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Dubucs X, Mercier É, Boucher V, Lauzon S, Balen F, Charpentier S, Emond M. Association Between Frailty and Head Impact Location After Ground-Level Fall in Older Adults. J Emerg Med 2024:S0736-4679(24)00007-6. [PMID: 38714480 DOI: 10.1016/j.jemermed.2024.01.005] [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: 07/14/2023] [Revised: 12/18/2023] [Accepted: 01/06/2024] [Indexed: 05/10/2024]
Abstract
BACKGROUND Mild traumatic brain injuries (TBIs) are highly prevalent in older adults, and ground-level falls are the most frequent mechanism of injury. OBJECTIVE This study aimed to assess whether frailty was associated with head impact location among older patients who sustained a ground-level fall-related, mild TBI. The secondary objective was to measure the association between frailty and intracranial hemorrhages. METHODS We conducted a planned sub-analysis of a prospective observational study in two urban university-affiliated emergency departments (EDs). Patients 65 years and older who sustained a ground-level fall-related, mild TBI were included if they consulted in the ED between January 2019 and June 2019. Frailty was assessed using the Clinical Frailty Scale (CFS). Patients were stratified into the following three groups: robust (CFS score 1-3), vulnerable-frail (CFS score 4-6), and severely frail (CFS score 7-9). RESULTS A total of 335 patients were included; mean ± SD age was 86.9 ± 8.1 years. In multivariable analysis, frontal impact was significantly increased in severely frail patients compared with robust patients (odds ratio [OR] 4.8 [95% CI 1.4-16.8]; p = 0.01). Intracranial hemorrhages were found in 6.2%, 7.5%, and 13.3% of robust, vulnerable-frail, and severely frail patients, respectively. The OR of intracranial hemorrhages was 1.24 (95% CI 0.44-3.45; p = 0.68) in vulnerable-frail patients and 2.34 (95% CI 0.41-13.6; p = 0.34) in those considered severely frail. CONCLUSIONS This study found an association between the level of frailty and the head impact location in older patients who sustained a ground-level fall. Our results suggest that head impact location after a fall can help physicians identify frail patients. Although not statistically significant, the prevalence of intracranial hemorrhage seems to increase with the level of frailty.
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Affiliation(s)
- Xavier Dubucs
- Centre Hospitalier Universitaire de Québec, Université Laval Research Center, Axe Santé des Populations et Pratiques Optimales en Santé, D'Estimauville, Québec, Québec, Canada; Université Laval, Québec, Québec, Canada; Centre d'Epidémiologie et de Recherche en Santé des Populations, UMR 1295, Toulouse, France; Pôle Médecine d'Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Éric Mercier
- Centre Hospitalier Universitaire de Québec, Université Laval Research Center, Axe Santé des Populations et Pratiques Optimales en Santé, D'Estimauville, Québec, Québec, Canada; VITAM, Centre de Recherche en Santé Durable de l'Université Laval, Québec, Québec, Canada
| | - Valérie Boucher
- Centre Hospitalier Universitaire de Québec, Université Laval Research Center, Axe Santé des Populations et Pratiques Optimales en Santé, D'Estimauville, Québec, Québec, Canada
| | | | - Frederic Balen
- Centre d'Epidémiologie et de Recherche en Santé des Populations, UMR 1295, Toulouse, France; Pôle Médecine d'Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sandrine Charpentier
- Centre d'Epidémiologie et de Recherche en Santé des Populations, UMR 1295, Toulouse, France; Pôle Médecine d'Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Marcel Emond
- Centre Hospitalier Universitaire de Québec, Université Laval Research Center, Axe Santé des Populations et Pratiques Optimales en Santé, D'Estimauville, Québec, Québec, Canada; Université Laval, Québec, Québec, Canada
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Boucher V, Frenette J, Neveu X, Tardif PA, Mercier É, Chauny JM, Berthelot S, Archambault P, Lee J, Perry JJ, McRae A, Lang E, Moore L, Cameron P, Ouellet MC, de Guise E, Swaine B, Émond M, Le Sage N. Lack of association between four biomarkers and persistent post-concussion symptoms after a mild traumatic brain injury. J Clin Neurosci 2023; 118:34-43. [PMID: 37857062 DOI: 10.1016/j.jocn.2023.10.007] [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: 03/24/2023] [Revised: 08/07/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
Approximately 15 % of individuals who sustained a mild Traumatic Brain Injury (TBI) develop persistent post-concussion symptoms (PPCS). We hypothesized that blood biomarkers drawn in the Emergency Department (ED) could help predict PPCS. The main objective of this project was to measure the association between four biomarkers and PPCS at 90 days post mild TBI. We conducted a prospective cohort study in seven Canadian EDs. Patients aged ≥ 14 years presenting to the ED within 24 h of a mild TBI who were discharged were eligible. Clinical data and blood samples were collected in the ED, and a standardized questionnaire was administered 90 days later to assess the presence of symptoms. The following biomarkers were analyzed: S100B protein, Neuron Specific Enolase (NSE), cleaved-Tau (c-Tau) and Glial Fibrillary Acidic Protein (GFAP). The primary outcome measure was the presence of PPCS at 90 days after trauma. Relative risks and Areas Under the Curve (AUC) were computed. A total of 595 patients were included, and 13.8 % suffered from PPCS at 90 days. The relative risk of PPCS was 0.9 (95 % CI: 0.5-1.8) for S100B ≥ 20 pg/mL, 1.0 (95 % CI: 0.6-1.5) for NSE ≥ 200 pg/mL, 3.4 (95 % CI: 0.5-23.4) for GFAP ≥ 100 pg/mL, and 1.0 (95 % CI: 0.6-1.8) for C-Tau ≥ 1500 pg/mL. AUC were 0.50, 0.50, 0.51 and 0.54, respectively. Among mild TBI patients, S100B protein, NSE, c-Tau or GFAP do not seem to predict PPCS. Future research testing of other biomarkers is needed to determine their usefulness in predicting PPCS.
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Affiliation(s)
- Valérie Boucher
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada
| | - Jérôme Frenette
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada
| | - Xavier Neveu
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada
| | - Pier-Alexandre Tardif
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada
| | - Éric Mercier
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada; VITAM-Centre de recherche en santé durable, 2480 Chem. de la Canardière, Québec, Québec G1J 2G1, Canada
| | - Jean-Marc Chauny
- Faculté de médecine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montréal, Québec H3T 1J4, Canada
| | - Simon Berthelot
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada
| | - Patrick Archambault
- Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada; VITAM-Centre de recherche en santé durable, 2480 Chem. de la Canardière, Québec, Québec G1J 2G1, Canada; Centre de recherche du CISSS de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, Québec, QC G6V 3Z1, Canada
| | - Jacques Lee
- Sunnybrook Health Science Center, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada; Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, 600 University Ave, Toronto, Ontario M5G 1X5, Canada
| | - Jeffrey J Perry
- The Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, Ontario K1H 8L6, Canada; Department of Emergency Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario K1N 6N5, Canada
| | - Andrew McRae
- Department of Emergency Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada; Foothills Medical Centre, 1403 29 St NW, Calgary, Alberta T2N 2T9, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada; Foothills Medical Centre, 1403 29 St NW, Calgary, Alberta T2N 2T9, Canada
| | - Lynne Moore
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada
| | - Peter Cameron
- Alfred Emergency and Trauma Centre, Monash University, 55 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Marie-Christine Ouellet
- Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada; Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), 525 Bd Wilfrid-Hamel, Québec, Québec G1M 2S8, Canada
| | - Elaine de Guise
- Département de psychologie, Université de Montréal, 2900, boul. Édouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Centre de recherche interdisciplinaire en réadaptation (CRIR) du Montréal métropolitain, 6363, chemin Hudson, Montréal, Québec H3S 1M9, Canada
| | - Bonnie Swaine
- Faculté de médecine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montréal, Québec H3T 1J4, Canada; Centre de recherche interdisciplinaire en réadaptation (CRIR) du Montréal métropolitain, 6363, chemin Hudson, Montréal, Québec H3S 1M9, Canada
| | - Marcel Émond
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada; VITAM-Centre de recherche en santé durable, 2480 Chem. de la Canardière, Québec, Québec G1J 2G1, Canada
| | - Natalie Le Sage
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada; VITAM-Centre de recherche en santé durable, 2480 Chem. de la Canardière, Québec, Québec G1J 2G1, Canada.
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Benhamed A, Batomen B, Boucher V, Yadav K, Isaac CJ, Mercier E, Bernard F, Blais-L'écuyer J, Tazarourte K, Emond M. Relationship between systolic blood pressure and mortality in older vs younger trauma patients - a retrospective multicentre observational study. BMC Emerg Med 2023; 23:105. [PMID: 37726708 PMCID: PMC10508012 DOI: 10.1186/s12873-023-00863-1] [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: 09/09/2022] [Accepted: 08/02/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND The population of older trauma patients is increasing. Those patients have heterogeneous presentations and need senior-friendly triaging tools. Systolic blood pressure (SBP) is commonly used to assess injury severity, and some authors advocated adjusting SBP threshold for older patients. We aimed to describe and compare the relationship between mortality and SBP in older trauma patients and their younger counterparts. METHODS We included patients admitted to three level-I trauma centres and performed logistic regressions with age and SBP to obtain mortality curves. Multivariable Logistic regressions were performed to measure the association between age and mortality at different SBP ranges. Subgroup analyses were conducted for major trauma and severe traumatic brain injury admissions. RESULTS A total of 47,661 patients were included, among which 12.9% were aged 65-74 years and 27.3% were ≥ 75 years. Overall mortality rates were 3.9%, 8.1%, and 11.7% in the groups aged 16-64, 65-74, and ≥ 75 years, respectively. The relationship between prehospital SBP and mortality was nonlinear (U-shape), mortality increased with each 10 mmHg SBP decrement from 130 to 50 mmHg and each 10-mmHg increment from 150 to 220 mmHg across all age groups. Older patients were at higher odd for mortality in all ranges of SBP. The highest OR in patients aged 65-74 years was 3.67 [95% CI: 2.08-6.45] in the 90-99 mmHg SBP range and 7.92 [95% CI: 5.13-12.23] for those aged ≥ 75 years in the 100-109 mmHg SBP range. CONCLUSION The relationship between SBP and mortality is nonlinear, regardless of trauma severity and age. Older age was associated with a higher odd of mortality at all SBP points. Future triage tools should therefore consider SBP as a continuous rather than a dichotomized predictor.
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Affiliation(s)
- Axel Benhamed
- CHU de Québec-Université Laval Research Centre, Québec, Québec, Canada
- Département de Médecine Familiale et de Médecine d'urgence, Université Laval, Québec, Québec, Canada
- Hospices Civils de Lyon, Service d'Accueil des Urgences - SAMU 69, Centre Hospitalier Universitaire Edouard Herriot, Lyon, 69003, France
| | - Brice Batomen
- CHU de Québec-Université Laval Research Centre, Québec, Québec, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Valérie Boucher
- CHU de Québec-Université Laval Research Centre, Québec, Québec, Canada
| | - Krishan Yadav
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Eric Mercier
- CHU de Québec-Université Laval Research Centre, Québec, Québec, Canada
- Département de Médecine Familiale et de Médecine d'urgence, Université Laval, Québec, Québec, Canada
| | - Francis Bernard
- Critical Care Unit, Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
| | - Julien Blais-L'écuyer
- Département de Médecine Familiale et de Médecine d'urgence, Université Laval, Québec, Québec, Canada
| | - Karim Tazarourte
- Hospices Civils de Lyon, Service d'Accueil des Urgences - SAMU 69, Centre Hospitalier Universitaire Edouard Herriot, Lyon, 69003, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, 69003, France
| | - Marcel Emond
- CHU de Québec-Université Laval Research Centre, Québec, Québec, Canada.
- Département de Médecine Familiale et de Médecine d'urgence, Université Laval, Québec, Québec, Canada.
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Benhamed A, Fraticelli L, Claustre C, Gossiome A, Cesareo E, Heidet M, Emond M, Mercier E, Boucher V, David JS, El Khoury C, Tazarourte K. Risk factors and mortality associated with undertriage after major trauma in a physician-led prehospital system: a retrospective multicentre cohort study. Eur J Trauma Emerg Surg 2023; 49:1707-1715. [PMID: 36508023 DOI: 10.1007/s00068-022-02186-5] [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: 08/17/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the incidence of undertriage in major trauma, its determinant, and association with mortality. METHODS A multicentre retrospective cohort study was conducted using data from a French regional trauma registry (2011-2017). All major trauma (Injury Severity Score ≥ 16) cases aged ≥ 18 years and managed by a physician-led mobile medical team were included. Those transported to a level-II/III trauma centre were considered as undertriaged. Multivariable logistic regression was used to identify factors associated with undertriage. RESULTS A total of 7110 trauma patients were screened; 2591 had an ISS ≥ 16 and 320 (12.4%) of these were undertriaged. Older patients had higher risk for undertriage (51-65 years: OR = 1.60, 95% CI [1.11; 2.26], p = 0.01). Conversely, injury mechanism (fall from height: 0.62 [0.45; 0.86], p = 0.01; gunshot/stab injuries: 0.45 [0.22; 0.90], p = 0.02), on-scene time (> 60 min: 0.62 [0.40; 0.95], p = 0.03), prehospital endotracheal intubation (0.53 [0.39; 0.71], p < 0.001), and prehospital focussed assessment with sonography [FAST] (0.15 [0.08; 0.29], p < 0.001) were associated with a lower risk for undertriage. After adjusting for severity, undertriage was not associated with a higher risk of mortality (1.22 [0.80; 1.89], p = 0.36). CONCLUSIONS In our physician-led prehospital EMS system, undertriage was higher than recommended. Advanced aged was identified as a risk factor highlighting the urgent need for tailored triage protocol in this population. Conversely, the potential benefit of prehospital FAST on triage performance should be furthered explored as it may reduce undertriage. Fall from height and penetrating trauma were associated with a lower risk for undertriage suggesting that healthcare providers should remain vigilant of the potential seriousness of trauma associated with low-energy mechanisms.
