VKA], non-VKA anticoagulant [NOAC], antiplatelet agent, parenteral anticoagulant) in 2012-2015, we linked the French nationwide Health Insurance database (SNIIRAM) with a local 'emergency database' (clinical and biological data collected in clinical records). In the VKA-NOAC comparison, a Cox regression analysis will be used to estimate the hazard ratio of major haemorrhagic event adjusted on gender, modified HAS-BLED score and comorbidities. A distinction on the type of major haemorrhagic event (intracranial, gastrointestinal and other haemorrhagic events) was made. We present here the study protocol and the database linkage results. Using six linkage keys, among 3 837 557 hospital visits identified in SNIIRAM, 5264 have been matched with a major haemorrhagic event identified in the 'emergency database', thus clinically confirmed. The 1090 unmatched haemorrhagic events could be explained by the fact that patients were not extracted in the SNIIRAM database (patients living in accommodation establishment with internal use of pharmacy, military people with specific insurance…). We showed the value of SNIIRAM enrichment with a clinical database, a necessary step to categorize haemorrhagic events by a clinically relevant definition and medical validation; it will allow to estimate more accuracy each type of haemorrhagic event.
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Affiliation(s)
- Jacques Bouget
- Univ Rennes, REPERES [Pharmacoepidemiology and Heath Services Research] - EA 7449, Univ Rennes, Rennes, F-35000, France.,Emergency Department, University hospital, Rennes, F-35033, France
| | - Frédéric Balusson
- Univ Rennes, REPERES [Pharmacoepidemiology and Heath Services Research] - EA 7449, Univ Rennes, Rennes, F-35000, France
| | - Lucie-Marie Scailteux
- Univ Rennes, REPERES [Pharmacoepidemiology and Heath Services Research] - EA 7449, Univ Rennes, Rennes, F-35000, France.,Pharmacovigilance, Pharmacoepidemiology and drug information center, Rennes, F-35033, France
| | - Maxime Maignan
- Emergency Department, University Hospital, Grenoble, F-38043, France
| | - Pierre-Marie Roy
- Emergency Department, University hospital, Angers, F-49033, France
| | - Erwan L'her
- Emergency Department, University hospital, Brest, F-29609, France
| | - Laure Pavageau
- Emergency Department, University hospital, Nantes, F-44093, France
| | - Emmanuel Nowak
- CHU de Brest, Brest, F-29200, France.,Inserm CIC 1412, IFR 148, Université de Brest, Brest, F-29200, France
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Viglino D, Plazanet A, Bailly S, Benmerad M, Jullian-Desayes I, Tamisier R, Leroy V, Zarski J, Maignan M, Joyeux-Faure M, Pepin J. Impact de la stéatopathie métabolique sur la survenue d’événements cardiovasculaires et la mortalité des patients BPCO. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
L’oligoanalgésie chez le patient traumatisé aux urgences est une situation fréquente du fait de la complexité de la prise en charge de la douleur. L’une des solutions les mieux décrites à ce problème est l’utilisation d’analgésiques dès l’admission du patient. Ce type de protocole est à privilégier notamment en cas de filière de prise en charge rapide au sein des urgences. Le méthoxyflurane est un éther halogéné volatil utilisé en médecine. Son inhalation produit une analgésie supérieure au placebo. Du fait de sa rapidité d’action, de sa facilité d’emploi et de ses propriétés antalgiques, le méthoxyflurane doit faire partie de l’arsenal des thérapeutiques antalgiques aux urgences. Aux urgences du CHU de Grenoble-Alpes, nous privilégions l’utilisation du méthoxyflurane au sein d’un protocole d’analgésie multimodale du patient adulte traumatisé. Dans cette indication, le méthoxyflurane permet d’amorcer l’analgésie et de faire le pont jusqu’à ce que les autres thérapeutiques soient efficaces.
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Belbezier, Deroux A, Lugosi M, Colombe B, Wintenberger C, Dumanoir P, Maignan M, Vaillant M, Larrat S, Lagrange E, Bouillet L. Hépatite E dans les troubles neurologiques non traumatiques et non vasculaires : étude prospective française monocentrique. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Viglino D, Plazanet A, Bailly S, Benmerad M, Jullian-Desayes I, Tamisier R, Leroy V, Zarski JP, Maignan M, Joyeux-Faure M, Pépin JL. Impact of Non-alcoholic Fatty Liver Disease on long-term cardiovascular events and death in Chronic Obstructive Pulmonary Disease. Sci Rep 2018; 8:16559. [PMID: 30410123 PMCID: PMC6224555 DOI: 10.1038/s41598-018-34988-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/18/2018] [Indexed: 12/17/2022] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) and Non-Alcoholic Fatty Liver Disease (NAFLD) both independently increase cardiovascular risk. We hypothesized that NAFLD might increase the incidence of cardiovascular disease and death in COPD patients. The relationship between NAFLD, incident cardiovascular events, and death was assessed in a prospective cohort of COPD patients with 5-year follow-up. Noninvasive algorithms combining biological parameters (FibroMax®) were used to evaluate steatosis, non-alcoholic steatohepatitis (NASH) and liver fibrosis. Univariate and multivariate Cox regression models were used to assess the hazard for composite outcome at the endpoint (death or cardiovascular event) for each liver pathology. In 111 COPD patients, 75% exhibited liver damage with a prevalence of steatosis, NASH and fibrosis of 41%, 37% and 61%, respectively. During 5-year follow-up, 31 experienced at least one cardiovascular event and 7 died. In univariate analysis, patients with liver fibrosis had more cardiovascular events and higher mortality (Hazard ratio [95% CI]: 2.75 [1.26; 6.03]) than those with no fibrosis; this remained significant in multivariate analysis (Hazard ratio [95% CI]: 2.94 [1.18; 7.33]). We also found that steatosis and NASH were not associated with increased cardiovascular events or mortality. To conclude, early assessment of liver damage might participate to improve cardiovascular outcomes in COPD patients.
