Sunday 16 October |
00:10 |
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
430
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test presentation A1.
|
A1 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
420
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test presentation A2.
|
A2 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
440
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test presentation A3.
|
A3 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
400
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test Presentation A4.
|
A4 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
410
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test presentation A5.
|
A5 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
459
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test presentation A6-A7.
|
A6-7 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
390
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test Presentation A8.
|
A8 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
460
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test presentation M1-2-3.
|
M1-2-3 |
08:30 |
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
PC80
08:30 - 12:30
Advanced Emergency Ultrasound Course
Keynote Speaker:
Nils Petter OVELAND (Doctor) (Keynote Speaker, STAVANGER, Norway)
Pre-course Directors:
Patrick KISHI (Emergency Medicine) (Pre-course Director, Phoenix, USA), Michael LAMBERT (not sure what this is for?) (Pre-course Director, Burr Ridge, USA)
Pre-course Facultys:
Zeki ATESLI (Pre-course Faculty, BRIGHTON, United Kingdom), Shari BRAND (Emergency Physician) (Pre-course Faculty, Phoenix, USA), Edmundo CHANTLER (Physician) (Pre-course Faculty, Scottsdale, USA), Eric CHIN (Residency Program Director) (Pre-course Faculty, San Antonio, USA), James CONNOLLY (Consultant) (Pre-course Faculty, Newcastle-Upon-Tyne, United Kingdom), Rip GANGAHAR (Consultant) (Pre-course Faculty, OLDHAM), Hani HARIRI (Pre-course Faculty, Besançon, France), Bob JARMAN (Pre-course Faculty, Newcastle upon Tyne, United Kingdom), Ernest LIM (Pre-course Faculty, Singapore), Dr Nicolas LIM (Consultant Emergency Medicine) (Pre-course Faculty, Singapore, Singapore), Andrew LITEPLO (Pre-course Faculty, Brookline, USA), Jennifer LUONG (Physician) (Pre-course Faculty, Philadelphia, USA), Wayne MARTINI (Physician) (Pre-course Faculty, Scottsdale, USA), Kalyanasundaram MURALI (Consultant in Emergency Medicine) (Pre-course Faculty, Birmingham), Najib NASRALLAH (PHYSICIAN) (Pre-course Faculty, SHEFAMER, Israel), Pr Joseph OSTERWALDER (Head of Hospital) (Pre-course Faculty, St. Gallen, Switzerland), Renato RAPADA (Pre-course Faculty, USA), Arthur ROSENDAAL (Emergency Physician) (Pre-course Faculty, Rotterdam, The Netherlands), Nora SHEMERY (Pre-course Faculty, USA), Andrej URUMOV (Emergency Medicine Physician) (Pre-course Faculty, Phoenix, AZ, USA, USA), Victoria VATSVÅG (Pre-course Faculty, STAVANGER, Norway)
08:30 - 08:45
Introduction.
09:00 - 09:45
Module 1.
09:45 - 10:30
Module 2.
10:30 - 10:45
Coffee break.
10:45 - 11:30
Module 3.
11:30 - 12:15
Module 4.
12:15 - 12:30
Wrap up.
08:30 - 12:30
12:00 - 12:45
Module 5.
08:30 - 12:30
08:30 - 12:30
|
M1-2-3 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
PC100
08:30 - 12:30
Minor Trauma
08:30 - 09:00
Basic rules on suture techniques.
09:00 - 11:00
Sutures Workshop.
11:00 - 11:30
Conclusion and Diploma.
|
M4-5 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
PC90
08:30 - 12:30
Geriatric Emergency Medicine
Pre-course Director:
Jacinta A. LUCKE (Emergency Phycisian) (Pre-course Director, Haarlem, The Netherlands)
Pre-course Facultys:
Aoife DILLON (Pre-course Faculty, DUBLIN, Ireland), Pieter HEEREN (Nurse - PhD student) (Pre-course Faculty, Leuven, Belgium), Rosa MCNAMARA (Consultant) (Pre-course Faculty, Dublin, Ireland), Dr Don MELADY (Associate Professor/Staff Physician) (Pre-course Faculty, Toronto, Canada), Aine MITCHELL (Consultant in Emergency Medicine) (Pre-course Faculty, Sligo, Ireland), Elizabeth MOLONEY (Pre-course Faculty, Ireland), Dr Ruth SNEEP (Senior Research & Clinical Fellow) (Pre-course Faculty, London, The Netherlands), Dr Arjun THAUR (Consultant) (Pre-course Faculty, London), James VAN OPPEN (Clinical Research Fellow / Specialty Registrar) (Pre-course Faculty, Leicester, United Kingdom)
08:30 - 09:00
Introduction.
09:00 - 10:40
Working groups.
10:40 - 11:00
Coffee break.
11:00 - 12:40
Working groups.
12:40 - 12:55
Summary of key-learning points.
|
M6-7 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
M1
08:30 - 12:30
Council meeting (EUSEM Council representatives only)
|
M8 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
PC120
08:30 - 13:00
European Leadership for Emergency Medicine (LeadEM) Programme
Pre-course Directors:
Dr Tajek HASSAN (Board Chair for Europe, IFEM) (Pre-course Director, Leeds, United Kingdom), Dr John HEYWORTH (Consultant) (Pre-course Director, Southampton, United Kingdom)
Pre-course Facultys:
Dr Katherine HENDERSON (Emergency Medicine Consultant) (Pre-course Faculty, London), Fergal HICKEY (Consultant in Emergency Medicine) (Pre-course Faculty, Sligo, Ireland), Dr Ian HIGGINSON (Emergency Physician) (Pre-course Faculty, Plymouth, United Kingdom), Dr Barbara C HOGAN (Past President of the European Society for Emergency Medicine, EuSEM) (Pre-course Faculty, HAMBURG, Germany), Cornelia HÄRTEL (Medical Director of the ED, Consultant in EM, Director of Medical Education in EM) (Pre-course Faculty, STOCKHOLM, Sweden), Peter LEES (Pre-course Faculty, United Kingdom), Priyadarshini MARATHE (Pre-course Faculty, OXFORD), Hannelore RAEMEN (Pre-course Faculty, Antwerp, Belgium), Anna SPITERI (Consultant) (Pre-course Faculty, Malta, Malta), Jan STROOBANTS (Head of the Emergency Department) (Pre-course Faculty, Brecht, Belgium)
08:30 - 09:00
Welcome & introduction.
09:00 - 09:30
Explaining the day.
09:30 - 10:00
Session 1.
10:00 - 10:30
Session 2.
10:30 - 11:00
Coffee break.
08:30 - 13:00
11:00 - 11:30
Session 3.
11:30 - 12:00
Session 4.
12:00 - 12:30
Session 5.
12:30 - 12:45
Wrap up.
08:30 - 13:00
|
R2 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
PC130
08:30 - 15:00
Procedrual Sedation and Analgesia in Paediatric Emergency Care
Pre-course Director:
Itai SHAVIT (Pediatric Emergency Physician) (Pre-course Director, Haifa, Israel)
Pre-course Facultys:
Oren FELDMAN (Physician) (Pre-course Faculty, Ramat Gan, Israel), Ron JACOB (Senior physician) (Pre-course Faculty, Afula, Israel)
08:30 - 09:15
Lecture: Acute pain and distress in children.
09:15 - 09:30
Interactive session: Video-based demonstrations.
09:30 - 10:00
Lecture: Key principles for safe sedation in the paediatric ED.
10:00 - 10:45
Lecture: Pharmacology of sedative agents commonly used in the ED.
10:45 - 11:00
Coffee break.
11:15 - 11:30
Q&A.
11:30 - 12:45
Simulation sessions.
12:45 - 13:45
Lunch.
13:45 - 14:30
Simulation sessions.
14:30 - 15:00
Course summary.
|
R4 |
13:00 |
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
A11
13:00 - 14:25
Pulmonary Emergencies - An update on basic treatments of dyspnoic patients
Moderators:
Roberta PETRINO (Head of department) (Moderator, Italie, Italy), Patrick PLAISANCE (Head of Department) (Moderator, Paris, France)
13:00 - 13:20
Spontaneous Pneumothorax - Current recommendations.
Christoph DODT (Head of the Department) (Speaker, München, Germany)
13:20 - 13:40
High Flow Oxygen - Who, when, why?
Erwan L'HER (PU-PH) (Speaker, BREST, France)
13:40 - 14:00
Death by breathing - Hidden dangers in excessive ventilations in various circumstances.
Francis MENCL (emergency medicine physician) (Speaker, Akron, USA)
|
A6-7 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
B11
13:00 - 14:25
Emergencies in the elderly - How to improve the quality of care in your Emergency Department
Moderators:
Jacinta A. LUCKE (Emergency Phycisian) (Moderator, Haarlem, The Netherlands), Pr Christian NICKEL (Vice Chair ED Basel) (Moderator, Basel, Switzerland)
13:00 - 13:25
Measuring quality of care.
James VAN OPPEN (Clinical Research Fellow / Specialty Registrar) (Speaker, Leicester, United Kingdom)
13:25 - 13:50
Different care models to improve care for older patients in your ED.
Pieter HEEREN (Nurse - PhD student) (Speaker, Leuven, Belgium)
13:50 - 14:15
Setting up a system to find & report mistreatment of older patients.
Sivera BERBEN (associate professor) (Speaker, Nijmegen, The Netherlands)
13:50 - 14:15
Setting up a system to find & report mistreatment of older patients.
Miriam VAN HOUTEN (Speaker, Sellingen, The Netherlands)
|
A8 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
C11
13:00 - 14:25
Disaster Medicine I
Moderator:
Steve PHOTIOU (Moderator, Crocetta del Montello (TV), Italy)
13:00 - 13:25
Are we prepared for war in Europe?
Luc J M MORTELMANS (PHYSICIAN) (Speaker, Antwerp, Belgium)
13:00 - 14:25
Round Table: European war - related population displacement.
13:00 - 14:25
European war - related population displacement - Round Table.
Steve PHOTIOU (Moderator, Crocetta del Montello (TV), Italy)
13:25 - 14:25
European war - related population displacement - Round Table.
Carmen Diana CIMPOESU (Prof. Head of ED) (Panelist, IASI, Romania)
13:25 - 14:25
European war - related population displacement - Round Table.
13:25 - 14:25
European war - related population displacement - Round Table.
Michele ALZETTA (Director) (Panelist, Venezia, Italy)
|
A1 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
D11
13:00 - 14:25
ENT emergencies - New evidence and procedures
Moderators:
Mohammad Ashraf BUTT (Consultant in Emergency Medicine) (Moderator, Cavan, Ireland), Anna SPITERI (Consultant) (Moderator, Malta, Malta)
13:00 - 13:25
The approach to facial and dental trauma in the ED.
Gordon MCNAUGHTON (Speaker, Glasgow)
13:25 - 13:50
Blunt cerebrovascular injury - to screen or not to screen.
Tobias BECKER (Speaker) (Speaker, Jena, Germany)
13:50 - 14:15
ENT emergency procedures.
Pr Jim DUCHARME (Immediate Past President) (Speaker, Mississauga, Canada)
|
A2 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
E11
13:00 - 14:25
Important symptoms: from chest pain to breath sounds
Moderator:
Eftychia POLYZOGOPOULOU (ASSISTANT PROFESSOR OF EMERGENCY MEDICINE) (Moderator, ATHENS, Greece)
13:00 - 13:30
Chest pain.
Andrej HOHNEC (No) (Speaker, Maribor, Slovenia)
13:30 - 14:00
Back pain.
Gregor PROSEN (EM Consultant) (Speaker, MARIBOR, Slovenia)
14:00 - 14:15
Abnormal breath sounds.
Anastasia SPARTINOU (Emergency Medicine Trainee) (Speaker, HERAKLION, Greece)
14:15 - 14:25
Dysuria.
Andrej HOHNEC (No) (Speaker, Maribor, Slovenia)
|
A4 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
F11
13:00 - 14:25
You won't believe what I have seen
Moderator:
Michela CASCIO (Trainee doctor) (Moderator, ROME, Italy)
13:00 - 13:25
How to communicate with your team and with your consultants like a pro.
Aleks ŠUŠTAR (EM Resident) (Speaker, Maribor, Slovenia)
13:25 - 13:50
A lethal spoonful of poison.
Christoph HUESER (Registrar) (Speaker, Cologne, Germany)
13:50 - 14:15
Outpatient treatment of pulmonary embolism.
Martina CERMAKOVA (Doctor) (Speaker, Hradec Králové, Czech Republic)
|
A5 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
G11
13:00 - 14:25
Besondere Lagen: Wie gut sind die notaufnahmen vorbereitet?
Moderators:
Raik SCHAEFER (Moderator, Hamburg, Germany), Hendrike STEIN (Moderator, Germany)
13:00 - 13:25
Auf welche externen Lagen mssen sich Notaufnahmen vorbereiten.
Patric TRALLS (Speaker, Solingen, Germany)
13:25 - 13:50
Kritische infrastruktur im Krankenhaus - was sind die Ausfallskonzepte.
Michael BERNHARD (Speaker, Meerbusch, Germany)
13:50 - 14:15
Schulung, Training und externe bungen - haben wir die Zeit und wer finanziert das?
Slatomir WENSKE (Speaker, Berlin, Germany)
|
A3 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
400
13:00 - 14:30
Digital Medicine Working Group Meeting
Chairperson:
Thomas SAUTER (Consultant) (Chairperson, Bern, Switzerland)
|
R2 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
PC110
13:00 - 17:30
Research essentials in Emergency Medicine
Pre-course Director:
Pr Martin MÖCKEL (Head of Department, Professor) (Pre-course Director, Berlin, Germany)
Pre-course Facultys:
Zerrin Defne DÜNDAR (Professor) (Pre-course Faculty, Konya, Turkey), Luis GARCIA-CASTRILLO (ED director) (Pre-course Faculty, ORUNA, Spain), Mehmet Akif KARAMERCAN (Chair of EuSEM Research Committee) (Pre-course Faculty, ANKARA, Turkey), Said LARIBI (PU-PH, chef de pôle) (Pre-course Faculty, Tours, France), Pr Anna SLAGMAN (Professor for Health Services Research in Emergency Medicine) (Pre-course Faculty, Berlin, Germany)
13:00 - 13:15
Opening remarks and Faculty members introduction.
13:15 - 14:30
Group work 1.
14:30 - 15:00
Coffee break.
15:00 - 17:30
Presentation of results.
17:30 - 18:00
Final discussion, plan of abstract presentations and feedback.
|
R3 |
14:30 |
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
EPOSCB1SC1
14:30 - 14:50
Coffee Break 1 - EPoster session - Screen 1
Moderator:
Ryan MCHENRY (EM Trainee) (Moderator, Glasgow, United Kingdom)
14:30 - 14:50
#30430 - Can a 2-week lockdown control a COVID- 19 outbreak?Cross sectional analysis of the Lebanese COVID 19 responses.
Can a 2-week lockdown control a COVID- 19 outbreak?Cross sectional analysis of the Lebanese COVID 19 responses.
Background: With the rise of the novel coronavirus cases and fatalities around the world, researchers were invested in studying not only the therapeutic measures, but also, the preventive ones. As observed in other countries, many governments resorted to the shutdown of all services and closure of all facilities thus isolating people in their homes. Due to the rapidly collapsing local currency and deteriorating Lebanese economy, the local government implemented a two-week lockdown hoping it will reduce the surge in newly diagnosed Corona Virus Disease – 19 (COVID-19) cases without worsening the economic situation.
Method: In this study, we aim to understand the effectiveness of such plans in Lebanon and the contribution of the Lebanese people in its accomplishment. We looked at the numbers in all Lebanese territories over 2 weeks before the lockdown, during the 2-week lockdown (from 16 till 28thNovember 2020) and 2 weeks post lockdown. After collecting the data, we analyzed the mean number of cases and death before, during and after lockdown and by followed the growth factor of cases during this period.
Result: It was shown that for all studied districts, there was a trend in decline of the total number of cases, but the results were not statistically significant to prove that a 2-week lockdown can impact the epidemic.
Conclusion: A short, partial lockdown has no benefit over the growth or reduction in the virus impact or transmission, however, it might have some positive outcomes if implemented for longer periods.
Cima HAMIEH (France), Mahmoud EL HUSSEIN, Jim ABI FREM, Khattar RITA, Ghinwa EL HAYEK, Elie EL ZAGHRINI
14:30 - 14:50
#31673 - Evaluation of the Burden on the Emergency Department After COVID-19.
Evaluation of the Burden on the Emergency Department After COVID-19.
Introduction: Novel Coronavirus Disease 2019 (COVID-19) is seen as the biggest health burden in the world. It is known that there is no type of research on Emergency Department (ED) admissions of the post-COVID-19 patients. Studies indicate that a decrease in emergency admission rates was observed during the COVID-19 pandemic. However, the variables related to admissions to the ED during the long-term follow-up of COVID-19 are not yet known. The role of follow-up centers, which take part in predicting the long-term outcomes of the COVID-19 disease and the early diagnosis of possible long-term complications, is increasing day by day. The study aimed to evaluate the emergency admissions of post-COVID-19 patients according to their follow up in the COVID-19 follow-up center.