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Affiliation(s)
- Axel Benhamed
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon, France.
| | | | - Clément Claustre
- RESUVal and RESCUe Network, Lucien Hussel Hospital, Vienne, France
| | - Amaury Gossiome
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon, France
| | - Eric Cesareo
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon, France
| | - Matthieu Heidet
- SAMU 94 and Emergency Department, Assistance Publique-Hôpitaux de Paris (AP-HP) University Hospital Henri Mondor, Créteil, France
- Université Paris-Est Créteil (UPEC), EA-3956 (CIR), Créteil, France
| | - Marcel Emond
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Eric Mercier
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Valérie Boucher
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Jean-Stéphane David
- Trauma Centre and Critical Care, Centre Hospitalier Universitaire Lyon Sud, Pierre-Bénite, France
| | - Carlos El Khoury
- RESUVal and RESCUe Network, Lucien Hussel Hospital, Vienne, France
- Emergency Department, Médipôle Hôpital Mutualiste, Villeurbanne, France
| | - Karim Tazarourte
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon, France
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Benhamed A, Isaac CJ, Boucher V, Yadav K, Mercier E, Moore L, D'Astous M, Bernard F, Dubucs X, Gossiome A, Emond M. Effect of age on the association between the Glasgow Coma Scale and the anatomical brain lesion severity: a retrospective multicentre study. Eur J Emerg Med 2023; 30:271-279. [PMID: 37161755 DOI: 10.1097/mej.0000000000001041] [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: 05/11/2023]
Abstract
Background and importance Older adults are at higher risk of undertriage and mortality following a traumatic brain injury (TBI). Early identification and accurate triage of severe cases is therefore critical. However, the Glasgow Coma Scale (GCS) might lack sensitivity in older patients. Objective This study investigated the effect of age on the association between the GCS and TBI severity. Design, settings, and participants This multicentre retrospective cohort study (2003-2017) included TBI patients aged ≥16 years with an Abbreviated Injury Scale (AIS of 3, 4 or 5). Older adults were defined as aged 65 and over. Outcomes measure and analysis Median GCS score were compared between older and younger adults, within subgroups of similar AIS. Multivariable logistic regressions were computed to assess the association between age and mortality. The primary analysis comprised patients with isolated TBI, and secondary analysis included patients with multiple trauma. Main results A total of 12 562 patients were included, of which 9485 (76%) were isolated TBIs. Among those, older adults represented 52% ( n = 4931). There were 22, 27 and 51% of older patients with an AIS-head of 3, 4 and 5 respectively compared to 32, 25 and 43% among younger adults. Within the different subgroups of patients, median GCS scores were higher in older adults: 15 (14-15) vs. 15 (13-15), 15 (14-15) vs. 14 (13-15), 15 (14-15) vs. 14 (8-15), for AIS-head 3, 4 and 5 respectively (all P < 0.0001). Older adults had increased odds of mortality compared to their younger counterparts at all AIS-head levels: AIS-head = 3 [odds ratio (OR) = 2.9, 95% confidence interval (CI) 1.6-5.5], AIS-head = 4, (OR = 2.7, 95% CI 1.6-4.7) and AIS-head = 5 (OR = 2.6, 95% CI 1.9-3.6) TBI (all P < 0.001). Similar results were found among patients with multiple trauma. Conclusions In this study, among TBI patients with similar AIS-head score, there was a significant higher median GCS in older patients compared to younger patients.
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Affiliation(s)
- Axel Benhamed
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot-Université Claude Bernard Lyon 1, Lyon, France
- CHU de Québec-Université Laval Research Centre, Québec, Québec
| | | | - Valérie Boucher
- CHU de Québec-Université Laval Research Centre, Québec, Québec
| | - Krishan Yadav
- Department of Emergency Medicine-University of Ottawa
- Ottawa Hospital Research Institute, Ottawa, Ontario
| | - Eric Mercier
- CHU de Québec-Université Laval Research Centre, Québec, Québec
- Département de médecine d'urgence et médecine familiale, Université Laval
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec, Québec
| | | | - Francis Bernard
- Services de soins intensifs, Hôpital du Sacré-Coeur de Montréal (CIUSSS-NIM)-Université de Montréal, Montréal, Québec, Canada
| | - Xavier Dubucs
- Service d'urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Amaury Gossiome
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot-Université Claude Bernard Lyon 1, Lyon, France
- CHU de Québec-Université Laval Research Centre, Québec, Québec
| | - Marcel Emond
- CHU de Québec-Université Laval Research Centre, Québec, Québec
- Département de médecine d'urgence et médecine familiale, Université Laval
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Benhamed A, Batomen B, Boucher V, Yadav K, Mercier É, Isaac CJ, Bérubé M, Bernard F, Chauny JM, Moore L, Sirois MJ, Tazarourte K, Gossiome A, Émond M. Epidemiology, injury pattern and outcome of older trauma patients: A 15-year study of level-I trauma centers. PLoS One 2023; 18:e0280345. [PMID: 36716316 PMCID: PMC9886263 DOI: 10.1371/journal.pone.0280345] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/26/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Older adults have become a significant portion of the trauma population. Exploring their specificities is crucial to better meet their specific needs. The primary objective was to evaluate the temporal changes in the incidence, demographic and trauma characteristics, injury pattern, in-hospital admission, complications, and outcome of older trauma patients. METHODS A multicenter retrospective cohort study was conducted using the Quebec Trauma Registry. Patients aged ≥16 years admitted to one of the three adult level-I trauma centers between 2003 and 2017 were included. Descriptive analyses and trend-tests were performed to describe temporal changes. RESULTS A total of 53,324 patients were included, and 24,822 were aged ≥65 years. The median [IQR] age increased from 57[36-77] to 67[46-82] years, and the proportion of older adults rose from 41.8% in 2003 to 54.1% in 2017. Among those, falls remain the main mechanism (84.7%-88.3%), and the proportion of severe thorax (+8.9%), head (+8.7%), and spine (+5%) injuries significantly increased over time. The proportion of severely injured older patients almost doubled (17.6%-32.3%), yet their mortality decreased (-1.0%). Their average annual bed-days consumption also increased (+15,004 and +1,437 in non-intensive care wards and ICU, respectively). CONCLUSIONS Since 2014, older adults have represented the majority of admissions in Level-I trauma centers in Québec. Their bed-days consumption has greatly increased, and their injury pattern and severity have deeply evolved, while we showed a decrease in mortality.
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Affiliation(s)
- Axel Benhamed
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, QC, Canada
- Hospices Civils de Lyon, Service d’Accueil des Urgences–SAMU 69, Centre Hospitalier Universitaire Édouard Herriot, Lyon, France
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Brice Batomen
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Dalla Lana school of public health, University of Toronto, Toronto, Ontario, Canada
| | - Valérie Boucher
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Krishan Yadav
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Éric Mercier
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Mélanie Bérubé
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Francis Bernard
- Section of Critical Care, Department of Medicine, University of Montreal, Montreal, Canada
| | - Jean- Marc Chauny
- Department of Emergency Medicine, Research Center, CIUSSS-Nord-de-l’Île de-Montréal, Hôpital Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, QC, Canada
| | - Marie Josée Sirois
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Karim Tazarourte
- Hospices Civils de Lyon, Service d’Accueil des Urgences–SAMU 69, Centre Hospitalier Universitaire Édouard Herriot, Lyon, France
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Amaury Gossiome
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Hospices Civils de Lyon, Service d’Accueil des Urgences–SAMU 69, Centre Hospitalier Universitaire Édouard Herriot, Lyon, France
| | - Marcel Émond
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, QC, Canada
- * E-mail:
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Truchot J, Benhamed A, Batomen B, Boucher V, Malo C, Chauny JM, de Champlain F, Émond M. Trauma team leader and early mortality: An interrupted time series analysis. Am J Emerg Med 2022; 62:32-40. [DOI: 10.1016/j.ajem.2022.09.048] [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] [Received: 08/05/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022] Open
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8
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Le Sage N, Chauny JM, Berthelot S, Archambault P, Neveu X, Moore L, Boucher V, Frenette J, De Guise É, Ouellet MC, Lee J, McRae AD, Lang E, Émond M, Mercier É, Tardif PA, Swaine B, Cameron P, Perry JJ. Post-Concussion Symptoms Rule: Derivation and Validation of a Clinical Decision Rule for Early Prediction of Persistent Symptoms after a Mild Traumatic Brain Injury. J Neurotrauma 2022; 39:1349-1362. [PMID: 35765917 PMCID: PMC9529302 DOI: 10.1089/neu.2022.0026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is a common problem. Depending on diagnostic criteria, 13 to 62% of those patients develop persistent post-concussion symptoms (PPCS). The main objective of this prospective multi-center study is to derive and validate a clinical decision rule (CDR) for the early prediction of PPCS. Patients aged ≥14 years were included if they presented to one of our seven participating emergency departments (EDs) within 24 h of an mTBI. Clinical data were collected in the ED, and symptom evolution was assessed at 7, 30 and 90 days post-injury using the Rivermead Post-Concussion Questionnaire (RPQ). The primary outcome was PPCS at 90 days after mTBI. A predictive model called the Post-Concussion Symptoms Rule (PoCS Rule) was developed using the methodological standards for CDR. Of the 1083 analyzed patients (471 and 612 for the derivation and validation cohorts, respectively), 15.6% had PPCS. The final model included the following factors assessed in the ED: age, sex, history of prior TBI or mental health disorder, headache in ED, cervical sprain and hemorrhage on computed tomography. The 7-day follow-up identified additional risk factors: headaches, sleep disturbance, fatigue, sensitivity to light, and RPQ ≥21. The PoCS Rule had a sensitivity of 91.4% and 89.6%, a specificity of 53.8% and 44.7% and a negative predictive value of 97.2% and 95.8% in the derivation and validation cohorts, respectively. The PoCS Rule will help emergency physicians quickly stratify the risk of PPCS in mTBI patients and better plan post-discharge resources.
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Affiliation(s)
- Natalie Le Sage
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
- VITAM-Centre de recherche en santé durable, Université Laval, Québec, Canada
| | - Jean-Marc Chauny
- Department of Emergency Medicine, Université de Montréal, Quebec, Canada
| | - Simon Berthelot
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Patrick Archambault
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Xavier Neveu
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Lynne Moore
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Valérie Boucher
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Jérôme Frenette
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Élaine De Guise
- Department of Emergency Medicine, McGill University, Québec, Canada
| | | | - Jacques Lee
- Department of Emergency Medicine, University of Toronto, Ontario, Canada
| | - Andrew D. McRae
- Department of Emergency Medicine, University of Calgary, Alberta, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Alberta, Canada
| | - Marcel Émond
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Éric Mercier
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | | | - Bonnie Swaine
- Department of Emergency Medicine, Université de Montréal, Quebec, Canada
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University Melbourne, Victoria, Australia
| | - Jeffrey J. Perry
- Department of Emergency Medicine, Ottawa Hospital Research Institute, Ontario, Canada
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9
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Laguë A, Boucher V, Joo P, Yadav K, Morasse C, Émond M. Survey on Current Practice of Canadian Physicians Regarding the Investigation in Older Patients with Delirium. Can Geriatr J 2022; 25:279-284. [PMID: 36117746 PMCID: PMC9427188 DOI: 10.5770/cgj.25.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The current literature provides heterogeneous recommendation regarding the investigation of older delirious patients, which may lead to over-testing. Our study aims to describe Canadian physicians’ current practice for the investigation of older patients with delirium. Our secondary objective is to define specific indications for performing a CT head scan in this population. Methods Design: cross-sectional online survey. Participants: physicians who conduct their clinical practice in Canada and who care for older patients with delirium. Potential study participants were reached through Canadian associations: Canadian Geriatrics Society, the Canadian Association of Emergency Physicians, the Association des Médecins d’Urgence du Québec, and members of Choosing Wisely Canada. Results We received 296 survey responses. More than 80% of respondents always order complete blood count, urea, and creatinine and electrolytes. Extended electrolytes, TSH, chest X-ray, electrocardiogram, urinalysis and urinary culture tests tend to be ordered somewhat frequently. Physicians mostly agreed to order a head CT scan for loss of consciousness, altered mental status, fall, and anticoagulation. Conclusions Physicians’ investigations for older patients with delirium are highly variable, even with the lack of evidence supporting a broad workup. Also, respondents mostly align with current recommendations of indications for CT head scans.