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Affiliation(s)
- Damien Viglino
- Emergency Department, Grenoble Alpes University Hospital, Grenoble, France
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Anais Plazanet
- Emergency Department, Grenoble Alpes University Hospital, Grenoble, France
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Sebastien Bailly
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Meriem Benmerad
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Ingrid Jullian-Desayes
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Renaud Tamisier
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Vincent Leroy
- Hepatogastroenterology Department, Grenoble Alpes University Hospital, Grenoble, France
- INSERM U823, IAPC Institute for Advanced Biosciences, University Grenoble Alpes, Grenoble, France
| | - Jean-Pierre Zarski
- Hepatogastroenterology Department, Grenoble Alpes University Hospital, Grenoble, France
- INSERM U823, IAPC Institute for Advanced Biosciences, University Grenoble Alpes, Grenoble, France
| | - Maxime Maignan
- Emergency Department, Grenoble Alpes University Hospital, Grenoble, France
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Marie Joyeux-Faure
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France.
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Dißmann PD, Maignan M, Cloves PD, Gutierrez Parres B, Dickerson S, Eberhardt A. A Review of the Burden of Trauma Pain in Emergency Settings in Europe. Pain Ther 2018; 7:179-192. [PMID: 29860585 PMCID: PMC6251834 DOI: 10.1007/s40122-018-0101-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Indexed: 12/16/2022] Open
Abstract
Trauma pain represents a large proportion of admissions to emergency departments across Europe. There is currently an unmet need in the treatment of trauma pain extending throughout the patient journey in emergency settings. This review aims to explore these unmet needs and describe barriers to the delivery of effective analgesia for trauma pain in emergency settings. A comprehensive, qualitative review of the literature was conducted using a structured search strategy (Medline, Embase and Evidence Based Medicine Reviews) along with additional Internet-based sources to identify relevant human studies published in the prior 11 years (January 2006-December 2017). From a total of 4325 publications identified, 31 were selected for inclusion based on defined criteria. Numerous barriers to the effective treatment of trauma pain in emergency settings were identified, which may be broadly defined as arising from a lack of effective pain management pan-European and national guidelines, delayed or absent pain assessment, an aversion to opioid analgesia and a delay in the administration of analgesia. Several commonly used analgesics also present limitations in the treatment of trauma pain due to the routes of administration, adverse side effect profiles, pharmacokinetic properties and suitability for use in pre-hospital settings. These combined barriers lead to the inadequate and ineffective treatment of trauma pain for patients. An unmet need therefore exists for novel forms of analgesia, wider spread use of available analgesic agents which overcome some limitations associated with several treatment options, and the development of protocols for pain management which include patient assessment of pain.Funding: Mundipharma International Ltd.
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Affiliation(s)
| | - Maxime Maignan
- Emergency Department, Grenoble Alpes University Hospital, CHUGA, Grenoble, France
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Freund Y, Goulet H, Leblanc J, Bokobza J, Ray P, Maignan M, Guinemer S, Truchot J, Féral-Pierssens AL, Yordanov Y, Philippon AL, Rouff E, Bloom B, Cachanado M, Rousseau A, Simon T, Riou B. Effect of Systematic Physician Cross-checking on Reducing Adverse Events in the Emergency Department: The CHARMED Cluster Randomized Trial. JAMA Intern Med 2018; 178:812-819. [PMID: 29710111 PMCID: PMC6145759 DOI: 10.1001/jamainternmed.2018.0607] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Emergency departments (ED) are environments that are at high risk for medical errors. Previous studies suggested that the proportion of medical errors may decrease when more than 1 physician is involved. OBJECTIVE To reduce the proportion of medical errors by implementing systematic cross-checking between emergency physicians. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized crossover trial includes a random sample of 14 adult patients (age ≥18 years) per day during two 10-day period in 6 EDs (n = 1680 patients) in France. INTERVENTIONS Systematic cross-checking between emergency physicians, 3 times a day, which included a brief presentation of one physician's case to another, followed by the second physician's feedback to the first. MAIN OUTCOMES AND MEASURES Medical error in the ED, defined as an adverse event (either a near miss or a serious adverse event). The primary end point was identified using a 2-level error detection surveillance system, blinded to the strategy allocation. RESULTS Among the 1680 included patients (mean [SD] age, 57.5 [21.7] years), 144 (8.6%) had an adverse event. There were 54 adverse events among 840 patients (6.4%) in the cross-check group compared with 90 adverse events among 840 patients (10.7%) in the standard care group (relative risk reduction [RRR], 40% [95% CI, 12% to 59%]; absolute risk reduction [ARR], 4.3%; number needed to treat [NNT], 24). There was also a significant reduction rate of near misses (RRR, 47% [95% CI, 15% to 67%]; ARR, 2.7%; NNT, 37) but not of the rate of preventable serious adverse events (RRR, 29% [95% CI, -18% to 57%]; ARR, 1.2%; NNT, 83). CONCLUSIONS AND RELEVANCE The implementation of systematic cross-checking between emergency physicians was associated with a significant reduction in adverse events, mainly driven by a reduction in near misses. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02356926.
