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Chu K, Kelly AM, Kuan WS, Kinnear FB, Keijzers G, Horner D, Laribi S, Cardozo A, Karamercan MA, Klim S, Wijeratne T, Kamona S, Graham CA, Body R, Roberts T. Predictive performance of the common red flags in emergency department headache patients: a HEAD and HEAD-Colombia study. Emerg Med J 2024:emermed-2023-213461. [PMID: 38658053 DOI: 10.1136/emermed-2023-213461] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Only a small proportion of patients presenting to an ED with headache have a serious cause. The SNNOOP10 criteria, which incorporates red and orange flags for serious causes, has been proposed but not well studied. This project aims to compare the proportion of patients with 10 commonly accepted red flag criteria (singly and in combination) between patients with and without a diagnosis of serious secondary headache in a large, multinational cohort of ED patients presenting with headache. METHODS Secondary analysis of data obtained in the HEAD and HEAD-Colombia studies. The outcome of interest was serious secondary headache. The predictive performance of 10 red flag criteria from the SNNOOP10 criteria list was estimated individually and in combination. RESULTS 5293 patients were included, of whom 6.1% (95% CI 5.5% to 6.8%) had a defined serious cause identified. New neurological deficit, history of neoplasm, older age (>50 years) and recent head trauma (2-7 days prior) were independent predictors of a serious secondary headache diagnosis. After adjusting for other predictors, sudden onset, onset during exertion, pregnancy and immune suppression were not associated with a serious headache diagnosis. The combined sensitivity of the red flag criteria overall was 96.5% (95% CI 93.2% to 98.3%) but specificity was low, 5.1% (95% CI 4.3% to 6.0%). Positive predictive value was 9.3% (95% CI 8.2% to 10.5%) with negative predictive value of 93.5% (95% CI 87.6% to 96.8%). CONCLUSION The sensitivity and specificity of the red flag criteria in this study were lower than previously reported. Regarding clinical practice, this suggests that red flag criteria may be useful to identify patients at higher risk of a serious secondary headache cause, but their low specificity could result in increased rates of CT scanning. TRIAL REGISTRATION NUMBER ANZCTR376695.
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Affiliation(s)
- Kevin Chu
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Footscray, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, Singapore
| | - Frances B Kinnear
- Emergency and Children's Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Daniel Horner
- Emergency Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
| | | | | | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Footscray, Victoria, Australia
| | - Tissa Wijeratne
- Department of Neurology, Western Health, Footscray, Victoria, Australia
| | - Sinan Kamona
- School of Medicine, University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Colin A Graham
- Emergency Medicine, Chinese University of Hong Kong - Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Richard Body
- Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Tom Roberts
- Trainee Emergency Research Network, London, UK
- North Bristol NHS Trust, Bristol, UK
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Rocher M, Benayoun Y, Quilbe S, Laribi S, Fournie P, Leveziel N, Trone MC, Bourcier T, Robert PY. [A randomized study of subconjonctival bevacizumab (Avastin®) injection for corneal neovascularization]. J Fr Ophtalmol 2024; 47:104152. [PMID: 38696862 DOI: 10.1016/j.jfo.2024.104152] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 05/04/2024]
Abstract
PURPOSE The goal of this phase III, comparative, multicentric, randomized, double-blinded clinical trial was to investigate the superiority of subconjunctival bevacizumab injections versus placebo in the treatment of corneal neovascularization. PATIENTS AND METHODS We included 38 eyes (38 patients) with corneal neovascularization. Twenty patients received bevacizumab and 18 placebos. Patients received 3 monthly injections of either 5mg (0.2mL) bevacizumab or placebo. The main criteria of success was reduction of the surface area of corneal neovascularization after 3months (M3) versus baseline, as measured using semi-automatic analysis of color photographs. RESULTS The percentage of neovascularized corneal surface decreased by -8.6%±32.8 with bevacizumab, versus -2.6%±20.8 with placebo (p=0.5284). Four patients were determined to be responders (reduction of more than 30%), 3 in the bevacizumab group and 1 in the placebo group, all with neovascularization of less than 1year duration. When restricting the analysis to neovascularization of less than 1 year duration, the difference approached the threshold for significance (-31.8%±42.4 in the bevacizumab group and -0.9%±23.1 in the placebo group) (p=0.0637), as well as the number of responders (3/6 in the bevacizumab group versus 1/10 in the placebo group) (p=0.1181). No serious adverse event was reported. CONCLUSION This study shows the efficacy of subconjunctival bevacizumab injection in the reduction of neovascularized corneal surface area versus placebo, but only when the neovascularization has been present less than 1year. Nevertheless, the study did not attain the statistical power to pass the threshold of significance.
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Affiliation(s)
- M Rocher
- CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Y Benayoun
- CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - S Quilbe
- CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - S Laribi
- CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - P Fournie
- CHU de Toulouse, 2, rue Charles-Viguerie, 31300 Toulouse, France
| | - N Leveziel
- CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - M-C Trone
- CHU de Saint Etienne, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - T Bourcier
- CHU de Strasbourg, 1, place de l'hôpital, BP 426, 67091 Strasbourg cedex, France
| | - P-Y Robert
- CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
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Coats T, Conroy S, de Groot B, Heeren P, Lim S, Lucke J, Mooijaart S, Nickel CH, Penfold R, Singler K, van Oppen JD, Polyzogopoulou E, Kruis A, McNamara R, de Groot B, Castejon-Hernandez S, Miro O, Karamercan MA, Dündar ZD, van Oppen JD, Pavletić M, Libicherová P, Balen F, Benhamed A, Dubucs X, Hernu R, Laribi S, Singler K, Fraidakis O, Fyntanidou VP, Polyzogopoulou E, Gaal S, Jónsdóttir AB, Kelly-Friel ME, McAteer CA, Sibthorpe LD, Synnott A, Zazzara MB, Coffeng SM, de Groot B, Lucke JA, Smits RAL, Castejon-Hernandez S, Llauger L, Mir SA, Ortiz MS, Padilla EE, Rodeles SC, Rojewski-Rojas W, Fadini D, Jegerlehner NS, Nickel CH, Rezzonico S, Zucconi EC, Cakmak S, Demir HA, Dündar ZD, Güven R, Karamercan MA, Sogut O, Tayfur I, Adams JA, Bernardo J, Brown L, Burton J, Butler MJ, Claassen RI, Compton F, Cooper JG, Heyes R, Ko S, Lightbody CJ, Masoli JAH, McKenzie STG, Mawhinney D, Moultrie NJ, Price A, Raman R, Rothwell LH, Shashikala RP, Smith EJ, Sorice V, van Oppen JD, Wallace JM, Young T, Benvin A, Breški E, Ćefo A, Dumić D, Ferenac R, Jurica I, Otočan M, Zinaić PŠ, Clement B, Jacquin L, Royer B, Apfelbacher SI, Bezati S, Gkarmiri S, Kaltsidou CV, Klonos G, Korka Z, Koufogianni A, Mavros V, Nano A, Ntousopoulos A, Papadopoulos N, Sason R, Zagalioti SC, Hjaltadottir I, Sigurþórsdóttir I, Skuladottir SS, Thorsteinsdottir T, Breslin D, Byrne CP, Dolan A, Harte O, Kazi D, McCarthy A, McMillan SS, Moiloa DN, O’Shaughnessy ÍL, Ramiah V, Williams S, Giani T, Levati E, Montenero R, Russo A, Salini S, van den Berg B, Booijen AM, Sir O, Vermeulen AE, ter Voert MA, Alvarez-Galarraga AC, Azeli Y, Gómez RGG, González González R, Lizardo D, Pérez ML, Madan CN, Medina JÁ, Moreno JS, Patiño EVB, Posada DMC, Rodrigo IC, Vitucci CF, Ballinari M, Dreher T, Gianinazzi L, Espejo T, Hautz WE, Rezzonico S, Bayramoğlu B, Cakmak S, Comruk B, Dogan T, Köse F, Allen TP, Ardley R, Beith CM, Boath KA, Britton HL, Campbell MMF, Capel J, Catney C, Clements S, Collins BP, Compton F, Cook A, Cosgriff EJ, Coventry T, Doyle N, Evans Z, Fasina TA, Ferrick JF, Fleming GM, Gallagher C, Golden M, Gorania D, Glass L, Greenlees H, Haddock ZP, Harris R, Hollas C, Hunter A, Ingham C, Ip SSY, James JA, Kenenden C, Jenkinson GE, Lee E, Lovick SA, McFadden M, McGovern R, Medhora J, Merchant F, Mishra S, Moreland GB, Narayanasamy S, Neal AR, Nicholls EL, Omar MT, Osborne N, Oteme FO, Pearson J, Price R, Sajan M, Sandhu LK, Scott-Murfitt H, Sealey B, Sharp EP, Spowage-Delaney BAC, Stephen F, Stevenson L, Tyrrell I, Ukoh CK, Walsh R, Watson AM, Whiteford JEC, Allston-Reeve C, Barson TJ, Giorgi MG, Godhania YL, Inchley V, Mirkes E, Rahman S. Prevalence of Frailty in European Emergency Departments (FEED): an international flash mob study. Eur Geriatr Med 2024; 15:463-470. [PMID: 38340282 PMCID: PMC10997678 DOI: 10.1007/s41999-023-00926-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/19/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Current emergency care systems are not optimized to respond to multiple and complex problems associated with frailty. Services may require reconfiguration to effectively deliver comprehensive frailty care, yet its prevalence and variation are poorly understood. This study primarily determined the prevalence of frailty among older people attending emergency care. METHODS This cross-sectional study used a flash mob approach to collect observational European emergency care data over a 24-h period (04 July 2023). Sites were identified through the European Task Force for Geriatric Emergency Medicine collaboration and social media. Data were collected for all individuals aged 65 + who attended emergency care, and for all adults aged 18 + at a subset of sites. Variables included demographics, Clinical Frailty Scale (CFS), vital signs, and disposition. European and national frailty prevalence was determined with proportions with each CFS level and with dichotomized CFS 5 + (mild or more severe frailty). RESULTS Sixty-two sites in fourteen European countries recruited five thousand seven hundred eighty-five individuals. 40% of 3479 older people had at least mild frailty, with countries ranging from 26 to 51%. They had median age 77 (IQR, 13) years and 53% were female. Across 22 sites observing all adult attenders, older people living with frailty comprised 14%. CONCLUSION 40% of older people using European emergency care had CFS 5 + . Frailty prevalence varied widely among European care systems. These differences likely reflected entrance selection and provide windows of opportunity for system configuration and workforce planning.
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Reed MJ, Karuranga S, Kearns D, Alawiye S, Clarke B, Möckel M, Karamercan M, Janssens K, Riesgo LGC, Torrecilla FM, Golea A, Fernández Cejas JA, Lupan-Muresan EM, Zaimi E, Nuernberger A, Rennét O, Skjaerbaek C, Polyzogopoulou E, Imecz J, Groff P, Camilleri R, Cimpoesu D, Jovic M, Miró Ò, Anderson R, Laribi S. Management of syncope in the Emergency Department: a European prospective cohort study (SEED). Eur J Emerg Med 2024; 31:136-146. [PMID: 38015745 DOI: 10.1097/mej.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND AND IMPORTANCE In 2018, the European Society of Cardiology (ESC) produced syncope guidelines that for the first-time incorporated Emergency Department (ED) management. However, very little is known about the characteristics and management of this patient group across Europe. OBJECTIVES To examine the prevalence, clinical presentation, assessment, investigation (ECG and laboratory testing), management and ESC and Canadian Syncope Risk Score (CSRS) categories of adult European ED patients presenting with transient loss of consciousness (TLOC, undifferentiated or suspected syncope). DESIGN Prospective, multicentre, observational cohort study. SETTINGS AND PARTICIPANTS Adults (≥18 years) presenting to European EDs with TLOC, either undifferentiated or thought to be of syncopal origin. MAIN RESULTS Between 00:01 Monday, September 12th to 23:59 Sunday 25 September 2022, 952 patients presenting to 41 EDs in 14 European countries were enrolled from 98 301 ED presentations (n = 40 sites). Mean age (SD) was 60.7 (21.7) years and 487 participants were male (51.2%). In total, 379 (39.8%) were admitted to hospital and 573 (60.2%) were discharged. 271 (28.5%) were admitted to an observation unit first with 143 (52.8%) of these being admitted from this. 717 (75.3%) participants were high-risk according to ESC guidelines (and not suitable for discharge from ED) and 235 (24.7%) were low risk. Admission rate increased with increasing ESC high-risk factors; 1 ESC high-risk factor; n = 259 (27.2%, admission rate=34.7%), 2; 189 (19.9%; 38.6%), 3; 106 (11.1%, 54.7%, 4; 62 (6.5%, 60.4%), 5; 48 (5.0%, 67.9%, 6+; 53 (5.6%, 67.9%). Furthermore, 660 (69.3%), 250 (26.3%), 34 (3.5%) and 8 (0.8%) participants had a low, medium, high, and very high CSRS respectively with respective admission rates of 31.4%, 56.0%, 76.5% and 75.0%. Admission rates (19.3-88.9%), use of an observation/decision unit (0-100%), and percentage high-risk (64.8-88.9%) varies widely between countries. CONCLUSION This European prospective cohort study reported a 1% prevalence of syncope in the ED. 4 in 10 patients are admitted to hospital although there is wide variation between country in syncope management. Three-quarters of patients have ESC high-risk characteristics with admission percentage rising with increasing ESC high-risk factors.
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Affiliation(s)
- Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Suvi Karuranga
- European Society for Emergency Medicine, Antwerp, Belgium
| | - David Kearns
- University of Edinburgh Medical School, Edinburgh, UK
| | - Salma Alawiye
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh
| | - Ben Clarke
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh
| | - Martin Möckel
- Department of Emergency and Acute Medicine, Campus Mitte and Virchow, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Mehmet Karamercan
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Kelly Janssens
- St Vincents University Healthcare Group, Dublin, Ireland
| | | | | | - Adela Golea
- Emergency Unit, University of Medicine and Pharmacy Cluj, University Emergency County Hospital, Cluj Napoca, Romania
| | | | - Eugenia Maria Lupan-Muresan
- Emergency Medicine Discipline, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Edmond Zaimi
- University Hospital Centre, Mother Teresa of Tirana, Tirana, Albania
| | | | | | | | | | | | - Paolo Groff
- Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Diana Cimpoesu
- University of Medicine and Pharmacy Grigore T Popa, Iasi, Romania
| | - Miljan Jovic
- General Hospital, Health Centre, Zaječar, Serbia
| | - Òscar Miró
- Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | | | - Said Laribi
- Emergency Medicine Department, CHU Tours, Tours University, Tours, France
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Behringer W, Böttiger BW, Biasucci DG, Chalkias A, Connolly J, Dodt C, Khoury A, Laribi S, Leach R, Ristagno G. Temperature control after successful resuscitation from cardiac arrest in adults: a joint statement from the European Society for Emergency Medicine (EUSEM) and the European Society of Anaesthesiology and Intensive Care (ESAIC). Eur J Emerg Med 2024; 31:86-89. [PMID: 38126247 PMCID: PMC10901227 DOI: 10.1097/mej.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Wilhelm Behringer
- Department of Emergency Medicine, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Bernd W. Böttiger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany
| | - Daniele G. Biasucci
- Department of Clinical Science and Translational Medicine, ‘Tor Vergata’ University of Rome, Rome, Italy
| | - Athanasios Chalkias
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
- Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Jim Connolly
- Accident and Emergency, Great North Trauma and Emergency Care, Newcastle-upon-Tyne, UK
| | - Christoph Dodt
- Department of Emergency Medicine, München Klinik, Munich, Germany
| | - Abdo Khoury
- Department of Emergency Medicine and Critical Care, Besançon University Hospital, Besançon
| | - Said Laribi
- Department of Emergency Medicine, Tours University Hospital, Tours, France
| | - Robert Leach
- Department of Emergency Medicine, Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
| | - Giuseppe Ristagno
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Behringer W, Böttiger BW, Biasucci DG, Chalkias A, Connolly J, Dodt C, Khoury A, Laribi S, Leach R, Ristagno G. Temperature control after successful resuscitation from cardiac arrest in adults: A joint statement from the European Society for Emergency Medicine and the European Society of Anaesthesiology and Intensive Care. Eur J Anaesthesiol 2024; 41:278-281. [PMID: 38126249 PMCID: PMC10906202 DOI: 10.1097/eja.0000000000001948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
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Le Cornec C, Le Pottier M, Broch H, Marguinaud Tixier A, Rousseau E, Laribi S, Janière C, Brenckmann V, Guillerm A, Deciron F, Kabbaj A, Jenvrin J, Péré M, Montassier E. Ketamine Compared With Morphine for Out-of-Hospital Analgesia for Patients With Traumatic Pain: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2352844. [PMID: 38285446 PMCID: PMC10825723 DOI: 10.1001/jamanetworkopen.2023.52844] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 10/12/2023] [Accepted: 11/30/2023] [Indexed: 01/30/2024] Open
Abstract
Importance Pain is a common out-of-hospital symptom among patients, and opioids are often prescribed. Research suggests that overprescribing for acute traumatic pain is still prevalent, even when limits restricting opioid prescriptions have been implemented. Ketamine hydrochloride is an alternative to opioids in adults with out-of-hospital traumatic pain. Objective To assess the noninferiority of intravenous ketamine compared with intravenous morphine sulfate to provide pain relief in adults with out-of-hospital traumatic pain. Design, Setting, and Participants The Intravenous Subdissociative-Dose Ketamine Versus Morphine for Prehospital Analgesia (KETAMORPH) study was a multicenter, single-blind, noninferiority randomized clinical trial comparing ketamine hydrochloride (20 mg, followed by 10 mg every 5 minutes) with morphine sulfate (2 or 3 mg every 5 minutes) in adult patients with out-of-hospital trauma and a verbal pain score equal to or greater than 5. Enrollment occurred from November 23, 2017, to November 26, 2022, in 11 French out-of-hospital emergency medical units. Interventions Patients were randomly assigned to ketamine (n = 128) or morphine (n = 123). Main Outcomes and Measures The primary outcome was the between-group difference in mean change in verbal rating scale pain scores measured from the time before administration of the study drug to 30 minutes later. A noninferiority margin of 1.3 was chosen. Results A total of 251 patients were randomized (median age, 51 [IQR, 34-69] years; 111 women [44.9%] and 140 men [55.1%] among the 247 with data available) and were included in the intention-to-treat population. The mean pain score change was -3.7 (95% CI, -4.2 to -3.2) in the ketamine group compared with -3.8 (95% CI, -4.2 to -3.4) in the morphine group. The difference in mean pain score change was 0.1 (95% CI, -0.7 to 0.9) points. There were no clinically meaningful differences for vital signs between the 2 groups. The intravenous morphine group had 19 of 113 (16.8% [95% CI, 10.4%-25.0%]) adverse effects reported (most commonly nausea [12 of 113 (10.6%)]) compared with 49 of 120 (40.8% [95% CI, 32.0%-49.6%]) in the ketamine group (most commonly emergence phenomenon [24 of 120 (20.0%)]). No adverse events required intervention. Conclusions and Relevance In the KETAMORPH study of patients with out-of-hospital traumatic pain, the use of intravenous ketamine compared with morphine showed noninferiority for pain reduction. In the ongoing opioid crisis, ketamine administered alone is an alternative to opioids in adults with out-of-hospital traumatic pain. Trial Registration ClinicalTrials.gov Identifier: NCT03236805.
