Saturday 15 October |
08:30 |
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PC10
08:30 - 17:15
Beginner Emergency Ultrasound Course
Pre-course Directors:
Eftychia POLYZOGOPOULOU (ASSISTANT PROFESSOR OF EMERGENCY MEDICINE) (Pre-course Director, ATHENS, Greece), Senad TABAKOVIC (Medical director emergency department) (Pre-course Director, Zürich, Switzerland), Paul VAN OVERBEEKE (Emergency Physician) (Pre-course Director, Amsterdam, The Netherlands)
Pre-course Facultys:
Nasim AZIZI (Pre-course Faculty, The Netherlands), Nour AL JALBOUT (Pre-course Faculty, Boston, USA), Mohit ARORA (Consultant Emergency Medicine) (Pre-course Faculty, Leeds), Zeki ATESLI (Pre-course Faculty, BRIGHTON, United Kingdom), Eric CHIN (Residency Program Director) (Pre-course Faculty, San Antonio, USA), Peter CROFT (Faculty Member) (Pre-course Faculty, Portland, Maine, USA), Hana DUBSKY (Pre-course Faculty, USA), Onyinyechi EKE (Pre-course Faculty, USA), Rip GANGAHAR (Consultant) (Pre-course Faculty, OLDHAM), Hani HARIRI (Pre-course Faculty, Besançon, France), Patrick KISHI (Emergency Medicine) (Pre-course Faculty, Phoenix, USA), Ernest LIM (Pre-course Faculty, Singapore), Dr Nicolas LIM (Consultant Emergency Medicine) (Pre-course Faculty, Singapore, Singapore), Kalyanasundaram MURALI (Consultant in Emergency Medicine) (Pre-course Faculty, Birmingham), Najib NASRALLAH (PHYSICIAN) (Pre-course Faculty, SHEFAMER, Israel), Pr Joseph OSTERWALDER (Head of Hospital) (Pre-course Faculty, St. Gallen, Switzerland), Farooq PASHA (CONSULTANT EMERGENCY) (Pre-course Faculty, Riyadh, Saudi Arabia), Renato RAPADA (Pre-course Faculty, USA), Arthur ROSENDAAL (Emergency Physician) (Pre-course Faculty, Rotterdam, The Netherlands), Nora SHEMERY (Pre-course Faculty, USA), Prem SUKUL (EP) (Pre-course Faculty, Rotterdam, The Netherlands), Tomas VILLEN (Attending Physician) (Pre-course Faculty, Madrid, Spain), Dr Christopher YAP (Consultant) (Pre-course Faculty, Sheffield, United Kingdom)
08:30 - 08:45
Welcome and introduction.
08:45 - 09:30
Physics-Knobology-Artefacts: The Basics.
09:30 - 09:45
AAA/IVC: Tips & Tricks.
09:45 - 10:30
Aorta/IVC.
10:30 - 10:45
e-FAST: Tips & Tricks.
10:45 - 11:15
Coffee break.
11:15 - 12:45
e-FAST.
12:45 - 13:45
Lunch Break.
13:45 - 14:00
Basic Echocardiography: Tips & Tricks.
14:00 - 14:45
Echocardiography.
14:45 - 15:00
US guided peripheral-central IV line placement: Tips & Tricks.
15:00 - 15:45
IV lines + practice on phantoms.
15:45 - 16:15
Coffee break.
16:15 - 17:00
Interactive case discussion.
17:00 - 17:15
Wrap up.
08:30 - 17:00
08:30 - 17:15
08:30 - 17:15
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M1-2-3 |
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PC20
08:30 - 18:30
Emergency Medicine Core Competences
Pre-course Directors:
Eric DRYVER (Consultant) (Pre-course Director, Lund, Sweden), Gregor PROSEN (EM Consultant) (Pre-course Director, MARIBOR, Slovenia)
Pre-course Facultys:
N'diorel BA-VIRTANEN (specialising physician in emergency medicine) (Pre-course Faculty, Lahti, Finland), Tobias BECKER (Speaker) (Pre-course Faculty, Jena, Germany), Veronique BRABERS (Emergency Physician) (Pre-course Faculty, MOL, Belgium), Christoph HUESER (Registrar) (Pre-course Faculty, Cologne, Germany), Caroline HÅRD AF SEGERSTAD (Senior consultant) (Pre-course Faculty, Ystad, Sweden), Rossana SOLOPERTO (Resident Doctor) (Pre-course Faculty, Roma, Italy)
08:30 - 09:30
Lectures.
09:30 - 11:00
Workshop.
11:00 - 11:15
Coffee break.
11:15 - 12:45
Workshop.
12:45 - 13:45
Lunch break.
13:45 - 14:30
Lectures.
14:30 - 16:00
Workshop.
16:00 - 16:15
Coffee break.
16:15 - 17:45
Workshop.
17:45 - 18:15
Q & A Course evaluation and diplomas.
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M4-5 |
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PC30
08:30 - 17:30
Non-Invasive Respiratory support: applications beyond the pandemic
Pre-course Director:
Roberto COSENTINI (Head of Emergency Medicine) (Pre-course Director, BERGAMO, Italy)
Pre-course Facultys:
Dr Rodolfo FERRARI (MD) (Pre-course Faculty, Bologna, Italy), Paolo GROFF (Director) (Pre-course Faculty, Perugia, Italy), Erwan L'HER (PU-PH) (Pre-course Faculty, BREST, France), Roberta MARINO (Chief of Borgosesia Hospital ED) (Pre-course Faculty, Vercelli, Italy), Patrick PLAISANCE (Head of Department) (Pre-course Faculty, Paris, France)
08:30 - 09:00
The How to of Awake self Re-Positioning.
09:00 - 10:45
Stations.
08:30 - 17:00
10:45 - 11:15
Coffee Break.
11:15 - 12:45
Stations.
12:45 - 13:45
Lunch.
13:45 - 14:30
Acute hypoxemic respiratory failure.
14:30 - 15:15
Acute hypercapnic respiratory failure.
15:15 - 16:00
COVID19 acute respiratory failure.
16:00 - 16:15
Coffee Break.
16:15 - 17:00
Final mega code.
17:00 - 17:30
FINAL RECAP Test.
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M6-7 |
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PC40
08:30 - 18:30
Minor Trauma
Pre-course Director:
Jean-Jacques BANIHACHEMI (MD PhD) (Pre-course Director, Grenoble, France)
Pre-course Facultys:
Pr Abdelouahab BELLOU (Director of Institute) (Pre-course Faculty, Guangzhou, China), Emilie DELLOYE (physicien) (Pre-course Faculty, Brussels, Belgium), Remi DEWEZ (infirmier) (Pre-course Faculty, Grenoble, France), Benoît GAULIN (Interne) (Pre-course Faculty, Grenoble, France), Alberto GREGORI (Consultant Trauma & Orthopaedic Surgeon) (Pre-course Faculty, GLASGOW), Patricia O'CONNOR (Consultant) (Pre-course Faculty, Glasgow, United Kingdom), Sabine SMEETS (Pre-course Faculty, Liège, Belgium)
08:30 - 09:00
Welcome & introduction.
10:00 - 10:45
Practice on immobilization workshop (Plaster) Part 1.
10:45 - 11:00
Coffee break.
11:00 - 12:45
Practice on immobilization workshop (Plaster) Part 2.
08:30 - 18:30
12:45 - 13:30
Lunch.
13:30 - 15:45
Practice on immobilization workshop (Plaster) Part 3.
15:45 - 16:00
Coffee break.
16:00 - 17:00
Practice on immobilization workshop (Plaster) Part 4.
17:00 - 18:00
Clinical Cases series with quiz MCQ.
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M8 |
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PC50
08:30 - 18:30
Advanced Paediatric Emergency Care course
Pre-course Director:
Said HACHIMI-IDRISSI (head clinic) (Pre-course Director, GHENT, Belgium)
Pre-course Facultys:
Dr Ruth FARRUGIA (Paediatrician) (Pre-course Faculty, Malta, Malta), Itai SHAVIT (Pediatric Emergency Physician) (Pre-course Faculty, Haifa, Israel), David WALKER (Speaker) (Pre-course Faculty, New York, NY, USA)
08:30 - 09:15
Introduction/Mentors -Mentees/Q&A: PAT and ABCDE approach.
09:00 - 18:00
09:15 - 10:45
Small groups discussions (2 groups): Kid with altered level of consciousness/ Kid with breathing difficulties.
10:45 - 11:15
Coffee Break.
09:00 - 18:00
11:15 - 12:45
Small groups discussions (2 groups): Kid with breathing difficulties in kids/ Kid with altered level of consciousness.
12:45 - 13:45
Lunch Break.
13:45 - 14:45
Small groups discussions (2 groups): Management of traumatic kid/ Radiology quiz.
14:45 - 15:45
Small groups discussions (2 groups): Radiology quiz /Management of traumatic kid.
15:45 - 16:15
Coffee Break.
16:15 - 17:00
Small groups discussions (2 groups): Short cases/ Lab results.
17:00 - 17:45
Small groups discussions (2 groups): Lab results /Short cases.
17:45 - 18:15
Feedback and questions.
18:15 - 18:30
Close & wrap up.
08:30 - 18:30
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R2 |
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PC60
08:30 - 17:30
Debriefing in simulated Emergency Medicine situations
Pre-course Directors:
Guillem BOUILLEAU (Urgentiste - Formateur en Santé) (Pre-course Director, Blois, France), Pier Luigi INGRASSIA (Pre-course Director, Lugano, Swaziland), Anne-Laure PHILIPPON (Médecin) (Pre-course Director, Paris, France)
Pre-course Facultys:
Alessandro COSTA (Intensive Care Physician) (Pre-course Faculty, Novara, Italy), Sarah UGÉ (Praticien Hospitalier) (Pre-course Faculty, Strasbourg, France)
08:30 - 09:00
Introduction.
09:00 - 10:00
Simulation session 1.
10:00 - 11:00
Simulation session 2.
11:00 - 11:15
Coffee Break.
11:15 - 12:45
Simulation session 3.
12:45 - 13:45
Lunch.
13:45 - 15:45
Simulations and debriefings with different frameworks.
15:45 - 16:15
Coffee break.
16:15 - 17:00
Simulations and debriefings with different frameworks.
17:00 - 17:30
Conclusion.
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R3 |
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PC70
08:30 - 18:30
SafeER PSA - Procedural Sedation and Analgesia for Emergency Physicians
Pre-course Director:
Christian HERINGHAUS (Emergency Physician) (Pre-course Director, Leiden, The Netherlands)
Pre-course Facultys:
Meys COHEN (Emergency Physician) (Pre-course Faculty, Leiden, The Netherlands), Vanessa HENDRIKS-VALK (Emergency physician) (Pre-course Faculty, The Hague, The Netherlands), Harald HENNIG (Emergency Physician) (Pre-course Faculty, Neumarkt i.d.OPf., Germany), Douwe RIJPSMA (Emergency Physician) (Pre-course Faculty, ARNHEM, The Netherlands), Dr Ruth SNEEP (Senior Research & Clinical Fellow) (Pre-course Faculty, London, The Netherlands), Egon ZWETS (Emergency Physician) (Pre-course Faculty, Rotterdam, The Netherlands)
08:30 - 09:00
Welcome and introduction.
09:00 - 09:30
Lecture:SafeER PSA The course.
09:30 - 09:45
Lecture:PSA a continuum.
09:45 - 10:20
Lecture:PSA a routine procedure?
10:20 - 10:35
Lecture:Risk assessment and pre-sedation screening.
10:35 - 10:50
Lecture:Airway.
10:50 - 11:00
Lecture:Patient characteristics and positioning.
11:00 - 11:15
Coffee break.
08:30 - 18:30
11:15 - 12:00
Lecture:Monitoring.
12:00 - 13:00
Lecture:Pharmacology.
13:00 - 13:45
Lunch.
13:45 - 14:05
Table Top exercise.
14:05 - 14:15
Demonstration.
14:15 - 15:55
Sedation workshops.
15:55 - 16:15
Coffee break.
16:15 - 17:55
Sedation workshops.
17:55 - 18:25
Quiz.
08:30 - 18:30
08:30 - 18:30
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R4 |
12:45 |
"Saturday 15 October"
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PC65
12:45 - 18:30
Debriefing in simulated Emergency Medicine situations
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M4-5 |
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"Saturday 15 October"
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PC25
12:45 - 18:30
Emergency Medicine Core Competences
|
R3 |
14:00 |
"Saturday 15 October"
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PC65
14:00 - 18:00
Debriefing in simulated Emergency Medicine situations
|
M4-5 |
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"Saturday 15 October"
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PC25
14:00 - 18:00
Emergency Medicine Core Competences
|
R3 |
Sunday 16 October |
00:10 |
"Sunday 16 October"
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430
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test presentation A1.
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A1 |
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"Sunday 16 October"
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420
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test presentation A2.
|
A2 |
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440
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test presentation A3.
|
A3 |
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400
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test Presentation A4.
|
A4 |
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"Sunday 16 October"
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410
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test presentation A5.
|
A5 |
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459
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test presentation A6-A7.
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A6-7 |
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390
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test Presentation A8.
|
A8 |
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"Sunday 16 October"
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460
00:10 - 01:00
Administration & Healthcare Policy
00:10 - 01:00
Test presentation M1-2-3.
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M1-2-3 |
08:30 |
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PC80
08:30 - 12:30
Advanced Emergency Ultrasound Course
Keynote Speaker:
Nils Petter OVELAND (Doctor) (Keynote Speaker, STAVANGER, Norway)
Pre-course Directors:
Patrick KISHI (Emergency Medicine) (Pre-course Director, Phoenix, USA), Michael LAMBERT (not sure what this is for?) (Pre-course Director, Burr Ridge, USA)
Pre-course Facultys:
Zeki ATESLI (Pre-course Faculty, BRIGHTON, United Kingdom), Shari BRAND (Emergency Physician) (Pre-course Faculty, Phoenix, USA), Edmundo CHANTLER (Physician) (Pre-course Faculty, Scottsdale, USA), Eric CHIN (Residency Program Director) (Pre-course Faculty, San Antonio, USA), James CONNOLLY (Consultant) (Pre-course Faculty, Newcastle-Upon-Tyne, United Kingdom), Rip GANGAHAR (Consultant) (Pre-course Faculty, OLDHAM), Hani HARIRI (Pre-course Faculty, Besançon, France), Bob JARMAN (Pre-course Faculty, Newcastle upon Tyne, United Kingdom), Ernest LIM (Pre-course Faculty, Singapore), Dr Nicolas LIM (Consultant Emergency Medicine) (Pre-course Faculty, Singapore, Singapore), Andrew LITEPLO (Pre-course Faculty, Brookline, USA), Jennifer LUONG (Physician) (Pre-course Faculty, Philadelphia, USA), Wayne MARTINI (Physician) (Pre-course Faculty, Scottsdale, USA), Kalyanasundaram MURALI (Consultant in Emergency Medicine) (Pre-course Faculty, Birmingham), Najib NASRALLAH (PHYSICIAN) (Pre-course Faculty, SHEFAMER, Israel), Pr Joseph OSTERWALDER (Head of Hospital) (Pre-course Faculty, St. Gallen, Switzerland), Renato RAPADA (Pre-course Faculty, USA), Arthur ROSENDAAL (Emergency Physician) (Pre-course Faculty, Rotterdam, The Netherlands), Nora SHEMERY (Pre-course Faculty, USA), Andrej URUMOV (Emergency Medicine Physician) (Pre-course Faculty, Phoenix, AZ, USA, USA), Victoria VATSVÅG (Pre-course Faculty, STAVANGER, Norway)
08:30 - 08:45
Introduction.
09:00 - 09:45
Module 1.
09:45 - 10:30
Module 2.
10:30 - 10:45
Coffee break.
10:45 - 11:30
Module 3.
11:30 - 12:15
Module 4.
12:15 - 12:30
Wrap up.
08:30 - 12:30
12:00 - 12:45
Module 5.
08:30 - 12:30
08:30 - 12:30
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M1-2-3 |
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PC100
08:30 - 12:30
Minor Trauma
08:30 - 09:00
Basic rules on suture techniques.
09:00 - 11:00
Sutures Workshop.
11:00 - 11:30
Conclusion and Diploma.
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M4-5 |
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PC90
08:30 - 12:30
Geriatric Emergency Medicine
Pre-course Director:
Jacinta A. LUCKE (Emergency Phycisian) (Pre-course Director, Haarlem, The Netherlands)
Pre-course Facultys:
Aoife DILLON (Pre-course Faculty, DUBLIN, Ireland), Pieter HEEREN (Nurse - PhD student) (Pre-course Faculty, Leuven, Belgium), Rosa MCNAMARA (Consultant) (Pre-course Faculty, Dublin, Ireland), Dr Don MELADY (Associate Professor/Staff Physician) (Pre-course Faculty, Toronto, Canada), Aine MITCHELL (Consultant in Emergency Medicine) (Pre-course Faculty, Sligo, Ireland), Elizabeth MOLONEY (Pre-course Faculty, Ireland), Dr Ruth SNEEP (Senior Research & Clinical Fellow) (Pre-course Faculty, London, The Netherlands), Dr Arjun THAUR (Consultant) (Pre-course Faculty, London), James VAN OPPEN (Clinical Research Fellow / Specialty Registrar) (Pre-course Faculty, Leicester, United Kingdom)
08:30 - 09:00
Introduction.
09:00 - 10:40
Working groups.
10:40 - 11:00
Coffee break.
11:00 - 12:40
Working groups.
12:40 - 12:55
Summary of key-learning points.
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M6-7 |
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M1
08:30 - 12:30
Council meeting (EUSEM Council representatives only)
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M8 |
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PC120
08:30 - 13:00
European Leadership for Emergency Medicine (LeadEM) Programme
Pre-course Directors:
Dr Tajek HASSAN (Board Chair for Europe, IFEM) (Pre-course Director, Leeds, United Kingdom), Dr John HEYWORTH (Consultant) (Pre-course Director, Southampton, United Kingdom)
Pre-course Facultys:
Dr Katherine HENDERSON (Emergency Medicine Consultant) (Pre-course Faculty, London), Fergal HICKEY (Consultant in Emergency Medicine) (Pre-course Faculty, Sligo, Ireland), Dr Ian HIGGINSON (Emergency Physician) (Pre-course Faculty, Plymouth, United Kingdom), Dr Barbara C HOGAN (Past President of the European Society for Emergency Medicine, EuSEM) (Pre-course Faculty, HAMBURG, Germany), Cornelia HÄRTEL (Medical Director of the ED, Consultant in EM, Director of Medical Education in EM) (Pre-course Faculty, STOCKHOLM, Sweden), Peter LEES (Pre-course Faculty, United Kingdom), Priyadarshini MARATHE (Pre-course Faculty, OXFORD), Hannelore RAEMEN (Pre-course Faculty, Antwerp, Belgium), Anna SPITERI (Consultant) (Pre-course Faculty, Malta, Malta), Jan STROOBANTS (Head of the Emergency Department) (Pre-course Faculty, Brecht, Belgium)
08:30 - 09:00
Welcome & introduction.
09:00 - 09:30
Explaining the day.
09:30 - 10:00
Session 1.
10:00 - 10:30
Session 2.
10:30 - 11:00
Coffee break.
08:30 - 13:00
11:00 - 11:30
Session 3.
11:30 - 12:00
Session 4.
12:00 - 12:30
Session 5.
12:30 - 12:45
Wrap up.
08:30 - 13:00
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R2 |
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PC130
08:30 - 15:00
Procedrual Sedation and Analgesia in Paediatric Emergency Care
Pre-course Director:
Itai SHAVIT (Pediatric Emergency Physician) (Pre-course Director, Haifa, Israel)
Pre-course Facultys:
Oren FELDMAN (Physician) (Pre-course Faculty, Ramat Gan, Israel), Ron JACOB (Senior physician) (Pre-course Faculty, Afula, Israel)
08:30 - 09:15
Lecture: Acute pain and distress in children.
09:15 - 09:30
Interactive session: Video-based demonstrations.
09:30 - 10:00
Lecture: Key principles for safe sedation in the paediatric ED.
10:00 - 10:45
Lecture: Pharmacology of sedative agents commonly used in the ED.
10:45 - 11:00
Coffee break.
11:15 - 11:30
Q&A.
11:30 - 12:45
Simulation sessions.
12:45 - 13:45
Lunch.
13:45 - 14:30
Simulation sessions.
14:30 - 15:00
Course summary.
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R4 |
13:00 |
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A11
13:00 - 14:25
Pulmonary Emergencies - An update on basic treatments of dyspnoic patients
Moderators:
Roberta PETRINO (Head of department) (Moderator, Italie, Italy), Patrick PLAISANCE (Head of Department) (Moderator, Paris, France)
13:00 - 13:20
Spontaneous Pneumothorax - Current recommendations.
Christoph DODT (Head of the Department) (Speaker, München, Germany)
13:20 - 13:40
High Flow Oxygen - Who, when, why?
Erwan L'HER (PU-PH) (Speaker, BREST, France)
13:40 - 14:00
Death by breathing - Hidden dangers in excessive ventilations in various circumstances.
Francis MENCL (emergency medicine physician) (Speaker, Akron, USA)
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A6-7 |
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B11
13:00 - 14:25
Emergencies in the elderly - How to improve the quality of care in your Emergency Department
Moderators:
Jacinta A. LUCKE (Emergency Phycisian) (Moderator, Haarlem, The Netherlands), Pr Christian NICKEL (Vice Chair ED Basel) (Moderator, Basel, Switzerland)
13:00 - 13:25
Measuring quality of care.
James VAN OPPEN (Clinical Research Fellow / Specialty Registrar) (Speaker, Leicester, United Kingdom)
13:25 - 13:50
Different care models to improve care for older patients in your ED.
Pieter HEEREN (Nurse - PhD student) (Speaker, Leuven, Belgium)
13:50 - 14:15
Setting up a system to find & report mistreatment of older patients.
Sivera BERBEN (associate professor) (Speaker, Nijmegen, The Netherlands)
13:50 - 14:15
Setting up a system to find & report mistreatment of older patients.
Miriam VAN HOUTEN (Speaker, Sellingen, The Netherlands)
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A8 |
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C11
13:00 - 14:25
Disaster Medicine I
Moderator:
Steve PHOTIOU (Moderator, Crocetta del Montello (TV), Italy)
13:00 - 13:25
Are we prepared for war in Europe?
Luc J M MORTELMANS (PHYSICIAN) (Speaker, Antwerp, Belgium)
13:00 - 14:25
Round Table: European war - related population displacement.
13:00 - 14:25
European war - related population displacement - Round Table.
Steve PHOTIOU (Moderator, Crocetta del Montello (TV), Italy)
13:25 - 14:25
European war - related population displacement - Round Table.
Carmen Diana CIMPOESU (Prof. Head of ED) (Panelist, IASI, Romania)
13:25 - 14:25
European war - related population displacement - Round Table.
13:25 - 14:25
European war - related population displacement - Round Table.
Michele ALZETTA (Director) (Panelist, Venezia, Italy)
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A1 |
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D11
13:00 - 14:25
ENT emergencies - New evidence and procedures
Moderators:
Mohammad Ashraf BUTT (Consultant in Emergency Medicine) (Moderator, Cavan, Ireland), Anna SPITERI (Consultant) (Moderator, Malta, Malta)
13:00 - 13:25
The approach to facial and dental trauma in the ED.
Gordon MCNAUGHTON (Speaker, Glasgow)
13:25 - 13:50
Blunt cerebrovascular injury - to screen or not to screen.
Tobias BECKER (Speaker) (Speaker, Jena, Germany)
13:50 - 14:15
ENT emergency procedures.
Pr Jim DUCHARME (Immediate Past President) (Speaker, Mississauga, Canada)
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A2 |
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E11
13:00 - 14:25
Important symptoms: from chest pain to breath sounds
Moderator:
Eftychia POLYZOGOPOULOU (ASSISTANT PROFESSOR OF EMERGENCY MEDICINE) (Moderator, ATHENS, Greece)
13:00 - 13:30
Chest pain.
Andrej HOHNEC (No) (Speaker, Maribor, Slovenia)
13:30 - 14:00
Back pain.
Gregor PROSEN (EM Consultant) (Speaker, MARIBOR, Slovenia)
14:00 - 14:15
Abnormal breath sounds.
Anastasia SPARTINOU (Emergency Medicine Trainee) (Speaker, HERAKLION, Greece)
14:15 - 14:25
Dysuria.
Andrej HOHNEC (No) (Speaker, Maribor, Slovenia)
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A4 |
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F11
13:00 - 14:25
You won't believe what I have seen
Moderator:
Michela CASCIO (Trainee doctor) (Moderator, ROME, Italy)
13:00 - 13:25
How to communicate with your team and with your consultants like a pro.
Aleks ŠUŠTAR (EM Resident) (Speaker, Maribor, Slovenia)
13:25 - 13:50
A lethal spoonful of poison.
Christoph HUESER (Registrar) (Speaker, Cologne, Germany)
13:50 - 14:15
Outpatient treatment of pulmonary embolism.
Martina CERMAKOVA (Doctor) (Speaker, Hradec Králové, Czech Republic)
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A5 |
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G11
13:00 - 14:25
Besondere Lagen: Wie gut sind die notaufnahmen vorbereitet?
Moderators:
Raik SCHAEFER (Moderator, Hamburg, Germany), Hendrike STEIN (Moderator, Germany)
13:00 - 13:25
Auf welche externen Lagen mssen sich Notaufnahmen vorbereiten.
Patric TRALLS (Speaker, Solingen, Germany)
13:25 - 13:50
Kritische infrastruktur im Krankenhaus - was sind die Ausfallskonzepte.
Michael BERNHARD (Speaker, Meerbusch, Germany)
13:50 - 14:15
Schulung, Training und externe bungen - haben wir die Zeit und wer finanziert das?
Slatomir WENSKE (Speaker, Berlin, Germany)
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400
13:00 - 14:30
Digital Medicine Working Group Meeting
Chairperson:
Thomas SAUTER (Consultant) (Chairperson, Bern, Switzerland)
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PC110
13:00 - 17:30
Research essentials in Emergency Medicine
Pre-course Director:
Pr Martin MÖCKEL (Head of Department, Professor) (Pre-course Director, Berlin, Germany)
Pre-course Facultys:
Zerrin Defne DÜNDAR (Professor) (Pre-course Faculty, Konya, Turkey), Luis GARCIA-CASTRILLO (ED director) (Pre-course Faculty, ORUNA, Spain), Mehmet Akif KARAMERCAN (Chair of EuSEM Research Committee) (Pre-course Faculty, ANKARA, Turkey), Said LARIBI (PU-PH, chef de pôle) (Pre-course Faculty, Tours, France), Pr Anna SLAGMAN (Professor for Health Services Research in Emergency Medicine) (Pre-course Faculty, Berlin, Germany)
13:00 - 13:15
Opening remarks and Faculty members introduction.
13:15 - 14:30
Group work 1.
14:30 - 15:00
Coffee break.
15:00 - 17:30
Presentation of results.
17:30 - 18:00
Final discussion, plan of abstract presentations and feedback.
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EPOSCB1SC1
14:30 - 14:50
Coffee Break 1 - EPoster session - Screen 1
Moderator:
Ryan MCHENRY (EM Trainee) (Moderator, Glasgow, United Kingdom)
14:30 - 14:50
#30430 - Can a 2-week lockdown control a COVID- 19 outbreak?Cross sectional analysis of the Lebanese COVID 19 responses.
Can a 2-week lockdown control a COVID- 19 outbreak?Cross sectional analysis of the Lebanese COVID 19 responses.
Background: With the rise of the novel coronavirus cases and fatalities around the world, researchers were invested in studying not only the therapeutic measures, but also, the preventive ones. As observed in other countries, many governments resorted to the shutdown of all services and closure of all facilities thus isolating people in their homes. Due to the rapidly collapsing local currency and deteriorating Lebanese economy, the local government implemented a two-week lockdown hoping it will reduce the surge in newly diagnosed Corona Virus Disease – 19 (COVID-19) cases without worsening the economic situation.
Method: In this study, we aim to understand the effectiveness of such plans in Lebanon and the contribution of the Lebanese people in its accomplishment. We looked at the numbers in all Lebanese territories over 2 weeks before the lockdown, during the 2-week lockdown (from 16 till 28thNovember 2020) and 2 weeks post lockdown. After collecting the data, we analyzed the mean number of cases and death before, during and after lockdown and by followed the growth factor of cases during this period.
Result: It was shown that for all studied districts, there was a trend in decline of the total number of cases, but the results were not statistically significant to prove that a 2-week lockdown can impact the epidemic.
Conclusion: A short, partial lockdown has no benefit over the growth or reduction in the virus impact or transmission, however, it might have some positive outcomes if implemented for longer periods.
Cima HAMIEH (France), Mahmoud EL HUSSEIN, Jim ABI FREM, Khattar RITA, Ghinwa EL HAYEK, Elie EL ZAGHRINI
14:30 - 14:50
#31673 - Evaluation of the Burden on the Emergency Department After COVID-19.
Evaluation of the Burden on the Emergency Department After COVID-19.
Introduction: Novel Coronavirus Disease 2019 (COVID-19) is seen as the biggest health burden in the world. It is known that there is no type of research on Emergency Department (ED) admissions of the post-COVID-19 patients. Studies indicate that a decrease in emergency admission rates was observed during the COVID-19 pandemic. However, the variables related to admissions to the ED during the long-term follow-up of COVID-19 are not yet known. The role of follow-up centers, which take part in predicting the long-term outcomes of the COVID-19 disease and the early diagnosis of possible long-term complications, is increasing day by day. The study aimed to evaluate the emergency admissions of post-COVID-19 patients according to their follow up in the COVID-19 follow-up center.
Methods: The data were obtained by evaluating the admission rate to the ED in the first three months of 2022. The study includes patients discharged from the COVID-19 inpatient of a tertiary hospital in Eskişehir, Turkey, in December 2021. The study groups were divided into two according to whether they applied to the COVID-19 follow-up center after discharge (Group 1, n=185) or not (Group 2, n=383). Patients' ED visits were categorized according to four urgency levels (white code: non-urgent patients; green code: urgent but non-critical patients; yellow code: fairly critical patients; red code: patients in danger of death). Re-hospitalization causes and rates were also compared.
Results: 568 inpatients were assessed, 48,2% male and 51,8% female. There was no significant difference between groups in terms of age and gender. The rate of admission to the emergency department in patients in Group 1 (n=25, % 13,5) was statistically significantly lower compared to Group 2 (n=84, % 21,9) (p = 0,017). When the diagnoses at the admission were evaluated, cases of yellow and red code (Group 1: % 39, Group 2: % 16) were statistically significant in Group 2 (p =0,028). In addition, the hospitalization of patients in Group 2 was significantly higher than in Group 1 (p < 0,01).
Conclusion: This study determined that post-COVID-19 patients admitted to the ED with a lower rate and milder complaints when they were examined in the COVID-19 follow-up centers. The most obvious finding to emerge from this study is COVID-19 follow-up centers could contribute positively to the burden on ED by preventing avoidable complications and severe emergency situations.
None
Gülşah UÇAN (Eskişehir, Turkey), Anıl UÇAN, Şebnem EKER GÜVENÇ
14:30 - 14:50
#31096 - Geospatial visualisation of emergency department attendance rates and their associations with deprivation and non-urgent attendances.
Geospatial visualisation of emergency department attendance rates and their associations with deprivation and non-urgent attendances.
Background:
Attendances at emergency departments in England continue to increase above the capacity of the urgent and emergency care system. There is significant variability in the rates of attendance at emergency departments across different localities. The aim of this study is to model the association of deprivation and non-urgent attendances with locality-based rates of emergency department attendance. The secondary aim is to create an interactive data visualisation tool to engage stakeholders, clinicians, and the public with the research.
Methods:
We undertook a retrospective, observational study using routinely collected emergency department attendance data from a large region in the North of England (population 5.4 million) with 7,463,272 attendances between January 2013 and March 2017. Attendances where age or address were missing or outside the study region were excluded leaving 6,416,087 attendances across 3,214 localities in the analytical sample. Average annual age and sex standardised attendance rates at emergency departments were calculated for small localities known as lower layer super output areas.
Proportions of non-urgent attendances for each locality were calculated using a marker in the data derived from a validated, process-based definition for non-urgent attendance.
The association between emergency department attendance rates, deprivation and non-urgent attendances was examined using multivariable linear and logistic regression models. The models were adjusted for travel time to the nearest emergency department, which was calculated using a geospatial information software.
Results:
The mean annual standardised emergency department attendance rate per 1000 population was 296 (95% confidence interval 292-301, interquartile range 234-381). The mean proportion of non-urgent attendances was 16.5% (95% confidence interval 16.2-16.7, interquartile range 11.7-21.2%). The study found high rates of emergency department attendance were associated with higher deprivation, higher proportions of non-urgent attendances and shorter travelling time to the emergency department.
After adjusting for travel time, each increasing decile of deprivation was associated with increased odds of emergency department attendance rates in the top quartile (odds ratio 2.58, P<0.001, 95% confidence interval 2.38–2.82). Localities with non-urgent attendance proportions above the mean had higher odds of attendance rates in the top quartile (odds ratio 2.87, P<0.001, 95% confidence intervals 2.28-3.63)
Each minute fewer of travel time to the nearest emergency department was associated with higher odds of high attendance rates (odds ratio 1.11, P<0.001 95% confidence interval 1.09-1.13). The best fitting model explained 54% (P<0.001) of the spatial variability in attendance rates. The data was visualised in an interactive choropleth map.
Discussion and conclusion:
A large proportion of the variability in emergency department attendance rates in different geographical areas can be explained by deprivation levels and proportion of non-urgent attendances. This provides an opportunity for targeted interventions to reduce emergency department attendances.
The visualisation of the data enables stakeholders, clinicians, and the public to explore and understand the variability in emergency department attendance rates across the region and suggest suitable locations and types of interventions. This research provides an example of routine data usage which can be replicated across other regions to inform interventions.
This research is independent research funded by the National Institute for Health Research, Yorkshire and Humber Applied Research Collaborations. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Joanna SUTTON-KLEIN (Manchester, ), Jen LEWIS, Richard CAMPBELL, Tony STONE, Colin O'KEEFFE, Suzanne MASON
14:30 - 14:50
#30927 - Palliative care & advance directives in the emergency department – a systematic review of the status quo.
Palliative care & advance directives in the emergency department – a systematic review of the status quo.
Objective.
Respecting patient wishes and preserving patient autonomy is challenging in emergency medicine. Documentation of patient wishes (DPW), e.g. in form of advance directives, can guide clinicians in end of life decisions, though effectiveness is limited by low availability.
Here, we present a systematic review which aims to congregate existing data on the rates of DPW ownership and availability in the emergency department (ED) as well as contributing factors.
Methods.
We systematically searched the MEDLINE database (Pubmed) in October 2021. All publications that provided primary quantitative data on DPW (excluding power of attorney) in the ED were assessed, culminating in a total of 17 studies included in the analysis. Most (9) were from the US, followed by Australia (4), Germany (2), Canada (1) and Switzerland (1). All but one were conducted in urban tertiary care centers, three were multicentric. In total, a culminated 9.854 ED patients were included, with a mean age variing from 41 to 88 years. Publication dates ranged from 1996 to 2021.
Results.
In the general adult population presenting to the ED, 12.8% to 27.0% possessed some kind of DPW, fewer than 3.2% had brought it with them to the ED. In older patient samples (heterogeneously defined, from ≥55 to ≥75 years of age), ownership and availability varied widely (7.9% to 51.9% and 1.7% to 48.8% respectively). The following variables were identified as positive predictors for DPW ownership: older age, worse overall health and presence of comorbidities as well as several sociodemographic factors, notably correlating with better social connections (e.g. having children, being female). Results were ambivalent on the influence of having a primary care provider.
Conclusion & Discussion.
Ownership and availability of DPW among ED patients was low in general and even in the older population mostly well below 50%. While we were able to gather data on prevalence and predictors, further research is needed to explore underlying causes of the high intra- and interfacility variability as well as possible public health measures to increase above mentioned rates.
This study was not registered due to its nature and did not receive any specific funding. Ethical approval was not needed.
Vincent WEBER (Berlin, Germany), Aurelia HÜBNER, Rajan SOMASUNDARAM, Eva DIEHL-WIESENECKER
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EPOSCB1SC4
14:30 - 14:50
Coffee Break 1 - EPoster session - Screen 4
Moderator:
Dr Firas ABOU-AUDA (Consultant) (Moderator, London)
14:30 - 14:50
#31476 - Descriptive analysis of opioids use in pre-hospital emergency medical services.
Descriptive analysis of opioids use in pre-hospital emergency medical services.
Introduction:
Prehospital emergency medical services care for patients in any type of setting with the resources that an ambulance can offer. Many of the patients seen for pain, dyspnea or requiring orotracheal intubation require treatment during transport with opioids.
The characteristics of the patients requiring opioids, the most frequent reasons for the use of this type of mediation and the percentage of admission and mortality in the short and long term are not well defined.
Objectives:
To describe the frequency of use of opioids, the characteristics of these patients and the reasons for care requiring it. To analyse the type of analgesic used according to the pathology with which the patient is treated. To know the percentages of admission and mortality in the short and long term in this type of patients.
Material and methods:
Observational, prospective, multicentre study. Inclusion criteria: over 18 years of age transferred by EMS by ambulance to hospital emergency departments (ED) between October 2019 and March 2021 in 4 Spanish provinces of the same health service. Exclusion criteria: <18 years, patients discharged in situ, follow-up <365 days since care.
Variables: epidemiological (age, sex, institutionalization, Charlson comorbidity index (ChI)), opioids yes/no and type, reason for transfer, destination: hospital admission or discharge. Mortality in the first 48 hours, between day 3 and 30, and between day 31 and day 365. Cumulative mortality in 365 days.
Statistical analysis: Normality tests. Frequencies, central measures, and dispersion in standard deviation (SD) or interquartile range (IQR). Chi-square (proportions), T Student (means) Mann-Whitney U (medians). Statistical significance: p <0.05, 95% confidence interval (95% CI). Software: SPSS.
Results:
Of 1508 patients analysed, 297 (19.69%) had required an opioid (Morphine 37.4% and fentanyl 62.6%). Of these 297 patients: 34% were women. Age: median 69 (RIC 53-84). Men: 63 (RIC 50-77) and women 79 (RIC 61-88) (p=0.000). Charlson index: 3 (RIC 0-5). 16.5% were institutionalized. Reasons for transfer: circulatory problems 32.42%, trauma 31.88%, infectious problems 11.77%, central nervous system pathology 8.15%, respiratory diseases 8.69% and others 7.2%.
Morphine vs fentanyl according to problem of care: infectious diseases 73.4% vs 26.56%; central nervous system (CNS) diseases 4.44% vs 95.5%; circulatory system diseases 59.2% vs 40.78%; respiratory diseases 80% vs 20%; trauma 1.13% vs 98.84%; others 42.1% vs 58.8% (p=0.000).
Hospital admission 91.6% and ICU admission 32%. Cumulative mortality in 365 days: 41.7%. Mortality first 48 hours: 17.8%, between day 3 and 30: 13.8%, and died between day 31 and 365 after care: 10.1%.
Conclusions:
Around 20% of the patients transferred by the EMS require opioids. These patients are predominantly men, and their age range is between 53 and 84 years. The most used opioid in the EMS are morphine and fentanyl. Morphine is used more for respiratory diseases, circulatory system and infections and fentanyl for polytrauma and CNS pathology. The percentages of hospital admission, ICU and short- and long-term mortality are high in this kind of patients.
Rodrigo ENRIQUEZ DE SALAMANCA, GAMBARA. (Valladolid, Spain), Enrique CASTRO PORTILLO, Maria Del Carmen GOEZ SANZ, Bolaños PACHECO, Francisco MARTÍN-RODRÍGUEZ, Raul LOPEZ IZQUIERDO, Juan F. DELGADO BENITO, Irene SÁNCHEZ SOBERÓN, M.a. CASTRO VILLAMOR
14:30 - 14:50
#31491 - Evaluation of the impact of pre-hospital gasometry in the development of diagnoses.
Evaluation of the impact of pre-hospital gasometry in the development of diagnoses.
Introduction :
The impact of biology in the medical understanding in pre-hospital is little studied.
The main objective of the study was to measure the decisional impact of the various paraclinical parameters in the formulation of diagnostic hypothesis at the end of treatment. The secondary objective was to show the existence of a hierarchy in the measured gasometry parameters for the formulation of diagnostic hypothesis.
Method :
The data analyzed came from the preliminary study for the BIOSMUR study carried out between 2019 and 2020 with the use of an on-board gas monitoring device in pre-hospital interventions. The clinical cases used were part of a nosological framework defined a priori: cardio-circulatory or respiratory failure. These data were transcribed in the form of clinical cases with a script concordance test type questionnary. Each thirty-three emergency physicians responded to three clinical cases assigned randomly and anonymously.
Results :
After collecting the various clinical cases, it turns out that gasometry has the highest impact compared to heart rate (OR=3.58, 95% CI [1.589; 4.880], p<0.001) compared to capillary saturation (OR= 1.811, 95% CI [1.048; 3.128], p=0.03). Blood pressure, ECG and temperature have no significant impact compared to the other parameters in these specific cases. Blood sugar is the parameter with the least impact (OR= 0.503, 95% CI [0.282; 0.895], p=0.03).
Conclusion :
Overall, the use of gasometry in the development of diagnostic hypothesis seems to have a significant impact compared to other parameters used routinely. It even seems to be the parameter with the most impact. We also observe that the paraclinical values have a significant place with a reduction of the number of hypothesis in more than 60% of the cases.
François NEZ, Jean-Baptiste MONANGE, Farès MOUSTAFA (Clermont-Ferrand), Romain DURIF, Maxime LAURENT, Arthur CHATRENET, Apolline GUILMAIN, Jeannot SCHMIDT
14:30 - 14:50
#31462 - Influence of diabetes mellitus on patients transported by prehospital emergency medical services.
Influence of diabetes mellitus on patients transported by prehospital emergency medical services.
INTRODUCTION: Diabetes Mellitus (DM) describes diseases of abnormal carbohydrate metabolism characterized by hyperglycemia. It is associated with a relative or absolute impairment of insulin secretion, along with varying degrees of peripheral resistance to insulin action. It is a frequent comorbidity among patients seen by Prehospital Emergency Medical Services (EMS), however, there is little literature on the characteristics of diabetic patients seen by EMS.
OBJECTIVES: To study demographic variables and causes of transfer of patients with DM at the time of EMS care. To determine percentages of hospital admission, mortality in the first 48 hours, 30-day mortality, mortality between 30 and 365 days, and cumulative mortality in one year. To compare the mortality of patients with DM with target organ damage (TOD) with patients with DM without TOD.
MATERIAL AND METHODS: Prospective, multicentre, observational study. Inclusion criteria: over 18 years of age with a diagnosis of DM in their medical history transferred by SEMP by ambulance to hospital emergency departments (ED) between October 2019 and January 2021 in 4 Spanish provinces of the same health service. Exclusion criteria: <18 years, patients without a diagnosis of DM or patients discharged in situ, follow-up <365 days since care.
Variables: epidemiological (age, sex, institutionalization, Charlson comorbidity index (ChI), reason for ambulance transfer, DM with or without LOD), hospital admission, mortality in the first 48 hours, between day 3 and 30 and between day 31 and 365, and cumulative one-year mortality.
Statistical analysis: normality tests. Frequencies, central measures and dispersion in standard deviation (SD) or interquartile range (IQR 25-75%). Chi-square (proportions), T Student (means), Mann-Whitney U (medians), ANOVA (means) and Kruskal-Wallis H (medians). Kaplan-Meier log rank. Statistical significance: p<0.05, 95% confidence interval (95% CI). Software: SPSS.
RESULTS: N: 378. Women 39.9%. Median age in years: overall 76 (RIC 64.75-83), women 78 (RIC 68-85) and men 74 (RIC 64-81) (p=0.003). ICh: 1-2 (23%), 3-4 (27%) and ≥5 (49.2%). Diabetics with LOD: 44.2%. Institutionalized: 23%. Reason for transfer: circulatory system disease (36.2%), nervous system disease (17.5%), infectious diseases (12.7%), respiratory diseases (8.7%), endocrine system diseases (8.5%) and others (16.4%). Hospital admission: 74.1%. Mortality in the first 48h (7.9%), between day 3 and 30 (13%), between day 31 and 365 (14.6%). One-year cumulative mortality: 37.6%.
DM without LOD vs DM with LOD: survive 1 year (72%-55.1%), mortality first 48h (7.1%-9%), mortality between 3 and 30 days (10%-16.8%) and mortality between day 31 and 365 (10.9%-19.2%) (p=0.007).
CONCLUSIONS: Patients transferred by EMS suffering from DM have an age range around 76 years old. Many of them have a high comorbid burden, with almost half of them having an organ affected by DM itself. The most frequent reason for transfer is circulatory system problems. The admission and mortality rates are high. Having DM with organ involvement seems to be associated with increased mortality in the short and long term.
Rodrigo ENRIQUEZ DE SALAMANCA, GAMBARA. (Valladolid, Spain), Raul LOPEZ IZQUIERDO, M.a. CASTRO VILLAMOR, Enrique CASTRO PORTILLO, Francisco MARTÍN-RODRÍGUEZ, Maria Del Carmen GOEZ SANZ, Irene SÁNCHEZ SOBERÓN, Juan F. DELGADO BENITO, Bolaños PACHECO
14:30 - 14:50
#31555 - Out of hospital STEMI and Stroke Clinical Pathways in 2021-Portugal.
Out of hospital STEMI and Stroke Clinical Pathways in 2021-Portugal.
Background: Cardiovascular diseases are the leading cause of death in Portugal therefore strategies to minimize the impact in mortality and mobility are imperative. As both Stroke and STEMI (ST elevation myocardial infarction) are time-dependent situations, strategies for the appropriate approach include implementation of clinical pathways from symptoms identification on the 112 call to hospital referral and treatment. The National Institute of Medical Emergency (INEM) is the agency responsible for coordinating the Integrated Medical Emergency System (SIEM) in mainland Portugal. INEM manages 112 medical calls, organizing Portuguese prehospital emergency services throughout CODU (Urgent Patient Guidance Centres) dispatch unit. INEM has since 2018 a paper-free technological system that allows clinical record and management of information produced by INEM’s units on the field -ITEAMS (INEM Tool for Emergency Alert Medical System). It contributes to real-time decision-making support and regulation based on clinical data in CODU. ITEAMS identifies clinical pathways aiming to bring value to the chain of help/surviving, optimizing early identification and allowing adequate patient referral during a time window of reference to the most adequate hospital. Methods: Retrospective descriptive analysis of out-of-hospital clinical records registered during 2021 in iTEAMS, referring to STEMI and Stroke. Results: During 2021, INEM attended 219,977 patients. From those 0.96% were reported as STEMI (n=852) and Stroke (n=1264). The population analyses revealed a prevalence of male in both subgroups, whereas age incidence, as expected, differed between the subgroups: Most STEMI patients had ages between 40-64 years while Stroke patients were mostly over 80 years old. We verified that both STEMI and Stroke patients had associated cardiovascular risk, with arterial hypertension accounting for 46% of all cases, while dyslipidemia was identified in 28%. Particularly in STEMI, smoking accounted for 20% of the records. In 39% of STEMI and in 44.8% of Stroke records the onset of symptoms had less than one hour when patients called 112. The Out of hospital time between the call and the arrival of the EMS team on scene was of 17min in STEMI and 15min in Stroke. The transportation time from the scene to hospital was higher in STEMI (27min) than in Stroke (18min). The total out-of-hospital actuation time (from 112 call to hospital) differed from STEMI (1h37min) to Stroke (1h26min) in a medium time of 11min. Conclusions: Well-structured Clinical Pathways are essential for improving prognosis in specific time dependent situations like STEMI and Stroke. Out-of-hospital performance dictates the initial compliance with the times stipulated in the STEMI and Stroke guidelines. Moreover, the referral to the correct hospital, capacitated with PCI (Percutaneous Coronary Intervention) and Trombectomy accordingly, elevates the responsibility not only of the out-of-hospital teams but also of the coordinating centers. The implementation of a monitoring and follow-up structure of STEMI and Stroke events in INEM pretends to alert, inform and educate our professionals in order to optimize out-of-hospital performance. In Portugal, INEM acts as the first link of the entire chain that represent the national pathways and can therefore promote a better outcome for patients with sudden onset of cardiovascular emergencies.
Cardiovascular diseases are the main cause of death and mobility in Portugal. With the creation of clinical pathways in out-of-hospital service, we pretend to improve the response and outcome of patients with STEMI and Stroke.
Margarida GIL (Lisboa, Portugal), Marta CUSTÓDIO, Filipa BARROS, João LOURENÇO, Pedro VASCONCELOS, Fátima RATO, Manuela LUCAS
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EPOSCB1SC3
14:30 - 14:50
Coffee Break 1 - EPoster session - Screen 3
14:30 - 14:50
#30352 - Effectiveness Of Shock Indices And Alteration Of Vital Parameters In The Diagnostic Suspicion Of Organ Damage From Pulmonary Embolism in elderly: The Emergency Room As A Window On Real Life.
Effectiveness Of Shock Indices And Alteration Of Vital Parameters In The Diagnostic Suspicion Of Organ Damage From Pulmonary Embolism in elderly: The Emergency Room As A Window On Real Life.
Background: Pulmonary embolism is a pathology still characterized by high mortality, greater in cases of organ damage. Raising suspicion and early recognition of this condition is therefore important to avoid delays in undertaking the right diagnostic and therapeutic process.
Aim: assess which vital parameters and shock indices correlate with the presence of organ damage from pulmonary embolism to see which ones can help to suspect this condition early.
Methods: single-center retrospective observational study, on all geriatric patients (> 75 y) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and Years), and for the presentation of the risk of mortality at 30 days (sPESI). We then had all chest CTs retested by an experienced radiologist. We went to see the correlation of vital parameters and shock indexes from these derivatives with the presence of organ damage from pulmonary embolism. We considered right ventricular dilation, pulmonary artery dilation and the presence of pulmonary infarction organ damage. We have considered as shock indices: the shock index (SI), the modified shock index (MSI) and the age-shock index (AGE_SI).
RESULTS: We enrolled 247 patients, with a mean age of 83 years and prevalence of female (F = 63%). Of these 79 (32%) have organ damage from pulmonary embolism. There is no correlation between the values of blood pressure, systolic and diastolic, respiratory rate with the presence of organ damage (p> 0.05). However, there is a strong statistical correlation between heart rate values and the presence of organ damage from pulmonary embolism (p < 0.001) The shock index correlates with the presence of organ damage with good statistical strength (p < 0.001 ); also the modified shock index, albeit with a slightly lower statistical strength (P <0.005). The age-shock index correlates with the presence of pulmonary embolism with excellent statistical strength (p < 0.001).
Conclusions: the alteration of the shock indices, in particular the AGE-shock index, correlate with the condition of organ damage. Taking into consideration these parameters, of very low cost, available from triage and obtainable in a few minutes at the medical examination, which can be easily performed in the various Italian situations, can help to raise the suspicion of organ damage from pulmonary embolism early and address more quickly the patient towards the therapeutic diagnostic process.
Dr Gabriele SAVIOLI, Iride Francesca CERESA, Massimiliano LAVA, Lorenzo PREDA, Amedeo MUGELLINI, Alessandra MARTIGNONI, Federica MANZONI, Antonio LO BELLO, Giacomo ALUNNO, Alessandra FUSCO, Luigi COPPOLA, Giovanni RIGANO, Aurora CECCO, Giulia BELLINI, Davide DIONISI, Maria Antonietta BRESSAN, Federica FUMOSO (Pavia, Italy)
14:30 - 14:50
#30348 - Management of acute pulmonary embolism in geriatric patients in the emergency room: does adherence to international guidelines reduce in atypical symptoms?
Management of acute pulmonary embolism in geriatric patients in the emergency room: does adherence to international guidelines reduce in atypical symptoms?
Premises: Pulmonary embolism is a pathology still characterized by high mortality. Some international studies have actually shown that adherence to guidelines is generally quite low in both primary and secondary care and ranges, depending on the studies, between 40 and 60%. Some authors have highlighted how adherence to the guidelines is more critical in patients with atypical symptoms, because diagnostic delay can be more likely in these.
Purpose of the study: evaluate if and how, in the real life of an Emergency Department, adherence to the Guidelines varies according to the presence of atypical symptoms. We understood dyspnoea, chest pain, signs and symptoms of deep vein thrombosis and syncope as typical symptoms. As atypical symptoms all the others (low-grade fever, vertigo ...)
Methods: single-center retrospective observational study on all geriatric patients (>75 y) who entered our ED, where they received a diagnosis of acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and YEARS), and for the presentation of the risk of mortality at 30 days (sPESI). We then analyzed adherence to the guidelines in three decision turning points: 1 Correct application of the decision scores examined, which classify the patient at low, intermediate or high risk of PE, calculated with Wells and simplified Geneva score; 2 Correct administration of therapy starting from ED as suggested by the guidelines; 3 Any observation in the care area of medium intensity with careful monitoring for the subpopulation of patients with evidence of right ventricular dilation or myocardial enzyme elevation (considered to be at high risk of shock and short-term mortality).