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Affiliation(s)
- Yonathan Freund
- Sorbonne Université, Paris, France.,Emergency department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Hélène Goulet
- Emergency department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Judith Leblanc
- Plateforme de recherche clinique (URC-CRC-CRB), Hôpital Saint-Antoine, APHP, Paris, France
| | - Jérôme Bokobza
- Emergency department, Hôpital Cochin, APHP, Paris, France
| | - Patrick Ray
- Sorbonne Université, Paris, France.,Emergency department, Hôpital Tenon, APHP, Paris, France
| | - Maxime Maignan
- Emergency department, University Grenoble Alps, Hôpital Michallon, Grenoble, France
| | | | | | | | - Youri Yordanov
- Sorbonne Université, Paris, France.,Emergency department, Hôpital Saint-Antoine, APHP, Paris, France
| | - Anne-Laure Philippon
- Emergency department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Edwin Rouff
- Emergency department, Hôpital Tenon, APHP, Paris, France
| | - Ben Bloom
- Emergency department, Barts Health NHS Trust, London, England
| | - Marine Cachanado
- Plateforme de recherche clinique (URC-CRC-CRB), Hôpital Saint-Antoine, APHP, Paris, France
| | - Alexandra Rousseau
- Plateforme de recherche clinique (URC-CRC-CRB), Hôpital Saint-Antoine, APHP, Paris, France
| | - Tabassome Simon
- Sorbonne Université, Paris, France.,Plateforme de recherche clinique (URC-CRC-CRB), Hôpital Saint-Antoine, APHP, Paris, France
| | - Bruno Riou
- Sorbonne Université, Paris, France.,Emergency department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
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30
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Riou B, Carli P, Charpentier S, de La Coussaye JE, Dumas F, Gueugniaud PY, Maignan M, Pateron D, Pelaccia T. Modalités de fonctionnement du Conseil national des universités (CNU) de médecine d'urgence. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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31
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Beaune S, Truchot J, Maignan M. Prix, contrats et bourses de recherche décernés par la Société française de médecine d'Urgence (SFMU) en 2017. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Deroux A, Dumestre-Peyrard C, Maignan M, Viglino D, Boccon-Gibod I, Bouillet L. Identification de biomarqueurs de la crise d’angiœdème bradykinique. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Guidet B, Leblanc G, Simon T, Woimant M, Quenot JP, Ganansia O, Maignan M, Yordanov Y, Delerme S, Doumenc B, Fartoukh M, Charestan P, Trognon P, Galichon B, Javaud N, Patzak A, Garrouste-Orgeas M, Thomas C, Azerad S, Pateron D, Boumendil A. Effect of Systematic Intensive Care Unit Triage on Long-term Mortality Among Critically Ill Elderly Patients in France: A Randomized Clinical Trial. JAMA 2017; 318:1450-1459. [PMID: 28973065 PMCID: PMC5710364 DOI: 10.1001/jama.2017.13889] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
IMPORTANCE The high mortality rate in critically ill elderly patients has led to questioning of the beneficial effect of intensive care unit (ICU) admission and to a variable ICU use among this population. OBJECTIVE To determine whether a recommendation for systematic ICU admission in critically ill elderly patients reduces 6-month mortality compared with usual practice. DESIGN, SETTING, AND PARTICIPANTS Multicenter, cluster-randomized clinical trial of 3037 critically ill patients aged 75 years or older, free of cancer, with preserved functional status (Index of Independence in Activities of Daily Living ≥4) and nutritional status (absence of cachexia) who arrived at the emergency department of one of 24 hospitals in France between January 2012 and April 2015 and were followed up until November 2015. INTERVENTIONS Centers were randomly assigned either to use a program to promote systematic ICU admission of patients (n=1519 participants) or to follow standard practice (n=1518 participants). MAIN OUTCOMES AND MEASURES The primary outcome was death at 6 months. Secondary outcomes included ICU admission rate, in-hospital death, functional status, and quality of life (12-Item Short Form Health Survey, ranging from 0 to 100, with higher score representing better self-reported health) at 6 months. RESULTS One patient withdrew consent, leaving 3036 patients included in the trial (median age, 85 [interquartile range, 81-89] years; 1361 [45%] men). Patients in the systematic strategy group had an increased risk of death at 6 months (45% vs 39%; relative risk [RR], 1.16; 95% CI, 1.07-1.26) despite an increased ICU admission rate (61% vs 34%; RR, 1.80; 95% CI, 1.66-1.95). After adjustments for baseline characteristics, patients in the systematic strategy group were more likely to be admitted to an ICU (RR, 1.68; 95% CI, 1.54-1.82) and had a higher risk of in-hospital death (RR, 1.18; 95% CI, 1.03-1.33) but had no significant increase in risk of death at 6 months (RR, 1.05; 95% CI, 0.96-1.14). Functional status and physical quality of life at 6 months were not significantly different between groups. CONCLUSIONS AND RELEVANCE Among critically ill elderly patients in France, a program to promote systematic ICU admission increased ICU use but did not reduce 6-month mortality. Additional research is needed to understand the decision to admit elderly patients to the ICU. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01508819.