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Abstract
OBJECTIVES To provide an overview of the available evidence regarding the safety of in situ simulation (ISS) in the emergency department (ED). DESIGN Scoping review. METHODS Original articles published before March 2021 were included if they investigated the use of ISS in the field of emergency medicine. INFORMATION SOURCES MEDLINE, EMBASE, Cochrane and Web of Science. RESULTS A total of 4077 records were identified by our search strategy and 2476 abstracts were screened. One hundred and thirty full articles were reviewed and 81 full articles were included. Only 33 studies (40%) assessed safety-related issues, among which 11 chose a safety-related primary outcome. Latent safety threats (LSTs) assessment was conducted in 24 studies (30%) and the cancellation rate was described in 9 studies (11%). The possible negative impact of ISS on real ED patients was assessed in two studies (2.5%), through a questionnaire and not through patient outcomes. CONCLUSION Most studies use ISS for systems-based or education-based applications. Patient safety during ISS is often evaluated in the context of identifying or mitigating LSTs and rarely on the potential impact and risks to patients simultaneously receiving care in the ED. Our scoping review identified knowledge gaps related to the safe conduct of ISS in the ED, which may warrant further investigation.
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Affiliation(s)
- Jennifer Truchot
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Emergency Department, CHU Cochin- Université de Paris, APHP, Paris, France
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Valérie Boucher
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Quebec, Canada
| | - Winny Li
- 5Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Guillaume Martel
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
| | - Eva Jouhair
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Éliane Raymond-Dufresne
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Andrew Petrosoniak
- 5Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marcel Emond
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Quebec, Canada
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11
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Benhamed A, Ndiaye A, Emond M, Lieutaud T, Boucher V, Gossiome A, Laumon B, Gadegbeku B, Tazarourte K. Road traffic accident-related thoracic trauma: Epidemiology, injury pattern, outcome, and impact on mortality—A multicenter observational study. PLoS One 2022; 17:e0268202. [PMID: 35522686 PMCID: PMC9075643 DOI: 10.1371/journal.pone.0268202] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Thoracic trauma is a major cause of death in trauma patients and road traffic accident (RTA)-related thoracic injuries have different characteristics than those with non-RTA related thoracic traumas, but this have been poorly described. The main objective was to investigate the epidemiology, injury pattern and outcome of patients suffering a significant RTA-related thoracic injury. Secondary objective was to investigate the influence of serious thoracic injuries on mortality, compared to other serious injuries.
Methods
We performed a multicenter observational study including patients of the Rhône RTA registry between 1997 and 2016 sustaining a moderate to lethal (Abbreviated Injury Scale, AIS≥2) injury in any body region. A subgroup (AISThorax≥2 group) included those with one or more AIS≥2 thoracic injury. Descriptive statistics were performed for the main outcome and a multivariate logistic regression was computed for our secondary outcome.
Results
A total of 176,346 patients were included in the registry and 6,382 (3.6%) sustained a thoracic injury. Among those, median age [IQR] was 41 [25–58] years, and 68.9% were male. The highest incidence of thoracic injuries in female patients was in the 70–79 years age group, while this was observed in the 20–29 years age group among males. Most patients were car occupants (52.3%). Chest wall injuries were the most frequent thoracic injuries (62.1%), 52.4% of which were multiple rib fractures. Trauma brain injuries (TBI) were the most frequent concomitant injuries (29.1%). The frequency of MAISThorax = 2 injuries increased with age while that of MAISThorax = 3 injuries decreased. A total of 16.2% patients died. Serious (AIS≥3) thoracic injuries (OR = 12.4, 95%CI [8.6;18.0]) were strongly associated with mortality but less than were TBI (OR = 27.9, 95%CI [21.3;36.7]).
Conclusion
Moderate to lethal RTA-related thoracic injuries were rare. Multiple ribs fractures, pulmonary contusions, and sternal fractures were the most frequent anatomical injuries. The incidence, injury pattern and mechanisms greatly vary across age groups.
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Affiliation(s)
- Axel Benhamed
- Service d’Accueil des Urgences–SAMU 69, Centre Hospitalier Universitaire Édouard Herriot, Lyon, Hospices Civils de Lyon, France
- INSERM U1290 (RESHAPE), Université de Lyon 1, Lyon, France
- Département d’urgences, Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Québec, Canada
- Research Centre, CHU de Québec-Université Laval, Québec, Québec, Canada
- * E-mail:
| | - Amina Ndiaye
- IFSTTAR, Université Gustave Eiffel, Bron, France
| | - Marcel Emond
- Département d’urgences, Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Québec, Canada
- Research Centre, CHU de Québec-Université Laval, Québec, Québec, Canada
| | | | - Valérie Boucher
- Research Centre, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Amaury Gossiome
- Service d’Accueil des Urgences–SAMU 69, Centre Hospitalier Universitaire Édouard Herriot, Lyon, Hospices Civils de Lyon, France
| | | | | | - Karim Tazarourte
- Service d’Accueil des Urgences–SAMU 69, Centre Hospitalier Universitaire Édouard Herriot, Lyon, Hospices Civils de Lyon, France
- INSERM U1290 (RESHAPE), Université de Lyon 1, Lyon, France
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12
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Benhamed A, Boucher V, Emond M. Pain management in emergency department older adults with pelvic fracture: still insufficient. CAN J EMERG MED 2022; 24:245-246. [PMID: 35403990 DOI: 10.1007/s43678-022-00299-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/15/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Axel Benhamed
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de Médecine d'urgence, CHU de Québec, Université Laval, Québec, QC, Canada.,Hospices Civils de Lyon, Centre Hospitalier Universitaire Édouard Herriot, 69003, Lyon, France
| | - Valérie Boucher
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Marcel Emond
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada. .,Département de Médecine d'urgence, CHU de Québec, Université Laval, Québec, QC, Canada. .,CHU de Québec - Hôpital de L'Enfant-Jésus, , rue, H-608, Québec, 1401, 18G1J 1Z4, Canada.
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13
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Lee JS, Tong T, Chignell M, Tierney MC, Goldstein J, Eagles D, Perry JJ, McRae A, Lang E, Hefferon D, Rose L, Kiss A, Borgundvaag B, McLeod S, Melady D, Boucher V, Sirois MJ, Émond M. Prevalence, management and outcomes of unrecognized delirium in a National Sample of 1,493 older emergency department patients: how many were sent home and what happened to them? Age Ageing 2022; 51:6527377. [PMID: 35150585 DOI: 10.1093/ageing/afab214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/31/2021] [Revised: 07/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Retrospective studies estimate Emergency Department (ED) delirium recognition at <20%; few prospective studies have assessed delirium recognition and outcomes for patients with unrecognized delirium. OBJECTIVES To prospectively measure delirium recognition by ED nurses and physicians, document their confidence in diagnosis and disposition, actual dispositions, and patient outcomes. METHODS Prospective observational study of people ≥65 years. We assessed delirium using the Confusion Assessment Method, then asked ED staff if the patient had delirium, confidence in their assessment, if the patient could be discharged, and contacted patients 1 week postdischarge. We report proportions and 95% confidence intervals (Cls). RESULTS We enrolled 1,493 participants; mean age was 77.9 years; 49.2% were female, 79 (5.3%, 95% CI 4.2-6.5%) had delirium. ED nurses missed delirium in 43/78 cases (55.1%, 95% CI 43.4-66.4%). Nurses considered 12/43 (27.9%) patients with unrecognized delirium safe to discharge. Median confidence in their delirium diagnosis for patients with unrecognized delirium was 7.0/10. Physicians missed delirium in 10/20 (50.0%, 95% CI 27.2-72.8) cases and considered 2/10 (20.0%) safe to discharge. Median confidence in their delirium diagnosis for patients with unrecognized delirium was 8.0/10. Fifteen patients with unrecognized delirium were sent home: 6.7% died at 1 week follow-up vs. none in those with recognized delirium and 1.1% in the rest of the cohort. CONCLUSION Delirium recognition by nurses and physicians was sub-optimal at ~50% and may be associated with increased mortality. Research should explore root causes of unrecognized delirium, and novel strategies to systematically improve delirium recognition and patient outcomes.
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Affiliation(s)
- Jacques S Lee
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tiffany Tong
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Mark Chignell
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Mary C Tierney
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Judah Goldstein
- Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Andrew McRae
- Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eddy Lang
- Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Darren Hefferon
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
| | - Alex Kiss
- Department of Epidemiology and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Bjug Borgundvaag
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shelley McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Don Melady
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Valérie Boucher
- Axe santé des populations et pratiques optimales en santé (SP-POS), CHU de Québec-Université Laval Research Centre, Québec City, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Québec City, QC, Canada
| | - Marie-Josée Sirois
- Axe santé des populations et pratiques optimales en santé (SP-POS), CHU de Québec-Université Laval Research Centre, Québec City, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Québec City, QC, Canada
- Département de réadaptation, Faculté de medécine, Université Laval, Quebec City, QC, Canada
| | - Marcel Émond
- Axe santé des populations et pratiques optimales en santé (SP-POS), CHU de Québec-Université Laval Research Centre, Québec City, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Québec City, QC, Canada
- Département de medécine familiale et de medécine d'urgence, Faculté de medécine, Université Laval, Québec City, QC, Canada
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Tourigny JN, Boucher V, Paquet V, Fortier É, Malo C, Mercier É, Chauny JM, Clark G, Blanchard PG, Carmichael PH, Gariépy JL, D'Astous M, Émond M. External validation of the updated Brain Injury Guidelines for complicated mild traumatic brain injuries: a retrospective cohort study. J Neurosurg 2022; 137:1-7. [PMID: 35078154 DOI: 10.3171/2021.10.jns211794] [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: 07/22/2021] [Accepted: 10/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Approximately 10% of patients with mild traumatic brain injury (mTBI) have intracranial bleeding (complicated mTBI) and 3.5% eventually require neurosurgical intervention, which is mostly available at centers with a higher level of trauma care designation and often requires interhospital transfer. In 2018, the Brain Injury Guidelines (BIG) were updated in the United States to guide emergency department care and patient disposition for complicated mild to moderate TBI. The aim of this study was to validate the sensitivity and specificity of the updated BIG (uBIG) for predicting the need for interhospital transfer in Canadian patients with complicated mTBI. METHODS This study took place at three level I trauma centers. Consecutive medical records of patients with complicated mTBI (Glasgow Coma Scale score 13-15) who were aged ≥ 16 years and presented between September 2016 and December 2017 were retrospectively reviewed. Patients with a penetrating trauma and those who had a documented cerebral tumor or aneurysm were excluded. The primary outcome was a combination of neurosurgical intervention and/or mTBI-related death. Sensitivity and specificity analyses were performed. RESULTS A total of 477 patients were included, of whom 8.4% received neurosurgical intervention and 3% died as a result of their mTBI. Forty patients (8%) were classified as uBIG-1, 168 (35%) as uBIG-2, and 269 (56%) as uBIG-3. No patients in uBIG-1 underwent neurosurgical intervention or died as a result of their injury. This translates into a sensitivity for predicting the need for a transfer of 100% (95% CI 93.2%-100%) and a specificity of 9.4% (95% CI 6.8%-12.6%). Using the uBIG could potentially reduce the number of transfers by 6% to 25%. CONCLUSIONS The patients in uBIG-1 could be safely managed at their initial center without the need for transfer to a center with a higher level of neurotrauma care. Although the uBIG could decrease the number of transfers, further refinement of the criteria could improve its specificity.
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Affiliation(s)
- Jean-Nicolas Tourigny
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Valérie Boucher
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- 3VITAM-Centre de recherche en santé durable de l'Université Laval, Québec, Québec, Canada
- 6Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - Véronique Paquet
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Émile Fortier
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Christian Malo
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Éric Mercier
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
- 3VITAM-Centre de recherche en santé durable de l'Université Laval, Québec, Québec, Canada
| | | | | | - Pierre-Gilles Blanchard
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- 3VITAM-Centre de recherche en santé durable de l'Université Laval, Québec, Québec, Canada
| | | | - Jean-Luc Gariépy
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Myreille D'Astous
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Marcel Émond
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- 3VITAM-Centre de recherche en santé durable de l'Université Laval, Québec, Québec, Canada
- 6Centre d'excellence sur le vieillissement de Québec, Québec, Canada
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15
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Laguë A, Boucher V, Joo P, Yadav K, Morasse C, Émond M. Investigation and treatment of asymptomatic bacteriuria in older patients with delirium: a cross-sectional survey of Canadian physicians. CAN J EMERG MED 2022; 24:61-67. [PMID: 34181215 DOI: 10.1007/s43678-021-00148-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/11/2021] [Accepted: 05/11/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Current guidelines suggest assessing non-infectious causes and careful observation before giving antibiotics to delirious patients with asymptomatic bacteriuria. Our study aims to describe the current practice of Canadian physicians regarding the investigation and treatment of asymptomatic bacteriuria in delirious older patients (aged ≥ 65 years). METHODS Our team of medical experts designed and reviewed a cross-sectional online survey. Study participants were physicians who conduct their clinical practice in Canada and care for older patients with delirium in their current practice. Potential study participants were reached through Canadian associations: Canadian Geriatrics Society, the Canadian Association of Emergency Physicians, the Association des Médecins d'Urgence du Québec and members of Choosing Wisely Canada. RESULTS 297 physicians were included. The main results show 79.4% of our participants request a urine dipstick or urinalysis in delirious patients and 52.4% immediately order a urine culture with the urinalysis. If bacteriuria is found in delirious but afebrile patients without urinary symptoms, 38% of physicians immediately treat with antibiotics, 33.8% wait for culture before initiating treatment, 14.4% treat if no other cause is found for delirium and only 13.7% would refrain from giving antibiotics. Results from respondents were similar for delirious patients with known cognitive impairment. Participants were almost unanimous (92.5%) in saying they need clear guidelines regarding the treatment of bacteriuria in older delirious patients. CONCLUSIONS This survey highlights the heterogeneous clinical management of asymptomatic bacteriuria in delirious patients and the need for clear guidelines for patients.
