Wednesday 19 October |
08:00 |
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A40
08:00 - 08:30
Keynote lecture: Managing challenges with a slack brain - ideas from a Neurosurgeon
Speaker:
Peter VAJKOCZY (Speaker, Germany)
Moderator:
Canberk Djan MESELI (EMERGENCY MEDICINE RESIDENT) (Moderator, DUBLIN, Ireland)
08:00 - 08:30
Speaker.
Peter VAJKOCZY (Speaker, Germany)
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A6-7 |
08:40 |
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A41
08:40 - 10:05
Major Trauma - Hot Topics and Research
Moderator:
Carlos GARCIA ROSAS (Moderator, MEXICO, Mexico)
08:40 - 10:05
08:40 - 09:05
Best Trauma Papes 2021/2022.
Simon CARLEY (Consultant in Emergency Medicine) (Speaker, Manchester, United Kingdom)
09:05 - 09:30
Improving outcomes for older patients.
Caroline LEECH (Speaker, Coventry)
09:30 - 09:55
Transfusion in the trauma patient - What's the current state of art?
Carlos GARCIA ROSAS (Speaker, MEXICO, Mexico)
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A6-7 |
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B41
08:40 - 10:05
Emergency Medicine in Rural Areas - From harm to telemedicine
Moderator:
Dr Monika BRODMANN MAEDER (Senior Consultant, Head of Education and Mountain Emergency Medicine) (Moderator, Bern, Switzerland)
08:40 - 09:00
Telemedicine Red Cross in Lower Austria - First steps into the future.
Berndt SCHREINER (Speaker, FUCHSENBIGL, Austria)
08:40 - 10:05
09:00 - 09:20
Rural medicin in Townships.
Stevan BRUIJNS (Honorary Associate Professor) (Speaker, Yetminster)
09:20 - 09:40
500 Kilometers to the nearest hospital.
Tanita LEHTONEN (Speaker, Ivalo, Finland)
09:20 - 09:40
How to instruct colleagues in the ED to perform invasive procedures via zoom.
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A8 |
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C41
08:40 - 10:05
Rheumatologic Emergencies - Red joints, strange rashes and difficult diagnoses
Moderator:
Eric REVUE (Chef de Service) (Moderator, Paris, France)
08:40 - 09:05
Assessment and management of back pain in the ED.
Adam CHESTERS (Speaker, Cambridge, United Kingdom)
09:05 - 09:30
Temporal arteritis in the ED.
Pascal SEITZ (Speaker, Switzerland)
09:30 - 09:55
Approach to the red joint in the ED.
Indy GHOSH (Speaker, MISSISSAUGA, Canada)
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A1 |
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D41
08:40 - 10:05
Toxicologic emergencies
Moderators:
Kurt ANSEEUW (Medical doctor) (Moderator, Antwerp, Belgium), Pr Bruno MEGARBANE (Professor, head of the department) (Moderator, Paris, France)
08:40 - 09:05
Ingested button battery; should we bother?
Stephanie VAN BIERVLIET (Speaker, Brugge, Belgium)
09:05 - 09:30
Paracetamol poisoning : is SNAP the new black? And what about fomepizole?
Ruben THANACOODY (Speaker, Newcastle-upon-Tyne)
09:30 - 09:55
Drug-induced respiratory depression.
Pr Bruno MEGARBANE (Professor, head of the department) (Speaker, Paris, France)
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A2 |
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E41
08:40 - 10:05
Psychiatric emergencies
Moderator:
Francesca INNOCENTI (PHYSICIAN) (Moderator, Florence, Italy)
08:40 - 08:55
Mental status examination.
Karen PEETERS (Resident) (Speaker, Antwerp, Belgium)
08:55 - 09:15
Agitation/aggression.
Karen PEETERS (Resident) (Speaker, Antwerp, Belgium)
09:15 - 09:40
Confusion/delirium.
Declan STEWART (Ltd. OA) (Speaker, Rostock, Germany, Germany)
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A4 |
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F41
08:40 - 10:05
You won't believe what I have seen II
Moderator:
Ryan MCHENRY (EM Trainee) (Moderator, Glasgow, United Kingdom)
08:40 - 09:05
What is rare, is beautiful.
Susan UI BHROIN (Emergency Medicine Specialist Registrar) (Speaker, Dublin, Ireland)
09:05 - 09:30
Paediatric traumatic cardiac arrest.
Niamh BEIRNE (Speaker, Ireland)
09:30 - 09:55
Grayanatoxin poisining.
Seyran S. NAS (Doctor) (Speaker, Turkey, Turkey)
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A5 |
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"Wednesday 19 October"
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G41
08:40 - 10:05
Kritische Interaktionen zwischen Patienten und Notaufnahmepersonal
Moderators:
Isabel LUECK (Resident) (Moderator, Hamburg, Germany), Frank WÖSTEN (Moderator, Germany)
08:40 - 09:05
Gewalt in Notaufnahmen - eine Bestandsaufnahme.
Greta ULLRICH (Leitende Ärztin ZNA) (Speaker, Köln, Germany)
09:05 - 09:30
Prventionsstrategien.
Tobias LINDNER (Consultant) (Speaker, Berlin, Germany)
09:30 - 09:55
Patienten mit Angst in der Notaufnahme.
Kristian WEIHERS (Speaker, Germany)
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A3 |
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H41
08:40 - 10:05
Well-being
Moderator:
Canberk Djan MESELI (EMERGENCY MEDICINE RESIDENT) (Moderator, DUBLIN, Ireland)
08:40 - 10:05
#31651 - A crossover study on the feasibility and the effect of powernaps for healthcare workers during nightshift.
A crossover study on the feasibility and the effect of powernaps for healthcare workers during nightshift.
Background
Nightshift workers have decreased cognitive capacity, vigilance, sleep deprivation and feel tired due to circadian dyssynchrony. To deliver excellent care and assure good wellbeing for nightshift workers, it is important to limit fatigue and sleepiness. Powernaps during nightshift might reduce these negative effects. The primary aim of this study was to assess the effect of powernapping during nightshifts on fatigue and vigilance.
Methods
A crossover design study was performed between March and April 2021. Candidates in this study were nurses, residents and emergency physicians working in a large, Dutch, hospital. After voluntary inclusion participants were followed during two nightshift blocks. They were randomly assigned to start with either the control condition, or the intervention condition and crossed over to the other condition during their next nightshift block. In the control condition no powernaps were allowed. In the intervention condition, they performed a 20-minute-powernap between 2-4 AM. Vigilance and sleepiness were tested three times during both conditions, before and after the powernap and at the end of the nightshift. Vigilance was tested using a 5-minute psychomotor vigilance test (PVT). Karolinska sleepiness score (KSS) measured sleepiness. For between-group comparisons estimated marginal means corrected for baseline measurements were used.
Results
56 healthcare workers were included in the study. 59% of the participants worked at the emergency department. 24% percent was able to complete all tests in both conditions. 16% of participants tested the intervention only and 14.5% the control condition only. 17% of participants tested more than one shift in both conditions. Overall, 91 nightshifts were analyzed with even distribution between the conditions. The mean KSS increased from 3.3 to 6.0 in the control condition comparing to 3.4 to 4.8 in the intervention condition. This increase was 1.3 points lower compared to the control group, which is statistically significant.
The mean reaction time in the control group started at 459 milliseconds (ms) and increased to 468 ms in the powernap condition starting reaction time was 449ms and increased to 532ms at the end of the shift. This difference was not considered statistically significant, p-value 0.07 compared to control situation.
Conclusions and discussion
Performing a powernap during a nightshift can be difficult due to working demands. However, when performed between 2-4 AM, it can improve subjective feeling of sleepiness. The increased reaction time at the end of a nightshift after a powernap might be due to sleep inertia. It is the feeling of grogginess people experience after awakening lasting between 15-30 minutes. The reported decrease of sleepiness after a powernap however contradicts this hypothesis. This might be due to a reporting bias in the KSS since the powernap chairs in this study were a trial installation in all of the participating departments except the ED. Evidence on the occurrence and timing of sleep inertia after a nap is inconsistent in current literature. The timing of the powernap as well as the timing of the last measurement isn’t registered in this study therefore these data cannot predict the timing or duration of sleep inertia.
Funding for this research was provided by the SGO-fonds. It is a foundation that supports scientific research by Emergency Physicians in The Netherlands. www.SGOfonds.nl
Nienke HOOGKAMP (Nijmegen, The Netherlands)
08:40 - 10:05
#31490 - Changes in Cortisol Level in Experimentally-induced Pain Model in Healthy Volunteers.
Changes in Cortisol Level in Experimentally-induced Pain Model in Healthy Volunteers.
Acute pain is one of the most common complaints concerning referral to the emergency department. Pain remains misdiagnosed and mistreated despite all current pain evaluation measurements (pain scales, physiological parameters). Cortisol is identified as stress and pain-marker during acute pain. The aim of this study was to evaluate any changes in cortisol and if there were any changes during the pain stimulus experiment in healthy volunteers.
Methods: a prospective experimental study was performed, and healthy volunteers were included in the study. All volunteers underwent a specific controlled-pain experimental procedure. The first phase (10min) – calm sitting followed by cold-water stimulus (2min, left hand, 7℃ water); recovery phase (5min) – calm sitting followed by a second cold-water stimulus (2min, left hand, 10℃ water); recovery phase (10min) followed with a deep breathing (1min) phase and 5min calm sitting. Saliva samples were collected at 8 time points as follows: at 0 (1) 10 (2), 12 (3), 17 (4), 19 (5), 29 (6), 30 (7), and 35min (8) respectivelly. All samples were stored at -80℃ until tested with the cortisol ELISA kit. Statistical analysis was performed using SPSS 27.0; p-value <0.05 was considered significant.
Results: Twenty-nine (10 female and 19 male) volunteers from 25 to 53 years (mean 25.86y) participated in the study. In all saliva tested samples, changes in cortisol levels were observed. The peak cortisol level was measured in the last time point (189.57+/-30.1 (158.9-261.8pg/ml)) with statistically significant changes compared to the initial values (timepoint 1–156.6+/-23.2 vs. timepoint 8–189.57+/-30.1pg/ml, p=0.0044). The final value (time point 8) was significantly higher compared to the 2nd, 3rd, and 4th time points (161.4+/-23.4, p=0.011; 160.4+/-17.6, p=0.006; 162.1+/-20.8, p=0.01, respectively). There was a tendency to increase cortisol levels through other time points; however, it was not significant compared to the final point. No association was observed between gender, age, and cortisol levels. However, body mass index (BMI) was correlated with the cortisol level at the 1st point of the cold stimulus (12th min) – the cortisol level was higher with the higher BMI (r=0.58, p=0.048). Pain level was directly correlated with the cortisol level at the 4th time point (r=0.900, p=0.037) as well as in the 5th and 6th time points (r=1, r=0.9 respectively, p=0.037). No changes were observed between HR, systolic or diastolic arterial blood pressure, and cortisol levels.
Discussion and Conclusions: Despite the recovery (when the painful stimulus was stopped) and the deep breathing phases (when the parasympathetic system started to act), the cortisol levels continued to increase. One minute of deep breathing could not be enough, and longer time intervals should be tested. Moreover, it was observed that those who did not identify a clear reduction in pain had higher cortisol levels. It is clear that a higher cortisol level can be associated with a higher pain level. However, some studies show that higher cortisol levels can change the pain threshold; thus, volunteers can define a higher pain level. Therefore, more studies with the later testing time points must be performed.
Dr Lina JANKAUSKAITE (Kaunas, Lithuania), Goda LAUCAITYTE, Andrius RAPALIS, Povilas PIARTLI, Eugenijus KANIUSAS, Vaidotas MAROZAS
08:40 - 10:05
#31374 - Depression of health care workers during the COVID-19 pandemic in the Czech Republic – the HEROES-CZ study.
Depression of health care workers during the COVID-19 pandemic in the Czech Republic – the HEROES-CZ study.
Background
The COVID-19 pandemic has generated an unprecedented pressure on healthcare, including frontline health care workers in emergency medical systems. Prolonged shifts, lack of protective measures, providing care despite the fear of infection, ethical dilemmas due to the lack of resources and increased stigma and violence pose a high risk of worsening mental health. We aimed to assess factors associated with moderate to severe depression of health care workers during the COVID-19 pandemic in the Czech Republic.
Methods
The COVID-19 HEalth caRe wOrkErS (HEROES) Study is a global prospective cohort study with the aim to evaluate the impact of COVID-19 pandemic on mental health of healthcare workers in 26 countries across 4 continents. The data collection in the Czech Republic was initiated in June 2020 (wave 1: June 24th to August 2020; n=1,795; 76.3% female; 39% nurses and 26.5% physicians), with the first follow-up conducted in spring 2021 (wave 2: 15th February 31st of April; n=1,845; 75.2% female; 31.9% nurses and 41.6% physicians). Participants were recruited through hospital administrators, scientific societies, professional bodies and associations. All participants gave informed consent prior to survey completion. The organizations were asked to confirm distribution to the study team to estimate response rates. Data on demographics, mental health, support needs and provision were collected via an online questionnaire. Information on moderate to severe depression was derived from the Patient Health Questionnaire (PHQ-9). Demographic comparison across waves was conducted using chi-square tests (categorical variables) or t-tests (continuous variables). Logistic regression was used to assess the association of several predictors with moderate to severe depression.
Results
1795 and 1845 respondents initiated the survey in wave 1 and wave 2, respectively, and 621 (46%) answered both. Demographic factors in both cohorts were similar, the only difference was the number of participating physicians (26,5% in wave 1 and 41,6% in wave 2). The presence of depression was associated with working at COVID-19 unit (ORwave2= 2.50), redeployment or assigning new tasks (ORwave1=1.25 and ORwave2=1.86) and contact with patients with COVID-19 (ORwave1=2.23 and ORwave2=2.05). The need of any type of support (economical, psychological or with care of children/relatives) was associated with 3.5 greater odds of depression in both waves. The frequency of depression doubled between wave 1 and wave 2 (10.2% vs. 20.2%). Suicide ideation in professionals had also increased from 5.9% to 7% between waves.
Discussion and conclusions
The data supports the hypothesis that COVID-19 worsened mental health and well-being of health care workers. Identification of the main stressors and needs as seen by professionals themselves can help to prepare for the future and establish targeted supportive programs for workers with the highest risk.
Ethical approval and informed consent: Ethical approval was obtained from the Ethics Committee of the Czech Ministry of Health (MZDR-23393/2020-1/MIN/KAN) and Ethics Committee at the 2nd Faculty of Medicine (EK-753.3.6121).
Funding: The research has been funded by the Ministry of Health of the Czech Republic (grant NU22J-09-00064)
Dr Jana SEBLOVA (PRAGUE, Czech Republic), Mirka JANOUSKOVA, Jaroslav PEKARA, Matej KUCERA, Pavla CERMAKOVA, Dominika SEBLOVA
08:40 - 10:05
#31525 - Identification of provider working conditions and well-being in emergency departments: A cross-European expert-based Delphi study.
Identification of provider working conditions and well-being in emergency departments: A cross-European expert-based Delphi study.
Background – Demands for hospital-based emergency care have significantly expanded in Emergency Departments (EDs). Since ED providers pursue to safeguard high-quality care, we need to determine strategies to establish work system solutions for resilient delivery of care under increasing workloads and persistent constraints. To date, there is a lack of empirical evidence and synthesis from large-scale investigations into ED providers’ work life surveys across European countries. Hence, our study aimed to identify and compare relevant work factors for ED providers’ well-being on the job and respective intervention practices in and across European ED settings.
Methods – A mixed-methods survey study was set out. Ethical and data protection approval were obtained prior to start. A purposive sample of 18 subject matter experts (i.e., ED physicians) was selected via snowball sampling from six EUSEM-member states (i.e., Belgium, Finland, Germany, Italy, Romania, UK). From each nation, three interviewees were drawn, equally selected across basic-, general- and maximum-care level hospitals; further selection criteria were: senior physicians, profound ED expertise, active professional practice, and sufficient English language skills. A two-round Delphi study with semi-structured interviews (~90 Min average duration) followed by semi-quantitative online surveys was conducted. Consensus was achieved by qualitative content analysis (round 1) and standardized approval metrics (round 2). Key survey contents were sociodemographic/contextual characteristics, ED work conditions, provider and patient outcomes, respective intervention approaches, and COVID-19-related challenges. Further analyses included comparisons among nations and care levels.