Methods: The data were obtained by evaluating the admission rate to the ED in the first three months of 2022. The study includes patients discharged from the COVID-19 inpatient of a tertiary hospital in Eskişehir, Turkey, in December 2021. The study groups were divided into two according to whether they applied to the COVID-19 follow-up center after discharge (Group 1, n=185) or not (Group 2, n=383). Patients' ED visits were categorized according to four urgency levels (white code: non-urgent patients; green code: urgent but non-critical patients; yellow code: fairly critical patients; red code: patients in danger of death). Re-hospitalization causes and rates were also compared.
Results: 568 inpatients were assessed, 48,2% male and 51,8% female. There was no significant difference between groups in terms of age and gender. The rate of admission to the emergency department in patients in Group 1 (n=25, % 13,5) was statistically significantly lower compared to Group 2 (n=84, % 21,9) (p = 0,017). When the diagnoses at the admission were evaluated, cases of yellow and red code (Group 1: % 39, Group 2: % 16) were statistically significant in Group 2 (p =0,028). In addition, the hospitalization of patients in Group 2 was significantly higher than in Group 1 (p < 0,01).
Conclusion: This study determined that post-COVID-19 patients admitted to the ED with a lower rate and milder complaints when they were examined in the COVID-19 follow-up centers. The most obvious finding to emerge from this study is COVID-19 follow-up centers could contribute positively to the burden on ED by preventing avoidable complications and severe emergency situations.
None
Gülşah UÇAN (Eskişehir, Turkey), Anıl UÇAN, Şebnem EKER GÜVENÇ
14:30 - 14:50
#31096 - Geospatial visualisation of emergency department attendance rates and their associations with deprivation and non-urgent attendances.
Geospatial visualisation of emergency department attendance rates and their associations with deprivation and non-urgent attendances.
Background:
Attendances at emergency departments in England continue to increase above the capacity of the urgent and emergency care system. There is significant variability in the rates of attendance at emergency departments across different localities. The aim of this study is to model the association of deprivation and non-urgent attendances with locality-based rates of emergency department attendance. The secondary aim is to create an interactive data visualisation tool to engage stakeholders, clinicians, and the public with the research.
Methods:
We undertook a retrospective, observational study using routinely collected emergency department attendance data from a large region in the North of England (population 5.4 million) with 7,463,272 attendances between January 2013 and March 2017. Attendances where age or address were missing or outside the study region were excluded leaving 6,416,087 attendances across 3,214 localities in the analytical sample. Average annual age and sex standardised attendance rates at emergency departments were calculated for small localities known as lower layer super output areas.
Proportions of non-urgent attendances for each locality were calculated using a marker in the data derived from a validated, process-based definition for non-urgent attendance.
The association between emergency department attendance rates, deprivation and non-urgent attendances was examined using multivariable linear and logistic regression models. The models were adjusted for travel time to the nearest emergency department, which was calculated using a geospatial information software.
Results:
The mean annual standardised emergency department attendance rate per 1000 population was 296 (95% confidence interval 292-301, interquartile range 234-381). The mean proportion of non-urgent attendances was 16.5% (95% confidence interval 16.2-16.7, interquartile range 11.7-21.2%). The study found high rates of emergency department attendance were associated with higher deprivation, higher proportions of non-urgent attendances and shorter travelling time to the emergency department.
After adjusting for travel time, each increasing decile of deprivation was associated with increased odds of emergency department attendance rates in the top quartile (odds ratio 2.58, P<0.001, 95% confidence interval 2.38–2.82). Localities with non-urgent attendance proportions above the mean had higher odds of attendance rates in the top quartile (odds ratio 2.87, P<0.001, 95% confidence intervals 2.28-3.63)
Each minute fewer of travel time to the nearest emergency department was associated with higher odds of high attendance rates (odds ratio 1.11, P<0.001 95% confidence interval 1.09-1.13). The best fitting model explained 54% (P<0.001) of the spatial variability in attendance rates. The data was visualised in an interactive choropleth map.
Discussion and conclusion:
A large proportion of the variability in emergency department attendance rates in different geographical areas can be explained by deprivation levels and proportion of non-urgent attendances. This provides an opportunity for targeted interventions to reduce emergency department attendances.
The visualisation of the data enables stakeholders, clinicians, and the public to explore and understand the variability in emergency department attendance rates across the region and suggest suitable locations and types of interventions. This research provides an example of routine data usage which can be replicated across other regions to inform interventions.
This research is independent research funded by the National Institute for Health Research, Yorkshire and Humber Applied Research Collaborations. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Joanna SUTTON-KLEIN (Manchester, ), Jen LEWIS, Richard CAMPBELL, Tony STONE, Colin O'KEEFFE, Suzanne MASON
14:30 - 14:50
#30927 - Palliative care & advance directives in the emergency department – a systematic review of the status quo.
Palliative care & advance directives in the emergency department – a systematic review of the status quo.
Objective.
Respecting patient wishes and preserving patient autonomy is challenging in emergency medicine. Documentation of patient wishes (DPW), e.g. in form of advance directives, can guide clinicians in end of life decisions, though effectiveness is limited by low availability.
Here, we present a systematic review which aims to congregate existing data on the rates of DPW ownership and availability in the emergency department (ED) as well as contributing factors.
Methods.
We systematically searched the MEDLINE database (Pubmed) in October 2021. All publications that provided primary quantitative data on DPW (excluding power of attorney) in the ED were assessed, culminating in a total of 17 studies included in the analysis. Most (9) were from the US, followed by Australia (4), Germany (2), Canada (1) and Switzerland (1). All but one were conducted in urban tertiary care centers, three were multicentric. In total, a culminated 9.854 ED patients were included, with a mean age variing from 41 to 88 years. Publication dates ranged from 1996 to 2021.
Results.
In the general adult population presenting to the ED, 12.8% to 27.0% possessed some kind of DPW, fewer than 3.2% had brought it with them to the ED. In older patient samples (heterogeneously defined, from ≥55 to ≥75 years of age), ownership and availability varied widely (7.9% to 51.9% and 1.7% to 48.8% respectively). The following variables were identified as positive predictors for DPW ownership: older age, worse overall health and presence of comorbidities as well as several sociodemographic factors, notably correlating with better social connections (e.g. having children, being female). Results were ambivalent on the influence of having a primary care provider.
Conclusion & Discussion.
Ownership and availability of DPW among ED patients was low in general and even in the older population mostly well below 50%. While we were able to gather data on prevalence and predictors, further research is needed to explore underlying causes of the high intra- and interfacility variability as well as possible public health measures to increase above mentioned rates.
This study was not registered due to its nature and did not receive any specific funding. Ethical approval was not needed.
Vincent WEBER (Berlin, Germany), Aurelia HÜBNER, Rajan SOMASUNDARAM, Eva DIEHL-WIESENECKER
|
Exhibition Hall |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
EPOSCB1SC4
14:30 - 14:50
Coffee Break 1 - EPoster session - Screen 4
Moderator:
Dr Firas ABOU-AUDA (Consultant) (Moderator, London)
14:30 - 14:50
#31476 - Descriptive analysis of opioids use in pre-hospital emergency medical services.
Descriptive analysis of opioids use in pre-hospital emergency medical services.
Introduction:
Prehospital emergency medical services care for patients in any type of setting with the resources that an ambulance can offer. Many of the patients seen for pain, dyspnea or requiring orotracheal intubation require treatment during transport with opioids.
The characteristics of the patients requiring opioids, the most frequent reasons for the use of this type of mediation and the percentage of admission and mortality in the short and long term are not well defined.
Objectives:
To describe the frequency of use of opioids, the characteristics of these patients and the reasons for care requiring it. To analyse the type of analgesic used according to the pathology with which the patient is treated. To know the percentages of admission and mortality in the short and long term in this type of patients.
Material and methods:
Observational, prospective, multicentre study. Inclusion criteria: over 18 years of age transferred by EMS by ambulance to hospital emergency departments (ED) between October 2019 and March 2021 in 4 Spanish provinces of the same health service. Exclusion criteria: <18 years, patients discharged in situ, follow-up <365 days since care.
Variables: epidemiological (age, sex, institutionalization, Charlson comorbidity index (ChI)), opioids yes/no and type, reason for transfer, destination: hospital admission or discharge. Mortality in the first 48 hours, between day 3 and 30, and between day 31 and day 365. Cumulative mortality in 365 days.
Statistical analysis: Normality tests. Frequencies, central measures, and dispersion in standard deviation (SD) or interquartile range (IQR). Chi-square (proportions), T Student (means) Mann-Whitney U (medians). Statistical significance: p <0.05, 95% confidence interval (95% CI). Software: SPSS.
Results:
Of 1508 patients analysed, 297 (19.69%) had required an opioid (Morphine 37.4% and fentanyl 62.6%). Of these 297 patients: 34% were women. Age: median 69 (RIC 53-84). Men: 63 (RIC 50-77) and women 79 (RIC 61-88) (p=0.000). Charlson index: 3 (RIC 0-5). 16.5% were institutionalized. Reasons for transfer: circulatory problems 32.42%, trauma 31.88%, infectious problems 11.77%, central nervous system pathology 8.15%, respiratory diseases 8.69% and others 7.2%.
Morphine vs fentanyl according to problem of care: infectious diseases 73.4% vs 26.56%; central nervous system (CNS) diseases 4.44% vs 95.5%; circulatory system diseases 59.2% vs 40.78%; respiratory diseases 80% vs 20%; trauma 1.13% vs 98.84%; others 42.1% vs 58.8% (p=0.000).
Hospital admission 91.6% and ICU admission 32%. Cumulative mortality in 365 days: 41.7%. Mortality first 48 hours: 17.8%, between day 3 and 30: 13.8%, and died between day 31 and 365 after care: 10.1%.
Conclusions:
Around 20% of the patients transferred by the EMS require opioids. These patients are predominantly men, and their age range is between 53 and 84 years. The most used opioid in the EMS are morphine and fentanyl. Morphine is used more for respiratory diseases, circulatory system and infections and fentanyl for polytrauma and CNS pathology. The percentages of hospital admission, ICU and short- and long-term mortality are high in this kind of patients.
Rodrigo ENRIQUEZ DE SALAMANCA, GAMBARA. (Valladolid, Spain), Enrique CASTRO PORTILLO, Maria Del Carmen GOEZ SANZ, Bolaños PACHECO, Francisco MARTÍN-RODRÍGUEZ, Raul LOPEZ IZQUIERDO, Juan F. DELGADO BENITO, Irene SÁNCHEZ SOBERÓN, M.a. CASTRO VILLAMOR
14:30 - 14:50
#31491 - Evaluation of the impact of pre-hospital gasometry in the development of diagnoses.
Evaluation of the impact of pre-hospital gasometry in the development of diagnoses.
Introduction :
The impact of biology in the medical understanding in pre-hospital is little studied.
The main objective of the study was to measure the decisional impact of the various paraclinical parameters in the formulation of diagnostic hypothesis at the end of treatment. The secondary objective was to show the existence of a hierarchy in the measured gasometry parameters for the formulation of diagnostic hypothesis.
Method :
The data analyzed came from the preliminary study for the BIOSMUR study carried out between 2019 and 2020 with the use of an on-board gas monitoring device in pre-hospital interventions. The clinical cases used were part of a nosological framework defined a priori: cardio-circulatory or respiratory failure. These data were transcribed in the form of clinical cases with a script concordance test type questionnary. Each thirty-three emergency physicians responded to three clinical cases assigned randomly and anonymously.
Results :
After collecting the various clinical cases, it turns out that gasometry has the highest impact compared to heart rate (OR=3.58, 95% CI [1.589; 4.880], p<0.001) compared to capillary saturation (OR= 1.811, 95% CI [1.048; 3.128], p=0.03). Blood pressure, ECG and temperature have no significant impact compared to the other parameters in these specific cases. Blood sugar is the parameter with the least impact (OR= 0.503, 95% CI [0.282; 0.895], p=0.03).
Conclusion :
Overall, the use of gasometry in the development of diagnostic hypothesis seems to have a significant impact compared to other parameters used routinely. It even seems to be the parameter with the most impact. We also observe that the paraclinical values have a significant place with a reduction of the number of hypothesis in more than 60% of the cases.
François NEZ, Jean-Baptiste MONANGE, Farès MOUSTAFA (Clermont-Ferrand), Romain DURIF, Maxime LAURENT, Arthur CHATRENET, Apolline GUILMAIN, Jeannot SCHMIDT
14:30 - 14:50
#31462 - Influence of diabetes mellitus on patients transported by prehospital emergency medical services.
Influence of diabetes mellitus on patients transported by prehospital emergency medical services.
INTRODUCTION: Diabetes Mellitus (DM) describes diseases of abnormal carbohydrate metabolism characterized by hyperglycemia. It is associated with a relative or absolute impairment of insulin secretion, along with varying degrees of peripheral resistance to insulin action. It is a frequent comorbidity among patients seen by Prehospital Emergency Medical Services (EMS), however, there is little literature on the characteristics of diabetic patients seen by EMS.
OBJECTIVES: To study demographic variables and causes of transfer of patients with DM at the time of EMS care. To determine percentages of hospital admission, mortality in the first 48 hours, 30-day mortality, mortality between 30 and 365 days, and cumulative mortality in one year. To compare the mortality of patients with DM with target organ damage (TOD) with patients with DM without TOD.
MATERIAL AND METHODS: Prospective, multicentre, observational study. Inclusion criteria: over 18 years of age with a diagnosis of DM in their medical history transferred by SEMP by ambulance to hospital emergency departments (ED) between October 2019 and January 2021 in 4 Spanish provinces of the same health service. Exclusion criteria: <18 years, patients without a diagnosis of DM or patients discharged in situ, follow-up <365 days since care.
Variables: epidemiological (age, sex, institutionalization, Charlson comorbidity index (ChI), reason for ambulance transfer, DM with or without LOD), hospital admission, mortality in the first 48 hours, between day 3 and 30 and between day 31 and 365, and cumulative one-year mortality.
Statistical analysis: normality tests. Frequencies, central measures and dispersion in standard deviation (SD) or interquartile range (IQR 25-75%). Chi-square (proportions), T Student (means), Mann-Whitney U (medians), ANOVA (means) and Kruskal-Wallis H (medians). Kaplan-Meier log rank. Statistical significance: p<0.05, 95% confidence interval (95% CI). Software: SPSS.
RESULTS: N: 378. Women 39.9%. Median age in years: overall 76 (RIC 64.75-83), women 78 (RIC 68-85) and men 74 (RIC 64-81) (p=0.003). ICh: 1-2 (23%), 3-4 (27%) and ≥5 (49.2%). Diabetics with LOD: 44.2%. Institutionalized: 23%. Reason for transfer: circulatory system disease (36.2%), nervous system disease (17.5%), infectious diseases (12.7%), respiratory diseases (8.7%), endocrine system diseases (8.5%) and others (16.4%). Hospital admission: 74.1%. Mortality in the first 48h (7.9%), between day 3 and 30 (13%), between day 31 and 365 (14.6%). One-year cumulative mortality: 37.6%.
DM without LOD vs DM with LOD: survive 1 year (72%-55.1%), mortality first 48h (7.1%-9%), mortality between 3 and 30 days (10%-16.8%) and mortality between day 31 and 365 (10.9%-19.2%) (p=0.007).
CONCLUSIONS: Patients transferred by EMS suffering from DM have an age range around 76 years old. Many of them have a high comorbid burden, with almost half of them having an organ affected by DM itself. The most frequent reason for transfer is circulatory system problems. The admission and mortality rates are high. Having DM with organ involvement seems to be associated with increased mortality in the short and long term.
Rodrigo ENRIQUEZ DE SALAMANCA, GAMBARA. (Valladolid, Spain), Raul LOPEZ IZQUIERDO, M.a. CASTRO VILLAMOR, Enrique CASTRO PORTILLO, Francisco MARTÍN-RODRÍGUEZ, Maria Del Carmen GOEZ SANZ, Irene SÁNCHEZ SOBERÓN, Juan F. DELGADO BENITO, Bolaños PACHECO
14:30 - 14:50
#31555 - Out of hospital STEMI and Stroke Clinical Pathways in 2021-Portugal.
Out of hospital STEMI and Stroke Clinical Pathways in 2021-Portugal.