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Affiliation(s)
- Antoine Laguë
- Axe Santé Des Populations Et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec - Université Laval, 1401, 18ièmerue, Québec, QC, G1J 1Z4, Canada
- VITAM - Centre de Recherche en Santé Durable, Québec, QC, Canada
- Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Valérie Boucher
- Axe Santé Des Populations Et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec - Université Laval, 1401, 18ièmerue, Québec, QC, G1J 1Z4, Canada
- VITAM - Centre de Recherche en Santé Durable, Québec, QC, Canada
- Faculté de Médecine, Université Laval, Québec, QC, Canada
- Centre D'Excellence Sur Le Vieillissement de Québec, Québec, QC, Canada
| | - Pil Joo
- University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Krishan Yadav
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Marcel Émond
- Axe Santé Des Populations Et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec - Université Laval, 1401, 18ièmerue, Québec, QC, G1J 1Z4, Canada.
- VITAM - Centre de Recherche en Santé Durable, Québec, QC, Canada.
- Faculté de Médecine, Université Laval, Québec, QC, Canada.
- Centre D'Excellence Sur Le Vieillissement de Québec, Québec, QC, Canada.
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Gobeille Paré S, Bestman-Smith J, Fafard J, Doualla-Bell F, Jacob-Wagner M, Lavallée C, Charest H, Beauchemin S, Coutlée F, Dumaresq J, Busque L, St-Hilaire M, Lépine G, Boucher V, Desforges M, Goupil-Sormany I, Labbé AC. Natural spring water gargle samples as an alternative to nasopharyngeal swabs for SARS-CoV-2 detection using a laboratory-developed test. J Med Virol 2021; 94:985-993. [PMID: 34672374 PMCID: PMC8661969 DOI: 10.1002/jmv.27407] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/28/2021] [Accepted: 10/18/2021] [Indexed: 01/23/2023]
Abstract
The objective of this study was to validate the use of spring water gargle (SWG) as an alternative to oral and nasopharyngeal swab (ONPS) for SARS‐CoV‐2 detection with a laboratory‐developed test. Healthcare workers and adults from the general population, presenting to one of two COVID‐19 screening clinics in Montréal and Québec City, were prospectively recruited to provide a gargle sample in addition to the standard ONPS. The paired specimens were analyzed using thermal lysis followed by a laboratory‐developed nucleic acid amplification test (LD‐NAAT) to detect SARS‐CoV‐2, and comparative performance analysis was performed. An individual was considered infected if a positive result was obtained on either sample. A total of 1297 adult participants were recruited. Invalid results (n = 18) were excluded from the analysis. SARS‐CoV‐2 was detected in 144/1279 (11.3%) participants: 126 from both samples, 15 only from ONPS, and 3 only from SWG. Overall, the sensitivity was 97.9% (95% CI: 93.7–99.3) for ONPS and 89.6% (95% CI: 83.4–93.6; p = 0.005) for SWG. The mean ONPS cycle threshold (Ct) value was significantly lower for the concordant paired samples as compared to discordant ones (22.9 vs. 32.1; p < 0.001). In conclusion, using an LD‐NAAT with thermal lysis, SWG is a less sensitive sampling method than the ONPS. However, the higher acceptability of SWG might enable a higher rate of detection from a population‐based perspective. Nonetheless, in patients with a high clinical suspicion of COVID‐19, a repeated analysis with ONPS should be considered. The sensitivity of SWG using NAAT preceded by chemical extraction should be evaluated. Using a laboratory‐developed NAAT preceded by thermal lysis, the overall percent agreement between spring water gargle (SWG) and oral combined with nasopharyngeal swab (ONPS), sampled at the same time among 1297 participants, is excellent (98.6%). Although the SARS‐CoV‐2 NAAT from SWG is globally less sensitive than from ONPS (89.6% vs. 97.9%), the difference is markedly less in individuals symptomatic for <3 days (2.7%; p=NS) than in those whose symptoms started ≥7 days before testing (35.7%; p= 0.005).
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Affiliation(s)
- Sarah Gobeille Paré
- Département de microbiologie-infectiologie et d'immunologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Julie Bestman-Smith
- Département de microbiologie-infectiologie et d'immunologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada.,Département de microbiologie et d'infectiologie du Centre hospitalier universitaire (CHU) de Québec, Québec, Québec, Canada
| | - Judith Fafard
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Québec, Canada.,Département de microbiologie, infectiologie et Immunologie, Université de Montréal, Montréal, Québec, Canada
| | - Florence Doualla-Bell
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Québec, Canada
| | - Mariève Jacob-Wagner
- Département de microbiologie et d'infectiologie du Centre hospitalier universitaire (CHU) de Québec, Québec, Québec, Canada
| | - Christian Lavallée
- Département de microbiologie, infectiologie et Immunologie, Université de Montréal, Montréal, Québec, Canada.,Département des laboratoires de biologie médicale, Grappe Optilab-CHUM, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Service de maladies infectieuses, CIUSSS de l'Est-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | - Hugues Charest
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Québec, Canada.,Département de microbiologie, infectiologie et Immunologie, Université de Montréal, Montréal, Québec, Canada
| | - Stéphanie Beauchemin
- Département des laboratoires de biologie médicale, Grappe Optilab-CHUM, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - François Coutlée
- Département de microbiologie, infectiologie et Immunologie, Université de Montréal, Montréal, Québec, Canada.,Département des laboratoires de biologie médicale, Grappe Optilab-CHUM, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Jeannot Dumaresq
- Département de microbiologie-infectiologie et d'immunologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada.,Département de microbiologie et d'Infectiologie, CISSS de Chaudière-Appalaches, Lévis, Québec, Canada
| | - Lambert Busque
- Département des laboratoires de biologie médicale, Grappe Optilab-CHUM, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Manon St-Hilaire
- Département des laboratoires de biologie médicale, Grappe Optilab-CHUM, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Guylaine Lépine
- Département des laboratoires de biologie médicale, Grappe Optilab-CHUM, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Valérie Boucher
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Marc Desforges
- Département de microbiologie, infectiologie et Immunologie, Université de Montréal, Montréal, Québec, Canada.,Département clinique de médecine de laboratoire, CHU Ste-Justine, Montréal, Québec, Canada
| | - Isabelle Goupil-Sormany
- Direction de la vigie sanitaire, Ministère de la Santé et des Services sociaux du Québec, Québec, Québec, Canada
| | - Annie-Claude Labbé
- Département de microbiologie, infectiologie et Immunologie, Université de Montréal, Montréal, Québec, Canada.,Département des laboratoires de biologie médicale, Grappe Optilab-CHUM, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Service de maladies infectieuses, CIUSSS de l'Est-de-l'Île-de-Montréal, Montréal, Québec, Canada
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17
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Tourigny JN, Paquet V, Fortier É, Malo C, Mercier É, Chauny JM, Clark G, Blanchard PG, Boucher V, Carmichael PH, Gariépy JL, Émond M. Predictors of neurosurgical intervention in complicated mild traumatic brain injury patients: a retrospective cohort study. Brain Inj 2021; 35:1267-1274. [PMID: 34488497 DOI: 10.1080/02699052.2021.1972147] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine the predicting demographic, clinical and radiological factors for neurosurgical intervention in complicated mild traumatic brain injury (mTBI) patients. METHODS Design: retrospective multicenter cohort study. Participants: patients aged ≥16 presenting to all level-I trauma centers in Quebec between 09/2016 and 12/2017 with mTBI(GCS 13-15) and complication on initial head CT (intracranial hemorrhage/skull fracture). Procedure: Consecutive medical records were reviewed and separated into two groups: no neurosurgical intervention and neurosurgical intervention (NSI). Main outcome: neurosurgical intervention. Analysis: multiple logistic regression model. RESULTS Four hundred and seventy-eight patients were included and 40 underwent NSI. One patient had radiological deterioration but no clinical deterioration prior to surgery. Subdural hemorrhage ≥4 mm width (OR:3.755 [95% CI:1.290-10.928]) and midline shift (OR:7.507 [95% CI: 3.317-16.989]) increased the risk of NSI. Subarachnoid hemorrhage was associated with a lower risk of NSI (OR:0.312 [95% CI: 0.136-0.713]). All other intracranial hemorrhages were not associated with NSI. CONCLUSION Radiological deterioration was not associated with the incidence of NSI. Subdural hemorrhage and midline shift should be predicting factors for neurosurgery. Some patients with isolated findings such as subarachnoid hemorrhage could be safely managed in their original center without being transferred to a level-I trauma center.
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Affiliation(s)
- Jean-Nicolas Tourigny
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada
| | - Véronique Paquet
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada
| | - Émile Fortier
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada
| | - Christian Malo
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada.,Chu de Québec - Université Laval, Québec, Canada
| | - Éric Mercier
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada.,Chu de Québec - Université Laval, Québec, Canada.,Vitam - Centre de Recherche en Santé Durable, Québec, Canada
| | | | | | - Pierre-Gilles Blanchard
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada.,Chu de Québec - Université Laval, Québec, Canada.,Vitam - Centre de Recherche en Santé Durable, Québec, Canada
| | - Valérie Boucher
- Chu de Québec - Université Laval, Québec, Canada.,Vitam - Centre de Recherche en Santé Durable, Québec, Canada.,Centre d'excellence Sur le Vieillissement de Québec, Québec, Canada
| | | | | | - Marcel Émond
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada.,Chu de Québec - Université Laval, Québec, Canada.,Vitam - Centre de Recherche en Santé Durable, Québec, Canada.,Centre d'excellence Sur le Vieillissement de Québec, Québec, Canada
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18
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Ouellet V, Boucher V, Beauchamp F, Neveu X, Archambault P, Berthelot S, Chauny JM, De Guise E, Émond M, Frenette J, Lang E, Lee J, Mercier, Moore L, Ouellet MC, Perry J, Le Sage N. Influence of concomitant injuries on post-concussion symptoms after a mild traumatic brain injury - a prospective multicentre cohort study. Brain Inj 2021; 35:1028-1034. [PMID: 34224275 DOI: 10.1080/02699052.2021.1945145] [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] [Indexed: 10/20/2022]
Abstract
Objectives: To compare post-concussion symptoms (PCS) and return to normal activities between mild Traumatic Brain Injury (mTBI) patients with or without concomitant injuries at 7-and 90 days post-mTBI.Methods: Design: Sub-analysis of a multicentre prospective cohort study. PARTICIPANTS AND SETTING patients with mTBI from 7 Canadian Emergency Departments. PROCEDURE Research assistants conducted telephone follow-ups using the Rivermead Postconcussion Symptoms Questionnaire (RPQ) at 7-, 30- and 90 days post-mTBI. MAIN OUTCOME Presence of PCS (RPQ: ≥3 symptoms) at 90 days. SECONDARY OUTCOMES RPQ score ≥21, prevalence of individual RPQ symptoms and patients' return to normal activities, at 7- and 90-days. Adjusted risk ratios (RR) were calculated.Results: 1725 mTBI patients were included and 1055 (61.1%) had concomitant injuries. Patients with concomitant injuries were at higher risk of having ≥3 symptoms on the RPQ (RR:1.26 [95% CI 1.01-1.58]) at 90 days. They were also at higher risk of experiencing specific symptoms (dizziness, fatigue, headaches and taking longer to think) and of non-return to their normal activities (RR:2.11 [95% CI 1.30-3.45]).Conclusion: Patients with concomitant injuries have slightly more PCS and seemed to be at higher risk of non-return to their normal activities 90 days, compared to patients without concomitant injuries.