Results: we enrolled 248 patients, with a mean age of 83 years with female prevalence (F = 63%). Of these, only 17 with atypical symptoms and 231 with typical symptoms. The vital signs were comparable in the two groups with no statistically significant difference (p> 0.05). Long-term outcomes such as mortality, need for hospitalization, hospitalization in intensive care and length of stay in hospital are also comparable results with no statistically significant difference (p> 0.05).
However, adherence to international guidelines was statistically significantly lower in patients with atypical symptoms (33%) than in patients with typical symptoms (59%) (p <0.05).
Conclusions: The study suggests that patients with atypical symptoms are more likely to have reduced adherence to international guidelines, most likely due to diagnostic delay.
Dr Gabriele SAVIOLI, Iride Francesca CERESA, Viola NOVELLI, Sara CUTTI, Enrico ODDONE, Giovanni RICEVUTI, Amedeo MUGELLINI, Alessandra MARTIGNONI, Massimiliano LAVA, Lorenzo PREDA, Antonio LO BELLO, Alessandra FUSCO, Luigi COPPOLA, Giovanni RIGANO, Francesco LAPIA, Aurora CECCO, Giulia BELLINI, Davide DIONISI, Maria Antonietta BRESSAN, Alessandro VENTURI, Federica FUMOSO (Pavia, Italy)
14:30 - 14:50
#30351 - Role Of Vital Signs And Indices Of Shock Derived From Them In The Suspicion Of Massive Pulmonary Embolism in elderly: The ER As A Window On Real Life.
Role Of Vital Signs And Indices Of Shock Derived From Them In The Suspicion Of Massive Pulmonary Embolism in elderly: The ER As A Window On Real Life.
Premise: Pulmonary embolism is a pathology still characterized by high mortality, greater in cases of massive embolism. Raising suspicion and recognizing this condition early is therefore important to avoid delays in undertaking the right diagnostic and therapeutic process.
Purpose: assess which vital parameters or shock parameters, in the real life of an Emergency Department, correlate with the presence of massive pulmonary embolism to see which ones can be of help to early suspect it.
Methods: single-center retrospective observational study, on all geriatric patients (> 75 y) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and Anni), and for the presentation of the risk of mortality at 30 days (sPESI). We then had all chest CTs retested by an experienced radiologist. We assess the correlation of vital parameters and shock indexes with the presence of massive pulmonary embolism. We took into consideration: the shock index (SI), the modified shock index (MSI) and the age-shock index (AGE_SI).
Results: We enrolled 247 patients, with a mean age of 83 years and prevalence of female (F = 63%). Of these, 85 (34.4 %) presented with massive pulmonary embolism. There is no correlation between blood pressure, systolic and diastolic values, respiratory rate with the presence of massive pulmonary embolism (p> 0.05). However, there is a strong statistical correlation between heart rate values and the presence of massive pulmonary embolism (p <0.0001). The shock index correlates with the presence of massive pulmonary embolism with good statistical strength (p <0.001); the modified shock index correlates with the with even greater statistical strength (P = 0.0005). The age-shock index correlates with the presence of pulmonary embolism with excellent statistical strength (p <0.0001).
Conclusions: The study suggests that the alteration of shock indices, in particular of the AGE-shock index, correlate with the condition of massive pulmonary embolism. Taking into consideration these parameters, of very low cost, available from triage and obtainable in a few minutes at the medical examination, easily performed in the various Italian situations, can help to raise the suspicion of massive pulmonary embolism early and direct the patient more quickly towards the correct procedure therapeutic diagnostic.
Dr Gabriele SAVIOLI, Iride Francesca CERESA, Massimiliano LAVA, Lorenzo PREDA, Federica MANZONI, Giovanni RICEVUTI, Amedeo MUGELLINI, Antonio LO BELLO, Alessandra FUSCO, Luigi COPPOLA, Giovanni RIGANO, Aurora CECCO, Giulia BELLINI, Davide DIONISI, Maria Antonietta BRESSAN, Federica FUMOSO (Pavia, Italy)
14:30 - 14:50
#30358 - When Harry met Sally. Description of elderly patients with pulmonary embolism arriving in the emergency room. The real-life experience of 5 years in the emergency room.
When Harry met Sally. Description of elderly patients with pulmonary embolism arriving in the emergency room. The real-life experience of 5 years in the emergency room.
Premises: Pulmonary embolism represents one of the major causes of mortality linked to cardiovascular events. The range of symptoms is extremely wide and its recognition difficult. The patients who therefore come to the emergency room are a diverse population.
Purpose: to describe the population that refers to the emergency room and finds there a diagnosis of acute pulmonary embolism.
Methods: single-center retrospective observational study, on all geriatric patients (> 75 years) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We analyzed means of presentation, priority codes for medical examination, exit code, hospitalization needs. We collected data from medical history, physical examination, laboratory tests, imaging, outcomes, severity scores.
Results: We enrolled 247 patients, all in need of hospitalization. 44% came for dyspnea, 17% for chest pain, 16% for signs of DVT, 8% for syncope. 5% had only atypical symptoms (dizziness, general malaise, low-grade fever, neurological symptoms ...). 45% had concomitant deep vein thrombosis. 50% showed alteration of the ECG tracing, 49% alteration of the shock index.
Among those subjected to blood gas analysis 11% showed alteration of pH, 16% showed alteration of pCO2, 8% showed alteration of pO2, 5% of BE, 2% of lactate. 34% showed massive PE, 32% showed organ damage. In particular, 21% showed pulmonary artery dilation, 16% pulmonary infarction and 19% right ventricular dilation. 40% showed elevation of myocardiospecific enzymes.
41% were considered to be at high risk of long-term mortality according to European guidelines, 41% at intermediate risk and 18% at low risk of mortality. 1.4% underwent thrombolysis, 2.4% required intubation. 2.8% needed an operating room for mechanical thrombolysis; 8% of hospitalization in the intensive ward during hospitalization. In-hospital mortality was 7.7%. 5% experienced bleeding during hospitalization following anticoagulation therapy.
Conclusions: The population that arrives in ED for pulmonary embolism presents extremely varied symptomatological pictures, but an overall high degree of clinical risk and assistance and therapeutic complexity.
Dr Gabriele SAVIOLI, Iride Francesca CERESA (pavia, Italy), Massimiliano LAVA, Lorenzo PREDA, Federica MANZONI, Amedeo MUGELLINI, Alessandra MARTIGNONI, Giovanni RICEVUTI, Antonio LO BELLO, Alessandra FUSCO, Giacomo ALUNNO, Luigi COPPOLA, Giovanni RIGANO, Aurora CECCO, Giulia BELLINI, Alessandro VENTURI, Maria Antonietta BRESSAN
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EPOSCB1SC2
14:30 - 14:50
Coffee Break 1 - EPoster session - Screen 2
Moderator:
Canberk Djan MESELI (EMERGENCY MEDICINE RESIDENT) (Moderator, DUBLIN, Ireland)
14:30 - 14:50
#30675 - Association of prehospital airway management technique with survival outcomes of out-of-hospital cardiac arrest patients according to transport time interval.
Association of prehospital airway management technique with survival outcomes of out-of-hospital cardiac arrest patients according to transport time interval.
Introduction
Despite numerous studies on airway management in out-of-hospital cardiac arrest (OHCA) patients, the choice of prehospital airway management technique remains controversial. Our study aimed to investigate the association between prehospital advanced airway management and survival outcomes according to a transport time interval (TTI) using nationwide OHCA registry database in Korea
Methods
The inclusion criteria were patients with OHCA aged over 18 years old with a presumed cardiac etiology between January 2015 and December 2018. The primary outcome was survival to hospital discharge. The main exposure was the prehospital airway management technique performed by the emergency medical technicians (EMTs), classified as bag-valve mask (BVM), supraglottic airway (SGA), or endotracheal intubation (ETI).We performed multivariable logistic regression analysis and interaction analysis between the type of airway management and TTI for adjusted odds ratios (aORs) and 95% confidence intervals (CIs)
Results
Of a total of 70,530 eligible OHCA patients, 26,547 (37.6%), 38,391 (54.4%), and 5,592 (7.9%) were managed with BVM, SGA, ETI, respectively. Patients in the SGA and ETI groups had a higher odds of survival to discharge than BVM groups (aOR, 1.11 (1.05-1.16) and 1.13 (1.05-1.23)). And the rates of survival to discharge with SGA and ETI were significantly higher in groups with TTI more than 8 minutes (1.17 (1.08-1.27) and 1.38 (1.20-1.59)).
Discussion
The survival to discharge was significantly higher among patients who received ETI and SGA than in those who received BVM. The transport time interval influenced the effect of prehospital airway management on the clinical outcomes after OHCA.
n/a
Young Sun RO, Eujene JUNG (Gwangju, Republic of Korea)
14:30 - 14:50
#31376 - Endotracheal intubation during and after the COVID-19 pandemics in a Brazilian academic emergency department.
Endotracheal intubation during and after the COVID-19 pandemics in a Brazilian academic emergency department.
Background:
During the COVID-19 pandemics, patients were submitted to endotracheal intubation (ETI) in the Emergency Department (ED) at higher rates than usual. It is unclear how different such intubations are in relation to those performed in patients without Covid-19, especially with the gradual return to pre-pandemic patient populations and ED volumes. Therefore, our objective was to compare baseline characteristics and periprocedural outcomes of ETIs performed during and after the COVID-19 pandemics.
Methods:
This analysis used two prospective cohort studies that enrolled patients at a large academic ED in Sao Paulo (Brazil). The first cohort was composed of Covid-19 patients aged ≥ 18 years who were intubated between March and May 2020 (Covid-19 cohort). In contrast, the second cohort was composed of adult patients without Covid-19 who were intubated between February and May 2022 (non-Covid cohort). Both cohorts excluded patients under cardiac arrest. The primary outcome was first-pass success (FPS) rate. Secondary outcomes included rates of periprocedural hypotension, hypoxemia, esophageal intubation, and cardiac arrest.
Results:
A total of 164 patients (112 in the Covid-19 cohort and 52 in the non-Covid cohort) were analyzed. Patients intubated with Covid-19 were older (61 vs. 53 years old, respectively), and hypoxemia was the main indication for ETI (98.2%). In the non-Covid cohort, most patients were intubated either due to decreased level of consciousness (61.5%) or anticipation of clinical course (21.2%). Rapid sequence intubation was more frequently performed for the Covid-19 cohort (96% vs. 86%, p<0.01). Patients in the Covid-19 cohort were more frequently pre-oxygenated with non-invasive ventilation (64% vs 11%, p<0.01), sedated with ketamine (72% vs 30%, p<0.01), blocked with succinylcholine (61% vs 50%, p=0.03), intubated by a senior resident (65% vs 11%, p<0.01), and the procedure was performed with a video device (55% vs 42%, p<0.01). The rate of FPS was higher in the Covid-19 cohort (82% vs. 69%, p<0.01). Although success in the first attempt was more common in Covid-19 patients, they also presented a higher incidence of one or more periprocedural complications (78% vs. 48%, p<0.01), including hypotension (42% vs. 23%) and hypoxemia (52% vs. 27%). The incidence of esophageal intubations (2% vs. 5%) and post-intubation cardiac arrest (1% vs. 1%) were relatively similar.
Discussion & Conclusions:
Emergency intubations performed in patients with Covid-19 were significantly different than those performed in patients without Covid-19 in an academic ED in Brazil. Nevertheless, despite higher rates of FPS in those with Covid-19, these patients had higher incidences of post-intubation complications. As an academic center in the post-pandemic period, it is part of the training for the junior resident to learn practical skills but we need to be careful not to increase risks to the patient.
Further research is required to understand the reasons behind such large differences in emergency airway management and the need of a more systematic and homogeneous approach to intubating patients in the ED.
Funding: FAPESP and HCFMUSP
Ethical approval and informed consent: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068), which also waived the need for written informed consent. We adhere to STROBE guidelines.
Ian WARD A. MAIA, Julio ALENCAR, Rodrigo BRANDÃO, Lucas OLIVEIRA J. E SILVA, Eduardo SORICE, Juliana STERNLICHT, Luisa BARINI, Giovanna OLIVEIRA, Patricia MOURA, Gabriela STANZANI, Yasmine FILIPPO, Fernanda GRECO, Luz GOMEZ, Julio MARCHINI, Heraldo SOUZA, Lucas MARINO (Sao Paulo, Brazil)
14:30 - 14:50
#30671 - Prehospital point-of-care testing to target potential life-threatening cases of non-unplanned ICU-admission in traumatic brain injury.
Prehospital point-of-care testing to target potential life-threatening cases of non-unplanned ICU-admission in traumatic brain injury.
Background: The incidence of traumatic brain injury (TBI) in our environment is 200/100,000 inhabitants/year, with rates of admission to intensive care units (ICU), related-mortality and morbidity, non-negligible. TBI is a complex condition involving Emergency Medical Systems (EMS), Emergency Departments (ED), ICU, surgery units, and so on. In short, TBI is a serious medical condition requiring a systematic evaluation and management at all levels to make a meaningful difference.
The purpose of this report is to examine the predictive ability of a basic prehospital biochemical panel (potassium, sodium, calcium, chloride, glucose, lactate, and creatinine) to detect the risk of non-unplanned ICU-admission in TBI.
Methods: Prospective, multicentric, EMS-delivery, ambulance-based, pragmatic cohort study of adults with prehospital TBI, referred to five hospitals (Spain), between January 2020, and December 2021. Any traumatic patient treated consecutively by EMS with prehospital diagnosis of TBI and transferred with high priority by ambulance to the ED was included in the study. Patients under 18 years of age, pregnant women, non-traumatic patients, risk in the scene and patients discharged on site were excluded. Demographic data (age and sex) and venous sampling were collected during the first contact with the patient in prehospital care. The basic prehospital biochemical panel was measured with the epoc® Blood Analysis System (Siemens Healthcare GmbH, Erlangen Germany). Data were obtained by reviewing the patient's electronic history. The primary dependent variable was all-cause ICU-admission. The area under the curve (AUC) of the receiver operating characteristic (ROC) of the biomarkers were calculated in terms of ICU-admissions.
Results: A total of 475 patients with a prehospital diagnosis of TBI were included in our study. The median age was 56 years (IQR: 33-74), with a range from 18 to 99 years, predominantly males with 302 cases (63.5%). The rate of non-unplanned ICU-admission was 23.3 % (111 cases), and in-hospital mortality was 14.1 % (67 cases).
The AUROC for potassium, sodium, calcium, chloride, glucose, lactate, and creatinine were 0.591 (95%CI: 0.53-0.65; p=0.003); 0.518 (95%CI: 0.45-0.57; p=0.575); 0.369 (95%CI: 0.31-0.42; p=0.273); 0.588 (95%CI: 0.52-0.65; p=0.005); 0.634 (95%CI: 0.57-0.69; p=0.001); 0.803 (95%CI: 0.75-0.85; p<0.001); and 0.604 (95%CI: 0.54-0.66; p=0.001).
Conclusions: the role of lactate is well-known in prehospital care, especially in trauma cases. Upper lactate levels are significantly correlated with a strong relationship with a marked increase in morbi-mortality. And according to our data, prehospital lactate above 3.19 mmol/L is associated with a rate of non-unplanned ICU-admission. Know this bedside data may help to determine from the scene the most appropriate hospital for TBI.
This work was supported by the Gerencia Regional de Salud, Public Health System of Castilla y León (Spain) [grant number GRS 1903/A/19 and GRS 2131/A/20]
Francisco MARTÍN-RODRÍGUEZ, Raúl LÓPEZ-IZQUIERDO, Carlos DEL POZO VEGAS (Valladolor, Spain), Enrique CASTRO PORTILLO, Santiago LÓPEZ TORREZ, Rodrigo ENRIQUEZ DE SALAMANCA GAMBARA, Almudena MORALES SÁNCHEZ, Ana BENITO JUSTEL, Arancha MORATE BENITO, Cristina VÁZQUEZ DONIS, M. Cristina RAMOS ORTEGA, Emma GARCÍA TARRERO, Esther FRAILE MARTÍNEZ, María GRAÑEDA IGLESIAS, M. Teresa BLAZQUEZ GARCÍA, Victor MENÉNDEZ GUTIÉRREZ, Rafael MARTÍN SÁNCHEZ, Santiago OTERO DE LA TORRE, Francisco Tomás MARTÍNEZ FERNÁNDEZ, Juan Francisco DELGADO BENITO
14:30 - 14:50
#31433 - Strategies to enhance the implementation and utilization of preprocedural checklists in pre-hospital emergency anesthesia (PHEA).
Strategies to enhance the implementation and utilization of preprocedural checklists in pre-hospital emergency anesthesia (PHEA).
Background
Pre-hospital emergency anesthesia (PHEA), despite being potentially lifesaving when delivered on a regular basis by specialist teams with high caseloads, currently remains a complex, high-risk procedure, at times leading to significant adverse events. The routine utilization of standard operating procedures (SOPs) and periprocedural checklists has been advocated to reduce the cognitive overload of clinicians, reduce procedural variance and improve patient safety. The ultimate goal is to improve long-term patient outcomes, but in spite of a significant build-up in literature on this topic, results so far have been controversial. Therefore, pre-hospital systems are sometimes reluctant to implement periprocedural checklists as part of their daily practice.
Objectives
This study aims to identify the main barriers to implementation of preprocedural checklists during PHEA and to gather a broader understanding of the rationale behind the hesitance in routine use. Our emphasis is both on optimizing human factors such as clinician reluctance when facing safety innovations, and technical aspects such as the compatibility with current practice and structural complexity of the checklists.
Methods
This study is a non-systematic review of the current literature regarding checklist implementation and utilization during PHEA. A literature search on Cochrane CENTRAL library, PubMed and Embase database was carried out to identify articles related to the topic of checklists during pre-hospital emergency anesthesia. Articles published in English during 2014-2021 were included after being thoroughly sorted according to their relevance. The data extracted in our study represent a preliminary investigation facilitating the future development of a local periprocedural PHEA checklist along with a pre and post implementation simulation-based study on checklist augmented PHEA in our physician-led pre-hospital critical care system.
Results
Qualitative data from the selected articles was analyzed. Most studies indicated that checklist implementation in real life without prior, supervised simulation-based training leads to increased reluctancy and failure to comply from clinicians. Continuous, standardized team-training is mandatory in order to improve familiarity with complex procedures like PHEA and to familiarize the clinician with novel tools. Mandatory checklist implementation through local guidelines drastically increases compliance but fails to take into consideration their suitability in special circumstances (in extremis patients). Advances in PHEA technology (video laryngoscopy, digital tools) might make checklists less feasible if their content is not regularly reviewed and modified accordingly. Real-time feedback from clinicians facilitates the adaptation to local specific needs in the pre-hospital environment (urban vs rural; ground-based vs air ambulance). Checklists must be written using non-ambiguous, concise language, focusing solely on the vital information for the procedure. Key elements on the list must be highlighted in case of sudden patient deterioration. Group-based discussions enhance familiarization with standardized PHEA protocols, leading to a more open-minded approach towards checklists.
Conclusion
The human mind is prone to errors when encountering challenges in high-risk, time-limiting environments. Periprocedural checklists must be viewed as practical and relevant by the clinician performing challenging procedures like PHEA. Regular training with pre-hospital critical care team members, preferably during simulation scenarios, increases compliance towards SOPs and standardized checklists.
Rareș-Alexandru STREZA (Cluj-Napoca, Romania), Sonia LUKA, Anda PINTEA, Vlad DANCILA, Darius TURCAS
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EPOSCB1SC5
14:30 - 14:50
Coffee Break 1 - EPoster session - Screen 5
Moderator:
Bulut DEMIREL (Clinical Development Fellow) (Moderator, Glasgow)
14:30 - 14:50
#31176 - Importance of elevated D-dimer and a high value on the Wells scale as factors associated with pulmonary embolism in COVID patients.
Importance of elevated D-dimer and a high value on the Wells scale as factors associated with pulmonary embolism in COVID patients.
Background:
The diagnosis of pulmonary embolism (PE) in Covid infection is a challenge due to its associated morbidity and mortality. In published studies, a prevalence of 13-21% of PE has been found in Covid patients. The Wells scale and the D-dimer could be useful to request an angioCT, but the limit for its efficiency has not been established. The objective is to determine the level of Dimer D related to the suspicion of PE and the association of the Wells scale with the presence of PE in COVID patients.
Methods:
Retrospective descriptive study of a cohort of patients with Covid infection diagnosed by PCR from January 2021 to June 2021 in the Emergency Department of a regional hospital in Barcelona who had undergone CT angiography. Sociodemographic data, comorbidities, presence of pneumonia, PaFi, vaccination, D-dimer level, and Wells scale value were collected when CTangiography was requested. The level of statistical significance considered for the analysis was 5%. The study was approved by the ethics and drug research committee of the Terrassa Hospital.
Results:
Of the 512 AngioCT performed in the Emergency Department, 148 met the inclusion criteria. The mean age was 64 ± 16 years, 55% were men. 56% of the patients had arterial hypertension, 27% diabetes, 40% dyslipidemia. 82% were not vaccinated, 89% had Covid pneumonia, mean PaFi was 330 ± 132. Mean D-Dimer was 5335 ± 11618, with a modified Wells Scale of 3.5 ± 1.2. In 20 (13.5%) of the 148 AngioCT, PE was diagnosed. Statistically significant differences (p<0.001) were obtained between the different levels of D-dimer higher than 1500, 2000, 3000 and 5000 and the diagnosis of PE by AngioCT. Requesting an AngioCT with D-dimer higher than 1500 collected 100% of those diagnosed with PE, with a limit of 2000, 10% of patients who had not undergone the test were found. Being 45% if the limit was 5000. No statistically significant relationship was found between the elevated Wells score and the presence of PD in COVID patients, but it was considered a clinically relevant finding that all patients with PD had a moderate or high risk. on the Wells scale with more than 3 points.
Conclusion:
A D-dimer limit higher than 1500 allows the diagnosis of all PE by AngioCT in COVID patients. The Wells scale has been clinically useful in the diagnosis of PE if they presented a moderate-high value of it.
Munir MOHAMED MIMUN (BARCELONA, Spain), Pozzi MARIA BELEN, Rodríguez Reyes LUNA, Catón Lacasa ALEJANDRA, Turmo Moliner CLARA, Aguilar Cruz FREDDY GONZALO
14:30 - 14:50
#31909 - Reliability of the HEART score using Point of care Troponin in the prehospital setting.
Reliability of the HEART score using Point of care Troponin in the prehospital setting.
Reliability of the HEART score using Point of care Troponin in the prehospital setting.
Introduction
Chest pain remains a common complaint for consultation of Emergency Medical Services (EMS) worldwide. In order to combat overcrowding at the emergency department (ED), decreased referral of low risk patients with chest pain would be favourable. Our study aims to validate the reliability of the HEART-score with a point of care troponin (POCT) in the prehospital setting.
Methods
This Dutch prospective observational study was performed in Rotterdam. A selected group of dedicated EMS nurses calculated a HEART-score using a POCT device (Roche Cobas, cut off value 40 ng/L). Two blood samples were collected in the prehospital setting (T0) and at the hospital (T1), in order to calculate a HEART-score with POCT (HEART-poct) and with central laboratory troponin (HEART-laboratory). Endpoints were overall agreement between HEART-poct and HEART-laboratory at T0 and at T1 and secondary the percentage of MACE after 30 days.
Results
In total 257 patients with acute chest pain were enrolled, average age was 62.6 ± 14.9 years (mean ± SD). In total 44 patients (17,1%) developed a MACE within 30 days, while 95 (37,0%) patients were deemed as low risk (HEART 0-3). Comparing HEART-poct and HEART-laboratory in the prehospital setting resulted in a Kappa value of 0,958, 95% CI [0,925 - 0,991] with a p < 0.001, meaning almost perfect agreement. While at the hospital, a Kappa value of 0,966, 95% CI [0,937 – 0,995] with a p < 0.001 was found, also showing almost perfect agreement.
Conclusion
The prehospital HEART-score using POCT shows almost perfect agreement with a HEART-score based on central laboratory troponin, demonstrating the reliability of the prehospital HEART-score. This study supports the implementation of the HEART-score in the ambulance by which patients with a low HEART-score could potentially be left at home without immediate referral to the hospital.
Nancy VAN DER WAARDEN (Rotterdam-Rijnmond, The Netherlands), Bob SCHOTTING, Kees-Jan ROYAARDS, Georgios VLACHOJANNIS, Barbra BACKUS
14:30 - 14:50
#31587 - The scope of EMS in major trauma in Portugal - analisys of clinical records 2021.
The scope of EMS in major trauma in Portugal - analisys of clinical records 2021.
Introduction:
The National Institute of Medical Emergency (INEM) is the agency responsible for coordinating the Integrated Medical Emergency System in Portugal. INEM manages 112 medical calls, organizing prehospital emergency services throughout its CODU (Urgent Patient Guidance Centres) dispatch unit.
Since 2018, INEM started a technological system that allows clinical record and management of information produced by INEM’s units on the field (ITEAMS – INEM Tool for Emergency Alert Medical System). It contributes to the real-time decision-making support and regulation based on clinical data in CODU, and enables the stratification of patient clinical deterioration risk in the first contact with an emergency medical services (EMS) team, with the support of clinical scores; specifically in major trauma we use RTS (Revised Trauma Score) and MGAP (Mechanism of Injury, Glasgow Coma Scale, Age, and Systolic Blood Pressure).
The aim is to bring value to the chain of help/surviving, optimizing the early identification and allowing the adequate patient referral during a time window of reference to trauma centers.
It should be noted that the portuguese emergency teams are stratified accordingly to skills, teams can have of technicians, nurse or doctor.
Methods:
Retrospective descriptive analysis out-of-hospital clinical records during 2021 in iTEAMS, referring to major trauma.
Results:
During 2021, INEM attended 107 606 trauma patients; from those 1.6% were referred as possible major trauma (n=2643).
The population analyses revealed a prevalence of male (70.9%) , with 71.3% of the victims aged between 18-64 years old.
66.1% of this suspected major trauma patients were attended by teams including a physician or/and a nurse (n=1746).
The average time between the emergency call and the arrival of the EMS on scene was 21 minutes, with an average time spent on scene of 29 minutes. Out-of-hospital average actuation time in major trauma was of 78 minutes.
When in the presence of a nurse or a doctor intra-venous analgesic treatment was administered in 69% of the cases. Endotracheal intubation was performed in 43.4% and tranexamic acid administered in 43.5% of the population identified as major trauma when a phisician was deployed on scene.
Conclusion:
Well-structured clinical pathways are essential for improving prognosis in specific time dependent situations like major trauma. Out-of-hospital performance dictates the initial compliance with trauma guidelines. Moreover, the referral to the correct trauma center elevates the responsibility not only of the out-of-hospital teams but also of the coordinating centers.
The implementation of a monitoring and follow-up structure of trauma events in INEM pretends to alert, inform and educate our professionals in order to optimize out-of-hospital performance. In Portugal, INEM acts as the first link of the entire chain that represent the national pathways and can therefore promote a better outcome for patients with sudden onset of emergencies like trauma.
Marta CUSTÓDIO (Lisboa, Portugal), Margarida GIL, Filipa BARROS, Pedro VASCONCELOS, Carlos RAPOSO, Fátima RATO, Teresa BRANDÃO, Manuela LUCAS, João LOURENÇO
14:30 - 14:50
#31193 - Use of High Flow Nasal Oxygen therapy in pre-hospital setting: About 107 cases.
Use of High Flow Nasal Oxygen therapy in pre-hospital setting: About 107 cases.
Introduction
High Flow Nasal Oxygen (HFNO) therapy has become the first line in-hospital treatment of acute hypoxemic respiratory distress.
In 2020, the COVID pandemic was responsible for an acute hypoxemic respiratory distress pandemic. Consequently, the use of HNFO therapy increased significantly. Despite the logistical and technical challenge, our Emergency Medical Service (EMS) made it possible to provide transport by Advance Life Support (ALS) ambulance under HFNO.
The objective of this study was to present the feasibility of using HFNO in pre-hospital care through a series of 107 patients COVID + transported by an Advanced Life Support (ALS) ambulance.
Methods
All patients treated by HFNO in an ALS ambulance in a catchment area of 1,600,000 inhabitants bordering Paris from 01/17/21 until 05/04/21 (3rd COVID wave in France) were included. All inter-hospital or on-scene-hospital transportations were considered. HFNO was provided through the Fisher & Paykel MR 850® humidifier-heater, compatible with available respirators (Air Liquide Medical System Monnal T60®). Patients’ status was collected: gender, age, Body mass index (BMI), blood pressure and heart rate, prior ventilation support, prior HFNO use, ROX index (respiratory rate-oxygenation, calculated by the ratio of SpO2/FiO2 to respiratory rate). Transportation time stamps and HFNO transport conditions were collected such as its stability, any change or incident occurring during transport, oxygen consumption. Finally, the patients’ outcome including ROX index at hospital arrival, change of ventilation system, death or hospital discharge were collected.
Results
107 patients were included. 98 (91.59%) benefitted from inter-hospital transport. 74 were male (69.16%), mean age was 64 years old (SD: 13) – 45% were obese and 36% had overweight; They were all hemodynamically stable. 46 patients (42.99%) had HFNO prior to transport. Mean SpO2 was 92%, mean Respiratory rate was 29,5/min. ROX index before transport: low ROX index (< 2,85) 21 patients (30.39%), intermediate ROX index (2,85-4,87) index: 65 patients (63.11%) and high ROX index (≥ 4,88) 17 patients (16.50%)
Mean transport time was 15 min 24 sec (SD: 7 min 44 sec). For 1 out of 107, HNFO was switched, no one was intubated during transport. No technical incident has been reported (lack of energy or oxygen supply, fall of material).
Upon ALS arrival, ROX index category was low for 7 patients (6.93%), intermediate for 62 patients (61.39%) and high for 32 patients (31.68%). 47 patients (47.47%) switched to oro-tracheal intubation (OTI), the mean time to be intubated was 2,19 days. In hospital outcome was death for 28 patients (26.17%), hospital discharge for 19 patients (17.76%) and transfer to other hospital facilities for the rest.
Conclusion
Despite the logistical and technical challenge, our Emergency Medical Service (EMS) made it possible to provide transport by Advance Life Support (ALS) ambulance under HFNO. HNFO is feasible in pre-hospital care. No technical incident has been reported and clinical condition of patients has improved. Nevertheless, further studies are needed to evaluate the use of HNFO in pre-hospital setting.
n/a
Armelle SEVERIN (Garches), Anna OZGULER, Michel BAER, Thomas LOEB
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390
14:30 - 15:30
Prehospital Section Meeting
Chairperson:
Eric REVUE (Chef de Service) (Chairperson, Paris, France)
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M4-5 |
14:55 |
"Sunday 16 October"
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A12
14:55 - 16:20
Emergencies in the Elderly - Working with a Multi-disciplinary Team
Moderators:
Rosa MCNAMARA (Consultant) (Moderator, Dublin, Ireland), Dr Don MELADY (Associate Professor/Staff Physician) (Moderator, Toronto, Canada)
14:55 - 16:20
Panel discussion: Working with a Multi-disciplinary Team.
Dr Don MELADY (Associate Professor/Staff Physician) (Speaker, Toronto, Canada)
14:55 - 16:20
Panel discussion: Working with a Multi-disciplinary Team.
Rosa MCNAMARA (Consultant) (Speaker, Dublin, Ireland)
14:55 - 16:20
Panel discussion: Working with a Multi-disciplinary Team.
Aine MITCHELL (Consultant in Emergency Medicine) (Speaker, Sligo, Ireland)
14:55 - 16:20
Panel discussion: Working with a Multi-disciplinary Team.
Aoife DILLON (Speaker, DUBLIN, Ireland)
14:55 - 16:20
Panel discussion: Working with a Multi-disciplinary Team.
Kara MCLOUGHLIN (Speaker, DUBLIN 6, Ireland)
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B12
14:55 - 16:20
Digital Emergency Medicine - Artificial Intelligence in the Emergency Department
Moderators:
Dr John HEYWORTH (Consultant) (Moderator, Southampton, United Kingdom), Thomas SAUTER (Consultant) (Moderator, Bern, Switzerland)
14:55 - 15:20
AI in EM - a revolution already taking place in medicine.
Dr Barbara C HOGAN (Past President of the European Society for Emergency Medicine, EuSEM) (Speaker, HAMBURG, Germany)
15:20 - 15:45
Clinical implications and applications of AI in the ED.
Dr Tajek HASSAN (Board Chair for Europe, IFEM) (Speaker, Leeds, United Kingdom)
15:45 - 16:10
AI - The academic perspective.
Wolf HAUTZ (Senior Attending Physician) (Speaker, Bern, Switzerland)
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C12
14:55 - 16:20
Disaster Medicine II
14:55 - 15:15
Zoom technology - The new tabletop for disaster drills?
Francis MENCL (emergency medicine physician) (Speaker, Akron, USA)
15:15 - 15:35
Lessons unlearned: crisis communication.
Steve PHOTIOU (Speaker, Crocetta del Montello (TV), Italy)
15:35 - 15:55
Response to natural disasters in Mexico - What have we learned from the past?
Carlos GARCIA ROSAS (Speaker, MEXICO, Mexico)
15:55 - 16:15
Counterterrorism.
Derrick TIN (Faculty) (Speaker, Sydney, Australia)
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"Sunday 16 October"
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D12
14:55 - 16:20
Difficult cases solved with current guidelines - The role of the ED in early diagnosis of difficult and special cases of various pathology
Moderators:
Pr Martin MÖCKEL (Head of Department, Professor) (Moderator, Berlin, Germany), Ari PALOMÄKI (Professor) (Moderator, Hämeenlinna, Finland)
14:55 - 15:15
The Miracle of chest pain.
Pr Rick BODY (Professor of Emergency Medicine) (Speaker, Manchester, United Kingdom)
15:15 - 15:35
I am so short of breath.
Rianne OOSTENBRINK (pediatrician) (Speaker, Rotterdam, The Netherlands)
15:35 - 15:55
I do not remember what happened.
15:55 - 16:15
I do not feel so well.
Ari PALOMÄKI (Professor) (Speaker, Hämeenlinna, Finland)
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"Sunday 16 October"
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E12
14:55 - 16:20
Important symptoms II
Moderator:
Dr Fazle ALAM (Consultant A&E) (Moderator, Birmingham, United Kingdom)
14:55 - 15:15
Constipation.
Dr Jovanka BLUNK (Doctor) (Speaker, Hoppegarten, Germany)
15:15 - 15:35
Diarrhea.
Metin OMEROVIĆ (Speaker, Maribor, Slovenia)
15:35 - 16:20
Dizzines & Vertigo .
Eric DRYVER (Consultant) (Speaker, Lund, Sweden)
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"Sunday 16 October"
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F12
14:55 - 16:20
Let me tell you something
Moderator:
Michela CASCIO (Trainee doctor) (Moderator, ROME, Italy)
14:55 - 15:20
Geriatrics for the Emergency Physician.
James VAN OPPEN (Clinical Research Fellow / Specialty Registrar) (Speaker, Leicester, United Kingdom)
15:20 - 15:45
E-scooters: Friend or Foe?
Robert HIRST (ST4 EM Trainee) (Speaker, Bristol)
15:45 - 16:10
Under Pressure.
Stef BOUMAN (Speaker, Maastricht, The Netherlands)
15:45 - 16:10
Under Pressure.
Jeroen SEESINK (Speaker, The Netherlands)
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G12
14:55 - 16:20
Notfallmedizin 2022 Teil 1
Moderators:
Carsten Eberhard MACH (Consultant) (Moderator, Aachen, Germany), Wilfried SCHNIEDER (Moderator, Hiddenhausen, Germany)
14:55 - 15:20
Schockraum-Management 2022.
Bernhard KUMLE (Head of Department) (Speaker, Villingen-Schwenningen, Germany)
15:20 - 15:45
Medizinische Versorgung in der Sozialen Isolation.
Patrick LARSCHEID (Speaker, Germany)
15:45 - 16:10
Versorgung von Kriegsverletzten.
Harald BERGMANN (Speaker, Germany)
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H12
14:55 - 16:20
Cardiovascular
Moderators:
Barbra BACKUS (Emergency Physician) (Moderator, Rotterdam, The Netherlands), Nancy VAN DER WAARDEN (Nurse practitioner emergency care) (Moderator, Rotterdam-Rijnmond, The Netherlands)
14:55 - 16:20
#31235 - Artificial Neural Network with systematic grid search in predicting Major Adverse Cardiac Events in the Emergency Department.
Artificial Neural Network with systematic grid search in predicting Major Adverse Cardiac Events in the Emergency Department.
Background
Early prediction of major cardiac adverse events would be beneficial in timely intervention and disposition of overcrowded low resource emergency departments. The purpose of this study was to develop and validate an artificial neural network model using systemic grid search for early prediction of major adverse cardiac events among adult patients presenting at the triage of an emergency department.
Methods
This is a single center electronic health record-based study. The primary outcome was the development of major cardiac adverse event (MACE) during hospital stay. We adopted a systematic grid search approach to optimize the artificial neural network (ANN) architecture on triage data. The ANN model with four hidden layers followed by an output layer was used. Each hidden layer was followed by back normalization and a dropout layer. Three binary classifiers; ANN, random forest (RF) and logistic regression (LR) were trained and tested for two independent tasks; prediction of MACE. The models were evaluated for overall accuracy of predictions in the validation dataset, along with sensitivity, specificity, precision, recall, receiver operating curve (ROC) and F1-score.
Results
During the study period, there were a total of 97,333 ED visits. The presentations used for the training and validation were 77,866 and 19,467 respectively. The mean age was 54.08 (±19.18). Diagnostic accuracy for MACE was better through random forest classifier 95.2% (95% to 95.5%) with sensitivity 99.4% (99.2% to 99.6%) and specificity 94.2% (93.8% to 94.6%). The AUC score for MACE using ANN was higher 0.97 compared to RF (0.96) and LR (0.96). Similarly, precision-recall curve for MACE using ANN was higher 0.94 compared to RF (0.93) and LR (0.93).
Conclusion:
The artificial neural network using systematic grid search was found to be sensitive in better prediction of MACE using presentation triage data. The findings of this study can be a valuable tool in prediction of MACE in an overcrowded emergency department of a low resource setting.
None
Ahmed RAHEEM, Shahan WAHEED (Karachi, Pakistan)
14:55 - 16:20
#31065 - Chest pain post anti-Covid-19 vaccination with mRNA BNT162b2 vaccine : the experience of a secondary hospital.
Chest pain post anti-Covid-19 vaccination with mRNA BNT162b2 vaccine : the experience of a secondary hospital.
Background : Vaccination against Covid-19 has been proved an effective protective measure against the pandemic. It has been noticed that a number of patients visited the emergency department (ED) complaining of chest pain following their vaccination.
Purpose : To record the patients that visited the ED of our hospital referring chest pain following their vaccination with BNT162b2 vaccine, the clinical and laboratory parameters as well as their final diagnosis.
Methods : We recorded the patients that visited the ED of our hospital (secondary hospital) referring “chest pain after the vaccine”, for a period of 6 months. We included patients that had received the first or the second dose of the vaccine 1-30 days prior their visit. We recorded basic demographic characteristics, ECG findings the laboratory test results as well as the possible diagnosis made in the ED.
Results: 207 patients visited the ED complaining of “chest pain after having the Covid-19 vaccine”, 96 male and 111 female, with mean age 47±8.2 years. 7 patients(3.38%) had elevated high sensitivity troponin and were diagnosed with myocarditis ( 2 female patients aged 5 and 62 years and 5 males aged 18-24 years. In 5/7 ST elevations were recorded in the 12-lead ECG, in 4/7 the transthoracic echocardiogram(TTE) revealed mildly impaired left ventricular function. Myocarditis was confirmed via cardiac MRI in all patients. Virology tests were negative for the common viruses.6/7 visited the ED 2-5 days after the second dose, whereas 1/7 10 days after the first dose). 2 patients(0.96%) were diagnosed with pericarditis (Both of them had received the second dose 5-7 days prior their visit, presented with pericardial rub and diffuse ST elevations in the ECG, as well as elevated CRP and moderate pericardial effusion). For the remaining 198 patients (95.65%) we did not record any abnormal findings in the ECG or the chest X ray and the chest pain was regarded non cardiac. Interestingly enough, 107 patients (51.69%) found to have a mild to moderate increase in the D-Dimer levels (mean 1.1±0.6 mg/l).Pulmonary embolism and aortic dissection was excluded to all of them based on our hospital’s protocol.
Conclusion : The vast majority (95.65%) of patients complaining of post Covid-19 vaccine chest pain had normal ECG and laboratory findings, suggesting a non cardiac origin.There were diagnosed some cases with myocarditis or pericarditis, a well described possible side effect of the BNT162b2 vaccine. Moreover, 51.69% of these patients were found to have elevated D-Dimer levels but we did not record any clinical significance.
Maria STRATINAKI, Anastasia SPARTINOU (HERAKLION, Greece), Dimitrios VASSILAKIS, Irini TRACHANATZI, A KOUFOGIANNI, Niki GRILLOU, M DETORAKI, M PITAROKOILIS, Ermis HONDA, Georgios ALETRAS, Eleftheriadou ELENI, D KORELA, Othon FRAIDAKIS, E FOUKARAKIS
14:55 - 16:20
#31439 - Comparison between HEART score and Troponin-only Manchester Acute Coronary Syndromes score in the evaluation of elderly patients presenting to the emergency department for chest pain: an observational prospective study.
Comparison between HEART score and Troponin-only Manchester Acute Coronary Syndromes score in the evaluation of elderly patients presenting to the emergency department for chest pain: an observational prospective study.
Background:
WHO defined an elderly person if the age is ≥ 65 years old. Age is one of the most important unmodifiable cardiovascular (CV) risk factor.
The aim of this study is to evaluate the performance of HEART score and Troponin-only Manchester Acute Coronary Syndromes (T-MACS) score in the rule out of acute coronary syndrome (ACS) in patients aged ≥ 65 years old.
Methods:
Observational prospective monocentric study carried out at the emergency department (ED) of a tertiary university hospital in Bologna, Italy. We enrolled 2035 consecutive 65 or older aged patients admitted for non-traumatic chest pain from 25th November 2019 to 24th November 2020. The main exclusion criteria were: presence of ST-segment elevation at the ECG; patients who denied their consent; patients lost during the follow up.
Each patient underwent serum sample for hs-TnI (Access; Beckman-Coulter), then the HEART and the T-MACS were calculated. The 90 days follow-up was performed through a phone call to the patients in order to register major adverse cardiac events (MACE).
The outcome was an occurrence of MACE below 1% in the low risk group (i.e. HEART score low risk and T-MACS very low risk).
The performance of the score has been described by the estimates of sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV).
Results:
1612 patients were included in the analysis. Median age was 78, 50.3% were female.
HEART score classified patients as follows: 280 low risk and 26 (9.2%) MACE; 898 intermediate risk and 143 (16%) MACE; 434 high risk and 253 (58%) MACE. Among low risk patients, 24 patients had the troponin dosage above the upper reference limit (URL); 256 patients had the hs-TnI dosage under the URL but 5.4% had MACE. Sensitivity was 93.8%, specificity was 21.3%, PPV was 29.7% and NPV was 90%. Positive likelihood ratio (LR+) 1.2, negative LR (LR-) 0.3.
T-MACS classified patients as follows: 570 very low risk and 41 (7.2%) MACE; 408 low risk and 56 (13.7%) MACE; 462 intermediate risk and 184 (39.8%) MACE; 172 high risk and140 (81%) MACE. In the very low risk category, nobody had a positive hs-TnI dosage. Sensibility was 90%, specificity was 44%, PPV 36.4% and NPV was 93%. LR+ 1.6, LR- 0.2.
Discussion and conclusion:
HEART scoring system gives 2 points for age ≥ 65, instead T-MACS does not consider age. Nevertheless, neither HEART score nor T-MACS showed a good performance in the correct identification of low risk patients. Even by excluding HEART score low risk patients who had a positive troponin dosage, it does not improve the accuracy of the rule. MACE rate in the low risk group of the two scores was sharply above 1% and this is unacceptable for an emergency physician who challenges every day with an increasingly number of elderly patients presenting to the ED.
Data obtained from this study require external and multicentric validation.
We can conclude that the evaluation of the elderly patients probably need further testing in order to exclude ACS.
Study approved by ethics committee with registration number 480/2019/Oss/AOUBo.
This study did not receive any specific funding.
Dr Eleonora TUBERTINI (Bologna, Italy), Gabriele FARINA, Luca SANTI, Maria Grazia MIRARCHI, Alice GRIGNASCHI, Maria Laura ARTESIANI, Ilaria CARAMELLA, Dario CARUSO, Elena CASADEI, Giulia CESTER, Vittorio CUCCIARDI, Valentina GAMBERINI, Sara NANNI, Daniela NIZZA, Francesca TRABALZA, Fabrizio GIOSTRA
14:55 - 16:20
#31365 - Factors influencing pain severity among patients with acute chest pain.
Factors influencing pain severity among patients with acute chest pain.
Introduction:
Acute chest pain (CP) is a frequent cause of emergency medical services (EMS) activation. It was shown that pain perception may be influenced by different factors. Our study aims to evaluate patients’ CP perception and factors influencing pain intensity.
Methods:
We conducted a Cross-sectional study including patients who contacted the east center EMS for CP between November 2021 and January 2022. Data were collected from digital regulation sheets and the corresponding transport sheets. Initial chest pain intensity was assessed on a 10-point numeric rating scale (NRS). We used student's t-test and analysis of variance (ANOVA) to compare mean NRS of different patient groups.
Results:
Our study population consisted of 203 patients. 71,9% of them were men with a sex ratio of 2,56. The mean age was 60,62±12,8 years. The mean NRS in the total population was 4,7 ± 2,7 with a minimum of 0 and a maximum 10. The pain intensity was slightly higher among men (4,8 ±2,8) than women (4,61 ±2,6) but with no significant difference (p=0,04). Concerning age, older patients tended to feel pain with significantly lower intensity than younger patients (p=0.009). Regarding medical history, patients who had at least one cardiovascular risk factor CVRF experienced less pain (4,53 ±2,7) than those with no CVRF (5,52 ±2,75; p=0,04). As for co-morbidities, diabetic patients felt significantly less pain (3,93 ±2,5) than non diabetic patients (5,28 ±2,7; p=0,002). This was also the case for patients with dyslipidemia who perceived pain with significantly lower intensity (3,98 ±2,4 vs 5,2 ±2,8; p=0,005). Concerning CP etiology, pain was perceived with greater intensity in patients with an ST-elevation myocardial infarction compared to non- ST-elevation myocardial infarction patients (6,35 ±2,2 vs 4,24 ±2,6) with a significant difference (p<0,001).
Conclusion:
In our study, we found a significant association between perceived CP intensity and age, CVRF, co-morbidities: diabetes, dyslipidemia, and ST elevation. These factors may lead to a misinterpretation of the pain. They should therefore be taken into consideration in the evaluation of CP patients as certain patients might need more intensive investigation in order to avoid potentially lethal conditions to go unrecognized.
Sondos LAAJIMI (Sousse, Tunisia), Khouloud ROMDHANE, Rabeb MBAREK, Khouloud HAMDI, Samar NAIFER, Moussa BOUDRIGUA, Naoufel CHEBILI
14:55 - 16:20
#30240 - Heart rate: is it truly a vital sign?
Heart rate: is it truly a vital sign?
Introduction Increased heart rate (HR) is believed to be a physiological response to hypotension and an early warning sign for the development of shock, although this response may change with ageing. The aim of this study was to assess the association between systolic blood pressure (SBP) and HR in ED patients of different age categories (18-50; 50-80; >80 years).
Methods A multicenter cohort study using the Netherlands Emergency Department Evaluation Database (NEED), including data from three hospitals. All patients ≥18 years in whom HR and SBP were registered at arrival to the ED were included. Unadjusted and adjusted associations were visualized with scatterplots and a generalized additive logistic regression model. Subgroup analyses were performed for patients with suspected infection and trauma. To externally validate our findings, analyses were performed by investigating the association between SBP and HR in three other cohorts: a Danish Multicenter Cohort including ED patients, a cohort including ED patients with suspected infection and a cohort with data from an Intensive Care Unit (ICU) of one hospital.
Results A total of 81750 patients were included from the NEED. No clinically relevant unadjusted or adjusted associations were found between SBP and HR in any age category or subgroup of ED patients, nor in two other ED cohorts, with less than 3 bpm change per 40mmHg decrease in SBP. In contrast with findings in ED patients, for ICU admitted patients HR increased linearly with decreasing SBP only for patients aged 18-50years (3.6bpm per 10mmhg, 95%CI 3.4-3.8), but no clinically relevant association existed in older patients.
Conclusion A clinically relevant association between SBP and HR is absent for all age-categories in the ED. As a result, recognizing shock may be difficult and physicians cannot solely rely on HR disturbances. Acute care guidelines should acknowledge these difficulties to recognize shock.
NTR trial NL9028, funding: none
Bart CANDEL, Wouter RAVEN, Soren Kabell NISSEN, Marlies MORSINK, Menno GAAKEER, Mikkel BRABRAND, Erik VAN ZWET, Evert DE JONGE, Bas DE GROOT (AMSTERDAM, The Netherlands)
14:55 - 16:20
#31329 - Management strategies in the emergency department of atrial fibrillation: rate versus rhythm control.
Management strategies in the emergency department of atrial fibrillation: rate versus rhythm control.
Introduction:
Atrial fibrillation (AF) is the most common dysarrhyth¬mia seen in the emergency department. The prevalence of AF globally has been reported to range from 0.5 to 3.2%
The primary pharmacologic strategy for managing AF includes medications that control either rate or rhythm.
Several trials in AF: PIAF, RACE, STAT, AF-CHF, had attempted to answer which option is more favorable in terms of clinical outcomes. However, studies showed no differences between the two treatment strategies.
Objective:
This study was designed to compare two treatment strategies in patients with atrial fibrillation (AF): rhythm-control versus. rate-control in terms of the epidemiological, clinical and prognosis data.
Methods:
In this retrospective observational study, we included all patients who consulted the emergency department for AF in the period from May 2011 to February 2020. Epidemiological, clinical, therapeutic and prognostic data of patients were collected. Patients were classified into the rhythm control or rate control groups according to the classification of AF and the severity of symptoms. The therapeutic strategy followed in each patient depended on the required recommendations of the European Society of Cardiology. In addition, we compare the epidemiological, clinical and prognostic data of the two groups. The prognosis was evaluated at 30 days and 90 days on the occurrence of thromboembolic and hemorrhagic accidents and mortality.
Results:
A total of 465 patients were included in this study, with a mean age of 64 ±15 years and a male/female sex ratio of 0.72. Rhythm control was adopted in 73 patients (15%) and rate control in 359 patients (77%).
In terms of medical history, the rhythm control and frequency control group had respectively: hypertension 37(50%) versus. 217(60%), diabetes 23(31%) versus. 95(26%), history of coronary heart disease 6(8%) versus. 49(13%), already diagnosed with AF 8(10%) versus. 177(49%) and chronic heart failure 3(4%) versus. 69(19%).
Average heart rate was 139 ±21 bpm for the rhythm control group versus. 125 ±28 bpm for the rate control group (p>0.05).
There was no difference in the occurrence of the combined primary end point between rhythm-control group versus. rate-control group.
In fact, at 30 day, mortality was 1.5 versus. 2.5%, cerebrovascular event was 4 versus. 2% and bleeding complications was 1 versus. 0.8% respectively in rhythm-control group versus. rate-control group.
At 90 day, mortality was 1.2 versus. 3.6%, cerebrovascular event was 3 versus.4%, and bleeding complications was 1 versus 1.6% respectively in rhythm-control group versus. rate-control group.
Conclusions:
Our results are in line with those of the studies carried out previously. There is no difference between rate and rhythm control in terms of complications.
Mokhtar MAHJOUBI, Hanen GHAZALI (Ben Arous, Tunisia), Yosra RADDAOUI, Fedya ELAYECH, Amira TAGOUGUI, Rihab DAOUD, Yousra MEJDOUB, Sami SOUISSI
14:55 - 16:20
#31573 - Neurological function at 6 months improves compared to 30 days after extracorporeal cardiopulmonary resuscitation at the emergency department.
Neurological function at 6 months improves compared to 30 days after extracorporeal cardiopulmonary resuscitation at the emergency department.