Background: Cardiovascular diseases are the leading cause of death in Portugal therefore strategies to minimize the impact in mortality and mobility are imperative. As both Stroke and STEMI (ST elevation myocardial infarction) are time-dependent situations, strategies for the appropriate approach include implementation of clinical pathways from symptoms identification on the 112 call to hospital referral and treatment. The National Institute of Medical Emergency (INEM) is the agency responsible for coordinating the Integrated Medical Emergency System (SIEM) in mainland Portugal. INEM manages 112 medical calls, organizing Portuguese prehospital emergency services throughout CODU (Urgent Patient Guidance Centres) dispatch unit. INEM has since 2018 a paper-free technological system that allows clinical record and management of information produced by INEM’s units on the field -ITEAMS (INEM Tool for Emergency Alert Medical System). It contributes to real-time decision-making support and regulation based on clinical data in CODU. ITEAMS identifies clinical pathways aiming to bring value to the chain of help/surviving, optimizing early identification and allowing adequate patient referral during a time window of reference to the most adequate hospital. Methods: Retrospective descriptive analysis of out-of-hospital clinical records registered during 2021 in iTEAMS, referring to STEMI and Stroke. Results: During 2021, INEM attended 219,977 patients. From those 0.96% were reported as STEMI (n=852) and Stroke (n=1264). The population analyses revealed a prevalence of male in both subgroups, whereas age incidence, as expected, differed between the subgroups: Most STEMI patients had ages between 40-64 years while Stroke patients were mostly over 80 years old. We verified that both STEMI and Stroke patients had associated cardiovascular risk, with arterial hypertension accounting for 46% of all cases, while dyslipidemia was identified in 28%. Particularly in STEMI, smoking accounted for 20% of the records. In 39% of STEMI and in 44.8% of Stroke records the onset of symptoms had less than one hour when patients called 112. The Out of hospital time between the call and the arrival of the EMS team on scene was of 17min in STEMI and 15min in Stroke. The transportation time from the scene to hospital was higher in STEMI (27min) than in Stroke (18min). The total out-of-hospital actuation time (from 112 call to hospital) differed from STEMI (1h37min) to Stroke (1h26min) in a medium time of 11min. Conclusions: Well-structured Clinical Pathways are essential for improving prognosis in specific time dependent situations like STEMI and Stroke. Out-of-hospital performance dictates the initial compliance with the times stipulated in the STEMI and Stroke guidelines. Moreover, the referral to the correct hospital, capacitated with PCI (Percutaneous Coronary Intervention) and Trombectomy accordingly, elevates the responsibility not only of the out-of-hospital teams but also of the coordinating centers. The implementation of a monitoring and follow-up structure of STEMI and Stroke events in INEM pretends to alert, inform and educate our professionals in order to optimize out-of-hospital performance. In Portugal, INEM acts as the first link of the entire chain that represent the national pathways and can therefore promote a better outcome for patients with sudden onset of cardiovascular emergencies.
Cardiovascular diseases are the main cause of death and mobility in Portugal. With the creation of clinical pathways in out-of-hospital service, we pretend to improve the response and outcome of patients with STEMI and Stroke.
Margarida GIL (Lisboa, Portugal), Marta CUSTÓDIO, Filipa BARROS, João LOURENÇO, Pedro VASCONCELOS, Fátima RATO, Manuela LUCAS
|
Exhibition Hall |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
EPOSCB1SC3
14:30 - 14:50
Coffee Break 1 - EPoster session - Screen 3
14:30 - 14:50
#30352 - Effectiveness Of Shock Indices And Alteration Of Vital Parameters In The Diagnostic Suspicion Of Organ Damage From Pulmonary Embolism in elderly: The Emergency Room As A Window On Real Life.
Effectiveness Of Shock Indices And Alteration Of Vital Parameters In The Diagnostic Suspicion Of Organ Damage From Pulmonary Embolism in elderly: The Emergency Room As A Window On Real Life.
Background: Pulmonary embolism is a pathology still characterized by high mortality, greater in cases of organ damage. Raising suspicion and early recognition of this condition is therefore important to avoid delays in undertaking the right diagnostic and therapeutic process.
Aim: assess which vital parameters and shock indices correlate with the presence of organ damage from pulmonary embolism to see which ones can help to suspect this condition early.
Methods: single-center retrospective observational study, on all geriatric patients (> 75 y) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and Years), and for the presentation of the risk of mortality at 30 days (sPESI). We then had all chest CTs retested by an experienced radiologist. We went to see the correlation of vital parameters and shock indexes from these derivatives with the presence of organ damage from pulmonary embolism. We considered right ventricular dilation, pulmonary artery dilation and the presence of pulmonary infarction organ damage. We have considered as shock indices: the shock index (SI), the modified shock index (MSI) and the age-shock index (AGE_SI).
RESULTS: We enrolled 247 patients, with a mean age of 83 years and prevalence of female (F = 63%). Of these 79 (32%) have organ damage from pulmonary embolism. There is no correlation between the values of blood pressure, systolic and diastolic, respiratory rate with the presence of organ damage (p> 0.05). However, there is a strong statistical correlation between heart rate values and the presence of organ damage from pulmonary embolism (p < 0.001) The shock index correlates with the presence of organ damage with good statistical strength (p < 0.001 ); also the modified shock index, albeit with a slightly lower statistical strength (P <0.005). The age-shock index correlates with the presence of pulmonary embolism with excellent statistical strength (p < 0.001).
Conclusions: the alteration of the shock indices, in particular the AGE-shock index, correlate with the condition of organ damage. Taking into consideration these parameters, of very low cost, available from triage and obtainable in a few minutes at the medical examination, which can be easily performed in the various Italian situations, can help to raise the suspicion of organ damage from pulmonary embolism early and address more quickly the patient towards the therapeutic diagnostic process.
Dr Gabriele SAVIOLI, Iride Francesca CERESA, Massimiliano LAVA, Lorenzo PREDA, Amedeo MUGELLINI, Alessandra MARTIGNONI, Federica MANZONI, Antonio LO BELLO, Giacomo ALUNNO, Alessandra FUSCO, Luigi COPPOLA, Giovanni RIGANO, Aurora CECCO, Giulia BELLINI, Davide DIONISI, Maria Antonietta BRESSAN, Federica FUMOSO (Pavia, Italy)
14:30 - 14:50
#30348 - Management of acute pulmonary embolism in geriatric patients in the emergency room: does adherence to international guidelines reduce in atypical symptoms?
Management of acute pulmonary embolism in geriatric patients in the emergency room: does adherence to international guidelines reduce in atypical symptoms?
Premises: Pulmonary embolism is a pathology still characterized by high mortality. Some international studies have actually shown that adherence to guidelines is generally quite low in both primary and secondary care and ranges, depending on the studies, between 40 and 60%. Some authors have highlighted how adherence to the guidelines is more critical in patients with atypical symptoms, because diagnostic delay can be more likely in these.
Purpose of the study: evaluate if and how, in the real life of an Emergency Department, adherence to the Guidelines varies according to the presence of atypical symptoms. We understood dyspnoea, chest pain, signs and symptoms of deep vein thrombosis and syncope as typical symptoms. As atypical symptoms all the others (low-grade fever, vertigo ...)
Methods: single-center retrospective observational study on all geriatric patients (>75 y) who entered our ED, where they received a diagnosis of acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and YEARS), and for the presentation of the risk of mortality at 30 days (sPESI). We then analyzed adherence to the guidelines in three decision turning points: 1 Correct application of the decision scores examined, which classify the patient at low, intermediate or high risk of PE, calculated with Wells and simplified Geneva score; 2 Correct administration of therapy starting from ED as suggested by the guidelines; 3 Any observation in the care area of medium intensity with careful monitoring for the subpopulation of patients with evidence of right ventricular dilation or myocardial enzyme elevation (considered to be at high risk of shock and short-term mortality).
Results: we enrolled 248 patients, with a mean age of 83 years with female prevalence (F = 63%). Of these, only 17 with atypical symptoms and 231 with typical symptoms. The vital signs were comparable in the two groups with no statistically significant difference (p> 0.05). Long-term outcomes such as mortality, need for hospitalization, hospitalization in intensive care and length of stay in hospital are also comparable results with no statistically significant difference (p> 0.05).
However, adherence to international guidelines was statistically significantly lower in patients with atypical symptoms (33%) than in patients with typical symptoms (59%) (p <0.05).
Conclusions: The study suggests that patients with atypical symptoms are more likely to have reduced adherence to international guidelines, most likely due to diagnostic delay.
Dr Gabriele SAVIOLI, Iride Francesca CERESA, Viola NOVELLI, Sara CUTTI, Enrico ODDONE, Giovanni RICEVUTI, Amedeo MUGELLINI, Alessandra MARTIGNONI, Massimiliano LAVA, Lorenzo PREDA, Antonio LO BELLO, Alessandra FUSCO, Luigi COPPOLA, Giovanni RIGANO, Francesco LAPIA, Aurora CECCO, Giulia BELLINI, Davide DIONISI, Maria Antonietta BRESSAN, Alessandro VENTURI, Federica FUMOSO (Pavia, Italy)
14:30 - 14:50
#30351 - Role Of Vital Signs And Indices Of Shock Derived From Them In The Suspicion Of Massive Pulmonary Embolism in elderly: The ER As A Window On Real Life.
Role Of Vital Signs And Indices Of Shock Derived From Them In The Suspicion Of Massive Pulmonary Embolism in elderly: The ER As A Window On Real Life.
Premise: Pulmonary embolism is a pathology still characterized by high mortality, greater in cases of massive embolism. Raising suspicion and recognizing this condition early is therefore important to avoid delays in undertaking the right diagnostic and therapeutic process.
Purpose: assess which vital parameters or shock parameters, in the real life of an Emergency Department, correlate with the presence of massive pulmonary embolism to see which ones can be of help to early suspect it.
Methods: single-center retrospective observational study, on all geriatric patients (> 75 y) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and Anni), and for the presentation of the risk of mortality at 30 days (sPESI). We then had all chest CTs retested by an experienced radiologist. We assess the correlation of vital parameters and shock indexes with the presence of massive pulmonary embolism. We took into consideration: the shock index (SI), the modified shock index (MSI) and the age-shock index (AGE_SI).
Results: We enrolled 247 patients, with a mean age of 83 years and prevalence of female (F = 63%). Of these, 85 (34.4 %) presented with massive pulmonary embolism. There is no correlation between blood pressure, systolic and diastolic values, respiratory rate with the presence of massive pulmonary embolism (p> 0.05). However, there is a strong statistical correlation between heart rate values and the presence of massive pulmonary embolism (p <0.0001). The shock index correlates with the presence of massive pulmonary embolism with good statistical strength (p <0.001); the modified shock index correlates with the with even greater statistical strength (P = 0.0005). The age-shock index correlates with the presence of pulmonary embolism with excellent statistical strength (p <0.0001).
Conclusions: The study suggests that the alteration of shock indices, in particular of the AGE-shock index, correlate with the condition of massive pulmonary embolism. Taking into consideration these parameters, of very low cost, available from triage and obtainable in a few minutes at the medical examination, easily performed in the various Italian situations, can help to raise the suspicion of massive pulmonary embolism early and direct the patient more quickly towards the correct procedure therapeutic diagnostic.
Dr Gabriele SAVIOLI, Iride Francesca CERESA, Massimiliano LAVA, Lorenzo PREDA, Federica MANZONI, Giovanni RICEVUTI, Amedeo MUGELLINI, Antonio LO BELLO, Alessandra FUSCO, Luigi COPPOLA, Giovanni RIGANO, Aurora CECCO, Giulia BELLINI, Davide DIONISI, Maria Antonietta BRESSAN, Federica FUMOSO (Pavia, Italy)
14:30 - 14:50
#30358 - When Harry met Sally. Description of elderly patients with pulmonary embolism arriving in the emergency room. The real-life experience of 5 years in the emergency room.
When Harry met Sally. Description of elderly patients with pulmonary embolism arriving in the emergency room. The real-life experience of 5 years in the emergency room.
Premises: Pulmonary embolism represents one of the major causes of mortality linked to cardiovascular events. The range of symptoms is extremely wide and its recognition difficult. The patients who therefore come to the emergency room are a diverse population.
Purpose: to describe the population that refers to the emergency room and finds there a diagnosis of acute pulmonary embolism.
Methods: single-center retrospective observational study, on all geriatric patients (> 75 years) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We analyzed means of presentation, priority codes for medical examination, exit code, hospitalization needs. We collected data from medical history, physical examination, laboratory tests, imaging, outcomes, severity scores.
Results: We enrolled 247 patients, all in need of hospitalization. 44% came for dyspnea, 17% for chest pain, 16% for signs of DVT, 8% for syncope. 5% had only atypical symptoms (dizziness, general malaise, low-grade fever, neurological symptoms ...). 45% had concomitant deep vein thrombosis. 50% showed alteration of the ECG tracing, 49% alteration of the shock index.
Among those subjected to blood gas analysis 11% showed alteration of pH, 16% showed alteration of pCO2, 8% showed alteration of pO2, 5% of BE, 2% of lactate. 34% showed massive PE, 32% showed organ damage. In particular, 21% showed pulmonary artery dilation, 16% pulmonary infarction and 19% right ventricular dilation. 40% showed elevation of myocardiospecific enzymes.
41% were considered to be at high risk of long-term mortality according to European guidelines, 41% at intermediate risk and 18% at low risk of mortality. 1.4% underwent thrombolysis, 2.4% required intubation. 2.8% needed an operating room for mechanical thrombolysis; 8% of hospitalization in the intensive ward during hospitalization. In-hospital mortality was 7.7%. 5% experienced bleeding during hospitalization following anticoagulation therapy.
Conclusions: The population that arrives in ED for pulmonary embolism presents extremely varied symptomatological pictures, but an overall high degree of clinical risk and assistance and therapeutic complexity.
Dr Gabriele SAVIOLI, Iride Francesca CERESA (pavia, Italy), Massimiliano LAVA, Lorenzo PREDA, Federica MANZONI, Amedeo MUGELLINI, Alessandra MARTIGNONI, Giovanni RICEVUTI, Antonio LO BELLO, Alessandra FUSCO, Giacomo ALUNNO, Luigi COPPOLA, Giovanni RIGANO, Aurora CECCO, Giulia BELLINI, Alessandro VENTURI, Maria Antonietta BRESSAN
|
Exhibition Hall |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
EPOSCB1SC2
14:30 - 14:50
Coffee Break 1 - EPoster session - Screen 2
Moderator:
Canberk Djan MESELI (EMERGENCY MEDICINE RESIDENT) (Moderator, DUBLIN, Ireland)
14:30 - 14:50
#30675 - Association of prehospital airway management technique with survival outcomes of out-of-hospital cardiac arrest patients according to transport time interval.
Association of prehospital airway management technique with survival outcomes of out-of-hospital cardiac arrest patients according to transport time interval.
Introduction
Despite numerous studies on airway management in out-of-hospital cardiac arrest (OHCA) patients, the choice of prehospital airway management technique remains controversial. Our study aimed to investigate the association between prehospital advanced airway management and survival outcomes according to a transport time interval (TTI) using nationwide OHCA registry database in Korea
Methods
The inclusion criteria were patients with OHCA aged over 18 years old with a presumed cardiac etiology between January 2015 and December 2018. The primary outcome was survival to hospital discharge. The main exposure was the prehospital airway management technique performed by the emergency medical technicians (EMTs), classified as bag-valve mask (BVM), supraglottic airway (SGA), or endotracheal intubation (ETI).We performed multivariable logistic regression analysis and interaction analysis between the type of airway management and TTI for adjusted odds ratios (aORs) and 95% confidence intervals (CIs)
Results
Of a total of 70,530 eligible OHCA patients, 26,547 (37.6%), 38,391 (54.4%), and 5,592 (7.9%) were managed with BVM, SGA, ETI, respectively. Patients in the SGA and ETI groups had a higher odds of survival to discharge than BVM groups (aOR, 1.11 (1.05-1.16) and 1.13 (1.05-1.23)). And the rates of survival to discharge with SGA and ETI were significantly higher in groups with TTI more than 8 minutes (1.17 (1.08-1.27) and 1.38 (1.20-1.59)).
Discussion
The survival to discharge was significantly higher among patients who received ETI and SGA than in those who received BVM. The transport time interval influenced the effect of prehospital airway management on the clinical outcomes after OHCA.
n/a
Young Sun RO, Eujene JUNG (Gwangju, Republic of Korea)
14:30 - 14:50
#31376 - Endotracheal intubation during and after the COVID-19 pandemics in a Brazilian academic emergency department.
Endotracheal intubation during and after the COVID-19 pandemics in a Brazilian academic emergency department.
Background:
During the COVID-19 pandemics, patients were submitted to endotracheal intubation (ETI) in the Emergency Department (ED) at higher rates than usual. It is unclear how different such intubations are in relation to those performed in patients without Covid-19, especially with the gradual return to pre-pandemic patient populations and ED volumes. Therefore, our objective was to compare baseline characteristics and periprocedural outcomes of ETIs performed during and after the COVID-19 pandemics.
Methods:
This analysis used two prospective cohort studies that enrolled patients at a large academic ED in Sao Paulo (Brazil). The first cohort was composed of Covid-19 patients aged ≥ 18 years who were intubated between March and May 2020 (Covid-19 cohort). In contrast, the second cohort was composed of adult patients without Covid-19 who were intubated between February and May 2022 (non-Covid cohort). Both cohorts excluded patients under cardiac arrest. The primary outcome was first-pass success (FPS) rate. Secondary outcomes included rates of periprocedural hypotension, hypoxemia, esophageal intubation, and cardiac arrest.