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Affiliation(s)
- V Ouellet
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
| | - V Boucher
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada
| | - F Beauchamp
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
| | - X Neveu
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada
| | - P Archambault
- Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada.,Centre Intégré De Santé Et De Services Sociaux De Chaudière-Appalaches, Centre Hospitalier Affilié Universitaire Hôtel-Dieu De Lévis, Lévis (Quebec) Canada
| | - S Berthelot
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
| | - J M Chauny
- Université De Montréal, Montréal, Québec, Canada
| | - E De Guise
- Université De Montréal, Montréal, Québec, Canada.,Research-Institute, McGill University Health CentreMontreal, Quebec, Canada.,Centre De Recherche Interdisciplinaire En Réadaptation Du Montréal Métropolitain (CRIR), Montreal, Quebec, Canada
| | - M Émond
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
| | - J Frenette
- Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada
| | - E Lang
- University of Calgary, Calgary, Alberta, Canada
| | - J Lee
- Schwartz/Reisman Emergency Medicine Institute, Toronto, Ontario, Canada
| | - Mercier
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
| | - L Moore
- Department of Social and Preventive Medicine, Faculté De Médecine, Université Laval Québec Canada
| | - M C Ouellet
- Département De Psychologie, Université Laval Québec Canada.,Centre Interdisciplinaire De Recherche En Réadaptation Et Intégration Sociale CIRRIS, Quebec, Canada
| | - J Perry
- Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa Ottawa Canada
| | - N Le Sage
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
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19
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Yadav K, Boucher V, Le Sage N, Malo C, Mercier É, Voyer P, Clément J, Émond M. A Delphi study to identify prehospital and emergency department trauma care modifiers for older adults. Can J Surg 2021; 64:E339-E345. [PMID: 34085511 PMCID: PMC8327996 DOI: 10.1503/cjs.021519] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Older patients (age ≥ 65 yr) with trauma have increased morbidity and mortality compared to younger patients; this is partly explained by undertriage of older patients with trauma, resulting in lack of transfer to a trauma centre or failure to activate the trauma team. The objective of this study was to identify modifiers to the prehospital and emergency department phases of major trauma care for older adults based on expert consensus. Methods We conducted a modified Delphi study between May and September 2019 to identify major trauma care modifiers for older adults based on national expert consensus. The panel consisted of 24 trauma care professionals from across Canada from the prehospital and emergency department phases of care. The survey consisted of 16 trauma care modifiers. Three online survey rounds were distributed. Consensus was defined a priori as a disagreement index score less than 1. Results There was a 100% response rate for all survey rounds. Three new trauma care modifiers were suggested by panellists. The panel achieved consensus agreement for 17 of the 19 trauma care modifiers. The prehospital modifier with the strongest agreement to transfer to a trauma centre was a respiratory rate less than 10 or greater than 20 breaths/min or need for ventilatory support. The emergency department modifier with the strongest level of agreement was obtaining 12-lead electrocardiography following the primary and secondary survey. Conclusion Using a modified Delphi process, an expert panel agreed on 17 trauma care modifiers for older adults in the prehospital and emergency department settings. These modifiers may improve the delivery of trauma care for older adults and should be considered when developing local and national trauma guidelines.
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Affiliation(s)
- Krishan Yadav
- From the Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. (Yadav); Université Laval, Québec, Que. (Boucher, Le Sage, Mercier, Voyer, Clement, Emond); and McGill University, Montréal, Que. (Malo)
| | - Valérie Boucher
- From the Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. (Yadav); Université Laval, Québec, Que. (Boucher, Le Sage, Mercier, Voyer, Clement, Emond); and McGill University, Montréal, Que. (Malo)
| | - Natalie Le Sage
- From the Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. (Yadav); Université Laval, Québec, Que. (Boucher, Le Sage, Mercier, Voyer, Clement, Emond); and McGill University, Montréal, Que. (Malo)
| | - Christian Malo
- From the Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. (Yadav); Université Laval, Québec, Que. (Boucher, Le Sage, Mercier, Voyer, Clement, Emond); and McGill University, Montréal, Que. (Malo)
| | - Éric Mercier
- From the Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. (Yadav); Université Laval, Québec, Que. (Boucher, Le Sage, Mercier, Voyer, Clement, Emond); and McGill University, Montréal, Que. (Malo)
| | - Philippe Voyer
- From the Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. (Yadav); Université Laval, Québec, Que. (Boucher, Le Sage, Mercier, Voyer, Clement, Emond); and McGill University, Montréal, Que. (Malo)
| | - Julien Clément
- From the Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. (Yadav); Université Laval, Québec, Que. (Boucher, Le Sage, Mercier, Voyer, Clement, Emond); and McGill University, Montréal, Que. (Malo)
| | - Marcel Émond
- From the Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. (Yadav); Université Laval, Québec, Que. (Boucher, Le Sage, Mercier, Voyer, Clement, Emond); and McGill University, Montréal, Que. (Malo)
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20
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Truchot J, Boucher V, Raymond-Dufresne É, Malo C, Brassard É, Marcotte J, Martel G, Côté G, Garneau C, Bouchard G, Emond M. Evaluation of the feasibility and impacts of in situ simulation in emergency medicine-a mixed-method study protocol. BMJ Open 2021; 11:e040360. [PMID: 33664066 PMCID: PMC7934732 DOI: 10.1136/bmjopen-2020-040360] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In situ simulation (ISS) consists of performing a simulation in the everyday working environment with the usual team members. The feasibility of ISS in emergency medicine is an important research question, because ISS offers the possibility for repetitive, regular simulation training consistent with specific local needs. However, ISS also raises the issue of safety, since it might negatively impact the care of other patients in the emergency department (ED). Our hypothesis is that ISS in an academic high-volume ED is feasible, safe and associated with benefits for both staff and patients. METHODS A mixed-method, including a qualitative method for the assessment of feasibility and acceptability and a quantitative method for the assessment of patients' safety and participants' psychosocial risks, will be used in this study.Two distinct phases are planned in the ED of the CHU de Québec-Université Laval (Hôpital de l'Enfant-Jésus) between March 2021 and October 2021. Phase 1: an ISS programme will be implemented with selected ED professionals to assess its acceptability and safety and prove the validity of our educational concept. The number of cancelled sessions and the reasons for cancellation will be collected to establish feasibility criteria. Semistructured interviews will evaluate the acceptability of the intervention. We will compare unannounced and announced ISS. Phase 2: the impact of the ISS programme will be measured with validated questionnaires for the assessment of psychosocial risks, self-confidence and perceived stress among nonselected ED professionals, with comparison between those exposed to ISS and those that were not. ETHICS AND DISSEMINATION The CHU de Québec-Université Laval Research ethics board has approved this protocol (#2020-5000). Results will be presented to key professionals from our institution to improve patient safety. We also aim to publish our results in peer-reviewed journals and will submit abstracts to international conferences to disseminate our findings.
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Affiliation(s)
- Jennifer Truchot
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Québec, Canada
- Research center- CHU de Québec, Université Laval, Quebec, Québec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Québec, Canada
| | - Valérie Boucher
- Research center- CHU de Québec, Université Laval, Quebec, Québec, Canada
- VITAM - Centre de recherche en santé durable, Quebec, Québec, Canada
| | | | - Christian Malo
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Québec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Québec, Canada
| | - Éric Brassard
- Emergency Department, CHU de Québec-Université Laval, Quebec, Québec, Canada
| | - Jean Marcotte
- Emergency Department, CHU de Québec-Université Laval, Quebec, Québec, Canada
| | - Guillaume Martel
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Québec, Canada
| | - Geneviève Côté
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Québec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Québec, Canada
| | - Christian Garneau
- Emergency Department, CHU de Québec-Université Laval, Quebec, Québec, Canada
| | - Gino Bouchard
- Emergency Department, CHU de Québec-Université Laval, Quebec, Québec, Canada
| | - Marcel Emond
- Emergency Department, CHU de Québec-Université Laval, Quebec, Québec, Canada
- VITAM - Centre de recherche en santé durable, Quebec, Québec, Canada
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21
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Boucher V, Lamontagne ME, Lee J, Émond M. Self-assessment of functional status in older emergency department patients: a cross-over randomized pilot trial. CAN J EMERG MED 2021; 23:337-341. [PMID: 33575976 DOI: 10.1007/s43678-020-00073-9] [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: 11/03/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the inter-rater reliability and feasibility of the self-assessed Older Americans Resources and Services scale compared to its administration by a research assistant in older Emergency Department (ED) patients. METHOD This is a planned sub-analysis of a single-center randomized cross-over pilot study. A convenience sample of ED patients aged ≥ 65 was constituted at the CHU de Québec-Université Laval (Hôpital de l'Enfant-Jésus) between 2018/05 and 2018/07. Research assistants assessed participants' functional status using the Older Americans Resources and Services scale and patients self-assessed using a modified Older Americans Resources and Services scale. Test administration order was randomized. The main outcome, inter-rater reliability, was measured using intraclass correlation (ICC). Feasibility was measured using self-assessment completion rate. RESULTS 67 patients were included and 60 completed self-assessment. Mean age was 74.4 ± 7.6 and 34 (56.7%) participants were women. Mean research assistant-assessed Older Americans Resources and Services scale score was 25.1 ± 3.3, while mean self-assessed Older Americans Resources and Services scale score was 26.4 ± 2.5 [ICC: 0.8 (95% CI: 0.7-0.9)]. Mean activities of daily living scores were 12.5 ± 1.8 for research assistant assessment and 13.5 ± 0.9 for self-assessment [ICC: 0.6 (95% CI: 0.4-0.7)]. Mean instrumental activities of daily living scores were 12.6 ± 1.8 and 12.9 ± 1.8 for research assistant assessment and self-assessment, respectively [ICC: 0.9 (95% CI: 0.8-0.9)]. CONCLUSION Our results indicate that self-assessment of functional status by older ED patients is feasible, and good-to-moderate inter-rater reliability results were obtained. A self-assessed score may identify patients in need of further geriatric/functional assessment who may otherwise have been left unscreened.
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Affiliation(s)
- Valérie Boucher
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, 1401, 18e rue, H-610, Québec, G1J 1Z4, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Marie-Eve Lamontagne
- Faculté de médecine, Université Laval, Québec, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada
| | - Jacques Lee
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
- Schwartz/ Reisman Emergency Medicine Institute, Toronto, ON, Canada
| | - Marcel Émond
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, 1401, 18e rue, H-610, Québec, G1J 1Z4, QC, Canada.
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada.
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada.
- Faculté de médecine, Université Laval, Québec, QC, Canada.
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22
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Giroux M, Émond M, Nadeau A, Boucher V, Carmichael PH, Voyer P, Pelletier M, Gouin É, Daoust R, Berthelot S, Lamontagne ME, Morin M, Lemire S, Sirois MJ. Functional and cognitive decline in older delirious adults after an emergency department visit. Age Ageing 2021; 50:135-140. [PMID: 32894748 DOI: 10.1093/ageing/afaa128] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND the aim of this study was to evaluate the impact of emergency department (ED) stay-associated delirium on older patient's functional and cognitive status at 60 days post ED visit. METHODS this study was part of the multi-centre prospective cohort INDEED study. This project took place between March 2015 and July 2016 in five participating EDs across the province of Quebec. Independent non-delirious patients aged ≥65, with an ED stay ≥8 hours, were monitored for delirium until 24 hours post ward admission. A 60-day follow-up phone assessment was conducted. Participants were screened for delirium using the Confusion Assessment Method. Functional and cognitive statuses were assessed at baseline and at the 60-day follow-up using OARS and TICS-m. RESULTS a total of 608 patients were recruited, 393 of which completed the 60-day follow-up. The Confusion Assessment Method was positive in 69 patients (11.8%) during ED stay or within the first 24 hours following ward admission. At 60 days, delirium patients experienced an adjusted loss of -2.9/28 [95%CI: -3.9, -2.0] points on the OARS scale compared to non-delirious patients who lost -1.6 [95%CI: -1.9, -1.3] (P = 0.006). A significant adjusted difference in cognitive function was also noted at 60 days, as TICS-m scores in delirious patients decreased by -1.6 [95%CI: -3.5, 0.2] compared to non-delirious patients, who showed a minor improvement of 0.5 [95%CI: -0.1, 1.1] (P = 0.03). CONCLUSION seniors who developed ED stay-associated delirium have lower baseline functional and cognitive status than non-delirious patients, and they will experience a more significant decline at 60 days post ED visit.
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Affiliation(s)
- Marianne Giroux
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - Marcel Émond
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Département de médecine d'urgence, CHU de Québec-Université Laval, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
| | - Alexandra Nadeau
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - Valérie Boucher
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | | | - Philippe Voyer
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - Mathieu Pelletier
- Université Laval, Québec, Canada
- Centre Intégré de Santé et de Services Sociaux de Lanaudière, Joliette, Canada
| | - Émilie Gouin
- Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Canada
| | - Raoul Daoust
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Simon Berthelot
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Département de médecine d'urgence, CHU de Québec-Université Laval, Québec, Canada
| | - Marie-Eve Lamontagne
- Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | - Michèle Morin
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
| | - Stéphane Lemire
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - Marie-Josée Sirois
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
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23
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Blais Lécuyer J, Mercier É, Tardif PA, Archambault PM, Chauny JM, Berthelot S, Frenette J, Perry J, Stiell I, Émond M, Lee J, Lang E, McRae A, Boucher V, Le Sage N. S100B protein level for the detection of clinically significant intracranial haemorrhage in patients with mild traumatic brain injury: a subanalysis of a prospective cohort study. Emerg Med J 2020; 38:285-289. [PMID: 33355233 PMCID: PMC7982939 DOI: 10.1136/emermed-2020-209583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 10/21/2020] [Accepted: 11/08/2020] [Indexed: 11/18/2022]
Abstract
Background Clinical assessment of patients with mild traumatic brain injury (mTBI) is challenging and overuse of head CT in the ED is a major problem. Several studies have attempted to reduce unnecessary head CTs following a mTBI by identifying new tools aiming to predict intracranial bleeding. Higher levels of S100B protein have been associated with intracranial haemorrhage following a mTBI in previous literature. The main objective of this study is to assess whether plasma S100B protein level is associated with clinically significant brain injury and could be used to reduce the number of head CT post-mTBI. Methods Study design: secondary analysis of a prospective multicentre cohort study conducted between 2013 and 2016 in five Canadian EDs. Inclusion criteria: non-hospitalised patients with mTBI with a GCS score of 13–15 in the ED and a blood sample drawn within 24 hours after the injury. Data collected: sociodemographic and clinical data were collected in the ED. S100B protein was analysed using ELISA. All CT scans were reviewed by a radiologist blinded to the biomarker results. Main outcome: the presence of clinically important brain injury. Results 476 patients were included. Mean age was 41±18 years old and 150 (31.5%) were women. Twenty-four (5.0%) patients had a clinically significant intracranial haemorrhage. Thirteen patients (2.7%) presented a non-clinically significant brain injury. A total of 37 (7.8%) brain injured patients were included in our study. S100B median value (Q1–Q3) was: 0.043 µg/L (0.008–0.080) for patients with clinically important brain injury versus 0.039 µg/L (0.023–0.059) for patients without clinically important brain injury. Sensitivity and specificity of the S100B protein level, if used alone to detect clinically important brain injury, were 16.7% (95% CI 4.7% to 37.4%) and 88.5% (95% CI 85.2% to 91.3%), respectively. Conclusion Plasma S100B protein level was not associated with clinically significant intracranial lesion in patients with mTBI.