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Affiliation(s)
- Bertrand Guidet
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France
- Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR S 1136, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Paris, France
| | - Guillaume Leblanc
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France
- Department of Anesthesiology and Critical Care, Université Laval, Québec City, Québec, Canada
| | - Tabassome Simon
- Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
- AP-HP, Hôpital Saint-Antoine, Department of Pharmacology and Unité de Recherche Clinique de l’Est Parisien, Paris, France
| | - Maguy Woimant
- AP-HP, Hôpital Avicenne, Service d’Accueil des Urgences (SAU), Bobigny, France
| | - Jean-Pierre Quenot
- CHU de Dijon, Service de Réanimation Médicale, Dijon, France
- Equipe LIPNESS, INSERM UMR 866, Université de Bourgogne Franche Comté, Dijon, France
| | | | | | | | | | | | | | | | | | | | | | - Anabela Patzak
- AP-HP, Hôpital européen Georges-Pompidou, SAU, Paris, France
| | | | - Caroline Thomas
- AP-HP, Hôpital Saint-Antoine, Service de Gériatrie Aiguë, Paris, France
| | - Sylvie Azerad
- AP-HP, Hôpital Ambroise Paré, Unité de Recherche Clinique Paris Île-de-France Ouest, Boulogne-Billancourt, 92104, France
| | - Dominique Pateron
- Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
- AP-HP, Hôpital Saint-Antoine, SAU, Paris, France
| | - Ariane Boumendil
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France
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Viglino D, Vesin A, Ruckly S, Morelli X, Slama R, Debaty G, Danel V, Maignan M, Timsit JF. Daily volume of cases in emergency call centers: construction and validation of a predictive model. Scand J Trauma Resusc Emerg Med 2017; 25:86. [PMID: 28851446 PMCID: PMC5576313 DOI: 10.1186/s13049-017-0430-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Variations in the activity of emergency dispatch centers are an obstacle to the rationalization of resource allocation. Many explanatory factors are well known, available in advance and could predict the volume of emergency cases. Our objective was to develop and evaluate the performance of a predictive model of daily call center activity. Methods A retrospective survey was conducted on all cases from 2005 to 2011 in a large medical emergency call center (1,296,153 cases). A generalized additive model of daily cases was calibrated on data from 2005 to 2008 (1461 days, development sample) and applied to the prediction of days from 2009 to 2011 (1095 days, validation sample). Seventeen calendar and epidemiological variables and a periodic function for seasonality were included in the model. Results The average number of cases per day was 507 (95% confidence interval: 500 to 514) (range, 286 to 1251). Factors significantly associated with increased case volume were the annual increase, weekend days, public holidays, regional incidence of influenza in the previous week and regional incidence of gastroenteritis in the previous week. The adjusted R for the model was 0.89 in the calibration sample. The model predicted the actual number of cases within ± 100 for 90.5% of the days, with an average error of −13 cases (95% CI: -17 to 8). Conclusions A large proportion of the variability of the medical emergency call center’s case volume can be predicted using readily available covariates. Electronic supplementary material The online version of this article (10.1186/s13049-017-0430-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Damien Viglino
- University Grenoble Alps, Emergency Department and Mobile Intensive Care Unit, CHU Grenoble Alps, Grenoble, France. .,University Grenoble Alps, INSERM U823, Institut Albert BONNIOT, Grenoble, France.
| | - Aurelien Vesin
- University Grenoble Alps, INSERM U823, Institut Albert BONNIOT, Grenoble, France
| | - Stephane Ruckly
- University Grenoble Alps, INSERM U823, Institut Albert BONNIOT, Grenoble, France
| | - Xavier Morelli
- University Grenoble Alps, INSERM U823, Institut Albert BONNIOT, Grenoble, France
| | - Rémi Slama
- University Grenoble Alps, INSERM U823, Institut Albert BONNIOT, Grenoble, France
| | - Guillaume Debaty
- University Grenoble Alps, Emergency Department and Mobile Intensive Care Unit, CHU Grenoble Alps, Grenoble, France.,University Grenoble Alps, CNRS UMR 5525, TIMC-IMAG laboratory, Team PRETA, Grenoble, France
| | - Vincent Danel
- University Grenoble Alps, Emergency Department and Mobile Intensive Care Unit, CHU Grenoble Alps, Grenoble, France
| | - Maxime Maignan
- University Grenoble Alps, Emergency Department and Mobile Intensive Care Unit, CHU Grenoble Alps, Grenoble, France.,University Grenoble Alps, CNRS UMR 5525, TIMC-IMAG laboratory, Team PRETA, Grenoble, France
| | - Jean-François Timsit
- University Grenoble Alps, INSERM U823, Institut Albert BONNIOT, Grenoble, France.,Paris Diderot University, Medical and Infectious Intensive Care Unit, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
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Viglino D, Maignan M, Michalon A, Turk J, Buse SK, Blancher M, Aufderheide TP, Belle L, Savary D, Ageron FX, Debaty G. Survival of cardiac arrest patients on ski slopes: A 10-year analysis of the Northern French Alps Emergency Network. Resuscitation 2017; 119:43-47. [PMID: 28827198 DOI: 10.1016/j.resuscitation.2017.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/20/2017] [Accepted: 07/28/2017] [Indexed: 11/27/2022]
Abstract
AIM Intense physical activity, cold and altitude make mountain sports a cause of increased risk of out-of-hospital cardiac arrest (OHCA). The difficulties of pre-hospital management related to this challenging environment could be mitigated by the presence of ski-patrollers in ski areas and use of helicopters for medical rescue. We assess whether this particular situation positively impacts the chain of survival compared to the general population. METHODS Analysis of prospectively collected data from the cardiac arrest registry of the Northern French Alps Emergency Network (RENAU) from 2004 to 2014. RESULTS 19,341 OHCAs were recorded during the period, including 136 on-slope events. Compared to other OHCAs, on-slope patients were younger (56 [40-65] vs. 66 [52-79] years, p<0.001) and more often in shockable initial rhythm (41.2% vs 20.1%, p<0.001). Resuscitation was more frequently started by a witness (43.4% vs 26.8%, p<0.001) and the time to the first electric shock was shorter (7.5min vs 14min, p<0.001), whereas time to the advanced life support (ALS) rescue arrival did not differ. The 30-day survival rate was higher for on-slope arrests (21.3% vs 5.9%, p<0.001, RR=3.61). In multivariate analysis, on-slope CA remained a positive 30-day survival factor with a 2.6 odds ratio (95% confidence interval, 1.42-4.81, p=0.002). CONCLUSION Despite difficult access and management conditions, patients undergoing OHCAs on ski slopes presented a higher survival rate, possibly explained by a healthier population, the efficiency of resuscitation by ski-patrols and similar time to ALS facilities compared to other cardiac arrests.