Results:
A total of 164 patients (112 in the Covid-19 cohort and 52 in the non-Covid cohort) were analyzed. Patients intubated with Covid-19 were older (61 vs. 53 years old, respectively), and hypoxemia was the main indication for ETI (98.2%). In the non-Covid cohort, most patients were intubated either due to decreased level of consciousness (61.5%) or anticipation of clinical course (21.2%). Rapid sequence intubation was more frequently performed for the Covid-19 cohort (96% vs. 86%, p<0.01). Patients in the Covid-19 cohort were more frequently pre-oxygenated with non-invasive ventilation (64% vs 11%, p<0.01), sedated with ketamine (72% vs 30%, p<0.01), blocked with succinylcholine (61% vs 50%, p=0.03), intubated by a senior resident (65% vs 11%, p<0.01), and the procedure was performed with a video device (55% vs 42%, p<0.01). The rate of FPS was higher in the Covid-19 cohort (82% vs. 69%, p<0.01). Although success in the first attempt was more common in Covid-19 patients, they also presented a higher incidence of one or more periprocedural complications (78% vs. 48%, p<0.01), including hypotension (42% vs. 23%) and hypoxemia (52% vs. 27%). The incidence of esophageal intubations (2% vs. 5%) and post-intubation cardiac arrest (1% vs. 1%) were relatively similar.
Discussion & Conclusions:
Emergency intubations performed in patients with Covid-19 were significantly different than those performed in patients without Covid-19 in an academic ED in Brazil. Nevertheless, despite higher rates of FPS in those with Covid-19, these patients had higher incidences of post-intubation complications. As an academic center in the post-pandemic period, it is part of the training for the junior resident to learn practical skills but we need to be careful not to increase risks to the patient.
Further research is required to understand the reasons behind such large differences in emergency airway management and the need of a more systematic and homogeneous approach to intubating patients in the ED.
Funding: FAPESP and HCFMUSP
Ethical approval and informed consent: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068), which also waived the need for written informed consent. We adhere to STROBE guidelines.
Ian WARD A. MAIA, Julio ALENCAR, Rodrigo BRANDÃO, Lucas OLIVEIRA J. E SILVA, Eduardo SORICE, Juliana STERNLICHT, Luisa BARINI, Giovanna OLIVEIRA, Patricia MOURA, Gabriela STANZANI, Yasmine FILIPPO, Fernanda GRECO, Luz GOMEZ, Julio MARCHINI, Heraldo SOUZA, Lucas MARINO (Sao Paulo, Brazil)
14:30 - 14:50
#30671 - Prehospital point-of-care testing to target potential life-threatening cases of non-unplanned ICU-admission in traumatic brain injury.
Prehospital point-of-care testing to target potential life-threatening cases of non-unplanned ICU-admission in traumatic brain injury.
Background: The incidence of traumatic brain injury (TBI) in our environment is 200/100,000 inhabitants/year, with rates of admission to intensive care units (ICU), related-mortality and morbidity, non-negligible. TBI is a complex condition involving Emergency Medical Systems (EMS), Emergency Departments (ED), ICU, surgery units, and so on. In short, TBI is a serious medical condition requiring a systematic evaluation and management at all levels to make a meaningful difference.
The purpose of this report is to examine the predictive ability of a basic prehospital biochemical panel (potassium, sodium, calcium, chloride, glucose, lactate, and creatinine) to detect the risk of non-unplanned ICU-admission in TBI.
Methods: Prospective, multicentric, EMS-delivery, ambulance-based, pragmatic cohort study of adults with prehospital TBI, referred to five hospitals (Spain), between January 2020, and December 2021. Any traumatic patient treated consecutively by EMS with prehospital diagnosis of TBI and transferred with high priority by ambulance to the ED was included in the study. Patients under 18 years of age, pregnant women, non-traumatic patients, risk in the scene and patients discharged on site were excluded. Demographic data (age and sex) and venous sampling were collected during the first contact with the patient in prehospital care. The basic prehospital biochemical panel was measured with the epoc® Blood Analysis System (Siemens Healthcare GmbH, Erlangen Germany). Data were obtained by reviewing the patient's electronic history. The primary dependent variable was all-cause ICU-admission. The area under the curve (AUC) of the receiver operating characteristic (ROC) of the biomarkers were calculated in terms of ICU-admissions.
Results: A total of 475 patients with a prehospital diagnosis of TBI were included in our study. The median age was 56 years (IQR: 33-74), with a range from 18 to 99 years, predominantly males with 302 cases (63.5%). The rate of non-unplanned ICU-admission was 23.3 % (111 cases), and in-hospital mortality was 14.1 % (67 cases).
The AUROC for potassium, sodium, calcium, chloride, glucose, lactate, and creatinine were 0.591 (95%CI: 0.53-0.65; p=0.003); 0.518 (95%CI: 0.45-0.57; p=0.575); 0.369 (95%CI: 0.31-0.42; p=0.273); 0.588 (95%CI: 0.52-0.65; p=0.005); 0.634 (95%CI: 0.57-0.69; p=0.001); 0.803 (95%CI: 0.75-0.85; p<0.001); and 0.604 (95%CI: 0.54-0.66; p=0.001).
Conclusions: the role of lactate is well-known in prehospital care, especially in trauma cases. Upper lactate levels are significantly correlated with a strong relationship with a marked increase in morbi-mortality. And according to our data, prehospital lactate above 3.19 mmol/L is associated with a rate of non-unplanned ICU-admission. Know this bedside data may help to determine from the scene the most appropriate hospital for TBI.
This work was supported by the Gerencia Regional de Salud, Public Health System of Castilla y León (Spain) [grant number GRS 1903/A/19 and GRS 2131/A/20]
Francisco MARTÍN-RODRÍGUEZ, Raúl LÓPEZ-IZQUIERDO, Carlos DEL POZO VEGAS (Valladolor, Spain), Enrique CASTRO PORTILLO, Santiago LÓPEZ TORREZ, Rodrigo ENRIQUEZ DE SALAMANCA GAMBARA, Almudena MORALES SÁNCHEZ, Ana BENITO JUSTEL, Arancha MORATE BENITO, Cristina VÁZQUEZ DONIS, M. Cristina RAMOS ORTEGA, Emma GARCÍA TARRERO, Esther FRAILE MARTÍNEZ, María GRAÑEDA IGLESIAS, M. Teresa BLAZQUEZ GARCÍA, Victor MENÉNDEZ GUTIÉRREZ, Rafael MARTÍN SÁNCHEZ, Santiago OTERO DE LA TORRE, Francisco Tomás MARTÍNEZ FERNÁNDEZ, Juan Francisco DELGADO BENITO
14:30 - 14:50
#31433 - Strategies to enhance the implementation and utilization of preprocedural checklists in pre-hospital emergency anesthesia (PHEA).
Strategies to enhance the implementation and utilization of preprocedural checklists in pre-hospital emergency anesthesia (PHEA).
Background
Pre-hospital emergency anesthesia (PHEA), despite being potentially lifesaving when delivered on a regular basis by specialist teams with high caseloads, currently remains a complex, high-risk procedure, at times leading to significant adverse events. The routine utilization of standard operating procedures (SOPs) and periprocedural checklists has been advocated to reduce the cognitive overload of clinicians, reduce procedural variance and improve patient safety. The ultimate goal is to improve long-term patient outcomes, but in spite of a significant build-up in literature on this topic, results so far have been controversial. Therefore, pre-hospital systems are sometimes reluctant to implement periprocedural checklists as part of their daily practice.
Objectives
This study aims to identify the main barriers to implementation of preprocedural checklists during PHEA and to gather a broader understanding of the rationale behind the hesitance in routine use. Our emphasis is both on optimizing human factors such as clinician reluctance when facing safety innovations, and technical aspects such as the compatibility with current practice and structural complexity of the checklists.
Methods
This study is a non-systematic review of the current literature regarding checklist implementation and utilization during PHEA. A literature search on Cochrane CENTRAL library, PubMed and Embase database was carried out to identify articles related to the topic of checklists during pre-hospital emergency anesthesia. Articles published in English during 2014-2021 were included after being thoroughly sorted according to their relevance. The data extracted in our study represent a preliminary investigation facilitating the future development of a local periprocedural PHEA checklist along with a pre and post implementation simulation-based study on checklist augmented PHEA in our physician-led pre-hospital critical care system.
Results
Qualitative data from the selected articles was analyzed. Most studies indicated that checklist implementation in real life without prior, supervised simulation-based training leads to increased reluctancy and failure to comply from clinicians. Continuous, standardized team-training is mandatory in order to improve familiarity with complex procedures like PHEA and to familiarize the clinician with novel tools. Mandatory checklist implementation through local guidelines drastically increases compliance but fails to take into consideration their suitability in special circumstances (in extremis patients). Advances in PHEA technology (video laryngoscopy, digital tools) might make checklists less feasible if their content is not regularly reviewed and modified accordingly. Real-time feedback from clinicians facilitates the adaptation to local specific needs in the pre-hospital environment (urban vs rural; ground-based vs air ambulance). Checklists must be written using non-ambiguous, concise language, focusing solely on the vital information for the procedure. Key elements on the list must be highlighted in case of sudden patient deterioration. Group-based discussions enhance familiarization with standardized PHEA protocols, leading to a more open-minded approach towards checklists.
Conclusion
The human mind is prone to errors when encountering challenges in high-risk, time-limiting environments. Periprocedural checklists must be viewed as practical and relevant by the clinician performing challenging procedures like PHEA. Regular training with pre-hospital critical care team members, preferably during simulation scenarios, increases compliance towards SOPs and standardized checklists.
Rareș-Alexandru STREZA (Cluj-Napoca, Romania), Sonia LUKA, Anda PINTEA, Vlad DANCILA, Darius TURCAS
|
Exhibition Hall |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
EPOSCB1SC5
14:30 - 14:50
Coffee Break 1 - EPoster session - Screen 5
Moderator:
Bulut DEMIREL (Clinical Development Fellow) (Moderator, Glasgow)
14:30 - 14:50
#31176 - Importance of elevated D-dimer and a high value on the Wells scale as factors associated with pulmonary embolism in COVID patients.
Importance of elevated D-dimer and a high value on the Wells scale as factors associated with pulmonary embolism in COVID patients.
Background:
The diagnosis of pulmonary embolism (PE) in Covid infection is a challenge due to its associated morbidity and mortality. In published studies, a prevalence of 13-21% of PE has been found in Covid patients. The Wells scale and the D-dimer could be useful to request an angioCT, but the limit for its efficiency has not been established. The objective is to determine the level of Dimer D related to the suspicion of PE and the association of the Wells scale with the presence of PE in COVID patients.
Methods:
Retrospective descriptive study of a cohort of patients with Covid infection diagnosed by PCR from January 2021 to June 2021 in the Emergency Department of a regional hospital in Barcelona who had undergone CT angiography. Sociodemographic data, comorbidities, presence of pneumonia, PaFi, vaccination, D-dimer level, and Wells scale value were collected when CTangiography was requested. The level of statistical significance considered for the analysis was 5%. The study was approved by the ethics and drug research committee of the Terrassa Hospital.
Results:
Of the 512 AngioCT performed in the Emergency Department, 148 met the inclusion criteria. The mean age was 64 ± 16 years, 55% were men. 56% of the patients had arterial hypertension, 27% diabetes, 40% dyslipidemia. 82% were not vaccinated, 89% had Covid pneumonia, mean PaFi was 330 ± 132. Mean D-Dimer was 5335 ± 11618, with a modified Wells Scale of 3.5 ± 1.2. In 20 (13.5%) of the 148 AngioCT, PE was diagnosed. Statistically significant differences (p<0.001) were obtained between the different levels of D-dimer higher than 1500, 2000, 3000 and 5000 and the diagnosis of PE by AngioCT. Requesting an AngioCT with D-dimer higher than 1500 collected 100% of those diagnosed with PE, with a limit of 2000, 10% of patients who had not undergone the test were found. Being 45% if the limit was 5000. No statistically significant relationship was found between the elevated Wells score and the presence of PD in COVID patients, but it was considered a clinically relevant finding that all patients with PD had a moderate or high risk. on the Wells scale with more than 3 points.
Conclusion:
A D-dimer limit higher than 1500 allows the diagnosis of all PE by AngioCT in COVID patients. The Wells scale has been clinically useful in the diagnosis of PE if they presented a moderate-high value of it.
Munir MOHAMED MIMUN (BARCELONA, Spain), Pozzi MARIA BELEN, Rodríguez Reyes LUNA, Catón Lacasa ALEJANDRA, Turmo Moliner CLARA, Aguilar Cruz FREDDY GONZALO
14:30 - 14:50
#31909 - Reliability of the HEART score using Point of care Troponin in the prehospital setting.
Reliability of the HEART score using Point of care Troponin in the prehospital setting.
Reliability of the HEART score using Point of care Troponin in the prehospital setting.
Introduction
Chest pain remains a common complaint for consultation of Emergency Medical Services (EMS) worldwide. In order to combat overcrowding at the emergency department (ED), decreased referral of low risk patients with chest pain would be favourable. Our study aims to validate the reliability of the HEART-score with a point of care troponin (POCT) in the prehospital setting.
Methods
This Dutch prospective observational study was performed in Rotterdam. A selected group of dedicated EMS nurses calculated a HEART-score using a POCT device (Roche Cobas, cut off value 40 ng/L). Two blood samples were collected in the prehospital setting (T0) and at the hospital (T1), in order to calculate a HEART-score with POCT (HEART-poct) and with central laboratory troponin (HEART-laboratory). Endpoints were overall agreement between HEART-poct and HEART-laboratory at T0 and at T1 and secondary the percentage of MACE after 30 days.
Results
In total 257 patients with acute chest pain were enrolled, average age was 62.6 ± 14.9 years (mean ± SD). In total 44 patients (17,1%) developed a MACE within 30 days, while 95 (37,0%) patients were deemed as low risk (HEART 0-3). Comparing HEART-poct and HEART-laboratory in the prehospital setting resulted in a Kappa value of 0,958, 95% CI [0,925 - 0,991] with a p < 0.001, meaning almost perfect agreement. While at the hospital, a Kappa value of 0,966, 95% CI [0,937 – 0,995] with a p < 0.001 was found, also showing almost perfect agreement.
Conclusion
The prehospital HEART-score using POCT shows almost perfect agreement with a HEART-score based on central laboratory troponin, demonstrating the reliability of the prehospital HEART-score. This study supports the implementation of the HEART-score in the ambulance by which patients with a low HEART-score could potentially be left at home without immediate referral to the hospital.
Nancy VAN DER WAARDEN (Rotterdam-Rijnmond, The Netherlands), Bob SCHOTTING, Kees-Jan ROYAARDS, Georgios VLACHOJANNIS, Barbra BACKUS
14:30 - 14:50
#31587 - The scope of EMS in major trauma in Portugal - analisys of clinical records 2021.
The scope of EMS in major trauma in Portugal - analisys of clinical records 2021.
Introduction:
The National Institute of Medical Emergency (INEM) is the agency responsible for coordinating the Integrated Medical Emergency System in Portugal. INEM manages 112 medical calls, organizing prehospital emergency services throughout its CODU (Urgent Patient Guidance Centres) dispatch unit.
Since 2018, INEM started a technological system that allows clinical record and management of information produced by INEM’s units on the field (ITEAMS – INEM Tool for Emergency Alert Medical System). It contributes to the real-time decision-making support and regulation based on clinical data in CODU, and enables the stratification of patient clinical deterioration risk in the first contact with an emergency medical services (EMS) team, with the support of clinical scores; specifically in major trauma we use RTS (Revised Trauma Score) and MGAP (Mechanism of Injury, Glasgow Coma Scale, Age, and Systolic Blood Pressure).
The aim is to bring value to the chain of help/surviving, optimizing the early identification and allowing the adequate patient referral during a time window of reference to trauma centers.
It should be noted that the portuguese emergency teams are stratified accordingly to skills, teams can have of technicians, nurse or doctor.
Methods:
Retrospective descriptive analysis out-of-hospital clinical records during 2021 in iTEAMS, referring to major trauma.
Results:
During 2021, INEM attended 107 606 trauma patients; from those 1.6% were referred as possible major trauma (n=2643).
The population analyses revealed a prevalence of male (70.9%) , with 71.3% of the victims aged between 18-64 years old.
66.1% of this suspected major trauma patients were attended by teams including a physician or/and a nurse (n=1746).
The average time between the emergency call and the arrival of the EMS on scene was 21 minutes, with an average time spent on scene of 29 minutes. Out-of-hospital average actuation time in major trauma was of 78 minutes.
When in the presence of a nurse or a doctor intra-venous analgesic treatment was administered in 69% of the cases. Endotracheal intubation was performed in 43.4% and tranexamic acid administered in 43.5% of the population identified as major trauma when a phisician was deployed on scene.
Conclusion:
Well-structured clinical pathways are essential for improving prognosis in specific time dependent situations like major trauma. Out-of-hospital performance dictates the initial compliance with trauma guidelines. Moreover, the referral to the correct trauma center elevates the responsibility not only of the out-of-hospital teams but also of the coordinating centers.
The implementation of a monitoring and follow-up structure of trauma events in INEM pretends to alert, inform and educate our professionals in order to optimize out-of-hospital performance. In Portugal, INEM acts as the first link of the entire chain that represent the national pathways and can therefore promote a better outcome for patients with sudden onset of emergencies like trauma.