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Affiliation(s)
- Julien Blais Lécuyer
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada.,Axe de recherche en Santé des populations et pratiques optimales en santé, CHU de Quebec-Universite Laval Research Center, Quebec, Quebec, Canada
| | - Éric Mercier
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada.,Axe de recherche en Santé des populations et pratiques optimales en santé, CHU de Quebec-Universite Laval Research Center, Quebec, Quebec, Canada
| | - Pier-Alexandre Tardif
- Axe de recherche en Santé des populations et pratiques optimales en santé, CHU de Quebec-Universite Laval Research Center, Quebec, Quebec, Canada
| | - Patrick M Archambault
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec, Quebec, Canada.,Chaudiere-Appalaches Integrated Health and Social Services Center, Lévis, Quebec, Canada
| | - Jean-Marc Chauny
- Department of family medicine and emergency medicine, University of Montreal, Montreal, Quebec, Canada
| | - Simon Berthelot
- Axe de recherche en Santé des populations et pratiques optimales en santé, CHU de Quebec-Universite Laval Research Center, Quebec, Quebec, Canada
| | - Jérôme Frenette
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Jeff Perry
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada.,Department of emergency medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ian Stiell
- Department of emergency medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marcel Émond
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada.,Axe de recherche en Santé des populations et pratiques optimales en santé, CHU de Quebec-Universite Laval Research Center, Quebec, Quebec, Canada
| | - Jacques Lee
- Schwartz/Reisman Emergency Medicine Institute, Toronto, Ontario, Canada
| | - Eddy Lang
- Department of emergency medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew McRae
- Department of emergency medicine, University of Calgary, Calgary, Alberta, Canada
| | - Valérie Boucher
- Axe de recherche en Santé des populations et pratiques optimales en santé, CHU de Quebec-Universite Laval Research Center, Quebec, Quebec, Canada
| | - Natalie Le Sage
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada .,Axe de recherche en Santé des populations et pratiques optimales en santé, CHU de Quebec-Universite Laval Research Center, Quebec, Quebec, Canada
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24
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Daoust R, Paquet J, Boucher V, Pelletier M, Gouin É, Émond M. Relationship Between Pain, Opioid Treatment, and Delirium in Older Emergency Department Patients. Acad Emerg Med 2020; 27:708-716. [PMID: 32441414 DOI: 10.1111/acem.14033] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Emergency department (ED) stay and its associated conditions (immobility, inadequate hydration and nutrition, lack of stimulation) increase the risk of delirium in older patients. Poorly controlled pain and paradoxically opioid pain treatment have also been identified as triggers for delirium. The aim of this study was to assess the relationship between pain, opioid treatment, and delirium in older ED patients. METHODS A multicenter prospective cohort study was conducted in four hospitals across the province of Québec (Canada). Patients aged ≥ 65 years old, waiting for hospital admission between March and July 2015, who were nondelirious upon ED arrival, who were independent or semi-independent in their daily living activities, and who had an ED stay of at least 8 hours were included. Delirium assessments were conducted twice a day during the patient's entire ED stay and their first 24 hours on the hospital ward using the Confusion Assessment Method. Pain intensity was evaluated using a visual analog scale (VAS = 0-100) during the initial interview, and all opioid treatments were documented. RESULTS A total of 338 patients were included; 51% were female, and mean (±SD) age was 77 (±8) years. Forty-one patients (12%) experienced delirium during their hospital stay occurring within a mean (±SD) delay of 47 (±19) hours after ED admission. Among patients with pain intensity ≥ 65 from VAS (0-100), 26% experienced delirium compared to 11% for patients with pain < 65 (p < 0.01), and no significant association was found between opioid consumption and delirium (p = 0.31). Logistic regression controlling for confounding factors showed that patients with pain intensity ≥ 65 are 3.3 (95% confidence interval = 1.4 to 7.9) times more likely to develop delirium than patients who had pain intensity of <65. CONCLUSIONS Severe pain, not opioids, is associated with the development of delirium during ED stay. Adequate pain control during the hospital stay may contribute to a decrease in delirium episodes.
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Affiliation(s)
- Raoul Daoust
- From the Centre d’Étude en Médecine d’Urgence Hôpital du Sacré‐Cœur de Montréal Montréal Québec Canada
- the Faculté de Médecine Département Médecine Familiale et Médecine d’Urgence Université de Montréal Montréal Québec Canada
| | - Jean Paquet
- the Faculté de Médecine Département Médecine Familiale et Médecine d’Urgence Université de Montréal Montréal Québec Canada
| | - Valérie Boucher
- CHU de Québec–Université Laval Québec Québec Canada
- the Centre d’Excellence du Vieillissement de Québec Québec Québec Canada
| | - Mathieu Pelletier
- the Faculté de Médecine Université Laval Québec Québec Canada
- the Centre Intégré de Santé et de Services Sociaux de Lanaudière Joliette Québec Canada
| | - Émilie Gouin
- and the Centre Hospitalier Régional de Trois‐Rivières Trois‐Rivières Québec Canada
| | - Marcel Émond
- CHU de Québec–Université Laval Québec Québec Canada
- the Centre d’Excellence du Vieillissement de Québec Québec Québec Canada
- the Faculté de Médecine Université Laval Québec Québec Canada
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25
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Boucher V, Mathy C, Lacroix J, Émériaud G, Jouvet P, Tse SM. Post-discharge respiratory outcomes of children with acute respiratory distress syndrome. Pediatr Pulmonol 2020; 55:468-473. [PMID: 31765521 DOI: 10.1002/ppul.24581] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 06/18/2019] [Accepted: 11/10/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES While long-term sequelae of acute respiratory distress syndrome (ARDS) are well-documented in adults, few studies reported post-discharge respiratory complications in pediatric ARDS (PARDS) and none used the recent Pediatric Acute Lung Injury Consensus Conference (PALICC) diagnostic criteria. This study describes the respiratory symptoms, pulmonary function, and health resource use of PARDS survivors at 3 months post-discharge. DESIGN Retrospective study. PATIENT SELECTION Children less than 18 years admitted to the intensive care unit of Sainte-Justine University Health Center from 1st September 2015 to 1st July 2017, and meeting PALICC diagnostic criteria for PARDS. METHODS We evaluated 38 of the 44 children with PARDS in the follow-up clinic at a mean (SD) of 3.4 (2.0) months post-discharge for respiratory symptoms, age-appropriate pulmonary function tests (spirometry or oscillometry, maximal respiratory pressures), and all-cause emergency department (ED) visits or rehospitalizations since discharge. RESULTS Fourteen (36.8%) had abnormal respiratory symptoms (most commonly cough between respiratory infections and wheezing), 7 of whom (18.4%) presented new respiratory symptoms since PARDS diagnosis. A mild-to-moderate restrictive pattern was observed in 3 of 10 patients who performed spirometry and mildly decreased maximal inspiratory pressures were noted in 2 of 8 patients who performed these maneuvers. Nine (23.7%) patients consulted in the ED and 4 (10.5%) were rehospitalized post-discharge. CONCLUSIONS Despite our cohort's limited sample size, our findings suggest that a significant proportion of PARDS survivors experience abnormal respiratory symptoms, pulmonary function deficits, and recurrent problems requiring medical attention. Larger, multicenter studies are required to identify risk factors associated with poor post-discharge outcomes among PARDS survivors.
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Affiliation(s)
- Valérie Boucher
- Department of Family Medicine, University of Montréal, Montréal, Canada
| | - Clémence Mathy
- Department of Psychology, University of Bourgogne, Dijon, France
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, CHU Sainte-Justine, Montréal, Canada.,Department of Pediatrics, University of Montréal, Montréal, Canada
| | - Guillaume Émériaud
- Division of Pediatric Critical Care Medicine, CHU Sainte-Justine, Montréal, Canada.,Department of Pediatrics, University of Montréal, Montréal, Canada
| | - Philippe Jouvet
- Division of Pediatric Critical Care Medicine, CHU Sainte-Justine, Montréal, Canada.,Department of Pediatrics, University of Montréal, Montréal, Canada
| | - Sze Man Tse
- Department of Pediatrics, University of Montréal, Montréal, Canada.,Division of Respiratory Medicine, CHU Sainte-Justine, Montréal, Canada
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26
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Yadav K, Boucher V, Carmichael PH, Voyer P, Eagles D, Pelletier M, Gouin É, Daoust R, Vu TTM, Berthelot S, Émond M. Serial Ottawa 3DY assessments to detect delirium in older emergency department community dwellers. Age Ageing 2019; 49:130-134. [PMID: 31755527 DOI: 10.1093/ageing/afz144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/11/2019] [Accepted: 10/07/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND delirium is associated with increased morbidity and mortality among older emergency department (ED) patients. When using physician gestalt, delirium is missed in the majority of patients. The Ottawa 3DY (O3DY) has been validated to detect cognitive dysfunction among older ED patients. OBJECTIVES to determine the sensitivity and specificity of serial O3DY assessments to detect delirium in older ED patients. DESIGN a prospective observational multicenter cohort study. SETTING four Quebec EDs. PARTICIPANTS independent or semi-independent older patients (age ≥ 65 years) with an ED stay of at least 8 hours that required hospitalisation. MEASUREMENTS eligible patients were evaluated using serial O3DY assessments at least 6 hours apart. The primary outcome was delirium after at least 8 hours in the ED. The reference standard for delirium assessment was the confusion assessment method (CAM). The sensitivity and specificity of the serial O3DY to detect delirium were calculated. RESULTS we enrolled 301 patients (mean age 77 years, 49.5% male, 3.0% with a history of mild dementia). Thirty patients (10.0%) were CAM positive for delirium. Patients had a median of three O3DY assessments. Serial O3DY evaluations to detect delirium among patients with at least one abnormal O3DY had a sensitivity of 86.7% (95% confidence interval-CI 69.3-96.2%) and a specificity of 44.3% (95%; CI 38.3-50.4%). CONCLUSION serial O3DY testing demonstrates good sensitivity as a screening tool to detect delirium among older adult patients with prolonged ED lengths of stay. Emergency physicians should consider the use of the serial O3DY over clinician gestalt to improve delirium detection.
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Affiliation(s)
| | - Valérie Boucher
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Faculté de Médecine, Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | | | - Philippe Voyer
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Faculté des sciences infirmières, Université Laval, Québec, Canada
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mathieu Pelletier
- Centre Intégré de Santé et de Services Sociaux de Lanaudière, Joliette, Canada
| | - Émilie Gouin
- Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Canada
- CIUSSS, Trois-Rivières, Canada
| | - Raoul Daoust
- Centre de recherche de l’Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
- Faculté de Médicine, Université de Montréal, Montréal, Canada
- Département Médecine d’Urgence, Hôpital Sacré-Cœur de Montréal, Montreal, Canada
| | - Thien Tuong Minh Vu
- Faculté de Médicine, Université de Montréal, Montréal, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, Canada
| | - Simon Berthelot
- Faculté de Médecine, Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de Médicine d’Urgence, CHU de Québec-Université Laval, Québec, Canada
| | - Marcel Émond
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Faculté de Médecine, Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de Médicine d’Urgence, CHU de Québec-Université Laval, Québec, Canada
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27
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Boucher V, Lamontagne ME, Lee J, Carmichael PH, Déry J, Émond M. Acceptability of older patients' self-assessment in the Emergency Department (ACCEPTED)-a randomised cross-over pilot trial. Age Ageing 2019; 48:875-880. [PMID: 31297513 DOI: 10.1093/ageing/afz084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/19/2019] [Accepted: 06/13/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND patient self-assessment using electronic tablet could improve the quality of assessment of older Emergency Department(ED) patients. However, the acceptability of this practice remains unknown. OBJECTIVE to compare the acceptability of self-assessment using a tablet in the ED to a standard assessment by a research assistant (RA), according to seniors and their caregivers. DESIGN randomised crossover pilot study. SETTING The Hôpital de l'Enfant-Jésus (CHU de Québec-Université Laval) (2018/05-2018/07). SUBJECTS (1) ED patients aged ≥65, (2) their caregiver, if present. METHODS participants' frailty, cognitive and functional status were assessed with the Clinical Frailty scale, Montreal Cognitive Assessment, and Older American Resources and Services scale and patients self-assessed using a tablet. Test administration order was randomised. The primary outcome, acceptability, was measured using the Treatment Acceptability and Preferences (TAP) scale. Descriptive analyses were performed for sociodemographic variables. TAP scores were adjusted using multivariate linear regression. Thematic content analysis was performed for qualitative data. RESULTS sixty-seven patients were included. Mean age was 75.5 ± 8.0 and 55.2% were women. Adjusted TAP scores for RA evaluation and patient self-assessment were 2.36 and 2.20, respectively (P = 0.08). Patients aged ≥85 showed a difference between the TAP scores (P < 0.05). Qualitative data indicates that this might be attributed to the use of technology. Data from nine caregivers showed a 2.42 mean TAP score for RA evaluation and 2.44 for self-assessment. CONCLUSIONS our results show that older patients believe self-assessment in the ED using an electronic tablet as acceptable as a standard evaluation by a research assistant. Patients aged ≥85 find this practice less acceptable.