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Affiliation(s)
- Clément Le Cornec
- Department of Emergency Medicine, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
| | | | - Hélène Broch
- Urgences Service Mobile d’Urgence et de Réanimation (SMUR), Centre Hospitalier Chateaubriant, Chateaubriant, France
| | - Alexandre Marguinaud Tixier
- Pôle Urgences Adultes–Service d’Aide Médicale Urgente (SAMU), Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | | | - Said Laribi
- Centre Hospitalier Régional et Universitaire Tours Urgences SAMU 37 SMUR de Tours, Tours, France
| | - Charles Janière
- SAMU85 Centre Hospitalier Départemental Vendée la Roche sur Yon, la Roche sur Yon, France
| | | | | | - Florence Deciron
- Centre Hospitalier Le Mans SAMU 72 SMUR du Mans, Le Mans, France
| | - Amine Kabbaj
- Centre Hospitalier Saint Nazaire Urgences SMUR de Saint Nazaire, Saint Nazaire, France
| | - Joël Jenvrin
- Department of Emergency Medicine, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
| | - Morgane Péré
- Plateforme de Méthodologie et Biostatistique, CHU Nantes, Nantes, France
| | - Emmanuel Montassier
- Department of Emergency Medicine, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
- Center for Research in Transplantation and Translational Immunology, Unité Mixte de Recherche 1064, Nantes Université, CHU Nantes, Institut National de la Santé et de la Recherche Médicale, Nantes, France
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Roussel M, Teissandier D, Yordanov Y, Balen F, Noizet M, Tazarourte K, Bloom B, Catoire P, Berard L, Cachanado M, Simon T, Laribi S, Freund Y. Overnight Stay in the Emergency Department and Mortality in Older Patients. JAMA Intern Med 2023; 183:1378-1385. [PMID: 37930696 PMCID: PMC10628833 DOI: 10.1001/jamainternmed.2023.5961] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Received: 07/10/2023] [Accepted: 08/26/2023] [Indexed: 11/07/2023]
Abstract
Importance Patients in the emergency department (ED) who are waiting for hospital admission on a wheeled cot may be subject to harm. However, mortality and morbidity among older patients who spend the night in the ED while waiting for a bed in a medical ward are unknown. Objective To assess whether older adults who spend a night in the ED waiting for admission to a hospital ward are at increased risk of in-hospital mortality. Design, Settings, and Participants This was a prospective cohort study of older patients (≥75 years) who visited the ED and were admitted to the hospital on December 12 to 14, 2022, at 97 EDs across France. Two groups were defined and compared: those who stayed in the ED from midnight until 8:00 am (ED group) and those who were admitted to a ward before midnight (ward group). Main Outcomes and Measures The primary end point was in-hospital mortality, truncated at 30 days. Secondary outcomes included in-hospital adverse events (ie, falls, infection, bleeding, myocardial infarction, stroke, thrombosis, bedsores, and dysnatremia) and hospital length of stay. A generalized linear-regression mixed model was used to compare end points between groups. Results The total sample comprised 1598 patients (median [IQR] age, 86 [80-90] years; 880 [55%] female and 718 [45%] male), with 707 (44%) in the ED group and 891 (56%) in the ward group. Patients who spent the night in the ED had a higher in-hospital mortality rate of 15.7% vs 11.1% (adjusted risk ratio [aRR], 1.39; 95% CI, 1.07-1.81). They also had a higher risk of adverse events compared with the ward group (aRR, 1.24; 95% CI, 1.04-1.49) and increased median length of stay (9 vs 8 days; rate ratio, 1.20; 95% CI, 1.11-1.31). In a prespecified subgroup analysis of patients who required assistance with the activities of daily living, spending the night in the ED was associated with a higher in-hospital mortality rate (aRR, 1.81; 95% CI, 1.25-2.61). Conclusions and Relevance The findings of this prospective cohort study indicate that for older patients, waiting overnight in the ED for admission to a ward was associated with increased in-hospital mortality and morbidity, particularly in patients with limited autonomy. Older adults should be prioritized for admission to a ward.
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Affiliation(s)
- Melanie Roussel
- Emergency Department, Centre Hospitalier Universitaire (CHU) de Rouen, Rouen, France
| | - Dorian Teissandier
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Youri Yordanov
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique–Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Sorbonne Université, Paris, France
| | - Frederic Balen
- Emergency Department, CHU de Toulouse, EQUITY (embodiment, social inequalities, life course epidemiology, cancer, and chronic diseases, interventions, methodology) team, Center for Epidemiology and Research in Population Health, INSERM, Toulouse, France
| | - Marc Noizet
- Emergency Department and Service d’Aide Médicale Urgente (SAMU) 68, Groupe Hospitalier de la Région Mulhouse Sud Alsace, Mulhouse, France
| | - Karim Tazarourte
- Emergency Department and SAMU 69, Hôpital Edouard Herriot, Hospices Civils de Lyon, Université Lyon 1 INSERM 1290 reshape, Lyon, France
| | - Ben Bloom
- Emergency Department, Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Pierre Catoire
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France
- Sorbonne Université, Paris, France
| | - Laurence Berard
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marine Cachanado
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tabassome Simon
- Sorbonne Université, Paris, France
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Said Laribi
- Emergency Department, CHU Tours, Tours, France
| | - Yonathan Freund
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France
- Sorbonne Université, Paris, France
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Chu K, Kelly AM, Keijzers G, Kinnear F, Kuan WS, Graham C, Laribi S, Roberts T, Karamercan M, Cardozo-Ocampo A, Kamona S, Body R, Horner D, Klim S, Brown N, Wijeratne T. Computed tomography brain scan utilization in patients with headache presenting to emergency departments: a multinational study. Eur J Emerg Med 2023; 30:356-364. [PMID: 37310953 DOI: 10.1097/mej.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND IMPORTANCE Recommended indications for emergency computed tomography (CT) brain scans are not only complex and evolving, but it is also unknown whether they are being followed in emergency departments (EDs). OBJECTIVE To determine the CT utilization and diagnostic yield in the ED in patients with headaches across broad geographical regions. DESIGN Secondary analysis of data from a multinational cross-sectional study of ED headache presentations over one month in 2019. SETTING AND PARTICIPANTS Hospitals from 10 participating countries were divided into five geographical regions [Australia and New Zealand (ANZ); Colombia; Europe: Belgium, France, UK, and Romania; Hong Kong and Singapore (HKS); and Turkey). Adult patients with nontraumatic headache as the primary presenting complaint were included. Patients were identified from ED management systems. OUTCOME MEASURES AND ANALYSIS The outcome measures were CT utilization and diagnostic yield. CT utilization was calculated using a multilevel binary logistic regression model to account for clustering of patients within hospitals and regions. Imaging data (CT requests and reports) were sourced from radiology management systems. MAIN RESULTS The study included 5281 participants. Median (interquartile range) age was 40 (29-55) years, 66% were women. Overall mean CT utilization was 38.5% [95% confidence interval (CI), 30.4-47.4%]. Regional utilization was highest in Europe (46.0%) and lowest in Turkey (28.9%), with HKS (38.0%), ANZ (40.0%), and Colombia (40.8%) in between. Its distribution across hospitals was approximately symmetrical. There was greater variation in CT utilization between hospitals within a region than between regions (hospital variance 0.422, region variance 0.100). Overall mean CT diagnostic yield was 9.9% (95% CI, 8.7-11.3%). Its distribution across hospitals was positively skewed. Regional yield was lower in Europe (5.4%) than in other regions: Colombia (9.1%), HKS (9.7%), Turkey (10.6%), and ANZ (11.2%). There was a weak negative correlation between utilization and diagnostic yield ( r = -0.248). CONCLUSION In this international study, there was a high variation (28.9-46.6%) in CT utilization and diagnostic yield (5.4-11.2%) across broad geographic regions. Europe had the highest utilization and the lowest yield. The study findings provide a foundation to address variation in neuroimaging in ED headache presentations.
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Affiliation(s)
- Kevin Chu
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane
- Faculty of Medicine, University of Queensland, Queensland
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne
- Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast
- School of Medicine, Bond University, Gold Coast
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | | | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - Colin Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Said Laribi
- Department of Emergency Medicine, Tours University Hospital, Tours, France
| | - Tom Roberts
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Mehmet Karamercan
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | | | - Sinan Kamona
- Adult Emergency Department, Auckland City Hospital
- Faculty of Health and Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Richard Body
- Emergency Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust
- Division of Cardiovascular Science, University of Manchester, Manchester
| | - Daniel Horner
- Emergency Department, Northern Care Alliance NHS Foundation Trust, Salford
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne
- Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria
| | - Nathan Brown
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane
- Faculty of Medicine, University of Queensland, Queensland
| | - Tissa Wijeratne
- Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
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Rousseau G, Thummel S, Vannier C, Paul Louis M, Debacq C, Ridoux C, Deneau P, Laribi S. Evaluation of the appropriateness of nursing home residents' transfer to emergency departments. Int Emerg Nurs 2023; 69:101312. [PMID: 37348235 DOI: 10.1016/j.ienj.2023.101312] [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: 04/05/2022] [Revised: 05/14/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION France is experiencing a steady increase in the number of residents living in nursing homes (NHs). Each year, 25% of these residents are hospitalized, half of them through emergency departments (EDs). A part of these transfers to EDs are unjustified and not without consequences. The first aim of our study is to evaluate the proportion of avoidable NHs resident transfer to EDs. METHODS An observational, prospective and multicentric study was conducted between January and August 2019 in the 6 EDs of a French county during 3 inclusion periods. A multidisciplinary expert panel determined the appropriateness of each ED transfer. The results were expressed in gross values and %. Expert agreement was assessed by Fleiss' kappa statistical measure. RESULTS Transfers were deemed avoidable in 12 to 35% of cases and appropriate in 53 to 81% of cases according to the experts. Fleiss' Kappa score on the concordance of the different experts' answers concerning the relevance of transfers was slight with k = 0.28 with a significant p-value (p < 0.0001). Infection could benefit of direct hospitalization whereas trauma/wound and acute heart/pulmonary failure are the most relevant reasons of presentation to the ED. CONCLUSIONS Too many ED transfers of NH residents remain avoidable. There is a disparity of results among the experts reflecting a limitation of this study related to the subjective nature of relevance. In a society where demographic projections predict a continuing aging population anywhere EDs are regularly crowded, it would be interesting to identify and prevent factors predisposing to ED transfer and consider alternative managements with a better geriatric and emergency physicians collaboration for this specific population.
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Affiliation(s)
| | - Simon Thummel
- Emergency Medicine Department, CHRU Tours, Tours, France; University of Tours, School of Medicine, Tours, France
| | - Clara Vannier
- Emergency Medicine Department, CHRU Tours, Tours, France; University of Tours, School of Medicine, Tours, France
| | | | - Camille Debacq
- Division of Geriatric Medicine, CHRU Tours, Tours, France
| | - Clément Ridoux
- Nursing home and Geriatric Medicine, CH Sainte-Maure de Touraine, Sainte Maure de Touraine, France
| | - Pierre Deneau
- Emergency Medicine Department, CHRU Tours, Tours, France
| | - Said Laribi
- Emergency Medicine Department, CHRU Tours, Tours, France; University of Tours, School of Medicine, Tours, France
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Roussel M, Bloom B, Taalba M, Choquet C, Douillet D, Fémy F, Marouk A, Gorlicki J, Gerlier C, Macrez R, Arnaud E, Bompard R, Montassier E, Hugli O, Czopik C, Eyer X, Benhamed A, Peyrony O, Chouihed T, Penaloza A, Marra A, Laribi S, Reuter PG, Behringer W, Douplat M, Guenezan J, Javaud N, Lucidarme O, Cachanado M, Aparicio-Monforte A, Freund Y. Temporal Trends in the Use of Computed Tomographic Pulmonary Angiography for Suspected Pulmonary Embolism in the Emergency Department : A Retrospective Analysis. Ann Intern Med 2023. [PMID: 37216659 DOI: 10.7326/m22-3116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/24/2023] Open
Abstract
BACKGROUND Recently, validated clinical decision rules have been developed that avoid unnecessary use of computed tomographic pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) in the emergency department (ED). OBJECTIVE To measure any resulting change in CTPA use for suspected PE. DESIGN Retrospective analysis. SETTING 26 European EDs in 6 countries. PATIENTS Patients with CTPA performed for suspected PE in the ED during the first 7 days of each odd month between January 2015 and December 2019. MEASUREMENTS The primary end points were the CTPAs done for suspected PE in the ED and the number of PEs diagnosed in the ED each year adjusted to an annual census of 100 000 ED visits. Temporal trends were estimated using generalized linear mixed regression models. RESULTS 8970 CTPAs were included (median age, 63 years; 56% female). Statistically significant temporal trends for more frequent use of CTPA (836 per 100 000 ED visits in 2015 vs. 1112 in 2019; P < 0.001), more diagnosed PEs (138 per 100 000 in 2015 vs. 164 in 2019; P = 0.028), a higher proportion of low-risk PEs (annual percent change [APC], 13.8% [95% CI, 2.6% to 30.1%]) with more ambulatory management (APC, 19.3% [CI, 4.1% to 45.1%]), and a lower proportion of intensive care unit admissions (APC, -8.9% [CI, -17.1% to -0.3%]) were observed. LIMITATION Data were limited to 7 days every 2 months. CONCLUSION Despite the recent validation of clinical decision rules to limit the use of CTPA, an increase in the CTPA rate along with more diagnosed PEs and especially low-risk PEs were instead observed. PRIMARY FUNDING SOURCE None specific for this study.
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Affiliation(s)
- Melanie Roussel
- Sorbonne Université, UMR Inserm 1166, IHU ICAN, Paris; Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.R., Y.F.)
| | - Ben Bloom
- Emergency Department, Royal London Hospital, London, United Kingdom (B.B.)
| | - Mehdi Taalba
- Emergency Department, Rouen University Hospital, Rouen, France (M.T.)
| | - Christophe Choquet
- Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (C. Choquet)
| | - Delphine Douillet
- Department of Emergency Medicine, University Hospital of Angers, Angers; and UNIV Angers, UMR MitoVasc CNRS 6215 INSERM 1083, Angers, France (D.D.)
| | - Florent Fémy
- Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cite, Paris; and Toxicology and Chemical Risks Department, French Armed Forces Biomedical Institute, Brétigny-sur-Orge, France (F.F.)
| | - Alexis Marouk
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France (A. Marouk)
| | - Judith Gorlicki
- Emergency Department, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France (J. Golicki)
| | - Camille Gerlier
- Emergency Department, Hôpital Saint-Joseph, Paris, France (C.G.)
| | - Richard Macrez
- Emergency Department, CHU Caen Côte de Nacre, Normandie Université UNICAEN, INSERM PhIND Institut Blood and Brain, Caen, France (R.M.)
| | - Emilien Arnaud
- Department of Emergency Medicine, Amiens-Picardy University Hospital, Amiens, France (E.A.)
| | - Rudy Bompard
- Emergency Department, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France (R.B.)
| | | | - Olivier Hugli
- Emergency Department, Lausanne University Hospital Emergency Care Service, Lausanne, Switzerland (O.H.)
| | - Charlotte Czopik
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France (C. Czopik)
| | - Xavier Eyer
- Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (X.E.)
| | - Axel Benhamed
- Emergency Department, Hospices Civils de Lyon, Lyon, France (A.B., M.D.)
| | - Olivier Peyrony
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France (O.P.)
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, Nancy, France (T.C.)
| | - Andrea Penaloza
- Emergency Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium (A.P.)
| | - Alessio Marra
- Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy (A. Marra)
| | - Said Laribi
- Tours University, Emergency Medicine Department, Tours University Hospital, Tours, France (S.L.)
| | - Paul-Georges Reuter
- Emergency Department, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne; and Université Versailles-Saint Quentin en Yvelines, Boulogne, France (P.-G.R.)
| | - Wilhelm Behringer
- Department of Emergency Medicine, Medical University Vienna, Vienna General Hospital, Vienna, Austria (W.B.)
| | - Marion Douplat
- Emergency Department, Hospices Civils de Lyon, Lyon, France (A.B., M.D.)
| | - Jeremy Guenezan
- Emergency Department, University Hospital of Poitiers, Poitiers, France (J. Guenezen)
| | - Nicolas Javaud
- Emergency Department, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Colombes; and Reference Center for Bradykinin Angiodema (CReAk), Université Paris Cite, Colombes, France (N.J.)
| | - Olivier Lucidarme
- Sorbonne Université, UMR Inserm 1166, IHU ICAN, Paris; and Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale LIB, Paris, France (O.L.)
| | - Marine Cachanado
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France (M.C., A.A.)
| | - Ainhoa Aparicio-Monforte
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France (M.C., A.A.)
| | - Yonathan Freund
- Sorbonne Université, UMR Inserm 1166, IHU ICAN, Paris; Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.R., Y.F.)