Ingrid Magnet1; Michael Poppe1; Christian Clodi1; Florian Ettl1; Alexandra-Maria Warenits1; Alexander Nürnberger1; Matthias Mueller1; Dominik Wiedemann2; Michael Holzer1; Heidrun Losert1; Andrea Zeiner-Schatzl1; Gerhard Ruzicka1; Jürgen Grafeneder1; Christoph Testori1; Christoph Schriefl1
1 Department of Emergency Medicine, Medical University of Vienna, Austria
2 Department of Cardiac Surgery, Medical University of Vienna, Austria
Background:
The Core Outcome Set for Cardiac Arrest and Utstein-style guidelines recommend reporting long-term survival and neurological function at 30 days for cardiac arrest effectiveness trials, partially due to ease of data collection. Patients in refractory cardiac arrest treated with extracorporeal cardiopulmonary resuscitation (eCPR) have longer low flow times compared to patients successfully treated with conventional cardiopulmonary resuscitation alone and will require prolonged recovery from ischaemia-reperfusion injury. Thus, neurological assessment at 30 days might not be representative of long-term outcome in these patients. The aim of this study was to compare the neurological function of cardiac arrest survivors at 30 days and 6 months following refractory cardiac arrest and eCPR.
Methods:
All patients >18 years of age with non-traumatic in hospital and out of hospital cardiac arrest (IHCA and OHCA) treated with eCPR at the emergency department of the medical university of Vienna between January 2013 and December 2021 were included in this retrospective observational study. Primary outcome was good neurological function at 6 months, defined as cerebral performance category (CPC) 1 or 2. Secondary outcomes included survival at 6 months, neurological function and survival at 30 days. The CPC was evaluated in-person or by telephone. Continuous data are presented as median (interquartile range) and discrete data as counts (%). McNemar’s test was used to compare good neurological function rates between 6 months and 30 days with an alpha of 0.05.
Results:
During the study period, 204 patients were treated with eCPR. At 6 months, good neurologic recovery had occurred in 16,7% (34 patients) and survival was 19,1% (39 patients). At 30 days, good neurological recovery had occurred in 12,3% (25 patients) and 22,1% (45 patients) were alive. Good neurological function rate was significantly improved at 6 months compared to 30 days (p=0.004).
Baseline characteristics of patients and cardiac arrest were as follows: male 164 (80%), cardiac cause of arrest 172 (84%), witnessed 179 (89%), CPR within 5 minutes of emergency call 166 (81%), initial rhythm of ventricular fibrillation 126 (62%), pulseless electrical activity 56 (27%), asystole 22 (11%). In 44 (22%) patients with IHCA time from emergency call to eCPR was 42 minutes (IQR 30; 66) and in 160 (78%) patients with OHCA 79 minutes (IQR 69; 91).
Discussion & Conclusions:
In patients treated with eCPR for refractory cardiac arrest, reporting long-term survival and neurological function at 6 months might better represent neurologic recovery when compared to 30 days.
Acknowledgements:
We want to thank the Vienna Resuscitation Research Group for their tireless work. Furthermore, we want to thank the Emergency Medical Service of Vienna for the excellent cooperation in patient care and science.
Funding:
This study did not receive any specific funding.
Ethical approval and informed consent:
The study was approved by the Ethics Committee of the Medical University of Vienna (1219/2018).
Ingrid MAGNET (Vienna, Austria)
14:55 - 16:20
#31489 - Over the Heart Score and far away: a new statistical model to better assess the risk of major adverse cardiac events in patients with chest pain.
Over the Heart Score and far away: a new statistical model to better assess the risk of major adverse cardiac events in patients with chest pain.
Background: To predict among all patients suffering form chest pain those at risk of developing major adverse cardiac event (MACE) is a clinical challenge. Heart Score is a post-test score simpler and more reliable than GRACE and TIMI RISK score, but fails to identify a number of cases ranging from 1.5 to 2.5%. The aim of this study was to evaluate the effectiveness of a new statistical model, the nomogram, in improving performance of Heart Score.
Methods: In this multicenter retrospective observational study we considered all the patients consecutively observed for chest pain from January to June 2021 in the Emergency Departments of the University Hospital of Verona and City Hospitals of Merano and Legnago. We excluded only the patients with incomplete or unreliable clinical documentation. Main outcome was the onset of MACE within a 3 months-follow-up. All anamnestic, clinical, laboratory and instrumental data were carefully recorded and included in the univariate analysis. The variables associated with outcome (significance level p<0.1) were subsequently evaluated in the multivariate anaysis by a Logistic Regression model and those proved to be significant predictors (accuracy level at least 0.5%) contributed to create the final model. In the nomogram, each variable was provided with an individual score based on its statistical weight and the total score corresponds to a risk probability. We further validate this model by internal bootstrap on a 5000 patients re-sample. Validation was performed with discrimination model, calculating the area under receiver operating characteristics curve (AUC).
Results: Out of 10964 observed patients, 9837 (5863 males, 3974 females, mean age 63 years) were enrolled in the study. Almost a quarter of them (22.9%) had a history of ischemic heart disease. In the follow-up period 1671 patients (16.9%) developed a MACE (MACE+) with a large prevalence of males (about 69%). In the univariate analysis variables proved more significantly (p<0.001) were: risk factors (median MACE+ 3 vs MACE- 1); Chest Pain Score (median 7 vs 4); duration of chest pain (median 1 vs 4 hours), electrocardiogram findings and troponin levels (median 70 vs 5). All these variables were confirmed significantly (p<0.001) in the subsequent multivariate analysis: risk factors (OR 2.66); Chest Pain Score (OR 1.24); pain duration (OR 1.47); electrocardiogram findings (OR 1.51); troponin levels (OR 2.01). The Logistic Regression model reached a good likelihood level (R=0.685). The individual score of these variables in the nomogram contributed to a final score from 0 to 220, corresponding to a 3-months MACE risk rate (range 0.1-0.9). Discrimination level of nomogram (AUC 0.954) was higher to the good ones (AUC 0.935) of Heart Score (p<0.005). In our series 5489 (55.8%) resulted “low-risk patients” according to Heart Score, but 89 of them suffered from MACE (1.6 out of MACE+). According to nomogram, only 3 of “low-risk patients” (risk rate < 0.2)developed a MACE (sensibility 99%, negative predictive value 99%).
Conclusions: The nomogram achieved a very good clinical and diagnostic performance and allowed a better stratification of the risk of MACE in an increasing continuum of probability.
As retrospective and non-randomized study neither Trail Registration nor informed consent was requested by our Ethical Committee
This study received no funds
Dr Antonio BONORA (VERONA, Italy), Gianni TURCATO, Arian ZABOLI, Angelica LUNARDI, Pasquale SALPIETRA, Francesco PRATTICÒ, Norbert PFEIFFER, Antonio MACCAGNANI
14:55 - 16:20
#30655 - Prehospital troponine, D-dimer and NT-proBNP as a trigger biomarker for quick-triage of high-risk in-hospital mortality by ischemic stroke.
Prehospital troponine, D-dimer and NT-proBNP as a trigger biomarker for quick-triage of high-risk in-hospital mortality by ischemic stroke.
Background: Fast recognition of acute stroke patients is a challenge for emergency medical systems (EMS). The time elapsed between presumptive diagnosis, confirmation by imaging studies, and reperfusion therapy makes the gap in morbimortality outcomes in ischemic stroke.
The aim of this study is to analyze the ability of prehospital cardiac biomarkers (troponine, D-dimer and NT-proBNP) to predict in-hospital mortality in patients attended in prehospital care with stroke code and final hospital diagnostic of ischemic stroke.
Methods: Prospective, multicentric, EMS-delivery, ambulance-based, pragmatic cohort study of adults with stroke code, referred to two tertiary care hospitals (Spain), between January 1st and December 31st, 2021. Any patient treated consecutively by EMS and transferred with high priority by ambulance to the ED was included in the study. Patients under 18 years of age, pregnant women, patients with psychiatric or terminal pathology, and patients discharged on site were excluded. Demographic data (age and sex) and venous sampling were collected during the first contact with the patient in prehospital care. The prehospital point-of-care cardiac was measured with the POC cobas h 232 analyzer (Roche Diagnostics, Mannheim, Germany). Mortality data were obtained by reviewing the patient's electronic history. The primary dependent variable was all-cause in-hospital mortality during 90-days follow-up from the index event. The area under the curve (AUC) of the receiver operating characteristic (ROC) of the cardiac biomarkers were calculated in terms of mortality.
Results: A total of 281 patients with a prehospital diagnosis of acute code stroke were transfer to ED, finally 150 patients with hospital diagnosis of ischemic stroke were included in our study. The median age was 61.8 years (IQR: 45-74 years), 48.6% of whom were women (73 cases). Mortality at 90-day was 5.33 % (8 cases). The cut-off points and AUROC of troponine, was 43.24 ng/L with an AUC of 0.725 (95%CI: 0.52-0.92; p=0.031); for D-dimer 464 ngr/ml and AUC of 0.678 (95%CI: 0.46-0.88; p=0.096); and for NT-proBNP 2091 pg/ml and AUC of 0.755 (95%CI: 0.55-0.95; p=0.012).
Conclusions: Cardiac biomarkers have a key role in the diagnosis, follow-up and prognosis of acute cardiovascular disease, but their role is not well defined in ischemic stroke
However, all 3 biomarkers analyzed in prehospital care do not yield spectacular results that could accurately guide the bedside diagnosis, nevertheless, indicate a tendency. The biomarker with the best performance is NT-proBNP, with elevated values of this biomarker corresponding to in-hospital mortality due to ischemic stroke.
This work was supported by the Gerencia Regional de Salud, Public Health System of Castilla y León (Spain) [grant number GRS 1903/A/19 and GRS 2131/A/20]
Francisco MARTÍN-RODRÍGUEZ, Carlos DEL POZO VEGAS (Valladolor, Spain), Ancor SANZ GARCÍA, Santiago OTERO DE LA TORRE, Francisco Tomás MARTÍNEZ FERNÁNDEZ, Miguel Angel CASTRO VILLAMOR, Juan Francisco DELGADO BENITO, Santiago LÓPEZ TORREZ, Rodrigo ENRIQUEZ DE SALAMANC GAMBARA, Enrique CASTRO PORTILLO, Irene SÁNCHEZ SOBERON, Almudena MORALES SÁNCHEZ, Ana BENITO JUSTEL, Rafael MARTÍN SÁNCHEZ
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Possibilities and dignity in Emergency Care for nursing home residents.
Annmarie LASSEN (Professor in Emergency medicine) (Speaker, Odense, Denmark)
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Palliative Sedation.
Eva DIEHL-WIESENECKER (Physician) (Speaker, Berlin, Germany)
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Research ethics.
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Sepsis guidelines 2021.
Mikkel BRABRAND (Clinical professor, consultant, PhD) (Speaker, Odense, Denmark)
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Do we need better infection prevention and control in the ED?
Martin PIN (Speaker, BORNHEIM, Germany)
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Do we need better infection prevention and control in the ED?
Sonja HANSEN (Senior Hospital Epidemiologist) (Speaker, Berlin, Germany)
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Cybersecurity.
Dr Jeffrey FRANC (Associate Professor) (Speaker, Edmonton, Italy)
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Roundtable: Is it possible to create a European Disaster Management plan?
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Is it possible to create a European Disaster Management plan? - Round Table.
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16:55 - 17:55
Is it possible to create a European Disaster Management plan? - Round Table.
Abdo KHOURY (PROFESSEUR ASSOCIE) (Panelist, Besançon, France)
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Eric DRYVER (Consultant) (Speaker, Lund, Sweden)
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Hospital without walls
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Retrieval Medicine from Dispatch to Patient: When the Medicine is easy.
Ryan MCHENRY (EM Trainee) (Speaker, Glasgow, United Kingdom)
16:55 - 17:20
Everyday life for a paramedic in South Africa.
Mikayla VAN WELIE (Lecturer) (Speaker, Johannesburg, South Africa)
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Life of prehospital EMS in France.
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Pflege in der Notaufnahme - wer arbeiter wie?
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16:30 - 16:55
Interprofessionalitt in der Notaufnahme (Arbeitstitel).
Mareen MACHNER (Speaker, Germany)
16:55 - 17:20
Personalmix - wer arbeitet da berhaupt.
Michael KEGEL (Speaker, Brem, Germany)
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Mindestpersonalbesetzung - wie viele Mitarbeiter braucht es?
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Meet the Digital EM Workgroup
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COVID
Moderator:
Pr Cem OKTAY (FACULTY) (Moderator, ANTALYA, Turkey)
16:30 - 17:55
#31313 - A comparison of emergency department presentations for medically unexplained symptoms in frequent attenders during COVID-19.
A comparison of emergency department presentations for medically unexplained symptoms in frequent attenders during COVID-19.
Background:
Particularly challenging emergency department (ED) presentations are those in which symptoms have no identified organic aetiology, referred to as medically unexplained symptoms (MUS) . MUS is a common presentation in frequent attenders (FAs). Our emergency department (ED) perceived an increase in MUS frequency during COVID-19. The aims were to compare the incidence of FA-MUS during COVID-19 with a control period and the frequency of MUS presenting complaints between the two time periods.
Methods:
A retrospective observational study was performed. Cambridge University Hospital ED attendance data were used to identify FA, defined as five or more ED visits during either 122-day study period: 1 March to 30 June 2019 (control) and 1 March to 30 June 2020 (COVID-19). A retrospective list of FA-MUS presenting during study period was compared. The presenting complaint was designated as MUS if there were investigations with no abnormal findings and no signs of organic disease. As we routinely collect FA data in our ED, we decided to use FA-MUS as a proxy for the general MUS population.
Fisher's exact test was used to compare binomial proportions; this was presented as relative risk (RR) with 95% confidence intervals (95%CI). In order to report population incidence per 1,000 people per year, the number of patients and the number of visits were multiplied by 2.99 (356.25 days/122 days) and then divided by the ONS local population estimate. The primary outcome was to compare the incidence of FA-MUS during COVID-19 with the control period. The secondary aim was to compare the frequency of MUS presenting complaints between the two time periods. To minimise reviewer bias, two authors independently reviewed all ED case notes. Any disagreement in either MUS diagnosis or categorisation was arbitrated by a third author.
Results
There were a total of n=42,785 ED visits in the control period and n=28,806 in the COVID-19 period, a decrease of 32.7%.Despite this, there was a significant increase in both the incidence of FA-MUS ED patients and the corresponding incidence of FA-MUS ED visits during the COVID-19 period compared to control: RR 1.5 (95%CI 1.1–1.8), p=0.0006, and RR 1.8 (95%CI 1.6–2.0), p<0.0001, respectively. Of the presenting symptoms for MUS patients, the only difference observed was a significant increase in the MUS category SOB during the COVID-19 period (p<0.01).
Discussion & Conclusions
Despite reduced ED attendances during COVID-19, there was a significant increase in the incidence of FA-MUS patients and corresponding ED visits by this cohort. SOB was the only MUS presentation that significantly increased during COVID-19, likely secondary to pandemic-related anxiety. The high prevalence of FA-MUS in the ED is likely a symptom of the general trend of unmet needs for this diverse and vulnerable group elsewhere in the healthcare system. This paper adds further evidence that the needs of these individuals with MUS may not be being met, and in added stressors such as the COVID-19 pandemic, their needs are further exacerbated.
This project was registered at CUH as a service evaluation (ID3270 PRN9270); ethical review was not required by the local research ethics committee. Data were handled in accordance with the UK Data Protection Act 2018.
Natasha Faye DANIELS ` (london, United Kingdom), Raiiq RIDWAN, Catherine HAYHURST, Talha AMANULLAH, Ed BARNARD
16:30 - 17:55
#31070 - Ambulance use during the COVID-19 pandemic; a nationwide population-based study.
Ambulance use during the COVID-19 pandemic; a nationwide population-based study.
Background:
Several studies have described the effect of the COVID-19 pandemic on the general population and on hospitals, but few on the prehospital setting. In general, we would expect the number of patients with severe medical issues to remain constant (i.e., the number of cardiac arrests each year) regardless of a pandemic. Our aim was to investigate the COVID-19 pandemic’s influence on patients requesting an ambulance.
Methods:
Registry-based study of patients transported by ambulance during the first COVID-19 waves in Denmark from 1 March to 31 December 2020, compared to the same period in 2019.
In Denmark, healthcare is tax funded. The police initially answer the emergency number (i.e., 112) and forward the call to a healthcare professional in case of a medical emergency. They assess the situation and dispatch the relevant emergency vehicles supported by a national guideline (Danish Index for Emergency care (Danish Index) with 37 categories) pertaining to the situation and/or symptoms.
We included all patients in Denmark who had called the emergency number and subsequently been transported to hospital by an ambulance. Patients without a valid civil registration number were excluded.
Primary outcome was the number of patients, and patients stratified by dispatch category, obtained from the Danish Prehospital Medical Records. We also extracted the hospital diagnosis, age and sex from the National Patient Register and the Danish Civil Registration System. All linkage of data was facilitated by the patients’ civil registration number.
Descriptive statistics were applied to summarize variables which were presented as frequency, means, percentages, and 95% confidence intervals. Stata 17 was used for all analyses.
Results:
We included 348,160 patients transported to a hospital by ambulance in the study period. Fewer patients were seen by an ambulance in 2020 compared to 2019 (29 vs 31 patients per 100.000 capita). The number of patients varied over the months with fewer patients in the spring, more in summer, and then again fewer in fall and winter – corresponding to the inverse number of citizens infected with COVID-19 in the same periods.
The four most frequently used dispatch categories (i.e., Chest pain, Decreased consciousness, Breathing difficulties and Accidents) all followed the same seasonal pattern. The fifth most frequently used category (i.e., Unclarified problem), had 5 - 33% fewer patients in all of 2020.
Discharge diagnoses also followed the same seasonal pattern for the four most frequent, Symptoms and signs, Injuries and poisoning, Other factors, and Circulatory diseases. Respiratory diseases (fifth most frequent) had 2 - 54% fewer patients in 2020.
Patients in 2020 were older with a mean age of 58.4 years (95%CI: 58.2 to 58.5) compared to 56.9 years (95%CI: 56.8 to 57.0).
Discussion & Conclusions:
The overall pattern in the number of patients, Danish Index category, and discharge diagnoses, demonstrate the effect of COVID-19. However, the excluded patients, representing the remaining prehospital population was not investigated and may follow a different pattern.
The results of this study could suggest the included patient populace was “redirected” elsewhere during the first COVID-19 wave.
Trial Registration: Protocol not registered as this was a registry-based study. However, The Danish Patient Safety Authority approved disclosure of patient medical records (31-1521-299). According to Danish legislation, registry-based studies that do not involve biological material do not require approval from the National Committee on Health Research Ethics.
Funding: This study did not receive any specific funding.
Tim LINDSKOU (Aalborg, Denmark), Søren BOGH, Torben KLØJGAARD, Erika CHRISTENSEN, Mikkel BRABRAND, Søren MIKKELSEN
16:30 - 17:55
#31498 - COVID-19 patients in the Brazilian second wave have more severe disease, but mortality did not increase: a retrospective cohort.
COVID-19 patients in the Brazilian second wave have more severe disease, but mortality did not increase: a retrospective cohort.
Background: Since its onset in 2020, the management of patients with COVID-19 has changed significantly. Other SARS-CoV-2 variants emerged, with different infectivity and lethality, while the physicians' knowledge and experience have grown. Given all these changes, this study aims to compare different pandemic periods to evaluate how these aspects impacted the disease outcomes.
Methods: It is a retrospective cohort, including patients admitted to the Emergency Department in a tertiary academic hospital, designated as the primary center for attending severe COVID-19 in São Paulo, Brazil. Patients were divided into two groups: from March to August 2020 and from November 2020 to March 2021, and the primary outcome analyzed was mortality. All consecutive adult patients with confirmed COVID-19 (defined as at least one positive result rtPCR obtained from nasopharyngeal swabs or bronchial secretions) admitted at the hospital at least two days after symptoms onset were included. Data were collected through electronic medical records, and the databases were built on REDCap® software. Analyses were performed on R software version 4.1.2. Numerical variables were analyzed using the Mann-Whitney-Wilcoxon test and categorical variables through the chi-square method. A p-value <0.05 was considered significant.
Results: Overall, 2955 patients were included. Inclusion of the first 2154 patients coincided with a higher prevalence of B.1.1.33 and B.1.1.28 variants. The second group comprised 801 patients, when the P.2 variant was predominant. There was no significant difference between groups regarding age and sex. Patients admitted to the hospital in the second period arrived nine days after the beginning of symptoms, compared to seven days in the first group (p<0.01). Patients from the second period also had higher SAPS3 (65 to 56, p<0.01), a score for mortality prediction validated for COVID-19. Patients from the second group presented fewer symptoms, such as fever, dyspnea, and cough; however, 65% were classified as regular or poor general state, compared to 47% in the first group (p<0.01). Patients in the second group received more corticosteroids (95% to 59%, p<0.01) and fewer vasoactive drugs (41% to 53%, p<0.01). Moreover, patients in the second group were submitted to endotracheal intubation more frequently (44% to 32%, p<0.01). Despite these differences, mortality was similar in both groups (32%).
Discussion and conclusions: During the pandemic course, people avoided seeking medical help earlier, getting to the ED in worse conditions. Probable causes were the high number of in-hospital COVID-19 deaths and the overcrowded hospitals. Interestingly, there was no increase in mortality, which shows that physicians' expertise, such as broadly administering corticosteroids, is positively weighting in patients' outcomes.
Ethical approval and informed consent: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068), which also waived the need for written informed consent. We adhere to STROBE guidelines.
Trial registration: This study was registered as RBR-5d4dj5 at ensaiosclinicos.gov.br
Ethical approval and informed consent: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068), which also waived the need for written informed consent. We adhere to STROBE guidelines.
Funding: FAPESP and HCFMUSP
Juliana STERNLICHT (São Paulo, Brazil), Eduardo CORREA, Lucas MARINO, Julio MARCHINI, Julio ALENCAR, Rodrigo BRANDÃO, Ian MAIA, Katia DA SILVA, Vilson COBELLO, Gomez LUZ, Heraldo SOUZA
16:30 - 17:55
#31594 - Efficacy of a herbal treatment in Headaches Caused by COVID 19.
Efficacy of a herbal treatment in Headaches Caused by COVID 19.
Introduction: Coronaviruses are a large family of viruses that can cause a variety of illnesses in humans, ranging from the common cold to Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). A new coronavirus (COVID-19) was identified in 2019 in Wuhan, China. He is currently responsible for a pandemic since November 2019.Since headache is one of the signs caused by this virus, the objective of our study is to test the efficacy of quercitin phytosome in the treatment of headache relatedtoCOVID-19.
Materials and methods: We report a randomized double-blind study. All cases of COVID-19 pneumonia confirmed by PCR requiring hospitalization or over 40 years of age with comorbidity and whose symptoms have progressed for less than five days during the period from June 2021 to October 2021 have been included. The patients were divided into 2 groups: a group A who will take a placebo and a group B who will be treated with quercitin plus.Each patient included, after signing the consent, will have a treatment for 27 days: This medication is taken as 1 capsule twice a day for the first 3 days, 30 minutes before meals. From the fourth day, this drug is taken as 1 capsule per day.
Results:We collected 186 cases during this period. The average age of our population is 46 with extremes of 17 and 80. A female predominance was noted in the entire study population with 60% of cases. 128 patients presented with headaches at the time of the consultation and are concerned by this analysis. 57 patients received quercitin phytosome (group B) and 71 received placebo (group A).A telephone check made on D2, D5, D10, D15 and D30 does not show any difference between the 02 groups in terms of the disappearance of the headache. On D30, 77% of the patients who received the active principle no longer suffered from headache compared to 70.4% in group A. this difference is not statistically significant (P = 0.387).
Conclusion: Based on our study and data from the literature, quercitin phytosome has no effect on headache caused by COVID-19.
Arij BAKIR, Hana KHARRAT (sousse, Tunisia), Wiem HOUAS, Houda BEN SALAH, Rym YOUSSEF, Asma ZORGATI, Lotfi BOUKADIDA, Riadh BOUKEF
16:30 - 17:55
#31545 - Evaluation of the effectiveness of different doses of corticosteroid therapy in the management of COVID-19 in emergency departement.
Evaluation of the effectiveness of different doses of corticosteroid therapy in the management of COVID-19 in emergency departement.
Introduction: Covid-19 is a pandemic of an emerging infectious disease, caused by the SARS-COV-2 coronavirus. Concrete scientific evidence adds up in favor of the use of corticosteroids, used in numerous indications for its powerful anti-inflammatory effect, in the management of severe forms of Covid19 disease, triggered by the SARS-COV coronavirus.Objective: The objective of this study is to assess the efficacy of corticosteroids according to the dose administered in the management of covid19 positive patients admitted to the emergency room.
Methods: This is a retrospective study including patients admitted to the emergency department diagnosed as SARS-COV-2 positive. Our study population was divided into three groups: the first group which received 6 mg of corticosteroid, the second group which received 10 mg and the third group which received 20 mg. Depending on the doses of corticosteroids administered (6 mg; 10 mg; 20 mg), we followed the evolution of the condition of each patient included in our study in terms of mortality, oxygen requirements, hospitalization in intensive care and / or recourse to invasive mechanical ventilation as well as complications arising during hospitalization.
Results: 1223 patients were included. The mean age was 49.2 ± 10. 51% are men. Associated comorbidities are: diabetes in 22.7%, hypertension in 25.2%, chronic renal failure in 7.5% and chronic respiratory disease in 6.5%.For patients not put on corticosteroids, mortality is 3%, the use of mechanical ventilation was noted in 5% of cases. For patients who received corticosteroid therapy at a dose of 6 mg, mortality was 0%; and mechanical ventilation was not used in any of these patients. These same results were also noted in patients who received corticosteroid therapy at a dose of 10 mg;In addition, the unfavorable evolution was more marked for the patients receiving the highest doses of corticosteroids with a percentage of hospitalization in intensive care of up to 24%, and a high complication rate (ARDS 28.9%; EP 1.2 %; CIVD 1.2%; myocarditis 2.4%). Mortality in this group was 23.8%.
Conclusion: Patients who have received low doses of corticosteroids have a lower risk of developing severe forms of covid pneumonia and the mortality rate is lower in patients who have not received a corticosteroid. For patients who have received high doses, even if the administration of corticosteroids seems effective in terms of reducing oxygen requirements and resorting to mechanical ventilation and consequently reducing mortality; this effectiveness remains proportional given that patients put on a high dose of corticosteroids are those with extensive lung injury with deep hypoxia and a high risk of progression to respiratory failure and death.
Ahmed MOHAMED EL HEDI (Sousse, Tunisia), Hajer YAAKOUBI, Kais MANSOURI, Roua CHOUIHI, Anouer FHAL, Rahma JABALLAH, Lotfi BOUKADIDA, Riadh BOUKEF
16:30 - 17:55
#31334 - Impact of COVID-19 in a highly vaccinated region.
Impact of COVID-19 in a highly vaccinated region.
Background: The Australian Capital Territory had an initial successful public health response to the COVID-19 pandemic with only 15 deaths in a population of 431000 and a very high double vaccination rate of 89% (aged over 5 years) by the end of 2021. Periods of lockdown were associated with reduced Emergency Department activity. Two further waves have now infected over 114000 though still with a low mortality of 43 (0.04%), whilst ongoing vaccination and targeted use of antivirals continue.
Aim: To describe the characteristics of local community- acquired cases of COVID-19 requiring hospitalisation and the impact on Emergency services during the three major waves.
Methods: Prospective descriptive study of community-acquired cases of COVID-19 admitted to hospital in the Australian Capital Territory from the local area. Cases were grouped into three waves based on the predominant circulating strain: Delta, 12-Aug-21 to 21-Dec-21, Omicron BA.1, 22-Dec-21 to 8-Feb-22, Omicron BA.2, 9-Feb-22 to 10-May-22 (ongoing). Cases were classified on the basis of record review as admitted due to COVID-19 or due to other causes (incidental case). Emergency Department activity was measured by 7day moving mean daily presentations and ward admissions in the one tertiary ED with retrospective controls from 2017-19.
Results: The Delta wave consisted of 2197 reported cases with 153 admissions by 148 patients (6.7%, 95%CI 5.7-7.9) over 19 weeks. The Omicron BA.1 wave consisted of 35729 cases with 233 admissions by 224 patients (0.65%, 0.57-0.74) over 7 weeks and the Omicron BA.2 wave consisted of 76937 cases with 398 admissions by 384 patients (0.50%, 0.45-0.55) over 13 weeks. Admission rates fell during the Delta wave as vaccinations rolled out, but remained constant during the Omicron waves. The proportion of "other cause" admissions rose significantly across the three waves: 16.3%, 39.7%, 47.5%. The age distribution for admissions peaked in 40-49 years for Delta, but in <10 years and >80 years for both Omicron waves. 92% of admissions came through Emergency Departments.
Tertiary Emergency Department activity decreased during the lockdown associated with the Delta wave with 7-day average presentations falling by 25.2% compared to controls and admissions by 21.1% before recovering by the end of the wave. During the BA.1 wave when no lockdown was imposed, presentations fell by 13.9% and admissions by 8.4%, recovering early in the BA.2 wave to then reach 7.8% and 7.1% higher respectively. In the BA.1 wave which was the busiest time for COVID-19 admissions they made up 202 of 2662 total admissions (7.6%, 6.6-8.7).
Conclusions: High vaccination rates and increasing preventative use of antivirals were associated with low and falling admission rates despite infections involving 25% of the population. Emergency activity was reduced during community lockdowns in the Delta wave and voluntarily early in the Omicron wave but has since returned to record high levels. The COVID-19 workload has not been a major numerical component of Emergency Department activity, though the pandemic had impacts through isolation procedures and staff quarantine.
Ethics: Approved by the ACT Health Research Ethics Committee
Internally funded, ethics approved, not registered
Drew RICHARDSON (Canberra, Australia)
16:30 - 17:55
#31660 - Impact of the SARS-CoV2 pandemic on the therapy of acute exacerbations of chronic obstructive lung disease (COPD) at the emergency department.
Impact of the SARS-CoV2 pandemic on the therapy of acute exacerbations of chronic obstructive lung disease (COPD) at the emergency department.
BACKGROUND: Acute exacerbation of COPD (AE-COPD) is common at the emergency department (ED), non-invasive ventilation (NIV, including CPAP-masks and high-flow nasal oxygen) often being the treatment of choice. Aerosol forming ways of treatment are, however, not recommended as long as a Covid-infection is possible. During the first wave of the pandemic, antigen-tests were not yet widely available and reliable, and it could take up to 2h until the SARS-CoV2-status was known. Together with limited ICU space due to need for isolation, this could have led to a deterioration of care.
METHODS: We compared the first year of the pandemic (15.3.2020-14.3.2021) to the same period one year before (15.3.2019-14.3.2020). We included all patients with AE-COPD at our ED, and analysed treatment received by those with an indication for NIV The study was approved by the local ethics board (Vote 1313/2021).
RESULTS: A total of 995 patients (53% male, median age 71 years) were included (581 before, 414 during pandemic), eleven being diagnosed with Covid. Patients were similar in both groups regarding vital signs, initial pCO2 (50 vs 52mmHg), and pH (7.3 vs 7.2). The proportion of patients with indication for NIV non-significantly increased from 19% (112 patients) to 22% (93 patients). Of those, 77 (69%) and 73 (78%, p=0.12) received NIV, the remainder being ventilated invasively.
CONCLUSION: During the pandemic, visits for AE-COPD declined. Those patients with an indication for NIV were however treated the same during both periods. We found no effect of a possible “fear from aerosols” on treatment.
We did not receive any funding.
Ethics comitee number: 1313/2021
Verena FUHRMANN (Vienna, Austria), Bettina WANDL, Anton LAGGNER, Dominik ROTH
16:30 - 17:55
#31425 - Post COVID and quality of life.
Post COVID and quality of life.
Introduction :
Thelong-term effects of coronavirus disease 2019 (COVID-19), also called long Covid, can lead to considerable disability, functional limitations and loss of productivity and resources. This significantly affects not only leisure and social activities, but also the ability to care for oneself, care for children or the elderly, and perform household chores. This study aims to assess the impact of long covidon the quality of life of patients who were hospitalized for covid 19.
Methods :
We carried out an exhaustive longitudinal descriptive study including patients hospitalized for hypoxemic pneumonia due to COVID 19 in December 2020 and January 2021. The follow-up lasted 3 months. We assessed their quality of life using the WHO EQ-5D health-related questionnaire.The evaluation concerned the autonomy, the degree of activity limitation, possible pains and the mental state.
Results :
Our study population consisted of 30 patients, among which63.3% were hospitalized in a medical department and 36.7% were hospitalized in the intensive care unit. The mean duration of hospitalization was 11.9 days and the medianduration of oxygen therapy was 12 days.
Regarding mobility, 20% of patientssuffered fromminormobility problems and 80%suffered from moderate to severe problems after 1 month of infection. After 3 months, only 5% of patients had minor mobility problems and 10% had moderate to severe problems.
For self-care, 13.3%of patients had minor problems and 12% had moderate to severe problems after one month. After 3 months, only 9% patients had moderate to severe problems.
For daily activities, 20% of patients had minor problems and 18% had moderate to severe problems after one month. After 3 months, 6.7% of patients had minor problems and 3% patients had moderate to severe problems.
Several patients complained from persistent pain with a prevalence of 36.7% which50%of them had moderate to severe pain after 1 month. After 3 months, only 30% remained in moderate to severe pain.
Regarding psychological well-being, 12% patients felt anxious or depressed after 1 month and 5% patients after 3 months.
Conclusion :
The long COVID can cause an alteration in the quality of life, psychological discomfort and problems of autonomy, hence the importance of multidisciplinary care for these patients in order to minimize the sequelaes and improve patients’ mental health.
Rabeb MBAREK, Khouloud ROMDHANE, Dr Dorra LOGHMARI, Ines KHALIFA, Farrouk DOUMA, Raed KADHI, Sondos LAAJIMI (Sousse, Tunisia), Naoufel CHEBILI
16:30 - 17:55
#31140 - Stigmatization of healthcare workers due to COVID-19 and its consequences on mental health: Mixed method study.
Stigmatization of healthcare workers due to COVID-19 and its consequences on mental health: Mixed method study.
Background:
Stigma associated with exposure to COVID-19 presents a threat to wellbeing of healthcare workers and functioning of the health care systems. Stigmatization leads to negative consequences, such as discrimination, social rejection or negative social judgements due to fear of infection. It also causes people to hide their illness and discourage them from adopting healthy behaviors. Stigma often also affects mental health of stigmatized people. The aim of this study was to describe occurrence of stigmatization-related experiences among healthcare workers and their association with mental health problems.
Methods:
Using mixed method design, we explored experiences of stigmatization related to COVID-19 reported in a prospective cohort study. Our respondents were healthcare workers (physicians, nurses, paramedics, and social workers) in Czech Republic enrolled in two waves of an on-line survey conducted in summer 2020 (n=929) and spring 2021 (n=1206). Surveys are a part of the global HEROES study taking place in 26 countries. Eligible respondents were workers in healthcare or social services. The questionnaire was distributed through medical professional organizations and hospital centers. Quantitative analysis included a question regarding experience of stigmatization and three indicators of mental health: 1) psychological distress, 2) depressive symptomatology, and 3) suicide ideation. Odds ratios (ORs) were calculated from logistic regression models for each wave to describe association between stigmatization and mental health outcomes (all models were adjusted for age, sex, and occupation). Qualitative analysis involved open-ended responses from the same survey. Qualitative data were processed in Atlas.ti software by using content analysis approach.
Results:
Similar percentage of respondents in both waves reported experiencing COVID-19-related stigmatization due to their profession (wave 1: 29.6%; wave 2: 26.2%). Experience of stigmatization was associated with considerably increased risk of at least moderate level of psychological distress in both waves (wave 1 OR: 2.72; wave 2 OR: 1.71), moderate level of depressive symptoms (wave 1 OR: 3.44; wave 2 OR: 2.38), and suicidal ideation (wave 1 OR: 3.55; wave 2 OR: 2.02). Qualitative analysis of open-ended responses revealed that healthcare workers experienced rejection and social isolation in various life spheres, such as leisure time activities, families, side jobs, community activities, and public life. They reported discrimination in childcare since their children were rejected in kindergartens or schools. Workplace stigmatization was represented by violation of work rules and conditions or rumor among colleagues.
Conclusions:
More than one quarter of Czech healthcare workers involved in this study experienced stigmatization due to their profession during the COVID-19 pandemic. Stigmatization was associated with increased probability of mental health problems. Anti-stigma interventions should focus on fostering long-term public support of frontline workers, highlight a sense of community and joint social responsibility. Workplaces should provide healthcare workers with supervision and mental health counselling.
Funding: The research has been funded by the Ministry of Health of the Czech Republic (grant NU22J-09-00064)
Miroslava JANOUŠKOVÁ (Prague, Czech Republic), Jana ŠEBLOVÁ, Pavla ČERMÁKOVÁ, Jaroslav PEKARA, Matěj KUČERA, Dominika ŠEBLOVÁ
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16:30 - 18:00
EUSEM Working Group on Quality and Safety in EM Meeting
Chairperson:
Pr Abdelouahab BELLOU (Director of Institute) (Chairperson, Guangzhou, China)
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18:05 |
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A14
18:05 - 18:35
Keynote lecture: Why I chose Emergency Medicine
Moderator:
Abdo KHOURY (PROFESSEUR ASSOCIE) (Moderator, Besançon, France)
18:05 - 18:35
Why I chose Emergency Medicine.
Koen MONSIEURS (Director) (Speaker, Antwerp, Belgium)
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18:35 |
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A15
18:35 - 19:05
Opening Ceremony
s:
Abdo KHOURY (PROFESSEUR ASSOCIE) (Besançon, France), Martin PIN (BORNHEIM, Germany), Patrick PLAISANCE (Head of Department) (Paris, France)
18:35 - 18:39
Welcome Addresses.
18:35 - 18:39
Welcome from local organizers.
18:35 - 19:05
18:39 - 18:45
Video from the Health minister.
18:45 - 18:47
Emergency Medicine day video.
18:47 - 18:50
Welcome from Chair Organizer.
18:50 - 18:52
EuroSimCup video.
18:52 - 18:54
Restart a Heart Day.
18:54 - 19:02
Official opening of the EUSEM congress by the EUSEM president.
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Monday 17 October |
08:00 |
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A21
08:00 - 09:00
EM in low-resource settings: a case based workshop on how to reach ethical,equitable and excellent practice
08:00 - 09:00
Speaker.
Giles CATTERMOLE (Consultant in Emergency Medicine) (Speaker, London, United Kingdom)
08:00 - 09:00
Speaker.
Gabin MBANJUMUCYO (Speaker, London, United Kingdom)
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B21
08:00 - 09:00
Dermatologic Emergencies - Quiz session
08:00 - 09:00
Dermatologic Emergencies Workshop.
Mara ZEHNDER (Speaker, Switzerland)
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D21
08:00 - 09:00
Vertigo workshop
08:00 - 09:00
Vertigo workshop.
Peter JOHNS (Speaker) (Speaker, Ottawa, Canada)
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C21
08:00 - 09:00
How to give feedback - interactive workshop
08:00 - 09:00
How to give feedback workshop.
Simon CARLEY (Consultant in Emergency Medicine) (Speaker, Manchester, United Kingdom)
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PC140
08:00 - 12:30
European Leadership for Emergency Medicine (LeadEM) Programme
08:30 - 09:00
Session 6.
09:00 - 09:30
Session 7.
09:30 - 10:00
Session 8.
10:00 - 10:30
Session 9.
10:30 - 11:00
Coffee break.
11:00 - 11:30
Session 10.
11:30 - 12:00
Plenary lecture.
12:00 - 12:30
Wrap up.
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09:00 |
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09:00 - 09:45
EUSEM Workgroup on Quality and Safety in EM present their projects
09:00 - 09:45
EUSEM Workgroup on Quality and Safety in EM Chair.
Pr Abdelouahab BELLOU (Director of Institute) (Moderator, Guangzhou, China)
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EUSEM Podium |
09:10 |
"Monday 17 October"
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A22
09:10 - 10:35
Emergency Ultrasound - Forget Volume Responsiveness - A more considered approach to Resuscitation
Moderators:
James CONNOLLY (Consultant) (Moderator, Newcastle-Upon-Tyne, United Kingdom), Eftychia POLYZOGOPOULOU (ASSISTANT PROFESSOR OF EMERGENCY MEDICINE) (Moderator, ATHENS, Greece)
09:10 - 10:35
09:10 - 10:10
Speaker.
Dr Nicolas LIM (Consultant Emergency Medicine) (Speaker, Singapore, Singapore)
09:10 - 10:10
Speaker.
Tomas VILLEN (Attending Physician) (Speaker, Madrid, Spain)
09:10 - 10:10
Speaker.
Dr Christopher YAP (Consultant) (Speaker, Sheffield, United Kingdom)
09:10 - 10:10
Speaker.
09:10 - 10:35
Speaker.
Ahbilash KORATALA (Speaker, USA)
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B22
09:10 - 10:35
Dermatologic Emergencies - What an Emergency Physician should know about skin
Moderators:
Wilhelm BEHRINGER (Chair) (Moderator, Vienna, Austria), Basak YILMAZ (Faculty) (Moderator, BURDUR, Turkey)
09:10 - 09:35
Approach to Paediatric rashes.
Bernard DANNENBERG (Emergency Physician) (Speaker, Palo Alto, USA)
09:35 - 10:00
The clinical presentation of systematic diseases in form of a rash - signs not to miss.
Dr David CARR (Associate Professor of Emergency Medicine) (Speaker, Toronto Canada, Canada)
10:00 - 10:25
It's written on the skin: 5 fatal efflorescences in Emergency Medicine.
Sebastian CASU (Speaker, Hamburg, Germany)
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D22
09:10 - 10:35
Paediatric Emergencies - Clinical Decision Tools
Moderator:
Pr Luigi TITOMANLIO (Head of Department) (Moderator, Paris, France)
09:10 - 09:35
Fever and petechiae.
Thomas WATERFIELD (Consultant/Clinical Lecturer in Paediatrics) (Speaker, Belfast, United Kingdom)
09:35 - 10:00
Febrile neutropenia in oncologic children.
Francois DUBOS (Pédiatre) (Speaker, Lille, France)
10:00 - 10:25
Abuse in young children.
Patrycja PUIMAN (pediatrician) (Speaker, Rotterdam, The Netherlands)
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E22
09:10 - 10:35
LAB tests and their interpretation
Moderator:
Evert VERHOEVEN (consultant) (Moderator, Etterbeek, Belgium)
09:10 - 09:25
Urinalysis.
Ruth BROWN (Speaker) (Speaker, London, United Kingdom)
09:25 - 09:40
CSF analysis.
Ruth BROWN (Speaker) (Speaker, London, United Kingdom)
09:40 - 09:50
Synovial fluid analysis.
Anna SPITERI (Consultant) (Speaker, Malta, Malta)
09:50 - 10:05
DD, cTn, CK/Mb.
Carmen Diana CIMPOESU (Prof. Head of ED) (Speaker, IASI, Romania)
10:05 - 10:15
Liver test interpretation.
Adela GOLEA (Associate Professor) (Speaker, Cluj Napoca, Romania)
10:15 - 10:25
CRP and ESR.
Anna SPITERI (Consultant) (Speaker, Malta, Malta)
10:25 - 10:35
Creatinin/Urea.
Muhammad Azim SAJJAD (Speaker, Dewsbury, United Kingdom)
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F22
09:10 - 10:35
Have you ever wondered...?
Moderator:
Eugenia - Maria LUPAN-MURESAN (Teaching Assistant) (Moderator, Cluj-Napoca, Romania)
09:10 - 09:35
Innovations section.
Gabor Zoltan XANTUS (PhD student) (Speaker, Pecs, Hungary)
09:35 - 10:00
Emergency Department Design.
Ben MILLAR (Emergency Physician) (Speaker, Vancouver, Canada)
10:00 - 10:25
Innovative POCUS.
Dennis CHO (Speaker, Toronto, Canada)
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C22
09:10 - 10:35
EMS/Paramedics
Moderators:
Vitor Manuel LOPES FERNANDES ALMEIDA (doctor) (Moderator, viseu, Portugal), Thomas WILP (Prehospital Emergency Medical Coordinator) (Moderator, Amman, Ukraine)
09:10 - 09:35
PIT-CREW-Tuning the CPR performance in EMS.
Thomas ANDERSEN (Speaker, Næstved, Denmark)
09:35 - 10:00
Patient experience of severe acute dyspnoea and relief during treatment in ambulances.
Tim LINDSKOU (nurse) (Speaker, Aalborg, Denmark)
10:00 - 10:25
Transcutaneous pacing in the field.
Tatjana JEVTIC (Medical Doctor) (Speaker, Sarajevo, Bosnia and Herzegovina)
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G22
09:10 - 10:35
Organisation der Notfallversorgung heute und morgen
Moderators:
Christoph DODT (Head of the Department) (Moderator, München, Germany), Pr Martin MÖCKEL (Head of Department, Professor) (Moderator, Berlin, Germany)
09:10 - 09:35
Ersteinschtzung 2022/2023: wo stehen wir?
Martin PIN (Speaker, BORNHEIM, Germany)
09:35 - 10:00
Beobachtungsstation - was ist das und wofr brauchen wir das?
Guido MICHELS (Speaker, Pulheim, Germany)
10:00 - 10:25
Wo steht die Notfallmedizin in Deutschland 2030?
Christian WREDE (Head of Department) (Speaker, Berlin, Germany)
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H22
09:10 - 10:35
CPR / Resuscitation
Moderators:
Dr Firas ABOU-AUDA (Consultant) (Moderator, London), Koen MONSIEURS (Director) (Moderator, Antwerp, Belgium)
09:10 - 10:35
#31451 - Airborne vs ground-based: association of transport mode and outcome in patients with ongoing resuscitation – a retrospective data analysis.
Airborne vs ground-based: association of transport mode and outcome in patients with ongoing resuscitation – a retrospective data analysis.
Background:
Out-of-hospital cardiac arrests continue to be a challenge in emergency medicine. Transport to a cardiac arrest centre with ongoing resuscitation can be reasonable in selected patients. As time is crucial, choosing a suitable mode of transport can be vital. This study was set out to investigate the association of transport mode (ground vs helicopter) with the 30-day outcome in patients with ongoing resuscitation on admission.
Methods:
We included patients ≥18 years with a non-traumatic out-of-hospital cardiac arrest between January 2013 and May 2021 from the prospective Vienna Clinical Cardiac Arrest Registry. Only ongoing resuscitations on admission without a sustained return of spontaneous circulation (ROSC) were included. Transport was performed either by ground emergency medical service (GEMS) or helicopter (HEMS). The Cerebral Performance Category (CPC) scale on day 30 was defined as primary outcome. We used a logistic regression to investigate the association of transport mode with the dichotomised CPC score (good: 1-2 vs poor: 3-5). Age (years), gender (male/female), witnessed cardiac arrest (yes/no), basic life support (BLS, yes/no), first analysed rhythm (shockable yes/no) and cumulative epinephrine dose (milligram) served as covariates.
Results:
725 Patients were included in this study (611 [84.3%] GEMS and 114 [15,7%] HEMS). Age (57.5 ± 14.5 years vs 54.3 ± 15.6 years), the rate of female patients (22.9 % vs 18.4 %), the rate of witnessed cardiac arrests (80.9% vs 75.4%) as well as the cumulative epinephrine dosage (8.5 mg ± 3.9 vs 8.1 mg ± 3.9) did not differ between the GEMS and HEMS group. The BLS (70% vs and 84.2 %, p = .002) and the rate of shockable first rhythm (57% vs 43.5%, p=.008) were higher in the HEMS group. A CPC score of 1-2 was achieved in 3.3% in the GEMS group and 7.0% in the HEMS group (p = .057). The mean time from collapse to arrival at the hospital was 53.6 min (± 21.4) in the GEMS and 60.27 min (± 20.11) in the HEMS group (p = .07). In logistic regression, age, witnessed cardiac arrest, first analysed rhythm, and cumulative epinephrine dose were significantly associated with good neurological outcome after 30 days (p ≤ .03). However, gender (OR 0.64, 95%CI 0.62 - 1.91, p = .50), BLS (OR 0.49, 95%CI -0.65 - 1.63, p = .22) and the mode of transport (OR 0.53, 95% CI -0.45 - 1.51, p = .21) did not show a significant association.
Discussion & Conclusions:
In the present study, no significant association between the mode of transport and good neurologic outcome after 30 days was found in patients with ongoing resuscitation on admission. This is especially interesting as some characteristics of the HEMS patients would suggest a better outcome (higher BLS and shockable first rhythm rate). Interestingly, our data showed no benefit in transport time. This might be due to logistical reasons (e.g. the greater distance travelled or difficulties stemming from landing in urban areas). In summary, our data do not show a ubiquitous benefit of airborne transport in patients with ongoing resuscitation.
Funding:
This study did not receive any specific funding.
Ethical approval and informed consent:
The study was approved by the Ethics Committee of the Medical University of Vienna (2376/2020).
Florian ETTL (Vienna, Austria), Matthias PERTL, Matthias MUELLER, Christoph SCHRIEFL, Michael POPPE, Ingrid Anna Maria MAGNET, Juergen GRAFENEDER
09:10 - 10:35
#31183 - Apnoeic oxygenation during endotracheal intubation. A tertiary Emergency Department’s airway registry.
Apnoeic oxygenation during endotracheal intubation. A tertiary Emergency Department’s airway registry.
Apnoeic oxygenation during endotracheal intubation. A tertiary Emergency Department’s airway registry
Authors Names: Izak Petrus Scholtz, Etimbuk Umana, Francis O’Keeffe
Authors Affiliation: Emergency Department, Mater Misericoridiae University Hospital, Dublin, Ireland
Background
Endotracheal intubation during emergency airway management is an integral part of the management of the critically unwell patient that presents to an emergency department (ED). Intubations, performed by rapid sequence intubation, is a potentially lifesaving intervention in this cohort of patients. However, they present with altered physiological parameters and elevated metabolic demands which predispose them to hypoxia and post intubation complications.
The use of apnoeic oxygenation in combination with standard care during intubation has been described as a potential buffer against hypoxaemia during and after endotracheal intubation. Apnoeic oxygenation refers to the use of nasal cannula to provide passive flow of oxygen against a gradient to oxygenate alveoli and to delay hypoxaemia in apnoeic patients. The aim this study was to evaluate the trend in the use of apnoeic oxygenation during endotracheal intubation in our institution and the role of apnoeic oxygenation on post intubation desaturation.
Method
A retrospective audit was undertaken of the Mater Misercoridea University Hospital Emergency Department’s Airway registry which evaluated data collected prospectively for the period of August 2018 until June 2022. The data used was recorded contemporaneously by clinician performing the endotracheal intubation. Intubations were excluded from the audit if it was performed during cardiac arrest. Data recorded in the registry included the following: age, patient gender, weight, indication for intubation, speciality performing intubation, anticipated difficult airway, formal airway assessment, use of standard care or apnoeic oxygenation and first pass success rate. Post intubation desaturation was defined as SpO2<93%.
Results
Over a 45-month period, 326 endotracheal intubations were recorded in MMUH. When cardiac arrest related aetiology excluded, only 220 meet inclusion criteria. Of the 220, majority were male (n=149, 68%) and the indication for intubation was mostly medical (n=174, 79%). Median age was 51,5 years (37,75 - 65). Majority of intubations were performed by EM clinicians (n=192, 87%)
Of the 220 patients, 99 (45%) patients had apnoeic oxygenation, while 121 (55%) received standard care during intubation. The trend of apnoeic oxygenation use increased over the last 4 years (Year 1-(41%), Year 2-(34%), Year 3-(55%) and Year 4-(55%)). In terms of post intubation desaturation, the apnoeic oxygenation group had a 5% rate of post-intubation desaturation compared to 8% in the standard care group.
Discussion
In our study intubations were more commonly performed by EM physicians. There was also an increased trend in the use of apnoeic oxygenation and a lower rate of post intubation desaturation. Our findings compare to other international studies. Apnoeic oxygenation should be used in daily practice in all disciplines performing intubations in critically ill patients in the ED.
Izak Petrus SCHOLTZ (Dublin, Ireland), Etimbuk UMANA, Francis O'KEEFFE
09:10 - 10:35
#31026 - Capillary refill time as predictor for return of spontaneous circulation – a pilot study with prospective inclusion.
Capillary refill time as predictor for return of spontaneous circulation – a pilot study with prospective inclusion.
Background: Persistent microperfusion alterations after return of spontaneous circulation (ROSC) are associated with poor survival. During cardiac arrest, sufficient microperfusion is associated with survival and highly correlates with coronary perfusion pressure in animal models. Capillary refill time (CRT) is a simple method to assess microperfusion of the skin. Thus, we hypothesized that CRT during cardiopulmonary resuscitation (CPR) might be a predictor for ROSC.
Methods: We performed a pilot study with prospective inclusion from 3/3/2021 to 3/31/2022 with 30 day follow up. During the study period, a special research car was dispatched to all out of hospital cardiac arrests in the city of Vienna during weekdays additionally to regular EMS units. This car was staffed with a physician and a paramedic.