Results – Concerning adverse work conditions, our results showed that utmost detrimental influences on organizational level were Time pressure (Mean rank: M=3.11, SD=2.16), Workflow interruptions & multitasking (M=3.39, SD=2.14), and Overcrowding (M=4.0, SD=2.56). Most mentioned personal influences were Lack of coping mechanisms (M=5.53, SD=3.85), Medical errors & adverse effects (M=5.94, SD=3.87), and Task overlap (M=6.11, SD=3.57). Most frequent patient-related influences were Verbal & physical violence (M=2.33, SD=1.97), Ungrateful feedback (M=3.94, SD=2.22) and Excessive claims (M=4.0, SD=1.28). Concerning provider outcomes, a spectrum of physical (including Fatigue: n=14, 77.8%; Musculoskeletal pain: 61.1%), mental health (including Burnout: 83.3%; Exhaustion: 72.2%; Depression: 44.4%), and psychosomatic complaints (including Insomnia: 100%; Hypertension/tachycardia: 50%; Digestive disorders: 38.9%) as well as behavioral outcomes were mentioned (including Drop-out: 55.6%; Intentions to leave: 50%; Substance abuse: 44.4%). Frequent intervention practices were Skills training (83.3%), ED modernization (77.8%), Roster redesigns (66.7%), as well as Performance evaluations (66.67%). Predominant COVID-19-related provider outcomes were Anxiety (72.2%), Infections (66.7%), PPE discomfort (61.1%), and Skin/respiratory irritation (50%). Round 1 findings serve as base for round 2 to confirm expert appraisals and establish consensus.
Discussion & Conclusions – Our study provides the first cross-European investigation into ED physicians’ work conditions and respective intervention approaches. Our results emphasize the significance of work-related influences on ED provider health and well-being as well as ensuing patient care outcomes. It further sheds lights on current status of improvement measures. Our study serves as base for future policy and practice recommendations as well as intervention studies for effective improvement approaches to ameliorate ED providers’ well-being on the job, and thereby promoting quality and safety of patient care.
Trial was not registered due to: no appropriate register, non-clinical work, no patients involved.
This study did not receive any specific funding.
Michael LIFSCHITZ (Munich, Germany), Christoph DODT, Matthias WEIGL
08:40 - 10:05
#31137 - Impact of digital technology in care homes on Emergency Department attendances.
Impact of digital technology in care homes on Emergency Department attendances.
Background
Evidence suggests that a substantial number of emergency department attendances from care homes could be classed as avoidable. There is a great deal of interest in how new technologies in care home settings can reduce avoidable hospital attendances. HealthCall is a technology that aims to reduce Emergency Department (ED) attendances by upskilling staff to use app-based technology whereby care home residents with new clinical presentations and their observations are recorded electronically using a structured SBAR approach. Information is automatically fed to a Single Point of Access, where clinical staff triage referrals. This study assessed the effectiveness of the HealthCall technology across the North East of England to safely reduce ED referrals and attendance.
Methods
The study involved 123 care homes across the North East covering a study period of 2018-2021. Routinely collected NHS secondary care data from County Durham and Darlington NHS Foundation Trust was obtained and linked with clinical data from the HealthCall technology. Pseudonymised NHS number linkage was used to identify the residents in the secondary care data. We describe the change in ED attendances over the period before, during and after the introduction of the technology to the care home cohort. We fitted a resident level, Poisson generalised linear mixture models to fit counts of emergency attendances for each resident each month, accounting for seasonality and external factors such as the effect of COVID-19. The impact of HealthCall technology being used on each resident’s expected number of monthly ED attendances is tested as both a ‘step’ change and an additional gradual ‘slope’ change over time after intervention.
Results
Our cohort included 8702 care home residents in 123 care homes. Preliminary models trained on a sample of 1000 residents include a yearly seasonal cyclic harmonic pair, COVID-19 bed days in the local Trust hospitals each month, a care home level random intercept and an individual level random intercept. The preliminary models suggest the use of the HealthCall technology shows a ‘step’ reduction of expected monthly ED attendances for care home residents by 19%, 95% CI [7, 30], p = 0.0036. There is currently insufficient evidence in the preliminary modelling to support an additional gradual decrease in attendances for each resident over time, p = 0.78.
Discussion
This study finds that the implementation of the HealthCall technology in care homes reduces the expected number of monthly emergency department attendances for residents. The technology also allows for ongoing monitoring of resident health alongside providing more convenient and timely access to clinical advice that promotes more appropriate and resident-focussed decision making leading to fewer unnecessary ED attendances.
This project was funded by HDRUK as part of the Learning Care Homes project.
Alex GARNER (Lancaster, ), Suzanne MASON, Jo KNIGHT, Nancy PRESTON, Simon DIXON, Camila CAIADO, Catherine MCSHANE, Graham KING
08:40 - 10:05
#30976 - Music in the Acute Preoperative Nursing Care — A Mixed-Method Pilot Study.
Music in the Acute Preoperative Nursing Care — A Mixed-Method Pilot Study.
Background: Patients often suffer from pain and have feelings of uncertainty and worries while waiting for acute surgery in the Emergency Department. Evidence shows that music has a positive effect on pain reduction, relaxation, and general well-being in other healthcare settings. However, knowledge of providing music interventions for patients during the acute preoperative nursing care is limited in the setting of Emergency Departments. The aim of this study was to (1) examine the association between music and pain, relaxation, and well-being and (2) explore the patients’ experience of using a music pillow during the waiting time for an acute surgery.
Methods: A mixed-method pilot study was carried out in the Emergency Department at Odense University Hospital. Participants were purposely sampled. Patients scheduled for any acute operation were offered a music pillow for 30 minutes during the waiting time. The primary outcome was the participants’ self-reported pain, relaxation, and well-being by a visual analog scale (VAS) ranging from 0 to10 conducted before and after the music intervention. Field observation during the music session followed by a semi-structured interview was carried out in the qualitative part of the study. Statistical analysis was performed using a Wilcoxon signed-rank test and the qualitative analysis was structured using Systematic text condensation.
Ethical approval and informed consent: The study is registered with the Danish Data Protection Agency (20/56891). Oral and written consent was given by the participants.
Results: The quantitative part included 30 participants with 14 men and 16 women. The age ranged from 18 to 93. The Wilcoxon signed-rank test showed that music had a positive statistically significant association with reduced pain, relaxation, and well-being (P < 0.001). The qualitative part of the study included 15 participants. Two themes were derived: 1) Feelings of physical and mental well-being and 2) A break from the acute preoperative context.
Discussion & conclusion: A statistically significant association was found between the music and acute preoperative patients’ self-reported reduced pain, relaxation, and well-being. Participants experienced that listening to music provided physical and mental well-being as it made them feel relaxed and took their minds off pain and worries. The study suggested that for the music to successfully promote mental and physical well-being patients should be undisturbed while listening to the music, which appeared as the main challenge in the current organizational structure in the Emergency Department.
Perspectives: This pilot study provides knowledge of the significance of music interventions and the potential of implementing music in preoperative nursing care. The results provide insight into improvements in the implementation of music in acute nursing care. For future research, it is relevant to include perspectives from nurses, patients, and caregivers to have a wider understanding of the implementation of music in acute preoperative nursing care.
Funding: This study did not receive any specific funding.
Lisa KVIST ANTONSEN (Odense, Denmark, Denmark), Karin BROCHSTEDT DIEPERINK, Christina ØSTERVANG
08:40 - 10:05
#31407 - Patients presenting to emergency departments after being assessed in primary care: Retrospective analysis of a random sample from two metropolitan EDs.
Patients presenting to emergency departments after being assessed in primary care: Retrospective analysis of a random sample from two metropolitan EDs.
Background:
Emergency departments care for patients with life threatening or urgent medical conditions. They also serve as a provider of last resort for health-related demands that are not provided for elsewhere. Analysis of use-patterns of emergency departments may not only serve to develop more efficient care models within hospitals, but also to assess unfulfilled needs in health-care outside the hospital system. Primary care is often regarded as fulfilling a gatekeeper role to protect emergency departments from unnecessary use, fending of patients that can be cared for on an out-patient basis. Primary care physicians, however, may also use emergency departments for diagnostic and therapeutic support in less acute cases not requiring hospital admission. We investigated hospital admissions and diagnostic and therapeutic resources used in the management of patients who presented to ED after being assessed in primary care.
Methods:
A computer-generated random sample out of all 80845 patients cared for in emergency< departments of two metropolitan general hospitals during 2019 (pre-covid) was analyzed. Patient demographic and medical data was extracted from the hospitals’ medical data mainframe system and documents provided by the patients upon presentation. Results are presented as Proportion (%), Mean ± SD or Median (25th – 75th) percentile for categorical, or not normally distributed or normally distributed continuous data, respectively. The study protocol was assessed by the Berlin Board of Physicians and need for informed written consent was waived.
Results:
1500 patients were analyzed. Age was 56.0 ± 22.8 years, 50.9% female. 34.7% presented by emergency ambulance, 47.7% were self-presenters, 13.1% arrived by patient transport services. 32 patients were referred by other hospitals and were excluded from further analysis. 183 (12.5%) patients were referred by primary care physicians. Referrals were older (61.2 ± 20.8 vs 55.1 ± 23.0 years, p < .001) and had a higher Charlson Comorbidity Index (CCI) ( 3 (1 – 5) vs 2 (0 – 4); p < .001). They had more often laboratory investigations (79.9% vs 60.6%; p < .001) more often imaging by ultrasound (27.6% vs 15.7%; p < .001) and more often ECG investigations (50.0% vs 37.5%); p < .001. There were no differences in sex, Manchester triage System classification or pain-scale values. Referrals presented by emergency medical transports less often (8.7% vs 38.8%; p < .001). Admission rates were 61.4% in referrals and 33.4% in non-referrals (p < .001).
Th following parameters were independently associated with outpatient treatment as compared to hospital admission: Referral (OR .220 (95%CI interval: .135 – .361); resources used per case (OR .502 (.449 – 562); any abnormal vital parameters (.617 (.443 - .859); CCI (.797 (.751 – .845); parenteral medication 1.419 (.969 – 2.078); lower MTS-class (1.387 – 2.128).
Conclusion:
Assessment by a primary care physician before presentation to an ED reduced the probability of hospital admission. Perceive acuity of most of the referred patients was low, as evidenced by MTS classification and the low proportion referred by emergency medical transport. A proportion of patients was probably referred for technical assistance despite being out-patient cases
no registration / no funding
Andreas UMGELTER (Berlin, Germany), Markus FAUST, Wenske SLATOMIR, Katrin UMGELTER, Georg WALTER
08:40 - 10:05
#31090 - Prevention of violence and aggression towards employees in emergency departments – A qualitative study conducted in Germany.
Prevention of violence and aggression towards employees in emergency departments – A qualitative study conducted in Germany.
Background: Among healthcare staff, especially employees in emergency departments (EDs) are affected by violence and aggression. The majority of employees regularly experiences violence caused by patients and their relatives. Measures to prevent violence can be taken on organizational, technical/architectural, or individual-focused levels. Overall, little is known on how employees perceive the implementation and effectiveness of respective measures. Thus, the aim of the current study is to explore which measures for violence prevention in EDs are known and perceived as effective, as well as which barriers exist regarding their implementation.
Methods: Due to the explorative nature of the research questions, a qualitative approach was chosen to reflect the participants’ perspectives and gain profound knowledge on advantages and disadvantages of available preventive measures. Thus, telephone interviews based on a semi-structured interview guide were conducted. A purposeful sampling technique was applied supplemented by snowball sampling. The sample comprised participants from all emergency care levels in Germany and included both employees and supervisors working in EDs. Inclusion criteria were employment in the current ED for at least 6 months and also immediate contact to patients in a medical or nursing position. Transcribed interviews were analysed using Mayring's approach to qualitative content analysis. Ethical approval was granted by the Local Psychological Ethics Committee of the University Medical Centre Hamburg-Eppendorf, Germany.
Results: 27 interviews were conducted between June and September 2021. Slightly more than half of participants were female (f = 56%, m = 44%), while 13 participants were doctors and 14 had a nursing profession. Furthermore, 16 participants worked as medical or nursing supervisors in the ED. The interviewees described technical/architectural measures (e.g., design of waiting areas and treatment rooms, alarm systems), organizational measures (e.g., security service) and individual-focused measures (e.g., staff training). Security services and verbal de-escalation skills were perceived as particularly effective. However, there was a lack of guidance for ED staff, e.g., in the form of standard operating procedures (SOPs). Furthermore, incidence reporting was more common for physical assaults, while verbal aggression was often perceived as part of the job. It further became apparent that due to hierarchical structures violence prevention was highly dependent on supervisors’ awareness, knowledge and motivation to implement respective measures, and the most important barrier for violence prevention measures was financial constraints.
Discussion and Conclusions: The results of this study provide an insight into the current state of implementation and perceived effectiveness of violence prevention measures in German EDs. They substantiate those of previous research indicating that many ED employees feel they could be better prepared for violent incidents. Furthermore, the results at hand allow to infer recommendations for violence prevention targeting both supervisors and employees. For instance, supervisors should encourage employees to report incidents in order to increase awareness, but also to justify the need for preventive measures in front of hospital managements. In this way, occupational safety and thus mental and physical health of ED staff could be improved in the long term.
This research was funded by the Institution for Statutory Accident Insurance and Prevention in the Healthcare and Welfare Services, Hamburg, Germany (grant number: ext FF_1524).
Sonja REIßMANN (Hamburg, Germany), Tanja WIRTH, Volker HARTH, Stefanie MACHE
08:40 - 10:05
#31234 - The sociodemographic gradient in out-of-hours healthcare use; a proxy for comorbidity? An observational study of 1.9 million citizens.
The sociodemographic gradient in out-of-hours healthcare use; a proxy for comorbidity? An observational study of 1.9 million citizens.
Background
In Denmark, out-of-hours emergency healthcare use (i.e., out-of-hours general practitioner/medical helpline and emergency medical services (EMS)) is associated with certain sociodemographic- and economic factors. Low education, low income, and employment were some of the most important factors related to emergency healthcare use, particularly EMS use. Studies indicate that such characteristics could be explained by comorbidity. Therefore, this study aimed to investigate sociodemographic/-economic characteristics and emergency healthcare use for patients with and without comorbidity.
Methods
An observational study, including all citizens aged 18 and above in the North Denmark Region and Capital Region of Copenhagen during 2016. Contacts were identified in the prehospital databases and in the National Health Service Registry. The unique personal identification number was used for linkage to numerous registries containing the characteristics: age, sex, residence, family type, ethnicity, education level, income, and employment. Comorbidity was established using Charlson Comorbidity Index based on each patient’s diagnoses five years prior to the study period. We calculated the proportions of selected sociodemographic and -economic characteristics in patients with emergency contacts compared to patients without contact and reported it overall and for both patients with and without known comorbidity.
Results
We included 1,899,468 citizens, 23.8% with an emergency healthcare contact. Overall, the proportion of low education was significantly higher among patients with contacts compared to patients without (37.2% vs 29.5%) as was the proportion of low income (27.7% vs 23.2%), whereas employment proportion was higher for patients with no contact compared to patients with contact (32.6% vs 23.8%). For the subgroup of patients with known comorbidity the tendency was similar: higher proportions of low income among contacts compared to no contacts (27.9% vs 22.5%) and higher proportions of low education (39.0% vs 31.2). Employment was higher for those without contacts (25.9% vs 17.7%). Likewise, in patients without comorbidity, low income was more prevalent among contacts compared to those without (27.4% vs 24.5%). As was low education: (33.6% vs 26.6%). Employment was higher among those with no contact (44.8% vs 35.9%). All reported differences were of statistical significance.
Discussion and conclusion
These preliminary results show that certain characteristics indicating low socioeconomic status are significantly more prevalent among patients with emergency healthcare contacts compared to patients without contacts. This applies to both patients with and without known comorbidity. Going forward, we aim to investigate if higher degrees of comorbidity increase the use of emergency care for patients with the reported sociodemographic- and economic characteristics.
None
Morten BREINHOLT SØVSØ (Aalborg, Denmark), Linda HUIBERS, Bodil HAMMER BECH, Morten BONDO CHRISTENSEN, Helle Collatz CHRISTENSEN, Søren Paaske JOHNSEN, Erika Frischknecht CHRISTENSEN
08:40 - 10:05
#30982 - The well-being of ambulance care professionals during covid-19 in the Netherlands: a cross sectional study.