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Affiliation(s)
- Damien Viglino
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; University Grenoble Alps - HP2 Laboratory INSERM U1042, Grenoble, France.
| | - Maxime Maignan
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; University Grenoble Alps - HP2 Laboratory INSERM U1042, Grenoble, France
| | - Arnaud Michalon
- Annecy-Genevois Hospital, Emergency Department and Mobile Intensive Care Unit, Annecy, France
| | - Julien Turk
- Chambery Metropole Savoie Hospital, Emergency Department and Mobile Intensive Care Unit, Chambery, France
| | - Sarah K Buse
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Marc Blancher
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Loïc Belle
- Annecy-Genevois Hospital, Cardiac Intensive Care Unit, Annecy, France
| | - Dominique Savary
- Annecy-Genevois Hospital, Emergency Department and Mobile Intensive Care Unit, Annecy, France
| | - François-Xavier Ageron
- Annecy-Genevois Hospital, Emergency Department and Mobile Intensive Care Unit, Annecy, France
| | - Guillaume Debaty
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; University Grenoble Alps - TIMC-IMAG laboratory Team PRETA CNRS UMR 5525, Grenoble, France
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Maignan M, Gennai S, Debaty G, Romanini D, Schmidt MH, Brenckmann V, Brouta A, Ventrillard I, Briot R. Exhaled carbon monoxide is correlated with ischemia reperfusion injuries during
ex vivo
lung perfusion in pigs. J Breath Res 2017. [DOI: 10.1088/1752-7163/aa7a73] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Dussourd L, Martinon B, Candille C, Paquier C, Wintenberger C, Dumanoir P, Plazanet A, Viglino D, Maignan M. Ultrasonography helps emergency physician identify the best lumbar puncture site under the conus medullaris. Scand J Trauma Resusc Emerg Med 2017; 25:60. [PMID: 28655356 PMCID: PMC5488483 DOI: 10.1186/s13049-017-0406-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Ultrasonography – assisted lumbar puncture helps physicians identify traditional anatomical landmarks. However, it could help to overcome the anatomical dogmas and thus identify the best interspinous space under the medullary cone. Methods Traditional anatomical landmarks were reported on a tracing paper in patients with an indication for lumbar puncture. Then, ultrasonography was used to locate the optimal interspinous level defined as the widest subarachnoid space located below the conus medullaris. Primary endpoint was the distance between traditional and ultrasound landmarks. Results Fifty-seven patients were included. Seven emergency physicians practiced the procedure. The median absolute distance between traditional anatomical landmarks and ultrasound marking was 32 [interquartile (IQR) 27 – 37] mm. The inter-spinous space identified in the two procedures was different in 68% of the cases. Conclusions Ultrasound not only allows us to better identify anatomical structures before lumbar puncture, but it also allows us to choose a site of puncture different from recommendations.
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Affiliation(s)
- Line Dussourd
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Batistin Martinon
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Clara Candille
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Carole Paquier
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Claire Wintenberger
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Perrine Dumanoir
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Anais Plazanet
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Damien Viglino
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Maxime Maignan
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France.
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Dres M, Hausfater P, Foissac F, Bernard M, Joly LM, Sebbane M, Philippon AL, Gil-Jardiné C, Schmidt J, Maignan M, Treluyer JM, Roche N. Mid-regional pro-adrenomedullin and copeptin to predict short-term prognosis of COPD exacerbations: a multicenter prospective blinded study. Int J Chron Obstruct Pulmon Dis 2017; 12:1047-1056. [PMID: 28408815 PMCID: PMC5383071 DOI: 10.2147/copd.s126400] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Exacerbations of COPD (ECOPD) are a frequent cause of emergency room (ER) visits. Predictors of early outcome could help clinicians in orientation decisions. In the current study, we investigated whether mid-regional pro-adrenomedullin (MR-proADM) and copeptin, in addition to clinical evaluation, could predict short-term outcomes. PATIENTS AND METHODS This prospective blinded observational study was conducted in 20 French centers. Patients admitted to the ER for an ECOPD were considered for inclusion. A clinical risk score was calculated, and MR-proADM and copeptin levels were determined from a venous blood sample. The composite primary end point comprised 30-day death or transfer to the intensive care unit or a new ER visit. RESULTS A total of 379 patients were enrolled in the study, of whom 277 were eventually investigated for the primary end point that occurred in 66 (24%) patients. In those patients, the median (interquartile range [IQR]) MR-proADM level was 1.02 nmol/L (0.77-1.48) versus 0.83 nmol/L (0.63-1.07) in patients who did not meet the primary end point (P=0.0009). In contrast, copeptin levels were similar in patients who met or did not meet the primary end point (P=0.23). MR-proADM levels increased with increasing clinical risk score category: 0.74 nmol/L (0.57-0.89), 0.83 nmol/L (0.62-1.12) and 0.95 nmol/L (0.75-1.29) for the low-, intermediate- and high-risk categories, respectively (P<0.001). MR-proADM was independently associated with the primary end point (odds ratio, 1.65; 95% confidence interval [CI], 1.10-2.48; P=0.015). MR-proADM predicted the occurrence of primary end point with a sensitivity of 46% (95% CI, 33%-58%) and a specificity of 79% (95% CI, 74-84). CONCLUSION MR-proADM but not copeptin was significantly associated with outcomes at 30 days, even after adjustment for clinical risk category. Overall, MR-proADM, alone or combined with the clinical risk score, was a moderate strong predictor of short-term outcomes.