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Karamercan MA, Dündar DZ, Slagman A, Ergin M, Janssens KAC, Fabbri A, Bjornsen LP, Somodi S, Adam VN, Polyzogopoulou E, Demir HA, Laribi S. Epidemiology of geriatric patients presenting to emergency departments in Europe: EGERS study. Eur J Emerg Med 2023; 30:117-124. [PMID: 36719188 DOI: 10.1097/mej.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND IMPORTANCE Patients aged 65 and above constitute a large and growing part of emergency department (ED) visits in western countries. OBJECTIVE The primary aim of this European prospective study was to determine the epidemiologic characteristics of elderly patients presenting to EDs across Europe. Our secondary objective was to determine the hospitalization rate, characteristics, and in-hospital mortality rates of geriatric patients presenting to EDs. DESIGN SETTING AND PARTICIPANTS An observational prospective cohort study over seven consecutive days between 19 October and 30 November 2020, in 36 EDs from nine European countries. Patients aged 65 years and older presenting to EDs with any complaint during a period of seven consecutive days were included. OUTCOME MEASURES Data were collected on demographics, the major presenting complaint, the presenting vital signs, comorbidities, usual medication, and outcomes after the ED, including disposition, in-hospital outcome, and the final hospital diagnosis. The patients were stratified into three groups: old (65-74 years), older (75-84 years), and oldest age (>85 years). MAIN RESULTS A total of 5767 patients were included in the study. The median age of the patients was 77 (interquartile range: 71-84) years. The majority presented with a non-traumatic complaint (81%) and about 90% of the patients had at least one comorbid disease and were on chronic medication. An ED visit resulted in subsequent hospital admission in 51% of cases, with 9% of patients admitted to an intensive care unit. Overall in-hospital mortality was 8%, and ED mortality was 1%. Older age was associated with a higher female proportion, comorbidities, need for home care service, history of previous falls, admission rates, length of ED, and hospital stay. CONCLUSION The characteristics of ED elderly patients and their subsequent hospital stay are reported in this prospective study.
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Affiliation(s)
- Mehmet A Karamercan
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara
| | - Defne Z Dündar
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara
| | - Ana Slagman
- Division of Emergency and Acute Medicine, Campus Virchow Klinikum and Charité Campus Mitte, Charite Universitatmedizin, Berlin, Germany
| | - Mehmet Ergin
- Department of Emergency Medicine, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | | | - Andrea Fabbri
- Dipartimento Emergenza, Azienda USL della Romagna, Forli, Italy
| | - Lars P Bjornsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sándor Somodi
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Visnja N Adam
- Department of Anesthesiology, Resuscitation and Intensive Care, Clinical Hospital Sveti Duh, Zagreb, Croatia
| | - Effie Polyzogopoulou
- Emergency Medicine Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Hüseyin A Demir
- Department of Emergency Medicine, Sanliurfa Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
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Nougué H, Michel T, Picard F, Lassus J, Sadoune M, Laribi S, Cohen-Solal A, Logeart D, Launay JM, Vodovar N. Deconvolution of BNP and NT-proBNP Immunoreactivities by Mass Spectrometry in Heart Failure and Sacubitril/Valsartan Treatment. Clin Chem 2023; 69:350-362. [PMID: 36762414 DOI: 10.1093/clinchem/hvac225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/13/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND Elevated BNP and the N-terminal fragment of the proBNP (NT-proBNP) are hallmarks of heart failure (HF). Generally, both biomarkers parallel each other. In patients receiving sacubitril/valsartan, BNP remained stable while NT-proBNP decreased. As BNP and NT-proBNP assays have limited specificity due to cross-reactivity, we quantified by mass spectrometry (MS) the contributing molecular species. METHODS We included 356 healthy volunteers, 100 patients with acute dyspnoea (49 acute decompensated HF; 51 dyspnoea of non-cardiac origin), and 73 patients with chronic HF and reduced ejection fraction treated with sacubitril/valsartan. BNP and NT-proBNP immunoreactivities (BNPir and NT-proBNPir) were measured by immunoassays (Abbott ARCHITECT and Roche Diagnostics proBNPII) and proBNP-derived peptides and glycosylation at serine 44 by MS on plasma samples. RESULTS BNPir corresponded to the sum of proBNP1-108, BNP1-32, BNP3-32, and BNP5-32 (R2 = 0.9995), while NT-proBNPir corresponded to proBNP1-108 and NT-proBNP1-76 not glycosylated at serine 44 (R2 = 0.992). NT-proBNPir was better correlated (R2 = 0.9597) than BNPir (R2 = 0.7643) with proBNP signal peptide (a surrogate of proBNP production). In patients receiving sacubitril/valsartan, non-glycosylated NT-proBNP1-76 remained constant (P = 0.84) despite an increase in NT-proBNP1-76 and its glycosylation (P < 0.0001). ProBNP1-108 remained constant (P = 0.12) while its glycosylation increased (P < 0.0001), resulting in a decrease in non-glycosylated proBNP1-108 (P < 0.0001), and in NT-proBNPir. CONCLUSIONS Glycosylation interfered with NT-proBNPir measurement, explaining the discrepant evolution of these 2 biomarkers in patients receiving sacubitril/valsartan. Both BNPir and NT-proBNPir are surrogates of proBNP1-108 production, NT-proBNPir being more robust in the clinical contexts studied.
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Affiliation(s)
- Hélène Nougué
- Université Paris Cité and Inserm UMR-S 942, Paris, France.,Department of Anesthesiology and Intensive Care, Saint-Louis and Lariboisière Hospital, Paris, France
| | | | | | - Johan Lassus
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Malha Sadoune
- Université Paris Cité and Inserm UMR-S 942, Paris, France
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
| | - Alain Cohen-Solal
- Université Paris Cité and Inserm UMR-S 942, Paris, France.,Department of Cardiology, Lariboisière Hospital, Paris, France
| | - Damien Logeart
- Université Paris Cité and Inserm UMR-S 942, Paris, France.,Department of Cardiology, Lariboisière Hospital, Paris, France
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15
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Affiliation(s)
- Robert Leach
- Department of Emergency Medicine, Centre Hospitalier de Wallonie Picarde, Tournai
| | - Davi Kaur
- European Society for Emergency Medicine, Antwerp, Belgium
| | - Said Laribi
- Emergency Department, Tours University Hospital, Tours, France
| | - Christoph Dodt
- Emergency Department, Städtisches Klinikum München Bogenhausen, Munich, Germany
| | - Wilhelm Behringer
- Department of Emergency Medicine, Medical University of Vienna, University Hospital of Vienna, Vienna, Austria
- Great North Trauma and Emergency Care, RVI, Newcastle upon Tyne, UK
| | - Jim Connolly
- Great North Trauma and Emergency Care, RVI, Newcastle upon Tyne, UK
| | - Abdo Khoury
- Department of Emergency Medicine and Critical Care, Besançon University Hospital
- INSERM CIC 1431, Besançon University Hospital, Besançon, France
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16
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Rousseau G, Clément J, Fezard JB, Laribi S. [Colchicum poisoning by confusion with wild garlic (Allium ursinum)]. Rev Med Interne 2022; 43:559-561. [PMID: 35597736 DOI: 10.1016/j.revmed.2022.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/19/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Colchicine poisoning is a life-threatening intoxication. CASE REPORT We report a case of food poisosing with Colchicum autumnale by confusion with wild garlic. The clinical presentation is the same as that of colchicine drug intoxication. The evolution can be fatal in case of massive ingestion. The proximity of the place of growth and their similar appearance in spring make Colchicum and wild garlic plants that can easily be confused. CONCLUSION Physicians have to be vigilant in case of dysenteric syndrome and biological disturbances in spring and look for the consumption of perennial plant preceding symptoms.
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Affiliation(s)
- G Rousseau
- Département de médecine d'urgences, CHRU Tours, Tours, France.
| | - J Clément
- Département de médecine d'urgences, CHRU Tours, Tours, France; Université de Tours, Tours, France
| | - J B Fezard
- Département de médecine d'urgences, CHRU Tours, Tours, France
| | - S Laribi
- Département de médecine d'urgences, CHRU Tours, Tours, France; Université de Tours, Tours, France
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Harjola P, Tarvasmäki T, Barletta C, Body R, Capsec J, Christ M, Garcia-Castrillo L, Golea A, Karamercan MA, Martin PL, Miró Ò, Tolonen J, van Meer O, Palomäki A, Verschuren F, Harjola VP, Laribi S. The emergency department arrival mode and its relations to ED management and 30-day mortality in acute heart failure: an ancillary analysis from the EURODEM study. BMC Emerg Med 2022; 22:27. [PMID: 35164693 PMCID: PMC8842939 DOI: 10.1186/s12873-022-00574-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 01/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background Acute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients’ ED management and short-term outcomes. Methods This was a sub-analysis of a European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from European EDs. Patients with ED diagnosis of acute heart failure were categorized into two groups: those using EMS and those self-presenting (non- EMS). The independent association between EMS use and 30-day mortality was evaluated with logistic regression. Results Of the 500 acute heart failure patients, with information about the arrival mode to the ED, 309 (61.8%) arrived by EMS. These patients were older (median age 80 vs. 75 years, p < 0.001), more often female (56.4% vs. 42.1%, p = 0.002) and had more dementia (18.7% vs. 7.2%, p < 0.001). On admission, EMS patients had more often confusion (14.2% vs. 2.1%, p < 0.001) and higher respiratory rate (24/min vs. 21/min, p = 0.014; respiratory rate > 30/min in 17.1% patients vs. 7.5%, p = 0.005). The only difference in ED management appeared in the use of ventilatory support: 78.3% of EMS patients vs. 67.5% of non- EMS patients received supplementary oxygen (p = 0.007), and non-invasive ventilation was administered to 12.5% of EMS patients vs. 4.2% non- EMS patients (p = 0.002). EMS patients were more often hospitalized (82.4% vs. 65.9%, p < 0.001), had higher in-hospital mortality (8.7% vs. 3.1%, p = 0.014) and 30-day mortality (14.3% vs. 4.9%, p < 0.001). The use of EMS was an independent predictor of 30-day mortality (OR = 2.54, 95% CI 1.11–5.81, p = 0.027). Conclusion Most acute heart failure patients arrive at ED by EMS. These patients suffer from more severe respiratory distress and receive more often ventilatory support. EMS use is an independent predictor of 30-day mortality.
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Affiliation(s)
- Pia Harjola
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
| | - Tuukka Tarvasmäki
- Cardiology, University of Helsinki and Heart and Lung Cent, Helsinki University Hospital, Helsinki, Finland
| | - Cinzia Barletta
- Servicio Urgencias Hospital Marqués de Valdecilla, Santander, Spain
| | - Richard Body
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Emergency Department, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, England
| | - Jean Capsec
- Department of Public Health, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Michael Christ
- Department of Emergency Care, Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Adela Golea
- Emergency Medicine, County Emergency Hospital Cluj-Napoca, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mehmet A Karamercan
- Emergency Medicine Department, Faculty of Medicine, Gazi University, Ankara, Turkey.,Department of Emergency Medicine, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Paul-Louis Martin
- School of Medicine and CHU Tours, Emergency Medicine Department, Tours University, Tours, France
| | - Òscar Miró
- Emergency Department, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Jukka Tolonen
- Internal Medicine, University of Helsinki and Department of Medicine, Helsinki University Hospital, Helsinki, Finland
| | - Oene van Meer
- Leiden University Medical Center, Leiden, The Netherlands
| | - Ari Palomäki
- Emergency Medicine, Campus of Tampere, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Franck Verschuren
- Department of Acute Medicine, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Said Laribi
- School of Medicine and CHU Tours, Emergency Medicine Department, Tours University, Tours, France
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18
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Roberts T, Horner DE, Chu K, Than M, Kelly AM, Klim S, Kinnear F, Keijzers G, Karamercan MA, Wijeratne T, Kamona S, Kuan WS, Graham CA, Body R, Laribi S. Thunderclap headache syndrome presenting to the emergency department: an international multicentre observational cohort study. Emerg Med J 2022; 39:803-809. [PMID: 35144978 DOI: 10.1136/emermed-2021-211370] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 01/26/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Most headache presentations to emergency departments (ED) have benign causes; however, approximately 10% will have serious pathology. International guidelines recommend that patients describing the onset of headache as 'thunderclap' undergo neuroimaging and further investigation. The association of this feature with serious headache cause is unclear. The objective of this study was to determine if patients presenting with thunderclap headache are significantly more likely to have serious underlying pathology than patients with more gradual onset and to determine compliance with guidelines for investigation. METHODS This was a planned secondary analysis of an international, multicentre, observational study of adult ED patients presenting with a main complaint of headache. Data regarding demographics, investigation strategies and final ED diagnoses were collected. Thunderclap headache was defined as severe headache of immediate or almost immediate onset and peak intensity. Proportion of patients with serious pathology in thunderclap and non-thunderclap groups were compared by χ² test. RESULTS 644 of 4536 patients presented with thunderclap headache (14.2%). CT brain imaging and lumbar puncture were performed in 62.7% and 10.6% of cases, respectively. Among patients with thunderclap headache, serious pathology was identified in 10.9% (95%CI 8.7% to 13.5%) of cases-significantly higher than the proportion found in patients with a different headache onset (6.6% (95% CI 5.9% to 7.4%), p<0.001.). The incidence of subarachnoid haemorrhage (SAH) was 3.6% (95% CI 2.4% to 5.3%) in those with thunderclap headache vs 0.3% (95% CI 0.2% to 0.5%) in those without (p<0.001). All cases of SAH were diagnosed on CT imaging. Non-serious intracranial pathology was diagnosed in 87.7% of patients with thunderclap headache. CONCLUSIONS Thunderclap headache presenting to the ED appears be associated with higher risk for serious intracranial pathology, including SAH, although most patients with this type of headache had a benign cause. Neuroimaging rates did not align with international guidelines, suggesting potential need for further work on standardisation.
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Affiliation(s)
- Tom Roberts
- Trainee Emergency Research Network (TERN), The Royal College of Emergency Medicine, London, UK .,Emergency Department, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Daniel E Horner
- Emergency/Critical Care Department, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Infection Immunity and Respiratory Medicine, The University of Manchester, Manchester, England, UK
| | - Kevin Chu
- Department of Emergency, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine and Biomedical Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Martin Than
- Emergency Department, Christchurch Hospital, Christchurch, Canterbury, New Zealand
| | - Anne-Maree Kelly
- JECEMR, Western Health, St Albans, Victoria, Australia.,Department of Emergency Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sharon Klim
- Department of Emergency Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Joseph Epstein Centre for Emergency Medicine Research at Western Health, St Albans, Victoria, Australia
| | - Frances Kinnear
- Emergency, Prince Charles Hospital, Chermside, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia.,Department of Emergency Medicine, Bond University, Gold Coast, Queensland, Australia
| | | | - Tissa Wijeratne
- Department of Neurology, La Trobe University, Melbourne, Victoria, Australia
| | - Sinan Kamona
- School of Medicine, University of Auckland, Auckland, New Zealand.,Auckland District Health Board, Auckland, New Zealand
| | - Win Sen Kuan
- Emergency Medicine, National University Health System, Singapore.,Department of Surgery, National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Richard Body
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
| | - Said Laribi
- Emergency Medicine, University Hospital of Tours, Tours, France.,EUSEM Research Network, Aarselaar, Belgium
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19
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Wijeratne T, Kuan WS, Kelly AM, Chu KH, Kinnear FB, Keijzers G, Body R, Karamercan MA, Klim S, Kamona S, Graham CA, Roberts T, Horner D, Laribi S. Migraine in the Emergency Department: A Prospective Multinational Study of Patient Characteristics, Management, and Outcomes. Neuroepidemiology 2022; 56:32-40. [PMID: 35021181 DOI: 10.1159/000520548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/08/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIM Migraine headache is commonly diagnosed in emergency departments (ED). There is relatively little real-world information about the epidemiology, investigation, management, adherence to therapeutic guidelines and disposition of patients treated in ED with a final diagnosis of migraine. The primary aim of the current study is to get a snapshot of assessment and management patterns of acute migraine presentations to the different settings of EDs with a view to raise awareness. METHODS This is a planned sub-study of a prospective study conducted in 67 health services in 10 countries including Australia, New Zealand, Southeast Asia, Europe, and the UK investigating the epidemiology and outcome of adult patients presenting to ED with nontraumatic headache. Outcomes of interest for this study are demographics, clinical features (including severity), patterns of investigation, treatment, disposition, and outcome of patients diagnosed as having migraine as their final ED diagnosis. RESULTS The cohort comprises 1,101 patients with a mean age of 39 years (SD ± 13.5; 73.7% [811]) were female. Most patients had had migraine diagnosed previously (77.7%). Neuroimaging was performed in 25.9% with a very low diagnostic yield or significant findings (0.07%). Treatment of mild migraine was in accordance with current guidelines, but few patients with moderate or severe symptoms received recommended treatment. Paracetamol (46.3%) and nonsteroidal anti-inflammatory drugs (42.7%) were the most commonly prescribed agents. Metoclopramide (22.8%), ondansetron (19.2%), chlorpromazine (12.8%), and prochlorperazine (12.8%) were also used. CONCLUSIONS This study suggests that therapeutic practices are not congruent with current guidelines, especially for patients with severe symptoms. Efforts to improve and sustain compliance with existing management best practices are required.