The well-being of ambulance care professionals during covid-19 in the Netherlands: a cross sectional study.
Background
The COVID-19 pandemic has a significant impact on the health and well-being of health care professionals. However, insight for ambulance care professionals is limited. Reported prevalence rates in the pre-COVID-19 era were 15% anxiety, 15% depression, 11% post-traumatic stress disorder (PTSD) and 20-27% insomnia. Insight in the health and wellbeing of ambulance care professionals is needed to develop targeted preventive and curative interventions to cope with the impact of COVID-19 and to prevent drop-out. The aim of this study was to gain insight in the prevalence of anxiety, depression, PTSD, need for recovery after work and insomnia among ambulance care professionals in the Netherlands.
Methods
A national cross-sectional study was performed. An online survey was distributed by national EMS organisations to all ambulance care professionals in the Netherlands, participation was voluntary. Data were collected from March 14th until April 15th 2022, three reminders were sent.
The impact on health and well-being was measured with internationally validated instruments. For anxiety and depression the Hospitality Anxiety and Depression Scale (HADS -A and HADS-D) were used, for PTSD the Impact of Event Scale (IES), for work fatigue the Need For Recovery after work (NFR) and for insomnia the Insomnia Severity Index (ISI). Also, demographic (age, gender) and workrelated (area of working, work experience in years) characteristics were collected.
Surveys with at least one completed outcome measure were included in the analysis. Descriptive statistics were calculated: mean and standard deviation [SD], median and first and third quartile (IQR) for continuous variables, or as number and percentage for categorical variables.
Results
In total 783 ambulance care professionals completed at least one outcome measure in the survey. Participants had a mean age of 47 years (SD ± 9,4), 38,6% is female and there was an average work experience of 13,6 years (SD ± 9,4).
Prevalence rates of symptoms of anxiety were 19% (N=149, median 4, IQR 2-7), for depression 16,2% (N=127, median 3, IQR 1-6) and for PTSD 10,5% (N=78, median 3, IQR 1-7). Of the respondents 32,2% (N=236, median 3, IQR 0-7) scored positive for need for recovery after work. 39,3% (N=285, median 5, IQR 2-11) of the respondents scored positive for insomnia problems (27,8% light problems, 9,9% moderate problems and 1,5% serious problems). In the total sample 51,5% of the respondents scored positive on at least one of the outcomes.
Discussion & Conclusions
COVID-19 had high impact on Dutch ambulance care professionals, as 51,5% of the ambulance care professionals scored positive on at least one outcome. Especially need for recovery after work and insomnia were highly prevalent,and seem higher compared to literature from the pre covid era. Our results indicate a need to systematically develop and test interventions aimed at recovery and work fatigue and insomnia.
Funding
This study was funded by the Taskforce for Applied Research SIA (part of the Dutch Research Council NWO), funding: RAAK.PUB08.044.
Ethical approval and informed consent
There is a letter of approval from the ethical research committee of the HAN University of Applied Sciences (ECO 334.03/22). The respondents give there consent to participate before starting with the survey.
Marieke OOSTERHUIS (Huissen, The Netherlands), Lilian VLOET, Mark VAN DEN BOOGAARD, Jan HOEFNAGEL, Mischa KNOL, Ellen SCHEPENS, Annet DE LANGE, Sivera BERBEN, Remco EBBEN
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09:00 - 09:30
Emergency Medicine Day@EUSEM Booth - What ideas did/will you implement to improve professional wellbeing
09:00 - 09:30
EM Day Working Group Chair.
Roberta PETRINO (Head of department) (Moderator, Italie, Italy)
09:00 - 09:30
EM Day Working Group Co-Chair.
Luis GARCIA-CASTRILLO (ED director) (Moderator, ORUNA, Spain)
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EPOSCB6SC1
10:10 - 10:30
Coffee Break 6 - Eposter session - Screen 1
Moderator:
Dr Federico CAPRILES (Médico adjunto) (Moderator, Reus, Spain)
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EPOSCB6SC4
10:10 - 10:30
Coffee Break 6 - Eposter session - Screen 4
Moderator:
Eeva TUUNAINEN (Emergency Medicine Registrar) (Moderator, Kajaani, Finland)
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EPOSCB6SC3
10:10 - 10:30
Coffee Break 6 - Eposter session - Screen 3
Moderator:
Julia KÜHNEMUND (Oberärztin) (Moderator, Weimar, Germany)
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EPOSCB6SC2
10:10 - 10:30
Coffee Break 6 - Eposter session - Screen 2
Moderator:
Hannah GREENLEES (Moderator, Paisley, United Kingdom)
10:15 - 10:20
No increased safety risk for methoxyflurane analgesia compared to other routinely administered analgesics in the emergency setting: a comparative hybrid prospective-retrospective post-authorisation safety study.
Bryan TAN (Senior Medical Officer) (Eposter Presenter, Melbourne, Australia)
10:20 - 10:25
Methoxyflurane (Penthrox) provides safe and effective pain relief of trauma-associated pain in clinical practice (Swiss post authorisation safety study).
Wolf HAUTZ (Senior Attending Physician) (Eposter Presenter, Bern, Switzerland)
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10:10 - 10:30
Coffee Break 6 - EPoster session - Screen 5
Moderator:
Mairi LAING (Moderator, PAISLEY)
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#31003 - A pilot study on the utility of Point-Of-Care (POC) Troponin assay in triage processing for patients with acute chest pain.
A pilot study on the utility of Point-Of-Care (POC) Troponin assay in triage processing for patients with acute chest pain.
Background: acute chest pain is one of the most frequent reason for admission to the emergency department (ED) and constitute a diagnostic and logistic challenge. Recently several point-of-care (POC) hs-troponin assays has been introduced but its role in clinical practice has not been well established and their use is still not validated.
Aims: to evaluate if POC hs-troponin assay could help in avoiding underestimate during triage processing for patients admitted to the ED for acute chest pain.
Matherial and methods: in our Hospital triage categories for acute chest pain are: red code (immediate category) for patients with hemodynamic instability or with cardiac arrest or with ECG criteria for STEMI or with Chest Pain Score (CPS) ≥ 4 and ECG criteria for NSTEMI; yellow code (urgent category) for patients with CPS ≥ 4 and/or with cardiovascular risk factors and ECG negative for STEMI or NSTEMI criteria; green code (delayed category) for patients with CPS < 4, without cardiovascular risk factors and ECG negative for STEMI or NSTEMI criteria. In our study we prospectively enrolled 36 subjects with chest pain whom triage category was green (delayed category). If the result of the POC hs-troponin was positive a yellow code (urgent category) was assigned. All patients underwent ECG recording within 10 minutes from arrival and almost one central laboratory hs-Troponin measurement. The first blood sample for central laboratory hs-troponin was collected in the same time with the sample for POC hs-troponin, the second hs-troponin was collected at 1 hour. For POC hs-tropoin assay we used The Atellica® VTLi Patient-side Immunoassay Analyzer, powered by Magnotech® Technology.
Results: in our study there were 22 males and 14 females. Mean age was 45,6 ± 15,7. Mean POC-hs-troponin was 40,4 ± 207,4, means central laboratory hs-troponin were 39 ± 202,2 at first measurement and 57 ± 274,2 at second measurement. We found a positive POC hs-troponin in only one subject (2,8% of the population included in the study) which was confirmed to the central laboratory hs-troponin measurement. After ED evaluation the patient was admitted to Cardiology department. In all the other cases acute coronary syndrome was ruled out after ED evaluation. We found a statistically significant association between POC hs-troponin and both first (p <.001) and second central laboratory hs-troponin determination (respectively p <.001)
Conclusions: in this pilot study POC hs-troponin seems to be able to help in avoiding underestimate during the triage processing for acute chest pain. Finding a positive result avoided the allocation to a possible dangerous delayed category in 2,8% of cases. Moreover POC hs-troponin results showed to be strictly correlated to central laboratory hs-troponin result and in none of the cases with a negative result a diagnosis of acute coronary syndrome was carried out. This could suggest that POC hs-troponin could be safe in the rule-out of acute coronary syndrome in subjects presenting to the ED with a CPS < 4 without cardiovascular risk factors and without signs of ischaemia on ECG. Multicentric studies on larger population are needed for validating these hypothesis
Stefano DE VUONO (Perugia, Italy), Leonora KLAHR, Laura SETTIMI, Sokol BERISHA, Pasquale CIANCI, Alessandra LIGNANI, Giorgia MANINA, Paolo GROFF
10:10 - 10:30
#31331 - Accuracy of a Self-Report Prescription Opioid Use Diary for Patients Discharge from the Emergency Department with Acute Pain.
Accuracy of a Self-Report Prescription Opioid Use Diary for Patients Discharge from the Emergency Department with Acute Pain.
Objectives: Self-reported approaches that assess opioid usage can be subject to social desirability and recall biases that may underestimate actual pill consumption. Our objective was to determine the accuracy of patient self-reported opioid consumption using a 14-day daily paper or electronic diary.
Methods: This is a planned sub-study of a multicenter prospective cohort study conducted in four hospitals across the province of Québec (Canada) in emergency department (ED) patients aged ≥18 years with acute pain (≤2 weeks) who were discharged with an opioid prescription. Patients completed a 14-day daily diary (paper or electronic) assessing the quantity of opioids consumed. Upon diary completion, a random sample from the main cohort was selected for a follow-up visit to the hospital or a virtual-video visit where they had to show and count the remaining pills. Patients were blinded to the main objective of the follow-up visit. Intraclass correlation coefficient (ICC) and Bland-Altman plots were used to assess accuracy.
Results: A total of 166 participants completed the 14-day diary as well as the in-person or virtual visit; 49% were women and median age was 48 years (IQR =21). The self-reported consumed quantity of opioid in the 14-day diary and the one calculated from counting remaining opioid pills during the follow-up visit were very similar (ICC=0.992; 95%CI: 0.989-0.994). The mean difference between both measures from Bland-Altman analysis was almost zero (0.048 pills; 95%CI: -3.77 to 3.87).
Conclusion: Self-reported prescription opioid use in a 14-day diary is an accurate assessment of the quantity of opioids consumed.
ClinicalTrials.gov: NCT03953534
Funding by the Canadian Institutes of Health Research
Raoul DAOUST (Montréal, Canada), Jean PAQUET, Williamson DAVID, Jeffrey PERRY, Iseppon MASSIMILIANO, Veronique CASTONGUAY, Judy MORRIS, Alexis COURNOYER, Research Group OPUM
10:10 - 10:30
#31327 - CARBON MONOXIDE POISONING SEEN IN EMERGENCIES : STUDY OF THE PRONOSTIC VALUE OF BLOOD LACTATE.
CARBON MONOXIDE POISONING SEEN IN EMERGENCIES : STUDY OF THE PRONOSTIC VALUE OF BLOOD LACTATE.
Carbon monoxide poisoning (COP) is a potentially mortal, though preventable, condition. It is a common cause of neuropsychic sequelae.The lactate level is an early marker of severity in severel pathologies but remains under studied as a prognostic factor at the COP.The aim of this study was to determinate the pronostic value of blood lactate levels at one month,for COP patients in the emergency departments.
MATHODS :
An observational prospective study was conducted over 5 years.Patients diagnosed with COP confirmed by anamnestic contex,clinical symptomatology and determination of carboxyhemoglobin (HBCO) in the blood> 5%, were included.A lactate level determination was performed at admission.Clinical,therapeutic and evolutionary parameters were collected.The prognosis at one month was evaluated through a phone survey.
RESULTS:
we included 639 patients,the mean age was 36+/-15 years, the sex ratio was 0,28. The symptomatology was dominated by neurological signs n(%) : headache 511(79),vertigo 374(58),unconsciousness 93(14.5) and seizures 23(4).The source of intoxication was n(%):gaz water heater 340(53),brazier 178(27),heater with gaz 72(11).The average value of HBCO was 16+/-12 %. The average value of Lactate was 2.3+/-1.5 mmol/L.Ninety-nine patients received normobaric oxygen therapy and 5.8 % received hyperbaric oxygen therapy.The evolution at one month was marked by the occurence in 20.6% of cases of neuropsychic sequelae (%): headache (5.9) ,irritability (3.3),anxiety(1.6), aggressiveness (1.3),irritabilité sleep disorders (0.9).The comparative study between the group devolopping neuropsychic sequelae versus the other group on patient didn’t found any statistical difference concerning the lactate level at admission (2,25+/-1,31 vs 2,31+/-1,64 (p=0,75).
CONCLUSION:
The COP is common accidental disease seen in the emergency department. Neuropsychic sequelae in found on 20% of patients
The initial hyperlactatemia does not predict the occurrence of neuropsychic sequelae at one month.
Héla CHABBEH, Héla BEN TURKIA (Ben Arous, Tunisia), Syrine KESKES, Hanene GHAZELI, Hanene SAKHRI, Ameni BENZARTI, Sami SOUISSI
10:10 - 10:30
#31287 - Clinical features of patients with atrial fibrillation rhythm in four prehospital emergency services.
Clinical features of patients with atrial fibrillation rhythm in four prehospital emergency services.
Background
Atrial fibrillation (AF) is the most common heart rhythm disorder encountered in clinical setting by Prehospital Emergency Services (PhEMS). As a progressive disease, AF is associated with a higher risk of all-cause and cardiovascular death. Despite the high prevalence of AF, there’s still little evidence of the clinical features of the patients who suffer this kind of disease in the prehospital setting. Knowing these features might help emergency professionals evaluate acute situations, improving their management.
Aim
The objective of this study is to evaluate the features of patients with AF rhythm referred to their reference hospitals by PhEMS, their prognosis and the characteristics of the care received by them.
Methods
Design: Retrospective, descriptive, multicenter study.
Study setting: PhEMS and Emergency Services in four provinces of Spain (Valladolid, Salamanca, Segovia, and Burgos).
Participants and date: We included all patients who were treated by advanced life support (ALS) units with AF rhythm and referred to their reference hospitals between October 1, 2019 and April 30, 2021.
Outcome variables: Sex, age, institutionalization, diagnosis, comorbidities, vital signs, hospital destination, intensive care unit (ICU) admission, in-hospital mortality, total care time (TCT).
Statistic methods: The quantitative variables were described as median and interquartile range (IQR) and the qualitative variables were described by absolute and
relative frequencies. Student`s T-test and Mann-Whitney-U test were used in the comparison of quantitative variables if necessary. Chi-square and Kruskal-Wallis test were used to study the association of qualitative variables. A P value of <0,05 was considered significant.
Results
261 patients. Men: 51,3%. Median age: 80 years(IQR:64-94). Institutionalization: 27,6%. Comorbidities average: congestive cardiac insufficiency 49,4%. Diagnosis average: Circulatory diseases 49,8%. Hospitalization average: 69,7%. ICU admission: 8,4%. In-hospital mortality average: 23,8%. TCT average (minutes): 58 (IQR:48-68).
Association between TCT and in-hospital mortality: 67,03 (p<0,001). Association between vital signs and mortality: respiratory rate 26,82(p<0,001),oxygen saturation 85,40 (p<0,001), inspired oxygen fraction26,7% (p 0,001).
Association between diagnosis and in-hospital mortality: infectious disease 53,3%, endocrinologic 50,0%, nervous 30,4%, circulatory13,8%, respiratory 34,3%, digestive 18,2%, trauma 16,7%, intoxications 50,0%(p 0,002)
Association between comorbidities and mortality: renal disease 32,3% (p 0,01).
Association between destination and mortality: hospital admission 34,1%(p<0,001), ICU admission 59,1% (p<0,001).
Discussion and conclusions
In our study, AF has shown to be a high mortality disease that requires hospitalization in most of the patients. Circulatory diseases have proven to be the most common diagnose. Patients with renal disease and those diagnosed with infectious diseases were the ones who showed a higher in-hospital mortality.
Funding
This trial has not received any special funding.
Ethical approval and informed consent
The study was approved by the Research Ethics Committee of all participating centers (reference CEIC: PI-GR-19-1258 and PI-049-19). All patients (or guardians) signed informed consent, including consent for data sharing.
This research has received support from the Gerencia Regional de Salud (SACYL) with registration number GRS 1903/A/19.