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Affiliation(s)
- Valérie Boucher
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL)
- Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
| | - Marie-Eve Lamontagne
- Faculté de médecine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | - Jacques Lee
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Center, Toronto, Canada
| | | | - Julien Déry
- Faculté de médecine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | - Marcel Émond
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL)
- Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
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Boucher V, Lamontagne ME, Nadeau A, Carmichael PH, Yadav K, Voyer P, Pelletier M, Gouin É, Daoust R, Berthelot S, Morin M, Lemire S, Minh Vu TT, Lee J, Émond M. Unrecognized Incident Delirium in Older Emergency Department Patients. J Emerg Med 2019; 57:535-542. [DOI: 10.1016/j.jemermed.2019.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
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Batomen Kuimi BL, Lague A, Boucher V, Guimont C, Chauny JM, Shields JF, Vanier L, Plourde M, Émond M. Potential benefits of incentive spirometry following a rib fracture: a propensity-score analysis - CORRIGENDUM. CAN J EMERG MED 2019; 21:1-2. [PMID: 30990155 DOI: 10.1017/cem.2019.341] [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: 11/06/2022]
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Giroux M, Sirois MJ, Boucher V, Daoust R, Gouin É, Pelletier M, Berthelot S, Voyer P, Émond M. Frailty Assessment to Help Predict Patients at Risk of Delirium When Consulting the Emergency Department. J Emerg Med 2018; 55:157-164. [DOI: 10.1016/j.jemermed.2018.02.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/31/2018] [Accepted: 02/22/2018] [Indexed: 12/20/2022]
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Émond M, Boucher V, Carmichael PH, Voyer P, Pelletier M, Gouin É, Daoust R, Berthelot S, Lamontagne ME, Morin M, Lemire S, Minh Vu TT, Nadeau A, Rheault M, Juneau L, Le Sage N, Lee J. Incidence of delirium in the Canadian emergency department and its consequences on hospital length of stay: a prospective observational multicentre cohort study. BMJ Open 2018. [PMID: 29523559 PMCID: PMC5855334 DOI: 10.1136/bmjopen-2017-018190] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 02/06/2023] Open
Abstract
OBJECTIVE We aim to determine the incidence of delirium and describe its impacts on hospital length of stay (LOS) among non-delirious community-dwelling older adults with an 8-hour exposure to the emergency department (ED) environment. DESIGN This is a prospective observational multicentre cohort study (March-July 2015). Patients were assessed two times per day during their entire ED stay and up to 24 hours on hospital ward. SETTING The study took place in four Canadian EDs. PARTICIPANTS 338 included patients: (1) aged ≥65 years; (2) who had an ED stay ≥8 hours; (3) were admitted to hospital ward and (4) were independent/semi-independent. MAIN OUTCOMES AND MEASURES The primary outcomes of this study were incident delirium in the ED or within 24 hours of ward admission and ED and hospital LOS. Functional and cognitive status were assessed using validated Older Americans Resources and Services and the modified Telephone Interview for Cognitive Status tools. The Confusion Assessment Method was used to detect incident delirium. Univariate and multivariate analyses were conducted to evaluate outcomes. RESULTS Mean age was 76.8 (±8.1), 17.7% were aged >85 years old and 48.8% were men. The mean incidence of delirium was 12.1% (n=41). Median IQR ED LOS was 32.4 (24.5-47.9) hours and hospital LOS was 146.6 (75.2-267.8) hours. Adjusted mean hospital LOS was increased by 105.4 hours (4.4 days) (95% CI 25.1 to 162.0, P<0.001) for patients who developed an episode of delirium compared with non-delirious patient. CONCLUSIONS An incident delirium was observed in one of eight independent/semi-independent older adults after an 8-hour ED exposure. An episode of delirium increases hospital LOS by 4 days and therefore has important implications for patients and could contribute to ED overcrowding through a deleterious feedback loop.
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Affiliation(s)
- Marcel Émond
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Québec, Canada
| | - Valérie Boucher
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | | | - Philippe Voyer
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Nursing, Université Laval, Québec, Canada
| | - Mathieu Pelletier
- Medicine, Université Laval, Québec, Canada
- Centre Intégré de Santé et de Services Sociaux de Lanaudière, Joliette, Canada
| | - Émilie Gouin
- Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Canada
| | - Raoul Daoust
- Centre de recherche de l’Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
- Medicine, Université de Montréal, Montréal, Canada
| | - Simon Berthelot
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
| | - Marie-Eve Lamontagne
- Medicine, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | - Michèle Morin
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
| | - Stéphane Lemire
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
| | - Thien Tuong Minh Vu
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, Canada
- Centre hospitalier de l’Université de Montréal, Montréal, Canada
- Institut de gériatrie de l’Université de Montréal, Montréal, Canada
| | - Alexandra Nadeau
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | | | - Lucille Juneau
- Centre Intégré Universitaire de Services Sociaux et de Santé de la Capitale-Nationale, Québec, Canada
| | - Natalie Le Sage
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
| | - Jacques Lee
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Center, Toronto, Canada
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Giroux M, Émond M, Sirois M, Boucher V, Daoust R, Gouin E, Pelletier M, Berthelot S. ASSOCIATION BETWEEN ED-INDUCED DELIRIUM AND COGNITIVE AND FUNCTIONAL DECLINE IN SENIORS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M. Giroux
- Readaptation, CHU de Québec, Québec, Quebec, Canada,
- Université Laval, Québec, Quebec, Canada,
- Centre d’excellence vieillissment de Québec, Québec, Quebec, Canada,
| | - M. Émond
- Readaptation, CHU de Québec, Québec, Quebec, Canada,
- Université Laval, Québec, Quebec, Canada,
- Centre d’excellence vieillissment de Québec, Québec, Quebec, Canada,
| | - M. Sirois
- Readaptation, CHU de Québec, Québec, Quebec, Canada,
- Université Laval, Québec, Quebec, Canada,
- Centre d’excellence vieillissment de Québec, Québec, Quebec, Canada,
| | - V. Boucher
- Readaptation, CHU de Québec, Québec, Quebec, Canada,
- Centre d’excellence vieillissment de Québec, Québec, Quebec, Canada,
- Université Laval, Québec, Quebec, Canada,
| | - R. Daoust
- CIUSSS Nord-de-l’ile-de-Montréal, Québec, Quebec, Canada,
- Université de montréal, Québec, Quebec, Canada,
| | - E. Gouin
- CIUSSS Mauricie-Centre-du-Québec, Québec, Quebec, Canada,
| | | | - S. Berthelot
- Readaptation, CHU de Québec, Québec, Quebec, Canada,
- Université Laval, Québec, Quebec, Canada,
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Giroux M, Émond M, Sirois M, Boucher V, Daoust R, Gouin E, Pelletier M, Berthelot S. FRAILTY ASSESSMENT TO HELP PREDICT PATIENTS AT RISK OF ED-INDUCED DELIRIUM. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M. Giroux
- Readaptation, CHU de Québec, Québec, Quebec, Canada,
- Centre d’excellence du Vieillissement de Québec, Québec, Quebec, Canada,
- Université Laval, Québec, Quebec, Canada,
| | - M. Émond
- Readaptation, CHU de Québec, Québec, Quebec, Canada,
- Centre d’excellence du Vieillissement de Québec, Québec, Quebec, Canada,
- Université Laval, Québec, Quebec, Canada,
| | - M. Sirois
- Readaptation, CHU de Québec, Québec, Quebec, Canada,
- Centre d’excellence du Vieillissement de Québec, Québec, Quebec, Canada,
- Université Laval, Québec, Quebec, Canada,
| | - V. Boucher
- Readaptation, CHU de Québec, Québec, Quebec, Canada,
- Centre d’excellence du Vieillissement de Québec, Québec, Quebec, Canada,
- Université Laval, Québec, Quebec, Canada,
| | - R. Daoust
- Université de Montréal, Québec, Quebec, Canada,
- CIUSSS du Nord-de-l’ile-de-Montreal, Québec, Quebec, Canada,
| | - E. Gouin
- CIUSSS Mauricie-centre-du-Québec, Quebec, Quebec, Canada,
| | | | - S. Berthelot
- Readaptation, CHU de Québec, Québec, Quebec, Canada,
- Université Laval, Québec, Quebec, Canada,
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Émond M, Guimont C, Chauny JM, Daoust R, Bergeron É, Vanier L, Moore L, Plourde M, Kuimi B, Boucher V, Allain-Boulé N, Le Sage N. Clinical prediction rule for delayed hemothorax after minor thoracic injury: a multicentre derivation and validation study. CMAJ Open 2017; 5:E444-E453. [PMID: 28611156 PMCID: PMC5498437 DOI: 10.9778/cmajo.20160096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND About 75% of patients with minor thoracic injury are discharged after an emergency department visit. However, complications such as delayed hemothorax can occur. We sought to derive and validate a clinical decision rule to predict hemothorax in patients discharged from the emergency department. METHODS We conducted a 6-year prospective cohort study in 4 university-affiliated emergency departments. Patients aged 16 years or older presenting with a minor thoracic injury were assessed at 5 time points (initial visit and 7, 14, 30 and 90 d after the injury). Radiologists' reports were reviewed for the presence of hemothorax. We used log-binomial regression models to identify predictors of hemothorax. RESULTS A total of 1382 patients were included: 830 in the derivation phase and 552 in the validation phase. Of these, 151 (10.9%) had hemothorax at the 14-day follow-up. Patients 65 years of age or older represented 25.3% (210/830) and 23.7% (131/552) of the derivation and validation cohorts, respectively. The final clinical decision rule included a combination of age (> 70 yr, 2 points; 45-70 yr, 1 point), fracture of any high to mid thorax rib (ribs 3-9, 2 points) and presence of 3 or more rib fractures (1 point). Twenty (30.8%) of the 65 high-risk patients (score ≥ 4) experienced hemothorax during the follow-up period. The clinical decision rule had a high specificity (90.7%, 95% confidence interval 87.7%-93.1%) in this high-risk group, thus guiding appropriate post-emergency care. INTERPRETATION One patient out of every 10 presented with delayed hemothorax after discharge from the emergency department. Implementation of this validated clinical decision rule for minor thoracic injury could guide emergency discharge plans.