Marta CUSTÓDIO (Lisboa, Portugal), Margarida GIL, Filipa BARROS, Pedro VASCONCELOS, Carlos RAPOSO, Fátima RATO, Teresa BRANDÃO, Manuela LUCAS, João LOURENÇO
14:30 - 14:50
#31193 - Use of High Flow Nasal Oxygen therapy in pre-hospital setting: About 107 cases.
Use of High Flow Nasal Oxygen therapy in pre-hospital setting: About 107 cases.
Introduction
High Flow Nasal Oxygen (HFNO) therapy has become the first line in-hospital treatment of acute hypoxemic respiratory distress.
In 2020, the COVID pandemic was responsible for an acute hypoxemic respiratory distress pandemic. Consequently, the use of HNFO therapy increased significantly. Despite the logistical and technical challenge, our Emergency Medical Service (EMS) made it possible to provide transport by Advance Life Support (ALS) ambulance under HFNO.
The objective of this study was to present the feasibility of using HFNO in pre-hospital care through a series of 107 patients COVID + transported by an Advanced Life Support (ALS) ambulance.
Methods
All patients treated by HFNO in an ALS ambulance in a catchment area of 1,600,000 inhabitants bordering Paris from 01/17/21 until 05/04/21 (3rd COVID wave in France) were included. All inter-hospital or on-scene-hospital transportations were considered. HFNO was provided through the Fisher & Paykel MR 850® humidifier-heater, compatible with available respirators (Air Liquide Medical System Monnal T60®). Patients’ status was collected: gender, age, Body mass index (BMI), blood pressure and heart rate, prior ventilation support, prior HFNO use, ROX index (respiratory rate-oxygenation, calculated by the ratio of SpO2/FiO2 to respiratory rate). Transportation time stamps and HFNO transport conditions were collected such as its stability, any change or incident occurring during transport, oxygen consumption. Finally, the patients’ outcome including ROX index at hospital arrival, change of ventilation system, death or hospital discharge were collected.
Results
107 patients were included. 98 (91.59%) benefitted from inter-hospital transport. 74 were male (69.16%), mean age was 64 years old (SD: 13) – 45% were obese and 36% had overweight; They were all hemodynamically stable. 46 patients (42.99%) had HFNO prior to transport. Mean SpO2 was 92%, mean Respiratory rate was 29,5/min. ROX index before transport: low ROX index (< 2,85) 21 patients (30.39%), intermediate ROX index (2,85-4,87) index: 65 patients (63.11%) and high ROX index (≥ 4,88) 17 patients (16.50%)
Mean transport time was 15 min 24 sec (SD: 7 min 44 sec). For 1 out of 107, HNFO was switched, no one was intubated during transport. No technical incident has been reported (lack of energy or oxygen supply, fall of material).
Upon ALS arrival, ROX index category was low for 7 patients (6.93%), intermediate for 62 patients (61.39%) and high for 32 patients (31.68%). 47 patients (47.47%) switched to oro-tracheal intubation (OTI), the mean time to be intubated was 2,19 days. In hospital outcome was death for 28 patients (26.17%), hospital discharge for 19 patients (17.76%) and transfer to other hospital facilities for the rest.
Conclusion
Despite the logistical and technical challenge, our Emergency Medical Service (EMS) made it possible to provide transport by Advance Life Support (ALS) ambulance under HFNO. HNFO is feasible in pre-hospital care. No technical incident has been reported and clinical condition of patients has improved. Nevertheless, further studies are needed to evaluate the use of HNFO in pre-hospital setting.
n/a
Armelle SEVERIN (Garches), Anna OZGULER, Michel BAER, Thomas LOEB
|
Exhibition Hall |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
390
14:30 - 15:30
Prehospital Section Meeting
Chairperson:
Eric REVUE (Chef de Service) (Chairperson, Paris, France)
|
M4-5 |
14:55 |
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
A12
14:55 - 16:20
Emergencies in the Elderly - Working with a Multi-disciplinary Team
Moderators:
Rosa MCNAMARA (Consultant) (Moderator, Dublin, Ireland), Dr Don MELADY (Associate Professor/Staff Physician) (Moderator, Toronto, Canada)
14:55 - 16:20
Panel discussion: Working with a Multi-disciplinary Team.
Dr Don MELADY (Associate Professor/Staff Physician) (Speaker, Toronto, Canada)
14:55 - 16:20
Panel discussion: Working with a Multi-disciplinary Team.
Rosa MCNAMARA (Consultant) (Speaker, Dublin, Ireland)
14:55 - 16:20
Panel discussion: Working with a Multi-disciplinary Team.
Aine MITCHELL (Consultant in Emergency Medicine) (Speaker, Sligo, Ireland)
14:55 - 16:20
Panel discussion: Working with a Multi-disciplinary Team.
Aoife DILLON (Speaker, DUBLIN, Ireland)
14:55 - 16:20
Panel discussion: Working with a Multi-disciplinary Team.
Kara MCLOUGHLIN (Speaker, DUBLIN 6, Ireland)
|
A6-7 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
B12
14:55 - 16:20
Digital Emergency Medicine - Artificial Intelligence in the Emergency Department
Moderators:
Dr John HEYWORTH (Consultant) (Moderator, Southampton, United Kingdom), Thomas SAUTER (Consultant) (Moderator, Bern, Switzerland)
14:55 - 15:20
AI in EM - a revolution already taking place in medicine.
Dr Barbara C HOGAN (Past President of the European Society for Emergency Medicine, EuSEM) (Speaker, HAMBURG, Germany)
15:20 - 15:45
Clinical implications and applications of AI in the ED.
Dr Tajek HASSAN (Board Chair for Europe, IFEM) (Speaker, Leeds, United Kingdom)
15:45 - 16:10
AI - The academic perspective.
Wolf HAUTZ (Senior Attending Physician) (Speaker, Bern, Switzerland)
|
A8 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
C12
14:55 - 16:20
Disaster Medicine II
14:55 - 15:15
Zoom technology - The new tabletop for disaster drills?
Francis MENCL (emergency medicine physician) (Speaker, Akron, USA)
15:15 - 15:35
Lessons unlearned: crisis communication.
Steve PHOTIOU (Speaker, Crocetta del Montello (TV), Italy)
15:35 - 15:55
Response to natural disasters in Mexico - What have we learned from the past?
Carlos GARCIA ROSAS (Speaker, MEXICO, Mexico)
15:55 - 16:15
Counterterrorism.
Derrick TIN (Faculty) (Speaker, Sydney, Australia)
|
A1 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
D12
14:55 - 16:20
Difficult cases solved with current guidelines - The role of the ED in early diagnosis of difficult and special cases of various pathology
Moderators:
Pr Martin MÖCKEL (Head of Department, Professor) (Moderator, Berlin, Germany), Ari PALOMÄKI (Professor) (Moderator, Hämeenlinna, Finland)
14:55 - 15:15
The Miracle of chest pain.
Pr Rick BODY (Professor of Emergency Medicine) (Speaker, Manchester, United Kingdom)
15:15 - 15:35
I am so short of breath.
Rianne OOSTENBRINK (pediatrician) (Speaker, Rotterdam, The Netherlands)
15:35 - 15:55
I do not remember what happened.
15:55 - 16:15
I do not feel so well.
Ari PALOMÄKI (Professor) (Speaker, Hämeenlinna, Finland)
|
A2 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
E12
14:55 - 16:20
Important symptoms II
Moderator:
Dr Fazle ALAM (Consultant A&E) (Moderator, Birmingham, United Kingdom)
14:55 - 15:15
Constipation.
Dr Jovanka BLUNK (Doctor) (Speaker, Hoppegarten, Germany)
15:15 - 15:35
Diarrhea.
Metin OMEROVIĆ (Speaker, Maribor, Slovenia)
15:35 - 16:20
Dizzines & Vertigo .
Eric DRYVER (Consultant) (Speaker, Lund, Sweden)
|
A4 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
F12
14:55 - 16:20
Let me tell you something
Moderator:
Michela CASCIO (Trainee doctor) (Moderator, ROME, Italy)
14:55 - 15:20
Geriatrics for the Emergency Physician.
James VAN OPPEN (Clinical Research Fellow / Specialty Registrar) (Speaker, Leicester, United Kingdom)
15:20 - 15:45
E-scooters: Friend or Foe?
Robert HIRST (ST4 EM Trainee) (Speaker, Bristol)
15:45 - 16:10
Under Pressure.
Stef BOUMAN (Speaker, Maastricht, The Netherlands)
15:45 - 16:10
Under Pressure.
Jeroen SEESINK (Speaker, The Netherlands)
|
A5 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
G12
14:55 - 16:20
Notfallmedizin 2022 Teil 1
Moderators:
Carsten Eberhard MACH (Consultant) (Moderator, Aachen, Germany), Wilfried SCHNIEDER (Moderator, Hiddenhausen, Germany)
14:55 - 15:20
Schockraum-Management 2022.
Bernhard KUMLE (Head of Department) (Speaker, Villingen-Schwenningen, Germany)
15:20 - 15:45
Medizinische Versorgung in der Sozialen Isolation.
Patrick LARSCHEID (Speaker, Germany)
15:45 - 16:10
Versorgung von Kriegsverletzten.
Harald BERGMANN (Speaker, Germany)
|
A3 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
H12
14:55 - 16:20
Cardiovascular
Moderators:
Barbra BACKUS (Emergency Physician) (Moderator, Rotterdam, The Netherlands), Nancy VAN DER WAARDEN (Nurse practitioner emergency care) (Moderator, Rotterdam-Rijnmond, The Netherlands)
14:55 - 16:20
#31235 - Artificial Neural Network with systematic grid search in predicting Major Adverse Cardiac Events in the Emergency Department.
Artificial Neural Network with systematic grid search in predicting Major Adverse Cardiac Events in the Emergency Department.
Background
Early prediction of major cardiac adverse events would be beneficial in timely intervention and disposition of overcrowded low resource emergency departments. The purpose of this study was to develop and validate an artificial neural network model using systemic grid search for early prediction of major adverse cardiac events among adult patients presenting at the triage of an emergency department.
Methods
This is a single center electronic health record-based study. The primary outcome was the development of major cardiac adverse event (MACE) during hospital stay. We adopted a systematic grid search approach to optimize the artificial neural network (ANN) architecture on triage data. The ANN model with four hidden layers followed by an output layer was used. Each hidden layer was followed by back normalization and a dropout layer. Three binary classifiers; ANN, random forest (RF) and logistic regression (LR) were trained and tested for two independent tasks; prediction of MACE. The models were evaluated for overall accuracy of predictions in the validation dataset, along with sensitivity, specificity, precision, recall, receiver operating curve (ROC) and F1-score.
Results
During the study period, there were a total of 97,333 ED visits. The presentations used for the training and validation were 77,866 and 19,467 respectively. The mean age was 54.08 (±19.18). Diagnostic accuracy for MACE was better through random forest classifier 95.2% (95% to 95.5%) with sensitivity 99.4% (99.2% to 99.6%) and specificity 94.2% (93.8% to 94.6%). The AUC score for MACE using ANN was higher 0.97 compared to RF (0.96) and LR (0.96). Similarly, precision-recall curve for MACE using ANN was higher 0.94 compared to RF (0.93) and LR (0.93).
Conclusion:
The artificial neural network using systematic grid search was found to be sensitive in better prediction of MACE using presentation triage data. The findings of this study can be a valuable tool in prediction of MACE in an overcrowded emergency department of a low resource setting.
None
Ahmed RAHEEM, Shahan WAHEED (Karachi, Pakistan)
14:55 - 16:20
#31065 - Chest pain post anti-Covid-19 vaccination with mRNA BNT162b2 vaccine : the experience of a secondary hospital.
Chest pain post anti-Covid-19 vaccination with mRNA BNT162b2 vaccine : the experience of a secondary hospital.
Background : Vaccination against Covid-19 has been proved an effective protective measure against the pandemic. It has been noticed that a number of patients visited the emergency department (ED) complaining of chest pain following their vaccination.
Purpose : To record the patients that visited the ED of our hospital referring chest pain following their vaccination with BNT162b2 vaccine, the clinical and laboratory parameters as well as their final diagnosis.
Methods : We recorded the patients that visited the ED of our hospital (secondary hospital) referring “chest pain after the vaccine”, for a period of 6 months. We included patients that had received the first or the second dose of the vaccine 1-30 days prior their visit. We recorded basic demographic characteristics, ECG findings the laboratory test results as well as the possible diagnosis made in the ED.
Results: 207 patients visited the ED complaining of “chest pain after having the Covid-19 vaccine”, 96 male and 111 female, with mean age 47±8.2 years. 7 patients(3.38%) had elevated high sensitivity troponin and were diagnosed with myocarditis ( 2 female patients aged 5 and 62 years and 5 males aged 18-24 years. In 5/7 ST elevations were recorded in the 12-lead ECG, in 4/7 the transthoracic echocardiogram(TTE) revealed mildly impaired left ventricular function. Myocarditis was confirmed via cardiac MRI in all patients. Virology tests were negative for the common viruses.6/7 visited the ED 2-5 days after the second dose, whereas 1/7 10 days after the first dose). 2 patients(0.96%) were diagnosed with pericarditis (Both of them had received the second dose 5-7 days prior their visit, presented with pericardial rub and diffuse ST elevations in the ECG, as well as elevated CRP and moderate pericardial effusion). For the remaining 198 patients (95.65%) we did not record any abnormal findings in the ECG or the chest X ray and the chest pain was regarded non cardiac. Interestingly enough, 107 patients (51.69%) found to have a mild to moderate increase in the D-Dimer levels (mean 1.1±0.6 mg/l).Pulmonary embolism and aortic dissection was excluded to all of them based on our hospital’s protocol.
Conclusion : The vast majority (95.65%) of patients complaining of post Covid-19 vaccine chest pain had normal ECG and laboratory findings, suggesting a non cardiac origin.There were diagnosed some cases with myocarditis or pericarditis, a well described possible side effect of the BNT162b2 vaccine. Moreover, 51.69% of these patients were found to have elevated D-Dimer levels but we did not record any clinical significance.
Maria STRATINAKI, Anastasia SPARTINOU (HERAKLION, Greece), Dimitrios VASSILAKIS, Irini TRACHANATZI, A KOUFOGIANNI, Niki GRILLOU, M DETORAKI, M PITAROKOILIS, Ermis HONDA, Georgios ALETRAS, Eleftheriadou ELENI, D KORELA, Othon FRAIDAKIS, E FOUKARAKIS
14:55 - 16:20
#31439 - Comparison between HEART score and Troponin-only Manchester Acute Coronary Syndromes score in the evaluation of elderly patients presenting to the emergency department for chest pain: an observational prospective study.
Comparison between HEART score and Troponin-only Manchester Acute Coronary Syndromes score in the evaluation of elderly patients presenting to the emergency department for chest pain: an observational prospective study.
Background:
WHO defined an elderly person if the age is ≥ 65 years old. Age is one of the most important unmodifiable cardiovascular (CV) risk factor.
The aim of this study is to evaluate the performance of HEART score and Troponin-only Manchester Acute Coronary Syndromes (T-MACS) score in the rule out of acute coronary syndrome (ACS) in patients aged ≥ 65 years old.
Methods:
Observational prospective monocentric study carried out at the emergency department (ED) of a tertiary university hospital in Bologna, Italy. We enrolled 2035 consecutive 65 or older aged patients admitted for non-traumatic chest pain from 25th November 2019 to 24th November 2020. The main exclusion criteria were: presence of ST-segment elevation at the ECG; patients who denied their consent; patients lost during the follow up.
Each patient underwent serum sample for hs-TnI (Access; Beckman-Coulter), then the HEART and the T-MACS were calculated. The 90 days follow-up was performed through a phone call to the patients in order to register major adverse cardiac events (MACE).
The outcome was an occurrence of MACE below 1% in the low risk group (i.e. HEART score low risk and T-MACS very low risk).
The performance of the score has been described by the estimates of sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV).
Results:
1612 patients were included in the analysis. Median age was 78, 50.3% were female.
HEART score classified patients as follows: 280 low risk and 26 (9.2%) MACE; 898 intermediate risk and 143 (16%) MACE; 434 high risk and 253 (58%) MACE. Among low risk patients, 24 patients had the troponin dosage above the upper reference limit (URL); 256 patients had the hs-TnI dosage under the URL but 5.4% had MACE. Sensitivity was 93.8%, specificity was 21.3%, PPV was 29.7% and NPV was 90%. Positive likelihood ratio (LR+) 1.2, negative LR (LR-) 0.3.
T-MACS classified patients as follows: 570 very low risk and 41 (7.2%) MACE; 408 low risk and 56 (13.7%) MACE; 462 intermediate risk and 184 (39.8%) MACE; 172 high risk and140 (81%) MACE. In the very low risk category, nobody had a positive hs-TnI dosage. Sensibility was 90%, specificity was 44%, PPV 36.4% and NPV was 93%. LR+ 1.6, LR- 0.2.