Enrique CASTRO PORTILLO (Valladolid, Spain), Rodrigo ENRÍQUEZ DE SALAMANCA GAMBARA, Raúl LÓPEZ IZQUIERDO, Miguel Ángel CASTRO VILLAMOR, Juan Francisco DELGADO BENITO, Irene SÁNCHEZ SOBERÓN, Francisco MARTÍN-RODRÍGUEZ
10:10 - 10:30
#31461 - Covid-19: Symptoms’ particularities of infection during the wave of Omicron variant.
Covid-19: Symptoms’ particularities of infection during the wave of Omicron variant.
Covid-19: Symptoms’ particularities of infection during the wave of Omicron variant
Bradai.H ; Soua.s; Loghmari.D. Soua.A ;Douma.F ; Zouaoui.M ; Chebili.N
Introduction:
Since the declaration of SARS-Cov2 pandemic on March12, 2020, there have been several waves of infection by this virus with the appearance of new mutants which have led not only to variability in transmission and morbid-mortality but also symptoms.
Our work aims to describe the particularities of the symptoms during the wave of the Omicron variant
Materials and methods:
Our work is a descriptive cross-sectional study including 246 patients belonging to the Sousse region, symptomatic of a Covid-19 infection, who contacted the Covid regulation of our service for a polymerase chain reaction (PCR) test and being positive, during the period from 01/01/2022 until 28/02/2022.
Results:
Our sample was composed of 246 patients, 58.1% of whom were females. The mean age was 35 +/- 14.3 years with extremes ranging between 8 and 77 years. The majority of patients came from an urban area (97.4%) while 2.6% came from a rural area.
The majority of patients were vaccinated against SARS-COV-2 (83.2%).
The main symptoms described by patients infected with covid 19 during the omicron variant wave were cough, arthromyalgia, fever and chills, fatigue, headache, sore throat and rhinorrhea with a prevalence of 62 .6%, 62.2%, 53.3%, 50.8%, 44.7%, 33.7%, and 29.3%, respectively. Palpitation was the least described symptom with a prevalence of 0.4%. Sorting by system, the general signs were the most frequently described (89%) with a predominance of arthromyalgia, followed by respiratory signs (76.7%) with a predominance of cough followed by ENT signs (40.7%) with a predominance of sore throats, followed by cardiovascular signs (8.1%) with a predominance of chest pain and finally digestive signs (10%) with a predominance of nausea and vomiting. No patient described ageusia and only 2.4% described anosmia.
Regarding self-medication, 97.2% of patients received vitamin therapy and 78% took paracetamol and 27.6% received antibiotic therapy.
Conclusion:
Certainly, previous variants of SARS-Cov-2 were associated with respiratory and digestive symptoms, as well as anosmia and ageusia. But cold-like symptoms were the most commonly reported by people with the new Omicron variant.
Haifa BRADAI, Sarra SOUA, Dr Dorra LOGHMARI, Asma SOUA, Farrouk DOUMA, Montassar ZOUAOUI, Sondos LAAJIMI (Sousse, Tunisia), Naoufel CHEBILI
10:10 - 10:30
#31371 - Early reattenders to the Paediatric Emergency Department: a prospective cohort study and multivariate analysis.
Early reattenders to the Paediatric Emergency Department: a prospective cohort study and multivariate analysis.
Aims
The rate of unplanned reattendances within 7 days is used as a quality indicator of the care delivered in Paediatric Emergency Departments (PEDs) in the UK. A high number may suggest inadequate initial management whereas a low number may reflect an approach that is too risk averse. With national early reattendance rates currently well above the target of 1-5%, there is a great need to further understand this phenomenon.
However, there is a scarcity of evidence relevant to the UK setting and the majority of the international literature uses an alternate time period (reattendance within 72 hours) to define an early reattender, limiting its application to the NHS.
Therefore, we aim to identify the factors which predict unplanned early reattendance to a PED in the UK within 7 days.
Methods
This was a prospective, single-centre cohort study undertaken over a 12-month period in a large district general hospital serving a mostly urban population.
Patients who reattended the PED within 7 days of their index visit form the cohort of interest whilst data were also collected on a comparative cohort of PED patients with no visit in the preceding or subsequent 7 days. Multiple variables including patient demographics, diagnosis, grade of clinician seen, timing of presentation and patient disposition were recorded and analysed using univariate and multivariate regression models.
Results
There was a total of 19,420 index visits to the PED, of which 1,461 patients had an unscheduled reattendance within 7 days – a rate of 7.5% which exceeds that reported in previous British studies but is in line with current national audit figures.
Factors associated with unplanned but related reattendance include young age and diagnosis with a respiratory or other medical illness. The majority of early reattenders had not suffered a clinically significant deterioration upon reattendance suggesting that this situation may be amenable to change with improved discharge or communication practices. In contrast to previous studies, the grade of clinician did appear to be relevant as patients seen by junior members of the medical team were less likely to reattend. The acuity of a patient's presentation and patient disposition were not significant factors.
A substantial number of patients (36.3%) who represented with a related problem would have been missed had a time period of 72 hours been used.
Conclusion
This is the largest British study of its kind and, to our knowledge, is the only one to examine this phenomenon with a prospective methodology.
It identifies the typical patient who will have an unplanned, related early reattendance to a PED in the UK – knowledge which can be used to develop strategies to improve care and reduce unnecessary reattendance.
This study also supports the use of a 7 day time period when using early reattendance as a performance indicator.
As this was an audit of routinely collected data, specific ethical approval for the study was not necessary. There was no funding for this study.
Matthew STOKLE (Newcastle upon Tyne, ), Rory James TINKER, Samuel Peter MUNRO, Niall MULLEN
10:10 - 10:30
#31514 - Evaluation of the Integrated Pulmonary Index (IPI) in Patients Presenting to Pediatric Emergency Department with Acute Asthma Attack.
Evaluation of the Integrated Pulmonary Index (IPI) in Patients Presenting to Pediatric Emergency Department with Acute Asthma Attack.
Background
It is important to quickly determine the severity of the attack for the earliest and appropriate treatment in children who have asthma attacks. Determining the severity of the attack regulates the duration of the patient's stay in the emergency room and hospitalization. There are many scores to determine the severity. However, until now, there has been no consensus on a score with high sensitivity and specificity that objectively determines the severity of attacks. In this sense, the integrated pulmonary index (IPI), which emerged with the mathematical algorithm of four different vital signs (EtCO2, SpO2, respiratory rate, heart rate), gives ventilation and oxygenation in a single digit. For this reason, it is thought to be a useful and objective respiratory assessment for healthcare professionals with little experience. In this study, it was aimed to investigate the value of IPI in determining the severity of asthma attacks in children.
Methods
This is a prospective cross-sectional study. Patients aged 2-18 years who administered to pediatric emergency department between January 1, 2019 and December 31, 2021 with asthma attack complaints were included in the study. Our hospital is a tertiary university hospital whose pediatric emergency department admits 70000 patients annually. Age, sex, age at diagnosis, long-term treatment, aeroallergen sensitivity, and risk factors for fatal asthma in included patients were questioned and recorded. Vital signs (pulse, respiratory rate, oxygen saturation), MPIS (Modified pulmonary index score) and IPI values were remeasured at admission and after the first treatment. Normally distributed variables were analyzed with parametric tests, nonnormally distributed variables were analyzed with nonparametric tests, and categorical variables were analyzed with Fisher's exact test and chi-square test. While investigating the associations between nonnormality distributed variables, the correlation coefficients and their significance were calculated using the Spearman test.
Results
52 patients were included in the study. With a median age of 61.5 months (43-116), 73% of the patients were male. 40% of the patients were using at least one drug for the diagnosis of existing asthma. The most common complaints were dry cough (46%) and shortness of breath (44.2%). According to the GINA asthma attack algorithm, 12 (23%) patients presented with mild , 27 (51.9%) patients with moderate, and 13 (25) patients with severe attacks. Although the mean MPIS was 9 (6-12) at admission, it was 7 (4-9) after treatment. The average of the measured IPI values was found to be 6 (3-8) at admission and 7 (5-8.25) after treatment. Patients were treated with inhaled salbutamol (92.3%), systemic steroids (71.1%), ipratropium bromide (32.6%) and mask oxygen (34.6%). A moderate negative correlation was found between MPIS and IPI values at admission (r=-0.47, p=0.001).
Discussion & Conclusions
This is the first study to investigate the role of IPI in determining the severity of attacks in patients with asthma attacks. A correlation was found between MPIS, which is an accepted score in the evaluation of patients with asthma attacks. This showed that IPI should be emphasized on this issue in larger studies.
Orkun AYDIN, Hande YIGIT, Burcu AKBABA, Ozge UYSAL SOYER, Umit Murat SAHINER, Bulent Enis SEKEREL, Ozlem TEKSAM (ANKARA, Turkey)
10:10 - 10:30
#31254 - How accurate are clinicians’ interpretations of paediatric elbow radiographs? A prospective international study.
How accurate are clinicians’ interpretations of paediatric elbow radiographs? A prospective international study.
Background:
Upper limb fractures account for over 75% of all childhood fractures, with elbow fractures accounting for 7-10% of these injuries. Paediatric trauma elbow radiographs are difficult to interpret due to the variability of ossification centres, with potentially significant implications if misdiagnosed. Little is known about healthcare professionals’ ability to successfully interpret these images. This study aimed to assess the accuracy of healthcare professionals, internationally, to formulate the correct diagnosis based on interpretation of paediatric elbow radiographs.
Methods:
This prospective international study was conducted online via the Free Open Access Medical Education platform Don’t Forget the Bubbles. Participants were invited and recruited via social media channels. Ethics was granted by Children’s Health Ireland Ethics Committee, Dublin, Ireland. Participants gave consent prior to commencing the study, which comprised of an online survey of demographic data followed by reporting of 10 trauma indicated elbow radiographs in 20 minutes, by selecting multiple choice options. The study was piloted. Radiographs were reviewed and reported by a paediatric radiologist prior to study commencement. Once completed, participants were shown the correct answer, radiologist’s report and explanation. The primary study outcome was correct diagnosis.
Results:
Between 17th August 2021 to 14th September 2021, 479 people consented to the study with 416 (87%) completing all study aspects. Of this, 318 (77%) self-reported regularly interpreting elbow radiographs in their clinical role. Of these 318 participants, 239 (75%) were doctors with 59 (19%) Advance Clinical Practitioners. 168 (53%) were based in the UK, 95(30%) in Australia, with the rest from 16 other countries. 9/318 (2.8%) participants got all ten diagnoses correct. The median number of radiographs correctly interpreted was 6, with the mean 5.44. The Gartland 3 supracondylar fracture was the fracture type with the most correct responses (269/318, 85%) and radial neck fracture most frequently reported incorrectly 99/31%). 119/318 (37.5%) participants had 11+ years of postgraduate experience and were the group who reported the most correct answers. Increasing postgraduate experience corresponded to a greater number of correct diagnoses.
Conclusion
This study shows that the healthcare professional's success in getting the correct diagnosis in paediatric elbow radiographs is suboptimal. Experienced clinicians, who interpret these radiographs daily, reported incorrect diagnoses. The absence of clinical history and examination findings may have influenced this outcome however the inaccuracy of interpretation remains. A clinical decision support tool (in parallel to education and quality improvement initiatives) for healthcare professionals tasked with interpreting paediatric elbow radiographs may improve these outcomes.
Lisa DANN, Sarah EDWARDS (Nottingham, United Kingdom), Dani HALL, Tessa DAVIS, Damian ROLAND, Aisling SNOW, Michael BARRETT, Don't Forget The Bubbles ON BEHALF OF
10:10 - 10:30
#31281 - Identification of HIV infection in the Emergency Department following recreational use of Crystal Methamphetamine and GHB/GBL.
Identification of HIV infection in the Emergency Department following recreational use of Crystal Methamphetamine and GHB/GBL.
Background:
Gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL) and crystal methamphetamines are often used in combination in the context of “chemsex” in the population of men who have sex with men (MSM). It is associated with high risk sexual behaviour and HIV transmission. (1) Guy’s & St Thomas’ NHS Foundation Trust is located in central London with our Emergency Department (ED) providing care to a local area with a large MSM population and night time economy. Our ED policy is to perform opt-out HIV testing to any patient requiring a blood test. Our aim was to identify the prevalence of HIV infection among presentations relating to recreational use of GHB/GBL and crystal methamphetamine. In addition we wanted to see how many of these patients were engaged with HIV treatment.
Methods:
We performed a retrospective review of all patients presenting to our emergency department, from January 2019 to the end of March 2021, who reported the use of crystal methamphetamine and/or GHB/GBL. Patients were identified from an existing database which records ED attendances secondary to overdose/ poisoning. Basic demographics were analysed. We reviewed clinical notes and investigations from the identified Emergency attendance and subsequent admissions, if relevant for HIV status and treatment engagement.
Results:
During the 27 month period, 873 attendances related to GHB/GBL and/or crystal methamphetamine were recorded. When filtered for re-attendances, this resulted in 611 patients. The median age was 35 (IQR 30-43). There were 578 (94.6%) male patients and 33 (5.4%) female patients. Of these patients, 447 (73.2%) were tested for HIV of which 187 (41.8%) tested HIV positive. In 260 (42.6%) patients, HIV antibodies were not detected. No HIV screening was performed for 164 (26%) of the patients. Of the patients identified as HIV positive, 62.6% (n= 117) were engaged in treatment. Nineteen (10.1%) patients were explicitly not on antiretroviral therapy either because of a new HIV diagnosis or because of non-compliance. We were unable to retrieve data on HIV treatment or a possible new diagnosis for 51 (27.3%) of the HIV positive patients.
Discussion/conclusion:
A recent study showed increased attendances in central London following methamphetamine use often used in combination with GHB/GBL (4). We noticed that patients presenting with GHB/GBL and/or crystal methamphetamine toxicity that were screened for HIV, had an HIV positivity rate of 41.8% which is significantly higher than the prevalence in our local boroughs. Ten percent were not engaged in treatment. Failure to identify HIV infection and engage individuals in treatment (with the aim to attaining undetectable viral loads) risks significant morbidity and mortality to the individual and the risk of virus transmission to others.
References:
1. Pakianathan, M., Whittaker, W., Lee, et al. (2018). Chemsex and new HIV diagnosis in gay, bisexual and other men who have sex with men attending sexual health clinics. HIV medicine, 19(7), 485-490.
2. Harnett, J. T., Dargan, P. I., Dines, A. M., Archer, J. R., et al (2021). Increasing emergency department attendances in central London with methamphetamine toxicity and associated harms. Emergency medicine journal.
n/a
Klara DE BAERDEMAEKER (London, ), Hennel AGRAWAL, Nikhita DATTANI, Kiran THIND, Matthew LEE, Kavin SATHANANTHAN, Laura HUNTER
10:10 - 10:30
#31186 - Methoxyflurane (Penthrox®) provides safe and effective pain relief of trauma-associated pain in clinical practice (Swiss post authorisation safety study).
Methoxyflurane (Penthrox®) provides safe and effective pain relief of trauma-associated pain in clinical practice (Swiss post authorisation safety study).
Background: Methoxyflurane (Penthrox®) is an inhalable medication for self-controlled analgesia of acute traumatic pain. It has been used for over four decades in several Anglo-Saxon countries. During national licensure, the Swiss authorities mandated the conduct of a post approval safety study (PASS).
Methods: Patients with acute moderate to severe traumatic pain were eligible for the study when treated in our level I university affiliated trauma centre and after receiving methoxyflurane during routine clinical practice either in our emergency department (ED) or from the local ambulance service (prehospital). Eligible patients were included upon their written informed consent. We recorded patient demographics, trauma characteristics, pain pre-existing co-morbidities and medication, concurrent pain medication, patient and provider satisfaction and adverse events. Patients were followed up for 28 days.
Results: We included 261 patients (safety population), of which 170 were first treated with methoxyflurane in the ED and 91 prehospital. The mean age of included patients was 47.52 years (standard deviation 19.22). 39.5% of patients were female. 257 patients were treated for acute traumatic pain, caused by a fall in the majority of cases (45.6%)(4 patients excluded from efficacy). Mean numeric pain scores (NRS) were 7.5 before treatment started and reduced to 5.0, 4.0 and 3.3 after 5, 10 and 25 minutes respectively (n=257). The pain reduction was significant in both the hospital as well as the pre-hospital group (all p<0.001). Patient satisfaction improved substantially from before to after treatment. 8 patients were lost to follow up. 21 patients experienced adverse drug reactions of which the vast majority were, mild and expected reactions such as dizziness (3.8%, n=10) or nausea (1.5%, n=4). 1 patient died in another hospital 26 days after treatment (unrelated to the drug), all other patients were alive at day 28. We observed one other serious adverse events- septic shock which was not related to the drug. One patient had a temporarily increase in liver enzymes which was considered drug related, non-serious and of moderate severity.