Patients ≥18 years with witnessed cardiac arrest and ongoing CPR were included to the study. Exclusion criteria were peripheral arterial disease, Raynaud’s disease, hypovolemia, severe hypo- or hyperthermia and logistic factors (e.g. limited space, study team had to perform CPR). The primary endpoint was ROSC.
CRT was measured by applying firm pressure to the ventral surface of a finger’s distal phalanx and the earlobe with a glass microscope slide. Pressure was increased until the skin went blank and was then maintained for 10 seconds. The time for return of the initial skin color was registered with a chronometer. CRT >10 seconds was defined as “no refill”. Measurements were repeated every two minutes until ROSC, termination of resuscitation efforts or decision to transport to hospital with ongoing CPR.
The first and last measured CRT on finger and earlobe are depicted with median and interquartile range. For statistical analyses, values were classified in quartiles. The association between ROSC and CRT was compared using Fisher’s exact test and estimated with exact logistic regression. Cochran Armitage (CA) was used for trend analyses.
Results: 50 patients (mean age 73.1 years, 26% female, 30% ROSC) could be included. Neither CRT on the earlobe (first CRT: noROSC 3 [3-4] vs. ROSC 4 [3-4] sec., p=0.431, CA: 0.211; last CRT: noROSC 3 [3-5] vs. ROSC 3 [3-4] sec., p=1.0, CA: 0.845) nor on the finger at first measure (noROSC 7.5 [6- >10] vs. ROSC 6 [5-9] sec., p=0.306, CA: 0.265) were statistically significant different. CRT at the last measurement on the finger was shorter in patients with ROSC compared to noROSC (6.5 [4-9] vs. >10 [9- >10], p=0.007, CA: 0.129). At last measurement on the finger, the odds ratio for achieving ROSC with CRT >10sec was 0.099.
Discussion & Conclusions: In this study, only the last measured CRT on the finger was shorter in patients with ROSC. Upper venous congestion may influence the findings on the earlobe, whereas microperfusion alterations on the finger might only evolve over time. However, CRT may be of use in the multifactorial decision to terminate a resuscitation.
Acknowledgements: We want to thank all Field Supervisors of the Emergency Medical Service of Vienna for their great support! We further want to thank C. Kienbacher, I.A.M. Magnet, G. Gelbenegger and A. Nuernberger for patient inclusion!
Trial registration: clinicaltrials.gov (NCT04791995).
Funding: This study was funded by the Medical Scientific Fund of the Mayor of the city of Vienna (AP21171)
Ethical approval: The study was approved by the Ethics Committee of the Medical University of Vienna (EK 2427/2020), written informed consent was obtained after patients regained consciousness.
Matthias MUELLER (Vienna, Austria), Mario KRAMMEL, Heidrun LOSERT, Florian ETTL, Daniel GRASSMANN, Michael GIRSA, Harald HERKNER, Mathias GATTERBAUER, Michael HOLZER
09:10 - 10:35
#31344 - CPR refresher course for healthcare providers: clinical experience and self-assessment of skills.
CPR refresher course for healthcare providers: clinical experience and self-assessment of skills.
Background: Cardiopulmonary resuscitation (CPR) skills are of the great importance to healthcare providers. CPR skill decay is a well-known phenomenon and occurs when skills are not used regularly. Recently a new law requiring Lithuanian healthcare providers to regularly take part in mandatory CPR training sessions was passed. CPR refresher courses were conducted for healthcare teams from hospitals and outpatient clinics in Vilnius district. Our team surveyed CPR course attendees to collect various demographic, CPR experience data and measured self-assessed CPR skills score. Goal of our research was to look for factors associated with self-assessed CPR skills score.
Methods: Prospective observational study was conducted from 2022 January until May. A questionnaire was constructed evaluating gender, age, specialty, type of work settings, years in clinical practice, previous clinical experiences in CPR, previous training in CPR. Participants had to evaluate their CPR skills and likelihood of taking part in CPR outside of clinical environment using 5 item score. Data was processed using IBM SPSS statistical package. Difference between the variables was reliable if p<0,05.
Results: A total number of 201 cases were analysed. Mean age was 53.3 (±9.64) with 96.5% female (n=194), 3,5% male (n=7). 24,4% physicians, 62,2% nurses and 14% non-clinical staff were taking part in survey. Mean working experience in years 28.1 (±10.33). 64% working in outpatient setting, 36% in hospitals – 7 % of them in intensive care units. 142 participants had no previous clinical CPR experience. Best self-evaluated CPR skill was chest compressions (mean=2,67) and worst was defibrillation (mean=1,97). We found that factors associated with better self-assessed CPR skills were: working in hospital, time form last CPR course, times of CPR performed in clinical setting, time from last CPR case (p<0,05). Higher self-assessed CPR skills score was associated with higher self-assessed likelihood to perform CPR outside of clinical environment (p<0,05).
Discussion & Conclusions: Educational effort directed to healthcare personnel working outside of hospital environment could improve self-confidence in resuscitation skills thus improving likelihood of participation in CPR outside of clinical environment. CPR course instructors could put more emphasis on defibrillation skills to improve overall self-confidence in ability to resuscitate.
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Aleksandras BRIEDIS (Vilnius, Lithuania), Jonas ANDRIUSKEVICIUS, Renata JUKNEVICIENE, Pranas SERPYTIS
09:10 - 10:35
#30424 - Decision support system for the prognostication of neurological outcome in the successfully resuscitated OHCA patient: Machine learning analysis using multi-center registry data.
Decision support system for the prognostication of neurological outcome in the successfully resuscitated OHCA patient: Machine learning analysis using multi-center registry data.
Background: This study uses machine learning and multi-center registry data for analyzing the determinants of favorable neurological outcome in the out-of-hospital cardiac arrest (OHCA) patient and developing its decision support systems for various subgroups.
Methods: Data came from Korean Cardiac Arrest Research Consortium registry with 2679 OHCA patients aged 18 or more with the return of spontaneous circulation (ROSC). The dependent variable was favorable neurological outcome (Cerebral Performance Category scores 1-2) and 68 independent variables were included, e.g., first monitored rhythm, in-hospital cardiopulmonary resuscitation (CPR) duration and post-ROSC pH. The random forest was used for identifying major determinants of favorable neurological outcome and developing its decision support systems for various subgroups stratified by major variables.
Results: Based on random forest variable importance, major determinants of OHCA outcome were in-hospital CPR duration (0.0824), in-hospital electrocardiogram on emergency room arrival (0.0692), post-ROSC pH (0.0579), prehospital ROSC before emergency room arrival (0.0565), coronary angiography (0.0527), age (0.0415), first monitored rhythm (EMS) (0.0402), first monitored rhythm (community) (0.0401), early coronary angiography within 24 hours (0.0304) and scene arrival to CPR stop (0.0301). It was also found that patients can be divided to 6 subgroups in terms of prehospital ROSC and first monitored rhythm (EMS) and that a decision tree can be developed as a decision support system for each subgroup to find its effective cut-off points regarding in-hospital CPR duration, post-ROSC pH, age and hemoglobin.
Conclusions: We identified the major determinants of favorable neurological outcome in successfully resuscitated OHCA patients using machine learning. This study demonstrated the strengths of the random forest as an effective decision support system for each stratified subgroup (prehospital ROSC and first monitored rhythm by EMS) to find its own optimal cut-off points for major in-hospital variables (in-hospital CPR duration, post-ROSC pH, age and hemoglobin).
This work was supported by the National Research Foundation of Korea grant (No.2019R1A2C1007110)
Su Jin KIM, Kang-Sig LEE, Si Jin LEE (Seoul, Republic of Korea), Sung Woo LEE, Sang-Hyun PARK
09:10 - 10:35
#30946 - Hypocapnia as a predictor of the need for non-invasive mechanical ventilation in subjects with SARS-CoV-2 related pneumonia.
Hypocapnia as a predictor of the need for non-invasive mechanical ventilation in subjects with SARS-CoV-2 related pneumonia.
Background: SARS-CoV-2 related pneumonia is characterized by moderate-to severe hypoxemia often associated with hypocapnia. Currently few studies investigated the possible role of hypocapnia as a severity predictor in SARS-CoV-2 related pneumonia.
Aims: evaluate if hypocapnia can predict the need for non-invasive mechanical ventilation (NIV) in subjects with SARS-CoV-2 related pneumonia.
Matherial and methods: we prospectively included in the study 52 subjects with moderate-severe SARS-CoV-2 related pneumonia. The end point of the study was the need for non-invasive mechanical ventilation. All the data were collected at admission to the Emergency Department and we included: clinical and laboratory data, blood gas analysis and lung ultrasound. All blood gas analysis were performed in room air. Lung ultrasound (LUS) was performed using a convex probe while patients were in sitting position and we used the 12-zone protocol, assigning a score from 0 to 3 for each zone for calculating the total LUS score.
Results: of the 52 subjects included 30 were males and 22 were females; mean age was 61 ± 12. 33 subjects (63,4%) reached the end point. Mean time between admission and NIV start was 20,3 ± 13 hours. At univariate analysis we did not find any significant association among age, gender, number of comorbidities, systolic and diastolic blood pressure, heart rate, respiratory rate, white blood cells count, platelets, blood urea, creatinin, glomerular filtration rate, d-dimer, aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum lactic dehydrogenase (LDH), and C-reactive protein (CRP), arterial oxygen partial pressure (PaO2), LUS SCORE and the need for NIV, but we observed a statistically significant inverse association between carbon dioxide partial pressure (PaCO2) and the need for NIV (OR 0,82, CI 95% 0,689-0,976, p .025). At multivariate analysis we observed that PaCO2 predicted the need for NIV independently from age, gender, number of comorbidities, d-dimer, CRP, PaO2 and LUS SCORE (OR 0,838, CI 95% 0,710-0,988, p .035)
Conclusions: our data suggest that hypocapnia could be a good predictor of rapid respiratory failure worsening in subjects affected by SARS-CoV-2 related pneumonia independently from other already known predictors of unfavourable outcome. We speculate that hypocapnia could reflect the occurrence of a spontaneous respiratory pattern characterized by deep and frequent breathing, typical of the initial phase of the disease, which can generate an excessive swing of transpulmonary pressure inducing a real risk of producing a self-induced lung injury (P-SILI). We observed that the majority of subjects need NIV support after few hours from admission suggesting that hypocapnia allows the early recognition of the presence of the respiratory pattern which can cause the P-SILI, thus allowing the early recognition of the subjects at higher risk of rapid deterioration. Further multicentric studies are needed for validating these data on greater populations.
Stefano DE VUONO (Perugia, Italy), Sokol BERISHA, Laura SETTIMI, Pasquale CIANCI, Alessandra LIGNANI, Giorgia MANINA, Maria Rita TALIANI, Paolo GROFF
09:10 - 10:35
#31377 - Lessons from the pandemic. Changing practices in the resuscitation room: a qualitative study.
Lessons from the pandemic. Changing practices in the resuscitation room: a qualitative study.
Introduction: The COVID-19 pandemic has imposed pressure for changes in the care provided in emergency departments (ED). We sought to explore the perceptions of different types of ED workers involved in resuscitation teams regarding these practice changes, aiming to understand the barriers and facilitators affecting their adoption.
Methods: We conducted this exploratory qualitative study using a narrative analysis approach. Participants were members of a multidisciplinary resuscitation team in an urban tertiary care academic ED (nurses, orderlies, respiratory therapists, emergency physicians, and case managers). They were recruited using a purposive sampling technique to maximize variation and aim for even representation of occupation and shift type. Focus groups with workers in the same occupation were interviewed in a semi-structured manner. The data were analyzed thematically using an inductive approach, combined with a structuring framework (Theoretical Domains Framework). Two members of the research team corroborated the coding and analysis of the data. The selected themes and quotes were submitted to the participants for validation.
Results: Thirty-three participants took part in six focus groups in March and April 2021. The changes described were related to protective measures, site organization, team functioning and care protocols. Participants identified barriers to their adaptation such as: (1) information overload due to multiple sources of information and frequent changes, (2) protocols established without fully considering the reality of the field, (3) communication challenges due to fragmentation of teams in isolation spaces and use of protective equipment, (4) perceived negative impact of new protocols and measures on patient care. Facilitating factors were: (1) identification of trusted peers to filter information, (2) sense of professional identity as an ED worker, (3) collaboration in resuscitation situations, as well as in the reorganization of work, and (4) peer support.
Conclusion: This project incorporated input from participants from often underrepresented groups of ED professionals. Many barriers were encountered by resuscitation team members in coping with the changes brought about by the pandemic. Potential solutions to consider include: (a) strategies to streamline the transmission of information from decision makers to teams, (b) intermediaries to bridge the gap between the field and decision-making bodies, (c) improvement of communication in the resuscitation room, and (d) the implementation of formal peer support measures.
Chaire Docteur Sadok Besrour grant
Association des spécialistes en médecine d'urgence du Québec grant
This study was supported by the Fonds de recherche des Urgentistes de l’hôpital Sacré-Cœur de Montréal.
Virginie LABOSSIÈRE, Raoul DAOUST (Montréal, Canada), Véronique CASTONGUAY, Bertrand LAVOIE, Patrick LAVOIE, Alexis COURNOYER, Lonergan ANN-MARIE, Vérilibe HUARD
09:10 - 10:35
#31373 - Pandemic effects on comas in the Emergency Department of Sibiu.
Pandemic effects on comas in the Emergency Department of Sibiu.
Background:
Coma is a disorder of consciousness, a true medical emergency determined by various pathologies whose identification and treatment in a timely manner is critical for the patient's outcome. The management begins with stabilization of the vital functions, adequate breathing and circulation, followed by a thorough physical examination to identify the possible causes. Definitive treatment and prognosis depends on the treatable disorders and reversible causes.
Methods:
We conducted a retrospective observational study on a total of 129,028 patients presented at the Emergency Unit of Sibiu in 2019 and 2021, a year before and one during the pandemic, using our means and frequencies to characterize and describe the susceptible population of risk most liable to this pathology.
Results:
The total number of presentations at the Emergency Unit remained similar in 2019 and 2021. Out of a total of 361 patients with comas, the number of cases decreased from 226 cases in 2019 to 135 cases in 2021.
The age distribution during the study was the following:
Age category 0-20 years old: 4 cases (1,10%);
Age category 21-40 years old: 26 cases (7,20%);
Age category 41-60 years old: 80 cases (22,16%);
Age category over 60 years old: 251 cases (69,52%).
The predominant pathologies that determined this condition were represented by:
Strokes: 33 cases in 2019 and 22 cases in 2021;
Traumas: 18 cases in 2019 and 6 cases in 2021;
Cardio-respiratory arrests: 103 cases in 2019 and 62 cases in 2021;
Metabolic acidosis: 8 cases in 2019 and 3 cases in 2021;
Hypercapnia: 10 cases in 2019 and 8 cases in 2021.
Discussion & Conclusions:
The number of presentations in the Emergency Unit remained similar in both years, even though we are speaking of a year before the pandemic hit and one in the midst of it.
The number of comas caused by strokes decreased from 2019 to 2021 although we would expect the number to increase due to the pro-coagulant effect of Covid-19.
Patients do not have as many routine investigations as during the time before the pandemic and they no longer had access to preventative methods and updated medication. Hospitals are clogged and access is becoming increasingly difficult, which is why some patients, who had a stroke at home, had neglected it due to mild onset symptoms. The second stroke, or maybe even the first because of the lack of preventive methods, that took place, were much more severe and not leading into a coma but directly into cardio-respiratory arrest. As we expected, it is still the prerogative of the elderly to have a stroke.
Chronic respiratory pathologies, such as chronic obstructive pulmonary disease, that have evolved into hypercapnia, remained constant.
Traumas, especially in young people, are still lower in number in 2021, thanks to the pandemic traffic restrictions and social distancing, which significantly lowered the risk of becoming a victim in road accidents.
Paula Maria ANDERCO (Sibiu, Romania), Cristian ICHIM, Dina MIHALACHE
09:10 - 10:35
#30899 - The impact of myosteatosis percentage on short-term mortality in patients with septic shock.
The impact of myosteatosis percentage on short-term mortality in patients with septic shock.
Background: The impact of myosteatosis on septic patients had not been fully revealed. The aim of study was to evaluate the impact of myosteatosis area and percentage on the 28-day mortality in patients with septic shock.
Methods: We conducted a single center, retrospective study from prospectively collected registry of adult patients with septic shock who presented to emergency department and performed abdominal computed tomography (CT) from May 2016 to May 2020. Myosteatosis area defined as the sum of low attenuation muscle area and intramuscular adipose tissue at the level of the third lumbar vertebra was measured by CT. Myosteatosis percentages were calculated by divide myosteatosis area into total abdominal muscle area. Odds ratios (ORs) and 95% confidence intervals (CIs) for 28-day mortality were estimated using a multivariate logistic regression model.
Results: Of the 896 patients, 28-day mortality was 16.3%, and abnormal myosteatosis area was commonly detected (81.7%). Among variables of body compositions, non-survivors had relatively lower normal attenuation muscle area, higher low attenuation muscle area, higher myosteatosis area and percentage than that of survivors. Trends of myosteatosis according to age group were different between male and female group. In subgroup analysis with male patients, the multivariate model showed that the myosteatosis percentage (adjusted OR 1.02 [95% CI 1.01 – 1.03]) was an independent risk factor for 28-day mortality. However, this association was not evident in female group.
Conclusions: Myosteatosis was common and high myosteatosis percentage was associated with short-term mortality in patients with septic shock. Our results implied that abnormal fatty disposition in muscle could impact on increased mortality. And this effect was more prominent in male patients.
This study was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI18C1216).
Boram KIM (Seoul, Republic of Korea), June-Sung KIM, Won Young KIM, Kyung Won KIM, Youn Sun KO
09:10 - 10:35
#30318 - The impact of resuscitative transesophageal echocardiography performed by emergency physicians on diagnosis and management of critically ill patients.
The impact of resuscitative transesophageal echocardiography performed by emergency physicians on diagnosis and management of critically ill patients.
Introduction: Transesophageal echocardiography (TEE) is an emerging tool that can aid emergency physicians in treating patients in cardiac arrest and undifferentiated shock. TEE can aid in diagnosis, resuscitation, identify cardiac rhythms, guide chest compression vectors, and shorten sonographic pulse checks. The objective of this study is to evaluate proportion of patients who underwent a change in their resuscitation management as a result of emergency department resuscitative TEE.
Methods: This was a retrospective cohort study that took place at an academic hospital in Toronto, Canada of all patients who underwent ED resuscitative TEE from 2015-2019. The primary outcome was the proportion of patients who underwent a change in their resuscitation management as a result of resuscitative TEE. Secondary outcomes were change in working diagnosis, complications, patient disposition, and survival to hospital discharge.
Results: 25 patients (median age 71, 40% female) underwent ED resuscitative TEE. All patients were intubated prior to probe insertion. The most common indication for resuscitative TEE was cardiac arrest (16/25) followed by undifferentiated shock (7/25) and post-cardiac arrest (2/25). Resuscitative TEE was performed by senior emergency medicine residents or ultrasound fellows under direct supervision in 10 cases. Probe insertion was successful in all 25 examinations (100%) with difficult insertions occurring in 9/25. Adequate TEE views were obtained for every patient. The most commonly obtained TEE views were the mid-esophageal four chamber (100%), mid-esophageal long axis (100%), mid-esophageal descending aorta (100%), trans-gastric short axis (96%), and mid-esophageal bicaval (68%).
After resuscitative TEE, the management changed in 76% (N=19) and information was diagnostically influential in 76% (N=19) of patients. Therapeutic recommendations included guidance of hemodynamic support with volume (8/25) or vasoactive medications (6/25), decision to transfer the patient to the cardiac catheterization lab (3/25), and decision to terminate resuscitation (3/25). The most common diagnostic contributions included hypovolemic shock (5/25), cardiogenic shock (4/25), pulmonary embolism (4/25), cardiac standstill (3/25), and acute coronary syndrome (2/25).
Ten patients died in the ED, 15 were admitted to hospital, and eight survived to hospital discharge. There were no immediate complications (0/15) and two delayed complications (2/15), both of which were minor gastrointestinal bleeding.
Conclusions: Resuscitative TEE is emerging as a valuable diagnostic and therapeutic tool for patients with cardiac arrest and undifferentiated shock in the ED. It is a relatively new emergency medicine modality with the first use described in the ED in 20085. It has been shown that it can be relatively easily taught to operators for resuscitations in the ED2,10. There is limited published evidence on the use of ED TEE and this study contributes important data to the literature. In this study we found that the use of ED resuscitative TEE was associated with significant therapeutic changes in critically ill patients and resulted in a higher rate of adequate cardiac visualization than TTE alone. There was a low complication rate.
Fraser KEGEL (Toronto, Canada), Jordan CHENKIN
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M1-2-3 |
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10:00 - 11:00
Geriatric Section Meeting
Chairperson:
Jacinta A. LUCKE (Emergency Phycisian) (Chairperson, Haarlem, The Netherlands)
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R3 |
10:35 |
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10:35 - 11:05
Webinars, courses and e-courses; Education Committee developments
10:35 - 11:05
Education Committee Chair.
Gregor PROSEN (EM Consultant) (Moderator, MARIBOR, Slovenia)
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EUSEM Podium |
10:40 |
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EPOSCB2SC1
10:40 - 11:00
Coffee Break 2 - EPoster session - Screen 1
Moderator:
Youri YORDANOV (Médecin) (Moderator, Lyon, France)
10:50 - 10:55
COVID-19 and H1N1 pneumonia: reanalysis and comparison of two retrospective cohorts.
Luis Fernando BRITO SANTOS (Medical Student) (Eposter Presenter, São Paulo, Brazil)
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Exhibition Hall |
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EPOSCB2SC2
10:40 - 11:00
Coffee Break 2 - EPoster session - Screen 2
Moderator:
Gabor Zoltan XANTUS (PhD student) (Moderator, Pecs, Hungary)
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Exhibition Hall |
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EPOSCB2SC4
10:40 - 11:00
Coffee Break 2 - EPoster session - Screen 4
Moderator:
Dr Federico CAPRILES (Médico adjunto) (Moderator, Reus, Spain)
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Exhibition Hall |
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EPOSCB2SC3
10:40 - 11:00
Coffee Break 2 - EPoster session - Screen 3
Moderator:
Adela GOLEA (Associate Professor) (Moderator, Cluj Napoca, Romania)
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Exhibition Hall |
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EPOSCB2SC5
10:40 - 11:00
Coffee Break 2 - EPoster session - Screen 5
Moderator:
Izaskun TELLITU (Emergency Specialist) (Moderator, Cambrils, Spain)
10:45 - 10:50
Overcapacity procedure to manage an emergency department with a defined closure time.
Neal DOUGLAS (Physician) (Eposter Presenter, Halifax, Canada)
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Exhibition Hall |
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EPOSCB2SC2bi
10:40 - 11:00
Coffee Break 2 - EPoster session
10:40 - 11:00
#31423 - A comparative analysis of prognostic scores in COVID-19 patients discharged from Emergency Department: CALL score, 4C mortality score e Quick COVID-19 Severity Index.
A comparative analysis of prognostic scores in COVID-19 patients discharged from Emergency Department: CALL score, 4C mortality score e Quick COVID-19 Severity Index.
INTRODUCTION: The aim of this study is to determine the prognostic performance of Quick Severity Index, CALL e 4C Mortality score on mortality and hospital readmission of patients diagnosed with COVID-19 in ED setting and sent home right after the workup.
METHODS: We retrospectively recorded data of patients admitted at Careggi University Hospital Emergency Department with SARS-COV2 infection and subsequently discharged home from 20 February 2020 to 27 June 2021. For all patients we calculated CALL score, 4C Mortality score and Quick COVID-19 Severity Index. To note that for the calculation of 4C Mortality score we estimated renal function according to creatinine value (Creatinine mg/dL): <1,199=0; 1,2-1,9= 1; >1,9= 3). Primary endpoints were hospitalization rate and all-cause mortality.
RESULTS: Overall 2373 patients admitted to ED were diagnosed with COVID; of that 211 were discharged home right after the ED workup. Mean age was 46±18 years, 52% male. Of these patients 21(10%) returned to the ED and 7 (3%) died after hospital discharge.
No important differences in vital signs were outlined amongst the two groups except for peripheral oxygen saturation that was significantly lower in non survivors (92%±5% vs 98%±2, p<0.001). Among patients that were hospitalized the most frequent concurrent illnesses were: Chronic cardiac disfunction (66.7% vs 9.2%), Chronic Kidney Failure (GFR<60 ml/min) (66.7% vs 11.8%), Diabetes (29.4% vs 8.3%) and Atrial Fibrillation (33.3% vs 9%). As compared to survivors, non survivors have a higher incidence of hypertension (13.3% vs 0.6%) and atrial fibrillation (33.3% vs 2%).
Higher values of 4C score (3 [1-9.5] vs 1 [0-3.5], p=0.017) and Quick score (0 [0-0] vs 0 [0-0], p=0.046) were acknowledged for patients who returned to the hospital. No differences were outlined for CALL score between the two groups (6 [5-7.5] vs 6 [4-7]). The prognostic performance was evaluated via ROC curves and showed a fair to good trend for 4C-Score (AUC, 0.65, p=0.020) and weak for CALL (AUC 0.58) and QUICK (AUC 0.54) scores. Non survivors showed higher values of all the scores as compared to survivors (4C-score: 8 [7-12] vs 1 [0-3.75], p<0.001; CALL: 9.5 [8.25-11.5] vs 6 [4-7], p=0.005; QUICK: 0 [0-2.75] vs 0 [0-0], p<0.001). The prognostic performance on mortality for 4C score and CALL score was excellent (AUC 0.89, p<0,001 and AUC 0.9, p< 0,001 respectively) and weak for Quick score (AUC 0.65, p=NS).
CONCLUSIONS: Both 4C and CALL scores showed a fair to good prognostic performance on mortality in particular amongst patients who were discharged home right after ED workup.
Anna DE PARIS (Firenze, Italy), Lorenzo PELAGATTI, Francesco PEPE, Francesca TODDE, Elisa PAOLUCCI, Ginevra FABIANI, Francesca CALDI, Francesca INNOCENTI, Riccardo PINI
10:40 - 11:00
#31196 - Acute management of Atrial Fibrillation in the ED. The earliest the better.
Acute management of Atrial Fibrillation in the ED. The earliest the better.
ABSTRACT
Title: Acute management of Atrial Fibrillation in the Emergency Department. The earliest the better
Background
Acute Atrial Fibrillation (AF) is the most common arrythmia presenting in the Emergency Department (ED) requiring either heart rate control or rhythm restoration. Widely used treatment strategies include pharmacological intervention or electrical cardioversion (EC). Commonly used restoration agents are amiodarone,propafenone and flecainide. Currently there are no known studies directly comparing pharmacological approach versus EC. The aim of this study was to investigate the efficacy and safety of rhythm restoration by intravenous flecainide versus EC.
Materials and Methods
This prospective, single-center, cross-sectional study was conducted in the ED of a tertiary university hospital,between December 2021 and May 2022.The study included a random sample of 30 patients, >18 years which presented to the ED due to palpitations, without life-threatening features and hemodynamically stable. The AF was of recent onset, less than 48 hours in duration, or recurrence of chronic AF under anticoagulation therapy. Patients with history of structural heart disease were excluded. Once AF was confirmed in the electrocardiogram, patients received intravenous flecainide (2mg/kg over 10 min) or synchronized EC (150-200 Joules). Procedural sedation was performed in patients treated with EC. The follow up was done in the 8th and 30th day. Statistical analysis was performed using SPSS Statistics 22. The primary outcomes of the study were the patient’s restoration percentage at the time of intervention and recurrence percentage during follow-up period.
Results
Of our study population, 23(76%) of the patients had chronic AF and 7(24%) had newly-diagnosed AF, 2 patients of them had atrial flutter. Pharmacological cardioversion was used in 11 (37%) patients and EC in 19 (63%).
Heart rhythm restoration was achieved in 9(47,3%) the patients of the EC group. 8(88.9%) of them had chronic AF and 1 (11.11%) had AF of recent onset. In the EC group, in the patients who failed to restore sinus rhythm, heart rate control was achieved. Successful cardioversion was occurred in 10 (90.9%) patients of flecainide group. 6(60%) of them had chronic AF and 4(40%) had newly diagnosed AF. No adverse events (life-threatening ventricular arrhythmia or death) were recorded during both interventions. All patients remained in the ED for up to 2 hours and they discharged safely from the ED.
At the first follow up on 8th day, 7(23.3%) patients of both groups showed relapse. Two of them included in the flecainide group. In the 30 day follow-up one more patient from the EC group showed relapse.
Conclusions
For the emergency medicine physicians, the common therapeutic strategy of choice is EC use, mainly in haemodynamically unstable patients or those with adverse features. However in stable patients with AF both therapeutic options, EC or pharmaceutical intervention, appear to be safe and effective for the management of AF upon presentation to the ED. The main advantages are reduction of the length of stay in the ED, patient satisfaction and avoidance of unnecessary admissions to the hospital.
This study did not receive any specific funding
Antonios DIAKANTONIS (ATHENS, Greece), Christos VERRAS, Antonios BOULTADAKIS, Ioanna RITA, Konstantina NTAI, Sofia BEZATI, John PARISSIS, Effie POLYZOGOPOULOU
10:40 - 11:00
#30330 - Automatic detection of Covid-19 pneumonia through artificial intelligence applied to chest X-rays.
Automatic detection of Covid-19 pneumonia through artificial intelligence applied to chest X-rays.
Introduction
Artificial intelligence (AI) techniques, such as Deep Learning, aimed at the analysis of radiological images are having a continuous advance, which will allow in the near future optimization in radiological diagnosis. Currently, the pandemic caused by COVID-19 has been a major diagnostic challenge, where chest radiography is a crucial technique due to its availability and accessibility. However, it is sometimes difficult to differentiate pneumonia caused by COVID-19 from that caused by other germs, especially at the emergency departments.
Aims and objectives
To evaluate different architectures based on convolutional neural networks and Deep Learning techniques for the diagnosis of coronavirus pneumonia and its differentiation from pneumonia of other origins.
Methods
We have retrospectively analyzed 1.341 normal chest X-rays, 1.200 X-rays of pneumonia caused by COVID-19, and 1.345 X-rays of pneumonia of bacterial or non-coronavirus viral origin. These images come from a public database and the usual clinical practice in a hospital. The Deep Learning architectures applied for image analysis were RestNet50, ResNet101, VGG, and inception, among others. Pre-processing pipeline was carried out for image normalization and segmentation of the region of interest. Explainability techniques were applied to choose the model more suitable according to the clinical interpretation of the image.
Results
The best Deep Learning-based model was built with the architecture ResNet50 with a diagnostic efficiency of 0.91. This model correctly diagnosed 83.1% of normal chest X-rays and 100% of pneumonias caused by COVID-19. Both accuracy and understandability were considered to choose the best-performing model. Because of that, ResNet101 based model was discarded even being the diagnostic efficiency of 0.94.
Conclusions
Deep Learning using the architecture RestNet50 based on a convolutional neural network allows a diagnosis of COVID-19 pneumonia with high diagnostic efficiency and could be used in routine clinical practice at the emergency departments.
Financed by Euskampus Fundazioa. Euskampus Fundazioa is an inter-institutional instrument to manage and govern the Euskampus International Campus of Excellence (CEI) of the University of the Basque Country.
Enrique AÑORBE (Vitoria, Spain), Aranzazu BERECIARTUA, Pilar AISA, Andrea GARÍA-TEJEDOR, Andrea VALERO, Artzai PICÓN, Teodoro PALOMARES
10:40 - 11:00
#31500 - COVID-19 and H1N1 pneumonia: reanalysis and comparison of two retrospective cohorts.
COVID-19 and H1N1 pneumonia: reanalysis and comparison of two retrospective cohorts.
Background:
Influenza A H1N1 and SARS-CoV2 have been responsible for important viral respiratory disease epidemics in the 21st century. Both diseases (H1N1 flu and COVID-19) usually present with upper respiratory infection and may evolve into pneumonia.
This study evaluated similarities and differences between these viral epidemics in hospitalized patients
Methods:
This is a reanalysis of retrospectively enrolled cohorts in a tertiary hospital – HCFMUSP in São Paulo, Brazil – during two different types of viral respiratory epidemics.
All RT-PCR confirmed H1N1 patients originally enrolled from July 12 to August 17 2009 were included. We paired these patients by sex and age 1:1 using propensity score matching with our COVID-19 database of patients, which includes RT-PCR confirmed COVID-19 patients from March 2020 to March 2021. The primary outcome was hospital death. Secondary outcomes included admission for ICU care, ICU length of stay, signs and symptoms at admission, vitals at admission and 72h blood tests. We used R software version 4.2.0 for statistical analysis (significance at 0.05).
Results:
We included 52 H1N1 patients and 52 matched COVID-19 patients. Enrolled patients were on average 41 years old and 41% were female. Hospital death was more common for COVID-19 patients (10% vs 31%, p=0,007). With regards to our secondary outcomes, Cold symptoms, including fever (92% vs 65%, p=0.001), sputum (25% vs 4%, p=0.003), coryza (79% vs 19%, p<0.0001) and odynophagia (39% vs 11%, p=0.002) were more common in H1N1 patients.
ICU care was more common for COVID-19 patients (52% vs. 89%, p<0.0001), and ICU stay was longer for them (1 vs 10, p<0,0001). There was no difference in heart or respiratory rate, but peripheral oxygen saturation, systolic and diastolic blood pressure were higher in COVID-19 patients at admission. 72-hour blood tests showed higher leukocytes and c-reactive protein in COVID-19 patients but higher lymphocytes, hematocrit, and lactic dehydrogenase in H1N1 patients. Finally, there was no difference in platelets or creatine phosphokinase levels.
Discussion & Conclusions:
These results reveal that H1N1 and COVID-19 patients present very different clinical conditions and exam results. On the one hand, H1N1 patients presented in a more similar fashion to influenza-like illness than COVID-19. On the other hand, COVID-19 had a rate of ICU admission with longer stays and higher mortality. These findings are despite H1N1 patients having worse initial vitals with lower blood pressures and peripheral oxygen saturation. Considering COVID-19 may become an endemic variety of respiratory virus, knowledge of different vitals and lab profiles will be important to classify disease probability in patients arriving at the emergency department.
Funding: FAPESP and HCFMUSP funded this study.
Ethical approval and informed consent: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068), which also waived the need for written informed consent. We adhere to STROBE guidelines.
Trial Registration:
This study was registered as RBR-5d4dj5 at ensaiosclinicos.gov.br.
Funding: FAPESP and HCFMUSP funded this study.
Ethical approval and informed consent: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068), which also waived the need for written informed consent. We adhere to STROBE guidelines.
Trial Registration:
This study was registered as RBR-5d4dj5 at ensaiosclinicos.gov.br
Eduardo SORICE (, Brazil), Luis Fernando SANTOS, Juliana STERNLICHT, Rodrigo BRANDÃO, Lucas MARINO, Júlio MARCHINI, Júlio ALENCAR, Luz MARINA, Heraldo SOUZA
10:40 - 11:00
#31475 - COVID19 in the emergency department: Predictive factors of admission to intensive care unit.
COVID19 in the emergency department: Predictive factors of admission to intensive care unit.
Background:
The SARS-COV2 infection, after emerging in China, has spread throughout the world despite the control measures undertaken, disrupting the various health systems.
Faced with this pandemic, which is responsible for severe forms of the disease and high morbidity and mortality, the emergency department and the intensive care units were quickly overwhelmed.
The aim of this work was to evaluate the predictive factors of admission in ICU in patients
admitted to the emergency department for SARS-COV2 infection.
Methods:
This was a prospective, observational, longitudinal and prognostic study conducted in emergency room (10 months). We included patients older than 15 years, managed in the emergency department buffer zone for SARS-COV2. The statistical study included:
Comparison of the groups admitted to the ICU versus not admitted to the ICU, analysis univariate and multivariate logistic regression analysis to identify the predictive factors of admission to the intensive care unit.
Results:
We collected 709 patients. The median age was 65 years; IQR (56.74). The gender ratio (M/F) was 1.27.Past medical history was dominated by n(%): hypertension (312;44) and diabetes (287 ;40,5). Eighty-seven patients (12.3%) were admitted to the intensive care unit from the emegency departement and the median intra-hospital length of stay was 10 days; IQR(6 - 14) with extremes of 1 day to 42 days. After logistic regression and multivariate study, 7 factors predicted the admission in the ICU were reatined: Age65years (adjusted OR=3.289; CI95% :
[1.886 - 5.736], p<0.001),fever (adjusted OR=1.897; CI95%: [1.062 - 3.390], p=0.031),
hemoptysis (adjusted OR=5.455; 95% CI: [1.168 - 25.481], p=0.031),hyperlactatemia (adjusted OR 2.214; 95% CI: [1.244 - 3.939], p=0.007),FR/G(A-a) 0.40 (adjusted OR=1.854; 95% CI: [1.028 - 3.346], p=0.040),Lymphocytes<1000 El/mm3 (adjusted OR=1.891; CI95%: [1.051 - 3.398], p=0.033),LDH>500 IU/l (adjusted OR=9.433; CI95%: [5.019 - 17.730], p<0.001).
Conclusion:
The clinical spectrum of SARS-CoV2 infection ranges from asymptomatic or paucisymptomatic forms to severe forms with ARDS and multivisceral failure requiring resuscitation management. Early detection of these forms and the identification of predictive factors for admission to intensive care unit would facilitate their management
Amal OUSSAIFI (Saint-Denis), Hamed RYM, Hanene GHAZALI, Nihel OUESLATI, Rim DHAOUEDI, Maaref AMEL, Aymen ZOUBLI
10:40 - 11:00
#30377 - DANTE (Diagnostic Acute patieNt Tool in Emergency) & BEATRICE (Bedside Echocardiographic AssesmenT foR Improve Clinical Evaluetion) for geriatric patients.
DANTE (Diagnostic Acute patieNt Tool in Emergency) & BEATRICE (Bedside Echocardiographic AssesmenT foR Improve Clinical Evaluetion) for geriatric patients.
Objectives: To determine whether comprehensive quantitative bed side echocardiogram could be used as a usual assessment tool in acute geriatric patients and to assess its effect on patient care. Design: retrospective. Setting: DEA di II livello IRCSS Policlinico san Matteo. Patients: acute ill medical, trauma and surgical patients. A doctor enrolled in the discipline of emergency medicine was assigned to perform bedside echocardiograms of acute inpatients. This work took only geriatric patients into consideration. (> 65aa) Interventions: The Bedside Echocardiographic AssesmenT foR Improve Clinical Evaluetion (BEATRICE), a comprehensive transthoracic echocardiogram was performed. Measurements and Main Results 6-month period, 369 BEATRICEs were performed. The mean patient age was 76.2 (±14.3) years. 95% were hospitalized in medical departments and 5% in surgical ward. In 97.4% of cases BEATRICE was performed in a timely manner. The ejection fraction, cardiac index and the volumetric indices of the left ventricle is reported in 97% of the reports. Estimated stroke volume, longitudinal systolic function with tissue Doppler and atrium study is reported in 99.7%, 98.6% and 98.9% of BEATRICE studies. The study of diastolic and atrium function is reported in 99.3% and 98.9% of the reports respectively. Estimated left ventricular filling pressures are reported in 98.3% of the measurements. Information on the vena cava reported for 98%. Right heart function was assessed for 91.8%. Mean or systolic right ventricular pressures, or both, were also estimated in 91.9% of the reports. The BEATRICE was judged to be useful by the consulting primary care team in over 96% of cases, BEATRICEs allow the modification of therapy or the diagnostic process in over 40% of cases (in 27% of cases they allow to significantly modify the therapy and in 16% of cases they allow to significantly modify the diagnostic therapeutic procedure) and speeding up the diagnostic process in over 30% of cases. Conclusions: The BEATRICE is feasible and alters care in the intensive care unit by providing clinical data not otherwise available at the bedside. Further studies are warranted to assess the impact of comprehensive echocardiogram-directed resuscitation on patient outcomes.
Dr Gabriele SAVIOLI, Francesco LAPIA, Tommaso BOSONI, Giacomo ALUNNO, Giovanni RIGANO, Alessandra FUSCO, Luigi COPPOLA, Antonio LO BELLO, Viola NOVELLI, Sara CUTTI, Dr Alba MUZZI, Alessandra MARTIGNONI, Amedeo MUGELLINI, Antonio DI SABATINO, Alessandro VENTURI, Federica FUMOSO (Pavia, Italy)
10:40 - 11:00
#31110 - Does machine learning with or without clinical judgment improves prediction of in-hospital mortality in older and younger ED patients with a suspected infection compared to qSOFA?
Does machine learning with or without clinical judgment improves prediction of in-hospital mortality in older and younger ED patients with a suspected infection compared to qSOFA?
Does machine learning with or without clinical judgment improves prediction of in-hospital mortality in older and younger ED patients with a suspected infection compared to qSOFA?
Objective
Risk stratification of Emergency Department (ED) patients with suspected infection based on clinical judgment and risk scores could be improved using machine learning (ML), especially in older patients. Therefore, we developed ML models with and without clinical judgment and examined whether the discriminatory performance was better than current strategies.
Methods
In this observational multi-centre study, we included consecutive ED patients>18 years with suspected infection. A ML model was developed to predict in-hospital mortality using XGBoost, incorporating routinely collected data (demographics, triage category, chief complaint, arrival mode, vital signs, laboratory tests). The performance was quantified with the Area Under the Curve (AUC). We subsequently assessed the AUC of the qSOFA (0, 1, 2, 3) and clinical judgement (discharge home, hospitalization on normal ward, MC, or ICU) . Finally, clinical judgement was included as a variable in the XGBoost model to investigate the combination of ML and clinical judgment.
Results
Of the 13,502 included ED patients with a suspected infection 744 (5.5%) died in the hospital. The AUC of the XGBoost model was 0.78 (0.76-0.81), similar to XGBoost + clinical judgment model. Clinical judgment alone had an AUC of 0.61 (0.59-0.63), while qSOFA had an AUC of 0.67 (0.64-0.70, P<0.05). In older patients the AUC of the XG Boost was 0.75 (0.71, 0.78), lower than the AUC of 0.80 (0.75-0.86) in patients <70 years.
Conclusion
An ML model has similar predictive performance to ML combined with clinical judgment but better than clinical judgment alone and the qSOFA score. ML improves existing risk stratification, especially in older patients with suspected infection.
Wouter RAVEN (Leiden, The Netherlands), Lisa-Milou BOUMA, Leandra MULDER, Anne DE HOND, Laurens SCHINKELSHOEK, Menno GAAKEER, Ewoud TER AVEST, Heleen LAMEIJER, Bas DE GROOT
10:40 - 11:00
#31565 - Epidemiology of sepsis in patients admitted to the emergency department.
Epidemiology of sepsis in patients admitted to the emergency department.
Introduction: The sepsis remains a frequent reason of hospitalization in emergency department (ED) and is deserving of greater public health attention. Despite an early management the incidence of mortality remains elevated. The objective of this study was to determine the epidemiological, clinical, therapeutic and outcome features in patient presenting to the emergency department (ED) for sepsis.
Methods: Prospective study over 6 months (November 2021-April 2022). Inclusion of patients (age ≥ 18 years) presenting to ED for sepsis. Collection of epidemiological, clinical data and outcomes have been noted and analyzed. QSOFA and SOFA scores were calculated. Prognosis was evaluated on intra-hospital mortality.
Results: Inclusion of 86 patients. Mean age = 64 ±16 years. Sex ratio = 0.95. Comorbidities (%): hypertension (44), diabetes (41), chronic heart failure (17). Clinical manifestations (%): fever (55), dyspnea (48), altered general state (35) and cough (34). Clinical parameters at admission: mean systolic blood pressure (SBP): 120 ±34mm Hg; mean heart rate (HR):107± 22 bpm and mean oxygen saturation :89± 11%. Site of Infection (%): pulmonary (40), renal (29) and cutaneous (15). Organ failure was identified in 78 % of patients: respiratory (70), renal (39), cardiac (38). Median QSOFA score = 2,1±1. Median SOFA score =3,1±2,8. The median duration of hospital stay in the emergency department was 60 hours [1-288]. Intra-hospital mortality was observed in 3% of patients.
Conclusion: This study showed that septic shock is common in ED occurring more in old patients. Its prognosis has improved but still associated with an important mortality.
Chiraz BEN SLIMANE, Meriem BEN AMOR, Mansouri SALWA, Boutheina FRADJ (Mahdia, Tunisia), Maha BCHIR, Manel BAYAR
10:40 - 11:00
#31177 - Extracorporeal cardiopulmonary resuscitation for adult out-of-hospital cardiac arrest patients: time-dependent propensity score-sequential matching analysis from a nationwide population-based registry.
Extracorporeal cardiopulmonary resuscitation for adult out-of-hospital cardiac arrest patients: time-dependent propensity score-sequential matching analysis from a nationwide population-based registry.
Background & objective
The influence of resuscitation time bias should be considered when assessing intra-cardiac arrest interventions with the observational study. Time-dependent propensity score matching is one of the methods to deal with resuscitation time bias. No previous study considered the effect of resuscitation bias regarding extracorporeal cardiopulmonary resuscitation (ECPR). This study aimed to compare outcomes for ECPR patients with a time-dependent propensity score matching cohort.
Method
This study used prospectively collected nationwide EMS-based OHCA registry of Korea. All emergency medical services (EMS)-treated adult OHCA patients aged >_18 years without prehospital return of spontaneous circulation (ROSC) between January 2013 and December 2019. Patients with or without ECPR were sequentially matched with the ratio of 1:4 using a risk set matching based on the time-dependent propensity scores within the same time interval. The primary outcome was good neurological recovery. The secondary outcome was survival to discharge.
Results
Of 191,839 EMS treated OHCA patients enrolled in our registry during the study period. 99,594 were included. Among them, 381 (0.04%) received ECPR. After time-dependent propensity score matching, 1,830 were included in the matched cohort. In the matched cohort, ECPR was not associated with good neurological recovery (ECPR : 10.1% [37/366] vs. no ECPR : 7.2%(105/1,464);RR 1.19 [95% confidence interval, CI 0.76-1.86]) nor survival to discharge (ECPR : 14.2% [52/366] vs. no ECPR : 13.6%(199/1,464);RR 1.05 [95% CI 0.79-1.39]). But in stratified analyses according to the timing of matching, earlier ECPR was associated with favorable neurological outcome (ECPR: 17.1% [12/70] vs. no ECPR: 8.9%(25/280); RR 1.92 [95% CI 1.02-3.63] in the 1-30 min group).
Conclusion
Using a nationwide, population-based OHCA registry with time-dependent propensity score matching analysis, we found that ECPR was not associated with good neurological outcome after time-dependent propensity score matching, but stratified analysis by the timing of matching shows early ECPR was positively associated with good neurological recovery.
Yeongho CHOI (Seoul, Republic of Korea), Soyun HWANG, Sang Do SHIN, Kyoung Jun SONG, Jeong Ho PARK
10:40 - 11:00
#31153 - Ion Shift Index at the Immediate Post-cardiac Arrest Period as an Early Prognostic Marker in Out-of-Hospital Cardiac Arrest Survivors.
Ion Shift Index at the Immediate Post-cardiac Arrest Period as an Early Prognostic Marker in Out-of-Hospital Cardiac Arrest Survivors.
Background
The ion shift index (ISI) indicates the disruption of cellular ion homeostasis after ischemia and correlates with the magnitude of ischemic injury. This study investigated the prognostic value of ISI at the immediate post-cardiac arrest period and evaluated the performance of ISI combined with other clinical features for predicting poor neurologic outcome at 1-month in comatose out-of-hospital cardiac arrest (OHCA) survivors.
Methods
This observational registry-based study was conducted at a tertiary care hospital in Korea using the data of all consecutive adult non-traumatic comatose OHCA survivors between 2015 and 2020. ISI was calculated using the first obtained serum electrolyte levels including potassium, phosphate, magnesium and calcium. The primary outcome was 1-month poor neurological outcome (Cerebral Performance Category score of 3, 4 or 5).
Results
Among 242 comatose OHCA survivors, 162 (66.9%) had poor neurological outcome at 1-month after OHCA. The median ISI was significantly higher in patients with poor neurologic outcome (median, 3.29 vs. 4,78; P<0.001). After adjusting other clinical characteristics, ISI showed positive association with poor neurological outcome (adjusted odds ratio, 2.401; 95% confidence interval, 1.727-3.337; P <0.001). Areas under the curve for ISI was 0.816 (95% confidence interval, 0.762-0.870) and the optimal cut-off value was 4.25 with a sensitivity of 66.7% and a specificity of 86.3%. A combination of the peak neuron specific enolase value between 48 and 72 hours after return of spontaneous circulation (< 60 ng/mL) with the ISI (> 4.25) increased predictive performance for poor neurologic outcomes with a high specificity of up to 100%.
Conclusion
The ISI reflects the systemic damage after OHCA and could be a useful prognostic marker for poor neurologic outcome in comatose OHCA survivors at the immediate post-cardiac arrest period.
This research was supported by the Basic Science Research Program, through the National Research Foundation of Korea (NRF-2021R1A2C2014304).
Boram KIM (Seoul, Republic of Korea), Youn-Jung KIM, Won Young KIM
10:40 - 11:00
#30987 - Is the initial pulseless electrical activity heart rate of cardiac arrest patients associated with clinical outcomes?
Is the initial pulseless electrical activity heart rate of cardiac arrest patients associated with clinical outcomes?
Introduction
The initial rhythm is one of the major prognostic determinants for out-of-hospital cardiac arrest (OHCA) patients. Shockable rhythms are generally associated with better prognosis than pulseless electrical activity (PEA). Studies evaluating the prognostic value of the initial PEA heart rate have reported conflicting results. The objective of this study is to evaluate the association between the initial PEA heart rate and clinical outcomes, and to compare their outcomes to patients with an initial shockable rhythm.
Methods
Using a North American OHCA registry, we included non-traumatic OHCA adult patients, but excluded those whose initial rhythm was an asystole or PEA without a known heart rate. Patients with an initial PEA were separated into groups according to their initial PEA heart rate: 1-20 beats per minute (bpm), 21-40 bpm, etc. The main outcome measure was survival to hospital discharge, and secondary outcome measure was good neurologic outcome (modified Rankin scale 0-2). Multivariable logistic regression models were constructed to adjust for demographic and on-scene variables. Assuming a survival rate of 10% and 25% of the variability explained by other variables, including over 15’000 patients would allow us to detect an absolute difference of 1% between groups with a power of over 90%.
Results
Out of 120’306 patients, we included a total of 17’675 patients (mean age: 66.9 years [95%CI 37.1-96.8]; male: 70.3%; PEA: 7’089 [40.1%] vs initial shockable rhythm: 10’797 [59.9%]). Patients with an initial PEA heart rate ≤100 bpm were less likely to survive to hospital discharge than patients with an initial shockable rhythm (adjusted odds ratio [AOR] from 0.15 [95%CI 0.11-0.21] to 0.55 [0.41-0.65]). However, patients with an initial PEA heart rate >100 bpm had similar outcomes compared to patients with an initial shockable rhythm (101-120 bpm: AOR=0.65 [95%CI 0.42-1.01]; >120 bpm: AOR=0.72 [95%CI 0.37-1.39]). Similar results were observed for the good neurologic outcome (101-120 bpm: AOR=0.60 [95%CI 0.31-1.15]; >120 bpm: AOR=1.08 [95%CI 0.50-2.28]).
Conclusion
We observed a strong association between higher initial PEA heart rate and good clinical outcomes for OHCA patients. Patients with an initial PEA heart rate of more than 100 bpm should not be considered for prehospital termination of resuscitation and instead be considered for advanced therapies such as extracorporeal resuscitation.
Fonds des urgentistes de l'Hôpital du Sacré-Coeur de Montréal
Dr Alexis COURNOYER (Montréal, Canada), Yiorgos Alexandros CAVAYAS, Martin ALBERT, Eli SEGAL, Yoan LAMARCHE, Brian POTTER, Luc DE MONTIGNY, Jean-Marc CHAUNY, Jean PAQUET, Martin MARQUIS, Sylvie COSSETTE, Justine LESSARD, Judy MORRIS, Castonguay VÉRONIQUE, Raoul DAOUST
10:40 - 11:00
#30347 - Management of acute pulmonary embolism in the emergency room in elderly: Does adherence to international guidelines increase in the most serious cases?
Management of acute pulmonary embolism in the emergency room in elderly: Does adherence to international guidelines increase in the most serious cases?
Premises: Pulmonary embolism is a pathology still characterized by high mortality. Some international studies have actually shown that adherence to guidelines is generally quite low in both primary and secondary care and ranges, depending on the studies, between 40 and 60%. However, it is the opinion of the authors of this abstract that adherence to the guidelines is higher in the most serious cases, where the resources of the Emergency Department are more concentrated and which absorb more medical and nursing time.
Purpose of the study: see if and how, in the real life of an Emergency Department, adherence to the Guidelines varies according to the severity of the acute pulmonary embolism. We understood this severity as the presence of organ damage or massive pulmonary embolism.