Discussion and conclusion:
HEART scoring system gives 2 points for age ≥ 65, instead T-MACS does not consider age. Nevertheless, neither HEART score nor T-MACS showed a good performance in the correct identification of low risk patients. Even by excluding HEART score low risk patients who had a positive troponin dosage, it does not improve the accuracy of the rule. MACE rate in the low risk group of the two scores was sharply above 1% and this is unacceptable for an emergency physician who challenges every day with an increasingly number of elderly patients presenting to the ED.
Data obtained from this study require external and multicentric validation.
We can conclude that the evaluation of the elderly patients probably need further testing in order to exclude ACS.
Study approved by ethics committee with registration number 480/2019/Oss/AOUBo.
This study did not receive any specific funding.
Dr Eleonora TUBERTINI (Bologna, Italy), Gabriele FARINA, Luca SANTI, Maria Grazia MIRARCHI, Alice GRIGNASCHI, Maria Laura ARTESIANI, Ilaria CARAMELLA, Dario CARUSO, Elena CASADEI, Giulia CESTER, Vittorio CUCCIARDI, Valentina GAMBERINI, Sara NANNI, Daniela NIZZA, Francesca TRABALZA, Fabrizio GIOSTRA
14:55 - 16:20
#31365 - Factors influencing pain severity among patients with acute chest pain.
Factors influencing pain severity among patients with acute chest pain.
Introduction:
Acute chest pain (CP) is a frequent cause of emergency medical services (EMS) activation. It was shown that pain perception may be influenced by different factors. Our study aims to evaluate patients’ CP perception and factors influencing pain intensity.
Methods:
We conducted a Cross-sectional study including patients who contacted the east center EMS for CP between November 2021 and January 2022. Data were collected from digital regulation sheets and the corresponding transport sheets. Initial chest pain intensity was assessed on a 10-point numeric rating scale (NRS). We used student's t-test and analysis of variance (ANOVA) to compare mean NRS of different patient groups.
Results:
Our study population consisted of 203 patients. 71,9% of them were men with a sex ratio of 2,56. The mean age was 60,62±12,8 years. The mean NRS in the total population was 4,7 ± 2,7 with a minimum of 0 and a maximum 10. The pain intensity was slightly higher among men (4,8 ±2,8) than women (4,61 ±2,6) but with no significant difference (p=0,04). Concerning age, older patients tended to feel pain with significantly lower intensity than younger patients (p=0.009). Regarding medical history, patients who had at least one cardiovascular risk factor CVRF experienced less pain (4,53 ±2,7) than those with no CVRF (5,52 ±2,75; p=0,04). As for co-morbidities, diabetic patients felt significantly less pain (3,93 ±2,5) than non diabetic patients (5,28 ±2,7; p=0,002). This was also the case for patients with dyslipidemia who perceived pain with significantly lower intensity (3,98 ±2,4 vs 5,2 ±2,8; p=0,005). Concerning CP etiology, pain was perceived with greater intensity in patients with an ST-elevation myocardial infarction compared to non- ST-elevation myocardial infarction patients (6,35 ±2,2 vs 4,24 ±2,6) with a significant difference (p<0,001).
Conclusion:
In our study, we found a significant association between perceived CP intensity and age, CVRF, co-morbidities: diabetes, dyslipidemia, and ST elevation. These factors may lead to a misinterpretation of the pain. They should therefore be taken into consideration in the evaluation of CP patients as certain patients might need more intensive investigation in order to avoid potentially lethal conditions to go unrecognized.
Sondos LAAJIMI (Sousse, Tunisia), Khouloud ROMDHANE, Rabeb MBAREK, Khouloud HAMDI, Samar NAIFER, Moussa BOUDRIGUA, Naoufel CHEBILI
14:55 - 16:20
#30240 - Heart rate: is it truly a vital sign?
Heart rate: is it truly a vital sign?
Introduction Increased heart rate (HR) is believed to be a physiological response to hypotension and an early warning sign for the development of shock, although this response may change with ageing. The aim of this study was to assess the association between systolic blood pressure (SBP) and HR in ED patients of different age categories (18-50; 50-80; >80 years).
Methods A multicenter cohort study using the Netherlands Emergency Department Evaluation Database (NEED), including data from three hospitals. All patients ≥18 years in whom HR and SBP were registered at arrival to the ED were included. Unadjusted and adjusted associations were visualized with scatterplots and a generalized additive logistic regression model. Subgroup analyses were performed for patients with suspected infection and trauma. To externally validate our findings, analyses were performed by investigating the association between SBP and HR in three other cohorts: a Danish Multicenter Cohort including ED patients, a cohort including ED patients with suspected infection and a cohort with data from an Intensive Care Unit (ICU) of one hospital.
Results A total of 81750 patients were included from the NEED. No clinically relevant unadjusted or adjusted associations were found between SBP and HR in any age category or subgroup of ED patients, nor in two other ED cohorts, with less than 3 bpm change per 40mmHg decrease in SBP. In contrast with findings in ED patients, for ICU admitted patients HR increased linearly with decreasing SBP only for patients aged 18-50years (3.6bpm per 10mmhg, 95%CI 3.4-3.8), but no clinically relevant association existed in older patients.
Conclusion A clinically relevant association between SBP and HR is absent for all age-categories in the ED. As a result, recognizing shock may be difficult and physicians cannot solely rely on HR disturbances. Acute care guidelines should acknowledge these difficulties to recognize shock.
NTR trial NL9028, funding: none
Bart CANDEL, Wouter RAVEN, Soren Kabell NISSEN, Marlies MORSINK, Menno GAAKEER, Mikkel BRABRAND, Erik VAN ZWET, Evert DE JONGE, Bas DE GROOT (AMSTERDAM, The Netherlands)
14:55 - 16:20
#31329 - Management strategies in the emergency department of atrial fibrillation: rate versus rhythm control.
Management strategies in the emergency department of atrial fibrillation: rate versus rhythm control.
Introduction:
Atrial fibrillation (AF) is the most common dysarrhyth¬mia seen in the emergency department. The prevalence of AF globally has been reported to range from 0.5 to 3.2%
The primary pharmacologic strategy for managing AF includes medications that control either rate or rhythm.
Several trials in AF: PIAF, RACE, STAT, AF-CHF, had attempted to answer which option is more favorable in terms of clinical outcomes. However, studies showed no differences between the two treatment strategies.
Objective:
This study was designed to compare two treatment strategies in patients with atrial fibrillation (AF): rhythm-control versus. rate-control in terms of the epidemiological, clinical and prognosis data.
Methods:
In this retrospective observational study, we included all patients who consulted the emergency department for AF in the period from May 2011 to February 2020. Epidemiological, clinical, therapeutic and prognostic data of patients were collected. Patients were classified into the rhythm control or rate control groups according to the classification of AF and the severity of symptoms. The therapeutic strategy followed in each patient depended on the required recommendations of the European Society of Cardiology. In addition, we compare the epidemiological, clinical and prognostic data of the two groups. The prognosis was evaluated at 30 days and 90 days on the occurrence of thromboembolic and hemorrhagic accidents and mortality.
Results:
A total of 465 patients were included in this study, with a mean age of 64 ±15 years and a male/female sex ratio of 0.72. Rhythm control was adopted in 73 patients (15%) and rate control in 359 patients (77%).
In terms of medical history, the rhythm control and frequency control group had respectively: hypertension 37(50%) versus. 217(60%), diabetes 23(31%) versus. 95(26%), history of coronary heart disease 6(8%) versus. 49(13%), already diagnosed with AF 8(10%) versus. 177(49%) and chronic heart failure 3(4%) versus. 69(19%).
Average heart rate was 139 ±21 bpm for the rhythm control group versus. 125 ±28 bpm for the rate control group (p>0.05).
There was no difference in the occurrence of the combined primary end point between rhythm-control group versus. rate-control group.
In fact, at 30 day, mortality was 1.5 versus. 2.5%, cerebrovascular event was 4 versus. 2% and bleeding complications was 1 versus. 0.8% respectively in rhythm-control group versus. rate-control group.
At 90 day, mortality was 1.2 versus. 3.6%, cerebrovascular event was 3 versus.4%, and bleeding complications was 1 versus 1.6% respectively in rhythm-control group versus. rate-control group.
Conclusions:
Our results are in line with those of the studies carried out previously. There is no difference between rate and rhythm control in terms of complications.
Mokhtar MAHJOUBI, Hanen GHAZALI (Ben Arous, Tunisia), Yosra RADDAOUI, Fedya ELAYECH, Amira TAGOUGUI, Rihab DAOUD, Yousra MEJDOUB, Sami SOUISSI
14:55 - 16:20
#31573 - Neurological function at 6 months improves compared to 30 days after extracorporeal cardiopulmonary resuscitation at the emergency department.
Neurological function at 6 months improves compared to 30 days after extracorporeal cardiopulmonary resuscitation at the emergency department.
Ingrid Magnet1; Michael Poppe1; Christian Clodi1; Florian Ettl1; Alexandra-Maria Warenits1; Alexander Nürnberger1; Matthias Mueller1; Dominik Wiedemann2; Michael Holzer1; Heidrun Losert1; Andrea Zeiner-Schatzl1; Gerhard Ruzicka1; Jürgen Grafeneder1; Christoph Testori1; Christoph Schriefl1
1 Department of Emergency Medicine, Medical University of Vienna, Austria
2 Department of Cardiac Surgery, Medical University of Vienna, Austria
Background:
The Core Outcome Set for Cardiac Arrest and Utstein-style guidelines recommend reporting long-term survival and neurological function at 30 days for cardiac arrest effectiveness trials, partially due to ease of data collection. Patients in refractory cardiac arrest treated with extracorporeal cardiopulmonary resuscitation (eCPR) have longer low flow times compared to patients successfully treated with conventional cardiopulmonary resuscitation alone and will require prolonged recovery from ischaemia-reperfusion injury. Thus, neurological assessment at 30 days might not be representative of long-term outcome in these patients. The aim of this study was to compare the neurological function of cardiac arrest survivors at 30 days and 6 months following refractory cardiac arrest and eCPR.
Methods:
All patients >18 years of age with non-traumatic in hospital and out of hospital cardiac arrest (IHCA and OHCA) treated with eCPR at the emergency department of the medical university of Vienna between January 2013 and December 2021 were included in this retrospective observational study. Primary outcome was good neurological function at 6 months, defined as cerebral performance category (CPC) 1 or 2. Secondary outcomes included survival at 6 months, neurological function and survival at 30 days. The CPC was evaluated in-person or by telephone. Continuous data are presented as median (interquartile range) and discrete data as counts (%). McNemar’s test was used to compare good neurological function rates between 6 months and 30 days with an alpha of 0.05.
Results:
During the study period, 204 patients were treated with eCPR. At 6 months, good neurologic recovery had occurred in 16,7% (34 patients) and survival was 19,1% (39 patients). At 30 days, good neurological recovery had occurred in 12,3% (25 patients) and 22,1% (45 patients) were alive. Good neurological function rate was significantly improved at 6 months compared to 30 days (p=0.004).
Baseline characteristics of patients and cardiac arrest were as follows: male 164 (80%), cardiac cause of arrest 172 (84%), witnessed 179 (89%), CPR within 5 minutes of emergency call 166 (81%), initial rhythm of ventricular fibrillation 126 (62%), pulseless electrical activity 56 (27%), asystole 22 (11%). In 44 (22%) patients with IHCA time from emergency call to eCPR was 42 minutes (IQR 30; 66) and in 160 (78%) patients with OHCA 79 minutes (IQR 69; 91).
Discussion & Conclusions:
In patients treated with eCPR for refractory cardiac arrest, reporting long-term survival and neurological function at 6 months might better represent neurologic recovery when compared to 30 days.
Acknowledgements:
We want to thank the Vienna Resuscitation Research Group for their tireless work. Furthermore, we want to thank the Emergency Medical Service of Vienna for the excellent cooperation in patient care and science.
Funding:
This study did not receive any specific funding.
Ethical approval and informed consent:
The study was approved by the Ethics Committee of the Medical University of Vienna (1219/2018).
Ingrid MAGNET (Vienna, Austria)
14:55 - 16:20
#31489 - Over the Heart Score and far away: a new statistical model to better assess the risk of major adverse cardiac events in patients with chest pain.
Over the Heart Score and far away: a new statistical model to better assess the risk of major adverse cardiac events in patients with chest pain.
Background: To predict among all patients suffering form chest pain those at risk of developing major adverse cardiac event (MACE) is a clinical challenge. Heart Score is a post-test score simpler and more reliable than GRACE and TIMI RISK score, but fails to identify a number of cases ranging from 1.5 to 2.5%. The aim of this study was to evaluate the effectiveness of a new statistical model, the nomogram, in improving performance of Heart Score.
Methods: In this multicenter retrospective observational study we considered all the patients consecutively observed for chest pain from January to June 2021 in the Emergency Departments of the University Hospital of Verona and City Hospitals of Merano and Legnago. We excluded only the patients with incomplete or unreliable clinical documentation. Main outcome was the onset of MACE within a 3 months-follow-up. All anamnestic, clinical, laboratory and instrumental data were carefully recorded and included in the univariate analysis. The variables associated with outcome (significance level p<0.1) were subsequently evaluated in the multivariate anaysis by a Logistic Regression model and those proved to be significant predictors (accuracy level at least 0.5%) contributed to create the final model. In the nomogram, each variable was provided with an individual score based on its statistical weight and the total score corresponds to a risk probability. We further validate this model by internal bootstrap on a 5000 patients re-sample. Validation was performed with discrimination model, calculating the area under receiver operating characteristics curve (AUC).
Results: Out of 10964 observed patients, 9837 (5863 males, 3974 females, mean age 63 years) were enrolled in the study. Almost a quarter of them (22.9%) had a history of ischemic heart disease. In the follow-up period 1671 patients (16.9%) developed a MACE (MACE+) with a large prevalence of males (about 69%). In the univariate analysis variables proved more significantly (p<0.001) were: risk factors (median MACE+ 3 vs MACE- 1); Chest Pain Score (median 7 vs 4); duration of chest pain (median 1 vs 4 hours), electrocardiogram findings and troponin levels (median 70 vs 5). All these variables were confirmed significantly (p<0.001) in the subsequent multivariate analysis: risk factors (OR 2.66); Chest Pain Score (OR 1.24); pain duration (OR 1.47); electrocardiogram findings (OR 1.51); troponin levels (OR 2.01). The Logistic Regression model reached a good likelihood level (R=0.685). The individual score of these variables in the nomogram contributed to a final score from 0 to 220, corresponding to a 3-months MACE risk rate (range 0.1-0.9). Discrimination level of nomogram (AUC 0.954) was higher to the good ones (AUC 0.935) of Heart Score (p<0.005). In our series 5489 (55.8%) resulted “low-risk patients” according to Heart Score, but 89 of them suffered from MACE (1.6 out of MACE+). According to nomogram, only 3 of “low-risk patients” (risk rate < 0.2)developed a MACE (sensibility 99%, negative predictive value 99%).
Conclusions: The nomogram achieved a very good clinical and diagnostic performance and allowed a better stratification of the risk of MACE in an increasing continuum of probability.
As retrospective and non-randomized study neither Trail Registration nor informed consent was requested by our Ethical Committee
This study received no funds
Dr Antonio BONORA (VERONA, Italy), Gianni TURCATO, Arian ZABOLI, Angelica LUNARDI, Pasquale SALPIETRA, Francesco PRATTICÒ, Norbert PFEIFFER, Antonio MACCAGNANI
14:55 - 16:20
#30655 - Prehospital troponine, D-dimer and NT-proBNP as a trigger biomarker for quick-triage of high-risk in-hospital mortality by ischemic stroke.
Prehospital troponine, D-dimer and NT-proBNP as a trigger biomarker for quick-triage of high-risk in-hospital mortality by ischemic stroke.
Background: Fast recognition of acute stroke patients is a challenge for emergency medical systems (EMS). The time elapsed between presumptive diagnosis, confirmation by imaging studies, and reperfusion therapy makes the gap in morbimortality outcomes in ischemic stroke.
The aim of this study is to analyze the ability of prehospital cardiac biomarkers (troponine, D-dimer and NT-proBNP) to predict in-hospital mortality in patients attended in prehospital care with stroke code and final hospital diagnostic of ischemic stroke.
Methods: Prospective, multicentric, EMS-delivery, ambulance-based, pragmatic cohort study of adults with stroke code, referred to two tertiary care hospitals (Spain), between January 1st and December 31st, 2021. Any patient treated consecutively by EMS and transferred with high priority by ambulance to the ED was included in the study. Patients under 18 years of age, pregnant women, patients with psychiatric or terminal pathology, and patients discharged on site were excluded. Demographic data (age and sex) and venous sampling were collected during the first contact with the patient in prehospital care. The prehospital point-of-care cardiac was measured with the POC cobas h 232 analyzer (Roche Diagnostics, Mannheim, Germany). Mortality data were obtained by reviewing the patient's electronic history. The primary dependent variable was all-cause in-hospital mortality during 90-days follow-up from the index event. The area under the curve (AUC) of the receiver operating characteristic (ROC) of the cardiac biomarkers were calculated in terms of mortality.