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Affiliation(s)
- Tissa Wijeratne
- Department of Neurology & AIMSS, Melbourne Medical School, Western Health, St Albans, Victoria, Australia.,Public Health School, La Trobe University, Bundoora, Victoria, Australia.,Institute of Health and Sport, Victoria University, St Albans, Victoria, Australia
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anne Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine, Victoria, Australia.,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Kevin H Chu
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Frances B Kinnear
- Emergency & Children's Services, The Prince Charles Hospital, Chermside, Queensland, Australia.,Department of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Richard Body
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, United Kingdom.,Emergency Department, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Mehmet A Karamercan
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine, Victoria, Australia.,Department of Medicine, Sunshine Hospital, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Sinan Kamona
- School of Medicine, University of Auckland, Auckland, New Zealand.,Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Colin A Graham
- Emergency Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Tom Roberts
- Trainee Emergency Research Network (TERN), United Kingdom and North Bristol NHS Trust, Bristol, United Kingdom
| | - Daniel Horner
- Emergency Department, Salford Royal NHS Foundation Trust, Salford, United Kingdom.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
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20
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Mintegi S, Maconochie IK, Waisman Y, Titomanlio L, Benito J, Laribi S, Moll H. Pediatric Preparedness of European Emergency Departments: A Multicenter International Survey. Pediatr Emerg Care 2021; 37:e1150-e1153. [PMID: 32398594 DOI: 10.1097/pec.0000000000001934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/27/2022]
Abstract
INTRODUCTION Children and adolescents often lack optimal emergency care. The objective of the study was to assess the level of preparedness of European emergency departments (EDs) for pediatric patients. METHODS This was an international multicenter Internet-based survey of EDs with attending children and adolescents younger than 18 years in 101 EDs from 21 countries. Questionnaires were based on the recommendations in the consensus document published by the International Federation for Emergency Medicine, which defines quality of care standards for children aged 0 to 18 years in the ED. A multivariate binary logistic regression was performed to identify independent factors that are related to the expected standards of care provided by the EDs. RESULTS Most (95.0%) of the EDs fulfilled more than 50% of the International Federation for Emergency Medicine essential standards of care, and 24 (23.7%) EDs fulfilled more than 80%. Best results were obtained in the standards that related to equipment, departmental policies, procedures, and protocols, and being able to stabilize an ill or injured child. Worst results were associated with inadequate staffing levels, quality, and safety; adolescents, mental health, and substance misuse delivery issues; and major incidents. Being included in a multicenter international research network was the unique independent factor associated with a good level of preparedness of the EDs for pediatric cases. CONCLUSIONS Overall, surveyed European EDs fit well the essential standards of pediatric emergency care. Certain improvement actions are required to guarantee that essential standards of care for pediatric emergency care are always fulfilled in European EDs.
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Affiliation(s)
- Santiago Mintegi
- From the Paediatric Emergency Department, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - Ian K Maconochie
- Paediatric Emergency Medicine, St Mary's Hospital, Imperial College NHS healthcare Trust, London, UK
| | - Yehezkel Waisman
- Department of Emergency Medicine, Schneider Children's Medical Centre of Israel, Petah Tikva, Israel
| | - Luigi Titomanlio
- Paediatric Emergency Department, Robert Debré Hospital, Paris Diderot University, Paris
| | - Javier Benito
- From the Paediatric Emergency Department, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - Said Laribi
- Emergency Medicine Department, School of Medicine and CHU Tours, Tours University, Tours, France
| | - Henriette Moll
- Sophia's Children's Hospital-Erasmus MC, Rotterdam, the Netherlands
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21
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Kelly AM, Kuan WS, Chu KH, Kinnear FB, Keijzers G, Karamercan MA, Klim S, Wijeratne T, Kamona S, Graham CA, Body R, Roberts T, Horner D, Laribi S. Epidemiology, investigation, management, and outcome of headache in emergency departments (HEAD study)-A multinational observational study. Headache 2021; 61:1539-1552. [PMID: 34726783 DOI: 10.1111/head.14230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/06/2021] [Revised: 07/06/2021] [Accepted: 07/23/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To describe the epidemiology of nontraumatic headache in adults presenting to emergency departments (EDs). BACKGROUND Headache is a common reason for presentation to EDs. Little is known about the epidemiology, investigation, and treatment of nontraumatic headache in patients attending EDs internationally. METHODS An international, multicenter, observational, cross-sectional study was conducted over one calendar month in 2019. Participants were adults (≥18 years) with nontraumatic headache as the main presenting complaint. Exclusion criteria were recent head trauma, missing records, interhospital transfers, re-presentation with same headache as a recent visit, and headache as an associated symptom. Data collected included demographics, clinical assessment, investigation, treatment, and outcome. RESULTS We enrolled 4536 patients (67 hospitals, 10 countries). "Thunderclap" onset was noted in 14.2% of cases (644/4536). Headache was rated as severe in 27.2% (1235/4536). New neurological examination findings were uncommon (3.2%; 147/4536). Head computed tomography (CT) was performed in 36.6% of patients (1661/4536), of which 9.9% showed clinically important pathology (165/1661). There was substantial variation in CT scan utilization between countries (15.9%-75.0%). More than 30 different diagnoses were made. Presumed nonmigraine benign headache accounted for 45.4% of cases (2058/4536) with another 24.3% classified as migraine (1101/4536). A small subgroup of patients have a serious secondary cause for their headache (7.1%; 323/4536) with subarachnoid hemorrhage (SAH), stroke, neoplasm, non-SAH intracranial hemorrhage/hematoma, and meningitis accounting for about 1% each. Most patients were treated with simple analgesics (paracetamol, aspirin, or nonsteroidal anti-inflammatory agents). Most patients were discharged home (83.8%; 3792/4526). In-hospital mortality was 0.3% (11/4526). CONCLUSION Diagnosis and management of headache in the ED is challenging. A small group of patients have a serious secondary cause for their symptoms. There is wide variation in the use of neuroimaging and treatments. Further work is needed to understand the variation in practice and to better inform international guidelines regarding emergent neuroimaging and treatment.
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Affiliation(s)
- Anne Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine, Victoria, Australia.,Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kevin H Chu
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Frances B Kinnear
- Emergency & Children's Services, The Prince Charles Hospital, Chermside, Queensland, Australia.,Department of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Mehmet A Karamercan
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine, Victoria, Australia.,Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Tissa Wijeratne
- Department of Neurology, Western Health, St Albans, Victoria, Australia.,Public Health School, La Trobe University, Bundoora, Victoria, Australia
| | - Sinan Kamona
- School of Medicine, University of Auckland, Auckland, New Zealand.,Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Colin A Graham
- Emergency Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Richard Body
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Emergency Department, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Tom Roberts
- Trainee Emergency Research Network (TERN), Bristol, UK.,North Bristol NHS Trust, Bristol, UK
| | - Daniel Horner
- Emergency Department, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
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22
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Pellatt RAF, Kamona S, Chu K, Sweeny A, Kuan WS, Kinnear FB, Karamercan MA, Klim S, Wijeratne T, Graham CA, Body R, Roberts T, Horner D, Laribi S, Keijzers G, Kelly AM. The Headache in Emergency Departments study: Opioid prescribing in patients presenting with headache. A multicenter, cross-sectional, observational study. Headache 2021; 61:1387-1402. [PMID: 34632592 DOI: 10.1111/head.14217] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/02/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the patterns of opioid use in patients presenting to the emergency department (ED) with nontraumatic headache by severity and geography. BACKGROUND International guidelines recognize opioids are ineffective in treating primary headache disorders. Globally, many countries are experiencing an opioid crisis. The ED can be a point of initial exposure leading to tolerance for patients. More geographically diverse data are required to inform practice. METHODS This was a planned, multicenter, cross-sectional, observational substudy of the international Headache in Emergency Departments (HEAD) study. Participants were prospectively identified throughout March 2019 from 67 hospitals in Europe, Asia, Australia, and New Zealand. Adult patients with nontraumatic headache were included as identified by the local site investigator. RESULTS Overall, 4536 patients were enrolled in the HEAD study. Opioids were administered in 1072/4536 (23.6%) patients in the ED, and 386/3792 (10.2%) of discharged patients. High opioid use occurred prehospital in Australia (190/1777, 10.7%) and New Zealand (55/593, 9.3%). Opioid use in the ED was highest in these countries (Australia: 586/1777, 33.0%; New Zealand: 221/593, 37.3%). Opioid prescription on discharge was highest in Singapore (125/442, 28.3%) and Hong Kong (12/49, 24.5%). Independent predictors of ED opioid administration included the following: severe headache (OR 4.2, 95% CI 3.1-5.5), pre-ED opioid use (OR 1.42, 95% CI 1.11-1.82), and long-term opioid use (OR 1.80, 95% CI 1.26-2.58). ED opioid administration independently predicted opioid prescription at discharge (OR 8.4, 95% CI 6.3-11.0). CONCLUSION Opioid prescription for nontraumatic headache in the ED and on discharge varies internationally. Severe headache, prehospital opioid use, and long-term opioid use predicted ED opioid administration. ED opioid administration was a strong predictor of opioid prescription at discharge. These findings support education around policy and guidelines to ensure adherence to evidence-based interventions for headache.
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Affiliation(s)
- Richard A F Pellatt
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia.,LifeFlight Retrieval Medicine, Brisbane, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Sinan Kamona
- Emergency Department, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand.,School of Medicine, University of Auckland, Auckland, New Zealand
| | - Kevin Chu
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Queensland, Australia.,Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Amy Sweeny
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Frances B Kinnear
- Faculty of Medicine, University of Queensland, Queensland, Australia.,Emergency & Children's Services, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Mehmet A Karamercan
- Gazi University Faculty of Medicine, Ankara, Turkey.,Department of Emergency Medicine, University of Health Sciences, Ankara, Turkey
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Sunshine, Victoria, Australia
| | - Tissa Wijeratne
- Department of Neurology, Western Health, St Albans, Victoria, Australia.,Public Health School, La Trobe University, Bundoora, Victoria, Australia
| | - Colin A Graham
- Emergency Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR
| | - Richard Body
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Emergency Department, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Tom Roberts
- Emergency Department, North Bristol NHS Trust, Bristol, UK
| | - Daniel Horner
- Emergency Department, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
| | - Gerben Keijzers
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Sunshine, Victoria, Australia.,Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
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23
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Rousseau G, Gonzalez L, Guillon A, Grammatico-Guillon L, Laribi S. Shorten the door-to-antibiotics time in acute bacterial meningitis using a glucometer to measure the cerebrospinal fluid/blood glucose ratio. Intern Emerg Med 2021; 16:2013-2015. [PMID: 34292459 DOI: 10.1007/s11739-021-02769-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Geoffroy Rousseau
- Emergency Medicine Department, CHRU Tours, 2 Boulevard Tonnellé, 37044 Cedex 9 , Tours, France.
| | - Lola Gonzalez
- Emergency Medicine Department, CHRU Tours, 2 Boulevard Tonnellé, 37044 Cedex 9 , Tours, France
| | - Antoine Guillon
- Intensive Care Unit, CHRU Tours, Tours, France
- University of Tours, Tours, France
| | | | - Said Laribi
- Emergency Medicine Department, CHRU Tours, 2 Boulevard Tonnellé, 37044 Cedex 9 , Tours, France
- University of Tours, Tours, France
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24
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Beck S, Kinnear FB, Maree Kelly A, Chu KH, Sen Kuan W, Keijzers G, Body R, Karamercan MA, Klim S, Wijeratne T, Kamona S, Graham CA, Roberts T, Horner D, Laribi S. Clinical presentation and assessment of older patients presenting with headache to emergency departments: A multicentre observational study. Australas J Ageing 2021; 41:126-137. [PMID: 34570422 DOI: 10.1111/ajag.12999] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the characteristics, assessment and management of older emergency department (ED) patients with non-traumatic headache. METHODS Planned sub-study of a prospective, multicentre, international, observational study, which included adult patients presenting to ED with non-traumatic headache. Patients aged ≥75 years were compared to those aged <75 years. Outcomes of interest were epidemiology, investigations, serious headache diagnosis and outcome. RESULTS A total of 298 patients (7%) in the parent study were aged ≥75 years. Older patients were less likely to report severe headache pain or subjective fever (both P < 0.001). On examination, older patients were more likely to be confused, have lower Glasgow Coma Scores and to have new neurological deficits (all P < 0.001). Serious secondary headache disorder (composite of headache due to subarachnoid haemorrhage (SAH), intracranial haemorrhage, meningitis, encephalitis, cerebral abscess, neoplasm, hydrocephalus, vascular dissection, stroke, hypertensive crisis, temporal arteritis, idiopathic intracranial hypertension or ventriculoperitoneal shunt complications) was diagnosed in 18% of older patients compared to 6% of younger patients (P < 0.001). Computed tomography brain imaging was performed in 66% of patients ≥75 years compared to 35% of younger patients (P < 0.001). Older patients were less likely to be discharged (43% vs 63%, P < 0.001). CONCLUSION Older patients with headache had different clinical features to the younger cohort and were more likely to have a serious secondary cause of headache than younger adults. There should be a low threshold for investigation in older patients attending ED with non-traumatic headache.
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Affiliation(s)
- Sierra Beck
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Emergency Department, Dunedin Hospital, Dunedin, New Zealand
| | - Frances B Kinnear
- Emergency & Children's Services, The Prince Charles Hospital, Chermside, Qld, Australia.,Department of Medicine, University of Queensland, St Lucia, Qld, Australia
| | - Anne Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine, Melbourne, Vic., Australia.,Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Parkville, Vic., Australia
| | - Kevin H Chu
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Qld, Australia.,Faculty of Medicine, University of Queensland, St Lucia, Qld, Australia
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Qld, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia.,School of Medicine, Griffith University, Gold Coast, Qld, Australia
| | - Richard Body
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Emergency Department, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Mehmet A Karamercan
- Faculty of Medicine Department of Emergency Medicine, Gazi University, Ankara, Turkey
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine, Melbourne, Vic., Australia
| | - Tissa Wijeratne
- The University of Melbourne, Parkville, Australia.,Department of Neurology, Western Health, St Albans, Vic., Australia.,Public Health School, La Trobe University, Bundoora, Vic., Australia
| | - Sinan Kamona
- School of Medicine, University of Auckland, Auckland, New Zealand.,Auckland District Health Board, Auckland City Hospital, Auckland, New Zealand
| | - Colin A Graham
- Emergency Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
| | - Tom Roberts
- Trainee Emergency Research Network (TERN), North Bristol NHS Trust, Bristol, UK
| | - Daniel Horner
- Emergency Department, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Oxford, UK
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France.,EUSEM Research Network, Aartselaar, Belgium
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25
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Pfendler M, Ghuysen A, Vranckx M, Laribi S, Verschuren F. [Epidemiology of patients presenting to the emergency room for dyspnea in Belgium]. Rev Med Liege 2021; 76:273-279. [PMID: 33830692] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Studies about patients' profile presenting to the emergency department for dyspnea are scarce in Europe, and even more in Belgium. We analyze here a cohort of patients with acute dyspnea in three Belgian centers, as to the epidemiology of this dyspnea, the tests carried out, the diagnoses retained, the treatments administered, the hospitalization and survival rates. The secondary objective is to compare this Belgian cohort with a European population resulting from a large multicenter study. The analysis of 131 patients showed that acute dyspnea in the emergency department corresponds to four main diagnoses (exacerbation of chronic obstructive pulmonary disease, infections of the lower respiratory tract, acute cardiac decompensation and asthma). The age of patients is over 80 years in a quarter of them, the hospitalization rate is 57 % and the mortality is 5 %. Our analysis also reveals that the check of vital parameters may be insufficiently realized, as may the use of non-invasive ventilation. Etiological diagnoses made in the emergency department are confirmed at the end of hospitalization in 75 % of cases. The Belgian population is younger than the European population (62 against 69 years), presents fewer infection of the lower respiratory tract (20 % against 31 %), and is comparable to the European population for the other parameters studied. The article ends with 10 key messages that will enlighten clinicians about the reality of acute dyspnea in emergency rooms in Belgium.
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Affiliation(s)
- M Pfendler
- Service des Urgences, Cliniques Universitaires Saint-Luc, Institut de Recherche Clinique UCLouvain, Bruxelles, Belgique
| | - A Ghuysen
- Service des Urgences, CHU Liège, Liège Université, Belgique
| | - M Vranckx
- Service des Urgences, CHU Charleroi, Université Libre de Bruxelles, Belgique
| | - S Laribi
- Service des Urgences, CHU Tours, Université de Tours, France
| | - F Verschuren
- Service des Urgences, Cliniques Universitaires Saint-Luc, Institut de Recherche Clinique UCLouvain, Bruxelles, Belgique
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26
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Hoedeman F, Puiman PJ, Smits AW, Dekker MI, Diderich-Lolkes de Beer H, Laribi S, Lauwaert D, Oostenbrink R, Parri N, García-Castrillo Riesgo L, Moll HA. Recognition of child maltreatment in emergency departments in Europe: Should we do better? PLoS One 2021; 16:e0246361. [PMID: 33544721 PMCID: PMC7864669 DOI: 10.1371/journal.pone.0246361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/12/2020] [Accepted: 01/18/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the different policies to recognize child maltreatment in emergency departments (EDs) in Europe in order to define areas of improvement. METHODS A survey was conducted on the recognition of child maltreatment in EDs in European countries with a focus on screening methods, parental risk factors, training and hospital policies. The survey was distributed through different key members from the EUSEM, REPEM and the EuSEN. A summary score based on the NICE guideline (4 questions on child characteristics, 4 questions on parental characteristics and 5 questions on hospital policy) was calculated. RESULTS We analysed 185 completed surveys, representing 148 hospitals from 29 European countries. Of the respondents, 28.6% used a screening tool, and 31.8% had guidelines on parental risk factors. A total of 42.2% did not follow training based on child characteristics, and 57.6% did not follow training on parental characteristics. A total of 71.9% indicated that there was a need for training. 50.8% of the respondents reported a standardized policy for the detection of child maltreatment. Translating the survey results to NICE summary scores of the EDs in Europe, we found that 25.6% (34/133) met most, 22.6% (30/133) met some and 51.9% (69/133) met few of the NICE guideline recommendations. More specifically, with respect to hospital policies, 33.8% (45/133) met most, 15.0% (20/133) met some and 51.1% (68/133) met few of the NICE guideline recommendations. CONCLUSION There is high variability regarding policies for child maltreatment detection and only a quarter of the EDs met most of the NICE guideline recommendations for child maltreatment. There is a need for the use of screening tools, training of ED staff and implementation of local hospital policies.