Conclusion: The use of methoxyflurane in a Swiss emergency setting was safe and effective both in the prehospital setting and within the ED. Adverse drug reactions were mostly non-serious, mild and transient.
BASEC registration number: 2019-01508
Funded by Mundipharma Research, UK and MDI, Australia
Stefanie KÜNG (Bern, Switzerland), Sabrina JEGERLEHNER, Wolf HAUTZ
10:10 - 10:30
#31082 - No increased safety risk for methoxyflurane analgesia compared to other routinely administered analgesics in the emergency setting: a comparative hybrid prospective-retrospective post-authorisation safety study.
No increased safety risk for methoxyflurane analgesia compared to other routinely administered analgesics in the emergency setting: a comparative hybrid prospective-retrospective post-authorisation safety study.
Background: Low-dose analgesic methoxyflurane (Penthrox®) was approved in Europe for emergency relief of moderate to severe pain in conscious adults with trauma in 2015. It is self-administered under supervision using the hand-held Penthrox® Inhaler. It is non-narcotic and provides rapid administration and rapid onset within 6-10 breaths. A comparative post-authorisation safety study (PASS) was conducted to assess the risk of hepatotoxicity and nephrotoxicity with methoxyflurane during routine clinical practice.
Methods: This was a prospective multicentre observational cohort study. The comparative cohorts consisted of adults who were given methoxyflurane (methoxyflurane cohort) or another analgesic (concurrent cohort) routinely used for moderate to severe trauma and associated pain in the Emergency Departments (EDs) setting in the UK between December 2016 and November 2018. Hepatic and renal events were captured in the ensuing 12 weeks. A blinded clinical adjudication committee assessed events.
An additional historical comparator cohort (non-concurrent cohort) was identified from patients with fractures in the English Hospital Episode Statistics (HES) accident and emergency (A&E) database from November 2013 and November 2015 (before commercial launch of methoxyflurane). Hepatic and renal events were captured in the ensuing 12 weeks via linkage with the Clinical Practice Research Datalink (CPRD) and HES hospital admissions databases.
Results: Overall, 1236, 1101 and 45112 patients were analysed in the methoxyflurane, concurrent and non-concurrent comparator cohorts respectively. There was no significant difference in hepatic events between the methoxyflurane and concurrent cohorts (1.9% vs 3.0%, P=0.079) or between the methoxyflurane and non-concurrent cohorts (1.9% vs 2.5%, P=0.192). Renal events were significantly less common in the methoxyflurane cohort than in the concurrent cohort (2.3% vs 5.6%, P<0.001). For methoxyflurane versus non-concurrent cohort the lower occurrence of renal events (2.3% vs 3.2%, P=0.070) was not statistically significant. Multivariate adjustment did not change these associations.
Conclusions: Methoxyflurane administration is safe from the perspective of hepatotoxicity or nephrotoxicity when compared to other routinely administered analgesics in emergency settings. In fact, methoxyflurane administration was associated with a decreased risk of nephrotoxicity compared with other routinely administered analgesics.
Study registered in the EU PAS Register (ENCEPP/SDPP/13040)
Nawab QIZILBASH (London, ), Himanshu KATARIA, Heather JARMAN, Ben BLOOM, Michelle BRADNEY, Maggie OH, Ana RONCERO, Ignacio MENDEZ, Stuart POCOCK
10:10 - 10:30
#31322 - NON-APPROPRIATE CONSULTATIONS IN POLYVALENT EMERGENCY DEPARTMENT : STATE OF THE SITUATION.
NON-APPROPRIATE CONSULTATIONS IN POLYVALENT EMERGENCY DEPARTMENT : STATE OF THE SITUATION.
Introduction:
The emergency department (ED) is a crucial component of any hospital structure. ED overcrowding is an international problem with negative repercussions for patients and caregivers. This overload is partly due to non-urgent and irrelevant consultations.
The objective of this study was to assess the situation and to identify factors that may influence the irrelevance of ED consultations.
Methods:
Cross-sectional study with an analytical aim including all patients aged over 15 years consulted a polyvalent ED during the 14-day study period, regardless of time and day of consultation. We excluded patients with: drunkenness, psychiatric conditions impairing judgment, and mental retardation.
A pre-established questionnaire was filled out by the care team. The doctor coded the consultation from 1 to 5 according to the Clinical Classification of Emergency Patients known as CCMU (Classification Clinique des Malades des Urgences). We compared 2 groups: group 1 with relevant consultation (CCMU 3,4 and 5) and group 2 with irrelevant consultation (classified CCMU 1 and 2).
Results:
N= 589, mean age 42± 17 years with a female predominance (54.5%). 61.1% of patients were married. Most of the patients who consulted had good socio-professional integration, went to the ED by their own means and had consulted spontaneously. The most common reasons for consultation were trauma, cardiovascular diseases and digestive diseases.
The first group included 149 patients and the second group 440 patients (74.7%). The groups were comparable in terms of gender, education level and distance from the hospital. There was no significant difference in the day of the consultation, the spontaneous nature of the consultation and the existence of a previous history similar to the reason for the consultation of the ED.
The patients were significantly younger in group 2 and the majority had social security coverage (p=0.006). There was a significant difference between the groups in terms of time to consultation (5 hours for group 1 vs 11 hours for group 2; p=0.004). There was a significant difference between the groups regarding family status, number of children, employment status and mode of transport to the emergency department, perception of severity and urgency, and patient's condition on admission. Group 1 subjects expressed more need for further examination (p<0.05). The presence of an attending physician significantly reduced the misuse of the ED. For the reasons that motivated the consultation of the emergency room, we noted a significant difference between the groups regarding proximity, the search for a quick solution and the lack of knowledge of the doctor to whom to refer (p<0.05).
Conclusion:
The easy access to check-ups and radiology at ED leads patients to consult them more often, thinking that they are better equipped and more efficient in terms of management. The poor organization of the health care system has been identified as a key factor in the overloading of EDs, and better communication between the EDs and the basic health centers is recommended for the management of CCMU 1 and 2 patients.
The authors declare no conflict of interest
Yousra AYACHI, Fatma HEBAIEB, Emna KAMOUN (Tunis, Tunisia), Safa CHAMMEM, Youssef ROUACHED, Yasmine GABSI, Sofiene GZARA, Sonia AISSA
10:10 - 10:30
#31294 - Prognostic value of prehospital N-terminal pro-B-type natriuretic peptide in patients with atrial fibrillation rhythm.
Prognostic value of prehospital N-terminal pro-B-type natriuretic peptide in patients with atrial fibrillation rhythm.
Background
Atrial fibrillation (AF) is the most common heart rhythm disorder encountered in clinical setting by Prehospital Emergency Services (PhEMS). N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels have proven to be a significant prognostic marker for adverse outcomes in patients with AF and may have clinical value. Despite that there’s still little evidence of the prognostic value of NT-proBNP in the prehospital setting.
Aim
The objective of this study is to evaluate the ability of prehospital NT-proBNP to predict in-hospital mortality in patients with AF rhythm referred to their reference hospitals by PhEMS.
Methods
Design: Retrospective, descriptive, multicenter study.
Study setting: PhEMS and Emergency Services in four provinces of Spain (Valladolid, Salamanca, Segovia, and Burgos).
Participants and date: We included all patients who were treated by advanced life support (ALS) units with FA rhythm and referred to their reference hospitals between October 1, 2019 and April 30, 2021.
Outcome variables: Sex, age, diagnosis, in-hospital mortality.
Statistic methods: The area under the curve (AUC) of the receiver-operating characteristic (ROC) of NT-proBNP was calculated for in-hospital mortality. We also calculated the score that offered the highest sensitivity and joint specificity in each case, and their positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR). In all the hypothesis tests carried out, a P value of <0.05 was considered significant, and for the confidence intervals, we chose the standard level of 95%.
Results
261 patients. Men: 51,3%. Median age: 80 years (IQR:64-94). In-hospital mortality average: 23,8%.
NT-proBNP AUC: 0,731 (IC 95% 0,652-0,810 p<0,0001). The best NT-proBNP cutoff point obtained with Younden’s index was 1812. A value of NT-proBNP equal or superior to 1812 had a sensitivity of 67,8% with a specificity of 73,6%; PPV of 43,5; NPV of 88,4; PLR of 2,258 and NLR of 0,438.
Discussion and conclusions
This is the first study that evaluates the prognostic value of NT-proBNP in patients AF rhythm in prehospital care. This biomarker presents a good AUROC when predicting in-hospital mortality in patients with AF. NT-proBNP in combination with other clinical and analytical parameters could help to make decisions and select the most appropriate destination for AF in prehospital care.
Funding
This trial has not received any special funding.
Ethical approval and informed consent
The study was approved by the Research Ethics Committee of all participating centers (reference CEIC: PI-GR-19-1258 and PI-049-19). All patients (or guardians) signed informed consent, including consent for data sharing.
This research has received support from the Gerencia Regional de Salud (SACYL) with registration number GRS 1903/A/19.
Enrique CASTRO PORTILLO (Valladolid, Spain), Francisco MARTÍN-RODRÍGUEZ, Rodrigo ENRÍQUEZ DE SALAMANCA GAMBARA, Miguel Ángel CASTRO VILLAMOR, Juan Francisco DELGADO BENITO, Irene SÁNCHEZ SOBERÓN, Raúl LÓPEZ IZQUIERDO
10:10 - 10:30
#30733 - Risk factors for post-contrast acute kidney injury in patients sequentially administered iodine- and gadolinium-based contrast media on the same visit to the emergency department: A retrospective study.
Risk factors for post-contrast acute kidney injury in patients sequentially administered iodine- and gadolinium-based contrast media on the same visit to the emergency department: A retrospective study.
Objectives
This study aimed to compare the incidence of post-contrast acute kidney injury (PC-AKI) between single iodine-based contrast media (ICM) and sequential administration of ICM and gadolinium-based contrast media (GBCA) on the same visit to emergency department (ED); and investigate its risk factors.
Methods
This retrospective study analyzed the data from 2016 to 2021. Patients who had eGFR of <30 mL/min/1.73 m2 measured in ED were excluded in this study. The primary outcome was the development of PC-AKI (increase in creatinine of ≥25% or 0.5 mg/dL over the baseline; or reduction in eGFR of ≥25%), and assessed using a propensity score matching (PSM) analysis between the ICM alone and ICM+GBCA groups. Additionally, its risk factors were assessed from multivariable logistic regression.
Results
Of the 29,635 patients administrated ICM, 6,318 were included. Among them, 139 patients were ICM+GBCA group. The ICM+GBCA group showed significantly higher rate of development of PC-AKI as compared with the ICM alone group in the total cohort (adjusted odds ratio [OR], 3.09 ;95% confidence interval [CI], 2.09–4.58]) and PSM cohort (adjusted OR, 2.38 [95% CI, 1.25–4.55]). On multivariate analysis in the ICM+GBCA group, osmolality (adjusted aOR, 1.05 [95% CI, 1.01–1.10]) and eGFR (adjusted OR, 0.931; 95% CI, 0.883–0.983) were associated with PC-AKI.
Conclusions
The sequential administrations of ICM and GBCA on the same visit to ED may be a risk factor for PC-AKI as compared with single administration of ICM alone. Osmolality and eGFR may be independently associated with PC-AKI after sequential administrations.
This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2021R1F1A1050858).
Changshin KANG (, Republic of Korea)
10:10 - 10:30
#31352 - Serious Medical Outcomes due to Opioid Exposures.
Serious Medical Outcomes due to Opioid Exposures.
Objectives: According to the Centers for Disease Control and Prevention (CDC), there were more than 108,000 overdose deaths in the United States (U.S.) in 2021, with over 75% of those involving an opioid – a 15% increase from the prior year. The present study sought to evaluate the recent trends in the severe outcomes due to opioid exposures (SO) reported to the U.S. poison centers (PCs).
Methods: The NPDS was queried for opioid exposures that were reported from 2017 to 2021 using the American Association of Poison Control Centers (AAPCC) generic codes. Cases with severe outcomes (SO) were defined as exposures that resulted in either a death or major clinical outcomes. We identified and descriptively assessed the relevant demographic and clinical characteristics. Poisson regression models were used to evaluate the trends in the number and rates (per 100,000 human exposures) of opioid exposures resulting in SO. Percent changes from the first year of the study (2017) were reported with the corresponding 95% confidence intervals (95% CI).
Results: Overall there were 47,893 opioid-related cases resulting in SO reported to the U.S. PCs during the study period. The proportion of cases from ACH decreased during the study period (75.9% vs 55.7%). Among cases with severe outcomes, ages between 30 and 39 years (23.2%) constituted the most common age group. The proportion of such cases (21.7% to 24.1%) increased during the study period. Males accounted for 57.8% cases. Most exposures with SO occurred in a residence (86.7%). Heroin (27.4%) was the most common opioid reported in cases followed by oxycodone (12.7%). The most frequently co-occurring non-opioid substances observed with the cases were benzodiazepines (16%) and alcohol (10.7%). Intentional abuse (50.3% vs 15.7%) and suspected suicides (29.7% vs 14.9%) were more common in exposures with SO compared to those without SO. The proportions of intentional abuse cases and suspected suicides was higher in cases reported by ACH. Similarly, non-oral routes of administration were more common in exposures with SO (43.5% vs 12.1%). Among the sample, approximately 40% of the cases were admitted to the critical care unit with 17% of patients being admitted to a psychiatric facility. About 90% of the cases were enroute to the healthcare facility when the PC was notified. Naloxone was the most frequently used therapy and in most cases was used prior to the PC recommendation. Tachycardia, come and drowsiness were the commonly seen clinical effects. The frequency of opioid exposures with SO increased by 61.3% (95% CI: 53.4%, 77.4%, p<0.001) while the rate increased by 55.4% (95% CI: 43.2%, 59.4%, p<0.001). Age, reason for exposure, substances involved and route of administration were significantly associated with the higher risk of a severe outcome in such exposures.
Conclusions: The number of opioid exposures cases with severe outcomes handled by the PCs increased significantly. Heroin and oxycodone were the most common opioid reported for the sample. Personalized evidence-based strategies, population level interventions, creation of protective environments, and better screening of patients are some key measure to limit this trend
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Saumitra REGE (Charlottesville, USA), Will GOODRICH, Christopher HOLSTEGE
10:10 - 10:30
#31130 - Singapore’s First Urgent Care Centre: a review of the caseload and impact.
Singapore’s First Urgent Care Centre: a review of the caseload and impact.
Background:
Urgent Care Centres (UCC) were conceptualized as alternatives to the Emergency Department (ED) for non-emergency care. They have longer operating hours than primary care centres (PCC), are located close to EDs and are staffed to handle conditions not requiring emergent care. Singapore piloted its first UCC in September 2020, 6km from a public hospital, serving the northern part of the island. This study reviews the caseload and impact of this newly-opened UCC on the nearby ED.
Methods:
We conducted a retrospective review of all UCC attendances from September 2020 to August 2021. Patients were referred by PCC, nursing homes, or self-referred.
The attendances were analysed according to ethnicity, monthly total and average daily attendances, patient acuity status at triage, source of referral, laboratory/radiology test utilization rate per visit, transfer rate to hospital ED, transfer outcomes, disposition from UCC and 72-hour unscheduled reattendance at UCC.
Results:
A total of 7121 cases were seen from September 2020 to August 2021. At 12 months of operations, the daily attendance ranged from 30 to 40. The ethnic distribution of attendances reflected the catchment population in the region, with 54% Chinese, 24% Malay and 12% Indian. More than 96% of patients had low-acuity conditions, in line with the care model of diverting such patients from ED.
The top 10 diagnoses at UCC were: upper respiratory infection, chest pain, low back pain, lacerations, contusions, gastroenteritis, wounds, abdominal pain, fever, ankle pain.
The majority of attendances (12-month average 84.9%) were self-referred. GP referrals comprised 13% of UCC attendance. The laboratory utilization rate was 1.54 per visit on average, below the ED benchmark of 1.6. In the first 5 months, the transfer rate to ED was approximately 10%. Subsequently, as operations settled, with senior physician vetting and monthly audit and review, the transfer rate dropped to 7%. An average of 1.25 % of these hospital transfers were high-acuity cases, eg. unstable vital signs, stroke, myocardial infarction. 55% of all transfers were admitted for inpatient care. The rest of the attendances were discharged from UCC, half with follow-up appointments.