Results: A total of 281 patients with a prehospital diagnosis of acute code stroke were transfer to ED, finally 150 patients with hospital diagnosis of ischemic stroke were included in our study. The median age was 61.8 years (IQR: 45-74 years), 48.6% of whom were women (73 cases). Mortality at 90-day was 5.33 % (8 cases). The cut-off points and AUROC of troponine, was 43.24 ng/L with an AUC of 0.725 (95%CI: 0.52-0.92; p=0.031); for D-dimer 464 ngr/ml and AUC of 0.678 (95%CI: 0.46-0.88; p=0.096); and for NT-proBNP 2091 pg/ml and AUC of 0.755 (95%CI: 0.55-0.95; p=0.012).
Conclusions: Cardiac biomarkers have a key role in the diagnosis, follow-up and prognosis of acute cardiovascular disease, but their role is not well defined in ischemic stroke
However, all 3 biomarkers analyzed in prehospital care do not yield spectacular results that could accurately guide the bedside diagnosis, nevertheless, indicate a tendency. The biomarker with the best performance is NT-proBNP, with elevated values of this biomarker corresponding to in-hospital mortality due to ischemic stroke.
This work was supported by the Gerencia Regional de Salud, Public Health System of Castilla y León (Spain) [grant number GRS 1903/A/19 and GRS 2131/A/20]
Francisco MARTÍN-RODRÍGUEZ, Carlos DEL POZO VEGAS (Valladolor, Spain), Ancor SANZ GARCÍA, Santiago OTERO DE LA TORRE, Francisco Tomás MARTÍNEZ FERNÁNDEZ, Miguel Angel CASTRO VILLAMOR, Juan Francisco DELGADO BENITO, Santiago LÓPEZ TORREZ, Rodrigo ENRIQUEZ DE SALAMANC GAMBARA, Enrique CASTRO PORTILLO, Irene SÁNCHEZ SOBERON, Almudena MORALES SÁNCHEZ, Ana BENITO JUSTEL, Rafael MARTÍN SÁNCHEZ
|
M1-2-3 |
16:30 |
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
A13
16:30 - 17:55
Ethics and Palliative Care
Moderator:
Bernard FOEX (Consultant in Emergency Medicine and Critical Care) (Moderator, Manchester, United Kingdom)
16:30 - 16:55
Possibilities and dignity in Emergency Care for nursing home residents.
Annmarie LASSEN (Professor in Emergency medicine) (Speaker, Odense, Denmark)
16:30 - 17:55
16:55 - 17:20
Palliative Sedation.
Eva DIEHL-WIESENECKER (Physician) (Speaker, Berlin, Germany)
17:20 - 17:45
Research ethics.
Bernard FOEX (Consultant in Emergency Medicine and Critical Care) (Speaker, Manchester, United Kingdom)
|
A6-7 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
B13
16:30 - 17:55
Infectious Disease and Sepsis Guidelines - Hyenas and Zebras
Moderator:
Youri YORDANOV (Médecin) (Moderator, Lyon, France)
16:30 - 17:55
16:30 - 16:55
Sepsis guidelines 2021.
Mikkel BRABRAND (Clinical professor, consultant, PhD) (Speaker, Odense, Denmark)
16:55 - 17:20
Do we need better infection prevention and control in the ED?
Martin PIN (Speaker, BORNHEIM, Germany)
16:55 - 17:20
Do we need better infection prevention and control in the ED?
Sonja HANSEN (Senior Hospital Epidemiologist) (Speaker, Berlin, Germany)
17:20 - 17:45
Animal bites in the ED.
Juan GUTIERREZ (Speaker, Bogota, Colombia)
|
A8 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
C13
16:30 - 17:55
Disaster Medicine III
Moderators:
Luc J M MORTELMANS (PHYSICIAN) (Moderator, Antwerp, Belgium), Steve PHOTIOU (Moderator, Crocetta del Montello (TV), Italy)
16:30 - 16:55
Cybersecurity.
Dr Jeffrey FRANC (Associate Professor) (Speaker, Edmonton, Italy)
16:55 - 17:55
Roundtable: Is it possible to create a European Disaster Management plan?
16:55 - 17:55
Moderator.
Steve PHOTIOU (Moderator, Crocetta del Montello (TV), Italy)
16:55 - 17:55
Is it possible to create a European Disaster Management plan? - Round Table.
Marc SABBE (Medical staff member) (Panelist, Leuven, Belgium)
16:55 - 17:55
Is it possible to create a European Disaster Management plan? - Round Table.
Abdo KHOURY (PROFESSEUR ASSOCIE) (Panelist, Besançon, France)
|
A1 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
D13
16:30 - 17:55
Award Ceremony
16:30 - 17:55
EMS Angels Awards.
Carmen Diana CIMPOESU (Prof. Head of ED) (Speaker, IASI, Romania)
16:30 - 17:10
EBEEM Graduation Ceremony.
Anna SPITERI (Consultant) (Moderator, Malta, Malta)
|
A2 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
E13
16:30 - 17:55
Various symptoms
Moderator:
Dr Jovanka BLUNK (Doctor) (Moderator, Hoppegarten, Germany)
16:30 - 16:45
Abnormal heart sounds.
Eric DRYVER (Consultant) (Speaker, Lund, Sweden)
16:45 - 16:55
Cyanosis.
Adela GOLEA (Associate Professor) (Speaker, Cluj Napoca, Romania)
17:45 - 17:55
Pain in the ear.
Nikolas SBYRAKIS (Consultant Emergency Physician) (Speaker, Heraklion, Greece)
16:55 - 17:05
Oedema.
Metin OMEROVIĆ (Speaker, Maribor, Slovenia)
17:05 - 17:20
Jaundice.
Adela GOLEA (Associate Professor) (Speaker, Cluj Napoca, Romania)
17:20 - 17:30
Pruritus.
Metin OMEROVIĆ (Speaker, Maribor, Slovenia)
17:30 - 17:45
Ulcers.
Nikolas SBYRAKIS (Consultant Emergency Physician) (Speaker, Heraklion, Greece)
|
A4 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
F13
16:30 - 17:55
Hospital without walls
Moderator:
Anastasia SPARTINOU (Emergency Medicine Trainee) (Moderator, HERAKLION, Greece)
16:30 - 16:55
Retrieval Medicine from Dispatch to Patient: When the Medicine is easy.
Ryan MCHENRY (EM Trainee) (Speaker, Glasgow, United Kingdom)
16:55 - 17:20
Everyday life for a paramedic in South Africa.
Mikayla VAN WELIE (Lecturer) (Speaker, Johannesburg, South Africa)
17:20 - 17:45
Life of prehospital EMS in France.
Eric REVUE (Chef de Service) (Speaker, Paris, France)
|
A5 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
G13
16:30 - 17:55
Pflege in der Notaufnahme - wer arbeiter wie?
Moderators:
Patrick DORMANN (Teammember) (Moderator, Köln, Germany), Philipp VERTON (Moderator, Germany)
16:30 - 16:55
Interprofessionalitt in der Notaufnahme (Arbeitstitel).
Mareen MACHNER (Speaker, Germany)
16:55 - 17:20
Personalmix - wer arbeitet da berhaupt.
Michael KEGEL (Speaker, Brem, Germany)
17:20 - 17:45
Mindestpersonalbesetzung - wie viele Mitarbeiter braucht es?
Stella MERENDINO (Nurse) (Speaker, Berlin, Germany)
|
A3 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
10
16:30 - 17:00
Meet the Digital EM Workgroup
16:30 - 17:00
Digital Medicine Working Group Chair.
Thomas SAUTER (Consultant) (Moderator, Bern, Switzerland)
|
EUSEM Podium |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
H13
16:30 - 17:55
COVID
Moderator:
Pr Cem OKTAY (FACULTY) (Moderator, ANTALYA, Turkey)
16:30 - 17:55
#31313 - A comparison of emergency department presentations for medically unexplained symptoms in frequent attenders during COVID-19.
A comparison of emergency department presentations for medically unexplained symptoms in frequent attenders during COVID-19.
Background:
Particularly challenging emergency department (ED) presentations are those in which symptoms have no identified organic aetiology, referred to as medically unexplained symptoms (MUS) . MUS is a common presentation in frequent attenders (FAs). Our emergency department (ED) perceived an increase in MUS frequency during COVID-19. The aims were to compare the incidence of FA-MUS during COVID-19 with a control period and the frequency of MUS presenting complaints between the two time periods.
Methods:
A retrospective observational study was performed. Cambridge University Hospital ED attendance data were used to identify FA, defined as five or more ED visits during either 122-day study period: 1 March to 30 June 2019 (control) and 1 March to 30 June 2020 (COVID-19). A retrospective list of FA-MUS presenting during study period was compared. The presenting complaint was designated as MUS if there were investigations with no abnormal findings and no signs of organic disease. As we routinely collect FA data in our ED, we decided to use FA-MUS as a proxy for the general MUS population.
Fisher's exact test was used to compare binomial proportions; this was presented as relative risk (RR) with 95% confidence intervals (95%CI). In order to report population incidence per 1,000 people per year, the number of patients and the number of visits were multiplied by 2.99 (356.25 days/122 days) and then divided by the ONS local population estimate. The primary outcome was to compare the incidence of FA-MUS during COVID-19 with the control period. The secondary aim was to compare the frequency of MUS presenting complaints between the two time periods. To minimise reviewer bias, two authors independently reviewed all ED case notes. Any disagreement in either MUS diagnosis or categorisation was arbitrated by a third author.
Results
There were a total of n=42,785 ED visits in the control period and n=28,806 in the COVID-19 period, a decrease of 32.7%.Despite this, there was a significant increase in both the incidence of FA-MUS ED patients and the corresponding incidence of FA-MUS ED visits during the COVID-19 period compared to control: RR 1.5 (95%CI 1.1–1.8), p=0.0006, and RR 1.8 (95%CI 1.6–2.0), p<0.0001, respectively. Of the presenting symptoms for MUS patients, the only difference observed was a significant increase in the MUS category SOB during the COVID-19 period (p<0.01).
Discussion & Conclusions
Despite reduced ED attendances during COVID-19, there was a significant increase in the incidence of FA-MUS patients and corresponding ED visits by this cohort. SOB was the only MUS presentation that significantly increased during COVID-19, likely secondary to pandemic-related anxiety. The high prevalence of FA-MUS in the ED is likely a symptom of the general trend of unmet needs for this diverse and vulnerable group elsewhere in the healthcare system. This paper adds further evidence that the needs of these individuals with MUS may not be being met, and in added stressors such as the COVID-19 pandemic, their needs are further exacerbated.
This project was registered at CUH as a service evaluation (ID3270 PRN9270); ethical review was not required by the local research ethics committee. Data were handled in accordance with the UK Data Protection Act 2018.
Natasha Faye DANIELS ` (london, United Kingdom), Raiiq RIDWAN, Catherine HAYHURST, Talha AMANULLAH, Ed BARNARD
16:30 - 17:55
#31070 - Ambulance use during the COVID-19 pandemic; a nationwide population-based study.
Ambulance use during the COVID-19 pandemic; a nationwide population-based study.
Background:
Several studies have described the effect of the COVID-19 pandemic on the general population and on hospitals, but few on the prehospital setting. In general, we would expect the number of patients with severe medical issues to remain constant (i.e., the number of cardiac arrests each year) regardless of a pandemic. Our aim was to investigate the COVID-19 pandemic’s influence on patients requesting an ambulance.
Methods:
Registry-based study of patients transported by ambulance during the first COVID-19 waves in Denmark from 1 March to 31 December 2020, compared to the same period in 2019.
In Denmark, healthcare is tax funded. The police initially answer the emergency number (i.e., 112) and forward the call to a healthcare professional in case of a medical emergency. They assess the situation and dispatch the relevant emergency vehicles supported by a national guideline (Danish Index for Emergency care (Danish Index) with 37 categories) pertaining to the situation and/or symptoms.
We included all patients in Denmark who had called the emergency number and subsequently been transported to hospital by an ambulance. Patients without a valid civil registration number were excluded.
Primary outcome was the number of patients, and patients stratified by dispatch category, obtained from the Danish Prehospital Medical Records. We also extracted the hospital diagnosis, age and sex from the National Patient Register and the Danish Civil Registration System. All linkage of data was facilitated by the patients’ civil registration number.
Descriptive statistics were applied to summarize variables which were presented as frequency, means, percentages, and 95% confidence intervals. Stata 17 was used for all analyses.
Results:
We included 348,160 patients transported to a hospital by ambulance in the study period. Fewer patients were seen by an ambulance in 2020 compared to 2019 (29 vs 31 patients per 100.000 capita). The number of patients varied over the months with fewer patients in the spring, more in summer, and then again fewer in fall and winter – corresponding to the inverse number of citizens infected with COVID-19 in the same periods.
The four most frequently used dispatch categories (i.e., Chest pain, Decreased consciousness, Breathing difficulties and Accidents) all followed the same seasonal pattern. The fifth most frequently used category (i.e., Unclarified problem), had 5 - 33% fewer patients in all of 2020.
Discharge diagnoses also followed the same seasonal pattern for the four most frequent, Symptoms and signs, Injuries and poisoning, Other factors, and Circulatory diseases. Respiratory diseases (fifth most frequent) had 2 - 54% fewer patients in 2020.
Patients in 2020 were older with a mean age of 58.4 years (95%CI: 58.2 to 58.5) compared to 56.9 years (95%CI: 56.8 to 57.0).
Discussion & Conclusions:
The overall pattern in the number of patients, Danish Index category, and discharge diagnoses, demonstrate the effect of COVID-19. However, the excluded patients, representing the remaining prehospital population was not investigated and may follow a different pattern.
The results of this study could suggest the included patient populace was “redirected” elsewhere during the first COVID-19 wave.
Trial Registration: Protocol not registered as this was a registry-based study. However, The Danish Patient Safety Authority approved disclosure of patient medical records (31-1521-299). According to Danish legislation, registry-based studies that do not involve biological material do not require approval from the National Committee on Health Research Ethics.
Funding: This study did not receive any specific funding.
Tim LINDSKOU (Aalborg, Denmark), Søren BOGH, Torben KLØJGAARD, Erika CHRISTENSEN, Mikkel BRABRAND, Søren MIKKELSEN
16:30 - 17:55
#31498 - COVID-19 patients in the Brazilian second wave have more severe disease, but mortality did not increase: a retrospective cohort.
COVID-19 patients in the Brazilian second wave have more severe disease, but mortality did not increase: a retrospective cohort.
Background: Since its onset in 2020, the management of patients with COVID-19 has changed significantly. Other SARS-CoV-2 variants emerged, with different infectivity and lethality, while the physicians' knowledge and experience have grown. Given all these changes, this study aims to compare different pandemic periods to evaluate how these aspects impacted the disease outcomes.
Methods: It is a retrospective cohort, including patients admitted to the Emergency Department in a tertiary academic hospital, designated as the primary center for attending severe COVID-19 in São Paulo, Brazil. Patients were divided into two groups: from March to August 2020 and from November 2020 to March 2021, and the primary outcome analyzed was mortality. All consecutive adult patients with confirmed COVID-19 (defined as at least one positive result rtPCR obtained from nasopharyngeal swabs or bronchial secretions) admitted at the hospital at least two days after symptoms onset were included. Data were collected through electronic medical records, and the databases were built on REDCap® software. Analyses were performed on R software version 4.1.2. Numerical variables were analyzed using the Mann-Whitney-Wilcoxon test and categorical variables through the chi-square method. A p-value <0.05 was considered significant.
Results: Overall, 2955 patients were included. Inclusion of the first 2154 patients coincided with a higher prevalence of B.1.1.33 and B.1.1.28 variants. The second group comprised 801 patients, when the P.2 variant was predominant. There was no significant difference between groups regarding age and sex. Patients admitted to the hospital in the second period arrived nine days after the beginning of symptoms, compared to seven days in the first group (p<0.01). Patients from the second period also had higher SAPS3 (65 to 56, p<0.01), a score for mortality prediction validated for COVID-19. Patients from the second group presented fewer symptoms, such as fever, dyspnea, and cough; however, 65% were classified as regular or poor general state, compared to 47% in the first group (p<0.01). Patients in the second group received more corticosteroids (95% to 59%, p<0.01) and fewer vasoactive drugs (41% to 53%, p<0.01). Moreover, patients in the second group were submitted to endotracheal intubation more frequently (44% to 32%, p<0.01). Despite these differences, mortality was similar in both groups (32%).
Discussion and conclusions: During the pandemic course, people avoided seeking medical help earlier, getting to the ED in worse conditions. Probable causes were the high number of in-hospital COVID-19 deaths and the overcrowded hospitals. Interestingly, there was no increase in mortality, which shows that physicians' expertise, such as broadly administering corticosteroids, is positively weighting in patients' outcomes.
Ethical approval and informed consent: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068), which also waived the need for written informed consent. We adhere to STROBE guidelines.
Trial registration: This study was registered as RBR-5d4dj5 at ensaiosclinicos.gov.br
Ethical approval and informed consent: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068), which also waived the need for written informed consent. We adhere to STROBE guidelines.