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Affiliation(s)
- Marcel Émond
- Affiliations: Centre hospitalier universitaire de Québec, Université Laval (Émond, Guimont, Plourde Moore, Kuimi, Boucher, Allain-Boulé, Le Sage); Université Laval (Émond, Guimont, Plourde, Boucher, Allain-Boulé, Le Sage), Laval, Que.; Centre d'excellence sur le vieillissement de Québec (Émond, Boucher), Québec, Que.; Hôpital du Sacré-Coeur de Montréal (Chauny, Daoust); Département de médecine familiale et médecine d'urgence (Chauny, Daoust), Université de Montréal, Montréal, Que.; Centre hospitalier de Charles-LeMoyne (Bergeron, Vanier), Greenfield Park, Que
| | - Chantal Guimont
- Affiliations: Centre hospitalier universitaire de Québec, Université Laval (Émond, Guimont, Plourde Moore, Kuimi, Boucher, Allain-Boulé, Le Sage); Université Laval (Émond, Guimont, Plourde, Boucher, Allain-Boulé, Le Sage), Laval, Que.; Centre d'excellence sur le vieillissement de Québec (Émond, Boucher), Québec, Que.; Hôpital du Sacré-Coeur de Montréal (Chauny, Daoust); Département de médecine familiale et médecine d'urgence (Chauny, Daoust), Université de Montréal, Montréal, Que.; Centre hospitalier de Charles-LeMoyne (Bergeron, Vanier), Greenfield Park, Que
| | - Jean-Marc Chauny
- Affiliations: Centre hospitalier universitaire de Québec, Université Laval (Émond, Guimont, Plourde Moore, Kuimi, Boucher, Allain-Boulé, Le Sage); Université Laval (Émond, Guimont, Plourde, Boucher, Allain-Boulé, Le Sage), Laval, Que.; Centre d'excellence sur le vieillissement de Québec (Émond, Boucher), Québec, Que.; Hôpital du Sacré-Coeur de Montréal (Chauny, Daoust); Département de médecine familiale et médecine d'urgence (Chauny, Daoust), Université de Montréal, Montréal, Que.; Centre hospitalier de Charles-LeMoyne (Bergeron, Vanier), Greenfield Park, Que
| | - Raoul Daoust
- Affiliations: Centre hospitalier universitaire de Québec, Université Laval (Émond, Guimont, Plourde Moore, Kuimi, Boucher, Allain-Boulé, Le Sage); Université Laval (Émond, Guimont, Plourde, Boucher, Allain-Boulé, Le Sage), Laval, Que.; Centre d'excellence sur le vieillissement de Québec (Émond, Boucher), Québec, Que.; Hôpital du Sacré-Coeur de Montréal (Chauny, Daoust); Département de médecine familiale et médecine d'urgence (Chauny, Daoust), Université de Montréal, Montréal, Que.; Centre hospitalier de Charles-LeMoyne (Bergeron, Vanier), Greenfield Park, Que
| | - Éric Bergeron
- Affiliations: Centre hospitalier universitaire de Québec, Université Laval (Émond, Guimont, Plourde Moore, Kuimi, Boucher, Allain-Boulé, Le Sage); Université Laval (Émond, Guimont, Plourde, Boucher, Allain-Boulé, Le Sage), Laval, Que.; Centre d'excellence sur le vieillissement de Québec (Émond, Boucher), Québec, Que.; Hôpital du Sacré-Coeur de Montréal (Chauny, Daoust); Département de médecine familiale et médecine d'urgence (Chauny, Daoust), Université de Montréal, Montréal, Que.; Centre hospitalier de Charles-LeMoyne (Bergeron, Vanier), Greenfield Park, Que
| | - Laurent Vanier
- Affiliations: Centre hospitalier universitaire de Québec, Université Laval (Émond, Guimont, Plourde Moore, Kuimi, Boucher, Allain-Boulé, Le Sage); Université Laval (Émond, Guimont, Plourde, Boucher, Allain-Boulé, Le Sage), Laval, Que.; Centre d'excellence sur le vieillissement de Québec (Émond, Boucher), Québec, Que.; Hôpital du Sacré-Coeur de Montréal (Chauny, Daoust); Département de médecine familiale et médecine d'urgence (Chauny, Daoust), Université de Montréal, Montréal, Que.; Centre hospitalier de Charles-LeMoyne (Bergeron, Vanier), Greenfield Park, Que
| | - Lynne Moore
- Affiliations: Centre hospitalier universitaire de Québec, Université Laval (Émond, Guimont, Plourde Moore, Kuimi, Boucher, Allain-Boulé, Le Sage); Université Laval (Émond, Guimont, Plourde, Boucher, Allain-Boulé, Le Sage), Laval, Que.; Centre d'excellence sur le vieillissement de Québec (Émond, Boucher), Québec, Que.; Hôpital du Sacré-Coeur de Montréal (Chauny, Daoust); Département de médecine familiale et médecine d'urgence (Chauny, Daoust), Université de Montréal, Montréal, Que.; Centre hospitalier de Charles-LeMoyne (Bergeron, Vanier), Greenfield Park, Que
| | - Miville Plourde
- Affiliations: Centre hospitalier universitaire de Québec, Université Laval (Émond, Guimont, Plourde Moore, Kuimi, Boucher, Allain-Boulé, Le Sage); Université Laval (Émond, Guimont, Plourde, Boucher, Allain-Boulé, Le Sage), Laval, Que.; Centre d'excellence sur le vieillissement de Québec (Émond, Boucher), Québec, Que.; Hôpital du Sacré-Coeur de Montréal (Chauny, Daoust); Département de médecine familiale et médecine d'urgence (Chauny, Daoust), Université de Montréal, Montréal, Que.; Centre hospitalier de Charles-LeMoyne (Bergeron, Vanier), Greenfield Park, Que
| | - Batomen Kuimi
- Affiliations: Centre hospitalier universitaire de Québec, Université Laval (Émond, Guimont, Plourde Moore, Kuimi, Boucher, Allain-Boulé, Le Sage); Université Laval (Émond, Guimont, Plourde, Boucher, Allain-Boulé, Le Sage), Laval, Que.; Centre d'excellence sur le vieillissement de Québec (Émond, Boucher), Québec, Que.; Hôpital du Sacré-Coeur de Montréal (Chauny, Daoust); Département de médecine familiale et médecine d'urgence (Chauny, Daoust), Université de Montréal, Montréal, Que.; Centre hospitalier de Charles-LeMoyne (Bergeron, Vanier), Greenfield Park, Que
| | - Valérie Boucher
- Affiliations: Centre hospitalier universitaire de Québec, Université Laval (Émond, Guimont, Plourde Moore, Kuimi, Boucher, Allain-Boulé, Le Sage); Université Laval (Émond, Guimont, Plourde, Boucher, Allain-Boulé, Le Sage), Laval, Que.; Centre d'excellence sur le vieillissement de Québec (Émond, Boucher), Québec, Que.; Hôpital du Sacré-Coeur de Montréal (Chauny, Daoust); Département de médecine familiale et médecine d'urgence (Chauny, Daoust), Université de Montréal, Montréal, Que.; Centre hospitalier de Charles-LeMoyne (Bergeron, Vanier), Greenfield Park, Que
| | - Nadine Allain-Boulé
- Affiliations: Centre hospitalier universitaire de Québec, Université Laval (Émond, Guimont, Plourde Moore, Kuimi, Boucher, Allain-Boulé, Le Sage); Université Laval (Émond, Guimont, Plourde, Boucher, Allain-Boulé, Le Sage), Laval, Que.; Centre d'excellence sur le vieillissement de Québec (Émond, Boucher), Québec, Que.; Hôpital du Sacré-Coeur de Montréal (Chauny, Daoust); Département de médecine familiale et médecine d'urgence (Chauny, Daoust), Université de Montréal, Montréal, Que.; Centre hospitalier de Charles-LeMoyne (Bergeron, Vanier), Greenfield Park, Que
| | - Natalie Le Sage
- Affiliations: Centre hospitalier universitaire de Québec, Université Laval (Émond, Guimont, Plourde Moore, Kuimi, Boucher, Allain-Boulé, Le Sage); Université Laval (Émond, Guimont, Plourde, Boucher, Allain-Boulé, Le Sage), Laval, Que.; Centre d'excellence sur le vieillissement de Québec (Émond, Boucher), Québec, Que.; Hôpital du Sacré-Coeur de Montréal (Chauny, Daoust); Département de médecine familiale et médecine d'urgence (Chauny, Daoust), Université de Montréal, Montréal, Que.; Centre hospitalier de Charles-LeMoyne (Bergeron, Vanier), Greenfield Park, Que
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Émond M, Grenier D, Morin J, Eagles D, Boucher V, Le Sage N, Mercier É, Voyer P, Lee JS. Emergency Department Stay Associated Delirium in Older Patients. Can Geriatr J 2017; 20:10-14. [PMID: 28396704 PMCID: PMC5383401 DOI: 10.5770/cgj.20.246] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Caring for older patients can be challenging in the Emergency Department (ED). A > 12 hr ED stay could lead to incident episodes of delirium in those patients. The aim of this study was to assess the incidence and impacts of ED-stay associated delirium. METHODS A historical cohort of patients who presented to a Canadian ED in 2009 and 2011 was randomly constituted. Included patients were aged ≥ 65 years old, admitted to any hospital ward, non-delirious upon arrival and had at least a 12-hour ED stay. Delirium was detected using a modified chart-based Confusion Assessment Method (CAM) tool. Hospital length of stay (LOS) was log-transformed and linear regression assessed differences between groups. Adjustments were made for age and comorbidity profile. RESULTS 200 records were reviewed, 55.5% were female, median age was 78.9 yrs (SD:7.3). 36(18%) patients experienced ED-stay associated delirium. Nearly 50% of episodes started in the ED and within 36 hours of arrival. Comorbidity profile was similar between the positive CAM group and the negative CAM group. Mean adjusted hospital LOS were 20.5 days and 11.9 days respectively (p<.03). CONCLUSIONS 1 older adult out of 5 became delirious after a 12 hr ED stay. Since delirium increases hospital LOS by more than a week, better screening and implementation of preventing measures for delirium could reduce LOS and overcrowding in the ED.
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Affiliation(s)
- Marcel Émond
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada; CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada; Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, QC, Canada
| | - David Grenier
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada; CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada; Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, QC, Canada
| | - Jacques Morin
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada; CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada; Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, QC, Canada
| | - Debra Eagles
- Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Valérie Boucher
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada; CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada
| | - Natalie Le Sage
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada; CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada; Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, QC, Canada
| | - Éric Mercier
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada; CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada; Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, QC, Canada
| | - Philippe Voyer
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada; CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada; Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, QC, Canada
| | - Jacques S Lee
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Caucheteux A, Es Sabar A, Boucher V. Occupancy measurement in building: A litterature review, application on an energy efficiency research demonstrated building. Int J Metrol Qual Eng 2013. [DOI: 10.1051/ijmqe/2013044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Measuring the energy efficiency of buildings and its confrontation with the current Building Energy Simulations now faces knowledge of what is commonly called “occupancy”. This work has been made in order to implement a monitoring system on a research demonstrator building at DLRCA in Angers (France). The goals were first to know the occupancy as input data of models but also to build occupancy models. Occupancy can be defined as all the action of occupants that affect building energy efficiency. The chosen monitoring deals with its presence, lightning, windows opening and internal gains. It seems that the use of an Infra- red detector allows a accuracy of 5 min in the detection of presence. The use of dry contact sensors allows the detection of five different rates of slide windows opening that can affect temperature decrease. Light sensors seem to be efficient to detect artificial lighting states when correctly configured.
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Leprince O, Boudet J, Hoekstra F, Lin X, Boucher V, Aubry C, Buitink J. Proteomic profiling and structure–function analysis of late embryogenesis abundant (LEA) proteins associated with desiccation tolerance in the legume seed Medicago truncatula. Comp Biochem Physiol A Mol Integr Physiol 2007. [DOI: 10.1016/j.cbpa.2007.01.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Boucher V, Leblond H, Nguyen-Phu X. Polarization switching in a planar optical waveguide. Phys Rev E Stat Nonlin Soft Matter Phys 2003; 68:056604. [PMID: 14682903 DOI: 10.1103/physreve.68.056604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2003] [Indexed: 11/07/2022]
Abstract
The multiscale expansion formalism is applied to the study of nonlinear planar optical waveguides. It allows us to describe the linear and nonlinear propagation for both transverse electric and transverse magnetic modes, and the interaction between them. An accurate computation of the nonlinear self- and cross-phase modulation coefficients allows one to give account of the polarization switching which has been observed experimentally.
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Affiliation(s)
- V Boucher
- Laboratoire POMA, UMR CNRS 6136, Université d'Angers, 2 Boulevard Lavoisier, 49045 Angers Cedex, France
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Boucher V, Lamontagne M. Effects of speaking rate on the control of vocal fold vibration: clinical implications of active and passive aspects of devoicing. J Speech Lang Hear Res 2001; 44:1005-1014. [PMID: 11708522 DOI: 10.1044/1092-4388(2001/079)] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Stevens (1991) has suggested that, while speakers control glottal apertures in producing consonants, the buildup of intraoral pressure during an oral closure creates decreases in transglottal flow, which can, in itself, reduce or halt vocal fold vibrations. The object of this study was to determine whether speakers can take advantage of such pressure effects in controlling the voicing attributes of intervocalic stops. Intraoral pressure, vocal fold vibration (Lx portions of electroglottograms), and electromyographic (EMG) activity of the orbicularis oris inferior were monitored for 6 subjects while they produced at "slow," "normal," and "fast" speaking rates utterances containing intervocalic stops /p/ and /b/. Product-moment correlations between the intervocalic pressure rises and the amplitude contour of Lx showed strong negative relationships at normal-to-fast rates of speech. However, this relationship was not maintained at slower rates, where decreases in the amplitude of Lx sometimes occurred before the onset of EMG activity in the labial adductor. The findings suggest that, at normal-to-fast rates of speech, speakers can use the passive effects of pressure in controlling vocal fold vibration for stop consonants.
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Affiliation(s)
- V Boucher
- University of Ottawa, Ontario, Canada.
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Boucher V, Langlois F, Laurent J, Herman D. [Desensitization]. Rev Infirm 1996:22-26. [PMID: 8868862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Lorès P, Boucher V, Mackay C, Pla M, Von Boehmer H, Jami J, Barré-Sinoussi F, Weill JC. Expression of human CD4 in transgenic mice does not confer sensitivity to human immunodeficiency virus infection. AIDS Res Hum Retroviruses 1992; 8:2063-71. [PMID: 1493054 DOI: 10.1089/aid.1992.8.2063] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.3] [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: 12/27/2022] Open
Abstract
Transfection of the human CD4 molecule into mouse cells does not confer susceptibility to human immunodeficiency virus type 1 (HIV-1) infection. Expression of the human CD4 molecule in transgenic mice was seen to offer some new possibilities. However, transgenic mouse T cells expressing either the human CD4 receptor, or a hybrid human/mouse CD4 receptor alone or in conjunction with human major histocompatibility complex class I molecules, were refractory to in vitro HIV-1 infection. In addition, no infection was observed after in vivo HIV inoculation to mice of these various transgenic lines. Injection of recombinant gp160 viral protein to the transgenic mice did not alter their T and B cell populations. The existence of a dominant block in mouse cells that prevents HIV entry is discussed.
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Affiliation(s)
- P Lorès
- Unité 257, Institut National de la Santé et de la Recherche Médicale, Institut Cochin de Génétique Moléculaire, Paris, France
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