Unscheduled reattendance rate was 2.45%, comparable to other EDs in Singapore. Based on 50th percentile, wait-time-to-consult was 11 minutes, 23 minutes lower than the nearest ED’s wait time.
Discussion:
The UCC brings acute care services to the community. In its first year, the UCC provided timely care for over 7000 patients, many of whom would have previously walked into the ED. UCC opened during the pandemic, coinciding with a time when low-acuity attendances dropped across most EDs nationally. A year on, while low-acuity ED attendances have largely recovered to pre-pandemic levels in most hospitals, UCC has blunted the recovery of low-acuity ED attendances in its partner hospital. These encouraging results provide basis for UCC to explore receiving lower-acuity cases directly from ambulance services in future. With senior physician oversight, direct admission to hospital or ED Short Stay Ward can also be planned.
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Eng Koon LIM (Singapore, Singapore), Juliana POH, Mohan TIRU, Michelle GU, Nanthini KUNARATNAM
10:10 - 10:30
#31507 - The Frequency of Serious Bacterial Infection in Febrile Infants Less Than 90 Days Old with COVID-19.
The Frequency of Serious Bacterial Infection in Febrile Infants Less Than 90 Days Old with COVID-19.
Background:
In the evaluation of children younger than 90 days old who admitted to the pediatric emergency department with a complaint of fever, it should be considered that patients in this age group are at high risk for serious bacterial infections (SBIs) including urinary tract infections, bacteremia, and meningitis. The severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection is a potential cause of fever in infants during the COVID-19 pandemic. The objectives of this study were to (1) describe the clinical, and laboratory characteristics and the frequency of SBIs in febrile infants less than 90 days old with infected SARS-CoV-2 and (2) to compare the clinical, and laboratory characteristics in patients infected by other respiratory viral pathogens with SARS-CoV-2 positive febrile infants.
Methods:
This was a retrospective multicenter cohort study conducted in four university hospitals from March 2020 to December 2021. Patients were included if their age was younger than 90 days old with a measured temperature of ≥38°C, and a SARS-CoV-2 test was performed. Patients with comorbidity/chronic diseases were excluded. Serious bacterial infection was defined as a urinary tract infection, bacteremia, and bacterial meningitis. We compared the demographics, clinical characteristics, laboratory results, and rates of SBI between patients with and without COVID-19 and between patients with COVID-19 and with other viral respiratory pathogens. Categorical variables, summarized as frequencies and percentages, were compared between groups using contingency table analysis (Chi-square test or Fisher’s exact test). Mann-Whitney U test was used to analyze continuous variables.
Results:
A total of 366 patients met the inclusion criteria. Two hundred and forty-two patients were COVID-19 PCR positive and 124 were COVID-19 negative. Total white blood cell, absolute neutrophil count, absolute lymphocyte count, C-reactive protein, and urinary leukocyte count were significantly lower in the COVID-19 positive group than in the COVID-19 negative group. The rate of SBI in the COVID-19 positive patients was 12.9% compared with 34.3% in the COVID-19 negative patients. The most common infections were urinary tract infections (8.1% vs 23%) (p<0.001). There was no significant difference in demographics, laboratory data, and the frequency of SBI between the patient infected with COVID-19 and with the other respiratory viral pathogens.
Discussion & Conclusions:
These results suggest that febrile infants younger than 90 days old infected with COVID-19 have lower rates of SBI than the patients without COVID-19. These data are consistent with previous studies describing lower risks of SBI in febrile infants with concomitant viral respiratory tract infections. However, there was no difference in the frequency of serious bacterial infections between COVID-19 and other viral respiratory pathogens. Further studies are needed to demonstrate the risk of SBI in febrile infants with COVID-19.
This is not a trial study. This study did not receive any specific funding.
Hande YIGIT, Emel ULUSOY, Murat DUMAN, Durgül YILMAZ, Songül TOMAR GUNEYSU, Özlem ÇETINKAYA ÇOLAK, Okşan DERINÖZ GÜLERYÜZ, Ayşe GÜLTEKINGIL, Özlem TEKŞAM (ANKARA, Turkey)
10:10 - 10:30
#31178 - The use of missing data strategies to build predictive models for structured data in emergency medicine: a systematic review.
The use of missing data strategies to build predictive models for structured data in emergency medicine: a systematic review.
Background. In the field of emergency medicine (EM), the use of decision support tools based on artificial intelligence has increased markedly in recent years. When a patient attends the emergency department, some variables are always collected and others are only collected if dictated by the context; for example, the capillary blood glucose level will not be measured for every patient. This specific context yields a heterogeneous dataset. Missing data (also referred to as “data not purposely collected” (DNPC)) do not constitute a bias per se because their absence is deliberate. Hence, the completion of DNPC is not the same as the completion of missing data in a standard, prospective study. This accepted information bias can be managed in various ways: dropping patients with missing data, imputing with the mean, or using automatic techniques (e.g. machine learning) to handle or impute the data. Here, we systematically reviewed the methods used to handle missing data in EM research.
Methods. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a systematic review after searching PubMed with the query “(emergency medicine OR emergency service) AND (artificial intelligence OR machine learning)”. We assessed all publications in English concerning the construction or application of a predictive model for structured data in an adult emergency department between 2000 and 2021. We counted the missing data strategies applied in the reviewed publication in a first matrix table. We described missing data in publications and considered the mean of the area under the receiver operator curve (AUROC) to describe the performance of the model when a unique strategy was applied.
Results. Seventy-two studies were included in the review. The trained models variously predicted diagnosis (in 35% of publications), mortality (29%), and probability of admission (29%). Eight publications (11%) predicted two outcomes. Forty-eight publications (67%) used a single strategy, 14 publications (19%) used more than one strategy, and 10 publications (14%) did not specify the strategy. The most frequently applied strategy was dropping (30 publications; 41%), followed by the mean value method (17 publications; 23%), ML strategies (13 publications; 18%), imputation (6 publications; 8%), and the physiological/reference value method (3 publications; 4%). The proportion of studies that used a dropping method fell from 67% in 2017 to 33% in 2021, whereas the proportion that used imputation rose from 6% in 2020 to 17% in 2021. Only 15 (21%) publications described their missing data.
Discussion and conclusions. DNPC constitute the “missing data” in EM machine learning studies. Although DNPC have been described more rigorously since 2020, the descriptions in the literature are not exhaustive, systematic or homogeneous. Imputation appears to be the best strategy but requires more time and computational resources. To increase the quality and the comparability of studies, we recommend inclusion of the TRIPOD checklist in each new publication, summarizing the machine learning process in an explicit methodological diagram, and always publishing the area under the receiver operating characteristics curve – even when it is not the primary outcome).
Funding: This research did not receive any specific funding from agencies or organizations in the public, commercial, or not-for-profit sectors
Competing interests: The authors have no competing interests to disclose.
Ethical statement: Not applicable.
Emilien ARNAUD (Amiens), Mahmoud EL-BATTAH, Christine AMMIRATI, Gilles DEQUEN, Daniel Aiham GHAZALI
10:10 - 10:30
#30743 - Ultrasound-guided superficial cervical plexus block for analgesia and local anaesthesia: A feasibility trial in a Belgian Emergency Department.
Ultrasound-guided superficial cervical plexus block for analgesia and local anaesthesia: A feasibility trial in a Belgian Emergency Department.
Introduction: In Belgian Emergency Departments (ED) the use of peripheral nerve blocks is not standard practice yet. We evaluated the implementation of the superficial cervical plexus block (SCPB) in two different patient groups, for central venous catheter (CVC) placement and clavicle fracture in a single Belgian Emergency Department.
Methods: A retrospective analysis of prospectively collected questionnaires on the use of the SCPB in a single centre. A sample of 37 patients was collected during a period of one year. The questionnaire reported a verbal numeric rating pain scale (VNRPS) for the following; during placement of SCPB, pre- and post-block for the fracture group, during placement of central line in internal jugular vein for the CVC group. Also duration of pain of the SCBP itself, a patient satisfaction score, a physician satisfaction score and an ease of placement score, physician reported time consumption of block placement and complications were reported. A median VNRPS for the local injection with central line placement was collected from literature to compare with the mean VNRPS for the CVC group.
Results: For the fracture group the mean difference in VNRPS before and after block was -3.33, albeit statistically insignificant. For the CVC group the mean VNRPS during central line placement was 2.4. The overall mean patient satisfaction was 8.2/10, for physicians this was 6.6/10. No complications were reported.
Conclusion: For the fracture group due to low incidence and low inclusion our dataset was too small to make an adequate statement, but there was a trend towards a considerable analgesic effect with the SCPB. For the CVC group there was a significant local anaesthetic effect, but without a direct comparison no statement could be made about superiority. Because of the time until onset of effect and difficulty in placement and organisational caveats, the SCPB would mostly be suitable for only a select group of patients for each indication.
No registration as this was retrospective
No funding or conflict of interest
Nick ADRIAENS (Antwerp, Belgium), Mark TIMMERMANS
10:10 - 10:30
#31685 - Web Search Vs ED Doctors, an observation study: How the Internet affects parents' expectations in ED pediatric trauma cases visiting the Emergency Department of a Tertiary Hospital.
Web Search Vs ED Doctors, an observation study: How the Internet affects parents' expectations in ED pediatric trauma cases visiting the Emergency Department of a Tertiary Hospital.
Introduction/Purpose. In recent decades due to free access to the internet, parents of pediatric surgery patients come to the Emergency Department (ED) after having already searched for information on their child's disease. Since pediatric trauma is a stressful situation for the parent, low-quality information from the internet can lead to specific expectations and requirements, thus modifying the classic way medicine is performed. The aim of this study was to understand to what extent, parents of pediatric trauma patients seek information on the internet before they come to the ED, what are their sources, how to they rate the quality of the information provided through the internet, and how this type of information affects parents' expectations about the their child's treatment. Material and method. This was a synchronous observation study that included the parents of all children who come our ED with a pediatric surgery problem from October to December 2021. Data was gathered in accordance with the European Union's General Data Protections Regulation. The study included a total of 100 parents. Out of these 57% searched for information on the internet before arriving with the main source of the search being medical sites via via Google. The majority reported that the quality of the information they found was very bad, of moderate reliability and utility, which greatly increased the parents’ stress before their child was examined by the doctor. Ninety-five percent of these parents did not inform the doctor about finding this information. After interactign with a doctors the parents’ stress levels were significantly reduced and the information they received from the doctor was considered as of better quality compared to what they found on the internet. Finally, 83% of arents requested guidance towards valid sites for proper information about their children's diseases. Conclusions. Most parents of pediatric trauma patients who come to the ED search the internet for information before arriving. However, they find that this information is of poor quality and induces their stress. The doctor remains the most reliable source of information, although parents avoid admitting that they have been looking for information from fear of attacking him. Finally, the majority of parents believe that they have the need to guide on targeted information sites by their doctors.
Panagiota KALEMOU, Ilia STAVRINA (Heraklion, Greece), Briasoulis GEORGIOS, Dr George NOTAS
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Exhibition Hall |
10:35 |
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A42
10:35 - 12:00
Wellbeing in Emergency Medicine - How to stay motivated despite psychological and physical violence
Moderators:
Petra BRYSIEWICZ (Moderator, South Africa), Eeva TUUNAINEN (Emergency Medicine Registrar) (Moderator, Kajaani, Finland)
10:35 - 10:55
Violence towards the ED staff.
Juan GUTIERREZ (Speaker, Bogota, Colombia)
10:55 - 11:15
Posttraumatic stress disorder in the ED.
Nicole BATTAGLIOLI (Speaker, Atlanta, GA, USA)
11:15 - 11:35
Compassion fatigue from the nurse perspective.
Petra BRYSIEWICZ (Speaker, South Africa)
11:35 - 11:55
What is necessary for working safely in the ED: a position statement from the Emergency Medicine Day.
Roberta PETRINO (Head of department) (Speaker, Italie, Italy)
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A6-7 |
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B42
10:35 - 12:00
Environmental Emergencies - Mountains, lightning and freezing cold
Moderators:
Christian HOHENSTEIN (PHYSICIAN) (Moderator, BAD BERKA, Germany), Marc SABBE (Medical staff member) (Moderator, Leuven, Belgium)
10:35 - 11:00
Assessment and management of high-altitude sickness.
Dr Monika BRODMANN MAEDER (Senior Consultant, Head of Education and Mountain Emergency Medicine) (Speaker, Bern, Switzerland)
11:00 - 11:25
Strategies and management of hypothermia and cold injuries.
Christian HOHENSTEIN (PHYSICIAN) (Speaker, BAD BERKA, Germany)
11:25 - 11:50
The ABC approach to electrical and lightning injuries.
Tatjana JEVTIC (Medical Doctor) (Speaker, Sarajevo, Bosnia and Herzegovina)
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A8 |
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C42
10:35 - 12:00
EUSEM Research Session - Current and future projects
Moderators:
Pr Martin MÖCKEL (Head of Department, Professor) (Moderator, Berlin, Germany), Ari PALOMÄKI (Professor) (Moderator, Hämeenlinna, Finland)
10:35 - 11:00
State of the art: Health care research in Emergency Medicine: Data sources, methods and actual topic.
Pr Anna SLAGMAN (Professor for Health Services Research in Emergency Medicine) (Speaker, Berlin, Germany)
11:00 - 11:20
The comparison of prognostic performance of various emergency scores in non-traumatic patients admitted to the ed.
Muammer Oğuz KANDABAŞ (RESIDENT) (Speaker, ANKARA, Turkey)
11:20 - 11:40
Patients trajectories to the ED.
Målfrid NUMMEDAL (Medical student) (Speaker, Trondheim, Norway)
11:40 - 12:00
Migration-specific disparities in Emergency Department Ccare.
Freddy IRORUTOLA (Assistenzarzt) (Speaker, Berlin, Germany)
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A1 |
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D42
10:35 - 12:00
Aortic dissection
Moderator:
Catherine FOWLER (Aortic Dissection Awareness UK & Ireland Vice Chair) (Moderator, United Kingdom)
10:35 - 10:45
Speaker.
Catherine FOWLER (Aortic Dissection Awareness UK & Ireland Vice Chair) (Speaker, United Kingdom)
10:45 - 11:10
Epidemiology and Pathophysiology.
Graham COOPER (Consultant Cardiac Surgery) (Speaker, Sheffield)
11:10 - 11:35
Characteristics of patients with delayed diagnosis.
Matthew REED (Consultant in Emergency Medicine) (Speaker, Edinburgh)
11:35 - 12:00
New approaches to diagnoses.
Eva GÖNCZ (Emergency Physician) (Speaker, Berlin, Germany)
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A2 |
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E42
10:35 - 12:00
Intoxications
Moderator:
Nicolas GOFFINET (Praticien Hospitalier) (Moderator, Nantes, France)
10:35 - 11:05
Toxidromes general review.
Eric DRYVER (Consultant) (Speaker, Lund, Sweden)
11:05 - 11:25
CA++/beta blockers.
Hanna OVASKA (PH) (Speaker, CRETEIL, France)
11:25 - 11:40
Digoxin.
Hanna OVASKA (PH) (Speaker, CRETEIL, France)
11:40 - 12:00
Etanol intoxication and withdrawal.
Karen PEETERS (Resident) (Speaker, Antwerp, Belgium)
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A4 |
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F42
10:35 - 12:00
Hospital without walls II
Moderator:
Anastasia SPARTINOU (Emergency Medicine Trainee) (Moderator, HERAKLION, Greece)
10:35 - 11:00
Physician respone unit.
Andrew BROOKES
11:00 - 11:25
EMS and hospital integration on large scale incidents.
11:25 - 11:50
Human factors and team performance in resuscitation attempts.
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G42
10:35 - 12:00
Notfallreform 2.0? Podiumdiskussion
Moderator:
Stephan BALLING (Moderator, Germany)
Panelist:
Susanne JOHNA (Panelist, Germany)
10:35 - 12:00
Panelist.
Kerstin BOCKHORST (Panelist, Germany)
10:35 - 12:00
Panelist.
Martin PIN (Panelist, BORNHEIM, Germany)
10:35 - 12:00
Panelist.
Stefan POLOCZEK (Panelist, Germany)
10:35 - 12:00
Panelist.