Methods: single-center retrospective observational study, on all geriatric patients (>75 y) who entered our ED, where they received a diagnosis of acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and Years), and for the presentation of the risk of mortality at 30 days (sPESI). We therefore analyzed adherence to the guidelines in three decisional turning points: 1 Correct application of the decision scores examined, which classify the patient at low, intermediate or high risk of PE, calculated with Wells and simplified Geneva score; 2 Correct administration of therapy starting from ED as suggested by the guidelines; 3 Any observation in the care area of medium intensity with careful monitoring for the subpopulation of patients with finding of right ventricular dilation or myocardial enzyme elevation (considered to be at high risk of shock and short-term mortality).
Results: we enrolled 248 patients, with a mean age of 83 years with female prevalence (F = 62%). Of these, 81 (32.7%) have organ damage and 86 (34.7%) have massive pulmonary embolism. Patients with organ damage received treatment with a higher adherence to the guidelines (68%) than those who did not have organ damage (51%) in a statistically significant way (p < 0.01). Patients with massive pulmonary embolism received treatment with a higher adherence to the guidelines (69 %) than those with peripheral pulmonary embolism (50%) in a statistically significant way (p <0.005).
Conclusions: The study suggests that patients with organ damage or massive pulmonary embolism are more likely to receive treatment in the emergency room with greater compliance with international guidelines.
Dr Gabriele SAVIOLI, Iride Francesca CERESA, Viola NOVELLI, Dr Alba MUZZI, Sara CUTTI, Enrico ODDONE, Giovanni RICEVUTI, Massimiliano LAVA, Lorenzo PREDA, Antonio LO BELLO, Alessandra FUSCO, Luigi COPPOLA, Giovanni RIGANO, Aurora CECCO, Giulia BELLINI, Davide DIONISI, Alessandro VENTURI, Maria Antonietta BRESSAN, Federica FUMOSO (Pavia, Italy)
10:40 - 11:00
#30672 - Modified sequential organ failure assessment score for prediction of 2-day in-hospital mortality in prehospital dyspnea.
Modified sequential organ failure assessment score for prediction of 2-day in-hospital mortality in prehospital dyspnea.
Background: Dyspnea is a subjective sensation of shortness of breath or difficulty in breathing and is a symptom that is present in a multitude of diseases, constituting one of the most frequent prehospital care symptoms, often associated with varying degrees of multi-organ dysfunction. Dyspnea severity assessment is a challenge for Emergency Medical Systems (EMS). Therefore, the use of early warning scores, biomarkers, etc., constitute an invaluable tool to evaluate the seriousness of the disease and the short-term outcome from the initial stages, taking the opportune measures for each case.
The outcome of the present analysis was to evaluate the performance of the modified sequential organ failure assessment score (mSOFA) to predict 2-day in-hospital all-cause mortality.
Methods: Prospective, multicentric, EMS-delivery, ambulance-based, pragmatic cohort study of adults with prehospital dyspnea, referred to five hospitals (Spain), between January 2020, and December 2021. Any patient treated consecutively by EMS with prehospital diagnosis of dyspnea and transferred by ambulance to the ED was included in the study. Patients under 18 years of age, traumatic patients, pregnant women, and patients discharged on site were excluded. Demographic data (age and sex), vital sings and biomarker (creatinine and lactate) were collected during the first contact with the patient in prehospital care. The biomarkers were measured with the epoc® Blood Analysis System (Siemens Healthcare GmbH, Erlangen Germany), and vital sings (mean arterial pressure and oxygen saturation) were measured with LifePak® 15 (Physio-Control, Inc., Redmond, USA) monitor-defibrillator. Finally, the SaFi ratio (pulse oximetry saturation / fraction of inspired oxygen ratio) was calculated, and the Glasgow coma scale was determined. The primary dependent variable was all-cause 2-day in-hospital mortality. The area under the curve (AUC) of the receiver operating characteristic (ROC) of the mSOFA was calculated in terms of early mortality.
Results: 203 patients with prehospital dyspnea were transferred to the ED and finally included in the study. The median age was 67.4 years (IQR: 55-77), between 18 to 104 years, with 39.4% females (80 cases). Fifty-six cases required non-invasive mechanical ventilation (27.5%) and 13 cases required invasive mechanical ventilation (6.4%) in prehospital care. The 2-day mortality occurred in 15.5 % (30 cases). The AUROC for mSOFA was 0.907 (95%CI: 0.83-0.98; p<0.001), for a cut-off point of 5 points, with a sensitivity of 93.3% (95%CI: 84.4-1) and a specificity of 79.2% (95%CI: 73.1-85.2). Finally, the mSOFA presented a positive likehood ratio of 4.485 and a negative likehood ratio of 0.084.
Conclusions: the use of early warning scores, biomarkers, and the combination of both is a reality in daily clinical practice and has timidly begun to be used also in prehospital care. In this sense, the mSOFA has an excellent capacity to predict early mortality in patients with dyspnea.
This work was supported by the Gerencia Regional de Salud, Public Health System of Castilla y León (Spain) [grant number GRS 1903/A/19 and GRS 2131/A/20]
Francisco MARTÍN-RODRÍGUEZ, Raúl LÓPEZ-IZQUIERDO, Carlos DEL POZO VEGAS (Valladolor, Spain), Rocio VARAS MANOVEL, M. Teresa HERRERO DE FRUTOS, Laura M. GARCÍA SANZ, Rafael CALDEVILLA ROMERA, J. José FERNÁNDEZ CARBAJO, Carlos NAVARRO GARCÍA, Jesús MINGUEZ BRAVO, Isabel JULIÁN CRESPO, Pablo DEL BRIO IBAÑEZ, Arancha MORATE BENITO, Cristina VÁZQUEZ DONIS, M. Cristina RAMOS ORTEGA, Emma GARCÍA TARRERO, Esther FRAILE MARTÍNEZ, María GRAÑEDA IGLESIAS, M. Teresa BLAZQUEZ GARCÍA, Victor MENÉNDEZ GUTIÉRREZ, Juan Francisco DELGADO BENITO
10:40 - 11:00
#31163 - Overcapacity procedure to manage an emergency department with a defined closure time.
Overcapacity procedure to manage an emergency department with a defined closure time.
Background: Some emergency departments (EDs) face a defined closure time which can result in processing capacity issues to manage all patients before department closure. Cobequid Community Health Centre ED (CCHC ED) is an urban community ED located in Halifax, Nova Scotia (NS), Canada with operational hours from 0700 to 2400 and an annual census of 44000 visits. There is no inpatient or observational capacity so all patients must be discharged from the facility at close. Surges on busier days resulted in patients being triaged and waiting (often many hours) until closure time, only to be redirected to other open EDs in Halifax without emergency physician (EP) assessment. This process was recognized for potential risk to patient safety and patient dissatisfaction. The aim of the study was to evaluate the impact and safety of an Over Capacity Procedure (OCP) developed to manage newly presenting patients with a consistent approach in overcapacity situations.
Methods: An OCP was developed and implemented by our ED Operations Committee to address situations where patient volumes exceeded available emergency staffing resources. The procedure involved initiating physician triage of Canadian Triage Acuity Score 2 & 3 patients once defined overcapacity criteria were met. EP decided appropriate disposition which included home to return next day or proceed to other local open EDs for full ED assessment. A retrospective quality review of patient outcomes for the period of June 1, 2015 to January 31, 2021 was performed. This study used administrative data supplemented by structured chart review to study all patients managed by the OCP at CCHC ED. Data from ED information system, the Nova Scotia Health Authority electronic medical record and NS Vital Statistics were used. Our primary outcome was death within 72 hours of ED discharge without repeat ED visit. Secondary outcomes included number of OCP patients assessed by EP and number of patients presenting to other EDs.
Results: A total of 3271 patients were managed by OCP during the study period. There were 3 deaths among study patients. One death occurred within 72 hours of discharge without repeat ED visit and two deaths after directed repeat ED visit within several hours of discharge. These were the only deaths within 7 days of discharge which represents a rate of 0.03% for patients without return ED visit. Overall there were 2849(88%) return visits within 72 hours. OCP affected an average of 7.4 patients on days initiated with sixty percent of OCP patients assessed by EP. An average of 1 patient registered at another site before 0700 on these days.
Discussion/Conclusions: There is a paucity of literature concerning physician triage of patients away from EDs. Other American and Canadian studies showed deaths within 7 days of ED discharge between 0.03 and 0.12%. Our study indicates that OCP was effective in safely managing patient volumes that exceeded processing capacity before closure. There was not significant impact on other facilities. These findings have potential application to other EDs facing closure or overcapacity situations potentiating need to redirect patients away from ED.
Michael CLORY (Halifax, Canada), Douglas NEAL
10:40 - 11:00
#31256 - Piedmont’s (Italy) Emergency Departments utilization during the first two waves of the COVID-19 Pandemic: an Interrupted Time-Series Analyses (ITSA).
Piedmont’s (Italy) Emergency Departments utilization during the first two waves of the COVID-19 Pandemic: an Interrupted Time-Series Analyses (ITSA).
Background
Emergency Departments (ED) are essential health services that have paramount importance during the COVID-19 pandemic. The analysis of ED visits and severity of the patients can be a useful tool to analyse direct and indirect effects of the COVID-19 outbreak on the Italian National Health System.
Methods
We performed an interrupted time-series analysis (ITSA) on the ED visits of the Piedmont Region, in the northeast of Italy, using daily aggregated data from January 2019 to January 2021 from 32EDs.
We defined 4 periods, according on the Infectious and Prevention Control measures: pre-COVID-19 (baseline), first wave, inter-waves and second wave. Firstly, we analyzed the change in rate of ED visits (change in level) from one period to the other; secondly, age, outcome and severity– defined by triage code (red), outcome and admission to Intensive (ICU) and Sub-Intensive Care Units.
Results and discussion
The ED visits decreased during first (-1314 daily visits) and second (-340 daily visits) waves compared to pre-COVID-19 and inter-waves respectively, mostly due to the decrease of less severe patients. In fact, public health officials emphasized the importance of visiting ED for serious symptoms that cannot be managed in other settings - to ease the hospital workload due to COVID-19 patients.
The elderly visits increased of 339 in first and 111 in second wave, probably due to the higher probability of developing severe COVID-19 symptoms for this population.
The visits daily mean by severe patients increased in both waves: discharged patients lessened (2206 pre-COVID-19 vs 1016 first wave and 1626 second wave vs 1098 interwaves), whereas deceased increased (8 pre-COVID-19 vs 10 first wave and 6 second wave vs 11 interwaves). Red codes showed an increase of 12 in daily visits in first wave, remained high both in interweaves - probably due for the worsening of chronic illnesses, caused by the interruption of outpatient rooms/elective surgical activities in first wave, despite the decreasing of COVID-19 trend, -and in second wave. Patients admitted to ICU and Sub-Intensive Care Units increased more in second wave than in first, although the number of the ICU admission for COVID-19 lessened: this was the result of the increase of the Sub-Intensive Care Unit admissions for COVID-19, probably due to the management and treatment of the COVID-19 disease at the early phase for the better knowledge of the disease.
Green codes decreased by 813 in first wave, increased in inter-waves but not to the baseline numbers and decreased of 357 in second wave.
The increase of daily mean visits of transferred patients (36 in second wave vs 21 in the other periods) was probably a consequence of the more severity of patients and of the regional strategies to face COVID-19, like the creation of COVID-19 hospitals.
Conclusion
During the COVID-19 first two waves in Piedmont daily ED visits decreased whereas severity of the cases increased, with patients being more frequently admitted to Sub-Intensive and Intensive Care Units and transferred to other services, also suggesting there was a more intensive use of resources per patient.
Ethical committee approval "Protocollo 66/CE Studio n. CE 2/21" from Università Del Piemonte Orientale Italy
No clinical work.
Valentina ANGELI (Pavia, Italy), Marcelo Farah DELL'ARINGA, Roberta PETRINO, Francesco DELLA CORTE
10:40 - 11:00
#31268 - ROX Index and modified ROX index : Predictor of mortality in sepsis and septic shock.
ROX Index and modified ROX index : Predictor of mortality in sepsis and septic shock.
Introduction :
The ROX index (ratio of pulse oximetry/FIO2 to respiratory rate) and the modified ROX index defined as the ratio of ROX index over HR (beats/min), multiplied by a factor of 100 have been validated to predict high flow nasal cannula therapy (HFNC) outcomes in patients with pneumonia. In patients with sepsis and septic shock, hypoxemia and tachypnea are common. Could the RI and mRI be a predictor of mortality in septic patients?
Methods :
We performed a prospective observational cohort study for 12 months . we included patients aged over than 18 year old and admitted to the Emergency Departement for sepsis and septic shock. RI and m RI were calculated for all patients included in this study. Evaluation was performed using a logistic regression and cutoffs assessed for prediction of hospital mortality.
Results :
We included 104 patients with a sex ratio of 1,5. The mean age was 65 ± 16 year old. Patient History was hypertension (48%), coronary (10%) atrial fibrilation (14%), asthma ( 11% ) and COBD ( 26 %). Twenty seven patients had septic shock, and 60 % had in acute dyspnea . The mean pulse oxymetry was 88 ± 12% , the mean q sofa was 1,78 [0-3], the mean fio2 was 0,39 [0,21-1], the mean rox index was 14 [0,79-29] , the mean mRI was 15,39[0,79-45]. Vascular filling was reported in 87% patients. Fifty seven patients (55%) required oxygen therapy . In hospital mortality was observed in 38%. the analytical study showed that RI ≤ 10 and Rim ≤11 predict intra hospital mortality with respectively (p=0,011) ;OR =2,94 ; IC[1,26 -6,5] and (p=0,035) ; OR = 2,41 ; IC[1,04-5,5].
Conclusion :
ROX Index ≤ 10 et m ROX index modifié ≤are significantly associated with high mortality in our population , hence the importance of calculating yhis index for estimating the vital prognosis of patients with sepsis or septic shock.
Wided BAHRIA LASGHAR, Youssef ZOUAGHI, Fatma LAAZAZ, Samah YAMOUN, Hanene DRIRA (Tunis, Tunisia), Fares HAMDI, Khayreddine JEMAI, Nour Elhouda NOUIRA
10:40 - 11:00
#31323 - ST-segment elevation myocardial infarction: Predictive factors of lack of reperfusion therapy.
ST-segment elevation myocardial infarction: Predictive factors of lack of reperfusion therapy.
ST-segment elevation myocardial infarction (STEMI) occurs as a result of a complete and persistent occlusion of a culprit coronary artery. Therapeutic management is essentially based on early interventional or pharmacological reperfusion therapy. Nevertheless, some patients did not undergo reperfusion. So, what are the main characteristics of this group?
Objective :
Identification of factors related to reperfusion ineligibility
Method :
Retrospective study from a monocentric register over a period of 14 years (April 2008 - April 2022).
Inclusion of patients over 18 years of age presenting with STEMI who were hospitalized during the first 24 hours, in the emergency department of a medical center not equipped with a cardiac catheterization room.
Collection of demographic, clinical and prognostic parameters.
Patients were considered ineligible for reperfusion after the first 24 hours from the onset of symptoms.
Telephone follow-up on the 30th day.
Descriptive and comparative study between patients with no-reperfusion therapy (R-) and those who underwent reperfusion (R+). Identification of factors related to non-reperfusion by univariate analysis
Results :
Inclusion of 1370 patients. Mean age = 60 +/- 12 years, sex–ratio = 4.75.
The main comorbidities were n (%): diabetes 476 (34), systemic arterial hypertension (SAH) 472 (34), coronary insufficiency 180 (13), dyslipidemia 179 (13), ischemic strokes (IS) 72 (5), and chronic renal failure (CKD) 23 (2).
Seventy-five patients (5.5%) were non-reperfused.
All patients had contraindications to thrombolysis. The main contraindications were n (%): First consultation 12 hours after onset of symptoms 35 (46), Diagnosis doubt 15 (19), History of ischemic stroke 12 (15) and History of head trauma 4 (5)
The comparative study of R- versus (vs) R+ patients found a predominance of female gender 26 (35%) vs 211 (16%) p<0.001, a higher age 67+/-13 years vs 59.5 +/-12 p<0.001, and a predominance of comorbidities n (%): hypertension 51 (38) vs 423 (32) p<0.001, Chronic kidney diseas 5 patients vs 16 (1) p<0.001, IS 50 (37) vs 15 (1.8) P<0.001. The median consultation time was 500 minutes (min) for R- patients vs 150 min for R+ patients p<0.001. Moreover, there was a predominance of complicated forms, such as the acute heart failure 30 (40%) vs 164 (13) for R+ p<0.001 and the cardiogenic shock 19 (25%) vs 76 (6) for R+ p<0.001.
Finally, the one-month mortality rate was 45% for patients who didn’t undergo reperfusion versus 7% for those who did.
Conclusion :
In this study, 5.5% of patients presenting with STEMI were ineligible for reperfusion. Female gender, age, comorbidities and complicated forms represent the main factors related to non-reperfusion.
Hela BEN TURKIA, Firas CHABAANE (tunis, Tunisia), Hanene GHAZELI, Nouelhouda ELLINI, Elisabeth DEBBICH, Rahma DHOKAR, Sami SOUISSI
10:40 - 11:00
#31321 - ST-segment elevation myocardial infarction: prognostic value of Timi risk index and modified Timi risk index.
ST-segment elevation myocardial infarction: prognostic value of Timi risk index and modified Timi risk index.
Therapeutic management of patients admited with ST-segment elevation myocardial infarction (STEMI) is based on early interventional or pharmacological reperfusion therapy. The Morbidity and Mortality risk stratification helps guide the therapeutic decision. Several algorithms have been studied to assess short-term and long-term mortality risk, such as the TIMI risk index (TRI) and the modified TIMI risk index (mTRI). TRI is a score exclusively based on clinical parameters and was the subject of a variety of studies. On the other hand, mTRI which is based on both clinical and biological parameters wasn’t neither frequently used nor sufficiently studied.
Objective :
Assessment of the prognostic value of TRI and mTRI in patients admitted to the emergency department for STEMI.
Method :
Retrospective study from a monocentric register over a period of 14 years (April 2008 - April 2022).
Inclusion of patients over 18 years of age who were admitted to the emergency department for STEMI.
Collection of demographic, clinical, biological and prognostic parameters.
Calculation of TRI and mTRI ((TRI x Plasmatic Urea) / 10), determination of predictive threshold values for intra-hospital and one-month mortality using the ROC curve (Receiver Operating Characteristic), calculation of the Sensitivity (Se), the Specificity (Sp), the Positive Predictive Value (PPV), the Negative Predictive Value (NPV) and the Likelihood Ratio (LR).
Telephone follow-up on the 30th day.
Results :
Inclusion of 710 patients. Mean age = 60,5 +/- 12 years, sex–ratio = 4.8.
The main cardiovascular disease risk factors n (%): smoking 480 (67), systemic arterial hypertension (SAH) 250 (35), diabetes 241 (34), coronary insufficiency 102 (14), dyslipidemia 95 (13). The median chest pain to first medical contact time was 180 minutes.
The selected reperfusion strategy was n (%): thrombolysis 494 (70), primary angioplasty 156 (22). The lysis success rate was 65 %. Intra-hospital and one-month mortality rates was respectively 5 and 7%.
The mean TRI was 3+/-2 while the median mTRI was 2
A TRI > 5 was predictive of intra-hospital death with a Se = 61%, a Sp = 88%, a PPV = 20%, a NPV = 97% and a LR = 5
A TRI > 5 was predictive of death at one month with a Se = 37%, a Sp = 90%, a PPV = 33%, a NPV = 91% and a LR = 3.7
A mTRI > 2 was predictive of intra-hospital death with a Se = 82%, a Sp = 68%, a PPV = 11%, a NPV = 98% and a LR = 3,7
A mTRI > 2 was predictive of death at one month with a Se = 82%, a Sp = 76%, a PPV = 19%, a NPV = 98% and a LR = 3.4
Conclusion:
Within the framework of STEMI, intra-hospital and one-month mortality rates are respectively 5 and 7%. A TRI > 5 allows to predict mortality with a specificity over 80%, yet, it has a low sensitivity. However, it is possible to predict mortality with a better sensitivity using mTRI.
Hela BEN TURKIA (Ben Arous, Tunisia), Firas CHABAANE, Hanene GHAZELI, Syrine KESKES, Marwa DHAOUI, Marwa HOUICHI, Amira TAGOUGUI, Sami SOUISSI
10:40 - 11:00
#31061 - The impact of cognitive impairment and mood disorders on quality of life in out-of-hospital cardiac arrest survivors.
The impact of cognitive impairment and mood disorders on quality of life in out-of-hospital cardiac arrest survivors.
The impact of cognitive impairment and mood disorders on quality of life in out-of-hospital cardiac arrest survivors
Background: Although not a few survivors from out-of-hospital cardiac arrest discharged with good neurological prognosis, they commonly experienced cognitive dysfunction, and mood disorders, and recent guidelines emphasized the need for early evaluation of these disorders and appropriate interventions. The objective of this study was to examine the prevalence and risk factors of cognitive and mood disorders in patients discharged with a favorable neurologic outcome among survivors after out-of-hospital cardiac arrest.
Methods: We conducted a single center, retrospective cross-sectional study from a prospectively enrolled registry of nontraumatic adult out-of-hospital cardiac arrest survivors treated with targeted temperature management from July 2012 to June 2021. Among them, non-face-to-face evaluation was conducted by telephone for patients with the Cerebral Performance Category 1 or 2 after six months of discharge. Cognitive functions were evaluated using telephone Montreal Cognitive Assessment and Alzheimer's Disease-8, and mood disorders were assessed by Patient Health Questionnaire-9 and Hospital Anxiety and Depression Scale. Quality of life was measured by using the EuroQol Five Dimensions Five Levels questionnaire and the EuroQol Visual Analogue Scale. Multivariable logistic analysis was performed to determine the independent risk factors of cognitive and mood disorders.
Results: A total of 364 non-traumatic adult out-of-hospital cardiac arrest patients, of which 107 (39.4%) patients showed good neurologic outcomes at the time of discharge. Of the 97 patients who were finally interviewed by telephone, 23 patients (23.7%) were confirmed to have cognitive impairment and 28 patients (28.9%) were confirmed to have mood disorders. Multivariable logistic regression analyses showed that age (adjusted odds ratio 1.06 [1.01 – 1.10]; p = 0.013), cardiac arrest of cardiac origin (adjusted odds ratio 0.14 [0.04 – 0.55]; p = 0.005) and initial asystole rhythm (adjusted odds ratio 15.33 [1.41 – 166.21]; p = 0.025) were independently associated with cognitive impairment. Mood disorders were associated with cardiac arrest of cardiac origin (adjusted odds ratio 0.10 [0.03 – 0.32]; p < 0.001), but not with age and initial rhythm. Although the quality of life was evaluated to be significantly low in the group with cognitive impairment, mood disorders did not affect the quality of life.
Discussion & Conclusions: Our results showed that not a few patients with a favorable neurological outcome experienced cognitive or mood disorders. Cardiac arrest of non-cardiac origin was independently associated with the occurrence of cognitive or mood disorders. Appropriate screening and active intervention of cognitive impairment, anxiety, and depression for these population would be necessary.
This Study was supported by a grant from the Korea Association of CardioPulmonary Resuscitation (grant no, 2021-004), Republic of Korea.
Boram KIM (Seoul, Republic of Korea), June-Sung KIM, Won Young KIM
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11:05 |
"Monday 17 October"
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A23
11:05 - 12:30
Neurologic emergencies - Guidelines and Zebras
Moderators:
Christian HOHENSTEIN (PHYSICIAN) (Moderator, BAD BERKA, Germany), Robert LEACH (Head of Dept.) (Moderator, BRUXELLES, Belgium)
11:05 - 11:30
Personalized blood pressure management in CVA - What's the latest guideline?
Else Charlotte SANDSET (Speaker, Norway)
11:30 - 11:55
Vertigo in the Emergency Department.
Peter JOHNS (Speaker) (Speaker, Ottawa, Canada)
11:55 - 12:20
PRES - Review for Emergency Physicians.
Christian HOHENSTEIN (PHYSICIAN) (Speaker, BAD BERKA, Germany)
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A6-7 |
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B23
11:05 - 12:30
EUSEM Project Outcomes: Quality indicators, working conditions and blood sampling guideline
Moderators:
Christoph DODT (Head of the Department) (Moderator, München, Germany), Dr John HEYWORTH (Consultant) (Moderator, Southampton, United Kingdom)
11:05 - 11:30
EUSEM Quality Indicators project: Project methodology, results and next steps.
Dr Kelly JANSSENS (PHYSICIAN) (Speaker, Dublin, Ireland)
11:30 - 11:55
EUSEM survey on Provider Working Conditions.
Christoph DODT (Head of the Department) (Speaker, München, Germany)
11:55 - 12:20
Blood sampling guideline.
Luis GARCIA-CASTRILLO (ED director) (Speaker, ORUNA, Spain)
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A8 |
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D23
11:05 - 12:30
Paediatric Emergencies - Yes or No
Moderator:
Rianne OOSTENBRINK (pediatrician) (Moderator, Rotterdam, The Netherlands)
11:05 - 11:30
Short-course antibiotherapy in pneumonia - Yes.
Jeffrey PERNICA (Speaker, Hamilton, Canada)
11:05 - 11:30
Short-course antibiotherapy in pneumonia - No.
Dr Roberto VELASCO ZUÑIGA (Pediatrician) (Speaker, Laguna de Duero, Spain)
11:30 - 11:55
Tranexamic acid in trauma - Yes.
Daniel NISHIJIMA (Speaker, USA)
11:30 - 11:55
Tranexamic acid in trauma - No.
Zsolt BOGNAR (Head of Department) (Speaker, Budapest, Hungary)
11:55 - 12:20
Viral tests in management of febrile infant - Yes.
José Antonio ALONSO CADENAS (Speaker, Madrid, Spain)
11:55 - 12:20
Viral tests in management of febrile infant - No.
Silvia BRESSAN (Moderator) (Speaker, Padova, Italy)
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A2 |
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E23
11:05 - 12:30
Acid-base and gases
Moderator:
Ruth BROWN (Speaker) (Moderator, London, United Kingdom)
11:05 - 12:05
Acid-base disorders, incl. Hypo/Hypercapnia.
Francesca INNOCENTI (PHYSICIAN) (Speaker, Florence, Italy)
12:05 - 12:30
Hyper/Hypo-glycemia.
Gregor PROSEN (EM Consultant) (Speaker, MARIBOR, Slovenia)
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A4 |
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F23
11:05 - 12:30
Wellbeing, resilience and more
Moderator:
Dr Heidi EDMUNDSON (Consultant) (Moderator, London)
11:05 - 11:30
TBA.
Dr Heidi EDMUNDSON (Consultant) (Speaker, London)
11:30 - 11:55
Recognizing barriers to training for women.
Katie BRILL (ED doctor) (Speaker, Birmingham, United Kingdom)
11:55 - 12:20
Surviving as a young mother during Emergency Medicine residency.
Jerica ZALOŽNIK (EM resident) (Speaker, MARIBOR, Slovenia)
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A5 |
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C23
11:05 - 12:30
EMS/Paramedics: Controlling the patient flow
Moderators:
Dr Kasia HAMPTON (Emergency Department Medical Director) (Moderator, USA/Poland, USA), Lydia HOTTENBACHER (Head of Department) (Moderator, Berlin, Germany)
11:05 - 11:30
Paramedic Norwegian Acute Stroke Pre-hospital Project (ParaNASPP) - Results of the clinical trial.
Mona GUTERUD (Speaker, Oslo, Norway)
11:30 - 11:55
Non-conveyance of patients suspected of covid-19 following a paramedic's assessment: a historical cohort study on the safety of a novel arrangement in an emergency medical service mikkel skov1.
Vibe Maria Laden NIELSEN (PhD student) (Abstract Presenter, Aalborg, Denmark)
11:55 - 12:20
The community Paramedic - The solid bridge between citizen and hospital. The Region Zeeland way.
Simon TINGAARD (Speaker, Næstved, Denmark)
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A1 |
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G23
11:05 - 12:30
Notfallmedizin 2022 Teil 2
Moderators:
Harald BERGMANN (Moderator, Germany), Hans Werner KOTTKAMP (Moderator, Germany)
11:05 - 11:30
Arzeimittelsicherheit - ein Thema fr die Notaufnahme?
Harald DORMANN (Speaker, Nürnberg, Germany)
11:30 - 11:55
Top 10 de Do-not-miss Sono-Befunde.
Dorothea HEMPEL (Atteding Physician) (Speaker, Magdeburg, Germany)
11:55 - 12:20
Notfallmedizin: welchen Einfluss hat der erste Eindruck?
Rajan SOMASUNDARAM (Head of ED) (Speaker, Berlin, Germany)
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A3 |
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H23
11:05 - 12:30
Decision
Moderators:
Dr Federico CAPRILES (Médico adjunto) (Moderator, Reus, Spain), Abdo SATTOUT (Consultant in Emergency Medicine) (Moderator, Liverpool, United Kingdom)
11:05 - 12:30
#31093 - A combined model to assess the individual risk of intracranial complications after minor head trauma.
A combined model to assess the individual risk of intracranial complications after minor head trauma.
Background: Current decision rules for minor head trauma (MHT) are reliable when applied to a population consistent with original trials, but their effectiveness decreases if more heterogeneous series of patients were considered. Although infrequent, clinical relevance of complications after MHT makes indispensable effective and appliable to all patients guidelines . The aim of this study was to develop a statistical model able to predict the individual risk of intracranial bleeding in patients suffering from MHT.
Methods: In this prospective observational study all patients consecutively observed for MHT from January 2018 to June 2019 in the Emergency Department of University Hospital of Verona were considered. Inclusion criteria were: MHT defined as Glasgow Coma Scale 14 or 15; age > 18 years; CT scan performed within 48 hours from trauma. All clinical features and common risk factors were reported at admission. Main outcome was CT report of any intracranial lesion. Secondary outcomes were need for hospitlization, neurosurgery or neurological intensive care support. Statistical analysis was aimed to create and validate two prediction tools: risk score and nomogram. All risk factor associated with outcome in the univariate analysis (signficance level p<0.1) were submitted to multivariate analysis by Logistic Regression. Those variables confirmed as significant predictors (accuracy level at least 0.5%) were included in the final model. We further validated the risk score by means of discrimination and calibration models. Discrimination was calculated through area under receiver operating characteristics (ROC) curve and calibration by calibration plot. The nomogram was based on multivariate logistic model and translated the probability of intracranial lesion into a risk rate per cent. Nomogram was developed using a statistical software package and also validated by discrimination and calibration models.
Results: In this study we enrolled 3722 patients (1826 males, 1896 females, mean age 74 years). CT scan positive for intracranial bleeding was reported in 316 patients (8.5%), but only 28 (0.75%) needed for neurosurgery. Independent variables proved significant after multivariate analysis were: dangerous mechanism, anticoagulant therapy, loss of consciousness, amnesia, repeated vomit, suspected fracture, GCS<15 (all p<0.001), neurological deficit (p=0.001), signs of trauma (p=0.003). The final score (range 0-26) was the total of single variable score derived from its statistical weight. Mean outcome was significantly related to increasing score, with concordance index in ROC curve equal to 0.809 (p<0.05). In 82% out of 11 patients with score > 12 CT scan was positive (specificity 0.99, positive predictive value 0.82). The 95.4% of 769 score < 3 patients and all of 71 completely risk-free ones presented a negative CT scan (sensibility 1.0, negative predictive value 1.0). Nomogram reached high accuracy level (concordance index 0.802, p<0.05). In ROC curve probability scores correlated with defined specificity and sensibility values. The 76.5% of patients with probability > 0.8% suffered from intracranial bleeding (specificity 0.99, positive predictive value 0.76), while in patients with probability < 0.2% (87.9%) specificity rate increased to 92.4%.
Conclusions: Our combined statistical model appears a reliable tool to assess the individual risk of intracranial bleeding after minor head trauma.
Trial Registration of the study is TCM-NOMO_RET (889 CESC)
The study received no fund
Dr Antonio BONORA (VERONA, Italy), Gianni TURCATO, Alice DILDA, Giorgio RICCI, Massimo ZANNONI, Beatrice BAMPA, Ciro PAOLILLO, Antonio MACCAGNANI
11:05 - 12:30
#30929 - An Assessment of the Management of Choledocholithiasis Based on Risk Scoring Guidelines at a Tertiary General Surgery Referral Centre.
An Assessment of the Management of Choledocholithiasis Based on Risk Scoring Guidelines at a Tertiary General Surgery Referral Centre.
Background: Right upper quadrant abdominal pain is a common presentation for a general surgery on-call. Differentials include choledocholithiasis, for which ASGE guidelines utilize a risk scoring system to determine appropriate ongoing investigations and treatment modalities. Their scoring system categorizes patients with suspected common bile duct (CBD) stones into low, intermediate, and high risk of choledocholithiasis, and based off risk stratification, patients are either advised to proceed straight to ERCP followed by cholecystectomy or for MRI/Endoscopy prior to any therapeutic intervention. Our audit reviewed the ASGE 2019 scoring system and management guidelines against current practices at a tertiary hospital to assess how well common practice matches guideline recommendations for the management of choledocholithiasis based on risk scoring.
Method: An independent audit across a three-month period was conducted of all patients presenting to a tertiary general surgical on-call with symptoms suggestive of choledocholithiasis (pain, jaundice, fevers). Primary quantitative and qualitative data was collected from electronic medical records for each patient, and this was used to retrospectively risk stratify each patient into low, intermediate, or high risk. The proceeding management that each patient received was analyzed against the recommended guidance, to assess compliance of current clinical practice.
Results: In total 83 patients were included. 23% categorized as, 58% as intermediate and 19% as high risk. The low-risk group had the greatest compliance to guidance; 89% of patients either had or were listed for a cholecystectomy. 75% of patients categorized as high risk went onto have an ERCP prior to consideration for cholecystectomy, without any further imaging (MRI or EUS). However, 50% had an MRI first (no one had an EUS) and for 75%, the results corroborated the initial clinical suspicion. The same proportion of patients, with or without further imaging, had an ERCP followed by plan for cholecystectomy. Of this group, only 1/3 of the patients had either complications or required repeat procedures. In the intermediate-risk group, only 38% of the group had further imaging and 4 confirmed to have stone disease. In those patients that did not have further imaging, 53% did not have a cholecystectomy either. Just under half of these were because intervention was considered too high risk. Age >55 scores immediate risk regardless of other factors, and a sub-group analysis of those only scoring immediate risk based on age was conducted. All patients had either an USS, CT or MRCP. There were no findings suggestive of choledocholithiasis on any imaging in this cohort and only 11% had an elective laparoscopic cholecystectomy either done or listed.
Conclusions: Overall, our audit showed that risk stratification is relatively safe and inclusive of appropriate patients with suspected choledocholithiasis presentation and current management does match a risk-scoring approach in certain aspects. However, some aspects of the criterion for each risk-strata may need revising and most often patients do not always fit into one risk group throughout their presentation and nor does solely basing on specific criteria acknowledge for comorbidities and frailty in an ever-aging population, which will impact management plans, regardless of perceived risk.
An Assessment of the Management of Choledocholithiasis Based on Risk Scoring Guidelines at a Tertiary General Surgery Referral Centre
Shreya SAXENA (London, )
11:05 - 12:30
#31134 - Are biomarkers of prognostic or diagnostic value in older emergency patients presenting with a recent fall? – a prospective observational trial.
Are biomarkers of prognostic or diagnostic value in older emergency patients presenting with a recent fall? – a prospective observational trial.
Introduction:
Falls are a major problem in the older emergency department population. Falls occur frequently after the age of 65 and account for 73% of cases of major trauma in that age group. They are associated with reduced mobility, functional decline, and death. Prognostic markers to distinguish between patients at high risk of death or adverse events and those who would benefit from rapid discharge would facilitate the time-consuming work-up in the emergency department (ED) and is therefore of utmost interest. D-dimer levels are commonly used to rule out thromboembolic disease and pulmonary embolism, while troponin T and I are used as a sensitive marker for myocardial infarction. It has been suggested that D-dimer might be helpful as a non-specific prognostic marker. This study aimed to determine the rate of elevated troponin levels in older patients presenting to the ED with falls and their prognostic value. Additionally, we aimed to evaluate whether D-dimer levels are predictive of 30d-mortality in the same population.
Methods:
This trial was conducted as a prospective international multicentre, cross-sectional observational study. Data collection was performed from November 2014 until January 2018. Study centres were University Hospital Basel, Charité Berlin (tertiary care hospitals), Hospital Bruderholz, and Hospital of Liestal (regional hospitals). Patients older than 65 years presenting to the ED within 24 hours after a fall and giving informed consent, were enrolled in the study. Upon presentation, Demographic baseline data, vital signs, D-dimer, and troponin T and I levels were determined. Follow-up analyses were performed after 30 days, 90 days, 180 days, and 1 year. The primary outcome of this study was 30-day mortality; the secondary outcomes were mortality after 30 days, 90 days, 180 days, and 1-year mortality.
Results:
Of 825 screened patients, 587 patients could be included in the study. 226 had missing D-dimer levels and 5 were lost to follow-up resulting in a final study population of 356. The median age was 83 years [IQR 78, 89], and 236 (66.3%) were female. Mortality rates were: 3.1% for 30 days, 5.1% for 90-days, 7% for 180 days and 12.1% for 1 year. 321 (90.2%) patients had elevated D-dimer levels with the regular cutoff (<500 ng/mL) applied while the age-adjusted cutoff (patient's age * 10 ng/L) resulted in 281 (78.9%) patients. None of the 11 Non-survivors after 30 days and the 18 Non-survivors after 90 days had a D-dimer below the regular or adjusted cutoff. Troponin data will be presented at the conference.
Discussion:
To our knowledge, this trial is the first prospective study investigating the mortality of older patients presenting to the ED after a recent fall - or the prognostic value of biomarkers regarding mortality in this population. We could confirm the generally high rate of elevated D-dimer levels in older patients questioning the value of the defined cut-offs for this age group. On the other hand, a low D-dimer level seems to be a strong predictor of survival in the next 30 and 90 days.
This study did not receive any specific funding.
Lukas TERHALLE (Basel, Switzerland), Alexandra MALINOVSKA, Kriemhild LIPPAY, Christoph BECKER, Christiane ROSIN, Laurentia PITASCH-PICKING, Karen DELPORT, Joanna ZUPPINGER, Christoph KEIL, Laura ARNTZ, Nicolas GEIGY, Jörg LEUPPI, Rajan SOMASUNDARAN, Christian H. NICKEL, Roland BINGISSER
11:05 - 12:30
#31238 - Clinical impact of a novel ambulatory computed tomography coronary angiography pathway for patients with suspected acute coronary syndromes in the observation zone.
Clinical impact of a novel ambulatory computed tomography coronary angiography pathway for patients with suspected acute coronary syndromes in the observation zone.
Introduction:
The introduction of high-sensitivity cardiac troponin (hs-cTn) assays has enabled earlier rule-out of acute coronary syndromes (ACS) in the Emergency Department (ED), often with a single blood test at the time of arrival. However, all current decision aids and pathways still leave some patients with uncertain diagnoses in the ‘observation zone’.
Computed tomography coronary angiography (CTCA) could be used to resolve uncertainty for patients in the ‘observation zone’. In January 2018, we implemented a novel ambulatory CTCA service for such patients. With this pathway, patients in the ‘observation zone’ after applying the T-MACS decision aid were potentially eligible for CTCA via an Ambulatory Care Unit (ACU), as an alternative to hospital admission. Eligible patients were identified in the T-MACS electronic application and the referral procedure was ‘pushed’ directly to clinicians.
We aimed to investigate the uptake of this service and its effects on patient outcomes including length of stay and the use of percutaneous coronary intervention (PCI).
Methods:
We conducted a retrospective, single-centre cohort study. From January 2018, patients were eligible for CTCA if they were in the ‘observation zone’ (moderate risk with T-MACS; troponin <99th percentile; no acute ECG ischaemia).
The data for all patients with suspected ACS were captured prospectively using the T-MACS electronic application. We extracted data for consecutive patients in the ‘observation zone’ both prior to implementing ambulatory CTCA (June 2016 – December 2018) and post-implementation (January 2018 – January 2020).
The primary outcome was adherence, defined as the number of eligible patients who received an ambulatory CTCA. Secondary outcomes include location of stay, length of stay, time to CTCA, and number of PCI. We summarised data using descriptive statistics.
Results:
We identified 1,341 patients in the ‘observation zone’ (524 pre-implementation of ambulatory CTCA; 817 post-implementation; 820 [61%] were male; mean age 57 [SD 14] years; 743 [55%] white; 91 [7%] black; 410 [31%] Asian; 97 [7%] other).
Pre-implementation, 53% (n=280) of these patients were admitted to inpatient beds. Post-implementation, 68% (n=559) were admitted to inpatient beds, while 32% (n=258) were admitted to the Ambulatory Care Unit. However, only 7 (1.3%) eligible patients received ambulatory CTCA after the service was implemented. A further 25 patients in the ‘observation zone’ received CTCA from an inpatient area.
For patients who received an ambulatory CTCA in adherence with local guidance, the median time to CTCA from admission was 1 (IQR 0.75-3) day. A total of 5 (71.4%) of the ambulatory CTCAs were abnormal, identifying significant coronary artery disease.
PCI was undertaken in 83 (6.2%) patients overall. Three patients (4.3% of all those undergoing CTCA) with abnormal CTCA underwent PCI, although only one had followed the ambulatory CTCA pathway.
Conclusions:
Despite providing a novel ambulatory CTCA pathway for ‘observation zone’ patients with electronic decision support to identify eligible patients, our two-year evaluation found that clinicians continued to admit patients to inpatient areas. This indicates suboptimal utilisation, potentially because of a lack of confidence from clinicians. Future work should focus on identifying barriers to adherence.
Trial Registration: Not applicable as this is a service evaluation and there is no appropriate register.
Funding information: This study did not receive any specific funding.
Verity BUGLASS (Manchester, United Kingdom), Richard BODY
11:05 - 12:30
#31011 - Comparison of three physiological-based scoring systems for predicting adverse clinical outcomes for elderly patients with acute upper gastrointestinal bleeding in emergency departments.
Comparison of three physiological-based scoring systems for predicting adverse clinical outcomes for elderly patients with acute upper gastrointestinal bleeding in emergency departments.
Background
Acute upper gastrointestinal bleeding (AUGIB) is one of the major causes of morbidity and mortality in the geriatric population in emergency departments (EDs). Therefore, it is important to rapidly identify high risk group in this vulnerable population and commence aggressive resuscitation and proper medical intervention. The aim of this study is to compare the ability of three simple physiological-based scoring systems including Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) in predicting adverse clinical outcome in geriatric patients with AUGIB in EDs.
Methods
This is a s retrospective cohort study conducted in a single suburban regional hospital from July 01,2016 to July 31, 2021 in Chiayi, Taiwan. Patients aged older than 65-year-old visited the ED with the diagnosis of AUGIB confirmed by endoscopy were recruited. Data including vital signs in triage, demographics, underlying comorbidities, presenting signs and symptoms, laboratory findings and endoscopic findings were recorded. Three physiological-based scoring systems including RAPS, REMS and MEWS were calculated by triage vital signs. Outcome was defined as in-hospital mortality or intensive care unit (ICU) admission during the hospitalization. Univariate logistic regression analyses were used to identify the variables that were significantly associated with in-hospital mortality or ICU admission. A two-tailed p value of less than 0.05 was considered statistically significant. The diagnostic performance with area under curve (AUC) was further evaluated by receiver operating characteristic curve analysis.
Results
A total of 317 geriatric AUGIB patients were recruited, 16 of which have poor clinical outcomes including ICU admission or in-hospital mortality. Patients with adverse clinical outcomes present with lower SBP (103.50 v.s. 121.84 mmHg) and more rapid respiratory rate (21.19 v.s. 19.08 time/min). Lower Hemoglobin (7.67 v.s. 9.26 g/dL) and albumin level (2.90 v.s. 3.47 g/dL) are in the group with adverse outcomes. The area under the receiver operating characteristic curve values for MEWS, RAPS and REMS were 0.739 [95% confidence interval (C.I.): 0.603-0.875, p = 0.001], 0.666 (95% C.I.: 0.523-0.808, p = 0.025), and 0.647 (95% C.I.: 0.471-0.802, p = 0.048), respectively.
Conclusion
Among the 3 physiological-based scores, MEWS has the best AUROC in predicting adverse clinical outcomes in geriatric patients with AUGIB in EDs. This simple, rapid, obtainable-by-the-bed parameters that can be calculated immediately could assist emergency physicians for initial management for this vulnerable group. However, to evaluate the real clinical impact, further prospective study is warranted.
Trial Registration: Not applicable for observational study.
Funding: This study did not receive any specific funding.
Ethical approval and informed consent: This study was approved by the Chang Gung Medical Foundation Institutional Review Board (IRB:201900828B0C102), waiving the need for obtaining the informed consent of the study participants.
Pohan WU (Chiayi, Taiwan)
11:05 - 12:30
#31248 - Derivation of a formula to predict mortality of High Impact Users attending an inner-city Emergency Department in the UK.
Derivation of a formula to predict mortality of High Impact Users attending an inner-city Emergency Department in the UK.
Introduction
The Royal College of Emergency Medicine defines Frequent Attenders (FA) as anyone who attends the Emergency Department(ED) five or more times per year. This group has a high mortality rate and is a significant burden on services. The Bristol Royal infirmary (BRI) is a city centre adult only ED, 51828 individual patients are seen per year 1.8% of which attend 5 times or more per year. Mortality rate of our adult FAs is 20%. The BRI High Impact User (HIU) team was established with the aim of supporting this population. Our aim is to further develop a triage tool used by the service, by using predicted mortality. The first step, outlined here, was to determine which factors increase mortality in this specific local population of FAs.
Methods
Data was collected retrospectively on a cohort of 250 patients, randomly selected from1780 FAs attending BRI ED between January 2016 and January 2017.
Six variables were chosen for analysis: current mental health problems, homelessness, injecting drug use, alcohol misuse, chronic medical problems and number of attendances during the 12-month period. Data was collected from electronic patient notes. Data on age, gender and 5-year mortality were also recorded. Logistic regression modelling was performed to determine which factors best predicted 5-year mortality.
This wasn’t a clinical research study therefore did not require NHS research ethical approval. Local Service development and information governance guidelines were followed.
Results
In univariate analysis, age and chronic medical problems were the only two variables were independently associated with 5-year mortality.
All except one of the 15 patients with >15 attendances per year had mental health problems(MHP). Patients who attended 10-20 times per year with MHP(n=22) had a higher mortality rate 31.3% than those in the >20 attendances group (n=6) where 5-year mortality was 0%.
Multivariate analysis suggested different predictors of mortality depending on the presence or absence of MHP. Therefore two different algorithms were derived; one for those without MHP and one for those with MHP, both of which had AUROC of over 0.7.
Discussion
This was a small-scale service development using a specific cohort of frequent attenders in inner-city Bristol, and therefore our findings are not generalisable.
However, there are some interesting results. In particular the complex relationship between mortality and frequency of attendance in patients with mental health problems. We must recognise that in most FA programmes there is a dual aim of reducing mortality, along-side reducing the burden of frequent use on emergency services. Our finding prompts the question of whether this second aim risks inadvertently discouraging high risk patients from accessing our services where their interactions may be protective. This is an under-researched and under-resourced population and we hope to encourage other local EDs to develop similar tools for their populations of FAs. Our service plans to now prospectively collect data using these scoring systems to further validate our tool in our specific population.
This wasn’t a clinical research study therefore did not require NHS research ethical approval. Local Service development and information governance guidelines were followed.
There was no specific funding for this work which was carried out by members of the HIU team and doctors employed by the Emergency Departmentin Bristol.
Lilian STANLEY, Mya DILLY, Jasmine SCHULKIND, Paul WHITE, Buckland SALLY, Lilian STANLEY (Bristol, United Kingdom)
11:05 - 12:30
#30241 - Development and external validation of the International Early Warning Score (IEWS): Improved mortality assessment in the Emergency Department for patients of all ages.
Development and external validation of the International Early Warning Score (IEWS): Improved mortality assessment in the Emergency Department for patients of all ages.
Introduction Despite poor predictive performance, with overestimation of risk in younger and underestimation of risk in older Emergency Department (ED) patients, the National Early Warning Score (NEWS) has been widely implemented and adopted. To improve predictive performance for all ages, the aim of this study was to develop and externally validate an International Early Warning Score (IEWS) based on a recalibrated NEWS model including age and sex and evaluate its performance independently in three age categories (18-65y;66-80y;>80years). Methods An international multicenter cohort study including all ED patients ≥18years using the Netherlands Emergency department Evaluation Database (NEED) including three Dutch EDs. External validation was performed using a Danish Multicenter Cohort (DMC). The primary outcome was in-hospital mortality.
Results In total, 95,553 patients were included for development of the model and 14,809 were included for external validation. Mortality rate was 2.4%. Overall, the IEWS performed significantly better than NEWS with an Area Under the Curve (AUC) of 0.89 (Confidence Intervals (CI) 0.89-0.90) versus 0.82 (CI 0.82-0.83) in the NEED and 0.87 (CI 0.85-0.88) versus 0.82 (CI 0.80-0.91) in external validation. For each age category discrimination improved significantly with IEWS. AUC was 0.92 (CI 0.90-0.93) for the age category 18-65, 0.85 (CI 0.84-0.86) for 66-80, 0.83 (CI 0.82-0.85) for >80, compared to NEWS that showed AUC of 0.87 (CI 0.85-0.88), 0.82 (CI 0.82-0.83), and 0.80 (CI 0.79-0.81) in the same age categories, respectively. NEWS underestimated risk in older patients and overestimated risk in the youngest, while IEWS improved calibration with a substantial reclassification of patients from low to high risk. With IEWS, 47.5% more patients were justifiably considered low risk, whereas 27.6% more patients who died were considered as medium or high risk.
Conclusions The IEWS, a recalibrated NEWS including age and sex, substantially improves mortality prediction for all ages. With better classification into low and high risk, IEWS may potentially contribute to better decision policies and should therefore replace NEWS in the ED.
None
Bart CANDEL, Soren Kabell NISSEN, Christian NICKEL, Wouter RAVEN, Wendy THIJSSEN, Menno GAAKEER, Annmarie Touborg LASSEN, Mikkel BRABRAND, Evert DE JONGE, Bas DE GROOT (AMSTERDAM, The Netherlands)
11:05 - 12:30
#31479 - Evaluation of qSOFA, CRB65 and fine score in the prediction of mortality from SARS-CoV2 infection.
Evaluation of qSOFA, CRB65 and fine score in the prediction of mortality from SARS-CoV2 infection.
Background:
The qSOFA, the CRB65 and the Fine score are simple tools allowing respectively identification of sepsis and prediction of mortality in acute community-acquired pneumonia . As SARS-CoV2 infection is an emerging disease, several scores have been proposed for the evaluation of its severity in the emergency department. The objective of this work was to evaluate the performance of the qSOFA, the CRB 65 and the fine score in the prediction of mortality due to SARS-CoV2 infection.
Methods:
Prospective, observational and prognostic study including patients aged over 15 years , treated in the emergency room for SARS-COV2 infection (October 2020-July 2021).
Calculation at admission of qSOFA, CRB65 and Fine score. Study of early mortality (D07) and in-hospital mortality: Comparison of deceased groups versus survivor groups
univariate study with elaboration of ROC curves and precision of their characteristics
Results:
We included 709 patients. Median age=65 years; IQR (56,74). Sex ratio (M/F) =1.27.
Forty-three patients (6.1%) had qSOFA 2 and 28 patients (4%) had qSOFA at
3. A CRB65 2 score was found in 20.5% of cases (145) and a Fine score >90 was noted in 40.3% of patients (145). The rates of mortality at D7 and in-hospital mortality were respectively N (%): 141(19.9) and 301(42.5).
All 3 scores were statistically higher in the deceased (at D07 and in-hospital) versus survivor groups. In the univariate study, qSOFA, CRB65 and Fine score were predictive of mortality at D07: qSOFA 2 (OR=3.469, CI95%: [1.820 - 6.612], p<0.001);
CRB65 2 (OR=2.984, CI95%: [1.984 - 4.487], p<0.001); Fine score > 90 (OR=3.086,
CI95%: [2.106 - 4.522], p<0.001) and in-hospital mortality: qSOFA 2 (OR=3.789,
CI95%:[1.912 - 7.509], p<0.001); CRB65 2 (OR=4.533, CI95%:[3.044 - 6.751], p<0.001);
Fine score > 90 (OR=2.585, CI95%:[1.897 - 3.522], p<0.001). The Fine score
presented the best ROC curve characteristics either for mortality at D07: AUC
0.690; 95% CI [0.639 - 0.741]; Sensitivity: 62.4%; NPV: 87.4% and for in-hospital mortality: AUC: 0.677; 95% CI [0.639 - 0.716]; Sensitivity: 69.3%; NPV: 66.7%
Conclusion:
In our study, qSOFA, CRB65 and Fine score were predictive of
mortality from SARS-CoV2 infection. These are simple and rapid prognostic scores commonly used in emergency departments to identify patients at risk of worsening. Their performance in the context of SARS-CoV2 infection would be a good tool for triage and management of patients during a pandemic.