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Affiliation(s)
- F. Hoedeman
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - P. J. Puiman
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - A. W. Smits
- Augeo Foundation, Driebergen, The Netherlands
| | | | | | - S. Laribi
- Emergency Department, Tours University Hospital, Tours, France
| | - D. Lauwaert
- Emergency Department, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - R. Oostenbrink
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - N. Parri
- Emergency Department & Trauma Center, Ospedale Pediatrico Meyer Firenze, Florence, Italy
| | | | - H. A. Moll
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- * E-mail:
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Kelly AM, Van Meer O, Keijzers G, Motiejunaite J, Jones P, Body R, Craig S, Karamercan M, Klim S, Harjola VP, Verschuren F, Holdgate A, Christ M, Golea A, Graham CA, Capsec J, Barletta C, Garcia-Castrillo L, Kuan WS, Laribi S. Get with the guidelines: management of chronic obstructive pulmonary disease in emergency departments in Europe and Australasia is sub-optimal. Intern Med J 2021; 50:200-208. [PMID: 30989793 DOI: 10.1111/imj.14323] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/11/2019] [Accepted: 04/08/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School - Western Precinct, The University of Melbourne, Melbourne, Victoria, Australia
| | - Oene Van Meer
- Leiden University Medical Center, Leiden, The Netherlands
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast Unviersty Hospital, Gold Coast, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Justina Motiejunaite
- INSERM, BIOmarkers in CArdioNeuroVAScular diseases, Paris, France.,Department of Anesthesiology and Critical Care, APHP, Saint Louis Lariboisière Hospitals, Paris, France.,Department of Cardiology, Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Peter Jones
- Department of Emergency Medicine, Auckland City Hosptial, Auckland, New Zealand
| | - Richard Body
- Emergency Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Cardiovascular Sciences Research Group, The University of Manchester, Manchester, UK
| | - Simon Craig
- Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Mehmet Karamercan
- Faculty of Medicine, Emergency Medicine Department, Gazi University, Ankara, Turkey.,Department of Emergency Medicine, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Helsinki, Finland.,Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Franck Verschuren
- Department of Acute Medicine, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Anna Holdgate
- Department of Emergency Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.,Southwest Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Christ
- Department of Emergency Care, Luzerner Kantonsspital, Luzern, Switzerland.,Paracelsus Medical University, Nuremberg, Germany
| | - Adela Golea
- Emergency Department of the University County Emergency Hospital, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Colin A Graham
- Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Jean Capsec
- Emergency Medicine Department, Tours University Hospital, Tours, France
| | - Cinzia Barletta
- Department of Emergency Medicine, St Eugenio Hospital, Rome, Italy
| | | | - Win S Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France.,School of Medicine, François-Rabelais University, Tours, France
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28
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Kelly AM, Keijzers G, Klim S, Craig S, Kuan WS, Holdgate A, Graham CA, Jones P, Laribi S. Epidemiology and outcome of older patients presenting with dyspnoea to emergency departments. Age Ageing 2021; 50:252-257. [PMID: 32997140 DOI: 10.1093/ageing/afaa121] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/02/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To describe the epidemiology and outcomes of non-traumatic dyspnoea in patients aged 75 years or older presenting to emergency departments (EDs) in the Asia-Pacific region. METHODS A substudy of a prospective interrupted time series cohort study conducted at three time points in EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia of patients presenting to the ED with dyspnoea as a main symptom. Data were collected over three 72-h periods and included demographics, co-morbidities, mode of arrival, usual medications, ED investigations and treatment, ED diagnosis and disposition, and outcome. The primary outcomes of interest are the epidemiology and outcome of patients aged 75 years or older presenting to the ED with dyspnoea. RESULTS 1097 patients were included. Older patients with dyspnoea made up 1.8% [95% confidence interval (CI) 1.7-1.9%] of ED presentations. The most common diagnoses were heart failure (25.3%), lower respiratory tract infection (25.2%) and chronic obstructive pulmonary disease (17.6%). Hospital ward admission was required for 82.6% (95% CI 80.2-84.7%), with 2.5% (95% CI 1.7-3.6%) requiring intensive care unit (ICU) admission. In-hospital mortality was 7.9% (95% CI 6.3-9.7%). Median length of stay was 5 days (interquartile range 2-8 days). CONCLUSION Older patients with dyspnoea make up a significant proportion of ED case load, and have a high admission rate and significant mortality. Exacerbations or worsening of pre-existing chronic disease account for a large proportion of cases which may be amenable to improved chronic disease management.
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Affiliation(s)
- Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine Australia and Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, St Albans, VLC, Parkville, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia and School of Medicine, Bond University, Gold Coast, QLD, Australia and School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Sharon Klim
- Joseph Centre for Emergency Medicine Research @ Western Health, Sunshine, Australia and The University of Melbourne, Parkville, Australia
| | - Simon Craig
- Emergency Department, Monash Medical Centre, Clayton, Australia; School of Clinical Sciences, Monash University, Clayton, Australia and Murdoch Children’s Research Institute, Parkville, Australia
| | - Win Sen Kuan
- Emergency Medicine Department, National University Health System, Singapore and Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore
| | - Anna Holdgate
- Department of Emergency Medicine, Liverpool Hospital, Sydney, Australia and University of New South Wales (Southwest Clinical School), Sydney, Australia
| | - Colin A Graham
- Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Peter Jones
- Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, 37044 Tours, France
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29
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Affiliation(s)
| | - Said Laribi
- Emergency Medicine Department, CHU Tours
- Medical school, University of Tours, France
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30
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Karamercan MA, Dündar ZD, Ergin M, VAN Meer O, Body R, Harjola VP, Verschuren F, Christ M, Golea A, Capsec J, Barletta C, Garcia-Castrillo L, Altuncı YA, Katırcı Y, Kelly AM, Laribi S. Seasonal variations of patients presenting dyspnea to emergency departments in Europe: Results from the EURODEM Study. Turk J Med Sci 2020; 50:1879-1886. [PMID: 32562519 PMCID: PMC7775711 DOI: 10.3906/sag-2002-221] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background/aim To describe seasonal variations in epidemiology, management, and short-term outcomes of patients in Europe presenting to an emergency department (ED) with a main complaint of dyspnea. Materials and methods An observational prospective cohort study was performed in 66 European EDs which included consecutive patients presenting to EDs with dyspnea as the main complaint during 3 72-h study periods. Data were collected on demographics, comorbidities, chronic treatment, prehospital treatment, mode of arrival of patient to ED, clinical signs at admission, treatment in the ED, ED diagnosis, discharge from ED, and in-hospital outcome. Results The study included 2524 patients with a median age of 69 (53–80) years old. Of the patients presented, 991 (39.3%) were in autumn, 849 (33.6%) were in spring, and 48 (27.1%) were in winter. The winter population was significantly older (P < 0.001) and had a lower rate of ambulance arrival to ED (P < 0.001). In the winter period, there was a higher rate for lower respiratory tract infection (35.1%), and patients were more hypertensive, more hypoxic, and more hyper/hypothermic compared to other seasons. The ED mortality was about 1% and, in hospital, mortality for admitted patients was 7.4%. Conclusion The analytic method and the outcome of this study may help to guide the allocation of ED resources more efficiently and to recommend seasonal ED management protocols based on the seasonal trend of dyspneic patients.
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Affiliation(s)
| | - Zerrin Defne Dündar
- Department of Emergency Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Ergin
- Department of Emergency Medicine, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Oene VAN Meer
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Richard Body
- Department of Emergency Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK,Department of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Veli-Pekka Harjola
- Department of Emergency Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland,Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Franck Verschuren
- Department of Acute Medicine, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Micheal Christ
- Department of Emergency Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Adela Golea
- Department of Emergency Medicine, County Emergency Hospital Cluj-Napoca, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jean Capsec
- Department of Public Health, Tours University Hospital, Tours, France
| | - Cinzia Barletta
- Department of Emergency Medicine, Santa Eugenio Hospital, Rome, Italy
| | | | - Yusuf Ali Altuncı
- Department of Emergency Medicine, Faculty of Medicine Hospital, Ege University, İzmir, Turkey
| | - Yavuz Katırcı
- Department of Emergency Medicine, Ankara Education and Research Hospital, Ankara, Turkey
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Australia,Department of Medicine, Melbourne Medical School – Western Precinct, The University of Melbourne, Melbourne, Australia
| | - Said Laribi
- Department of Emergency Medicine, Faculty of Medicine, Tours University, Tours, France
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31
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Freund Y, Cachanado M, Delannoy Q, Laribi S, Yordanov Y, Gorlicki J, Chouihed T, Féral-Pierssens AL, Truchot J, Desmettre T, Occelli C, Bobbia X, Khellaf M, Ganansia O, Bokobza J, Balen F, Beaune S, Bloom B, Simon T, Mebazaa A. Effect of an Emergency Department Care Bundle on 30-Day Hospital Discharge and Survival Among Elderly Patients With Acute Heart Failure: The ELISABETH Randomized Clinical Trial. JAMA 2020; 324:1948-1956. [PMID: 33201202 PMCID: PMC7672513 DOI: 10.1001/jama.2020.19378] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [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: 12/13/2022]
Abstract
IMPORTANCE Clinical guidelines for the early management of acute heart failure in the emergency department (ED) setting are based on only moderate levels of evidence, with subsequent low adherence to these guidelines. OBJECTIVE To test the effect of an early guideline-recommended care bundle on short-term prognosis in older patients with acute heart failure in the ED. DESIGN, SETTING, AND PARTICIPANTS Stepped-wedge cluster randomized trial in 15 EDs in France of 503 patients 75 years and older with a diagnosis of acute heart failure in the ED from December 2018 to September 2019 and followed up for 30 days until October 2019. INTERVENTIONS A care bundle that included early intravenous nitrate boluses; management of precipitating factors, such as acute coronary syndrome, infection, or atrial fibrillation; and moderate dose of intravenous diuretics (n = 200). In the control group, patient care was left to the discretion of the treating emergency physician (n = 303). Each center was randomized to the order in which they switched to the "intervention period." After the initial 4-week control period for all centers, 1 center entered in the intervention period every 2 weeks. MAIN OUTCOMES AND MEASURES The primary end point was the number of days alive and out of hospital at 30 days. Secondary outcomes included 30-day all-cause mortality, 30-day cardiovascular mortality, unscheduled readmission, length of hospital stay, and kidney impairment. RESULTS Among 503 patients who were randomized (median age, 87 years; 298 [59%] women), 502 were analyzed. In the intervention group, patients received a median (interquartile range) of 27.0 (9-54) mg of intravenous nitrates in the first 4 hours vs 4.0 (2.0-6.0) mg in the control group (adjusted difference, 23.8 [95% CI, 13.5-34.1]). There was a significantly higher percentage of patients in the intervention group treated for their precipitating factors than in the control group (58.8% vs 31.9%; adjusted difference, 31.1% [95% CI, 14.3%-47.9%]). There was no statistically significant difference in the primary end point of the number of days alive and out of hospital at 30 days (median [interquartile range], 19 [0- 24] d in both groups; adjusted difference, -1.9 [95% CI, -6.6 to 2.8]; adjusted ratio, 0.88 [95% CI, 0.64-1.21]). At 30 days, there was no significant difference between the intervention and control groups in mortality (8.0% vs 9.7%; adjusted difference, 4.1% [95% CI, -17.2% to 25.3%]), cardiovascular mortality (5.0% vs 7.4%; adjusted difference, 2.1% [95% CI, -15.5% to 19.8%]), unscheduled readmission (14.3% vs 15.7%; adjusted difference, -1.3% [95% CI, -26.3% to 23.7%]), median length of hospital stay (8 d in both groups; adjusted difference, 2.5 [95% CI, -0.9 to 5.8]), and kidney impairment (1% in both groups). CONCLUSIONS AND RELEVANCE Among older patients with acute heart failure, use of a guideline-based comprehensive care bundle in the ED compared with usual care did not result in a statistically significant difference in the number of days alive and out of the hospital at 30 days. Further research is needed to identify effective treatments for acute heart failure in older patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03683212.
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Affiliation(s)
- Yonathan Freund
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris (APHP), Paris, France
| | - Marine Cachanado
- Clinical Research Platform (URC-CRC-CRB), Hôpital Saint-Antoine, APHP, Paris, France
| | - Quentin Delannoy
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris (APHP), Paris, France
| | - Said Laribi
- Emergency Department, Hôpital Bretonneau, Tours, France
| | - Youri Yordanov
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Emergency Department, Hôpital Saint Antoine, APHP, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
| | - Judith Gorlicki
- Emergency Department, Hôpital Avicenne, APHP, Bobigny, France
| | - Tahar Chouihed
- Emergency Department, Hôpital CHRU Nancy, INSERM U1116, Université de Lorraine, Vandoeuvre les Nancy, France
| | | | | | | | | | | | - Mehdi Khellaf
- Emergency Department, Hôpital Henri Mondor, APHP, Université Paris Est – INSERM U955, Créteil, France
| | - Olivier Ganansia
- Emergency Department, Hôpital Paris Saint Joseph, Groupe Hospitalier Paris Saint Joseph
| | - Jérôme Bokobza
- Emergency Department, Hôpital Cochin, APHP, Paris, France
| | - Frédéric Balen
- Emergency Department, Centre hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sebastien Beaune
- Emergency Department, Hôpital Ambroise-Paré, APHP, Boulogne, Inserm U1144, Université de Paris, France
| | - Ben Bloom
- Emergency Department, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Tabassome Simon
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Clinical Research Platform (URC-CRC-CRB), Hôpital Saint-Antoine, APHP, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesia, Burn and Critical Care, Hôpitaux Universitaires Saint Louis Lariboisière, FHU PROMICE INI-CRCT, AP-HP, France
- Université de Paris, Paris, France
- U942 – MASCOT- Inserm, Paris, France
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32
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Manzo-Silberman S, Chouihed T, Fraticelli L, Peiretti A, Claustre C, Laribi S, Charpentier S, Bonnefoy-Cudraz E, El Khoury C. Assessment of atrial fibrillation in emergency department. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Atrial Fibrillation (AF) is the most common arrythmia, especially in older adults. AF represents 1% of emergency department (ED) visits a third of which are de novo or recurrent. While the diagnosis is given quickly by reading the electrocardiogram (ECG), its management both remains complex. European guidelines have been published in 2016.
Purpose
Our study aimed to investigate guidelines implementation in French ED.
Methods
Prospective national multicenter study (clinical trials NCT 03836339) and core interpretation of ECG. Consecutive patients admitted in 32 French ED for AF confirmed by ECG were prospectively included. Clinical characteristics at admission were recorded by the physician. The 3-months telephone follow-up was ensured by one operator.
Results
From 1/10/2018 to 30/11/2018, 1369 patients with AF were included, of whom 295 (21.55%) had a de novo AF. Patients were 80 [65; 87] years old, 51.17% of men, 71.53% self-ruling, 91.53% living at home, 65.42% transported by firemen or by ambulances and 4,07% by a mobile intensive care unit. Twenty-six (8.84%) patients had a history of stroke or transient ischemic stroke and none of them on anticoagulants. CHA2DS2-VASC score was performed in 66.78% of patients and was 0 in 14 (7.11%) patients. HAS-BLED score = 2 [1; 3]. At admission 50.17% of patients received anticoagulants, of whom 49.32% a non-vitamin K antagonist oral anticoagulant, 0.68% Vitamin K antagonists, 50.68% UFH or LMWH. Beta-blockers were administered in 102 (24.01%) patients and amiodarone in 38 (12.89%). Cardiac echography has been performed in 20.34% of patients. Atrial fibrillation was the primary diagnosis in 42.71% of patients. It has been associated to a pneumopathy in 25.17% of patients, a pulmonary embolism in 4.76% and acute alcoholism in 1.36% of them. Precipitating factor was often undetermined. The discharge to the home concerned 18.64% of patients, 26.78% of patients were hospitalized in ED hospitalization unit, 23.05% in cardiology or intensive care unit. At 3 months, 49% of patients were on anticoagulants, of whom 90% on non-vitamin K antagonist oral anticoagulants, 95% of them didn't report any bleeding event and 41.77% of them were able to have a cardiology consultation within three months. Three-months mortality was about 22.09%, and rehospitalization rate about 22.89%.