Dominik GRAF VON STILLFRIED (Panelist, Germany)
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A3 |
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H42
10:35 - 12:00
COVID-airway / Imaging / Miscellaneous
Moderators:
Carmen Diana CIMPOESU (Prof. Head of ED) (Moderator, IASI, Romania), Roberto COSENTINI (Head of Emergency Medicine) (Moderator, BERGAMO, Italy)
10:35 - 10:43
Consistency of respiratory viruses detection between nasopharyngeal swab and bronchoalveolar lavage in adults admitted for a suspected pneumonia: the imortance of BAL testing.
Donia BOUZID (MD-PHD) (Abstract Presenter, Paris, France)
11:23 - 11:31
Ready or not, PoCUS en route!
Carmen Diana CIMPOESU (Prof. Head of ED) (Abstract Presenter, IASI, Romania)
11:31 - 11:39
Lactic acidosis secondary to metformin in hospital Emergency Department.
Isabel MORALES (physician) (Abstract Presenter, Seville, Spain)
11:39 - 11:47
Epidemiology of patients who died in the ED an need of end-of-life care: A nationwide observational study, 2016-2019.
Sun Young LEE (Physician) (Abstract Presenter, Seoul, Republic of Korea)
11:47 - 11:55
Interest of an emergency stock of red blood cell (RBC) in Emergency Department: a retrospective observational study of 3 years at the University Hospital in Rennes (France).
Sylvia GIESE (RPPS :10100331601) (Abstract Presenter, RENNES, France)
10:35 - 12:00
#30975 - Abdominal Point-of-Care Ultrasound for the exclusion of bowel obstruction: prospective multicenter observational study.
Abdominal Point-of-Care Ultrasound for the exclusion of bowel obstruction: prospective multicenter observational study.
Introduction
The diagnosis pathway for small bowel obstruction (SBO) in the Emergency Department (ED) usually includes abdominal CT which has excellent performances. However, its access could be difficult in some ED and the waiting time before its realization important. Point-of-Care Ultrasound (POCUS) has been investigated and has demonstrated interesting performances. However, the ability of POCUS to rule-out SBO in ED patients with a clinical suspicion remains currently unknown but could be interesting, in particular in ED with limited resources. The goal of this study was thus to assess the ability of POCUS to exclude SBO in such patients.
Patients and methods
It was a prospective multicenter observational study. Included patients were a convenience sample of adults consulting in the ED for acute abdominal pain with a clinical suspicion of SBO. Exclusion criteria were patients < 18 years old and protected adults. After informed consent, a POCUS was performed. The following items were assessed in the 9 abdominal quadrants: dilated incompressible intestinal loop (>25 mm) with back and forth fluid movements. The main objective was the ability to rule-out the diagnosis of SBO (sensitivity). The secondary objectives were the other diagnostic performances, duration of POCUS, operator’ experience, delay between POCUS and CT. The study was approved by an ethic committee and registered on clinicaltrial.gov (NCT04848415). For a 95% sensitivity with 5% confidence interval, 145 patients were needed.
Results
152 patients were included, 2 secondarily excluded (no CT performed) leaving 84 women and 66 men (mean age 69 + 20 years old). A SBO was excluded by CT in 67 patients (55% [95%CI 47-62%]). There was a false negative case with POCUS. The sensitivity was 99% [95%CI: 93-99%]. Other diagnostic values were: specificity 84% [95%CI: 73-90%], positive predictive value 88% [95%CI: 80-93%], negative predictive value 98% [95%CI: 91-99%], accuracy 92% [95%CI: 87-95%]. The operator’s experiences were beginner for 28 patients, intermediate for 61 and experienced for 61. The duration of POCUS were <5 min for 118 patients, 5-10 min for 30 and >10 for 2 patients. Delay between POCUS and CT was 120 min [60-182] (median [1st - 3rd quartiles]).
Discussion
The performances of POCUS to rule-out SBO were excellent even when performed by Emergency Physicians without major ultrasound experience. POCUS was achieved in a short amount of time. This rule-out ability was concordant with a recent meta-analyse [1] but the rule-in (specificity and positive predictive value) was less efficient. This could be related with the lake of Ultrasound experience of the Emergency Physicians.
In conclusion, POCUS could save time and radiation for patients with a suspected SBO in the ED.
1 Gottlieb M et al. Utilization of ultrasound for the evaluation of small bowel obstruction: A systematic review and meta-analysis. The American Journal of Emergency Medicine 2018;36:234–42.
clinicaltrial.gov: NCT04848415
Sylvain AMIMIER, Quentin LE BASTARD, Christophe BERRANGER, François JAVAUDIN, Eric BATARD, Philippe LE CONTE (Nantes)
10:35 - 12:00
#31185 - Chest computed tomography and lung-ultrasound by emergency department physicians in the diagnosis of pneumonia during the Covid-19 pandemic. A prospective method comparison trial.
Chest computed tomography and lung-ultrasound by emergency department physicians in the diagnosis of pneumonia during the Covid-19 pandemic. A prospective method comparison trial.
Background:
Lung ultrasound (LUS) has been established in intensive care medicine as a bed-side routine tool for the assessment of pleural conditions, effusions, consolidation and interstitial edema. Due to its availability and ease of use, LUS is increasingly used in emergency medicine in the differential diagnosis of dyspnea and thoracic pain, among others. During the Covid-19 pandemic there was a need for a screening tool for pneumonia in patients with suspected Covid-19 disease.
Methods:
We performed a prospective method comparison trial in patients suspected or known to have Covid-19 or other indications for pulmonary imaging. The setting was a medium sized metropolitan general hospital with an emergency department caring for about 40000 patients per year. All patients received LUS by an emergency physician (EP), thoracic CT and rtPCR for SARS-CoV-2. EP and radiologists were blinded to the respective images and reports of their counterparts. Enrollment was between April 2020 and march 2021.
During shifts with presence of an EP with skills in LUS consecutive patients where included if they fulfilled the following inclusion criteria: dyspnea and/or age > 60 years and/or relevant comorbidities and either lymphopenia or temperature > 37.3°C or if chest CT was indicated for another reason. A LUS diagnosis of Covid-19 pneumonia (B-Profiles, no large consolidation, no large effusion) was compared to the final adjudicated diagnosis of Covid-19 pneumonia. Most chest CTs were performed as low-dose CT.
Results:
220 patients were included (mean age 67,6 ± 16,5 years, 42,8% female). 133 (60%) had a final clinical diagnosis of Covid -19 pneumonia. Over the whole cohort, patients with covid-19 pneumonia compared to patients without covid-19 pneumonia, were significantly less likely female (36.8 vs. 51.7%; p = .048), had a lower oxygen saturation (95% (91 – 97) vs. 96% (93 – 98); p = .046), lower lymphocyte counts (0.89 G/L (0.66 – 1.24) vs 1.23 G/L (0.70 vs 1.68); p = .006 and higher CRP (65.0mg/L (37.5 – 114.2) vs 31.6mg/L (9.2 – 113.8); p = .001). 27 patients were treated as outpatients. Hospital mortality was 10.4%, 3.4% in patients with and 17.3% in patient without Covid-19 pneumonia (p < .001).
SARS-CoV-2 PCR was positive in 144 patients (64.9%). 163 (73.4%) patients had any infiltrates on LDCT, 134 (60.6%) had bilateral infiltrates. In 120 (54.1%) pulmonary infiltrates were judged typical of Covid-19 pneumonia (CORADS 4 or 5).
LUS had an accuracy of 0.7387 (95% CI: 0.6757 – 0.7952) predicting a final diagnosis of SARS-CoV-2 pneumonia in that patient. Sensitivity and specificity were 0.8346 and 0.5955, respectively. Positive predictive value in this cohort was 0.7551, negative predictive value 0.7067. Positive and negative likelihood-ratios were 2.06 and 0.277, respectively. Cohen’s Kappa was 0.4416. 5 cases were classified as false negative LUS. On CT, these had small patchy central infiltrates in 4 cases and a large consolidation possibly due to superinfection in one case.
Conclusion:
In this cohort of undiagnosed emergency department patients with respiratory/thoracic symptoms we found a moderate accuracy of LUS in predicting Covid-19 pneumonia.
DRKS00021585 / no funding was received
Andreas UMGELTER, Daisy Patricia ARRUA MORINIGO (Berlin, Germany), Sai Ram GANESH, Rania DARDANE, Luis Alonso JIMENEZ URQUIA, Wenske SLATOMIR, Marcel EBERL, Carolin NESTLER, Roland M. SCHMID, Karsten KRÜGER
10:35 - 12:00
#31437 - Comparison of need for respiratory support in patients during eras of the Delta and Omicron variants of SARS-CoV-2.
Comparison of need for respiratory support in patients during eras of the Delta and Omicron variants of SARS-CoV-2.
Aim: SARS-CoV-2 is prone to genetic evolution, which resulted in the emergence of multiple variants with different characteristics. With Delta and Omicron being the last two leading variants, we aimed to compare the need for respiratory support in patients treated in two different eras of the SARS- CoV-2 pandemic.
Materials and methods: We retrospectively enrolled consecutive adult patients treated in the Emergency Department, University Hospital Centre Zagreb in November 2021 (presumed Delta era) and January 2022 (presumed Omicron era). The patients were not tested for specific variants and the cohorts are based upon epidemiological reports of variant prevalence. Data on 839 SARS-CoV-2-positive patients (409 in the Delta era and 430 in the Omicron era) included demographics, relevant comorbidities, vaccination status, vitals upon admission, initial laboratory parameters and administration of oxygen support. Zou´s modified Poisson regression was used to compute relative risks (RRs) for the need for oxygen support (any method) and advanced oxygen support (non-invasive ventilation, high-flow nasal cannula or mechanical ventilation).
Result and conclusion: The cohort from the Omicron era was significantly younger (median age 64 vs. 67.1, P=0.021) and had more fully vaccinated patients (39.5% vs. 29.6%, P=0.011). They also had significantly higher oxygen saturation of the arterial blood upon initial presentation, lower C-reactive peptide (P<0.001) and high-sensitive cardiac troponin T levels (P=0.002). The need for oxygen supplementation and advanced oxygen supplementation was significantly lower for patients in the Omicron era relative to the Delta era both at univariate analysis and after adjusting for age, sex and vaccination status (RRadj 0.8, 95% CI 0.7 – 0.9; P valueadj <0.001 for total oxygen supplementation; RRadj 0.2, 95% CI 0.1 – 0.4; P valueadj <0.001 for use of advanced oxygen supplementation). Increased prevalence of the Omicron variant in our population seems to have reduced the number of patients presenting with more severe forms of COVID-19 requiring respiratory support.
Lea MIKLIC (Zagreb, Croatia), Adis KERANOVIC, Zrinka SERTIC, Stela HRKAC, Ivana Karla FRANIC, Barbara RUBINIC, Elena JELLIN, Anamarija RAGUZ
10:35 - 12:00
#30315 - Consistency of respiratory viruses detection between nasopharyngeal swab and bronchoalveolar lavage in adults admitted for a suspected pneumonia: the importance of BAL testing.
Consistency of respiratory viruses detection between nasopharyngeal swab and bronchoalveolar lavage in adults admitted for a suspected pneumonia: the importance of BAL testing.
Background: COVID-19 has highlighted that nasopharyngeal swab (NPS) has high diagnosis accuracy, including in ICU patients. However, little data are available on the consistency of detecting other viruses’ between NPS and bronchoalveolar lavage (BAL) among adults. The objective of this study was to compare NPS and BAL results for non-SARS-CoV-2 viruses in case of suspected pneumonia.
Materials/methods: A retrospective analysis was performed in one Parisian academic hospital using data from 276 adults with suspected pneumonia from 2012 to 2018 and tested within 48h by multiplex-PCR in both NPS and BAL. The consistency in pathogen detection between the paired NPS and BAL was evaluated.
Results: Patients were primarily male (65%), with a median age of 59.7 (IQR: 50.9-67.8). One hundred sixty-nine patients (61%) were admitted to ICU for acute respiratory distress. One hundred and eight patients have a chronic respiratory disease (38%), 109 were immunocompromised (39%), and 38 died during their hospital stay (14%). We detected at least one respiratory virus in 95 NPS (34%) and 80 BAL (29%). Two or more viruses were detected in 7 NPS (3%) and 6 BAL (2%). Compared to a positive BAL, NPS had a sensitivity of 71.6%, specificity of 93.4%, and a Kappa coefficient of 0.67. The same pathogen or pathogen combination was observed in 231 patients (84%) positive in NPS and BAL. Influenza B, parainfluenza, coronaviruses HKU1, NL63, 229E had the highest agreement (100%) between NPS and BAL, while coronavirus OC43 and rhinovirus had the lowest agreement (33% and 67%, respectively). In a multivariate regression model adjusted on age and immunodepression, we observed that samples from patients with a chronic respiratory disease showed a poorer agreement between NPS and BAL (aOR 0.5, 95%CI [0.25-0.97], p=0.043).
Conclusions: There was good consistency between NPS and BAL in detecting respiratory viruses among patients with suspected pneumonia. However, these data still encourage performing a BAL when available for a more precise diagnosis.
No funding
Donia BOUZID, Quentin LE HINGRAT (Paris), Florian SALIPANTE, Valentine FERRÉ, Thierry CHEVALIER, Christophe CHOQUET, Diane DESCAMPS, Yazdan YAZDANPANAH, Benoit VISSEAUX, Paul LOUBET
10:35 - 12:00
#30794 - Epidemiology of patients who died in the ED and need of end-of-life care: A nationwide observational study, 2016-2019.
Epidemiology of patients who died in the ED and need of end-of-life care: A nationwide observational study, 2016-2019.
Backgrounds
The need of palliative and end-of-life (EOL) care is growing, but not much attention is paid to the emergency departments (ED). Although death in the ED is unavoidable, information on who dies in the ED is insufficient. This study aimed to investigate the size and characteristics of ED death using the representative national data.
Methods
Retrospective observational study was conducted for all ED visits between 2016 and 2019 using the National Emergency Department Information System (NEDIS) database. Except for death on arrival and cardiac arrest at ED arrival, the patients who died during the ED treatment was included as study population. The primary outcome was reason of ED visit. The secondary outcomes were length of stay (EDLOS) and provision of life-sustaining treatment (LST) in the ED. The patient characteristics and ED treatment were compared according to the reason of ED visit. For patients who died of disease, most common diagnoses and whether they had palliative care eligible disease were investigated.
Results
Among the 36,538,486 ED visits for 4 years, 34,086 patients were died in the ED during the treatment. Only 9.9% (3,370) died from non-disease, and 90% (30,716) died from disease. For disease patients, the most common ED diagnoses were cardiac arrest (22.1%), pneumonia (8.6%), and myocardial infarction (4.7%). The median EDLOS was 4.5 hours (IQR, 1.9-11.7), and 34.0% (10,452) stayed in the ED over 8 hours. 44.2% (13,562) received cardiopulmonary resuscitation (CPR) at the EOL time. Patients with palliative care eligible disease were cancer 16.9% (5,187), liver disease 3.8% (1,176), heart failure 3.5% (1,076), and chronic respiratory disease 1.4% (416), accounting for a quarter of the disease death. Cancer patients received less CPR and had longer EDLOS than other disease patients (CPR rate 23.4% and EDLOS 7.3 (3.2-15.9)).
Conclusion
Over the past 4 years, 30,000 people, including 5,200 cancer patients, died in the ED during the treatment. More than 30% stayed in the ED over 8 hours and half did not received CPR at the end-of-life time. It is time to discuss about need of palliative and EOL care in the ED.
Sun Young LEE (Seoul, Republic of Korea), Young Sun RO
10:35 - 12:00
#31132 - Incidence of Contrast Nephropathy in the Emergency Department.
Incidence of Contrast Nephropathy in the Emergency Department.
Contrast Induced Acute Kidney Injury (CI-AKI) refers to the elevation of serum creatinine from baseline by ≥25% or ≥0.5 mg/dl (44 μmol/l) within 48 hours of receiving a contrast medium. While NICE guidelines recommend mitigating strategies for patients at increased risk of CI-AKI, it is stressed that this should never delay emergency imaging.
The clinical impact of CI-AKI has come under considerable scrutiny, with recent data suggesting that patients come to greater harm from our attempts to prevent CI-AKI than the nephrotoxic effects of contrast medium itself. Any delays to urgent imaging and subsequent management, particularly emergency surgery, can have significant clinical consequences for patients.