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Affiliation(s)
- Martin Dres
- Pulmonary and Critical Care Department, Pitié-Salpêtrière Hospital, AP-HP
- UMRS1158: Clinical and Experimental Respiratory Neurophysiology, Paris 6 University
| | - Pierre Hausfater
- Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP
- Sorbonne Universités UPMC Univ-Paris06, GRC-14 BIOSFAST
| | - Frantz Foissac
- Clinical Research Department, Necker Cochin Hospital, AP-HP
- EA 7323, Sorbonne Paris-Cité
| | - Maguy Bernard
- Biochemistry Department, Pitié-Salpêtrière Hospital, AP-HP, Paris
| | | | - Mustapha Sebbane
- Department of Emergency Medicine, Lapeyronie Hospital, Montpellier
| | - Anne-Laure Philippon
- Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP
- Sorbonne Universités UPMC Univ-Paris06, GRC-14 BIOSFAST
| | | | - Jeannot Schmidt
- Emergency Department, Gabriel Montpied Hospital, Clermont-Ferrand
| | - Maxime Maignan
- Emergency Department, Grenoble University Hospital, Grenoble
| | - Jean-Marc Treluyer
- Clinical Research Department, Paris Descartes University, Hôpital Cochin, AP-HP
| | - Nicolas Roche
- Pulmonary Department, Cochin Hospital, AP-HP
- Paris Descartes University, Paris, France
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Debaty G, Babaz V, Durand M, Gaide-Chevronnay L, Fournel E, Blancher M, Bouvaist H, Chavanon O, Maignan M, Bouzat P, Albaladejo P, Labarère J. Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. Resuscitation 2017; 112:1-10. [DOI: 10.1016/j.resuscitation.2016.12.011] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 11/07/2016] [Accepted: 12/04/2016] [Indexed: 12/29/2022]
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Allibe N, Richeval C, Willeman T, Humbert L, Allorge D, Maignan M, Eysseric-Guerin H, Stanke-Labesque F, Gaulier JM. Case reports: Four concomitant non-fatal intoxications with AB-FUBINACA and MDMA. Toxicologie Analytique et Clinique 2017. [DOI: 10.1016/j.toxac.2016.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Viglino D, Maignan M. Opioids and adverse outcomes in elderly chronic obstructive pulmonary disease patients. Eur Respir J 2016; 48:1817. [PMID: 27903696 DOI: 10.1183/13993003.01610-2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/14/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Damien Viglino
- University Hospital Grenoble Alps - Emergency Dept and Mobile Intensive Care Unit, Grenoble, France.,INSERM U1042, HP2 Laboratory, University Grenoble Alps, Grenoble, France
| | - Maxime Maignan
- University Hospital Grenoble Alps - Emergency Dept and Mobile Intensive Care Unit, Grenoble, France .,INSERM U1042, HP2 Laboratory, University Grenoble Alps, Grenoble, France
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Pernod G, Maignan M, Marlu R. Questioning the use of an age-adjusted D-dimer threshold to exclude venous thromboembolism: analysis of individual patient data from two diagnostic studies: comment. J Thromb Haemost 2016; 14:2553-2554. [PMID: 27537421 DOI: 10.1111/jth.13472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/15/2016] [Indexed: 11/29/2022]
Affiliation(s)
- G Pernod
- Department of Vascular Medicine, University Hospital Grenoble-Alpes, Grenoble, France
- CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble-Alpes University, Grenoble, France
| | - M Maignan
- Department of Emergency, University Hospital Grenoble-Alpes, Grenoble, France
| | - R Marlu
- Hemostasis Unit, University Hospital Grenoble-Alpes, Grenoble, France
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Legris G, Maignan M. Paresthésies radiculaires et cervicalgies : diagnostic d’un gangliogliome bulbomédullaire. Ann Fr Med Urgence 2016. [DOI: 10.1007/s13341-016-0671-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Deroux A, Dumestre-Perard C, Khalil-Mgharbel A, Maignan M, Boccon-Gibod I, Fevre MC, Vilgrain I, Bouillet L. BIOBRAD Study: The Search for Biomarkers of Bradykinin-Mediated Angio-Oedema Attacks. Int Arch Allergy Immunol 2016; 170:108-14. [PMID: 27475458 DOI: 10.1159/000446959] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 05/17/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aetiology of angio-oedema (AE) is difficult to determine; however, it is essential in emergency situations when two major contexts may be present: mast cell-mediated AE and bradykinin-mediated AE. Different forms of AE are currently distinguished based on clinical criteria (spontaneous duration of the attack, presence of concomitant or late-appearing superficial urticaria, history of atopy, and others), but specific biomarkers could improve patient management. OBJECTIVE In this prospective study, potential biomarkers have been identified, and their statistical characteristics were examined. METHODS Samples were taken on day 0 (D0) and D7 for 3 patient groups (n = 11 each): bradykinin-mediated AE [peripheral site of attack, ear, nose, throat (ENT), and abdominal involvement], mast cell-mediated AE, and non-bradykinin-mediated abdominal pain. RESULTS Assay of the potential biomarkers revealed no significant differences in C1 inhibitor and C4 levels. In contrast, D-dimer levels peaked during bradykinin-mediated AE attacks (median 2.2 mg/l at D0 vs. 0.52 mg/l at D7; p < 10-3) as well as during mast cell-mediated AE attacks (1.97 vs. 0.65 mg/l; p = 0.04) and were high in bradykinin-mediated AE compared to the control group (0.69 mg/l; p = 0.01). A threshold value of 0.62 mg/l was found to have a negative predictive value of 100% for bradykinin-mediated AE compared to other causes of abdominal pain (group 3). Circulating VE-cadherin levels were also increased during an attack (1,990 at D0 vs. 1,566 ng/ml at D7; p = 0.01), but could not distinguish between bradykinin-mediated and mast cell-mediated AE, like D-dimers. CONCLUSIONS Exploration of changes in fibrinolysis-related markers (particularly D-dimers) is thus promising for the diagnosis of AE attacks in difficult-to-diagnose abdominal forms, although it was not able to differentiate between bradykinin and mast cell-mediated AE.