Conclusion
It seems to be a reticence to initiate anticoagulation of patients admitted to ED with a de novo AF. It could be explained by both the advanced age of the patients and the lack of an organized access to a systematic cardiology consultation at discharge. Patients with chronic AF are subject to high mortality at 3 months and a significant risk of readmission. The application of the guidelines could be optimized by a better training program and the implementation of a dedicated pathway of care.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Bayer
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Affiliation(s)
| | - T Chouihed
- University Hospital of Nancy, Emergency, Nancy, France
| | - L Fraticelli
- Hospital Center Lucien Hussel, RESUVal, Vienne, France
| | - A Peiretti
- Hospital Center Lucien Hussel, RESUVal, Vienne, France
| | - C Claustre
- Hospital Center Lucien Hussel, RESUVal, Vienne, France
| | - S Laribi
- University Hospital of Tours, Emergency, Tours, France
| | - S Charpentier
- University Hospital of Toulouse, Emergency, Toulouse, France
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Rousseau G, Stach E, Laribi S. Mutisme akinétique révélateur d’un accident vasculaire cérébral ischémique. Ann Fr Med Urgence 2020. [DOI: 10.3166/afmu-2020-0227] [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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Jones P, Kelly AM, Keijzers G, Klim S, Holdgate A, Graham CA, Craig S, Kuan WS, Laribi S. Chronic disease management in emergency department patients presenting with dyspnoea. Emerg Med Australas 2020; 32:1067-1070. [PMID: 32945106 DOI: 10.1111/1742-6723.13625] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Guideline recommended treatments for chronic conditions are thought to reduce ED presentations. METHOD We used data from 1958 ED patients with dyspnoea to describe medication use in patients with chronic conditions. RESULTS A total of 1233 (63.5%) patients had one or more of: chronic obstructive pulmonary disease 547 (28%), asthma 454 (23%), atrial fibrillation 368 (19%) or heart failure 401 (21%). Approximately, 70% were prescribed appropriate preventative medication for their chronic condition when they presented to ED with dyspnoea. CONCLUSION Prescription of guideline recommended therapies for chronic conditions in patients presenting to the ED in Australasia with acute dyspnoea is similar or higher than reported previously.
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Affiliation(s)
- Peter Jones
- Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand.,Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia.,School of Medicine - Western Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia
| | - Anna Holdgate
- Department of Emergency Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.,Southwest Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Colin A Graham
- Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Simon Craig
- Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Win Sen Kuan
- Emergency Medicine Department, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Said Laribi
- Department of Emergency Medicine, Tours University Hospital, Tours, France.,School of Medicine, Tours University, Tours, France
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35
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Freund Y, Drogrey M, Miró Ò, Marra A, Féral‐Pierssens A, Penaloza A, Hernandez BAL, Beaune S, Gorlicki J, Vaittinada Ayar P, Truchot J, Pena B, Aguirre A, Fémy F, Javaud N, Chauvin A, Chouihed T, Montassier E, Claret P, Occelli C, Roussel M, Brigant F, Ellouze S, Le Borgne P, Laribi S, Simon T, Lucidarme O, Cachanado M, Bloom B. Association Between Pulmonary Embolism and COVID-19 in Emergency Department Patients Undergoing Computed Tomography Pulmonary Angiogram: The PEPCOV International Retrospective Study. Acad Emerg Med 2020; 27:811-820. [PMID: 32734624 DOI: 10.1111/acem.14096] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND There have been reports of procoagulant activity in patients with COVID-19. Whether there is an association between pulmonary embolism (PE) and COVID-19 in the emergency department (ED) is unknown. The aim of this study was to assess whether COVID-19 is associated with PE in ED patients who underwent a computed tomographic pulmonary angiogram (CTPA). METHODS A retrospective study in 26 EDs from six countries. ED patients in whom a CTPA was performed for suspected PE during a 2-month period covering the pandemic peak. The primary endpoint was the occurrence of a PE on CTPA. COVID-19 was diagnosed in the ED either on CT or reverse transcriptase-polymerase chain reaction. A multivariable binary logistic regression was built to adjust with other variables known to be associated with PE. A sensitivity analysis was performed in patients included during the pandemic period. RESULTS A total of 3,358 patients were included, of whom 105 were excluded because COVID-19 status was unknown, leaving 3,253 for analysis. Among them, 974 (30%) were diagnosed with COVID-19. Mean (±SD) age was 61 (±19) years and 52% were women. A PE was diagnosed on CTPA in 500 patients (15%). The risk of PE was similar between COVID-19 patients and others (15% in both groups). In the multivariable binary logistic regression model, COVID-19 was not associated with higher risk of PE (adjusted odds ratio = 0.98, 95% confidence interval = 0.76 to 1.26). There was no association when limited to patients in the pandemic period. CONCLUSION In ED patients who underwent CTPA for suspected PE, COVID-19 was not associated with an increased probability of PE diagnosis. These results were also valid when limited to the pandemic period. However, these results may not apply to patients with suspected COVID-19 in general.
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Affiliation(s)
- Yonathan Freund
- From Sorbonne Université Paris France
- the Emergency Department Hôpital Pitié‐Salpêtrière Assistance Publique–Hôpitaux de Paris (APHP), APHP.SU Paris France
| | - Marie Drogrey
- the Emergency Department Hôpital Pitié‐Salpêtrière Assistance Publique–Hôpitaux de Paris (APHP), APHP.SU Paris France
| | - Òscar Miró
- the Emergency Departement Hospital Clínic Barcelona Catalonia Spain
| | - Alessio Marra
- the Emergency Department Centro EAS–Emergenza Alta Specializzazione ASST Papa Giovanni XXIII Hospital Bergamo Italy
| | - Anne‐Laure Féral‐Pierssens
- the Charles Lemoyne–Saguenay Lac Saint‐Jean Research Center on Health Innovations (CR CSIS) Sherbrooke University Longueuil Québec Canada
- the Emergency Department European Georges Pompidou hospital APHP Paris France
| | - Andrea Penaloza
- the Service des Urgences Cliniques Universitaires Saint‐Luc Université Catholique de Louvain Louvain‐la‐Neuve Belgium
| | | | - Sebastien Beaune
- the Emergency Department Hôpital Ambroise‐Paré, APHP, Boulogne, INSERM UMR 1144 Université Paris Centre Paris France
| | - Judith Gorlicki
- the Emergency Department SAMU 93 Avicenne University Hospital, APHP.HUPSSD Bobigny France
- INSERM UMR‐S 942 Sorbonne Paris Nord University Bobigny France
| | - Prabakar Vaittinada Ayar
- the Emergency Department University Hospital of Beaujon, APHP Clichy France
- UMR‐S 942 INSERM MASCOT Paris France
- University Paris France
| | - Jennifer Truchot
- the Emergency Department Cochin Hospital Hôpitaux Universitaire Paris Centre APHP Paris France
| | - Barbara Pena
- the Emergency Department Hospital General Universitario de Alicante Alicante Spain
| | - Alfons Aguirre
- the Emergency Department Hospital del Mar Barcelona Catalonia Spain
| | - Florent Fémy
- the Emergency Department Georges Pompidou European Hospital APHP, Université de Paris Paris France
- the Toxicology and Chemical Risks Department French Armed Forces Biomedical Institute Bretigny‐Sur‐Orges France
| | - Nicolas Javaud
- the Emergency Department Louis Mourier Hospital University of Paris, APHP.North Paris France
| | - Anthony Chauvin
- the Emergency Department Hopital Lariboisière Assistance Publique‐Hôpitaux de Paris Paris France
- the Faculté de Médecine Université de Paris Paris France
| | - Tahar Chouihed
- the Emergency Department Université de Lorraine, University Hospital of Nancy, Centre d'Investigations Cliniques‐1433, and INSERM UMR_S 1116 Nancy France
- the F‐CRIN INI‐CRCT Nancy France
| | - Emmanuel Montassier
- the Department of Emergency Medicine CHU Nantes Nantes France
- the MiHAR Laboratory Université de Nantes Nantes France
| | - Pierre‐Géraud Claret
- the Department of Anesthesia Resuscitation Pain Emergency Medicine Nîmes University Hospital Nîmes France
| | - Céline Occelli
- the Emergency Department CHU Pasteur 2 Nice France
- the University Nice Côte d'Azur Nice France
| | - Mélanie Roussel
- the Emergency Department Rouen University Hospital Rouen France
| | - Fabien Brigant
- the Emergency Department Hôpital Saint‐Antoine, APHP.SU Paris France
| | - Sami Ellouze
- the Emergency Department Hôpital Saint‐Louis, APHP Paris France
| | - Pierrick Le Borgne
- the Emergency Department Hôpitaux Universitaires de Strasbourg Strasbourg France
- the INSERM (French National Institute of Health and Medical Research), UMR 1260 Regenerative NanoMedicine (RNM) Fédération de Médecine Translationnelle (FMTS) University of Strasbourg Strasbourg France
| | - Said Laribi
- the Emergency Department School of Medicine and CHU Tours Tours University Tours France
| | - Tabassome Simon
- From Sorbonne Université Paris France
- the Clinical Research Platform (URC‐CRC‐CRB) AP‐HP Hôpital Saint‐Antoine Paris France
| | - Olivier Lucidarme
- From Sorbonne Université Paris France
- the APHP‐Sorbonne Universités Pitié Salpêtrière Hospital, Radiology Department and UPMC Univ Paris 06 CNRS, INSERM, Laboratoire d'Imagerie Biomédicale Paris France
| | - Marine Cachanado
- the Emergency Department Royal London Hospital Barts Health NHS Trust London UK
| | - Ben Bloom
- and the Emergency Department European Georges Pompidou Hospital, APHP Paris France
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36
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Laurent E, Lahondere A, Godillon L, Vannier S, Bonnaud I, Gaudron M, Laribi S, Grammatico-Guillon L. Enquête Suspi-AVC en Centre-Val de Loire, prise en charge initiale des suspicions d’accident vasculaire cérébral. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.03.053] [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: 10/23/2022] Open
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Lafon T, Cazalis MA, Vallejo C, Tazarourte K, Blein S, Pachot A, Laterre PF, Laribi S, François B. Prognostic performance of endothelial biomarkers to early predict clinical deterioration of patients with suspected bacterial infection and sepsis admitted to the emergency department. Ann Intensive Care 2020; 10:113. [PMID: 32785865 PMCID: PMC7423829 DOI: 10.1186/s13613-020-00729-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 04/09/2020] [Accepted: 07/31/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the ability of endothelial biomarkers to early predict clinical deterioration of patients admitted to the emergency department (ED) with a suspected sepsis. This was a prospective, multicentre, international study conducted in EDs. Adult patients with suspected acute bacterial infection and sepsis were enrolled but only those with confirmed infection were analysed. The kinetics of biomarkers and organ dysfunction were collected at T0, T6 and T24 hours after ED admission to assess prognostic performances of sVEGFR2, suPAR and procalcitonin (PCT). The primary outcome was the deterioration within 72 h and was defined as a composite of relevant outcomes such as death, intensive care unit admission and/or SOFA score increase validated by an independent adjudication committee. RESULTS After adjudication of 602 patients, 462 were analysed including 124 who deteriorated (27%). On admission, those who deteriorated were significantly older (73 [60-82] vs 63 [45-78] y-o, p < 0.001) and presented significantly higher SOFA scores (2.15 ± 1.61 vs 1.56 ± 1.40, p = 0.003). At T0, sVEGFR2 (5794 [5026-6788] vs 6681 [5516-8059], p < 0.0001), suPAR (6.04 [4.42-8.85] vs 4.68 [3.50-6.43], p < 0.0001) and PCT (7.8 ± 25.0 vs 5.4 ± 17.9 ng/mL, p = 0.001) were associated with clinical deterioration. In multivariate analysis, low sVEGFR2 expression and high suPAR and PCT levels were significantly associated with early deterioration, independently of confounding parameters (sVEGFR2, OR = 1.53 [1.07-2.23], p < 0.001; suPAR, OR = 1.57 [1.21-2.07], p = 0.003; PCT, OR = 1.10 [1.04-1.17], p = 0.0019). Combination of sVEGFR2 and suPAR had the best prognostic performance (AUC = 0.7 [0.65-0.75]) compared to clinical or biological variables. CONCLUSIONS sVEGFR2, either alone or combined with suPAR, seems of interest to predict deterioration of patients with suspected bacterial acute infection upon ED admission and could help front-line physicians in the triage process.
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Affiliation(s)
- Thomas Lafon
- Emergency Department, Dupuytren University Hospital, Limoges, France.,Inserm CIC 1435, Dupuytren University Hospital, Limoges, France
| | | | - Christine Vallejo
- Emergency Department, Dupuytren University Hospital, Limoges, France.,Inserm CIC 1435, Dupuytren University Hospital, Limoges, France
| | - Karim Tazarourte
- Emergency Department, University Hospital Edouard Herriot - HCL, Lyon, France
| | - Sophie Blein
- Medical Diagnostic Discovery Department MD3, bioMerieux SA, Marcy L'Etoile, France
| | - Alexandre Pachot
- Medical Diagnostic Discovery Department MD3, bioMerieux SA, Marcy L'Etoile, France
| | - Pierre-François Laterre
- Departments of Emergency and Intensive Care, Cliniques Universitaires Saint Luc, UCL, Brussels, Belgium
| | - Said Laribi
- School of Medicine and Tours University Hospital, Emergency Medicine Department, Tours University, Tours, France
| | - Bruno François
- Inserm CIC 1435, Dupuytren University Hospital, Limoges, France. .,Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, Limoges, France. .,UMR 1092, University of Limoges, Limoges, France.
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38
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Rousseau G, Keijzers G, van Meer O, Craig S, Karamercan M, Klim S, Body R, Kuan WS, Harjola VP, Jones P, Verschuren F, Holdgate A, Christ M, Golea A, Capsec J, Barletta C, Graham CA, Garcia-Castrillo L, Laribi S, Kelly AM. Epidemiology, treatment and outcome of patients with lower respiratory tract infection presenting to emergency departments with dyspnoea (AANZDEM and EuroDEM studies). Emerg Med Australas 2020; 33:58-66. [PMID: 32748553 DOI: 10.1111/1742-6723.13567] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Lower respiratory tract infection (LRTI) is a frequent cause of dyspnoea in EDs, and is associated with considerable morbidity and mortality. We described and compared the management of this disease in Europe and Oceania/South-East Asia (SEA) cohorts. METHODS We conducted a prospective cohort study with three time points in Europe and Oceania/SEA. We included in this manuscript patients presenting to EDs with dyspnoea and a diagnosis of LRTI in ED. We collected comorbidities, chronic medication, clinical signs at arrival, laboratory parameters, ED management and patient outcomes. RESULTS A total of 1389 patients were included, 773 in Europe and 616 in SEA. The European cohort had more comorbidities including chronic heart failure, obesity, chronic obstructive pulmonary disease and smoking. Levels of inflammatory markers were higher in Europe. There were more patients with inflammatory markers in Europe and more hypercapnia in Oceania/SEA. The use of antibiotics was higher in SEA (72.2% vs 61.8%, P < 0.001) whereas intravenous diuretics, non-invasive and invasive ventilation were higher in Europe. Intensive care unit admission rate was 9.9% in Europe cohort and 3.4% in Oceania/SEA cohort. ED mortality was 1% and overall in-hospital mortality was 8.7% with no differences between regions. CONCLUSIONS More patients with LRTI in Europe presented with cardio-respiratory comorbidities, they received more adjunct therapies and had a higher intensive care unit admission rate than patients from Oceania/SEA, although mortality was similar between the two cohorts.
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Affiliation(s)
- Geoffroy Rousseau
- Department of Emergency Medicine, Tours University Hospital, Tours, France
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Oene van Meer
- Emergency Department, Leiden University Medical Center, Leiden, The Netherlands
| | - Simon Craig
- Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Mehmet Karamercan
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia
| | - Richard Body
- Emergency Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Win Sen Kuan
- Department of Emergency Medicine, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Helsinki, Finland.,Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Peter Jones
- Emergency Department, Auckland City Hospital, Auckland, New Zealand.,Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Franck Verschuren
- Department of Acute Medicine, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Anna Holdgate
- Department of Emergency Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.,Southwest Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Christ
- Emergency Department, Luzerner Kantonsspital, Luzern, Switzerland
| | - Adela Golea
- Emergency Medicine, County Emergency Hospital Cluj-Napoca, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jean Capsec
- Department of Public Health, Tours University Hospital, Tours, France
| | - Cinzia Barletta
- Department of Emergency Medicine, Santa Eugenio Hospital, Rome, Italy
| | - Colin A Graham
- Emergency Medicine, Chinese University of Hong Kong, Hong Kong
| | | | - Said Laribi
- Department of Emergency Medicine, Tours University Hospital, Tours, France.,School of Medicine, Tours University, Tours, France
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School - Western Precinct, The University of Melbourne, Melbourne, Victoria, Australia
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39
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Harjola P, Miró Ò, Martín-Sánchez FJ, Escalada X, Freund Y, Penaloza A, Christ M, Cone DC, Laribi S, Kuisma M, Tarvasmäki T, Harjola VP. Pre-hospital management protocols and perceived difficulty in diagnosing acute heart failure. ESC Heart Fail 2019; 7:289-296. [PMID: 31701683 PMCID: PMC7083500 DOI: 10.1002/ehf2.12524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/21/2019] [Accepted: 09/01/2019] [Indexed: 12/28/2022] Open
Abstract
Aim To illustrate the pre‐hospital management arsenals and protocols in different EMS units, and to estimate the perceived difficulty of diagnosing suspected acute heart failure (AHF) compared with other common pre‐hospital conditions. Methods and results A multinational survey included 104 emergency medical service (EMS) regions from 18 countries. Diagnostic and therapeutic arsenals related to AHF management were reported for each type of EMS unit. The prevalence and contents of management protocols for common medical conditions treated pre‐hospitally was collected. The perceived difficulty of diagnosing AHF and other medical conditions by emergency medical dispatchers and EMS personnel was interrogated. Ultrasound devices and point‐of‐care testing were available in advanced life support and helicopter EMS units in fewer than 25% of EMS regions. AHF protocols were present in 80.8% of regions. Protocols for ST‐elevation myocardial infarction, chest pain, and dyspnoea were present in 95.2, 80.8, and 76.0% of EMS regions, respectively. Protocolized diagnostic actions for AHF management included 12‐lead electrocardiogram (92.1% of regions), ultrasound examination (16.0%), and point‐of‐care testings for troponin and BNP (6.0 and 3.5%). Therapeutic actions included supplementary oxygen (93.2%), non‐invasive ventilation (80.7%), intravenous furosemide, opiates, nitroglycerine (69.0, 68.6, and 57.0%), and intubation 71.5%. Diagnosing suspected AHF was considered easy to moderate by EMS personnel and moderate to difficult by emergency medical dispatchers (without significant differences between de novo and decompensated heart failure). In both settings, diagnosis of suspected AHF was considered easier than pulmonary embolism and more difficult than ST‐elevation myocardial infarction, asthma, and stroke. Conclusions The prevalence of AHF protocols is rather high but the contents seem to vary. Difficulty of diagnosing suspected AHF seems to be moderate compared with other pre‐hospital conditions.