Amal OUSSAIFI (Saint-Denis), Hamed RYM, Hanene GHAZALI, Nihel OUESLATI, Raja FADHEL, Emna REZGUI, Aymen ZOUBLI
11:05 - 12:30
#31264 - Loss of independence – a prospective, observational study of a simple, alternative frailty assessment tool for the ED setting.
Loss of independence – a prospective, observational study of a simple, alternative frailty assessment tool for the ED setting.
Background
Frailty, an aging-associated decline in function across multiple physiologic systems, is a common clinical syndrome in older adults and carries an increased risk for poor health outcomes.
The proportion of older people in Swedish Emergency Departments accounts for approximately 40%. Proper identification and stratified management based on frailty is needed to direct the use of limited ED resources to patients most susceptible to adverse events.
EDs in Sweden are implementing clinical judgment of frailty as a compulsory part in the care of elderly. There are many frailty tools of different precision and time demand. Loss of Independence (LOI) defined as inability to rise unaided, has been shown to be prognostic regarding risk for readmission as well as mortality. Adding LOI to triage increased the prognostic precision for mortality within 24-72 hours compared to Modified Early Warning Score (MEWS). The aim of this study was to investigate whether LOI, can be a simple alternative frailty assessment tool to predict adverse outcomes such as mortality, hospital admission, Length of Stay (LOS) in ED and Length of Hospitalisation (LOH).
Methods
The study was a multi-centre, prospective, observational cohort study of a consecutive sample of geriatric patients (≥65) visiting one of three EDs within a regional healthcare system in Sweden serving 450 000 inhabitants. LOI was assessed by either the physician, registered nurse or the assistant nurse. The primary outcome variable was mortality at 30 days after index visit. The secondary outcome variables were: Mortality at 7 respectively 90 days, LOS, admission rate, LOH and return visits to the ED. Descriptive statistics have been used for outcomes of admission rate, mortality at 7, 30 and 90 days, LOS and LOH. Variables regarding LOI was set to LOI 1 = independent, LOI 2 = frail and LOI 3 = very frail. LOI 1 was set to non-frail and LOI 2 + 3 = frail for dichotomisation in statistical processing using Chi-square test and Fisher’s exact test (Graphpad prism).
Results
2169 patients were included and 1929 (52% male) remained for analysis after excluding planned revisits to the ED and patients with missing data concerning LOI and regular frailty assessment scores (Clinical Frailty Scale). 25% (n=482/1929) were deemed frail at index visit. Frail patients had a significantly higher admittance rate (66% (319/482) compared to 37% (n=529/1447) of the non-frail (p<0.0001). Preliminary data suggests a doubled relative risk of death 30 days after index visit comparing frail (44/482) to non-frail (25/1447). The LOS in the ED as well hospitalisation was less influenced by frailty but showed a wide variation.
Discussion and conclusions
Adverse outcomes associated with frailty has been shown in many studies with different frailty scoring systems. LOI is a simple assessment that seems associated with increased admission rates and higher mortality. The data may lead to relocation of resources in the ED to the patients in most need as well as add to future re-dimensioning of hospital resources.
The study was registered on ClinicalTrials.gov identifier: NCT04877028
This study did not receive any specific funding.
Ethical approval and informed consent: The study was approved by the Swedish Ethical Review Authority (permit 2021-00875). Written informed consent was obtained.
Rani TOLL (Linköping, Sweden), Samia MUNIR EHRLINGTON, Erika HÖRLIN, Daniel WILHELMS
11:05 - 12:30
#31059 - Serum concentration of spectrin breakdown product 145 kDa does not predict the six-month outcome after cardiac arrest: a prognostic accuracy study.
Serum concentration of spectrin breakdown product 145 kDa does not predict the six-month outcome after cardiac arrest: a prognostic accuracy study.
Background:
Biomarkers of brain injury, such as neuron specific enolase (NSE), can be a good component of the multimodal prognostication model predicting post-cardiac arrest outcomes. Adding more ideal parameters will improve prognostic accuracy. Recently, spectrin breakdown products (SBDP) have been studied as biomarkers of traumatic brain injury. However, SBDP have not been investigated as biomarkers of post-cardiac arrest neurological injury. Therefore, we evaluated the prognostic accuracy of the serum SBDP 145 kDa for the long-term outcome after cardiac arrest.
Methods:
This prognostic accuracy study was prospectively planned before testing. A sample size of 56 was calculated with an expected area under curve (AUC) of 0.85 (null hypothesis 0.65, power 0.95, and beta 0.2). Unconscious, adult survivors regardless of the cardiac arrest rhythm were consecutively recruited in two university-affiliated hospitals. NSE was selected as the reference test. Blood samples were obtained as soon as possible (0h), 24 hours, and 48 hours after the return of spontaneous circulation (ROSC). Clinical information was unavailable to testers. Modified Rankin Scale greater than 4 at six months after cardiac arrest was defined as a poor outcome. There were no preliminary data for the cut-off value of SBDP predicting a poor outcome. Therefore, we used the median value of SBDP145 as the cut-off value. According to the cut-off value, we calculated AUC, sensitivity, specificity, and likelihood ratio (LR). We compared AUCs of biomarkers using the DeLong test. Median values of SBDP in each outcome group were compared using the Mann-Whitney test.
Results:
Between November 2019 and February 2021, 56 patients were recruited. General characteristics were as follows: Mean age 57 years; 38 males; 54 out-of-hospital cardiac arrest; 22 shockable arrest rhythm. Within 24 hours after ROSC, seven patients expired and 49 samples were obtained at 24h. At 48 hours after ROSC, eight more patients expired and 41 samples were available. Forty-three patients were found to have poor outcomes six months after ROSC. AUC of SBDP145 was 0.58 (95% CI 0.44-0.71) at 0h, 0.56 (95% CI 0.41-0.7) at 24h, and 0.5 (95% CI 0.34-0.66) at 48h, respectively. AUC of NSE was 0.51 (95% CI 0.37-0.65) at 0h, 0.91 (95% CI 0.78-0.98) at 24h, and 0.98 (95% CI 0.86-1) at 48h, respectively. AUCs of NSE at 24h and 48h were significantly larger than those of SBDP145 (p<0.05). Median value of SBDP145 was 6.6 ng/mL at 0h, 6.5 ng/mL at 24h, and 6.7 ng/mL at 48h, respectively. Prognostic accuracy of SBDP145 predicting poor outcome was poor at all time points (0h: sensitivity 53.49%, specificity 61.54%, positive LR 1.39, negative LR 0.76; 24h: sensitivity 50%, specificity 61.54%, positive LR 1.3, negative LR 0.81; 48h: sensitivity 51.72%, specificity 41.67%, positive LR 0.89, negative LR 1.16). Median values of SBDP145 were not significantly different between the poor outcome group and good outcome group at all time points (p>0.05).
Discussion & Conclusions:
SBDP145 did not discriminate between poor and good outcomes six months after cardiac arrest at all time points, while NSE predicted poor outcomes at 24 and 48h after ROSC.
This work was supported by the Catholic University of Korea, Uijeongbu St. Mary's Hospital Clinical Research Laboratory Foundation program (UJBCR201918).
Hyunho JUNG, Kiwook KIM, Jungtaek PARK, Young Min OH, Semin CHOI, Kyoung Ho CHOI, Pr Joo Suk OH (Seoul, Republic of Korea)
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11:10 |
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11:10 - 11:35
Pre-Hospital care within Emergency medicine
11:10 - 11:35
Pre-Hospital Section Chair.
Eric REVUE (Chef de Service) (Moderator, Paris, France)
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11:40 - 12:10
Disaster Medicine, does it become more and more important?
11:40 - 12:10
Disaster Medicine Section Chair.
Steve PHOTIOU (Moderator, Crocetta del Montello (TV), Italy)
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YEMDSN
12:30 - 14:00
YEMD Speed Networking
12:30 - 14:00
Speaker.
Dr David CARR (Associate Professor of Emergency Medicine) (Speaker, Toronto Canada, Canada)
12:30 - 14:00
Speaker.
Roberta PETRINO (Head of department) (Speaker, Italie, Italy)
12:30 - 14:00
Speaker.
Dr Barbara C HOGAN (Past President of the European Society for Emergency Medicine, EuSEM) (Speaker, HAMBURG, Germany)
12:30 - 14:00
Speaker.
Eric DRYVER (Consultant) (Speaker, Lund, Sweden)
12:30 - 14:00
Speaker.
Eric REVUE (Chef de Service) (Speaker, Paris, France)
12:30 - 14:00
Speaker.
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12:45 - 13:45
EMCREG-International & Total CME: Life-Threatening Intracranial Hemorrhage, Gastrointestinal, and Trauma-Related Bleeding in Anticoagulated Patients:
Chairperson:
Brian GIBLER (Professor) (Chairperson, Cincinnati, USA)
12:45 - 13:45
Intracranial hemorrhages and anticoagulation reversal in the ED.
Barbra BACKUS (Emergency Physician) (Speaker, Rotterdam, The Netherlands)
12:45 - 13:45
Life-threatening gi bleeds and anticoagulation reversal in the ED.
Pr Rick BODY (Professor of Emergency Medicine) (Speaker, Manchester, United Kingdom)
12:45 - 13:45
Life-threatening traumatic bleeds and anticoagulation reversal in the ED.
Pr Martin MÖCKEL (Head of Department, Professor) (Speaker, Berlin, Germany)
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INDS4
12:45 - 13:45
MSD: The role of the Emergency Department in optimizing outcomes in mild to moderate Covid-19 patients
Chairperson:
Juan GONZÁLEZ DEL CASTILLO (Chairperson, Madrid, Spain)
12:45 - 13:45
COVID-19: state of the art.
Juan GONZÁLEZ DEL CASTILLO (Speaker, Madrid, Spain)
12:45 - 13:45
COVID-19: state of the art.
Sven SCHELLBERG (Speaker, Berlin, Germany)
12:45 - 13:45
Patients with suspected covid-19 presenting to the ED today.
Juan GONZÁLEZ DEL CASTILLO (Speaker, Madrid, Spain)
12:45 - 13:45
At home COVID-19 treatment options.
Sven SCHELLBERG (Speaker, Berlin, Germany)
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INDS5
12:45 - 13:45
Qiagen: Using rapid multiplex-PCR Syndromic testing for infectious diseases diagnosis in the Emergency Department
Chairperson:
Marti Juanola FALGARONA (Chairperson, France)
12:45 - 13:45
Overall value and benefits of syndromic testing in the emergency department.
Donia BOUZID (MD-PHD) (Speaker, Paris, France)
12:45 - 13:45
Impact of rapid multiplex-PCR syndromic testing during COVID-19 in an emergency department.
Olivier PEYRONY (MD, PhD) (Speaker, Paris, France)
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DGINA-1
12:45 - 14:00
DGINA Poster Session: Case reports and miscellaneous
Moderators:
Harald DORMANN (Moderator, Nürnberg, Germany), Clemens KILL (Director) (Moderator, Essen, Germany)
12:45 - 12:53
Clinical presentation of acute aortic dissection type a: cases emergency room Arnas G. Brotzu.
Raffaela ARGIOLAS (emergency physician) (Eposter Presenter, Cagliari, Italy)
13:01 - 13:09
PASUH: ANALYSE DER VERWALTUNG DER AKUTE PYELONEPHRITIS IN DER NOTAUFNAHME VON KRANKENHUSERN.
Alvaro MARTIN PÉREZ (Médico Adjunto) (Eposter Presenter, Badajoz, Spain)
13:25 - 13:33
PERSONALISIERTE THERAPIE DIREKTER ANTIKOAGUNTIEN BEI VORHOFFLIMMERN.
Alvaro MARTIN PÉREZ (Médico Adjunto) (Eposter Presenter, Badajoz, Spain)
12:53 - 13:01
St-elevation acute myocardial infarction in a young male.
Daisuke USUDA (Clinician, Rsearcher) (Eposter Presenter, Tokyo, Japan)
13:09 - 13:17
BEWERTUNG VERWIRKLICHER BILDER IN NOTFLLEN.
Alvaro MARTIN PÉREZ (Médico Adjunto) (Eposter Presenter, Badajoz, Spain)
13:33 - 13:41
Kardiale thrombose bei TVT mit pulmonaler und femoraler embolisation im rahmen eines antiphospholipid-syndroms.
Benjamin IRMSCHER (Consultant) (Eposter Presenter, Berlin, Germany)
13:17 - 13:25
ANSATZ FR ONKOLOGIE-PATIENTEN IM NOTFALL.
Alvaro MARTIN PÉREZ (Médico Adjunto) (Eposter Presenter, Badajoz, Spain)
13:49 - 13:57
Massiver perikarderguss bei Pulmonaler Hypertonie.
Susan UI BHROIN (Emergency Medicine Specialist Registrar) (Eposter Presenter, Dublin, Ireland)
13:41 - 13:49
Ein Todesfall von Mycobacterium Bovis Tuberkulose in Irland.
Susan UI BHROIN (Emergency Medicine Specialist Registrar) (Eposter Presenter, Dublin, Ireland)
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12:45 - 13:45
Abbott: Mild Traumatic Brain Injury: Finally, light at the end of the tunnel
Chairperson:
Peter BIBERTHALER (Chair) (Chairperson, Munich, Germany)
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12:45 - 13:45
E.Care ED: Customer experience and New Functionality
12:45 - 13:05
Allgemeine erfahrungen mit E.Care ED mit fokus auf pflege-workflow inkl. wertsachendokumentation.
12:45 - 13:45
Meine erfahrungen mit E.Care ED.
13:05 - 13:25
Mobile patient intake.
13:25 - 13:45
Mobile patient intake.
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A24
14:00 - 14:30
Keynote lecture: The Complete Emergency Physician: Capacity building for Emergency Care in Africa
Moderator:
Senad TABAKOVIC (Medical director emergency department) (Moderator, Zürich, Switzerland)
14:00 - 14:30
The Complete Emergency Physician: Capacity building for Emergency Care in Africa.
Joseph BONNEY (Specialist) (Speaker, Kumasi, Ghana)
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14:30 |
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14:30 - 16:30
Disaster Medicine Section Meeting
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Steve PHOTIOU (Crocetta del Montello (TV), Italy)
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A25
14:40 - 16:05
New important clinical guidelines for Emergency Physicians
Moderators:
Christian HOHENSTEIN (PHYSICIAN) (Moderator, BAD BERKA, Germany), Elke PLATZ (Moderator, Boston, USA)
14:40 - 15:05
ESER Polytrauma Guideline.
Elizabeth DICK (Speaker, United Kingdom)
15:05 - 15:30
Heart Failure ESC 2021.
Elke PLATZ (Speaker, Boston, USA)
15:30 - 15:55
Intracranial hemorrhage.
Else Charlotte SANDSET (Speaker, Norway)
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B25
14:40 - 16:05
Ultrasound Gameshow - Interactive, entertaining and educational
Speakers:
James CONNOLLY (Consultant) (Speaker, Newcastle-Upon-Tyne, United Kingdom), Dr Nicolas LIM (Consultant Emergency Medicine) (Speaker, Singapore, Singapore), Eftychia POLYZOGOPOULOU (ASSISTANT PROFESSOR OF EMERGENCY MEDICINE) (Speaker, ATHENS, Greece), Senad TABAKOVIC (Medical director emergency department) (Speaker, Zürich, Switzerland), Paul VAN OVERBEEKE (Emergency Physician) (Speaker, Amsterdam, The Netherlands)
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14:40 - 16:05
Paediatric Emergencies - Interactive cases
Moderator:
Dr Ruud G NIJMAN (academic clinical lecturer) (Moderator, London, United Kingdom)
14:40 - 15:05
Acute Starvation Ketosis in children, SKA.
Ruth Mari LÖLLGEN (Consultant) (Speaker, Stockholm, Sweden)
15:45 - 16:05
Intro Video.
Dani HALL (PEM Consultant) (Speaker, Dublin, Ireland)
15:05 - 15:45
PEM Adventures.
Dani HALL (PEM Consultant) (Speaker, Dublin, Ireland)
15:05 - 15:45
PEM Adventures.
Constantinos KANARIS (Speaker, Virgin Islands, British)
15:05 - 15:45
PEM Adventures.
Sam THENABADU
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E25
14:40 - 16:05
Critical conditions of heart and upper airway
Moderator:
Dr Dagmar Angela MILICEVIC (Emergency Physician) (Moderator, Essen, Germany)
14:40 - 15:25
Myo/peri-carditis including tamponade.
Michael GLEENBERG (Attending, Residency Program Director) (Speaker, Ashdod, Israel)
15:25 - 15:40
Thermal damage to the upper airway.
Nejc GORENJAK (Speaker, Slovenia)
15:40 - 16:05
Pharyngitis, tonsilitis, laryngitis Tracheitis.
Declan STEWART (Ltd. OA) (Speaker, Rostock, Germany, Germany)
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F25
14:40 - 16:05
Panel: Research
14:40 - 16:05
Speaker.
14:40 - 16:05
Speaker.
Thomas SHANAHAN (NIHR Academic Clinical Fellow, Honorary Clinical Research Fellow and Emergency Medicine Trainee) (Speaker, Manchester, United Kingdom)
14:40 - 16:05
Speaker.
Dr Anisa Jabeen Nasir JAFAR (Emergency Medicine trainee) (Speaker, Manchester, United Kingdom)
14:40 - 16:05
Panel Lead.
Pr Rick BODY (Professor of Emergency Medicine) (Panel Lead, Manchester, United Kingdom)
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A5 |
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C25
14:40 - 16:05
EMS/Paramedics
Moderator:
Viliam DOBIAS (Head of Chair) (Moderator, Bratislava, Slovakia)
14:40 - 15:05
The problem of the paramedic profession in Europe.
Thomas WILP (Prehospital Emergency Medical Coordinator) (Speaker, Amman, Ukraine)
15:05 - 15:30
Prevention of unrecognized oesophageal intubation.
George KOVACS (Speaker, Canada)
15:30 - 15:55
Focussed echocardiography by paramedics in the pre-hospital environment - an effective intervention?
Matthew REED (Consultant in Emergency Medicine) (Speaker, Edinburgh)
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A1 |
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G25
14:40 - 16:05
Pflege in der Notaufnahme - wer kann was?
Moderators:
Michael KEGEL (Moderator, Brem, Germany), Denise LEE (Moderator, Germany)
14:40 - 15:05
Praxisanleitung fr die Notfallpflege - Welche Anleitung ist fr wen die beste?
Philipp VERTON (Speaker, Germany)
15:05 - 15:30
Kompetenzen in der Notfallpflege - Was knnen weitergebildete Notfallpflegekrfte?
Dominique OLBRICH (Speaker, Germany)
15:30 - 15:55
Pflege in der Notaufnahme: wo stehen wir, wo gehen wir hin?
Patrick DORMANN (Teammember) (Speaker, Köln, Germany)
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A3 |
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60
14:40 - 15:00
Geriatric Section activities; task forces, guidelines, podcasts, whats next?
14:40 - 15:00
Geriatric Section Chair.
Jacinta A. LUCKE (Emergency Phycisian) (Moderator, Haarlem, The Netherlands)
14:40 - 15:00
New Geriatric Section Chair.
James VAN OPPEN (Clinical Research Fellow / Specialty Registrar) (Moderator, Leicester, United Kingdom)
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EUSEM Podium |
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H25
14:40 - 16:05
Education and Geriatrics
Moderators:
Mairi LAING (Moderator, PAISLEY), Ryan MCHENRY (EM Trainee) (Moderator, Glasgow, United Kingdom)
14:40 - 16:05
#31432 - A mixed-methods study examining student perceived educational benefit of using students as simulated patients in place of mannequins in an undergraduate multidisciplinary simulation event.
A mixed-methods study examining student perceived educational benefit of using students as simulated patients in place of mannequins in an undergraduate multidisciplinary simulation event.
Title
A mixed-methods study examining student perceived educational benefit of using students as simulated patients in place of mannequins in an undergraduate multidisciplinary simulation event.
Authors
Lennie I., Wallace R., Moulds Y., Bell L.
Background
Previous literature has demonstrated significant educational benefit when healthcare professionals role-play as patients during simulation training.
We set out to establish student perceived educational benefit of role-playing patients in place of simulator mannequins during undergraduate multidisciplinary simulation.
Methods
Undergraduate final and penultimate year medical and nursing students undertaking their emergency medicine placements were included in the study. Study period extended between August 2021 and April 2022. Existing University of Glasgow ‘5EM’ simulation scenarios were adapted, and new scenarios designed, to facilitate students role-playing patients in place of simulator mannequins. All students were briefed on the format of the day and familiarised with the simulation environment. Chest and abdomen mannequins and a venepuncture arm were used to prevent unsolicited exposure/examination of actors and elicit clinical signs. Participants were invited to volunteer to play the role of a patient and were briefed and given an instruction card with the details of the patient scenario. The volunteer students were also provided with an earpiece to allow researchers to guide them to scenario template during the scenario. During the debrief and at the end of the simulation event, students were asked to provide feedback on their patient experiences. Feedback was collected both quantitatively, via a feedback form, and qualitatively via focus groups. Feedback forms were statistically analysed. Analysis of the qualitative data is ongoing.
Results
52 undergraduate medical (28) and nursing (24) students participated in the research project. 36 participants were female. Age of participants ranged from 19-46 (mean =23).
90% of participants agreed that, as a result of being a simulated patient, they developed new insights to incorporate into their working role. 90% of participants agreed that playing the role of a patient in a simulation session was a valuable learning experience. 95% of participants agreed or strongly agreed that they gained a new perspective on how patients experience resuscitation. 91% of participants agreed they feel more empathy towards patients undergoing resuscitation.
Early analysis of focus group feedback has shown improved empathy, compassion and better understanding of the workings of the multi-disciplinary team. Students have commented on how this will positively influence their future practice through enhanced communication and empathy. They described enhanced simulation fidelity compared to previous experience of simulation using mannequins.
Discussion
To our knowledge, this is the first research project examining the potential educational benefits of using the patient experience in both a multidisciplinary simulation setting and undergraduate medical curriculum. The project reinforces previous literature findings and demonstrates student-perceived learning, particularly increased patient empathy.
Future work will involve further quantitative feedback forms, 6 months following simulation, to examine whether there has been sustained learning and if changes to practice have been implemented. Cohort studies comparing scenarios with mannequin patients vs student actor patients would provide a more robust data set to further establish educational benefit.
Yvonne MOULDS, Linda BELL, Iona LENNIE (Glasgow, ), Rebekah WALLACE
14:40 - 16:05
#31530 - Brain cell damage markers may be helpful in diagnosing delirium etiology.
Brain cell damage markers may be helpful in diagnosing delirium etiology.
Background: Delirium is a highly prevalent condition in elderly patients, characterized by fluctuating disturbances in attention, cognition, and consciousness level. Its diagnosis is based on clinical scores since no blood test is helpful as a marker. Therefore, this study addresses whether plasma levels of brain cell damage markers may be used as diagnostic and prognostic tools for delirium identification in the emergency department.
Methods: We conducted a prospective cohort study of consecutive patients (>65 years old) admitted to the Emergency Department in a tertiary academic hospital between April 2019 and November 2020. We collected baseline sociodemographic/clinical data and performed the confusion assessment method (CAM), a standardized and evidence-based instrument to recognize the occurrence of delirium at admission. In addition, blood samples were collected at admission, and cytokines and brain cell injury markers (S100beta, Neuron Specific Enolase, Tau protein) were measured by Luminex or ELISA. Statistical analyses were performed using the nonparametric Kruskal-Wallis chi-squared command in R Studio (version 4.0.3 for Windows) for categorical variables and the results expressed in percentage. Mann-Withney test was used for continuous variables and results expressed in median and interquartile range. A p-value < 0.05 was considered significant.
Results: Two hundred patients were included and divided according to the presence of delirium (CAM+) or not(CAM-). In addition, each group was also divided regarding the presence of infection (INF+) or not (INF-). Patients in CAM+ were older than CAM- (median age 77 [73-85] vs. 72 [68-77.5] years, respectively), and the previous diagnosis of dementia and cerebrovascular events were more prevalent. Other demographic characteristics and previous conditions were equally distributed. Moreover, patients in the CAM+ group present higher mortality rates and ICU stays (31.92% and 42.55%, respectively) when compared to CAM- group (7.89% and 24.34%) and more extended hospital stay. There was no significant difference in circulating proteins that are markers for neuronal death between the CAM+ and CAM- groups. However, when only the CAM+ patients were evaluated, higher levels of NSE (2.68 [1.63-3.40] ng/ml) and Tau (75.09 [43.8-102.1]) were measured in the INF+ patients when compared to non-infected patients (NSE 1.51 [0.85-2.05]; Tau 55.56 [40.09-84.78] ng/ml)
Discussion and conclusion: Circulating proteins used to detect neuronal death (S100Beta, NSE and Tau) do not help diagnose and prognosis of delirium. However, they may be useful for identifying the infectious etiology of delirium at Emergency Services.
Ethical approval and informed consent: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068), which also waived the need for written informed consent. We adhere to STROBE guidelines.
Funding: FAPESP and HCFMUSP
Agnes ARAUJO SARDINHA PINTO (Sao Paulo, Brazil), Maira MELLO DE CARVALHO, Hermes VIEIRA BARBEIRO, Luz MARINA GOMEZ GOMEZ, Thiago AVELINO-SILVA, Flavia BARRETO GARCEZ CARVALHO, Heraldo POSSOLO DE SOUZA, Julio GARCIA DE ALENCAR
14:40 - 16:05
#31272 - Establishment of a rural emergency medicine residency to address an underserved population.
Establishment of a rural emergency medicine residency to address an underserved population.
Background: Rural citizens are an underserved community in terms of health care with access to trained emergency physicians (EPs) even less available for this population. Emergency medicine (EM) residencies in the United States have historically been located in urban and suburban areas. Upon completion of training, newly minted emergentologists typically enter practice in larger communities where access to other specialists and diagnostic and therapeutic options generally mirrors the environment in which they were trained. Rural hospitals are much more resource limited in terms of specialists, procedures and available diagnostic tests. EPs in such an environment are required to perform tasks that are unnecessary for them in tertiary care centers including the management of patients longer while effecting transfers to a higher level of care.
Methods: We were recruited by the leadership of the hospital (Magnolia Regional Health Center in Corinth, Mississippi) to establish a rural EM residency. The facility had a preexisting Office of Graduate Medical Education with an internal medicine residency and cardiology fellowship. Upon recruitment of adequate faculty and establishing a partnership with the University of Mississippi Medical Center for a required Pediatric Intensive Care Unit rotation, the residency application was submitted and approved. Our first residency class began July 1, 2020.
Results: Quality EM metrics such as patient satisfaction scores improved, presumably, from increased facetime with physicians by both patients and their families. Our EM residents are easily meeting metrics on required procedures because there is no competition with residents in other programs. Initial concerns over lack of interaction with residents and fellows from other disciplines were allayed by communication with members of the medical staff in those specialties and with accepting physicians when transfers were arranged. The medical staff welcomed the interaction and integration of EM residents into the facility.
Conclusions: A quality EM residency can and must exist in a rural setting to facilitate recruitment and retention of sufficient numbers of trained EPs into such a practice. Collaboration with larger educational institutions is essential to procure required or needed services and rotations that are unavailable locally. Additionally, residents at larger institutions would benefit from rotations in rural programs by (1) acquiring experience working closely with the medical staff; (2) learning quality measures that are tracked and reported; (3) having more responsibility in patient care due to reduced competition from other residency programs for procedures, etc. and (4) honing skills rarely needed in a tertiary care hospital such as transferring patients to another facility and caring for them until the transfer can be effected. A symbiotic relationship should exist between rural and traditional residency programs. Additionally, our model should be exportable in developing rural residencies.
None
Frederick CARLTON (Oxford, MS USA, USA), Japheth BAKER
14:40 - 16:05
#31217 - EXTENDED REALITY AS A TRAINING METHOD FOR MEDICAL EMERGENCIES: A SYSTEMATIC REVIEW.
EXTENDED REALITY AS A TRAINING METHOD FOR MEDICAL EMERGENCIES: A SYSTEMATIC REVIEW.
Introduction:
The rapid evolution and growing popularity of extended reality systems (virtual, mixed and augmented reality) have expanded their use as a learning tool, especially in healthcare. This novel technology brings significant benefits, such as the possibility of training in safe environments, the capacity for repetition to perfect skills, or the opportunity to better internalise the knowledge and skills acquired, thanks to greater realism and immersion in the simulation.
Considering the essential role of healthcare first responders in mass casualty incidents (MCI), it is crucial to enhance the training they receive to strengthen their preparedness and response to this type of situation. Consequently, the European project MED1STMR will develop a new mixed reality training to train first responders for disasters.
Objectives:
In the initial phase of the project, a systematic review is being conducted to:
First, synthesise the existing scientific literature on extended reality to train emergency medical teams in MCI.
Determine the effectiveness of these training systems.
Finally, explore the perception and acceptability of healthcare first responders.
Method:
For transparency and reproducibility, the recommendations of the PRISMA guidelines were followed, and this systematic review was registered in PROSPERO. To identify relevant studies, a search strategy was developed with the support of a librarian. This strategy is based on inclusion/exclusion criteria. It comprises terms related to the four main aspects: out-of-hospital emergency medical personnel (participants), education/training (intervention), MCI (setting/environment), and extended reality. The search was conducted in four databases: Medline, EMBASE, CINAHL, LILACS, and grey literature and reference lists of included studies. To facilitate the article selection processes and duplicate data extraction, the Covidence platform was used, in which META-QAT was also integrated as a tool to assess study quality. The information collected is being analysed and summarised in narrative and semi-quantitative form.
Results:
The search strategy identified 2799 studies, of which finally included 18. Preliminary results reveal that it is not possible to conduct a meta-analysis, given the heterogeneity of the articles concerning participants, types and duration of the training, and ways of assessing effectiveness. Most studies were conducted in North America (n=12), and publication date ranges from 2007 to 2020. Participants include combinations of physicians, nurses and EMTs, paramedics and students from the professions mentioned earlier. The MCI scenarios are varied, although explosions are the most commonly reported (n=8). The most frequently used type of extended reality is virtual reality (n=15), and the most commonly learned skills during training are triage (n=15). Regarding the effectiveness of the interventions, there is much diversity in measurement methods, ranging from subjective Likert scales to validated questionnaires. However, in all studies where participants' perception or experience was explored (n=12), satisfaction and acceptance were high and positive.
Conclusions:
This systematic review will serve as a basis for the MED1STMR to measure the effectiveness of extended reality training. It will also provide insight into the previous experiences of first responders.
Particular emphasis should be placed on this innovative training methodology to improve the preparedness and performance of out-of-hospital emergency medical teams for future MCI.
This project is funded by the European projects Horizon 2020 with Grant Agreement number: 101021775 — MED1stMR — H2020-SU-SEC-2018-2019-2020 / H2020-SU-SEC-2020
Mario AROCA, Tatiana VAZQUEZ (Madrid, Spain), Alberto BLANCO, Lucia OTERO, Jessica NALDRETT, Miriam UZURIAGA, Raquel MORENO, Carmen CARDÓS ALONSO
14:40 - 16:05
#31383 - Immigration bias in medical students – a randomized control trial.
Immigration bias in medical students – a randomized control trial.
Background:
Ethnical and racial disparities are widespread in health care. Racial bias has been found in physicians and medical students, mainly in the US. To our knowledge it is however yet unknown whether medical students in Europe show a bias towards immigrant patients.
Methods:
This study was conducted in a 2 x 2 randomised controlled design. All medical students at the Medical University of Vienna enrolled in the mandatory doctor-patient communication course during their second year of studies were included. Two professional actors were instructed to depict patients suffering from abdominal pain of a strength of 4 out of 10. Four different patients were portrayed: Two males, two females, each with and without immigration status. Immigration status was depicted by stereotypical clothing and name. Besides gender and immigrant status, the patients reported the same complaints and identical medical history. Students were randomised to be shown one of the four videos. Afterwards, they were asked whether they would administer pain medication (yes/no, primary outcome), as well as their assessment of strength of pain (secondary outcome). For the primary outcome, the proportion of patients receiving pain medication by the students, a logistic regression model was used. Migration status of the patient, gender of the patient, age of the student and gender of the student served as covariates. The study was performed using an online teaching platform (Moodle®).
Results:
A total of 607 medical students (56% female [n=337], 42% male [n=255], 2% other [n=15]) were recruited between January and February 2022. The majority was in the age-group of 18-22 years (64%, n=387), followed by 23-27 years (27%, n=163). For the patients without immigrant status, 95.2% of students stated they would administer pain medication, and for patients with migration status 94.6% of students stated they would do so (absolute difference 0.6%, 95% CI -2.9% - 4.1%). The logistic regression model showed no significant association between migration status of the patient and the proportion of suggested pain medication (OR 0.80, 95% CI 0.38 - 1.67, p = 0.56). Furthermore, the gender of the patient and the age of the student did not show a significant association for pain medication rate.
Discussion & Conclusions:
Our data showed no association between migration background and the proportion of pain medication administered by second year medical students. It is important to note that these results do not rule out bias towards patients with immigration status. However, medical students appear to show no explicit bias in our theoretical example.
Funding: This study did not receive any specific funding.
Ethical approval and informed consent: This study was approved by the independent Ethics Committee of the Medical University of Vienna and complies with the Declaration of Helsinki.
Jürgen GRAFENEDER (Vienna, Austria), Andjela BÄWERT, Viktoria DREXLER, Jan NIEDERDÖCKL, Anita HOLZINGER, Dominik ROTH
14:40 - 16:05
#31188 - Improved emergency medicine residents’ clinical and non-technical skills, confidence, learning and patient care through simulation-based education: an observational study.
Improved emergency medicine residents’ clinical and non-technical skills, confidence, learning and patient care through simulation-based education: an observational study.
Introduction:
All residency programs, especially emergency medicine (EM), incorporate simulation-based education (SBE) in their curriculum as an integral part. This is in addition to traditional teaching methods like didactics. Simulation-based education is generally considered to be better than traditional methods in developing not only clinical but also non-clinical skills according to many studies. This is attributed to the educational theories which underpin the concept of simulation. It is essential that any successful emergency medicine residency program should have an effective simulation-based learning experience for its residents.
Objective:
We aimed to study the effect of simulation-based education in improving the emergency medicine residents’ clinical and non-technical skills along with their overall confidence, learning experience and patient care.
Method:
We designed a prospective observational study at our Emergency Medicine Institute, Cleveland Clinic Abu Dhabi. All the current emergency medicine residents (Year 1, R1 = 3 and Year 2, R2 = 3) were included. We started an Emergency Medicine Simulation Series based on simulation-based curriculum which was specifically designed for EM residents. Each month, a 4-hour simulation session was conducted involving 3 simulation scenarios separately for both R1 and R2. From August 2020 to April 2022, total of 20 such simulation sessions were conducted (20 x 3 = 60 scenarios). Expert faculty used, our own designed, objective Emergency Medicine Simulation Assessment Tool (EMSAT) to record performance against clinical and non-technical skills. Total 15 sub-tasks were divided into 60% clinical (9 sub-tasks) and 40 % non-clinical/non-technical (6 sub-tasks). Overall competency assessment score (CAS) was calculated at the end. Residents were also given a feedback form at the end of each session and evaluations were sought against a 5-point rating scale. We divided the data into two groups, first 10 sessions (30 scenarios) as phase-I and last 10 sessions (30 scenarios) as phase-II. We used the two-tailed paired T test to compare both phases. Primary outcome was considered to be the improvement in clinical and non-technical skills using EMSAT as percentage scores. The secondary outcome was considered to be improvement in confidence, learning and patient care using resident’s feedback against 5-point rating scale.
Results:
Results of the paired T test indicated that there was a significant large difference for clinical skills between phase-I (M=65.7, SD=9.4) and phase-II (M=84.9, SD=4.4), t(29) =10.1, p < .001. Similarly, for non-technical skills the difference was noted between phase-I (M=59, SD=7.7) and phase-II (M=79.1, SD=7.3), t(29) =9.1, p < .001. The secondary outcomes showed similar trend for confidence (phase-I (M=2.2, SD=0.8) and phase-II (M=3.9, SD=0.8), t(29) =8.9, p < .001), learning experience (phase-I (M=1.9, SD=0.8) and phase-II (M=4, SD=0.8), t(29) = 9.1, p < .001) and patient care (phase-I (M=2, SD=0.9) and phase-II (M=4.1, SD=0.8), t(29) =9.2, p < .001).
Conclusion:
A significant improvement is noted in emergency medicine resident’s clinical and non-technical skills as well as their confidence, learning experience and patient care with simulation-based education. In addition to the standard clinical training for residents in the emergency medicine, simulation-based education is a valuable adjunct.
Trial registration was not required.
No funding was required.
Study was done as a part of regular simulation program for EM residents.
Muhammad Saif REHMAN (Abu Dhabi, United Arab Emirates), Shaza KARRAR, Falak SAYED, Waqaas AHMAD
14:40 - 16:05
#31203 - Longitudinal Survey Assessment of a Virtual Simulation Workshop on Clinical Debriefing in the Emergency Department.
Longitudinal Survey Assessment of a Virtual Simulation Workshop on Clinical Debriefing in the Emergency Department.
Introduction: Structured clinical debriefs in the emergency department (ED) have been shown to improve team performance and departmental processes yet debriefs are infrequently performed. One reported barrier is staff discomfort in leading debriefs stemming from the lack of formal training in clinical debriefing. The purpose of our study was to develop and evaluate the impact of a simulation-based workshop designed to train ED staff in clinical debriefing. Our primary outcome was measurement of participant comfort in leading debriefs post-workshop. Additional outcome measures included frequency of debriefs and debrief leadership skill-level following the workshop.
Methods: We developed a two-hour simulation-based workshop with clinical experts that was refined through an iterative process. The workshop was administered virtually by two physicians experienced with clinical debriefing through a video-conferencing platform. Recruitment of ED staff included physicians, nurses and allied health staff at a large single-center Urban hospital in Toronto, Canada via convenience sampling. Participants were provided with a structured debriefing tool that was already in use in the ED at the institution. Simulation sessions in the workshop required participants to lead observed clinical debriefs with feedback provided from facilitators. For data collection, we created surveys with clinical and research experts modeled after the Kirkpatrick model of training evaluation. Participants completed structured surveys at three time points i) pre-workshop, ii) post-workshop, and iii) two-months post-workshop. Survey questions consisted of Likert-Scale items that were later coded for statistical analysis. Data analysis was done using IBM SPSS analytical software and included student’s paired t-test and Wilcoxon rank-sum test for ordinal data. Our study was approved by the hospital research ethics board as a department education project.
Results: A total of 36 participants were recruited in the study. 72% of participants completed all three surveys. Significantly more participants rated an increase in level of comfort leading debriefs at the two-month follow-up (mean Likert score 4.15, p 0.001) compared to pre-workshop (mean Likert score 3.23). Similarly, the debrief leadership skill-level at two-month follow-up was significantly higher (mean Likert score 3.22, p 0.01) compared to pre-workshop (mean 2.66). Regarding the frequency of debriefs, there was no significant change in ED clinical debriefs performed by participants before and after the workshop. Sources of bias that limited our study were selection bias and participant re-call bias.
Discussion and Conclusion: Our results indicate that a case-based virtual simulation workshop is an effective educational tool to improve staff learning and performance in leading clinical debriefs in the ED. Furthermore, the workshop displayed versatility as an effective educational tool for nurses and allied health professions in addition to physicians. The workshop did not impact the number of debriefs completed. A possible explanation is that other barriers to performing debriefs in the ED, such as time constraints on staff, need to be addressed in addition to formalized training of staff. Additionally, our follow-up time may have been too short at the two-month period to assess frequency of debriefs.
none
Priyank BHATNAGAR, Alia DHARAMSI (Toronto, Canada)
14:40 - 16:05
#30911 - Unplanned Re-visits of Seniors in the Emergency Department.
Unplanned Re-visits of Seniors in the Emergency Department.
Background:
Seniors have a high risk of re-visits to emergency departments (ED) varying between 12-20% within the first month and 19-33% within three months after ED discharge. The rate of ED re-visits within 72 hours is a key indicator for quality of care in emergency medicine and varies between 1-15%. Reasons for ED re-visits are the natural course of illness, misdiagnosis, lack of homecare and self-discharge against medical advice. However, risk factors for ED re-visits have not been fully investigated. Therefore, the aim was to analyse the incidence of ED re-visits and to identify risk factors for ED re-visits within 72 hours one and three months after ED discharge.
Methods:
In this retrospective study, seniors (≥ 70 yrs.) were consecutively enrolled if they presented with an Emergency Severity Index of 2 or 3 in a tertiary care ED in 2019, and were discharged after the ED visit.
The frequencies of unplanned ED re-visits within 72 hours, one and three months after ED discharge as well as reasons and potential risk factors for ED re-visits were investigated by univariate and multivariable logistic regression models.
Results:
592 seniors were enrolled of whom 30 patients (5.1%) re-visited the ED significantly more often for gastrointestinal complaints (OR 2.9, 95% CI 1.04 – 8.2, p=0.043) such as vomiting and abdominal pain within 72 hours after ED discharge. Furthermore, discharge against medical advice (OR 5.6, 95% CI 1.7 – 18.1, p=0.004) and ED presentation during night shifts (OR 2.7, 95% CI 1.2 – 6.1, p=0.014) were significant risk factors for ED re-visits within 72 hours after discharge.
Sixty-six seniors (11.2%) re-visited the ED within one month after discharge and 79 patients (13.3%) within three months. Hospital stay in the preceding six months before the index ED presentation was a risk factor for ED re-visits within one (OR 2.0, 95% CI 1.2 – 3.4, p=0.009) and three months (OR 2.0, 95% CI 1.2 – 3.3, p=0.005) after ED discharge. Seniors who presented at the index ED visit with uro-genital symptoms (OR 2.1, 95% CI 1.0 – 4.5, p=0.050), during night shifts (OR 1.9, 95% CI 1.1 – 3.4, p=0.028) or living alone (OR 1.9, 95% CI 1.04. – 3.5, p=0.036) had an increased risk for ED re-visits within three months after discharge.
Conclusion:
Although the frequencies of ED re-visits among seniors at 72 hours, one and three months after discharge tends to be low and most re-visits were illness-related, seniors need to be assessed for risk factors for ED re-visits. Discharge should be carefully evaluated in order to improve patient safety and in balance to ED overcrowding and health care costs.
It is not a trial therefore, no trial registration.
No funding.
Dr Ksenija SLANKAMENAC (Zurich, Switzerland), Jenny MÜLLER, Dagmar I. KELLER
14:40 - 16:05
#31390 - Use of technology to deliver and enhance Paediatric Emergency Medicine Induction: An Evaluation Study.
Use of technology to deliver and enhance Paediatric Emergency Medicine Induction: An Evaluation Study.
Background:
The Royal College of Emergency Medicine provides standards for inducting junior doctors in training who are rotating into emergency medicine, including how to gain senior support, access guidelines and workplace policies as well as how to raise concerns. Despite these guidelines junior doctors often feel underprepared and anxious about starting their new role. There is no national consensus on how to best deliver an induction program, but there is increasing evidence to support online induction in combination with face to face near pear teaching and simulation. These methods have shown improvement in junior doctor knowledge retention, reduction in anxiety and improved confidence.
Aim:
This evaluation study assessed the effectiveness of online videos followed by a near-peer simulation as methods for delivering junior doctor induction in a paediatric emergency department.
Methods:
Participants were purposefully selected as junior doctors rotating into a tertiary paediatric emergency department in the UK between February and March 2022. They were a mix of both paediatric and emergency medicine trainees. They received a 2-day induction comprising of both online videos and simulation. The online induction covered a wide range of topics from introductions to senior team members, accessing guidelines and how to make referrals. As part of the face-to-face induction the participants were orientated to the department and then underwent a near-peer simulation. The simulation was tailored to include scenarios that would be most useful to the participants based on their training background. A questionnaire was distributed to collect qualitative and quantitative data on the induction.
Results:
A total number of 9 participants rotated into the ED between February and March 2022. 90% rated the induction as either good or excellent. Comments included: ‘the best induction I’ve had during training’ and ‘a mixture of online and face to face is the best way forward.’
Online induction:
There was an 89% response rate to the questionnaire. 80% of participants either strongly agreed or agreed that the induction had prepared them to start working in the department. 91% felt welcomed and well orientated to the departments. Comments included: ‘excellent online videos, can go at own pace’ and ‘videos introducing the consultants were friendly and welcoming’.
Near-peer simulation:
There was a 78% response rate to the questionnaire. 100% of participants found the simulation sessions extremely or very useful and 100% of participants either strongly agreed or agreed that the induction simulation had improved their confidence when dealing with unwell patients in the department.
Conclusion:
This evaluation study highlights the benefits of using both online and near-peer simulation to orientate and prepare junior doctors to start work in a paediatric ED. Online induction video allows user flexibility, whereas the simulation provides hands-on skills and training related to the job and the specific department. These simple methods can be incorporated by other trusts to help junior doctors feel orientated and prepared to start work in their new role.
Rebecca AYRES (Birmingham, ), Hannah COONEY, Anand KANANI
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M1-2-3 |
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15:00 - 15:30
Q&A with Chairs of Sections and Committees
15:00 - 15:30
Geriatric Section Chair.
Jacinta A. LUCKE (Emergency Phycisian) (Panelist, Haarlem, The Netherlands)
15:00 - 15:30
Pre-hospital Section Chair.
Eric REVUE (Chef de Service) (Panelist, Paris, France)
15:00 - 15:30
Professional Commitee Chair.
Dr John HEYWORTH (Consultant) (Panelist, Southampton, United Kingdom)
15:00 - 15:30
Paediatric Section Chair.
Zsolt BOGNAR (Head of Department) (Panelist, Budapest, Hungary)
15:00 - 15:30
YEMD Section Chair.
Canberk Djan MESELI (EMERGENCY MEDICINE RESIDENT) (Panelist, DUBLIN, Ireland)
15:00 - 15:30
Education Committee Chair.
Gregor PROSEN (EM Consultant) (Panelist, MARIBOR, Slovenia)
15:00 - 15:30
Toxiciology Section Chair.
Kurt ANSEEUW (Medical doctor) (Panelist, Antwerp, Belgium)
15:00 - 15:30
Ethics Committee Chair.
Bernard FOEX (Consultant in Emergency Medicine and Critical Care) (Panelist, Manchester, United Kingdom)
15:00 - 15:30
Fellowship Committee Chair.
Dr Barbara C HOGAN (Past President of the European Society for Emergency Medicine, EuSEM) (Panelist, HAMBURG, Germany)
15:00 - 15:30
New Geriatric Section Chair.
James VAN OPPEN (Clinical Research Fellow / Specialty Registrar) (Panelist, Leicester, United Kingdom)
15:00 - 15:30
EMERGE Co-Chair.
Mohammad Ashraf BUTT (Consultant in Emergency Medicine) (Panelist, Cavan, Ireland)
15:00 - 15:30
Workgroup Quality & Safety Chair.
Pr Abdelouahab BELLOU (Director of Institute) (Guangzhou, China)
15:00 - 15:30
EMERGE Co-Chair.
Anna SPITERI (Consultant) (Panelist, Malta, Malta)
15:00 - 15:30
Professional Wellbeing Workgroup Chair.
Roberta PETRINO (Head of department) (Italie, Italy)
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16:05 - 16:35
EMERGE about why to take the European Board Examination in Emergency Medicine (EBEEM)
16:05 - 16:35
EMERGE Co-Chair.
Mohammad Ashraf BUTT (Consultant in Emergency Medicine) (Moderator, Cavan, Ireland)
16:05 - 16:35
EMERGE Co-Chair.
Anna SPITERI (Consultant) (Moderator, Malta, Malta)
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EPOSCB3SC1
16:10 - 16:30
Coffee Break 3 - EPoster session - Screen 1
Moderator:
Canberk Djan MESELI (EMERGENCY MEDICINE RESIDENT) (Moderator, DUBLIN, Ireland)
16:10 - 16:15
Prediction of pain intensity after 15 and 30min post analgesia: a pilot study in PED.
Kristina GANZIJEVA (Medical student) (Eposter Presenter, Kaunas, Lithuania, Lithuania)
16:20 - 16:25
Meducation in Lithuania: basic life support workshops for high school children.
Beatrice RASCIUTE (Resident Doctor) (Eposter Presenter, Vilnius, Lithuania)
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16:10 - 16:30
Coffee Break 3 - EPoster session - Screen 4
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EPOSCB3SC3
16:10 - 16:30
Coffee Break 3 - EPoster session - Screen 3
Moderator:
Gabor Zoltan XANTUS (PhD student) (Moderator, Pecs, Hungary)
16:10 - 16:15
Prognostic factors in non st elevation myocardial infarction.
Hela BEN TURKIA (Medical student) (Eposter Presenter, Ben Arous, Tunisia)
16:15 - 16:20
Prognostic performance of shock-index and modified shock-index in non st elevation myocardial infarction.
Syrine KESKES MESTIRI (MEDECIN) (Eposter Presenter, Tunis, Tunisia)
16:30 - 16:35
Epidemiology of sepsis in patients admitted to the emergency department.
Boutheina FRADJ (Medical Student) (Eposter Presenter, Mahdia, Tunisia)
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16:10 - 16:30
Coffee Break 3 - EPoster session - Screen 2
Moderator:
James VAN OPPEN (Clinical Research Fellow / Specialty Registrar) (Moderator, Leicester, United Kingdom)
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16:10 - 16:30
Coffee Break 3 - EPoster session - Screen 5
Moderator:
Silvia BRESSAN (Moderator) (Moderator, Padova, Italy)
16:15 - 16:20
Qualitative study exploring perspectives of Ambulance and Emergency Department staff and people who use opiates on the feasibility of distributing Take Home Naloxone in Emergency Settings.
Fiona SAMPSON (Health Services Researcher) (Eposter Presenter, Sheffield, United Kingdom)
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16:10 - 16:30
Coffee Break 3 - EPoster session
16:10 - 16:30
#31001 - Analysis of the bacterial resistance profile in the emergency department of a regional hospital over a five-year period and its possible influence on the pandemic.
Analysis of the bacterial resistance profile in the emergency department of a regional hospital over a five-year period and its possible influence on the pandemic.
Introduction/Objectives:
The emergence, spread and selection of bacteria resistant to antibiotics are a threat to the patient safety as they increase morbimortality and hospital stay. In recent decades there has been a progressive increase in the use of antimicrobials and also in infections caused by multidrug-resistant bacteria. Therefore, it is necessary a global intervention to optimise the use of antibiotics and prolong their lifetime.
The aim of this study is to analyse the resistance profile of enterobacteria such as E. coli and K. pneumoniae, and Gram-positive bacteria such as S. aureus towards β-lactam and quinolone antibiotics over a five-year period in the emergency department of a regional hospital. The last two years of the period analysed (2017-2021) coincide with the pandemic caused by COVID-19.
Material and Methods:
Retrospective study of the aforementioned bacterial strains isolated in biological samples over the period 2017-2021. The sensitivity study was performed with the automated MicroScan Walkaway System (Beckman Coulter®). The interpretation of MIC results was based on the criteria recommended by EUCAST.
Results:
Over this period, 5145 isolates of the microorganisms of study were recorded. This total included 3686 E. coli (2017: 1057, 2018: 948, 2019: 545 2020: 591 2021:545), 899 K. pneumoniae (2017: 366, 2018: 197, 2019: 162, 2020: 91, 2021: 83) and 556 S. aureus (2017:181, 2018:153, 2019:85, 2020:53, 2021:68). Among the microorganisms analysed during the five years, there were obtained 204 E. coli BLEE, 733 E.coli R-quinolones; 99 K. pneumoniae BLEE, 334 K. pneumoniae R-quinolones, no resistance to carbapemens was detected in the enterobacteria; 66 S. aureus R-methicillin and 66 S. aureus R-quinolones. The percentages of resistance per microorganism and year (2017, 2018, 2019, 2020, 2021) were: E. coli BLEE (4,7,12,5, 6), E. coli R-Carbapemens (0,0,0,0,0), E. coli R-Quinolones (25,30,53,21,30), K. pneumoniae BLEE (8,11,20,9,8), K. pneumoniae R-Carbapemens (0,0,0,0,0), K. pneumoniae R-Quinolones (33,68,34,18,12), S. aureus R-Methicillin (8,18,9,9,5), S. aureus R-Quinolones (12,18,9,9,5).