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Affiliation(s)
- Alban Deroux
- Internal Medicine Department, Grenoble University Hospital, Grenoble, France
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Debaty G, Maignan M, Perrin B, Brouta A, Guergour D, Trocme C, Bach V, Tanguy S, Briot R. Cardiopulmonary responses during the cooling and the extracorporeal life support rewarming phases in a porcine model of accidental deep hypothermic cardiac arrest. Scand J Trauma Resusc Emerg Med 2016; 24:91. [PMID: 27391370 PMCID: PMC4939029 DOI: 10.1186/s13049-016-0283-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/28/2016] [Indexed: 05/29/2023] Open
Abstract
Background This study aimed to assess cardiac and pulmonary pathophysiological responses during cooling and extracorporeal life support (ECLS) rewarming in a porcine model of deep hypothermic cardiac arrest (DHCA). In addition, we evaluated whether providing a lower flow rate of ECLS during the rewarming phase might attenuate cardiopulmonary injuries. Methods Twenty pigs were cannulated for ECLS, cooled until DHCA occurred and subjected to 30 min of cardiac arrest. In order to assess the physiological impact of ECLS on cardiac output we measured flow in the pulmonary artery using Doppler echocardiography as well as a modified thermodilution technique using the Swan-Ganz catheter (injection site in the right ventricle). The animals were randomized into two groups during rewarming: a group with a low blood flow rate of 1.5 L/min (LF group) and a group with a normal flow rate of 3.0 L/min (NF group). The ECLS temperature was adjusted to 5 °C above the central core. Cardiac output, hemodynamics and pulmonary function parameters were evaluated. Results During the cooling phase, cardiac output, heart rhythm and blood pressure decreased continuously. Pulmonary artery pressure tended to increase at 32 °C compared to the initial value (20.2 ± 1.7 mmHg vs. 29.1 ± 5.6 mmHg, p = 0.09). During rewarming, arterial blood pressure was higher in the NF than in the LF group at 20° and 25 °C (p = 0.003 and 0.05, respectively). After rewarming to 35 °C, cardiac output was 3.9 ± 0.5 L/min in the NF group vs. 2.7 ± 0.5 L/min in LF group (p = 0.06). At the end of rewarming under ECLS cardiac output was inversely proportional to the ECLS flow rate. Moreover, the ECLS flow rate did not significantly change pulmonary vascular resistance. Discussion Using a newly developed experimental model of DHCA treated by ECLS, we assessed the cardiac and pulmonary pathophysiological response during the cooling phase and the ECLS rewarming phase. Despite lower metabolic need during hypothermia, a low ECLS blood flow rate during rewarming did not improved cardiopulmonary injuries after rewarming. Conclusion A low ECLS flow rate during the rewarming phase did not attenuate pulmonary lesions, increased blood lactate level and tended to decrease cardiac output after rewarming. A normal ECLS flow rate did not increase pulmonary vascular resistance compared to a low flow rate. This experimental model on pigs contributes a number of pathophysiological findings relevant to the rewarming strategy for patients who have undergone accidental DHCA.
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Affiliation(s)
- Guillaume Debaty
- Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble, Grenoble, France. .,University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525/Team PRETA, Grenoble, F-38041, France.
| | - Maxime Maignan
- Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble, Grenoble, France
| | - Bertrand Perrin
- University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525/Team PRETA, Grenoble, F-38041, France
| | - Angélique Brouta
- University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525/Team PRETA, Grenoble, F-38041, France
| | - Dorra Guergour
- Department of Biochemistry Toxicology and Pharmacology, University Hospital of Grenoble, Grenoble, France
| | - Candice Trocme
- Department of Biochemistry Toxicology and Pharmacology, University Hospital of Grenoble, Grenoble, France
| | - Vincent Bach
- Department of cardiac surgery, University Hospital of Grenoble, Grenoble, France
| | - Stéphane Tanguy
- University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525/Team PRETA, Grenoble, F-38041, France
| | - Raphaël Briot
- Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble, Grenoble, France.,University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525/Team PRETA, Grenoble, F-38041, France
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Debaty G, Maignan M, Perrin B, Brouta A, Guergour D, Trocme C, Bach V, Tanguy S, Briot R. Deep Hypothermic Cardiac Arrest Treated by Extracorporeal Life Support in a Porcine Model: Does the Rewarming Method Matter? Acad Emerg Med 2016; 23:665-73. [PMID: 26728797 DOI: 10.1111/acem.12893] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/20/2015] [Accepted: 12/16/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Extracorporeal life support (ECLS) is the reference rewarming technique of accidental deep hypothermic cardiac arrest (DHCA). This study was designed to examine the impact of different rewarming blood flow rates and temperature setting of ECLS on cardiopulmonary lesions after DHCA in a porcine model of accidental hypothermia. METHODS Twenty-four pigs were cannulated for ECLS, cooled until DHCA occurred, and subjected to 30 minutes of cardiac arrest. During the rewarming phase, we compared a low blood flow rate of 1.5 L/min versus a high flow rate of 3.0 L/min as well as two-temperature-setting rewarming strategies: a temperature during ECLS adjusted to 5°C above the central core temperature versus 38°C maintained throughout the rewarming phase. Cardiac output, hemodynamics and pulmonary function parameters were evaluated. Biologic markers of ischemia-reperfusion injuries were analyzed at baseline and at the end of the experiment. RESULTS DHCA occurred at 21.2 ± 2°C. There was a trend for better cardiac output in groups with high blood flow (p = 0.053), with no interaction between ECLS flow and temperature (p = 0.63), a trend toward lower pulmonary vascular resistance (PVR; p = 0.075) and a significant decrease in arterial PVR in groups with high blood flow (p = 0.013) with no interaction (p = 0.47 and p = 0.60 for PVR and arterial PVR, respectively). Serum interleukin-6, tumor necrosis factor-α, receptor for advanced glycation end products (RAGE), and neuron-specific enolase were significantly increased between baseline and endpoint. The increase in the serum RAGE concentration was higher in the 38°C rewarming temperature groups compared to 5°C above adjusted temperature. There were no other significant differences in biomarkers. CONCLUSIONS We developed a porcine model of DHCA treated by ECLS. Our data suggest that cardiac output tended to improve with a high-flow-rate rewarming strategy while a high-temperature delta between core temperature and ECLS increased the RAGE markers of lung injury.