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Affiliation(s)
- Pia Harjola
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Òscar Miró
- Emergency Department, Hospital Clínic, University of Barcelona, Villarroel 170, Barcelona, 08036, Spain
| | - Francisco J Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Facultad de Medicina de Universidad Complutense de Madrid, Madrid, Spain
| | | | - Yonathan Freund
- Emergency Department, Hôpital Pitie-Salpêtrière, Assistance Publique-Hôpitaux de Paris, INSERM 1166, Sorbonne University, Paris, France
| | - Andrea Penaloza
- Emergency Department, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Michael Christ
- Department of Emergency Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | - David C Cone
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Said Laribi
- Département de Médecine d'Urgence, CHRU de Tours, Faculté de Médecine, Université de Tours Centre d'Étude des Pathologies Respiratoires - Inserm U1100, Tours, France
| | - Markku Kuisma
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Tuukka Tarvasmäki
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.,Cardiology, University of Helsinki, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
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40
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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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41
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Quaegebeur A, Brunard L, Javaudin F, Vibet MA, Bemer P, Le Bastard Q, Batard E, Montassier E, Roman F, Llorens P, Salvi F, Galeazzi R, Ortega M, Marco F, Martinez Ortiz de Zarate M, Figueroa Ceron R, Trovato FM, Carpinteri G, Moustafa F, Romaszko JP, Pedersen M, Westh H, Dejaune P, Fihman V, Joost I, Blumel B, Parrilla Ruiz FM, Alvarez Corral G, Bieler D, Bergmann H, Granzer H, Carron PN, Prod’hom G, Greub G, Gonzalez Del Castillo JM, Candel Gonzalez FJ, Juvin ME, Occelli C, Ruimy R, Claret PG, Lavigne JP, Hausfater P, Robert J, Ramacciati N, Mencacci A, Tartaglia D, Rossi L, Ojetti V, Petruzziello C, Fiori B, Bonenfant J, Piau-Couape C, Dejoies L, Garcia-Garcia Á, Cores-Calvo O, Van Den Brand CL, van Veen SQ, Laribi S, Lartigue MF. Trends and prediction of antimicrobial susceptibility in urinary bacteria isolated in European emergency departments: the EuroUTI 2010-2016 Study. J Antimicrob Chemother 2019; 74:3069-3076. [DOI: 10.1093/jac/dkz274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To assess recent trends in susceptibility to antibiotics among urinary isolates isolated in European emergency departments (EDs) and to identify isolates with a high (90% or more) predicted probability of susceptibility to fluoroquinolones or third-generation cephalosporins (3GCs).
Methods
In this cross-sectional study, we included urine cultures obtained from adult patients between 2010 and 2016 in 24 European EDs. Temporal trends were assessed using time-series analysis and multivariate logistic models. Multivariate logistic models were also used to predict susceptibility to fluoroquinolones or 3GCs from patient age and sex, year, month and ED.
Results
We included 88242 isolates. Time-series analysis found a significant increase in susceptibility to fluoroquinolones and no significant trend for susceptibility to 3GCs. Adjusting for patient age and sex, ED and organism, multivariate models showed that susceptibility to 3GCs decreased from 2014 to 2016, while susceptibility to fluoroquinolones increased in 2015 and 2016. Among isolates from 2016, multivariate models predicted high probability of susceptibility to fluoroquinolones in 11% of isolates (positive predictive value 91%) and a high probability of susceptibility to 3GCs in 35% of isolates (positive predictive value 94%).
Conclusions
Susceptibility of ED urinary isolates to fluoroquinolones increased from 2014, while susceptibility to 3GCs decreased from 2015. Predictive models identified isolates with a high probability of susceptibility to fluoroquinolones or 3GCs. The ability of such models to guide the empirical treatment of pyelonephritis in the ED remains to be determined.
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Affiliation(s)
- Alice Quaegebeur
- Lausanne University Hospital, Emergency Department, Lausanne, Switzerland
| | - Loïc Brunard
- CHU Nantes, Emergency Department, Nantes, France
| | - François Javaudin
- CHU Nantes, Emergency Department, Nantes, France
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
| | - Marie-Anne Vibet
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
- CHU Nantes, DRCI, Plateforme de Méthodologie et de Biostatistique, Nantes, France
| | - Pascale Bemer
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
- CHU Nantes, Bacteriology and Infection Control, Nantes, France
| | - Quentin Le Bastard
- CHU Nantes, Emergency Department, Nantes, France
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
| | - Eric Batard
- CHU Nantes, Emergency Department, Nantes, France
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
| | - Emmanuel Montassier
- CHU Nantes, Emergency Department, Nantes, France
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
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42
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Craig S, Kuan WS, Kelly AM, Van Meer O, Motiejunaite J, Keijzers G, Jones P, Body R, Karamercan MA, Klim S, Harjola VP, Verschuren F, Holdgate A, Christ M, Golea A, Graham CA, Capsec J, Barletta C, Garcia-Castrillo L, Laribi S. Treatment and outcome of adult patients with acute asthma in emergency departments in Australasia, South East Asia and Europe: Are guidelines followed? AANZDEM/EuroDEM study. Emerg Med Australas 2019; 31:756-762. [PMID: 30806041 DOI: 10.1111/1742-6723.13242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Asthma exacerbations are common presentations to ED. Key guideline recommendations for management include administration of inhaled bronchodilators, systemic corticosteroids and titrated oxygen therapy. Our aim was to compare management and outcomes between patients treated for asthma in Europe (EUR) and South East Asia/Australasia (SEA) and compliance with international guidelines. METHODS In each region, prospective, interrupted time series studies were performed including adult (age >18 years) patients presenting to ED with the main complaint of dyspnoea during three 72 h periods. This was a planned sub-study that included those with an ED primary diagnosis of asthma. Data was collected on demographics, clinical features, treatment in ED, diagnosis, disposition and in-hospital outcome. The results of interest were differences in treatment and outcome between EUR and SEA cohorts. RESULTS Five hundred and eighty-four patients were identified from 112 EDs (66 EUR and 46 SEA). The cohorts had similar demographics and co-morbidity patterns, with 89% of the cohort having a previous diagnosis of asthma. There were no significant differences in treatment between EUR and SEA patients - inhaled beta-agonists were administered in 86% of cases, systemic corticosteroids in 66%, oxygen therapy in 44% and antibiotics in 20%. Two thirds of patients were discharged home from the ED. CONCLUSION The data suggests that compliance with guideline-recommended therapy in both regions, particularly corticosteroid administration, is sub-optimal. It also suggests over-use of antibiotics.
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Affiliation(s)
- Simon Craig
- Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Win Sen Kuan
- Emergency Medicine Department, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School - Western Precinct, The University of Melbourne, Melbourne, Victoria, Australia
| | - Oene Van Meer
- Leiden University Medical Center, Leiden, The Netherlands
| | - Justina Motiejunaite
- INSERM, U942, BIOmarkers in CArdioNeuroVAScular diseases, Paris, France.,Department of Anesthesiology and Critical Care, APHP, Saint Louis Lariboisière Hospitals, Paris, France.,Department of Cardiology, Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Brisbane, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Peter Jones
- Emergency Department, Auckland City Hospital, Auckland, New Zealand.,Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Richard Body
- Emergency Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Mehmet A Karamercan
- Emergency Medicine Department, Faculty of Medicine, Gazi University, Ankara, Turkey.,Department of Emergency Medicine, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Helsinki, Finland.,Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Franck Verschuren
- Department of Acute Medicine, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Anna Holdgate
- Department of Emergency Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.,Southwest Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Christ
- Emergency Department, Luzerner Kantonsspital, Luzern, Switzerland
| | - Adela Golea
- Emergency Medicine, County Emergency Hospital Cluj-Napoca, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Colin A Graham
- Emergency Medicine, Chinese University of Hong Kong, Hong Kong
| | - Jean Capsec
- Public Health Department, Tours University Hospital, Tours, France
| | - Cinzia Barletta
- Department of Emergency Medicine, Santa Eugenio Hospital, Rome, Italy
| | | | - Said Laribi
- School of Medicine, INSERM U1100, Tours University, Tours, France.,Emergency Medicine Department, Tours University Hospital, Tours, France
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43
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Dos Reis D, Fraticelli L, Bassand A, Manzo-Silberman S, Peschanski N, Charpentier S, Elbaz M, Savary D, Bonnefoy-Cudraz E, Laribi S, Henry P, Guerraoui A, Tazarourte K, Chouihed T, El Khoury C. Impact of renal dysfunction on the management and outcome of acute heart failure: results from the French prospective, multicentre, DeFSSICA survey. BMJ Open 2019; 9:e022776. [PMID: 30782685 PMCID: PMC6340446 DOI: 10.1136/bmjopen-2018-022776] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/25/2022] Open
Abstract
OBJECTIVES Cardiorenal syndrome (CRS) is the combination of acute heart failure syndrome (AHF) and renal dysfunction (creatinine clearance (CrCl) ≤60 mL/min). Real-life data were used to compare the management and outcome of AHF with and without renal dysfunction. DESIGN Prospective, multicentre. SETTING Twenty-six academic, community and regional hospitals in France. PARTICIPANTS 507 patients with AHF were assessed in two groups according to renal function: group 1 (patients with CRS (CrCl ≤60 mL/min): n=335) and group 2 (patients with AHF with normal renal function (CrCl >60 mL/min): n=172). RESULTS Differences were observed (group 1 vs group 2) at admission for the incidence of chronic heart failure (56.42% vs 47.67%), use of furosemide (60.9% vs 52.91%), insulin (15.52% vs 9.3%) and amiodarone (14.33% vs 4.65%); additionally, more patients in group 1 carried a defibrillator (4.78% vs 0%), had ≥2 hospitalisations in the last year (15.52% vs 5.81%) and were under the care of a cardiologist (72.24% vs 61.63%). Clinical signs were broadly similar in each group. Brain-type natriuretic peptide (BNP) and BNP prohormone were higher in group 1 than group 2 (1157.5 vs 534 ng/L and 5120 vs 2513 ng/mL), and more patients in group 1 were positive for troponin (58.2% vs 44.19%), had cardiomegaly (51.04% vs 37.21%) and interstitial opacities (60.3% vs 47.67%). The only difference in emergency treatment was the use of nitrates, (higher in group 1 (21.9% vs 12.21%)). In-hospital mortality and the percentage of patients still hospitalised after 30 days were similar between groups, but the median stay was longer in group 1 (8 days vs 6 days). CONCLUSIONS Renal impairment in AHF should not limit the use of loop diuretics and/or vasodilators, but early assessment of pulmonary congestion and close monitoring of the efficacy of conventional therapies is encouraged to allow rapid and appropriate implementation of alternative therapies if necessary.
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Affiliation(s)
| | | | - Adrien Bassand
- SAMU-SMUR-SAU Nancy, Hôpital Central, Nancy, Lorraine, France
| | | | | | - Sandrine Charpentier
- Emergency Department, Rangueil University Hospital, Toulouse, France
- INSERM, U1027, Toulouse, France
- Medical Department, Université Toulouse III – Paul Sabatier, Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, Rangueil Hospital, Toulouse, France
| | - Dominique Savary
- Emergency Department and Intensive Care Unit, Metz-Tessy, France
| | | | - Said Laribi
- Emergency Medicine Department, University Hospital of Tours, Tours, France
- INSERM UMR-S 942, Université Paris-Diderot, Paris, France
| | - Patrick Henry
- Lariboisière Hospital, Department of Cardiology, Université Paris-Diderot, Paris, France
| | | | - Karim Tazarourte
- Emergency Department, Edouard Herriot Hospital, Rhône-Alpes, France
| | - Tahar Chouihed
- SAMU-SMUR-SAU Nancy, Hôpital Central, Nancy, Lorraine, France
- Centre d’Investigation Clinique Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre-lès-Nancy, France
- INSERM U1116, Université de Lorraine, Nancy, France
| | - Carlos El Khoury
- Emergency Department and RESCUe Network, Lucien Hussel Hospital, Vienne, France
- University Lyon, Claude Bernard Lyon 1 University, HESPER EA, Lyon, France
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44
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Kuan WS, Craig S, Kelly AM, Keijzers G, Klim S, Graham CA, Jones P, Holdgate A, Lawoko C, Laribi S. Asthma among adult patients presenting with dyspnea to the emergency department: An observational study. Clin Respir J 2018; 12:2117-2125. [PMID: 29469993 DOI: 10.1111/crj.12782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/03/2018] [Accepted: 02/18/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Shortness of breath is a common presenting symptom to the emergency department (ED) that can arise from a myriad of possible diagnoses. Asthma is one of the major causes. OBJECTIVE The aim of this study was to describe the demographic features, clinical characteristics, management and outcomes of adults with an ED diagnosis of asthma who presented to an ED in the Asia Pacific region with a principal symptom of dyspnea. METHODS Planned sub-study of patients with an ED diagnosis of asthma identified in the Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM) study. AANZDEM was a prospective cohort study conducted in 46 EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia over three 72 hour periods in May, August and October 2014. Primary outcomes were patient epidemiology, clinical features, treatment and outcomes (hospital length of stay (LOS) and mortality). RESULTS Of the 3044 patients with dyspnea, 387 (12.7%) patients had an ED diagnosis of asthma. The median age was 45 years, 60.1% were female, 16.1% were active or recent smokers and 30.4% arrived by ambulance. Inhaled bronchodilator therapy was initiated in 88.1% of patients, and 66.9% received both inhaled bronchodilators and systemic corticosteroids. After treatment in the ED, 65.4% were discharged. No death was reported. CONCLUSION Asthma is common among patients presenting with a principal symptom of dyspnea in the ED of the Asia Pacific region. There was a suboptimal adherence to international guidelines on investigations and treatments of acute asthma exacerbations presenting an opportunity to improve the efficiency of care.
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Affiliation(s)
- Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Simon Craig
- Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research at Western Health, Sunshine, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research at Western Health, Sunshine, Victoria, Australia
| | - Colin A Graham
- Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Peter Jones
- Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Anna Holdgate
- Department of Emergency Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.,University of New South Wales (Southwest Clinical School), Sydney, New South Wales, Australia
| | - Charles Lawoko
- Industry Doctoral Training Centre, ATN Universities, Melbourne, Victoria, Australia
| | - Said Laribi
- School of Medicine, Francois Rabelais University, Tours, France.,Emergency Medicine Department, Tours University Hospital, Tours, France
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45
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Akiyama E, Van Aelst LNL, Arrigo M, Lassus J, Miró Ò, Čelutkienė J, Choi DJ, Cohen-Solal A, Ishihara S, Kajimoto K, Laribi S, Maggioni AP, Motiejunaite J, Mueller C, Parenica J, Park JJ, Sato N, Spinar J, Zhang J, Zhang Y, Kimura K, Tamura K, Gayat E, Mebazaa A. East Asia may have a better 1-year survival following an acute heart failure episode compared with Europe: results from an international observational cohort. Eur J Heart Fail 2018; 20:1071-1075. [PMID: 29431285 DOI: 10.1002/ejhf.1152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/12/2017] [Accepted: 01/10/2018] [Indexed: 11/05/2022] Open
Affiliation(s)
- Eiichi Akiyama
- Inserm UMR-S 942, Paris, France.,Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Lucas N L Van Aelst
- Inserm UMR-S 942, Paris, France.,Department of Cardiology, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique des Hopitaux de Paris, Paris, France.,Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg O&N1, Leuven, Belgium
| | - Mattia Arrigo
- Inserm UMR-S 942, Paris, France.,Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisiere, Assistance Publique des Hopitaux de Paris, Paris, France.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Johan Lassus
- Cardiology, Helsinki University and Division of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Òscar Miró
- Emergency Department, Hospital Clinic and 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, Barcelona, University of Barcelona, Catalonia, Spain
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Centre of Cardiology and Angiology, Vilnius University, Vilnius, Lithuania
| | - Dong-Ju Choi
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Alain Cohen-Solal
- Inserm UMR-S 942, Paris, France.,Department of Cardiology, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique des Hopitaux de Paris, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Shiro Ishihara
- Inserm UMR-S 942, Paris, France.,Division of Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan
| | | | - Said Laribi
- Emergency Medicine Department, François-Rabelais University and Tours University Hospital, Tours, France
| | | | - Justina Motiejunaite
- Inserm UMR-S 942, Paris, France.,Department of Cardiology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Christian Mueller
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Jiri Parenica
- Department of Cardiology, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Jin Joo Park
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Naoki Sato
- Division of Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan
| | - Jindrich Spinar
- Department of Cardiology, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Jian Zhang
- Heart Failure Center Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuhui Zhang
- Heart Failure Center Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Etienne Gayat
- Inserm UMR-S 942, Paris, France.,Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisiere, Assistance Publique des Hopitaux de Paris, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Alexandre Mebazaa
- Inserm UMR-S 942, Paris, France.,Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisiere, Assistance Publique des Hopitaux de Paris, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France
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46
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Kelly AM, Holdgate A, Keijzers G, Klim S, Graham CA, Craig S, Kuan WS, Jones P, Lawoko C, Laribi S. Epidemiology, treatment, disposition and outcome of patients with acute exacerbation of COPD presenting to emergency departments in Australia and South East Asia: An AANZDEM study. Respirology 2018; 23:681-686. [PMID: 29394524 DOI: 10.1111/resp.13259] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/26/2017] [Accepted: 01/04/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common presentation to emergency departments (ED) but data regarding its epidemiology and outcomes are scarce. We describe the epidemiology, clinical features, treatment and outcome of patients treated for AECOPD in ED. METHODS This was a planned sub-study of patients with an ED diagnosis of AECOPD identified in the Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM) study. The AANZDEM was a prospective, interrupted time series cohort study conducted in 46 ED in Australia, New Zealand, Singapore, Hong Kong and Malaysia over three 72-h periods in May, August and October 2014. Primary outcomes were patient epidemiology, clinical features, treatment and outcomes (hospital length of stay (LOS) and mortality). RESULTS Forty-six ED participated. There were 415 patients with an ED primary diagnosis of AECOPD (13.6% of the overall cohort; 95% CI: 12.5-14.9%). Median age was 73 years, 60% males and 65% arrived by ambulance. Ninety-one percent had an existing COPD diagnosis. Eighty percent of patients received inhaled bronchodilators, 66% received systemic corticosteroids and 57% of those with pH < 7.30 were treated with non-invasive ventilation (NIV). Seventy-eight percent of patients were admitted to hospital, 7% to an intensive care unit. In-hospital mortality was 4% and median LOS was 4 days (95% CI: 2-7). CONCLUSION Patients treated in ED for AECOPD commonly arrive by ambulance, have a high admission rate and significant in-hospital mortality. Compliance with evidence-based treatments in ED is suboptimal affording an opportunity to improve care and potentially outcomes.