Conclusions:
During the pandemic, there has been a marked decrease in the number of isolates of the microorganisms studied. In addition, the resistotyping of the microorganisms analysed during the pandemic presented some variations. E. coli isolates presented an increase in their resistance to β-lactams and R-quinolones in 2019. The number of S. aureus R-methicillin and R-quinolones strains decreased during the last 3 years. However, in K. pneumoniae isolates, there is an increase in the number of strains resistant to β-lactams, while resistance to quinolones decreased. Due to the variations in sensitivity profiles observed, it is necessary to update the control strategies to prevent the spread of resistant strains.
Virginia PÉREZ DOÑATE, Carla RUBIO ARONA, Álvaro LIESA TORDERA, Olalla MARTÍNEZ MACÍAS, María BORRÁS MAÑEZ, Tania PASCUAL MARTÍN, Elisa IBÁÑEZ MARTÍNEZ, María CUENCA TORRES (alzira, Spain)
16:10 - 16:30
#31429 - Application of the CARE rule in the triage of patients with chest pain: an observational prospective study.
Application of the CARE rule in the triage of patients with chest pain: an observational prospective study.
Background:
In the Western countries non-traumatic chest pain represents 6-10% of admission to the Emergency Department (ED), but only 15-20% of these is due to acute coronary syndrome (ACS).
In the last 15 years many scoring systems have been developed for the ED physician to stratify patients depending on the risk of major adverse cardiac events (MACE), particularly the HEART score. Instead, the sensitivity of triage systems in identifying acute cardiovascular events in patients presented to the ED with chest pain is yet not optimal.
In 2018, Moumneh et al. proposed a new rule, derived from HEART score by excluding the troponin item, named CARE (characteristics of the pain, age, risk factors, and ECG). The results of the CARE rule are considered low risk if the sum of these four criteria is below 2.
The aim of this study is to test the performance of the CARE rule in the correct stratification of ACS risk during the triage of patients complaining of non-traumatic chest pain.
Method:
This is an observational prospective monocentric study carried out at the emergency department (ED) of a tertiary university hospital in Bologna, Italy. We enrolled 4086 consecutive 18 or older aged patients admitted for non-traumatic chest pain from 25th November 2019 to 24th November 2020. The main exclusion criteria were: presence of ST-segment elevation at the ECG; patients who denied their consent; patients lost during the follow up.
Each patient underwent ECG and a complete triage interview at the arrival to the ED, then the CARE rule was calculated. The 30 days follow-up was performed through a phone call to the patients in order to register MACE.
The main outcome of the study was an occurrence of MACE below 1% in the low risk group.
The performance of the score has been described by the estimates of sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV).
Results:
Through the application of exclusion criteria, 3157 patients were included in the analysis.
730 patients (23%) had a CARE rule < 2 and 1 (0.1%) of them presented MACE (death for active malignancy at 25 days). 2427 (77%) patients were classified at high risk and 507 (21%) presented MACE. Sensitivity was 99.8%, specificity was 27%, PPV was 21% and NPV was 99.8%. Positive likelihood ratio (LR+) 1.4, negative LR (LR-) 0.01.
Discussion and conclusion
The results of this study suggest that CARE rule has a good discriminatory capacity for acute cardiovascular
events and it could help triage nurses in the identification of low risk patients.
During the triage assesment for chest pain patients the nurse collect many information about the patient, his past medical hysory, the characteristcs of the pain and he acquire an ECG. Thus, the calculation of the CARE scoring could be rapidly obtained.
Of our best knowledge, the routine application of CARE rule may improve triage performance for patients with non traumatic chest pain, especially in the decision of the medical assesment priority.
Study approved by ethics committee with registration number 480/2019/Oss/AOUBo.
This study did not receive any specific funding.
Gabriele FARINA, Dr Eleonora TUBERTINI (Bologna, Italy), Luca SANTI, Alice GRIGNASCHI, Maria Grazia MIRARCHI, Maria Laura ARTESIANI, Ilaria CARAMELLA, Dario CARUSO, Elena CASADEI, Giulia CESTER, Vittorio CUCCIARDI, Valentina GAMBERINI, Sara NANNI, Daniela NIZZA, Francesca TRABALZA, Sauro CANOVI, Nicola CARANGELO, Giulia FUSCHILLO, Daniele PERRONE, Mario CAVAZZA, Fabrizio GIOSTRA
16:10 - 16:30
#31422 - Can assessed frailty predict adverse outcomes in a Swedish Emergency Department Setting? A multicentre prospective observational study.
Can assessed frailty predict adverse outcomes in a Swedish Emergency Department Setting? A multicentre prospective observational study.
Background:
Frailty is a common syndrome associated with increased risk for adverse events including falls or other accidents, hospitalization, and mortality. Increasing numbers of elderly visit the Emergency department(ED), and identification of frail elderly patients at increased risk of adverse events holds promise for improved patient outcomes. The Clinical Frailty Scale (CFS) is a 9-points frailty assessment instrument in patients ≥ 65 years of age, with assessments ≥ 5 points being regarded as frailty. The instrument is globally used and has been recommended for use in the ED, but no larger study has investigated the predictive performance of CFS when assessed by regular ED staff. The aim of this study was to prospectively investigate the predictive ability of CFS scoring regarding adverse outcomes in three Swedish EDs.
Method:
This was a prospective observational study of consecutive patients, 65 years and older, visiting one of three EDs within a regional healthcare system in Sweden serving 450 thousand inhabitants. CFS was assessed by either the physician, registered nurse or the assistant nurse. Frail patients were defined as having CFS ≥ 5 and compared with non-frail patients (CFS < 5). The primary outcome was mortality at 30 days. The secondary outcomes were: Mortality at 7 and 90 days, length of stay in the ED, admission rate, hospital length of stay (LOS) and return visits to the ED. Association between frailty and mortality at 7, 30, and 90 days post index visit, admission rate and return visits to the ED was calculated with the Chi2-test or Fisher’s exact test when the number of outcomes were lower than 5 in any group. Correlation between the CFS score and LOS was assessed by Spearman's correlation.
Results:
A total of 1928 patients were analyzed, of which 656 (34%) were assessed as frail. Mortality was higher in frail patients compared to non-frail patients at 7 days (19/659 (3%) vs 2/1269 (0.2%), p<0.001), 30 days (57/659 (9%) vs 12/1269 (1%), p<0.001) and 90 days (105/659 (16%) vs 32/1269 (3%), p<0.001) respectively. Frail patients had higher admission rates (382/659 (58%) vs 464/1269 (37%), p<0.0001) and more return visits to the ED (290/659 (44%) vs 409/1269 (32%), p<0.001) compared to non-frail patients. There was no correlation between CFS score and ED LOS (r=0.02, p=0.56) and weak correlation with inhospital LOS (r=0.13, p=0.0007).
Conclusion:
Frailty in ED patients was associated with adverse outcomes, indicating that frailty assessment using the Clinical Frailty Scale may provide valuable information for identifying elderly patients at increased risk of poor outcomes in the ED.
Trial registration: The study was registered on ClinicalTrials.gov identifier: NCT04877028
Funding: This study did not receive any specific funding.
Samia MUNIR EHRLINGTON (LINKÖPING, Sweden), Erika HÖRLIN, Rani TOLL JOHN, Jens WRETBORN, Daniel WILHELMS
16:10 - 16:30
#31520 - Can video counselling decrease the work stress among health care professionals during and after Covid-19 pandemic. An intervention Study.
Can video counselling decrease the work stress among health care professionals during and after Covid-19 pandemic. An intervention Study.
Introduction
The novel corona virus COVID-19 has burdened frontline health care workers in a non before seen scale internationally. In a Cochrane review (2020) Pollock et al reviewed the interventions to support the resilience and mental health of frontline health and social care professionals during and after disease outbreak, epidemic or pandemic. They concluded that there is a lack of evidence from studies carried out during or after disease outbreaks, epidemics or pandemics that can inform the selection of interventions that are beneficial to the resilience and mental health of frontline health and social care professionals. Alternative sources of evidence, such as evidence arising from other healthcare crises, and general evidence relating to the effectiveness of interventions to support mental well-being during stressful situations, should therefore be used to inform decision making.
Our study group is currently conducting a study among frontline healthcare workers in Finland. The main aims of the study are the following:
To affirm our hypothesis that with solution-based video-counselling we can improve the work
resilience of health-care professionals working with COVID-positive or suspected positive patients in various ways:
1. By developing coping mechanisms to prevent empathy-strain (where health care
professional lives thru the pain of the patient).
2. By creating methods to leave distressing cases at work with the help of defusing group.
3. By enhancing routines that helps to cope with the prolonged demanding work environment
that has developed due to COVID-pandemic.
By proofing our hypothesis, our goal is to get more governmental resources diverted into
preventative occupational mental health care in the health professionals dealing with the
direct/in-direct pressures of COVID-19 pandemic in their work.
Methods
The study consists two groups of participants; the intervention group and the control group.
Healthcare professionals are referred to FinnHELP counselling service by their employers.
Inclusion criteria is that the participants have to be working with covid-19 positive or -
suspected positive patients. Stress/anxiety questionnaire is filled before, right after, three months after and six months after
the counselling for all of the participants, in both groups.
Results
During the time of sending this abstract we have initial results from the study which will be concluded during the summer of 2022 and presented in EUSEM2022 in Berlin.
Discussion
There is a lack of evidence from studies carried out during or after disease outbreaks, epidemics or pandemics that can inform the selection of interventions that are
beneficial to the resilience and mental health of frontline health and social care professionals. With a careful planning and executing this research the information gained from this study can be used as a guideline to support healthcare professionals in the future.
References
Pollock_A, Campbell_P, Cheyne_J, Cowie_J, Davis_B, McCallum_J, McGill_K, Elders_A,
Hagen_S, McClurg_D, Torrens_C, Maxwell_M. Interventions to support the resilience and
mental health of frontline health and social care professionals during and after a disease
outbreak, epidemic or pandemic: a mixed methods systematic review. Cochrane Database of
Systematic Reviews 2020, Issue 11.
The study has been so far funded by the medical association of Finland.
Sampsa PUTTONEN, Eeva TUUNAINEN (Kajaani, Finland)
16:10 - 16:30
#31133 - Concussion knowledge and self-reported attitudes in youth rugby players and their coaches: a population-wide cross-sectional survey.
Concussion knowledge and self-reported attitudes in youth rugby players and their coaches: a population-wide cross-sectional survey.
Background: Awareness of concussion is the first step to ensure its appropriate management, although it is not sufficient alone. There is evidence that concussion knowledge and attitudes towards its management are sub-optimal in countries with broad nation-wide dedicated policies, but little is known about settings where such policies are missing or limited, such as Italy, where rugby is a highly practiced contact sport.
Aim: To investigate concussion knowledge and self-reported attitudes in Italian youth rugby players and their coaches.
Design: Cross-sectional population-wide survey study.
Dates: From 18 Sept 2021 to 13 Dec 2021.
Setting: All rugby clubs (n=52) of the Veneto region, Italy.
Participants: Players and coaches of all under 15, 17 and 19 teams were eligible to participate.
Outcome measures: Knowledge scores were reported as a percentage of correct answers, along with interquartile ranges. Descriptive statistics were reported for all answers.
Results: A total of 1719 athlete surveys and 235 coach surveys were eligible for analysis, corresponding to a response rate of 71.1% and 93.2% respectively. 92.2% of players and 93.6% of coaches were male.
Median knowledge scores were 55% (IQR: 44-67) for athletes and 60% (IQR: 52.5-69) for coaches. Only 20.7% and 33.3% of athletes were aware of an increased risk of other musculoskeletal injuries or of a second concussion after sustaining one, respectively, compared to 18.3% and 40% of coaches. Only 8% of athletes and 17.4% of coaches responded much/very much to the question “Do you believe you have adequate knowledge of concussion?”.
As for self-reported attitudes, of those coaches who witnessed a concussion, nearly all declared have never allowed or put pressure on a player with suspected concussion to keep playing. However, 23.9% admitted they saw other coaches engaging in such a behaviour. Furthermore, only 25.5% identified return-to-school activities as a priority over return to play. Among athletes, 45.4% would not disclose concussion-related symptoms to anyone for fear of not playing following games.
World Rugby was reported to be the main source for gaining education on concussion for 88.5% of coaches, whereas athletes reported as main sources of education the Internet, the television, the coach and the doctor with percentages of 38.9%, 36.4%, 34.7% and 34.3%, respectively.
Discussion and Conclusion: Knowledge about concussion was suboptimal in both athletes and coaches, although the latter achieved higher scores. Similar studies conducted in countries where broad nation-wide dedicated policies are in place showed a general higher level of concussion knowledge compared to our results. However, some features like a tendency from coaches to put pressure on a player with suspected concussion to keep playing and from athletes not to report concussion-related symptoms for fear of not playing following games, appear consistent across different geographical contexts.
Funding: the study was funded through the Fondazione Salus Pueri (Padova, Italy)
Ethical Approval: the study was approved by the ethical committee of the University of Padova (n. 0053599).
Marco BAZO, Marta ARPONE, Veronica BAIOCCATO, Andrea ERMOLAO, Dario GREGORI, Liviana DA DALT, Silvia BRESSAN (Padova, Italy)
16:10 - 16:30
#31671 - Diagnostic accuracy of point-of-care lung ultrasound for COVID-19: A systematic review and meta-analysis of 20 studies including more than 4000 patients.
Diagnostic accuracy of point-of-care lung ultrasound for COVID-19: A systematic review and meta-analysis of 20 studies including more than 4000 patients.
Background
Point-of-care (POC) lung ultrasound (LUS) is widely used in the emergency setting and an established evidence base supports this across a range of respiratory diseases. During previous viral epidemics LUS demonstrated superior test characteristics compared to chest radiography for detecting viral pneumonia, (pneumonitis) and was more accurate in discriminating viral from bacterial pneumonia. LUS may convey advantages over conventional imaging modalities in COVID-19 enabling rapid diagnosis at the bedside without exposure to ionising radiation. CXR has been shown to have suboptimal diagnostic accuracy whilst chest computed tomography scanning (CT) is neither an appropriate nor feasible test for every patient. Furthermore, a single initial reverse-transcriptase polymerase chain reaction (RT-PCR) test has been found to have a sensitivity as low as 70% when compared to serial testing and access to newer rapid molecular tests remains variable. This purpose of this systematic review and meta-analysis was to determine the diagnostic accuracy of LUS in adult patients presenting with suspected COVID-19 infection.
Methods
This systematic review and meta-analysis was registered on PROSPERO and produced according to the PRISMA guideline. The research question was developed according to the PICOTS framework. We included all prospective and retrospective trials of adult patients (>16 years of age) presenting with suspected COVID-19 infection, comparing the diagnostic accuracy of POC LUS to one of three commonly reported reference standards; (1) RT-PCR, (2) chest CT, (3) final clinical diagnosis. Traditional and grey-literature searches were performed on June 1st 2021. Two authors independently carried out the searches, selected studies and completed the Quality Assessment Tool for Diagnostic Test Accuracy Studies (QUADAS-2). Meta-analysis was carried out using established open-source packages in R. We report overall sensitivity, specificity, positive and negative predictive values and the hierarchical summary receiver operating characteristic curve for LUS. Heterogeneity was determined using the I2 statistic.
Results
Twenty studies were included, providing data from a total of 4,314 patients. The prevalence and admission rates were generally high across all studies. Overall, LUS was found to be 87.2% sensitive (95% CI 83.6-90.2) and 69.5% specific (95% CI 62.2-72.5) and demonstrated overall positive and negative predictive values of 3.0 (95% 2.3-4.1) and 0.16 (95% 0.12-0.22) respectively. Separate analyses for each reference standard revealed similar sensitivities and specificities for LUS. Heterogeneity between studies was found to be high across the studies and overall, the quality of studies was low. All the studies used convenience sampling introducing a high risk of selection bias and were undertaken during periods of high prevalence in populations with a high hospital admission rate resulting in applicability concerns.
Discussion / Conclusion
During a period of high prevalence, LUS is a highly sensitive diagnostic test for COVID-19. However, more research is required to confirm these results in more generalisable populations, including those less likely to be admitted to hospital.
PROSPERO
Registration number: CRD42021250464
Ashley MATTHIES (London, United Kingdom), Michael TRAUER, Karl CHOPRA, Robert JARMAN
16:10 - 16:30
#30935 - Emergency Care for Older People: a mixed methods study and development of a Systems Dynamics model.
Emergency Care for Older People: a mixed methods study and development of a Systems Dynamics model.
Introduction:
This study addressed emergency care for older people, following them from entering the emergency care system by ambulance or direct attendance at the Emergency Department (ED) through to hospital admission, discharge, and any subsequent reattendance or admission. The study aimed to develop an understanding of what best practice looks like and how it could be delivered in the UK NHS, thus offering insight into what might influence better outcomes for older patients.
Methods:
The three-year programme involved:
1) a review of existing literature on interventions that span emergency and community care of older people;
2) qualitative fieldwork (interviews, ethnography, documentary analysis) in four NHS sites;
3) analysis of a large linked patient-level dataset on ambulance, ED and hospital care in Yorkshire and Humber from 2011-2017 for ED attendances by older people, through which we described emergency care journeys, outcomes, and costs; and,
4) the development of a System Dynamics (SD) decision support tool to represent patient flow through the entire care process for different pathways, through which we examined the effect sizes associated with conveyance to the ED, hospital admission, readmission, mortality, and nursing home admission.
Results:
1) The literature review identified that successful interventions integrated social and medical care, included screening and assessment, initiated care in the ED and bridged this with follow-up, and monitored implementations for success. Five key interventions were identified for inclusion in the SD tool: proactive care, hospital at home, geriatric emergency medicine, front door frailty, and acute frailty wards.
2) Interviews with patients and carers revealed participants’ reluctance to attend ED and emphasised the importance of being treated with respect and dignity, receiving timely and accurate information, being involved in decision making and experiencing clear communication. Interviewed healthcare professionals favoured the holistic nature of interventions identified in the earlier review and affirmed disparities across current practice.
3) Data analysis included 1,039,251 ED attendances by 368,754 older people. 552,940 arrived by ambulance, 293,102 (28%) had ED length of stay exceeding four hours, and 600,368 (58%) were admitted to hospital. 48,017 (8%) died during their observed attendance and 212,050 (20%) reattended within 30 days. The average cost of hospital care for those admitted was £2,760. The strongest predicting factor for long ED stay, hospital admission, and reattendance was the priority assigned by ambulance service call handler.
4) The decision support tool was developed to allow users to run one of five evidence-based scenarios to simulate a chosen service being implemented. It is configurable for users to input their own data or choose from a range of archetypes that reflect their own setting.
Conclusions:
The study has examined key considerations for emergency care for older people. Valuable feedback from both patients and healthcare professionals was captured through fieldwork, and thorough analysis of linked patient-level data provided insight into key factors influencing outcome. The assimilated evidence has been incorporated in a tool to support service- and system-level decisions about which model of urgent care might best suit a given setting.
This work was supported by the National Institute for Health Research (HS&DR: 17/05/96).
The programme and sub-studies received approvals from: University of Leicester (17525-spc3-ls:healthsciences), IRAS 262143, CAG 19/CAG/0194, IRAS 215818, REC 17/YH/0024, and CAG 17/CAG/0024
Suzanne M MASON, Louise PRESTON, Graham MARTIN, Kay PHELPS, Emma REGEN, Christopher BURTON, Andrew STREET, Laia MAYNOU-PUJOLRAS, Sally BRAILSFORD, Tracey ENGLAND, James D VAN OPPEN (Leicester, United Kingdom), Simon CONROY
16:10 - 16:30
#31139 - Impact of a quick multidisciplinary simulation-based training program on the multiple techniques of intraosseous access: a prospective multicentric study.
Impact of a quick multidisciplinary simulation-based training program on the multiple techniques of intraosseous access: a prospective multicentric study.
Background: The intra-osseous (IO) catheter is an emergency peripheral vascular access that can be utilized by physicians or nurses in most countries. In adults, IO access is required in emergency situations as soon as peripheral access is not easily obtained.
Objectives: To assess IO access placement performance during a quick multidisciplinary simulation-based training (SBT) program according to the professional status, experience of caregivers, and the setting of the course.
Methods: This prospective, multicentric study included emergency physicians, residents, certified registered nurse anesthetists, registered nurses, and students. It was carried out between April 06, 2020 and April 30, 2021 in emergency medical services, an emergency department, and a simulation center. Trainee performance was evaluated by two independent observers using a validated scale, before and after SBT. Self-assessment of satisfaction was carried out. Interobserver reproducibility was analyzed by intraclass correlation coefficient (ICC). The continuous variables were compared using a Student t-test or a non-parametric Mann-Whitney U-test. Comparative analysis between the different groups used ANOVA. Correlation analysis was performed by a non-parametric Spearman test. A p-value of 0.05 was considered significant.
Results: Ninety-eight participants were included. ICC between the two observers was 0.96. Performance significantly increased after training, regardless of the site or device used (for the semi-automatic device, p=0.004 in tibia and p=0.001 in humeral; for the manual device p<0.001). SBT significantly reduced time for IO access (p=0.02). After SBT, no difference was found according to professional status and the setting of the course. Performance was not correlated with professional experience. All trainees were satisfied with the training.
Discussion and conclusions: Quick SBT improved the IO access using a semi-automatic or a manual device, regardless of the experience or status of the trainees. The course is easy to apply, whatever the setting of SBT.
Not applicable
Daniel Aiham GHAZALI (Amiens), Rania AL KHALIL, Amina OUERSIGHNI, Philippe KENWAY, Franck LUDWIG, Enrique CASALINO, Patrick PLAISANCE, Denis ORIOT
16:10 - 16:30
#31198 - Influence of vaccination against Covid-19. An analysis by age groups.
Influence of vaccination against Covid-19. An analysis by age groups.
Background:
The vaccine against Covid-19 has been carried out throughout the year 2021 with different doses depending on the patient's age and immunosuppression factors. The vaccine is believed to have lessened the severity of this infection. Assessing this aspect in the emergency department can influence the outcome of the admitted patient.
Aim:
To Know how vaccination against Covid-19 influences the prognosis of hospitalized patients globally and depending on the age of the patients.
Methods.
Retrospective descriptive study. Patients diagnosed with Pneumonia by Covid-19 in emergency department (ED) and admitted in hospital. Months: august 2021-february 2022 and vaccination status against Covid-19 was known (0 dosis vs one or more dosis). Independent variables: age, age group (AG): 18-50, 51-65, 66-75, >75, sex, Charlson comorbidity index (CCI). Dependent variable: 30 days mortality (30M) and inpatient in critical unit (ICU). Descriptive study: quantitative variables: median and interquartile range (IQR), qualitative variables: absolute and relative frequency. Univariate study, comparison of quantitative variables: Mann-Whitney U, qualitative variables: Chi-square. All statistical analyses were performed using the SPSS 24.0. software package. p<0,05. 95% confidence interval (CI).
Results.
N: 402; median age: 64 (IQR: 52-80); female: 40.8%; CCI: 2,5 (IQR: 1-5); 30M: 9.2%; ICU: 9.5%; Vaccinated: 67.2%. Vaccinated and AG: 18-50: 55.1%, 51-65: 68.3%, 66-75: 60.0%, >75: 78.0% (p<0.05). Vaccinated and sex: male: 69.7%, female: 63.4% (p>0.05). 30M and Vaccinated: 8.9%, No vaccinated: 9.8% (p>0.05). ICU and vaccinated: 7.0%, No vaccinated: 14.9% (p<0.05). AG and 30M and vaccinated: 18-50: No deaths; 51-65: 30M Vaccinated: 4.7%, 30M no Vaccinated: 2.5% (p>0.05); 66-75: 30M vaccinated: 11.1%, 30M no vaccinated: 4.2% (p>0.05); >75: 30M vaccinated: 16.2%, 30M no vaccinated: 39.3% (p<0.05). AG and ICU and vaccinated:18-50: ICU vaccinated: 2%, ICU no vaccinated: 7.5% (p>0.05); 51-65: ICU vaccinated: 12.8%, ICU no vaccinated: 25.0% (p>0.05); 66-75: ICU vaccinated: 16.7%, ICU no vaccinated: 25.0% (p>0.05); >75: ICU vaccinated: 1%, ICU no vaccinated: 0% (p>0.05).
Discussion. Vaccination among patients admitted for Covid-19 was relatively high. Vaccination was significantly higher among older age groups, with no difference by sex. Overall, vaccination reduces admission to the ICU but not mortality. However, in the stratification by age groups, it is observed that mortality decreases significantly in the group over 75 years. Regarding the ICU, we can verify that income decreases in the younger groups. We think that the vaccine clearly influences improving the prognosis of patients infected by Covid-19.
Dr Raul LOPEZ IZQUIERDO (Valladolid, Spain), Delgado Alonso LORENA, Enriquez De Salamanca Gambara RODRIGO, Berta TIJERO RODRIGUEZ, Virginia CARBAJOSA RODRIGUEZ, Susana SANCHEZ RAMÓN, Raquel TALEGON MARTIN, Sobradillo Castrodeza NIEVES, Hernando Fernandez RAQUEL, Ruiz Merino ROCIO, Ruben PEREZ GARCIA, Campuzano Juarez ILSE KARINA, Irene CEBRIAN RUIZ, Jose Ramón OLIVA RAMOS, Francisco MARTÍN RODRIGUEZ
16:10 - 16:30
#31347 - Inter-rater Reliability of the Clinical Frailty Scale by staff members in a Swedish Emergency Department setting – an observational study.
Inter-rater Reliability of the Clinical Frailty Scale by staff members in a Swedish Emergency Department setting – an observational study.
Background:
As frailty among the elderly receives increased attention in emergency departments (EDs) globally, the use of tools for assessing frailty increases. A commonly used tool is the Clinical Frailty Scale (CFS). In EDs, inter-rater reliability of CFS has been evaluated to a limited extent, with results defined as good. However, no inter-rater reliability study regarding CFS has previously been done within the Scandinavian ED context. The primary aim of this study was to evaluate the inter-rater reliability of the CFS in a clinical Swedish ED setting.
Methods:
This was a prospective observational study which was conducted at three Swedish EDs: one university hospital and two community hospitals. Data collection was performed during 22 work shifts in May and September 2021 and randomization of shifts was weighed according to the typical diurnal pattern of arrival, i.e. most patients arriving from the middle to the end of the day. During the shifts randomized for data collection, staff was included by convenience sampling. Patients ≥65 years were independently assessed with CFS by their responsible physician (emergency physician or intern/resident from another specialty), registered nurse and assistant nurse. Demographic information for each assessor was collected, along with frailty status (frail/not frail) on the basis of clinical judgement. The primary outcome was the level of inter-rater reliability concerning frailty as assessed by CFS, expressed as Intraclass Correlation Coefficient (ICC). Secondary outcomes included: (1) difference in measures for inter-rater reliability between care teams with emergency physicians and care teams with interns/residents from other specialties; (2) descriptive comparison of degree of frailty (CFS 1-9) and degree of inter-rater reliability; and (3) intrapersonal agreement between clinical judgement (frail/not frail) and frailty assessed by CFS (dichotomised by cut-off CFS ≤4 meaning not frail and CFS ≥5 meaning frail), expressed in percentages.
Results:
100 patients were included and a total of 300 assessments were performed by 54 physicians (48% emergency physicians), 47 registered nurses and 43 assistant nurses. Patients median age was 77 (IQR=11) and; 52 (53%) were women. The assistant nurses had the longest professional experience whereas physicians had the shortest. Most professionals were women, with physicians being the only group not exceeding 50%. We found inter-rater reliability to be moderate to good (ICC=0.784, CI 0.715-0.842), regardless if the care team included an emergency physician (ICC=0.741, CI 0.625-0.832) or an intern/resident from another speciality (ICC=0.828, CI 0.743-0.892). The agreement of clinically judged frailty (frail/not frail) compared to frailty according to CFS (cut off CFS ≥5) was 84%. In the opposing cases, staff tended to assess patients as frail in a higher extent when using solely clinical judgement than when applying CFS on the same patient.
Conclusions:
The Clinical Frailty Scale appears to have a moderate to good inter-rater reliability when used in a clinical ED setting. When guiding clinical decisions, we advise that the CFS score should be discussed within the team.
The study was registered on ClinicalTrials.gov identifier: NCT04869878./This study did not receive any specific funding.
Erika HÖRLIN, Erika HÖRLIN (Linköping, Sweden), Samia MUNIR EHRLINGTON, Rani TOLL JOHN, Daniel WILHELMS
16:10 - 16:30
#30990 - Meducation in Lithuania: basic life support workshops for high school children.
Meducation in Lithuania: basic life support workshops for high school children.
Background:
Out-of-hospital cardiac arrest is one of the most common causes of death in Europe and worldwide. However, the majority of cardiac arrests happen at home with a bystander witnessing the event. Moreover, thousands of lives could be saved if members of the public, including children, were educated what is basic life support (BLS) and how to do cardiopulmonary resuscitation (CPR). According to the situation, our team created BLS training workshop for high school students and carried them out in various schools of Vilnius city. We aimed to compare the level of knowledge before and after the BLS training and to evaluate the efficacy of these workshops.
Methods:
A prospective observational study was conducted from 2021 January until December. Two questionnaires were constructed to evaluate the knowledge of BLS. The students were asked to fill the 1st questionnaire before the workshop started and the 2nd questionnaire right after the training. Various characteristics were registered: age, gender, knowledge of the CPR and self-assessment. The answers of the 1st questionnaire were compared with the results of the 2nd questionnaire. Data were processed using R statistical package. The difference between the variables was reliable if p <0.05.
Results:
A total of 224 cases were analyzed. Mean age was 15.3 (±0.9) years old with 39.7% (n=89) male and 60.3% (n=135) female participants. 90.2% (n=202) of correspondents think that person can be resuscitated, but only 7.1% (n=16) would resuscitate if the person had a cardiac arrest in front of their eyes. However, 13 (5.8%) students have already tried to resuscitate in their personal experience. The knowledge about chest compressions improved after the training and proportions of right answers increased in all categories: about depth from 0.272 to 0.610 (p<0.001), about frequency from 0.504 to 0.691 (p<0.001), and about rate from 0.522 to 0.854 (p<0.001). 53.7% (n=120) participants valued their resuscitation skills as good after training compared to 19.2% (n=43) who found their skills being good before the workshop (p<0.001). 78.9% (n=176) correspondents agree that it is useful to learn resuscitation skills.
Discussion & Conclusions:
Due to basic life support training the knowledge of CPR significantly increased. Moreover, the students evaluated their skills as improved after the workshops. However, the number of active bystanders remains low. Knowing that most correspondents agreed the CPR workshop is useful, the training should be carried out continuously to improve the rate of successful resuscitation in out-of-hospital environment.
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Aleksandras BRIEDIS (Vilnius, Lithuania), Beatrice RASCIUTE, Renata JUKNEVICIENE, Pranas SERPYTIS
16:10 - 16:30
#31468 - Non-ST segment Elevation Myocardial Infarction: Predictive factors of complication.
Non-ST segment Elevation Myocardial Infarction: Predictive factors of complication.
Introduction: Non-ST segment Elevation Myocardial Infarction (NSTEMI) is a common reason for admission in the emergency department (ED). They have an elevated risk of complications. The stratification of patients presented with NSTMI is a challenge for the physician. Over time, multiple scores have been evaluated to predict patients at risk of complications.
Aim: The aim of our study is to determine the predictive factors of complications in patients presented to our emergency department with NSTEMI
Methods: A prospective monocentric cohort study, was conducted between December 2021 and April 2022. It included patients older than 18 years old, admitted to the emergency department for NSTEM. Clinical and biology data were collected and GRACE, CRUSADE and TIMI scores were calculated. During hospitalization, adverse events were recorded: rhythm and conduction disturbances, left ventricular failure, cardiogenic shock, and cardiorespiratory arrest(CRA). Accuracy of clinical parameters and biological scores as predictors of complications were evaluated.
Results: Our study included 76 patients, with a mean age of 62±13 years old with a sex ratio of 3. The main risk factors were: diabetes in 40 patients (53%), high blood pressure in 39 patients (52%), smoking in 33patients (43%) and history of coronary disease in 29 patients (38%). The clinical parameters upon admission were: Mean systolic blood pressure (SBP)= 135 ± 21 mmHg, mean heart rate (HR)= 88±20 bpm, mean respiratory rate (RR) = 19±5, oxygen saturation= 95±5%. The mean value of CRUSADE score was 42±20, of TIMI score was 3±1, and of GRACE score was 147±42. Twenty-six patients (34 %) developed adverse events: 1 patient presented CRA, 5 patients had a rhythm disturbance, and 20 patients developed left ventricular failure. The multivariate analysis identified 4 factors independent predictors of adverse events: a Heart Rate ≥90 bpm (OR=2,43; p=0,03; IC95% [0,073-0,362]), An oxygen Saturation ≤95% (OR= 4,18; p˂0,001; IC95% [0,177-0,596]), A GRACE score ≥154 (OR=4,18; p˂0,001; IC95% [0,083-0,526]) and a CRUSADE score ≥49 (OR= 2,30; p=0,02; IC95% [0,023-0,673]).
Conclusion: The early identification of predictive factors of complications in patients with NSTEMI, improves the mortality prediction in initially stable patients.
Chiraz BEN SLIMANE, Boutheina FRADJ (Mahdia, Tunisia), Maha BCHIR, Manel BAYAR, Mansouri SALWA
16:10 - 16:30
#31606 - Predictors of in hospital mortality in patients with severe SARS-CoV-2 Delta variant pneumonia.
Predictors of in hospital mortality in patients with severe SARS-CoV-2 Delta variant pneumonia.
Background:
The coronavirus pandemic is rapidly evolving and continues to strain health systems. In 2021, the Delta VOC variant of SARS-CoV-2 emerged and spread worldwide with high morbidity and mortality. An outbreak of COVID-19 caused by the Delta variant occurred in Tunisia in July 2021 and emergency services were overloaded. Emerging research was conducted to identify patient-related factors that predict COVID-19 severity and mortality. The objective of this study was to identify factors that predict mortality in severe pneumonia due to the Delta variant of SARS-CoV-2.
Methods:
Retrospective study over 1-month period that included consecutively ER-admitted patients with severe SARS-CoV-2 Delta variant pneumonia in July 2021. Severe covid-19 pneumonia was defined by the National Institutes of Health guidelines, referring to individuals with confirmed SARS-CoV-2 infection who have SpO2 <94% on room air at sea level, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mm Hg, respiratory frequency >30 breaths/min, or lung infiltrates >50%. Baseline characteristics and treatment outcome were evaluated for each patient.
Results:
The cohort included fourty-six patients with 11% in-hospital mortality. The mean age was 55 + 13 years with a sex ratio of 2,3. Medical history: hypertension (37%), diabetes (33%) tobacco (6,5%), COPD (2%), chronic respiratory failure (13%). Only 6 patients were vaccinated against covid-19. Findings associated with in-hospital mortality were: history of hypertension, CT scan results indicating extensive lung involvement (>75%), various laboratory test abnormalities and biomarkers of organ dysfunction, especially deterioration of renal function, hyperglycemia and throbopenia.
Conclusions:
Covid-19 pneumonia remains a frequent condition of morbidity and mortality. Biomarkers of organ dysfunction, and CT scan results are important to predict the prognosis in order to improve decisions and guide ICU admissions of patients .
Khaled KEMICHA, Fatma HEBAIEB, Heykel GUEFFRACHE (Tunis, Tunisia), Emna KAMOUN, Abir AMDOUNI, Nessrine RJEIBI, Asma BRAHEM, Rania HMAISSI
16:10 - 16:30
#31356 - Prognostic factors in non st elevation myocardial infarction.
Prognostic factors in non st elevation myocardial infarction.
Introduction:
Many prognostic factors have been established to predict mortality in non st elevation myocardial infarction (NSTEMI). Among these factors, Grace score was validated and had a good prognostic performance to predict mortality in NSTEMI patients. But in some study, other items not included in Grace score was associated to mortality.
The objective of this study was to identify factors associated with mortality in NSTEMI patients.
Methodology:
A prospective prognostic study in emergency department (ED) during five years including all adult patients presenting in ED with the diagnosis of NSTEMI. Collection of demographic, clinical, electrocardiographic, biological and therapeutic features. We contacted patients six months after their consultation to get their evolution. Prognosis was evaluated on mortality. A multivariate logistic regression study was performed to determinate prognostic factors associated with mortality.
Results:
We included 465 patients. The average age was 61 ± 16 years. The gender-ratio was 1.38. Comorbidities were (%): Hypertension (57); Diabetes (43); Coronary artery disease (29) and dyslipidemia (28). Six months mortality was 5.9 %. In multivariate analysis, four factors were independently associated with mortality: (adjusted OR, 95 % CI and p):
• ST segment depression in more than five leads: 4.521; [1.053-3.559]; 0.033.
• History of Coronary bypass: 5.881; [1,314-13.93]; 0.015.
• Grace > 145: 15.03; [1.935-7.46]; <0.0001.
• TIMI score >3: 12.796; [1.47-5.233]; <0.0001.
Conclusion:
Our study found that history of coronary bypass and the number of leads in which repolarization disorders exsists are two factors independently associated to six months mortality. So should we include them in Grace Score or should we create another score more specific?
Sarra AKKARI, Hanen GHAZALI (Ben Arous, Tunisia), Fadwa LACHTAR, Amel ARBAOUI, Amel BEN GARFA, Rahma DHOKAR, Amira TAGOUGUI, Sami SOUISSI
16:10 - 16:30
#31368 - Prognostic performance of shock-index and modified shock-index in non st elevation myocardial infarction.
Prognostic performance of shock-index and modified shock-index in non st elevation myocardial infarction.
Introduction:
Shock-index (SI) and modified shock-index (mSI) have shown their prognosis values in many studies in patients admitted for shock. A SI >1.0 has been widely found to predict increased risk of mortality and other markers of morbidity, such as need for massive transfusion protocol activation and admission to intensive care units.
The aim of this study was to determinate the prognosis value of SI and mSI in non st elevation myocardial infarction (NSTEMI) in order to validate or not its use in the triage in emergency department (ED) and its use to influence delay to coronary angiography for these patients.
Methodology:
A prospective prognostic study in ED among five years including all adult patients presenting in ED with NSTEMI. We excluded patients who were medicated with beta-blockers. SI is defined as the heart rate (HR) divided by systolic blood pressure (SBP) and mSI is defined as the HR divided by mean blood pressure (MBP). Prognosis was evaluated at six months mortality. A multivariate logistic regression study, the determination of ROC curves and the study of survival curves according to the Kaplan Meier method were carried out to evaluate the prognostic performance of SI and mSI in STEMI patients.
Results:
We included 516 patients. The average age was 61 ± 11.89 years. The gender-ratio was 1.45. Comorbidities were (%): Hypertension (52); Diabetes (40); dyslipidemia (26); and coronary artery disease (20). Mean SI was 0.60 ± 0.16. Mean mSI was 0.71 ± 0.18. Six months mortality was 6.6%. The performance of SI for mortality was satisfactory with an AUC=0.861; p<0.0001. The performance of mSI for mortality was satisfactory with an AUC=0.863; p<0.0001. The threshold value for SI was 0.6 with sensitivity = 91%, specificity = 55%, positive predictive value (PPV) = 13% and negative predictive value (NPV) = 98%. The threshold value for mSI was 0.7 with sensitivity = 91%, specificity = 56%, PPV = 13% and NPV = 98%. The survival curve for SI<0.6 was better with p=0.025. The survival curve for mSI<0.9 was better with p=0.025. In multivariate analysis, only mSI ≥0.7 was independently associated with mortality with an adjusted OR of 17.939; 95% CI [2.005-26.649] and p<0.0001.
Conclusion:
SI and mSI sould be used carefully to predict mortality in STEMI patients. A largest study should be down to validate our results.
Sarra AKKARI, Hanen GHAZALI (Ben Arous, Tunisia), Fadwa LACHTAR, Jihen SEBAI, Syrine KESKES, Rihab DAOUD, Sami SOUISSI
16:10 - 16:30
#30784 - Saliva Assay for Viral Examination of SARS-CoV-2 (SAVE-CoV): A Pilot Study.
Saliva Assay for Viral Examination of SARS-CoV-2 (SAVE-CoV): A Pilot Study.
OBJECTIVES:
Saliva is as an alternate to the gold standard nasopharyngeal (NP) swab for SARS-CoV-2 detection by RT-PCR (reverse transcription polymerase chain reaction). This method saves health care worker time, personal protective equipment, and NP swab supplies, and enables patients to collect a sample away from the health care setting. This pilot study sought to assess the sensitivity of saliva compared to NP swabs collected in viral transport media for SARS-CoV-2 detection by RT-PCR using the Seegene’s Allplex™ 2019-nCoV Assay.
METHODS:
700 patients attending a COVID-19 assessment centre in Toronto, Canada, May 2020, who met screening criteria for symptomatic COVID-19 self-collected neat (undiluted) saliva samples in sterile containers (Starplex, Canada). NP swabs were also collected following routine practice. Saliva was tested neat and mixed 1:1 with sterile normal saline alongside the NP swab on the same Seegene Allplex™ 2019-nCoV Assay run. Results were compared for yield and cycle threshold (Ct) were compared. Statistical analysis was performed using tests of proportions for paired samples.
RESULTS:
A total of 689 NP/saliva pairs were received with sufficient quantity of saliva for testing. Of these, 47 (6.82%) were positive for SARS-CoV-2 in either one or both of the specimens. Of these, 74.5% (CI 71.1 % - 77.7%) had positive NP swabs, 57.5% (CI 53.8% - 61.2%) had positive diluted saliva, and 59.6% (CI 55.8% - 63.2%) had positive neat saliva. Compared to NP swabs, average Ct values were 3.39 and 3.72 higher between diluted saliva and neat saliva results. Discrepancies between NP and saliva were occurred with higher Ct (average Ct >33.5). Invalid results were noted in 0.1%, 2.5%, and 13.6% of NP, diluted saliva, and neat saliva specimens, respectively.
CONCLUSIONS:
Using the Seegene’s Allplex™ 2019-nCoV Assay, COVID-19 cases will be missed with either NP swabs (75% sensitive) or saliva (58% sensitive) as the sole specimen type. In patients with high pre-test probability of COVID-19, combination testing or repeat testing should be considered. Comparing novel tests to NP swab RT-PCR as the gold standard should take into consideration the limitations of the yield of NP swabs.
Funding: This project was supported by a grant from Fast Grants: Thistledown Foundation & Mercatus Center, George Mason University.
Trial Registration: Protocol description available at grant agency website. https://fastgrants.org/
Steven Marc FRIEDMAN (Toronto, Canada), Susan POUTANEN, Tony MAZZULLI, Bryn HAZLETT, Camille LEMIEUX, Megan LANDES, Allison MCGEER
16:10 - 16:30
#31038 - SARS-CoV-2 DETECTION BY QUICK PCR TEST THROUGH POCT EQUIPMENT.
SARS-CoV-2 DETECTION BY QUICK PCR TEST THROUGH POCT EQUIPMENT.
INTRODUCTION:
SARS-CoV-2 pandemic has produced a saturation of the cubicles in most of the Emergency Services, especially during the night shifts due to a remarkable delay in order to get the results of the diagnostics tests applied for the detection of this virus in hospitals where there is no Molecular Biology laboratories available during 24 hours.
With the aim of hastening the process of transferring patients to hospitalizations rooms, a quick PCR test was implemented through a POCT equipment (Point of care testing) which allowed the achievement of the results 20 minutes after the professional request.
OBJETIVE:
Describing the results obtained by the implemented of SARS-CoV-2 quick detection test in patients in a Spanish Emergency Service in order to descongest cubicles at night time.
MATERIAL AND METHODS:
An observational, descriptive and retrospective study of patient samples who had undergone SARS-CoV-2 detection by quick PCR test in the first 2021 term, has been performed.
The number of determinations done, the result of those determinations, the percentage of patients with confirmation test carried out through the mainstream PCR technique in a short period of time in the same hospitalization episode and the concordance between the result obtained in both techniques was studied.
RESULTS:
1367 determinations obtained by quick PCR test were requested during the research period. 1262 of these determinations turned out to be negative and 105 were positive. 7,53% of the patients were asked for a mainstream PCR test in the following days. Discordant results were observed in 26 patients. 10 of these results could be explained by a deficient collection of sample, a greater sensitive of the quick PCR test which can detect a residual load of the virus and due to sample collection during the incubation period. The result of the order 7 cases left was a false positive.
CONCLUSIONS:
The low number of verification test demanded by clinical confirms a high degree of the confidence in this type of test.
Despite the high rate of false positives cases, the fact that applications related to patients with a high clinical suspicion of being infected by covid 19 were excluded from the quick PCR test must be taken into account, since all these patients were derived to isolation plants. Otherwise, the concordance between both techniques would have been 100%.
Furthermore, as any other diagnostic test, the technique could lead to either false negative results or false positive results. Regarding the last ones, Roche Diagnostics published a security note in which an alert was released with respect to the observation 0f 0,1% of false positive results in their quick PCR test equipment. That would explain part of the false positive results in this study.
María CUENCA TORRES (alzira, Spain), Julia GONZALEZ CANTÓ, Luis MANCLÚS MONTOYA, Clara OSCA GÓMEZ, Olalla MARTÍNEZ MACÍAS, Antonio BURGOS TERUEL
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Exhibition Hall |
16:35 |
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A26
16:35 - 18:00
Procedural Sedation and Analgesia - Pain management and sedation in different patient groups
Moderator:
Marc SABBE (Medical staff member) (Moderator, Leuven, Belgium)
16:35 - 16:55
PSA equity in children visiting the ED - are we there yet?
Silvia BRESSAN (Moderator) (Speaker, Padova, Italy)
16:35 - 18:00
16:55 - 17:15
Pain management in the cancer patient in the ED.
Carlos ROLDAN (Professor) (Speaker, Houston, USA)
17:15 - 17:35
Peripheral nerve blocks for a headache - approach to pain management in the ED.
Benjamin FRIEDMAN (Speaker, USA)
17:35 - 17:55
Approach to pain management in patients with substance abuse disorders.
Felicia COX (Speaker, LONDON, Australia)
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A6-7 |
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B26
16:35 - 18:00
Obstetrics and gynecologic emergencies - From the streets to the ward
Moderators:
Carmen Diana CIMPOESU (Prof. Head of ED) (Moderator, IASI, Romania), Gregor PROSEN (EM Consultant) (Moderator, MARIBOR, Slovenia)
16:35 - 17:00
Are you prepared to deliver a baby in the field?
Tatjana RAJKOVIC (Speaker, NIS, Serbia)
17:00 - 17:25
Emergencies in the 1st/2nd/3rd trimester.
Nicole BATTAGLIOLI (Speaker, Atlanta, GA, USA)
17:25 - 17:50
The use of Ultrasound in pregnancy-related emergencies.
Beatrice HOFFMANN (Speaker, Boston, USA)
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A8 |
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"Monday 17 October"
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D26
16:35 - 18:00
Paediatric Emergencies - Recent studies
Moderator:
Ozlem TEKSAM (PEDIATRICS) (Moderator, ANKARA, Turkey)
16:35 - 17:00
Paediatric sepsis definition.
Mark PETERS (Speaker, London)
17:00 - 17:25
Febrile infant guidelines.
Borja GOMEZ (Pediatric Emergency Physician) (Speaker, Barakaldo, Spain)
17:25 - 17:50
COVID - EPISODES study.
Dr Ruud G NIJMAN (academic clinical lecturer) (Speaker, London, United Kingdom)
18:06 - 18:14
Limping children in ED: Is the switch from face to face to telephone follow-up safe?
Cecilia LUSUARDI (Presentation) (Abstract Presenter, Cambridge)
16:35 - 18:00
#30880 - Prednisolone for Bell's palsy in children: A randomised, double-blind, placebo-controlled, multicentre trial.
Prednisolone for Bell's palsy in children: A randomised, double-blind, placebo-controlled, multicentre trial.
Background:
Corticosteroids can be used to treat idiopathic facial paralysis (Bell’s palsy) in children, but their effectiveness is uncertain.
Aims:
To determine if prednisolone improves recovery of children with Bell’s palsy at one month.
Method:
Double-blind, placebo-controlled, randomised, trial of prednisolone in children presenting to the emergency department with Bell’s palsy.1 Patients 6 months to <18 years, recruited <72 hours after symptom onset, were randomly assigned to receive 10 days of treatment with oral prednisolone (1 mg/kg) or placebo. The primary outcome: complete recovery of facial function at 1 month on the House–Brackmann scale.2 Secondary outcomes: facial function, adverse events and pain to 6 months.
Results:
Between October 2015 to August 2020, 187 children were randomised (94 to prednisolone and 93 to placebo) and included in the intention-to-treat analysis (Table 1). At 1 month, the proportions of patients who had recovered facial function were 49% (n=43/87) in the prednisolone group compared with 57% (n=50/87) in the placebo group (risk difference -8.1%, 95% CI -22.8 to 6.7; adjusted odds ratio [aOR] 0.7, 95% CI 0.4 to 1.3). At 6 months these proportion were 99% (n=77/78) for prednisolone and 93% (n=76/82) for placebo respectively (risk difference 6.0%, 95% CI -0.1 to 12.2; aOR 3.0 95% CI 0.5 to 17.7). There were no serious adverse events and little evidence for group differences in secondary outcomes.
Conclusion:
In children with Bell’s palsy the vast majority recover without treatment. The study does not provide evidence that early treatment with prednisolone improves complete recovery.
References:
1. Babl FE, Mackay MT, Borland ML, et al; PREDICT (Paediatric Research In Emergency Departments International Collaborative) research network. Bell’s Palsy in Children (BellPIC): Protocol for a Multicentre, Placebo-Controlled Randomized Trial. BMC Pediatrics 2017 Feb 13;17(1):53. doi: 10.1186/s12887-016-0702-y.
2. House JW, Brackmann DE: Facial nerve grading system. Otolaryngol Head Neck Surg. 1985; 93(2): 146-7.
Table 1: Baseline characteristics of the patients in the intention-to-treat analysis
Prednisolone Placebo
Child age [years]
N Mdn IQR 93 11.13(5.17-14.01) 94 9.44 (5.09-11.84)
Child sex, N n %
Male 93 45 48.39 94 45 47.87
Length of illness [hours]
N Mdn IQR 89 24.00 (12.00-48.00) 91 24.00 (10.00-36.00)
Symptoms on presentation
House-Brackmann score
N Mdn IQR 93 3.00 (3.00-4.00) 94 4.00 (3.00-4.00)
VAS score - Child
N Mdn IQR 72 0.00 (0.00-1.50) 70 0.00 (0.00-1.00)
Revised Faces Pain Scale - Child
N Mdn IQR 13 0.00 (0.00-0.00) 20 0.00 (0.00-2.00)
VAS score - Parent
N Mdn IQR 78 0.00 (0.00-1.00) 83 0.00 (0.00-1.00)
N number Mdn median IQR interquartile range
VAS visual analogue scale
Funded by: National Health and Medical Research Council, Emergency Medicine Foundation, Perth Children’s Hospital Foundation.
Pr Franz BABL (Melbourne, Australia), David HERD, Meredith BORLAND, Amit KOCHAR, Ben LAWTON, Jason HORT, Adam WEST, Shane GEORGE, Michael ZHANG, Karthik VELUSAMY, Frank SULLIVAN, Ed OAKLEY, Andrew DAVIDSON, Sandy HOPPER, John CHEEK, Robert BERKOWITZ, Stephen HEARPS, Catherine WILSON, Amanda WILLIAMS, Hannah ELBOROUGH, Donna LEGGE, Mark MACKAY, Katherine LEE, Stuart DALZIEL
16:35 - 18:00
#31162 - Validation of the American Academic Pediatric (AAP) guideline in febrile infants attending the emergency department in the UK and Ireland.
Validation of the American Academic Pediatric (AAP) guideline in febrile infants attending the emergency department in the UK and Ireland.
Background
The assessment and management of febrile young infants (under 90 days of age) is challenging. Young infants are at higher risk of serious and invasive bacterial infections (SBI/IBI) compared to older children and the symptoms and signs of SBI/IBI in young infants are subtle. This leads to an appropriately cautious approach with many guidelines advocating a “just in case” strategy with all febrile infants undergoing an infection screen and receiving broad-spectrum parenteral antibiotics.
In recent years there have been a number of validated clinical practice guidelines developed including the PECARN and StepByStep. These guidelines advise a tailored approach with the lowest risk infants suitable for management in the community without parenteral antibiotics. These guidelines can only be applied in settings where procalcitonin (PCT) testing is available.
In 2021 the American Academy of Paediatrics (AAP) published a new consensus guideline for the management of febrile infants. Unlike the PECARN and StepByStep guidelines AAP guidelines can be applied without the need for PCT testing. The objective of this secondary analysis was to validate the AAP guideline in UK and Irish populations.