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Affiliation(s)
- Guillaume Debaty
- University Grenoble Alps; CNRS; TIMC-IMAG UMR 5525; Team PRETA; Grenoble France
- Department of Emergency Medicine; SAMU 38; University Hospital of Grenoble Alps; Grenoble France
| | - Maxime Maignan
- Department of Emergency Medicine; SAMU 38; University Hospital of Grenoble Alps; Grenoble France
| | - Bertrand Perrin
- University Grenoble Alps; CNRS; TIMC-IMAG UMR 5525; Team PRETA; Grenoble France
| | - Angélique Brouta
- University Grenoble Alps; CNRS; TIMC-IMAG UMR 5525; Team PRETA; Grenoble France
| | - Dorra Guergour
- Department of Biochemistry Toxicology and Pharmacology; University Hospital of Grenoble Alps; Grenoble France
| | - Candice Trocme
- Department of Biochemistry Toxicology and Pharmacology; University Hospital of Grenoble Alps; Grenoble France
| | - Vincent Bach
- Department of Cardiac Surgery; University Hospital of Grenoble Alps; Grenoble France
| | - Stéphane Tanguy
- University Grenoble Alps; CNRS; TIMC-IMAG UMR 5525; Team PRETA; Grenoble France
| | - Raphaël Briot
- University Grenoble Alps; CNRS; TIMC-IMAG UMR 5525; Team PRETA; Grenoble France
- Department of Emergency Medicine; SAMU 38; University Hospital of Grenoble Alps; Grenoble France
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Viglino D, Maignan M, Debaty G. A modified Sequential Organ Failure Assessment score using the Richmond Agitation-Sedation Scale in critically ill patients. J Thorac Dis 2016; 8:311-3. [PMID: 27076924 DOI: 10.21037/jtd.2016.02.61] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Damien Viglino
- 1 Department of Emergency Medicine, University Hospital of Grenoble Alps, France ; 2 University Grenoble Alps, Inserm U1042, HP2 laboratory, Grenoble, France ; 3 University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525/PRETA Team, Grenoble, France
| | - Maxime Maignan
- 1 Department of Emergency Medicine, University Hospital of Grenoble Alps, France ; 2 University Grenoble Alps, Inserm U1042, HP2 laboratory, Grenoble, France ; 3 University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525/PRETA Team, Grenoble, France
| | - Guillaume Debaty
- 1 Department of Emergency Medicine, University Hospital of Grenoble Alps, France ; 2 University Grenoble Alps, Inserm U1042, HP2 laboratory, Grenoble, France ; 3 University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525/PRETA Team, Grenoble, France
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Maignan M, Koch FX, Chaix J, Phellouzat P, Binauld G, Collomb Muret R, Cooper SJ, Labarère J, Danel V, Viglino D, Debaty G. Team Emergency Assessment Measure (TEAM) for the assessment of non-technical skills during resuscitation: Validation of the French version. Resuscitation 2016; 101:115-20. [DOI: 10.1016/j.resuscitation.2015.11.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/19/2015] [Accepted: 11/29/2015] [Indexed: 11/26/2022]
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Viglino D, Bourez D, Collomb-Muret R, Schwebel C, Tazarourte K, Dumanoir P, Paquier C, Danel V, Debaty G, Maignan M. Noninvasive End Tidal CO2 Is Unhelpful in the Prediction of Complications in Deliberate Drug Poisoning. Ann Emerg Med 2016; 68:62-70.e1. [PMID: 26810758 DOI: 10.1016/j.annemergmed.2015.11.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/19/2015] [Accepted: 11/25/2015] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVE We study the performance of capnometry in the detection of early complications after deliberate drug poisoning. METHODS This was a prospective cohort study of self-poisoned adult patients who presented at an emergency department (ED) between April 20, 2012, and May 6, 2014. Patients who ingested at least 1 neurologic or respiratory depressant drug were included. The primary outcome was the predictive value of an end tidal CO2 (etco2) measurement greater than or equal to 50 mm Hg for the detection of early complications defined a priori by hypoxia requiring oxygen greater than or equal to 3 L/min, bradypnea less than or equal to 10 breaths/min, or ICU admission after intubation or antidote administration because of unresponsiveness to pain or respiratory arrest. Consciousness scales and clinical data were recorded at admission and every 30 minutes. Noninvasive etco2 was continuously measured for 2 hours after inclusion unless the patient was admitted to the ICU. Patients and physicians were blinded to etco2 values. RESULTS Two hundred one patients were included, 35 of whom exhibited at least 1 complication. An etco2 measurement greater than or equal to 50 mm Hg predicted the onset of a complication, with a sensitivity of 46% (95% confidence interval [CI] 29% to 63%) and a specificity of 80% (95% CI 73% to 86%), leading to a positive predictive value of 33% (95% CI 20% to 48%) and a negative predictive value of 88% (95% CI 81% to 92%). etco2 was less able to predict complications than the Glasgow Coma Scale score at inclusion. CONCLUSION Capnometry in isolation does not provide adequate prediction of early complications in self-poisoned patients referred to the ED. A dynamic minute-by-minute assessment of etco2 could be more predictive.
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Affiliation(s)
- Damien Viglino
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; INSERM U1042, HP2 Laboratory, University Grenoble Alps, Grenoble, France
| | - Delphine Bourez
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Roselyne Collomb-Muret
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Carole Schwebel
- University Grenoble Alps-Medical Intensive Care Unit, CHU Michallon, Grenoble, France
| | | | - Perrine Dumanoir
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Carole Paquier
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Vincent Danel
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Guillaume Debaty
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; CNRS UMR 5525, TIMC-IMAG Laboratory, Team PRETA, University Grenoble Alps, Grenoble, France
| | - Maxime Maignan
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; CNRS UMR 5525, TIMC-IMAG Laboratory, Team PRETA, University Grenoble Alps, Grenoble, France.
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Collart C, Maignan M, Sakhri L, Paquier C, Moro-Sibilot D, Carpentier F, Toffart A. Caractéristiques et orientation des patients atteints d’un cancer bronchique avec défaillance d’organe admis aux urgences du CHU de Grenoble. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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