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Affiliation(s)
- Anne Maree Kelly
- Joseph Epstein Centre for Emergency Medicine, Sunshine Hospital, St Albans, VIC, Australia.,School of Medicine - Western Clinical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Anna Holdgate
- Department of Emergency Medicine, Liverpool Hospital, Sydney, NSW, Australia.,University of New South Wales (Southwest Clinical School), Sydney, NSW, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia.,School of Medicine, Bond University, Gold Coast, QLD, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine, Sunshine Hospital, St Albans, VIC, Australia
| | - Colin A Graham
- Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Simon Craig
- Emergency Department, Monash Medical Centre, Melbourne, VIC, Australia.,School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Win Sen Kuan
- Emergency Medicine Department, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Peter Jones
- Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Charles Lawoko
- Industry Doctoral Training Centre, ATN Universities, Melbourne, VIC, Australia
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, François-Rabelais University, Tours, France
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47
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Miró Ò, Hazlitt M, Escalada X, Llorens P, Gil V, Martín-Sánchez FJ, Harjola P, Rico V, Herrero-Puente P, Jacob J, Cone DC, Möckel M, Christ M, Freund Y, di Somma S, Laribi S, Mebazaa A, Harjola VP. Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure: the SEMICA-2 study. Clin Res Cardiol 2017; 107:347-361. [PMID: 29285622 DOI: 10.1007/s00392-017-1190-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/27/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Little is known about treatments provided by advanced life support (ALS) ambulance teams to patients with acute heart failure (AHF) during the prehospital phase, and their influence on short-term outcome. We evaluated the effect of prehospital care in consecutive patients diagnosed with AHF in Spanish emergency departments (EDs). METHODS We selected patients from the EAHFE registry arriving at the ED by ALS ambulances with available follow-up data. We recorded specific prehospital ALS treatments (supplemental oxygen, diuretics, nitroglycerin, non-invasive ventilation) and patients were grouped according to whether they received low- (LIPHT; 0/1 treatments) or high-intensity prehospital therapy (HIPHT; > 1 treatment) for AHF. We also recorded 46 covariates. The primary endpoint was all-cause 7-day mortality, and secondary endpoints were prolonged hospitalisation (> 10 days) and in-hospital and 30-day mortality. Unadjusted and adjusted odds ratios were calculated to compare the groups. RESULTS We included 1493 patients [mean age 80.7 (10) years; women 54.8%]. Prehospital treatment included supplemental oxygen in 71.2%, diuretics in 27.9%, nitroglycerin in 13.5%, and non-invasive ventilation in 5.3%. The LIPHT group included 1041 patients (70.0%) with an unadjusted OR for 7-day mortality of 1.770 (95% CI 1.115-2.811; p = 0.016), and 1.939 (95% CI 1.114-3.287, p = 0.014) after adjustment for 16 discordant covariables. The adjusted ORs for all secondary endpoints were always > 1 in the LIPHT group, but none reached statistical significance. CONCLUSIONS Patients finally diagnosed with AHF at then ED that have received LIPHT by the ALS ambulance teams have a poorer short-term outcome, especially during the first 7 days.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain. .,"Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain. .,, .
| | - Melissa Hazlitt
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Pere Llorens
- Home Hospitalization and Short Stay Unit, Emergency Department, Hospital General de Alicante, Alicante, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain.,"Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Pia Harjola
- Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University Hospital,, Helsinki University, Helsinki, Finland
| | - Verónica Rico
- Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain.,"Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - David C Cone
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Martin Möckel
- Division of Emergency Medicine and Chest Pain Units (CPUS), Charité Campus Virchow Klinikum and Mitte, Berlin, Germany
| | - Michael Christ
- .,Department of Emergency and Critical Care Medicine, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Yonathan Freund
- Emergency Department, Hôpital Pitie-Salpêtrière, Sorbonne University, Paris, France
| | - Salvatore di Somma
- .,Department of Medical-Surgery Sciences and Translational Medicine Emergency Department Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Said Laribi
- .,Emergency Medicine Department, School of Medicine and Tours University Hospital, François-Rabelais University, 37044, Tours, France
| | - Alexandre Mebazaa
- .,Department of Anesthesiology and Critical Care Medicine, Hospital Lariboisière, Université Paris Diderot, Paris, France
| | - Veli-Pekka Harjola
- .,Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University Hospital,, Helsinki University, Helsinki, Finland
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48
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Laribi S, Pemberton CJ, Kirwan L, Nouira S, Turkdogan K, Yilmaz MB, Troughton RW, Gayat E, Rivas-Lasarte M, Sadoune M, Sabti Z, Hansconrad E, Motiejunaite J, Plaisance P, Beshiri A, Chen W, Collet C, FitzGerald JM, Mueller C, Launay JM, Richards M, Mebazaa A. Mortality and acute exacerbation of COPD: a pilot study on the influence of myocardial injury. Eur Respir J 2017; 49:49/6/1700096. [PMID: 28663316 DOI: 10.1183/13993003.00096-2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/20/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Said Laribi
- François-Rabelais University, School of Medicine, Tours, France.,Tours University Hospital, Emergency Medicine Dept, Tours, France.,INSERM, U942, BIOmarkers in CArdioNeuroVAScular diseases, Paris, France
| | - Chris J Pemberton
- Christchurch Heart Institute, Dept of Medicine, University of Otago, Christchurch, New Zealand
| | - Lyndsey Kirwan
- INSERM, U942, BIOmarkers in CArdioNeuroVAScular diseases, Paris, France
| | - Semir Nouira
- Emergency Dept and Research Unit UR06SP21, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Kenan Turkdogan
- Adnan Menderes University, Faculty of Medicine, Dept of Emergeny Medicine, Aydin, Turkey
| | | | - Richard W Troughton
- Christchurch Heart Institute, Dept of Medicine, University of Otago, Christchurch, New Zealand
| | - Etienne Gayat
- INSERM, U942, BIOmarkers in CArdioNeuroVAScular diseases, Paris, France.,Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.,APHP, Saint Louis Lariboisière Hospitals, Dept of Anesthesiology and Critical Care, Paris, France
| | - Mercedes Rivas-Lasarte
- INSERM, U942, BIOmarkers in CArdioNeuroVAScular diseases, Paris, France.,Cardiology Dept, Hospital de la Santa CreuiSant Pau, Biomedical Research Institute IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Malha Sadoune
- INSERM, U942, BIOmarkers in CArdioNeuroVAScular diseases, Paris, France
| | - Zaid Sabti
- Dept of Internal Medicine, University Hospital, Basel, Switzerland
| | - Erwin Hansconrad
- APHP, Saint Louis Lariboisière Hospitals, Emergency Medicine Dept, Paris, France
| | - Justina Motiejunaite
- INSERM, U942, BIOmarkers in CArdioNeuroVAScular diseases, Paris, France.,APHP, Saint Louis Lariboisière Hospitals, Dept of Anesthesiology and Critical Care, Paris, France.,Dept of Cardiology, Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania
| | - Patrick Plaisance
- INSERM, U942, BIOmarkers in CArdioNeuroVAScular diseases, Paris, France.,Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.,APHP, Saint Louis Lariboisière Hospitals, Emergency Medicine Dept, Paris, France
| | | | - Wenjia Chen
- Institute for Heart and Lung Health, Respiratory Division, University of British Columbia, Vancouver, BC, Canada
| | - Corinne Collet
- APHP, Saint Louis Lariboisière Hospitals, Dept of Biochemistry, Paris, France
| | - J Mark FitzGerald
- UBC and VGH Divisions of Respiratory Medicine, Institute for Heart and Lung Health, Vancouver, BC, Canada
| | | | - Jean-Marie Launay
- INSERM, U942, BIOmarkers in CArdioNeuroVAScular diseases, Paris, France.,APHP, Saint Louis Lariboisière Hospitals, Dept of Biochemistry, Paris, France
| | - Mark Richards
- Christchurch Heart Institute, Dept of Medicine, University of Otago, Christchurch, New Zealand.,Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Alexandre Mebazaa
- INSERM, U942, BIOmarkers in CArdioNeuroVAScular diseases, Paris, France .,Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.,APHP, Saint Louis Lariboisière Hospitals, Dept of Anesthesiology and Critical Care, Paris, France.,Vilnius University, Vilnius, Lithuania
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49
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Mebazaa A, Seronde MF, Gayat E, Tibazarwa K, Anumba DOC, Akrout N, Sadoune M, Sarb J, Arrigo M, Motiejunaite J, Laribi S, Legrand M, Deschamps L, Fazal L, Bouadma L, Collet C, Manivet P, Solal AC, Launay JM, Samuel JL, Sliwa K. Imbalanced Angiogenesis in Peripartum Cardiomyopathy - Diagnostic Value of Placenta Growth Factor. Circ J 2017; 81:1654-1661. [PMID: 28552862 DOI: 10.1253/circj.cj-16-1193] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Concentrations of the anti-angiogenic factor soluble fms-like tyrosine kinase-1 (sFlt-1) are altered in peripartum cardiomyopathy (PPCM). In this study we investigated changes in the angiogenesis balance in PPCM.Methods and Results:Plasma concentrations of sFlt-1 and the pro-angiogenic placenta growth factor (PlGF) were determined in patients with PPCM during the post-partum phase (n=83), in healthy women at delivery (n=30), and in patients with acute heart failure (AHF; n=65). Women with cardiac failure prepartum or associated with any form of hypertension, including pre-eclampsia, were excluded. Compared with non-pregnant women, in women with AHF and PPCM, median PlGF concentrations were greater (19 [IQR 16-22] and 98 [IQR 78-126] ng/mL, respectively; P<0.001) and the sFlt-1/PlGF ratio was lower (9.8 [6.6-11.3] and 1.2 [0.9-2.8], respectively; P<0.001). The sFlt-1/PlGF ratio was lower in PPCM than in normal deliveries (1.2 [0.9-2.8] vs. 94.8 [68.8-194.1], respectively; P<0.0001). The area under the curve for PlGF (cut-off value: 50ng/mL) and/or the sFlt-1/PlGF ratio (cut-off value: 4) to distinguish PPCM from either normal delivery or AHF was >0.94. Median plasma concentrations of the anti-angiogenic factor relaxin-2 were lower in PPCM and AHF (0.3 [IQR 0.3-1.7] and 0.3 [IQR 0.3-1] ng/mL, respectively) compared with normal deliveries (1,807 [IQR 1,101-4,050] ng/mL; P<0.001). CONCLUSIONS Plasma of PPCM patients shows imbalanced angiogenesis. High PlGF and/or low sFlt-1/PlGF may be used to diagnose PPCM.
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Affiliation(s)
- Alexandre Mebazaa
- UMR-S 942 INSERM, Lariboisière Hospital.,Paris Diderot University, Sorbonne Paris Cité.,Department of Anaesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
| | - Marie-France Seronde
- UMR-S 942 INSERM, Lariboisière Hospital.,Department of Cardiology EA3920, University Hospital Jean Minjoz
| | - Etienne Gayat
- UMR-S 942 INSERM, Lariboisière Hospital.,Paris Diderot University, Sorbonne Paris Cité.,Department of Anaesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
| | - Kemi Tibazarwa
- Hatter Institute for Cardiovascular Research in Africa and MRC Inter-Cape Heart Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town.,Soweto Cardiovascular Research Unit, University of the Witwatersrand
| | - Dilly O C Anumba
- Gynecology, Obstetric, Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield Medical School
| | - Najla Akrout
- UMR-S 942 INSERM, Lariboisière Hospital.,Department of Anaesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
| | - Malha Sadoune
- UMR-S 942 INSERM, Lariboisière Hospital.,Paris Diderot University, Sorbonne Paris Cité
| | - Jamela Sarb
- Gynecology, Obstetric, Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield Medical School
| | - Mattia Arrigo
- UMR-S 942 INSERM, Lariboisière Hospital.,Department of Anaesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
| | - Justina Motiejunaite
- UMR-S 942 INSERM, Lariboisière Hospital.,Department of Anaesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
| | - Said Laribi
- UMR-S 942 INSERM, Lariboisière Hospital.,Department of Emergency Medicine, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
| | - Matthieu Legrand
- UMR-S 942 INSERM, Lariboisière Hospital.,Paris Diderot University, Sorbonne Paris Cité.,Department of Anaesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
| | | | - Loubina Fazal
- UMR-S 942 INSERM, Lariboisière Hospital.,Paris Diderot University, Sorbonne Paris Cité
| | - Lila Bouadma
- Department of Medical ICU, Bichat Hospital, AP-HP
| | - Corinne Collet
- Biochemistry Department, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
| | - Philippe Manivet
- UMR-S 942 INSERM, Lariboisière Hospital.,Biochemistry Department, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
| | - Alain Cohen Solal
- UMR-S 942 INSERM, Lariboisière Hospital.,Paris Diderot University, Sorbonne Paris Cité.,Department of Cardiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
| | - Jean-Marie Launay
- UMR-S 942 INSERM, Lariboisière Hospital.,Biochemistry Department, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris.,Paris Descartes University
| | - Jane-Lise Samuel
- UMR-S 942 INSERM, Lariboisière Hospital.,Paris Diderot University, Sorbonne Paris Cité.,Department of Anaesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa and MRC Inter-Cape Heart Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town.,Soweto Cardiovascular Research Unit, University of the Witwatersrand
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50
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Pang PS, Lane KA, Tavares M, Storrow AB, Shen C, Peacock WF, Nowak R, Mebazaa A, Laribi S, Hollander JE, Gheorghiade M, Collins SP. Is there a clinically meaningful difference in patient reported dyspnea in acute heart failure? An analysis from URGENT Dyspnea. Heart Lung 2017; 46:300-307. [PMID: 28433323 DOI: 10.1016/j.hrtlng.2017.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 11/23/2016] [Revised: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dyspnea is the most common presenting symptom in patients with acute heart failure (AHF), but is difficult to quantify as a research measure. The URGENT Dyspnea study compared 3 scales: (1) 10 cm VAS, (2) 5-point Likert, and (3) a 7-point Likert (both VAS and 5-point Likert were recorded in the upright and supine positions). However, the minimal clinically important difference (MCID) to patients has not been well established. METHODS We performed a secondary analysis from URGENT Dyspnea, an observational, multi-center study of AHF patients enrolled within 1 h of first physician assessment in the ED. Using the anchor-based method to determine the MCID, a one-category change in the 7-point Likert was used as the criterion standard ('minimally improved or worse'). The main outcome measures were the change in visual analog scale (VAS) and 5-point Likert scale from baseline to 6-h assessment relative to a 1-category change response in the 7-point Likert scale ('minimally worse', 'no change', or 'minimally better'). RESULTS Of the 776 patients enrolled, 491 had a final diagnosis of AHF with responses at both time points. A 10.5 mm (SD 1.6 mm) change in VAS was the MCID for improvement in the upright position, and 14.5 mm (SD 2.0 mm) in the supine position. However, there was no MCID for worsening, as few patients reported worse dyspnea. There was also no significant MCID for the 5-point Likert scale. CONCLUSION A 10.5 mm change is the MCID for improvement in dyspnea over 6 h in ED patients with AHF.
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Affiliation(s)
- Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine, USA; Indianapolis EMS, USA.
| | - Kathleen A Lane
- Department of Biostatistics, Indiana University School of Medicine, USA
| | - Miguel Tavares
- Department of Anesthesiology and Critical Care, Hospital Geral de Santo António, Porto, Portugal
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University, Nashville, VA, USA
| | - Changyu Shen
- Department of Biostatistics, Indiana University School of Medicine, USA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Richard Nowak
- Department of Emergency Medicine, Henry Ford Health System, Wayne State University, USA
| | - Alexandre Mebazaa
- Department of Anesthesia and Critical Care, Hôpitaux Universitaires Saint Louis Lariboisière, France
| | - Said Laribi
- Tours University Hospital, Emergency Department, 37044, France; INSERM, U942, BIOmarkers in CArdioNeuroVAScular diseases, France
| | - Judd E Hollander
- Sidney Kimmel Medical College of Thomas Jefferson University, USA
| | - Mihai Gheorghiade
- Division of Cardiology, Northwestern University Feinberg School of Medicine, USA
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University, Nashville, VA, USA
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