Funding: FAPESP and HCFMUSP
Juliana STERNLICHT (São Paulo, Brazil), Eduardo CORREA, Lucas MARINO, Julio MARCHINI, Julio ALENCAR, Rodrigo BRANDÃO, Ian MAIA, Katia DA SILVA, Vilson COBELLO, Gomez LUZ, Heraldo SOUZA
16:30 - 17:55
#31594 - Efficacy of a herbal treatment in Headaches Caused by COVID 19.
Efficacy of a herbal treatment in Headaches Caused by COVID 19.
Introduction: Coronaviruses are a large family of viruses that can cause a variety of illnesses in humans, ranging from the common cold to Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). A new coronavirus (COVID-19) was identified in 2019 in Wuhan, China. He is currently responsible for a pandemic since November 2019.Since headache is one of the signs caused by this virus, the objective of our study is to test the efficacy of quercitin phytosome in the treatment of headache relatedtoCOVID-19.
Materials and methods: We report a randomized double-blind study. All cases of COVID-19 pneumonia confirmed by PCR requiring hospitalization or over 40 years of age with comorbidity and whose symptoms have progressed for less than five days during the period from June 2021 to October 2021 have been included. The patients were divided into 2 groups: a group A who will take a placebo and a group B who will be treated with quercitin plus.Each patient included, after signing the consent, will have a treatment for 27 days: This medication is taken as 1 capsule twice a day for the first 3 days, 30 minutes before meals. From the fourth day, this drug is taken as 1 capsule per day.
Results:We collected 186 cases during this period. The average age of our population is 46 with extremes of 17 and 80. A female predominance was noted in the entire study population with 60% of cases. 128 patients presented with headaches at the time of the consultation and are concerned by this analysis. 57 patients received quercitin phytosome (group B) and 71 received placebo (group A).A telephone check made on D2, D5, D10, D15 and D30 does not show any difference between the 02 groups in terms of the disappearance of the headache. On D30, 77% of the patients who received the active principle no longer suffered from headache compared to 70.4% in group A. this difference is not statistically significant (P = 0.387).
Conclusion: Based on our study and data from the literature, quercitin phytosome has no effect on headache caused by COVID-19.
Arij BAKIR, Hana KHARRAT (sousse, Tunisia), Wiem HOUAS, Houda BEN SALAH, Rym YOUSSEF, Asma ZORGATI, Lotfi BOUKADIDA, Riadh BOUKEF
16:30 - 17:55
#31545 - Evaluation of the effectiveness of different doses of corticosteroid therapy in the management of COVID-19 in emergency departement.
Evaluation of the effectiveness of different doses of corticosteroid therapy in the management of COVID-19 in emergency departement.
Introduction: Covid-19 is a pandemic of an emerging infectious disease, caused by the SARS-COV-2 coronavirus. Concrete scientific evidence adds up in favor of the use of corticosteroids, used in numerous indications for its powerful anti-inflammatory effect, in the management of severe forms of Covid19 disease, triggered by the SARS-COV coronavirus.Objective: The objective of this study is to assess the efficacy of corticosteroids according to the dose administered in the management of covid19 positive patients admitted to the emergency room.
Methods: This is a retrospective study including patients admitted to the emergency department diagnosed as SARS-COV-2 positive. Our study population was divided into three groups: the first group which received 6 mg of corticosteroid, the second group which received 10 mg and the third group which received 20 mg. Depending on the doses of corticosteroids administered (6 mg; 10 mg; 20 mg), we followed the evolution of the condition of each patient included in our study in terms of mortality, oxygen requirements, hospitalization in intensive care and / or recourse to invasive mechanical ventilation as well as complications arising during hospitalization.
Results: 1223 patients were included. The mean age was 49.2 ± 10. 51% are men. Associated comorbidities are: diabetes in 22.7%, hypertension in 25.2%, chronic renal failure in 7.5% and chronic respiratory disease in 6.5%.For patients not put on corticosteroids, mortality is 3%, the use of mechanical ventilation was noted in 5% of cases. For patients who received corticosteroid therapy at a dose of 6 mg, mortality was 0%; and mechanical ventilation was not used in any of these patients. These same results were also noted in patients who received corticosteroid therapy at a dose of 10 mg;In addition, the unfavorable evolution was more marked for the patients receiving the highest doses of corticosteroids with a percentage of hospitalization in intensive care of up to 24%, and a high complication rate (ARDS 28.9%; EP 1.2 %; CIVD 1.2%; myocarditis 2.4%). Mortality in this group was 23.8%.
Conclusion: Patients who have received low doses of corticosteroids have a lower risk of developing severe forms of covid pneumonia and the mortality rate is lower in patients who have not received a corticosteroid. For patients who have received high doses, even if the administration of corticosteroids seems effective in terms of reducing oxygen requirements and resorting to mechanical ventilation and consequently reducing mortality; this effectiveness remains proportional given that patients put on a high dose of corticosteroids are those with extensive lung injury with deep hypoxia and a high risk of progression to respiratory failure and death.
Ahmed MOHAMED EL HEDI (Sousse, Tunisia), Hajer YAAKOUBI, Kais MANSOURI, Roua CHOUIHI, Anouer FHAL, Rahma JABALLAH, Lotfi BOUKADIDA, Riadh BOUKEF
16:30 - 17:55
#31334 - Impact of COVID-19 in a highly vaccinated region.
Impact of COVID-19 in a highly vaccinated region.
Background: The Australian Capital Territory had an initial successful public health response to the COVID-19 pandemic with only 15 deaths in a population of 431000 and a very high double vaccination rate of 89% (aged over 5 years) by the end of 2021. Periods of lockdown were associated with reduced Emergency Department activity. Two further waves have now infected over 114000 though still with a low mortality of 43 (0.04%), whilst ongoing vaccination and targeted use of antivirals continue.
Aim: To describe the characteristics of local community- acquired cases of COVID-19 requiring hospitalisation and the impact on Emergency services during the three major waves.
Methods: Prospective descriptive study of community-acquired cases of COVID-19 admitted to hospital in the Australian Capital Territory from the local area. Cases were grouped into three waves based on the predominant circulating strain: Delta, 12-Aug-21 to 21-Dec-21, Omicron BA.1, 22-Dec-21 to 8-Feb-22, Omicron BA.2, 9-Feb-22 to 10-May-22 (ongoing). Cases were classified on the basis of record review as admitted due to COVID-19 or due to other causes (incidental case). Emergency Department activity was measured by 7day moving mean daily presentations and ward admissions in the one tertiary ED with retrospective controls from 2017-19.
Results: The Delta wave consisted of 2197 reported cases with 153 admissions by 148 patients (6.7%, 95%CI 5.7-7.9) over 19 weeks. The Omicron BA.1 wave consisted of 35729 cases with 233 admissions by 224 patients (0.65%, 0.57-0.74) over 7 weeks and the Omicron BA.2 wave consisted of 76937 cases with 398 admissions by 384 patients (0.50%, 0.45-0.55) over 13 weeks. Admission rates fell during the Delta wave as vaccinations rolled out, but remained constant during the Omicron waves. The proportion of "other cause" admissions rose significantly across the three waves: 16.3%, 39.7%, 47.5%. The age distribution for admissions peaked in 40-49 years for Delta, but in <10 years and >80 years for both Omicron waves. 92% of admissions came through Emergency Departments.
Tertiary Emergency Department activity decreased during the lockdown associated with the Delta wave with 7-day average presentations falling by 25.2% compared to controls and admissions by 21.1% before recovering by the end of the wave. During the BA.1 wave when no lockdown was imposed, presentations fell by 13.9% and admissions by 8.4%, recovering early in the BA.2 wave to then reach 7.8% and 7.1% higher respectively. In the BA.1 wave which was the busiest time for COVID-19 admissions they made up 202 of 2662 total admissions (7.6%, 6.6-8.7).
Conclusions: High vaccination rates and increasing preventative use of antivirals were associated with low and falling admission rates despite infections involving 25% of the population. Emergency activity was reduced during community lockdowns in the Delta wave and voluntarily early in the Omicron wave but has since returned to record high levels. The COVID-19 workload has not been a major numerical component of Emergency Department activity, though the pandemic had impacts through isolation procedures and staff quarantine.
Ethics: Approved by the ACT Health Research Ethics Committee
Internally funded, ethics approved, not registered
Drew RICHARDSON (Canberra, Australia)
16:30 - 17:55
#31660 - Impact of the SARS-CoV2 pandemic on the therapy of acute exacerbations of chronic obstructive lung disease (COPD) at the emergency department.
Impact of the SARS-CoV2 pandemic on the therapy of acute exacerbations of chronic obstructive lung disease (COPD) at the emergency department.
BACKGROUND: Acute exacerbation of COPD (AE-COPD) is common at the emergency department (ED), non-invasive ventilation (NIV, including CPAP-masks and high-flow nasal oxygen) often being the treatment of choice. Aerosol forming ways of treatment are, however, not recommended as long as a Covid-infection is possible. During the first wave of the pandemic, antigen-tests were not yet widely available and reliable, and it could take up to 2h until the SARS-CoV2-status was known. Together with limited ICU space due to need for isolation, this could have led to a deterioration of care.
METHODS: We compared the first year of the pandemic (15.3.2020-14.3.2021) to the same period one year before (15.3.2019-14.3.2020). We included all patients with AE-COPD at our ED, and analysed treatment received by those with an indication for NIV The study was approved by the local ethics board (Vote 1313/2021).
RESULTS: A total of 995 patients (53% male, median age 71 years) were included (581 before, 414 during pandemic), eleven being diagnosed with Covid. Patients were similar in both groups regarding vital signs, initial pCO2 (50 vs 52mmHg), and pH (7.3 vs 7.2). The proportion of patients with indication for NIV non-significantly increased from 19% (112 patients) to 22% (93 patients). Of those, 77 (69%) and 73 (78%, p=0.12) received NIV, the remainder being ventilated invasively.
CONCLUSION: During the pandemic, visits for AE-COPD declined. Those patients with an indication for NIV were however treated the same during both periods. We found no effect of a possible “fear from aerosols” on treatment.
We did not receive any funding.
Ethics comitee number: 1313/2021
Verena FUHRMANN (Vienna, Austria), Bettina WANDL, Anton LAGGNER, Dominik ROTH
16:30 - 17:55
#31425 - Post COVID and quality of life.
Post COVID and quality of life.
Introduction :
Thelong-term effects of coronavirus disease 2019 (COVID-19), also called long Covid, can lead to considerable disability, functional limitations and loss of productivity and resources. This significantly affects not only leisure and social activities, but also the ability to care for oneself, care for children or the elderly, and perform household chores. This study aims to assess the impact of long covidon the quality of life of patients who were hospitalized for covid 19.
Methods :
We carried out an exhaustive longitudinal descriptive study including patients hospitalized for hypoxemic pneumonia due to COVID 19 in December 2020 and January 2021. The follow-up lasted 3 months. We assessed their quality of life using the WHO EQ-5D health-related questionnaire.The evaluation concerned the autonomy, the degree of activity limitation, possible pains and the mental state.
Results :
Our study population consisted of 30 patients, among which63.3% were hospitalized in a medical department and 36.7% were hospitalized in the intensive care unit. The mean duration of hospitalization was 11.9 days and the medianduration of oxygen therapy was 12 days.
Regarding mobility, 20% of patientssuffered fromminormobility problems and 80%suffered from moderate to severe problems after 1 month of infection. After 3 months, only 5% of patients had minor mobility problems and 10% had moderate to severe problems.
For self-care, 13.3%of patients had minor problems and 12% had moderate to severe problems after one month. After 3 months, only 9% patients had moderate to severe problems.
For daily activities, 20% of patients had minor problems and 18% had moderate to severe problems after one month. After 3 months, 6.7% of patients had minor problems and 3% patients had moderate to severe problems.
Several patients complained from persistent pain with a prevalence of 36.7% which50%of them had moderate to severe pain after 1 month. After 3 months, only 30% remained in moderate to severe pain.
Regarding psychological well-being, 12% patients felt anxious or depressed after 1 month and 5% patients after 3 months.
Conclusion :
The long COVID can cause an alteration in the quality of life, psychological discomfort and problems of autonomy, hence the importance of multidisciplinary care for these patients in order to minimize the sequelaes and improve patients’ mental health.
Rabeb MBAREK, Khouloud ROMDHANE, Dr Dorra LOGHMARI, Ines KHALIFA, Farrouk DOUMA, Raed KADHI, Sondos LAAJIMI (Sousse, Tunisia), Naoufel CHEBILI
16:30 - 17:55
#31140 - Stigmatization of healthcare workers due to COVID-19 and its consequences on mental health: Mixed method study.
Stigmatization of healthcare workers due to COVID-19 and its consequences on mental health: Mixed method study.
Background:
Stigma associated with exposure to COVID-19 presents a threat to wellbeing of healthcare workers and functioning of the health care systems. Stigmatization leads to negative consequences, such as discrimination, social rejection or negative social judgements due to fear of infection. It also causes people to hide their illness and discourage them from adopting healthy behaviors. Stigma often also affects mental health of stigmatized people. The aim of this study was to describe occurrence of stigmatization-related experiences among healthcare workers and their association with mental health problems.
Methods:
Using mixed method design, we explored experiences of stigmatization related to COVID-19 reported in a prospective cohort study. Our respondents were healthcare workers (physicians, nurses, paramedics, and social workers) in Czech Republic enrolled in two waves of an on-line survey conducted in summer 2020 (n=929) and spring 2021 (n=1206). Surveys are a part of the global HEROES study taking place in 26 countries. Eligible respondents were workers in healthcare or social services. The questionnaire was distributed through medical professional organizations and hospital centers. Quantitative analysis included a question regarding experience of stigmatization and three indicators of mental health: 1) psychological distress, 2) depressive symptomatology, and 3) suicide ideation. Odds ratios (ORs) were calculated from logistic regression models for each wave to describe association between stigmatization and mental health outcomes (all models were adjusted for age, sex, and occupation). Qualitative analysis involved open-ended responses from the same survey. Qualitative data were processed in Atlas.ti software by using content analysis approach.
Results:
Similar percentage of respondents in both waves reported experiencing COVID-19-related stigmatization due to their profession (wave 1: 29.6%; wave 2: 26.2%). Experience of stigmatization was associated with considerably increased risk of at least moderate level of psychological distress in both waves (wave 1 OR: 2.72; wave 2 OR: 1.71), moderate level of depressive symptoms (wave 1 OR: 3.44; wave 2 OR: 2.38), and suicidal ideation (wave 1 OR: 3.55; wave 2 OR: 2.02). Qualitative analysis of open-ended responses revealed that healthcare workers experienced rejection and social isolation in various life spheres, such as leisure time activities, families, side jobs, community activities, and public life. They reported discrimination in childcare since their children were rejected in kindergartens or schools. Workplace stigmatization was represented by violation of work rules and conditions or rumor among colleagues.
Conclusions:
More than one quarter of Czech healthcare workers involved in this study experienced stigmatization due to their profession during the COVID-19 pandemic. Stigmatization was associated with increased probability of mental health problems. Anti-stigma interventions should focus on fostering long-term public support of frontline workers, highlight a sense of community and joint social responsibility. Workplaces should provide healthcare workers with supervision and mental health counselling.
Funding: The research has been funded by the Ministry of Health of the Czech Republic (grant NU22J-09-00064)
Miroslava JANOUŠKOVÁ (Prague, Czech Republic), Jana ŠEBLOVÁ, Pavla ČERMÁKOVÁ, Jaroslav PEKARA, Matěj KUČERA, Dominika ŠEBLOVÁ
|
M1-2-3 |
|
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
410
16:30 - 18:00
EUSEM Working Group on Quality and Safety in EM Meeting
Chairperson:
Pr Abdelouahab BELLOU (Director of Institute) (Chairperson, Guangzhou, China)
|
R2 |
18:05 |
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
A14
18:05 - 18:35
Keynote lecture: Why I chose Emergency Medicine
Moderator:
Abdo KHOURY (PROFESSEUR ASSOCIE) (Moderator, Besançon, France)
18:05 - 18:35
Why I chose Emergency Medicine.
Koen MONSIEURS (Director) (Speaker, Antwerp, Belgium)
|
A6-7 |
18:35 |
"Sunday 16 October"
Added to your list of favorites
Deleted from your list of favorites
A15
18:35 - 19:05
Opening Ceremony
s:
Abdo KHOURY (PROFESSEUR ASSOCIE) (Besançon, France), Martin PIN (BORNHEIM, Germany), Patrick PLAISANCE (Head of Department) (Paris, France)
18:35 - 18:39
Welcome Addresses.
18:35 - 18:39
Welcome from local organizers.
18:35 - 19:05
18:39 - 18:45
Video from the Health minister.
18:45 - 18:47
Emergency Medicine day video.
18:47 - 18:50
Welcome from Chair Organizer.
18:50 - 18:52
EuroSimCup video.
18:52 - 18:54
Restart a Heart Day.
18:54 - 19:02
Official opening of the EUSEM congress by the EUSEM president.
|
A6-7 |