The aim of this study was to determine the incidence of CI-AKI in patients who had contrast enhanced CT scans in the ED. Of those who developed renal impairment, data was reviewed to determine the proportion of patients requiring dialysis as a result. Given the risks associated with imaging delays we also wanted to determine whether precautions to prevent CIAKI (including waiting for U+E result) led to delays in CT scanning for emergency patients.
We reviewed retrospective data for all CT imaging with contrast performed in the ED of a DGH from 01/11/2020 to 19/05/2021. We excluded CTPA and CT cerebral angiogram as these investigations tend to be performed on an inpatient basis at our site. Renal function pre- and post-scanning (where available) was reviewed against patient case notes to determine if renal function became impaired and if the patient required dialysis.
370 CT scans with contrast were reviewed. Findings revealed no patient with previously normal renal function (n = 292) required dialysis following CT with contrast in the ED.
1 patient required dialysis in ICU post-contrast. This patient had pre-existing renal impairment and was critically ill on presentation.
16 patients had an elevation in serum creatinine consistent with CI- AKI post-contrast imaging. However almost all had significant findings on CT imaging which could also contribute to pre-renal causes of renal impairment. Over half of this cohort of patients were for end-of- life care as a result of CT findings and clinical presentation. 46.5% of patients in this study waited over an hour for CT imaging in the ED. There was very little documentation regarding causes of scan delays.
Waiting for U&Es and providing pre-emptive treatment against CI-AKI should not delay patients receiving urgent CT imaging with IV contrast. The incidence of CI-AKI, or even the need for subsequent renal replacement therapy, is low and delays to definitive management poses a greater potential risk to the patient.
We can support patients thought to be at risk of CI-AKI in the ED by following NICE guidance: oral hydration where possible, IV fluids considered if – eGFR <30, renal transplant, large volume contrast, or intra-arterial use. In doing so we will be managing a range of factors known to precipitate AKI and providing more holistic care. While further studies would be required to support large scale change in practice these results demonstrate safe practice within our department.
Abbie MCALINDEN (Glasgow, ), Irene BENARAN, Millie STOKES, Jennifer COCHRANE
10:35 - 12:00
#31538 - Interest of an emergency stock of red blood cell (RBC) in emergency department (ED): a retrospective observational study of 3 years at the university hospital in Rennes (France).
Interest of an emergency stock of red blood cell (RBC) in emergency department (ED): a retrospective observational study of 3 years at the university hospital in Rennes (France).
Introduction: An emergency stock (ES) allows emergency-release transfusion of labile blood products in life-threatening situations. In particularly for haemorrhagic shock, current guidelines recommend early transfusion. This demand to deliver RBC without delay. Is the access to an ES pertinent for ED?
Background: Actually, emergency physicians (EP) of the university hospital of Rennes use the ES for the management of haemorrhagic shock (medical and traumatic origin; exempted trauma centre for massive transfusion managed by anaesthetists). A new architectural project is considering the removal of access to the ES for EP. The primary outcome of this study is transfusion delay after the prescription of RBC, comparing the path coming directly from the « Etablissement Français du Sang » (EFS) (on the site, but not in the same building) and that using the ES next to ED (floor under).
Methods: In this retrospective single-centre observational study, we assessed all emergency-release prescriptions of RBC in the shock room between the Jan 1, 2018 and Dec 31, 2020. The primary outcome is prescription – connection delay between de RBC issue of de ES and the EFS. Path was chosen by EP. Secondarily, were compared the 1 day and 1 month survival, clinical characteristics and the respect of national guidelines of transfusing D negative RBC in the 2 groups.
Statistical analysis utilized Wilcoxon and Fisher exact tests by using R v. 4.0.2 software (R Core Team, 2019) and p-value < 0,05 was considered significative.
Results: In 3 years, 99 patients were included. 64 patients received RBCs directly from the EFS and 35 patients from the ES. Delays were significantly shorter by the ES path with 86% of RBCs connected < 15 minutes after prescription, vs 9% by the EFS path (p = 5.286 x10-12). Patients benefiting from the ES were younger (median = 62 years [IC 48-75] vs median = 73 years [IC 61-84], p = 0.03434), with a more severe hypotension (systolic blood pressure median = 84mmHg [IC 71-93] vs median = 91mmHg [IC 80-110], p = 0.01978). Survival was not different either at 24 hours or at 1 month. National guidelines were respected in 74% with no difference between groups.
Discussion: The existence of an ES allowed a significant reduction in prescription-connection times without impact on survival in this study. The necessity of an ES in proximity of the ED depends on architectural and logistic organization in the hospital, also if it is mutualized by different structures (ED, trauma centre, UCI, emergency operating room).
Other stages of the classic EFS path could also be optimized to accelerate the prescription-connection process. New prospective studies have to prove the impact on delay and on survival.
Progress is possible concerning the overuse of O Rhesus D negative RBCs in our ED.
Conclusion: In emergency-release transfusion, the existence of ES allowed a significant reduction in prescription-connection delay without impact on survival in this study.
Trial Registration: no appropriate register
Funding Information: This study did not receive any specific funding.
Matthieu HUYNH TUONG, Sylvia GIESE (RENNES), Remi VALTER, Louis SOULAT, François SAGET, Nicolas PESCHANSKI
10:35 - 12:00
#30780 - Lactic acidosis secondary to metformin in hospital emergency department.
Lactic acidosis secondary to metformin in hospital emergency department.
Background: Metformin is one of the most prescribed drugs in the world. This makes it especially important to pay attention to the possible adverse effects among which the possible induction of lactic acidosis stands out by severity. In some series the mortality of this picture is very high. However, it is believed that the true incidence is unkown, as well as practical transcendence.
To know the characteristics of patients with lactic acidosis induced by metformin is very important to diagnosis and treatment.
- Material/Methods: It is a descriptive analysis de all cases diagnosis of “ Lactic acidosis secundary by metfomin were diagnosis in Emergency Department from January 1, 2014 until March 1, 2017, in a third level hospital. Being a retrospective search, informed consent was not requested.
Results:Sample was composed of 20 cases, of which 10 were males(50%) with an average of 76.7 ± 8.6 SD years.
The number of drugs per day was 10.15 (7.25-12.5). The consumption of metformin in 35% of the patients, was carried out together with another antidiabetic, although the most frequent pattern was in solitary (65%): in 9 cases with 850 mg every 8 h (45%) and 3 of them each 12 hours (15%) Only in one case was it overdosed at home (3000 mg/day).
Charlson was 3.94 ± 1.81 SD, and only 20% had diabetes with organ involvement.
Symptoms on arrival in 40% were confusional, followed by vomiting (30%), diarrhea (20%) and dyspnea (5%).
The situation of patients upon arrival at the emergency room presented Glasgow 12.29 ± 3.22 SD, and a respiratory rate
The renal function was reviewed in hospital clinical history, only in 2 cases there were data of chronic kidney disease, being its Basal Glomerular Filtration > 60 mL / min. 80% had acute kidney failure at the time of assessment, with mean creatinine values 6.5 ± 2.9 mg/dl, Urea 191 ± 74.5 mg/dl and potassium levels 6.1 ± 1.34 mEq/L.
A total of 7 patients (35%) required admission to the ICU compared to 13 (65%) that was not required, were admitted mostly in the nephrology service in 10 of the cases (50%). In 12 cases required purification treatment, 9 cases required hemodialysis ( 45%). The number of sessions was 3.2 ± 2.9 SD. Continuous venovenous hemofiltration (HFVVC) is applied in 3 cases (15%). The duration of the hemodialysis sessions carried out by the Nephrology service was scheduled in l 4-6 hours.
The average of the days that were admitted until the time of discharge or the moment of success was 12.60 days (5-13.75). Only 5 cases (25%) the patient died during admission
- Conclusions: All our cases were older with acute renal failure and polymedicated. Patients must be warned about the most common lactic-acidosis inducing situation, especially dehydratation and gastrointestinal syndrome if they continue taking the drug at such times. Mortality was similar to what was published.
Isabel MORALES BARROSO (Seville, Spain), Maria Carmen MANZANO ALBA, Rosa GARCIA HIDALGO
10:35 - 12:00
#31226 - Ready or not, PoCUS en route!
Ready or not, PoCUS en route!
Background:
In the early 1990’s a group of volunteer Intensive Care doctors, proposed a change in the Emergency Medicine Services in Romania based on existing models from fellow European states and the United States. The proposed model continued to develop under faculty guidance, from these countries and by 2008 it became an integral part of Romania’s Healthcare System continuing to develop since.
In 2019 our department took steps to implement Point-of-Care-Ultrasound (PoCUS) in pre-hospital. We started with a PoCUS course under EUSEM faculty guidance, acquired two portable ultrasounds for pre-hospital ground and helicopter crews and conducted several seminars.
Methods:
An 11-question anonymous survey was emailed in early 2022 to the doctors that practice pre-hospital medicine within our university and local level 1 trauma centre. The survey has been done as an overview of the current state before the start of a prospective study. Descriptive statics are reported.
The doctors involved are from their final year of speciality training up to consultant level. We documented how they are utilizing PoCUS in pre-hospital care and how having it on hand is impacting the decisions they make in patient care and case management.
No incentives were provided for completion of the questionnaire.
Results:
23 answered within the allotted time. 5 (21.7%) stated that they don’t use PoCUS in pre-hospital, the main reason is the lack of legal framework and lack of experience with PoCUS. 18(100%) stated they use it for trauma and cardiac arrest patient, 14 (77.8%) use it in non-differentiated shock and 11 (57 %) use it for invasive procedures. 16 (88.89%) have used PoCUS for evaluation of Pulseless Electrical Activity. All of the participants consider that PoCUS has increased in clinical importance since the start of the pandemic and 10 (55.56%) state that the use of PoCUS changed their management of the patient, reporting an improvement in their care decisions.
23 (100%) stated that bi-annual, experience based, workshops and the need to introduce ultrasound in the training curricula of future residents is necessary in order to make PoCUS common use.
Discussion & Conclusions:
The last two years of COVID have brought PoCUS up front, with an increased use due to a lack of repeatable imaging in a resource scarce, COVID isolated environment. Bringing PoCUS to pre-hospital has helped it become more ingrained in the arsenal of local emergency physicians becoming a common thing. Although a positive progression has been made with workshops and ultrasound availability there is still a lot to do in terms of standardizing use, standardization and implementation of training and supervision of trainees and the creation of a legal framework where non-radiologists ultrasound targeted findings, be it from the Emergency Department or Intensive Care, can be recognised. Further observation and working in collaboration with other medical systems could hold the key to a smoother implementation
Catalin BOUROS, Paul NEDELEA, Gabriela GRIGORAS, Ovidiu Tudor POPA, Emilian MANOLESCU, Diana CIMPOESU (IASI, Romania)
10:35 - 12:00
#31016 - Treatment guided by monitoring acute dyspnoeic adult patients with serial cardiopulmonary point-of-care ultrasound: a randomised trial.
Treatment guided by monitoring acute dyspnoeic adult patients with serial cardiopulmonary point-of-care ultrasound: a randomised trial.
Background: Dyspnea is a common symptom for admittance and evokes anxiety. Serial point-of-care ultrasound (PoCUS) has the potential for improving acute patient care through modifying the treatment to the dynamic ultrasound findings. The objective was to investigate if treatment guided by serial PoCUS of the heart and the lungs in patients admitted to an emergency department (ED) with acute dyspnoea could reduce the severity of dyspnoea compared to usual care.
Methods: The study was a randomised, controlled, blinded-outcome trial in one ED in Denmark between Oct 9, 2019, to May 26, 2021, with a follow-up period of 30 days. In a convenience sample, patients > 18 years admitted with a primary complaint of dyspnoea and no trauma were included and allocated 1:1 to a serial ultrasound and control group. Patients in both groups received standard care within one hour from arrival, including a single cardiopulmonary PoCUS. In the serial ultrasound group, additional two extra PoCUS was performed with two hours interval. The primary outcome was a reduction of dyspnoea on a verbal dyspnoea scale (VDS) from 0-10, where 10 was worst, registered at inclusion and after two, four, and five hours. Outcome assessors were blinded, whereas the treating physician and patients were not. The secondary outcomes in both groups were length of stay, 7- and 30-days mortality, number of readmissions, and the proportion of patients with a correct presumptive diagnosis in agreement with a final audit diagnosis. The sample size was calculated based on the primary outcome. The primary outcome was analysed with a mixed-effect model.
Results: We included 102 patients in the serial ultrasound group and 104 in the control group. Median age was 76, sex was even distributed, many were previous smokers, and had chronic obstructive pulmonary disease or arterial hypertension as the most common comorbidities. The mean difference in VDS between patients in the serial ultrasound and the control group was -1·09 (95% CI -1·51 to -0·66) and -1·66 (95% CI -2·09 to -1·23) after four and five hours, respectively. The treatment in the two groups differed, with a larger proportion of patients receiving diuretics in the serial ultrasound group. No differences were observed between the two groups regarding the secondary outcomes. No adverse events were present.
Discussion and conclusion: Serial PoCUS-guided treatment can, together with standard care, reduce the severity of dyspnoea compared to standard care alone because it gives the ED physician the possibility to tailor the treatment according to ultrasound findings. PoCUS could therefore be considered for routine use to aid the physician in stabilising the patients and thereby handling crowding and flow.
Trial registration number: ClinicalTrial.gov, NCT04091334.
Funding: Department of Emergency Medicine, Slagelse Hospital; Naestved, Slagelse, and Ringsted Hospitals’ Research Fund; Research Fund of Region Zealand and Region of Southern Denmark; and the University of Southern Denmark.
Michael Dan ARVIG (Odense M, Denmark), Annmarie Touborg LASSEN, Peter Haulund GÆDE, Stefan Wernblad GÄRTNER, Casper FALSTER, Inge Raadal SKOV, Henrik Ømark PETERSEN, Stefan POSTH, Christian B. LAURSEN
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M1-2-3 |
12:00 |
"Wednesday 19 October"
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A43
12:00 - 12:30
Herman Delooz Lecture: Fighting a global health crisis, lessons learned for the future
Moderator:
Abdo KHOURY (PROFESSEUR ASSOCIE) (Moderator, Besançon, France)
12:00 - 12:30
Fighting a global health crisis, lessons learned for the future.
Chikwe IHEKWEAZU (Speaker, Switzerland)
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A6-7 |
12:30 |
"Wednesday 19 October"
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270
12:30 - 13:10
Issues and urgent actions required to reduce burnout and increase the wellbeing of professionals working in Emergency Departments
Moderator:
Abdo KHOURY (PROFESSEUR ASSOCIE) (Moderator, Besançon, France)
Panelists:
Nicole BATTAGLIOLI (Panelist, Atlanta, GA, USA), Ruth BROWN (Speaker) (Panelist, London, United Kingdom), Christoph DODT (Head of the Department) (Panelist, München, Germany), Meredith FENDT-NEWLIN (Panelist, Switzerland), Luis GARCIA-CASTRILLO (ED director) (Panelist, ORUNA, Spain), Roberta PETRINO (Head of department) (Panelist, Italie, Italy), Basak YILMAZ (Faculty) (Panelist, BURDUR, Turkey)
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13:10 |
"Wednesday 19 October"
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A44
13:10 - 13:40
Closing Ceremony
s:
Guillem BOUILLEAU (Urgentiste - Formateur en Santé) (Blois, France), Bulut DEMIREL (Clinical Development Fellow) (Glasgow), Rajan SOMASUNDARAM (Head of ED) (Berlin, Germany), Senad TABAKOVIC (Medical director emergency department) (Zürich, Switzerland), Christian WREDE (Head of Department) (Berlin, Germany)
13:10 - 13:40
Closing ceremony.
13:10 - 13:40
Introduction.
Patrick PLAISANCE (Head of Department) (Speaker, Paris, France)
13:10 - 13:12
DGINA Award.
13:12 - 13:14
Best Research Award.
13:14 - 13:16
Audience Award.
13:16 - 13:18
Euro SimCup Award.
13:24 - 13:28
Summary of the congress.
Patrick PLAISANCE (Head of Department) (Paris, France)
13:19 - 13:24
New EUSEM President.
James CONNOLLY (Consultant) (Newcastle-Upon-Tyne, United Kingdom)
13:28 - 13:31
DGINA President.
Martin PIN (BORNHEIM, Germany)
13:31 - 13:35
Barcelona introduction.
Luis GARCIA-CASTRILLO (ED director) (Speaker, ORUNA, Spain)
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