Methods
The data for this secondary analysis comes from the Febrile Infants Diagnostic assessment and Outcome (FIDO) study (www.clinicaltrials.gov). The FIDO study, described previously, was a multicentre cohort study conducted on behalf of the Paediatric Emergency UK and Ireland (PERUKI) network at six PERUKI sites. Infants up to 90 days of age attending between 31/08/2018 - 01/09/2019 were screened for inclusion. Infants with a recorded fever (≥38°C) at triage were eligible for inclusion. There were no exclusion criteria. Invasive bacterial infection (IBI) defined as either bacterial meningitis or bacteraemia (non-contaminant) confirmed by culture or molecular diagnostic testing of a sterile site i.e. blood or cerebrospinal fluid (CSF). The diagnostic accuracy of the AAP guideline was reported with sensitivity and specificity with 95% confidence intervals (CI).
Result
Of 1362 eligible infants, 555 met the inclusion criteria. The median age of participants was 53 days (IQR 32 to 70). There were 325 male participants (59%). The incidence of IBI was 14 (3%). The AAP guidelines had a reported sensitivity 1.0 (95%CI: 0.7 – 1.0) and specificity of 0.14 (95%CI: 0.12 – 0.18) in febrile infants < 90 days of age. For febrile infants 8 – 60 days of age (N=333, IBI-11 (3%)), the reported sensitivity and specificity were 1.0 (95%CI: 0.7 – 1.0) and 0.14 (95%CI: 0.10 – 0.18) respectively. The AAP guideline identified 78/555 (14%) of infants as low risk out of which none had an IBI.
Discussion
The APP guidance was 100% sensitive for detecting IBI when applied to our cohort. Based on AAP guidance infants who appear well, are over 28 days of age, have a maximum temperature of <38.5oC, a CRP of <20mg/l and an absolute neutrophil count of <4,000 can safely be managed without parenteral antibiotics.
Etimbuk UMANA (Belfast, Ireland), Hannah NORMAN-BRUCE, Clare MILLS, Hannah MITCHELL, Lisa MCFETRIDGE, Thomas WATERFIELD, Febrile Infants Diagnostic Assessment And Outcome STUDY GROUP
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"Monday 17 October"
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E26
16:35 - 18:00
Vessels gone away
Moderator:
Abdo SATTOUT (Consultant in Emergency Medicine) (Moderator, Liverpool, United Kingdom)
16:35 - 17:00
Limb ischemia.
Mohammad Ashraf BUTT (Consultant in Emergency Medicine) (Speaker, Cavan, Ireland)
17:00 - 17:20
rAAA w/PoCUS.
Nikolas SBYRAKIS (Consultant Emergency Physician) (Speaker, Heraklion, Greece)
17:20 - 18:00
Aortic/Cardotid/vertebral artery dissection.
Pr Cem OKTAY (FACULTY) (Speaker, ANTALYA, Turkey)
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"Monday 17 October"
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F26
16:35 - 18:00
Have you ever wondered...? II
Moderator:
Eugenia - Maria LUPAN-MURESAN (Teaching Assistant) (Moderator, Cluj-Napoca, Romania)
16:35 - 17:00
The green ED.
Sandy Alexander ROBERTSON (Speaker, EDINBURGH)
17:00 - 17:25
The chain of survival in 2050.
Tommaso SCQUIZZATO (Speaker, Milan, Italy)
17:25 - 17:50
I'm no coder.
Dale KIRKWOOD (.) (Speaker, Manchester, United Kingdom)
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C26
16:35 - 18:00
Quality and Safety in Emergency Medicine: The EUSEM Working Group on Quality and Safety in Emergency Medicine
Moderators:
Pr Abdelouahab BELLOU (Director of Institute) (Moderator, Guangzhou, China), Dr John HEYWORTH (Consultant) (Moderator, Southampton, United Kingdom)
16:35 - 16:55
Definition and concepts on quality and safety.
Pr Abdelouahab BELLOU (Director of Institute) (Speaker, Guangzhou, China)
16:55 - 17:15
Overview on quality and safety in EM in Europe.
Eric REVUE (Chef de Service) (Speaker, Paris, France)
17:15 - 17:35
EUSEM Quality Indicators project: Summary of results and impact on patient safety.
Dr Kelly JANSSENS (PHYSICIAN) (Speaker, Dublin, Ireland)
17:25 - 17:45
Impact of time on quality and safety in the ED.
Zoubir BOUDI (Speaker, Dubai, United Arab Emirates)
17:45 - 18:00
Audience Discussion.
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"Monday 17 October"
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G26
16:35 - 18:00
Qualifizierung und Arbeitszeitmodelle im rztlichen Bereich
Moderators:
Wilhelm BEHRINGER (Chair) (Moderator, Vienna, Austria), Ranka MAROHL (Moderator, Germany)
16:35 - 17:00
Wie kann die Transformation in der ZNA von multi- zu inter- und monodisziplinr gelingen?
Christoph DODT (Head of the Department) (Speaker, München, Germany)
17:00 - 17:25
Arbeitszeitmodelle und Qualifizierungsmanahmen fr rztinnen und rzte in der Notaufnahme: wie machen est andere Lnder?
Andreas Rudolf Johannes HÜFNER (Head of Department) (Speaker, Regensburg, Germany)
17:25 - 17:50
Herausforderungen fr die Personalqualifikation und den Personaleinsatz bei Basis-Notfallversorgern.
David GARCIA-BARDON (Speaker, Germany)
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H26
16:35 - 18:00
Paediatrics
Moderator:
Said HACHIMI-IDRISSI (head clinic) (Moderator, GHENT, Belgium)
16:35 - 18:00
#31252 - A survey study on hospital policy to improve recognition and management of child maltreatment in Europe.
A survey study on hospital policy to improve recognition and management of child maltreatment in Europe.
Background:
Child maltreatment is known for its detrimental impact on children, families and society, but remains challenging to identify. To improve detection of child maltreatment at the emergency department (ED), screening tools combined with training have shown to be effective. Multidisciplinary child abuse teams and policy officers support healthcare professionals and initiate appropriate follow-up. The presence of these strategies should be embedded in a hospital policy to ensure healthcare professionals are supported by the hospital for adequate management of child maltreatment cases. We investigated whether having a hospital policy regarding child maltreatment is associated with the use of different strategies for recognition of child maltreatment in the ED.
Methods:
A survey on child maltreatment recognition in European EDs was conducted focusing on screening methods, training and hospital policies. The survey was distributed through key members from collaborative emergency medicine societies and research networks (European Society for Emergency Medicine (EUSEM), Research in Pediatric Emergency Medicine (REPEM) and European Society for Emergency Nursing (EuSEN)) from September 2018 to January 2019. The following strategies for recognition of child maltreatment were investigated: use of a screening tool, training of hospital staff, availability of a child abuse team and presence of a child abuse policy officer. Descriptive analyses were performed with additional chi-squared tests to assess any associations between the current hospital policy (‘Does your hospital have a standardised policy or guideline for the detection of child abuse?) and the aforementioned strategies.
Results:
185 surveys were analysed, representing 148 hospitals from 29 European countries. The estimated response rate ranged from 33.8% to 54.6%. Half of the respondents (51%; n=94/185) had a standardised policy regarding child maltreatment in place, while 24% (44/185) stated they did not have such a policy. 25% (47/185) had a missing or ‘unknown’ response to the question. The presence of a hospital policy was significantly associated with the use of screening strategies in comparison with the absence of a hospital policy: screening tool (p<0.001) (resp. 52%; n=49/94 vs. 5%; n=2/44), training (p<0.001) (resp. 63%; n=59/94 vs. 30%; n=13/44), child abuse team (p<0.001) (resp. 73%; n=69/94 vs. 27%; n=12/44) and policy officer (p<0.001) (resp. 51%; n=48/94 vs. 20%; n=9/44). Respondents with missing or ‘unknown’ responses on the question regarding a current hospital policy showed comparable results to respondents with no policy. Correlating respondents (n=185) to hospitals (n=148), analyses showed that out of the hospitals with a child maltreatment policy (55%; n=81/148), 28% (23/81) used all four strategies for recognition of child maltreatment.
Discussion & conclusions:
Our study shows that presence of a hospital policy on child maltreatment facilitates the use of different strategies for recognition of child maltreatment. Only half of the EDs in Europe have such a policy in place, and even in the presence of a policy, the different available strategies are not widely implemented on the ED floor. Development of a child maltreatment hospital policy and investigating barriers and facilitators for the implementation of different strategies are the next step to improve recognition and management of child maltreatment in Europe.
Trial registration: This study was not registered since this was a descriptive study amongst healthcare professionals and no appropriate register was available.
Funding: This study did not receive any specific funding.
Ethical approval: This study was approved by the Ethics Committee of the European Society of Emergency Medicine (EUSEM, April 16th 2018). The completion of the survey by the participants was taken as consent and data was analyzed anonymized.
Feline HOEDEMAN (Rotterdam, The Netherlands), Patrycja PUIMAN, Andrea SMITS, Mariëlle DEKKER, Hester DIDERICH-LOLKES DE BEER, Said LARIBI, Door LAUWAERT, Rianne OOSTENBRINK, Niccolo PARRI, Luis GARCIA-CASTRILLO RIESGO, Henriëtte MOLL
16:35 - 18:00
#31428 - Capnography for non intubated patients: Useful or unnecessary?
Capnography for non intubated patients: Useful or unnecessary?
Background: End tidal carbon dioxide measurement is mainly used for confirmation of intubation and continuous measurement of carbon dioxide levels in intubated pediatric patients. However it is possible to use it in non intubated patients as well as a non invasive method to measure carbon dioxide levels. Our aim in this study is to search for a correlation between end tidal carbon dioxide levels measured by a capnograph with carbon dioxide levels in blood gas analysis in non intubated pediatric patients.
Methods: Our study was designed as a prospective cohort study. Patients that applied to Pediatric Emergency Unit of a 3rd level University Hospital with a complaint of acute gastroenteritis between July 1st 2018 and September 30th 2021 were included. Patients that had chronic diseases that would interfere with acid base levels (metabolic diseases, chronic diarrhea, renal tubular acidosis etc), patients that needed emergency interventions and the patients that did not want to participate were excluded.
End tidal carbon dioxide was measured with capnograph with an attached mask. Correct sized mask is used for each patient.
Statistical analysis was performed by SPSS v25.0 program. Descriptive statistics were presented with frequencies and percentages for discrete variables and with mean and standard deviation for continuous variables. Continuous variables were compared using the Mann-Whitney U test and correlation analysis was performed with Spearman's rank correlation coefficient. For all tests, p < 0.05 was considered statistically significant.
Results: 60 patients were eligible for the study. Mean age of the patients was 65,3251,52 months and %63,6 was boys. Mean end tidal carbon dioxide level was 28,275,32 mm Hg and mean carbon dioxide level in blood gas analysis was 30,035,83 mm Hg with mean pH of 7,390,05. Correlation between mean carbon dioxide levels in capnography and blood gas analysis was significant correlated (r=0.410, p=0.0019).
Discussion and Conclusion: End tidal carbon dioxide levels was shown to be valuable predictive tool in non intubated patients in literature1,2. However these studies mainly included adult patients and used side stream capnography. Our study showed that a simple capnograph with an attached face mask suitable for patient’s face can also be used safely or non invasive measurement of carbon dioxide levels in non intubated pediatric patients as well.
1Kartal M, Eray O, Rinnert S, Goksu E, Bektas F, Eken C ETCO2: a predictive tool for excluding metabolic disturbances in non intubated patients. American Journal of Emergency Medicine (2011) 29, 65–69.
2 Chebl RB, Madden B, Belsky J, Harmouche E, Yessayan L. Diagnostic value of end tidal capnography in patients with hyperglycemia in the emergency department. BMC Emergency Medicine (2016) 16:7 .
Ayse GULTEKINGIL (ÇANKAYA, Turkey)
16:35 - 18:00
#31143 - Importance of thorough evaluation of suspected child abuse in a prospective study: identifying additional injuries, providing adequate medical care and recognizing the need for psychosocial therapy and support.
Importance of thorough evaluation of suspected child abuse in a prospective study: identifying additional injuries, providing adequate medical care and recognizing the need for psychosocial therapy and support.
Background
Evaluation of suspected child maltreatment remains a challenge for clinicians. Adequate physical examination, diagnostic work-up and follow-up with respect to somatic and psychological symptoms require specialized skills. In the Erasmus Medical Center in the Netherlands these children are evaluated by a child abuse expert team consisting of pediatricians, psychologists and social workers. We provide an overview of the characteristics and outcomes of children assessed at the emergency department by this expert team.
Methods
Prospective data were collected on children aged 0-16 years who were assessed for maltreatment from 2019 through 2021 in the Erasmus Medical Center (Rotterdam, the Netherlands). Patients were evaluated for signs of child maltreatment by physical examination and STD testing. All children were psychologically evaluated for trauma-related symptoms and they and their families were screened for risk factors of child maltreatment. The data were analyzed descriptively.
Results
414 children (median age 7.0 years, 75% girls) were investigated. Children were referred to the expert team by the hospital’s own emergency department or specialists (10%, n=41), general practitioner (41%, n=169), other health care providers (16%, n=64), child protection services (16%, n=67), police (16%, n=68) or social services (1%, n=5). Children were referred with suspicions of (a combination of) the following types of maltreatment: sexual abuse (81%, n=337), physical abuse (21%, n=86), physical neglect (8%, n=35), psychological abuse (2%, n=9), psychological neglect (1%, n=6), domestic violence (2%, n=9) and pediatric falsification syndrome (0.2%, n=1). Of the children investigated for sexual abuse (n=337), 31% (n=105) were acute cases and 81% (n=274) were routinely tested for sexually transmitted diseases (STDs). 15 children aged 3-16 years were diagnosed with a STD: chlamydia (n=6), gonorrhea (n=5), both chlamydia and gonorrhea (n=3) and trichomonas (n=1). Of the children investigated for physical abuse or neglect (n=104), 64% had one or more physical injuries such as skin lesions (n=54), fractures (n=18) or traumatic brain injury (n=17). Two or more child-, parental- and/or family-related risk factors for child abuse were identified in 60% (n=250) of cases. In 46% (n=190) concerns for child abuse were confirmed, in 14% (n=60) refuted and in 40% (n=164) inconclusive by expert opinion of the team. In 64% (n=265) of cases a need for help was identified which corresponded to 84% (n=159) of cases with confirmed and 60% (n=99) of cases with inconclusive concerns for child maltreatment. Because of trauma-related symptoms 31% (n=130) of all children were referred to specialized mental health services. In 12% (n=48) of all children suspected child maltreatment was reported to the Safe at Home centre (national child safety organization).
Conclusion
Our study shows that a thorough evaluation of children suspected for maltreatment yields results, especially when performed by a child abuse expert team. Suspected sexual child abuse was the main reason for consultation and routine STD testing showed positive results including in the young. Psychosocial evaluation identified psychological trauma-related symptoms in a third of children suspected for abuse and a need for help in a large percentage of cases, even when the diagnosis of child maltreatment remained inconclusive.
N.a.
Annelotte PRIES (Rotterdam, The Netherlands), Féline HOEDEMAN, Emma ELTRINGHAM, Joyce TEN DOESCHATE-DE GRUIJL, Marjo AFFOURTIT, Henriëtte MOLL, Patrycja PUIMAN
16:35 - 18:00
#30710 - Pharmacogenetic and pharmacokinetic profiles in children who experience vomiting or recovery agitation during sedation with ketamine.
Pharmacogenetic and pharmacokinetic profiles in children who experience vomiting or recovery agitation during sedation with ketamine.
Background: Ketamine is one of the sedatives most used in North America for procedural sedation outside the operating room in children. Vomiting and recovery agitation are the adverse events most frequently reported after ketamine administration in children. The aim of this study was to identify genetic variants associated with the development of vomiting or recovery agitation after intravenous ketamine administration.
Material and methods: This was an explorative single-center prospective pharmacogenetic study performed at the tertiary-level children’s hospital Institute for Maternal and Child Health IRCCS Burlo Garofolo of Trieste, Italy. Children, between 1 and 17yrs of age, performing procedural sedation with intravenous ketamine as the sole sedative agent were enrolled. Children with intellectual disability or who received other sedatives during the procedure or who received antiemetics before the procedure were excluded from the analysis. Pharmacogenetic and pharmacokinetic analyses were predisposed. The genotyping was performed through Illumina Global screening array. The search for biomarkers was performed through the analysis of the variants of 10 candidate genes coding for proteins responsible for the metabolism (CYP3A4, CYP2B6, CYP2C9, CYP3A5, CYP2A6) and pharmacodynamics (GRIN1, GRIN2A-D) of ketamine. A genome-wide analysis was carried out to identify the presence of genetic variants associated with the development of adverse events but not related to the candidate genes. The plasma concentration of ketamine and norketamine were determined through liquid chromatography-tandem mass spectrometry and pharmacokinetic parameters were determined with R software.
Results: From September 2019 to October 2021, 106 patients were enrolled in the study. Among them, 87 patients were analyzed. The median age was 8yrs (5-11). Forty-seven (55%) were females, 32 (37%) were affected by chronic diseases. Arthrocentesis and bone fracture reduction were the procedures most frequently performed. A median dose of 1.7mg/kg of intravenous ketamine was employed to perform the procedures.
Thirty-one patients (35%) experienced vomiting or recovery agitation and were compared to the 56 patients (65%) without these events. No statistically significant differences were found between patients with vomiting, recovery agitation and without these events regarding the age, gender, weight, presence of chronic disease and median dose of ketamine received during the procedure.
The pharmacogenetic analysis showed that the polymorphisms more associated with the development of vomiting and recovery agitation were GSA-rs71379063 on the GRIN2A gene on chromosome 16 (p 0.0038, OR 7.16) and GSA-rs28399442 on the CYP2A6 on chromosome 19 (p 0.0065, OR 4.97). The polymorphism GSA-rs71379063 on the GRIN2A gene was present in 7 patients (22.5%) with vomiting or recovery agitation, compared to 2 patients (3.5%) without these events. The polymorphism GSA-rs28399442 on the CYP2A6 gene was present in 3 patients (9.7%) with vomiting or recovery agitation compared to 1 patient (1.8%) without these events.
We found a statistically significant different pharmacokinetic profile in patients with recovery agitation compared to the others regarding ketamine clearance (p<0.001). No significant differences were found considering Ke, T1/2, Vd, and AUC.
Conclusion: The development of vomiting and recovery agitation after intravenous ketamine administration seems associated with specific genetic variants. These findings should be confirmed in a greater population.
Giorgio COZZI (Trieste, Italy, Italy), Gabriele STOCCO, Pio D'ADAMO, Martina FRANZIN, Marianna LUCAFÒ, Alessandro AMADDEO, Giuliana DECORTI, Egidio BARBI
16:35 - 18:00
#30922 - Prehospital benzodiazepine use and need for respiratory support in paediatric seizures.
Prehospital benzodiazepine use and need for respiratory support in paediatric seizures.
Background:
Paramedics are frequently called to attend seizures in children. High-quality evidence on second-line treatment of benzodiazepine (BZD)-refractory convulsions with parenteral long-acting antiepileptic drugs in children has become available from the ED.1,2
Aims:
To determine the association of BZD use pre-hospital and the need for respiratory support; to address the potential need for an alternative pre-hospital agent.
Methods:
Retrospective observational study of state-wide ambulance service data (Ambulance Victoria (AV) in Victoria, Australia, population: 6.5 million). Children aged 0-17 years assessed for seizures by paramedics were analyzed for demographics, process factors, treatment and airway management. We calculated adjusted odds ratios (AOR) of the requirement for respiratory support in relation to the number of BZD doses administered.
Results:
Paramedics attended 5,112 children with suspected seizures over 1 year (July 2018 to June 2019). Overall, need for respiratory support was low (n=166; 3.2%). Before ambulance arrival, 509 (10.0%) had already received a BZD and 420 (8.2%) were treated with midazolam by paramedics. Of the 846 (16.5%) patients treated with BZD, 597 (70.6%) received 1 BZD dose, 156 (18.4%) 2 doses and 93 (11.0%) >2 doses of BZD (Table 1,2). Patients who were administered 1, 2 and >2 doses of BZD received respiratory support in 8.9%, 32.1% (AOR 4.6 vs. 1 dose, 95% CI 2.9-7.4) and 49.5% (AOR 10.3 vs. 1 dose, 95% CI 6.0-17.9) respectively.
Conclusions:
Increasing administration of BZD doses was associated with higher use of respiratory support. Alternative pre-hospital anti-epileptic drugs to minimize respiratory depression should be investigated in future research.
Christina PFEIFFER, Karen SMITH, Stuart DALZIEL, Stephen HEARPS, Michael KABESCH, Pr Franz BABL (Melbourne, Australia)
16:35 - 18:00
#31274 - Qualitative Phenomenological Study exploring challenges of Junior Doctors in a tertiary Paediatric Emergency Department.
Qualitative Phenomenological Study exploring challenges of Junior Doctors in a tertiary Paediatric Emergency Department.
Background:
The emergency department (ED) can be an extremely stressful environment with factors quoted to contribute to stress being that of heavy workload, unwell patients, psychosocial stressors. These are especially so in a paediatric setting.3 Challenges of those who work in the emergency have been studied but few studies have looked at the paediatric emergency setting. In addition, junior doctors who may be rotating into the environment for the first time are a subgroup who may have additional challenges of sharp learning curves and adjusting to the environment. Therefore, this study aimed to explore the challenges that junior doctors experienced in the paediatric emergency department.
Methods:
We conducted a qualitative study using interpretive phenomenological analysis to study the challenges of junior doctors working in a tertiary paediatric ED setting in Singapore.
Prior to the commencement of the study, we obtained approval from the Centralised Institutional Review Board.
A thorough literature review was conducted and an interview guide was formulated. Sixteen junior doctors were working in the Paediatric ED during the time of the study were recruited. Semi-structured interviews were then conducted within a one-month period in December 2019. Data was collected until saturation point. All interviews were recorded and transcribed verbatim manually and subsequently analysed.
Results:
The main challenges that the junior doctors studied faced were broadly categorised into subject matter, communication difficulties, emotional stressors and uncertainty in patient care. In terms of subject matter, they cited difficulties in terms of becoming familiar with the breadth of the information required to work in the emergency in view of the extensive number of conditions the emergency department deals with ranging from minor trauma cases and procedures to high acuity resuscitation situations. Communication difficulties were especially noted in communication with parents of children who may have been anxious or grieving. In terms of psychological stressors these were seen in exposure to traumatic or unfortunate cases involving children or adolescents which was an added emotional stress to the junior doctors. The junior doctors also reported stress relating to uncertainty in patient care in which they worried about the decisions they had made had impacted on the child negatively especially if the child was discharged from the care of the hospital.
Conclusion:
The challenges of the junior doctors in the emergency were explored. These surrounded areas over subject matter, communication difficulties, clinical uncertainty, and emotional stressors from traumatic scenarios. Knowing these challenges can help the individuals interacting with these junior doctors in the emergency setting understand them better and find ways to work together more efficiently. More research can be done in evaluating how the doctors had dealt with these challenges and how these junior doctors would like to be assisted.
Jaime TAN (Singapore, Singapore), Junaidah BADRON, Sashikumar GANAPATHY
16:35 - 18:00
#31253 - Screening for child maltreatment in emergency departments in Europe: a survey study on barriers and facilitators for implementation of a toolkit.
Screening for child maltreatment in emergency departments in Europe: a survey study on barriers and facilitators for implementation of a toolkit.
Background:
Systematic screening for child maltreatment at the emergency department (ED) has shown to increase the detection rate of child maltreatment. Our previous survey showed the need for a screening checklist, training of hospital staff and availability of a hospital policy regarding child maltreatment. Implementation of a child maltreatment toolkit containing these elements could fill this need, and improve recognition and management of child maltreatment. This study investigated healthcare professionals’ barriers and facilitators for the implementation of this toolkit at European EDs.
Methods:
A survey for healthcare professionals was developed based on the ‘Barriers and Facilitators Assessment Instrument’ and consists of statements (5-point Likert scale) on barriers and facilitators regarding implementation of our child maltreatment toolkit. In the survey, detailed information on the toolkit was given with illustrative videos and figures concerning the screening checklist, training of hospital staff and availability of a hospital policy. Collaborative emergency medicine societies and research networks (European Society for Emergency Medicine (EUSEM), Research in Pediatric Emergency Medicine (REPEM) and European Society for Emergency Nursing (EuSEN)), previous respondents (n=96) and additional contacts at European EDs were approached starting from September 2021 for distribution of the survey. Descriptive analyses were performed and missing answers on statements were excluded. Based on the statements of the majority of the respondents, barriers (>50% (fully) disagreed) and facilitators (>50% (fully) agreed) were identified.
Results:
131 surveys were analysed, representing 87 hospitals from 24 European countries. The estimated response rate ranged from 34 to 52%. The following most important facilitators for implementation of the screening checklist, training and hospital policy were identified:
- Not too time consuming (screening checklist 90%, training 71%, hospital policy 80%).
- Fits into way of working at the ED (screening checklist 87%, training 77%, hospital policy 90%).
- Leaves enough room to make own conclusions (screening checklist 90%, hospital policy 66%).
- Sufficient to improve the recognition of child maltreatment (training 84%).
- Mandatory (national) implementation (hospital policy 96%).
- Trust in the implementation and use (hospital policy 79%).
- Allocation of a part of the hospital budget to the recognition of child maltreatment (hospital policy 94%).
- No resistance to working according to protocols (screening checklist 92%).
With respect to the complete toolkit, respondents were willing to use the toolkit in the future (82%) and think other doctors/assistants (82%) and managers/directors (57%) will cooperate in applying the toolkit. Although above results reflect facilitators for implementation, as only barrier respondents stated the need for more information on the toolkit before implementation (>50%).
Discussion & conclusions:
The identification of the barriers and facilitators for a child maltreatment toolkit will enhance successful implementation. This survey amongst healthcare professionals at European EDs mostly provided facilitators for the implementation of a child maltreatment toolkit. These included that the child maltreatment toolkit fits into the dynamic working environment at the ED. Furthermore, our results showed that professionals are motivated to implement a toolkit for better recognition of child maltreatment.
Trial registration: This study was not registered since this was a descriptive study amongst health care professionals and no appropriate register was available.
Funding: This study did not receive any specific funding.
Ethical approval: This study was approved by the Ethics Committee of the Erasmus Medical Center (MEC-2021-0246) and does not fall under the scope of the WMO. Data was analyzed anonymized.
Feline HOEDEMAN (Rotterdam, The Netherlands), Patrycja PUIMAN, Andrea SMITS, Mariëlle DEKKER, Door LAUWAERT, Rianne OOSTENBRINK, Niccolo PARRI, Luis GARCIA-CASTRILLO RIESGO, Marjolein VAN DER VLEGEL, Suzanne POLINDER, Henriëtte MOLL
16:35 - 18:00
#30912 - Serious bacterial infection in recently immunized young infants with fever without a source.
Serious bacterial infection in recently immunized young infants with fever without a source.
Background:
The American Academy of Pediatrics recently published guidelines addressing the evaluation and management of infants 8 to 60 days of age with fever ≥38.0ºC. Evidence is lacking regarding the best approach to young febrile infants who have received immunizations within the previous 48 hours. For this reason, these infants were excluded from these guidelines. The objective of our study was to compare the prevalence of invasive bacterial infection (IBI) and urinary tract infection (UTI) in infants 42 to 90 days of age with fever without a source (FWS) who have received immunizations in the preceding 48 hours and those who have not.
Methods:
We carried out a secondary analysis of an observational prospective registry that includes all the infants ≤90 days of age with FWS attended in a pediatric ED. We analyzed those 42 to 90 days of age infants attended over an 11-year period (2010–2021). Preterm infants (<37 weeks’ gestation) were excluded. We classified the infants either as having received immunizations (RI group) within the 48 hours preceding the ED visit or as not having received immunizations (non-RI group) during that period. We compared the prevalence of IBI (isolation of a bacterial pathogen in blood or cerebrospinal fluid) and UTI (urine culture with growth of ≥10 000 CFU/mL in combination with leukocyturia) in both groups.
Results:
We registered 1490 episodes corresponding to infants 42 to 90 days of age born at term with FWS. Information about recent immunization was available in 1448 (97.1%): 174 (12.0%) included in the RI group and 1274 (88.0%) in the non-RI group. Among the infants included in the RI-group, 77.6% of them had received the immunization in the same day the fever began.
Overall, 272 (18.7%) were diagnosed with an UTI and 18 (1.2%) with an IBI (10 UTIs with associated bacteremia, 7 occult bacteremias and 1 sepsis). The prevalence of UTI was significantly lower in the RI group [6.9% vs 20.4% in the non-RI group, p<0.01; Odds Ratio: 0.28 (95% CI: 0.15-0.52)]. None of the recently immunized infants were diagnosed with an IBI [vs 18 of the non-RI group (1.4%), p=0.15]
Discussion & Conclusions:
Although the prevalence of UTI in infants 42 to 90 days of age with FWS who have received immunizations within the previous 48 hours is lower, recommending screening for UTI seems appropriate. Prevalence of IBI was also lower among infants with a recent immunization. If further studies confirm this finding, the recommendation of performing blood tests systematically in these infants should be reconsidered.
The study was approved by Ethical Committee of our hospital (CEIC EI4/55).
Given that all the data were extracted from a database in which patients were anonymous and inclusion in the registry did not imply any additional interventions, informed consent was waived.
This study did not receive any specific funding.
Borja GOMEZ (Barakaldo, Spain), Eider LOPEZ, Ana Maria BARREIRO, Amaia FERNANDEZ-URIA, Ainara LEJARZEGI, Javier BENITO, Santiago MINTEGI
16:35 - 18:00
#30981 - The impact of the use of the novel tablet app PediAppRREST on the adherence to international guidelines during the management of paediatric cardiac arrest: a simulation-based randomized controlled trial.
The impact of the use of the novel tablet app PediAppRREST on the adherence to international guidelines during the management of paediatric cardiac arrest: a simulation-based randomized controlled trial.
Background: Deviations from international guidelines during the management of paediatric cardiac arrest (PCA) are still frequent and can affect clinical outcomes. Different cognitive aids have been developed to support health care professionals during the management of cardiac arrest, however very limited data are available on their effectiveness in the management of PCA. We aimed to assess the effectiveness of the use of a novel cognitive aid, in the format of a tablet app, named PediAppRREST, in improving the management of a simulated in-hospital PCA scenario.
Methods: We conducted a multicentre three-parallel-arm simulation-based randomized controlled trial, between September 2020 and December 2021, at four Italian University Hospitals. Residents in Paediatrics, Emergency Medicine, and Anaesthesiology were recruited and randomized into teams of three members each. For each team, one resident needed to be a Paediatric Advanced Life Support (PALS) certified provider and had the role of team leader, while the two other team members had to be Basic Life Support providers. Teams were randomized by an external statistician to three study arms, in a 1:1:1 ratio, using a computer-generated sequence and sealed envelopes. In the intervention arm teams used the PediAppRREST app (PediAppRREST+), while in the first control arm teams used a paper based cognitive aid, the PALS pocket reference card (CtrlPALS+), and in the second control arm teams did not use any cognitive aid (CtrlPALS-). All the teams managed the same standardized simulated scenario of non-shockable PCA. The primary outcome was the number of deviations from guideline recommendations, measured by a novel checklist named c-DEV15plus. Secondary outcomes were team performance, measured by the Clinical Performance Tool (CPT) score, and perceived team leaders’ workload, measured by the Raw NASA-Task Load Index. Scenarios were video recorded and analysed by two independent reviewers. Sample size was calculated as 29 scenarios per arm. Primary and secondary outcome scores were compared between groups with one-way ANOVA model, followed by the Tukey-Kramer multiple comparisons adjustment procedure in case of statistical significance.
Results: A total of 324 residents were randomized into 108 teams. Eight teams were excluded due to sick leave or withdrawal of consent. Overall, 100 teams were analysed (PediAppRREST+=32, CtrlPALS+=35, CtrlPALS-=33). Participants’ demographics and previous experience in simulation and resuscitation were not significantly different among the three study arms. c-DEV15plus scores were significantly lower in the PediAppRREST arm (mean 3.4, standard deviation [SD] 2.0) than control arms (CtrlPALS+ mean 6.4, SD 1.8; CtrlPALS- 6.0, SD 1.6, p<0.0001). CPT scores were significantly higher in the PediAppRREST arm than control arms (mean 8.9 [SD1.6] vs 7.5 [1.5] and 7.7 [1.6] respectively; p 0.0028). Team leaders’ perceived workload did not significantly differ among the three study arms.
Conclusion: The use of the PediAppRREST app was associated with a lower number of deviations from international guidelines and a better team performance, and it was not associated with an increase in the team leaders’ perceived workload. Further studies and systematic training are necessary before considering the use of the PediAppRREST app during real events.
Trial Registration: This trial was registered at ClinicalTrials.gov (NCT04619498).
Funding: This research has received funding support from internal grants from the University of Padova (BIRD 191291/2019, 203279/2020).
Ethical approval and informed consent: The Human Ethics Committee of the University Hospital of Padova, coordinating centre of the trial, deemed the trial to be a negligible risk study and approved it through an expedited review process. All participants signed an informed consent form.
Francesco CORAZZA (Padova, Italy), Marta ARPONE, Giacomo TARDINI, Valentina STRITONI, Giulia MORMANDO, Alessandro GRAZIANO, Elena FIORESE, Sofia PORTALONE, Marco DE LUCA, Marco BINOTTI, Luca TORTOROLO, Serena SALVADEI, Alessia NUCCI, Alice MONZANI, Giulia GENONI, Marco BAZO, Adam CHENG, Anna Chiara FRIGO, Liviana DA DALT, Silvia BRESSAN
16:35 - 18:00
#31086 - The novel augmented reality mobile application for weight estimation in children: A prospective cross-sectional study.
The novel augmented reality mobile application for weight estimation in children: A prospective cross-sectional study.
Background: Accurate weighing of pediatric patient is essential because drug dosage is based on body weight. It is difficult to determine the exact weight of the children in emergency situations, so current American Heart Association guidelines recommend using the length-based weight estimation tool such as Broselow tape (BT) or Pediatric Advanced Weight Prediction in the Emergency Room (PAWPER) XL tape. However, these tape-based weight-estimating methods have problems such as the need to carry the tape in emergency situations, spending time to find it, and lack of knowledge about the proper use of the tape. We developed the application for length-based weight estimation that uses augmented reality by combining the strength of the mobile phone’s accessibility and convenience. Our application was programmed to provide medication dosage, defibrillation energy, and equipment size as well. The aim of our study was to evaluate the performance of the application compared to BT and PAWPER XL.
Methods: This prospective cross-sectional study was conducted on pediatric patients aged from 1 month to 12 years who had visited the emergency department of a tertiary university hospital in Gyeonggi-do, South Korea from August 2021 to March 2022. Weights were estimated using the BT, PAWPER XL, and application. Our application used length-based weight estimation adjusted by 7 stages of body habitus based on 2017 Korean National Growth charts and was developed by Unity engine. The performance was analyzed by calculating the intraclass correlation coefficient (ICC), median performance error, median absolute performance error (MAPE), and root mean squared error (RMSPE). In addition, the percentage of estimations within 10% of the actual weight (PW10) was calculated as index of the overall accuracy of the measurements.
Results: In total, 1090 pediatric patients were enrolled in our study. Compared with BT and PAWPER XL, our application had the smallest MAPE (9.49%) and RMSPE (2.89%). Also, the PW10 of the application was 63.39%, indicating better accuracy than the BT (57.25%), and PAWPER XL (62.47%). The ICC of the BT, PAWPER XL and application between actual weight and estimated weight were 0.9516, 0.9694 and 0.9755, respectively (p<0.001).
Discussion & Conclusions: The performance and accuracy of the application were slightly superior to the BT and PAWPER XL. The estimated body weight by our application was sufficiently correlated with the actual body weight. Our application may be useful in pediatric emergencies.
No appropriate register./National Research Foundation.
Nah SANGUN (Bucheon-si, Republic of Korea), Choi SUNGWOO, Han SANGSOO
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820
18:00 - 19:00
YEMD Section Meeting
Chairperson:
Canberk Djan MESELI (EMERGENCY MEDICINE RESIDENT) (Chairperson, DUBLIN, Ireland)
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M8 |
18:10 |
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INDS9
18:10 - 18:50
Siemens Healthineers: The Value of High Sensitivity Troponin at the Point of Care
18:10 - 18:50
High-sensitivity troponin at the point of care: whats the added value?
Pr Rick BODY (Professor of Emergency Medicine) (Speaker, Manchester, United Kingdom)
18:10 - 18:50
Paradigm shift in the care of patients with ACS. how atellica VTLi hs-cTnI assay can revolutionize the treatment pathway at the point of care.
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INDS7
18:10 - 19:10
ThermoFisher: Acute Dyspnea in the ED: How Biomarkers help to solve the puzzle
Chairpersons:
Said LARIBI (PU-PH, chef de pôle) (Chairperson, Tours, France), Matthew REED (Consultant in Emergency Medicine) (Chairperson, Edinburgh)
18:10 - 19:10
Is this infection and how severe?
18:10 - 19:10
Cardiovascular dyspnea how can I know?
Evangelos GIANNITSIS (Speaker, Germany)
18:10 - 19:10
Just fatigue or more? differential diagnosis of infection in the ED with consideration of an elderly population.
Juan GONZÁLEZ DEL CASTILLO (Speaker, Madrid, Spain)
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M4-5 |
Tuesday 18 October |
08:00 |
"Tuesday 18 October"
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A31
08:00 - 09:00
Emergency Radiology - interactive session TED
08:00 - 09:00
Speaker.
Elizabeth DICK (Speaker, United Kingdom)
08:00 - 09:00
Speaker.
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A6-7 |
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B31
08:00 - 09:00
Prehospital performance - Where medicine is the easy part
08:00 - 09:00
Speaker.
Adam CHESTERS (Speaker, Cambridge, United Kingdom)
08:00 - 09:00
Suprise session workshop.
08:00 - 09:00
Speaker.
Dr Gareth DAVIES (Speaker) (Speaker, London)
08:00 - 09:00
Suprise sesion workshop.
08:00 - 09:00
Speaker.
08:00 - 09:00
Suprise session workshop.
08:00 - 09:00
Speaker.
Chris STEELE (Speaker, United Kingdom)
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C31
08:00 - 09:00
ECG Masterclass
08:00 - 09:00
ECG Masterclass workshop.
Martin FANDLER (Consultant) (Speaker, Bamberg, Germany, Germany)
08:00 - 09:00
ECG Masterclass Workshop.
Klaus FESSELE (Speaker, Nürnberg, Germany)
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D31
08:00 - 09:00
Rebuild the world with Lego, starting with the Emergency Department
08:00 - 09:00
Rebuild the ED Workshop.
Jochen BERGS (Speaker, Hasselt, Belgium)
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A2 |
09:00 |
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830
09:00 - 10:00
Ultrasound Section Meeting
Chairperson:
Eftychia POLYZOGOPOULOU (ASSISTANT PROFESSOR OF EMERGENCY MEDICINE) (Chairperson, ATHENS, Greece)
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R3 |
09:10 |
"Tuesday 18 October"
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A32
09:10 - 10:35
Cardiovascular Emergencies - Pump, pipes and guidelines
Moderators:
Christian HOHENSTEIN (PHYSICIAN) (Moderator, BAD BERKA, Germany), Elke PLATZ (Moderator, Boston, USA)
09:10 - 09:35
The cold and pale limb - how to approach and manage acute vascular emergencies in the ED.
Dr David CARR (Associate Professor of Emergency Medicine) (Speaker, Toronto Canada, Canada)
09:35 - 10:00
How feasible are the cardiology guidelines for the Emergency Physician?
Pr Rick BODY (Professor of Emergency Medicine) (Speaker, Manchester, United Kingdom)
10:00 - 10:25
Acute Heart Failure guidelines: what the Emergency Physician should know.
John PARISSIS (Speaker, ATHENS, Greece)
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B32
09:10 - 10:35
Minor Trauma - Non-vital but very important
Moderators:
Hannah GREENLEES (Moderator, Paisley, United Kingdom), Canberk Djan MESELI (EMERGENCY MEDICINE RESIDENT) (Moderator, DUBLIN, Ireland)
09:10 - 09:30
Ankle injuries - an evidence-based approach for the most common injury in the ED.
09:10 - 09:30
Hand injuries.
Bernd A. LEIDEL (Vice Head) (Speaker, Berlin, Germany)
09:30 - 09:50
Difficult dislocations and their management.
Adam CHESTERS (Speaker, Cambridge, United Kingdom)
10:50 - 11:10
Using Ultrasound to enhance your musculo skeletal physical exam.
Dr Rudolf HORN (head of ED) (Speaker, Glarus, Switzerland)
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C32
09:10 - 10:35
Prehospital Emergencies - New Guidelines Emergency Physicians Should Know
Moderator:
Carmen Diana CIMPOESU (Prof. Head of ED) (Moderator, IASI, Romania)
09:10 - 10:35
09:10 - 09:35
Acute coronary syndrome.
Eric REVUE (Chef de Service) (Speaker, Paris, France)
09:35 - 10:00
Prehospital preparedness in Paediatric trauma.
Dr Jana SEBLOVA (Emergency Physician) (Speaker, PRAGUE, Czech Republic)
10:00 - 10:25
Suspected Sepsis in Prehospital Environment.
Carmen Diana CIMPOESU (Prof. Head of ED) (Speaker, IASI, Romania)
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D32
09:10 - 10:35
Emergency Nursing - Education
09:10 - 09:35
Facilitating learning in the workplace.
Florian GROSSMANN (Clincal Nurse Specialist) (Speaker, BASEL, Switzerland)
09:35 - 10:00
In-situ trauma simulations.
Agusta Hjordis KRISTINSDOTTIR (Emergency nurse specialist) (Speaker, Reykjavik, Iceland)
09:35 - 10:00
In-situ trauma simulations.
Dóra BJÖRNSDÓTTIR (Nurse, BSc, MSc) (Speaker, Iceland, Iceland)
10:00 - 10:25
Education in the ED.
Fay MILLS (sim cup) (Speaker, Truro)
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E32
09:10 - 10:35
Big killers: from stroke to SAH
Moderator:
Ruth BROWN (Speaker) (Moderator, London, United Kingdom)
09:10 - 09:50
Stroke and TIA.
Eugenia - Maria LUPAN-MURESAN (Teaching Assistant) (Speaker, Cluj-Napoca, Romania)
09:50 - 10:10
Neuro exam and NIHSS.
Eric DRYVER (Consultant) (Speaker, Lund, Sweden)
10:10 - 10:35
SAH.
Tobias BECKER (Speaker) (Speaker, Jena, Germany)
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F32
09:10 - 10:35
Limited resources
Moderator:
Bulut DEMIREL (Clinical Development Fellow) (Moderator, Glasgow)
09:10 - 09:35
Redefining Global Health using th ARCH principle.
Dr Anisa Jabeen Nasir JAFAR (Emergency Medicine trainee) (Speaker, Manchester, United Kingdom)
09:35 - 10:00
Remote and rural.
Tatjana DINKELAKER (Speaker, Freiburg, Germany)
10:00 - 10:25
Running an ED is like catering a wedding.
Carolyn HUNTER (work) (Speaker, Glasgow)
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G32
09:10 - 10:35
Digitalisierung in der Notfallmedizin
Moderators:
Sabine BLASCHKE (Head of Department) (Moderator, GOETTINGEN, Germany), Kirsten HABBINGA (Leitende Ärztin) (Moderator, Edewecht, Germany)
09:10 - 09:35
Zuknftige Rolle der Telemedizin in der Notfallmedizin.
Max SKORNING (Speaker, Germany)
09:35 - 10:00
Digitale Notaufnahme - wie gelingt die Transformation?
Clemens KILL (Director) (Speaker, Essen, Germany)
10:00 - 10:25
Nationales Notaufnahmeregister - welche Ergebnisse gibt es?
Wiebke SCHIRRMEISTER (Speaker, Magdeburg, Germany)
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H32
09:10 - 10:35
Pre-hospital / EMS / Out of Hospital
Moderators:
Erika FRISCHKNECHT CHRISTENSEN (Professor) (Moderator, DENMARK, Denmark), Izaskun TELLITU (Emergency Specialist) (Moderator, Cambrils, Spain)
09:10 - 10:35
#31289 - Clinical features of patients diagnosed from intoxication in four prehospital emergency services.
Clinical features of patients diagnosed from intoxication in four prehospital emergency services.
Background
Poisoning is an uncommon cause of activation of the Prehospital Emergency Services (PhEMS). There’s little evidence of the clinical features of the patients referred to the hospital with this diagnosis. 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 diagnosed from intoxication and then referred to their reference hospitals by PhEMS as well as to objectify whether there are differences between patients referred from rural vs. urban areas.
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 intoxication diagnosis and referred to their reference hospitals between October 1, 2019 and April 30, 2021.
Outcome variables: Sex, age, zone (rural/urban) hospital destination, intensive care unit (ICU) admission, in-hospital mortality, type of intoxication (TOI), total care time by PhEMS (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
119 patients. Women:52,9%. Median age: 43 years (IQR: 32-54). Urban 79,2% Hospitalization average: 35,3%. ICU average: 16%. In-hospital mortality average: 4,2%. TOI: average: Benzodiazepines (48,7%), alcohol (18,5%), other (12,6%), other abuse drugs (5,9%), gas/smoke (5%), antidepressants (3,4%), paracetamol (2,5%), opioids (1,7%), cocaine (0,8%), insulin (0,8%). TCT average (minutes): 52 (IQ: 44-60).
Association between TCT average (minutes) and zone: Rural: 22,2. Urban 12,5 (p<0,05). Association between TOI and zone: Rural: Benzodiazepines 54,2%, alcohol 20,8%. Urban: Benzodiazepines 47,4%, alcohol 17,9% (p>0,05). Association between hospital admission and zone: Rural 29,2%, urban 36,8% (p>0,05). Association between in-hospital mortality and zone: Rural 0%, urban 5,3% (p>0,05). Association between TOI an in-hospital mortality: Antidepressants 25%, other abuse drugs 14,3% (p>0,05). Association between age (years) and in hospital mortality: < 30: 4%, 31-60: 2,4%, >60: 16,7% (p>0,05).
Discussion and conclusions
In our study, intoxications have shown to be high mortality diseases that often require hospitalization. Benzodiazepine and alcohol intoxication have proved to be the most common diagnose in all age-spans and in both rural and urban patients. Patients diagnosed with antidepressant intoxications 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, Miguel Ángel CASTRO VILLAMOR, Juan Francisco DELGADO BENITO, Raúl LÓPEZ IZQUIERDO, Irene SÁNCHEZ SOBERÓN, Francisco MARTÍN-RODRÍGUEZ
09:10 - 10:35
#30799 - Documentation of vital signs for paediatric patients in ambulances: A cross-regional prospective observational study.
Documentation of vital signs for paediatric patients in ambulances: A cross-regional prospective observational study.
Background: Caring for paediatric patients may be stressful for emergency medical services (EMS) professionals, and vital sign documentation in paediatric patients is inadequate, especially in patients ≤2 years. The study objective was to investigate if educational initiatives for EMS professionals could increase the proportion of paediatric patients for whom vital signs were documented in the prehospital medical record.
Method: Prospective cohort study in the North Denmark and South Denmark Regions with a consecutive patients sample of children aged <18 years who were attended by EMS in a 15-month period from October 1, 2020, to December 31, 2021, excluding interfacility transfers and patients with cardiac arrest. The two regions have similar demographic structures; there are 29 and 28 emergency calls regarding children <18 years per 1000 inhabitants annually in the North and South Denmark Regions, respectively. Educational initiatives were conducted in one of the regions amid the study period and included video learning and classroom training based on European Paediatric Advanced Life Support principles. Virtually all EMS professionals had completed the video learning (98.6%). The primary outcome was the proportion of patients, who had their Glasgow Coma Score, peripheral capillary oxygen saturation (SpO2), heart rate, and respiratory rate documented at least once during the prehospital phase. We used a two independent samples proportions test to compare regions with a crude estimate of the proportion difference with 95% confidence intervals.
Ethical approval and informed consent: The North Denmark Region Ethics Committee reviewed the study and concluded that obtaining informed consent from each individual patient was not required. Permission to collect outcome data from patient medical records according to the General Data Protection Regulation was granted by The North Denmark Region on behalf of the Danish National Health Authorities (id nos. 2020-100 and 2020-027132).
Results: 15,772 patients from South Denmark and 7,682 patients from North Denmark were included. The total study population involved patients at ages <1 year (12.8%), 1-2 years (18.6%), 3-7 years (16.0%), 8-12 years (14.1%) and 13-17 years (37.9%). The proportion of patients that had all of the four vital signs documented was 0.62 [0.61;0.63] in the usual care region during both the pre- and post-educational periods. In the region that implemented the educational initiatives, the proportion increased from 0.66 [0.65;0.68] in the pre-educational period to 0.70 [0.69;0.72] in the post-educational period. Between the regions, the proportion difference of the primary outcome was 8.4 %-points [6.6;10.2] in the post-educational period. Subgroup analyses with patients <2 years (N=2,928) showed that the primary outcome was present in 56.3% [53.1;59.4] of patients following the educational initiatives compared to 32.3% [30.3;34.4] of patients in the region without the initiatives.
Conclusions: The study implies that educational initiatives can increase the extent of vital sign documentation in paediatric EMS patients, especially in the youngest patients <2 years.
Trial registration: None. There was no collection or analysis of any biological material, and no interventions were introduced on patient level.
Funding: VN has received a research grant from the Danish Air Ambulance.
Vibe Maria Laden NIELSEN (Aalborg, Denmark), Morten Breinholt SØVSØ, Torben Anders KLØJGÅRD, Søren MIKKELSEN, Erika Frischknecht CHRISTENSEN
09:10 - 10:35
#31453 - Early warning scores in patients with atrial fibrillation in prehospital emergency medical services.
Early warning scores in patients with atrial fibrillation in prehospital emergency medical services.
Early warning scores (EWS) help to prevent and recognize patients presenting the first signs of clinical and physiological deterioration. Therefore, they are systems that are very helpful to prehospital emergency medical services (EMS) due to the complexity of patients and scenarios in which they must act.
The aim of this study is to evaluate different EWS (National Early Warning Score 2 (NEWS2), Quick Sequence Organ Failure Assessment Score (qSOFA), Modified Rapid Emergency Medicine Score (MREMS) and Rapid Acute Physiology Score (RAPS)) to predict mortality within the first 48 h in patients with electrocardiogram compatible with atrial fibrillation (AF) at the time of care by the EMS.
Observational, prospective, multicenter study. Inclusion criteria: over 18 years of age with a diagnosis of atrial fibrillation on electrocardiogram performed in the ambulance at the time of transfer by the SEMP to hospital emergency departments (ED) between October 2019 and March 2021 in 4 Spanish provinces of the same health service. Exclusion criteria: < 18 years, patients without a diagnosis of AF on electrocardiogram, patients discharged in situ, follow-up < 48 hours.
Variables: NEWS2: heart rate (Fc), respiratory rate (Fr), temperature (Tª), Systolic Blood Pressure (SBP), oxygen saturation (SpO2), patient with hypercapnic respiratory failure, need for supplemental oxygen, AVPU score (alertness, verbal response, response to pain, unversponsive). qSOFA: Fr, SBP and Glasgow Coma Scale (ECG). MREMS: Fc, Fr, SBP, SpO2, GCS, age. RAPS: Fc, Fr, mean arterial pressure (MAP) and GCS. Main dependent variable: early mortality in the first 48 hours after care (EM).
Statistical analysis: Normality tests. Frequencies, central measures and dispersion in standard deviation (SD) or interquartile range (IQR). Chi-square (proportions), T Student (means) Mann-Whitney U (medians). Univariate regressions using logistic regression. Odds ratio (OR) calculation. Area under the curve (AUC) of the receiver operating characteristics (ROC). Younden test to determine the cuttoff point (CP). Calculation of sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (-LR). Statistical significance: p <0.05, 95% confidence interval (95% CI). Software: SPSS.
Results: N: 261. Women: 48.7%. Age: median total 80 (RIC 73.87). Men 76 (RIC 71-85) vs women 83 (77-89) (p<0.001). NEWS 6 (RIC 3-9). qSOFA 1 (0-1). MREMS 11 (9-13). RAPS 3 (2-5). EM: 11.5%.
NEWS2 scale: AUC of 0.867 (95%CI 0.804-0.931) (p<0.001). CP: 8. Sensitivity 0.87 and Specificity 0.73 +LR 3.28 and -LR 0.18. OR 18.11 (95% CI: 6.07-54.06) (p<0.001). qSOFA AUC 0.870 (95% CI 0.813-0.928) (p<0.001). CP 1. Sensitivity 0.700. Specificity 0,874. +LR 5.58 and -LR 0.34. OR 16.25 (95% CI: 6.79-38.89) (p<0.001). MREMS AUC 0.800 (95%CI 0.718-0.913) (p<0.001). CP 11. Sensitivity 0.800. Specificity 0.632. +LR 2.71 and -LR 0.30. OR 6.871 (95% CI: 2.70-17.47) (p<0.001). RAPS AUC 0.817 (95%CI 0.727-0.907) (p<0.001). PC 3. Sensitivity 0.800. Specificity 0.662. +LR 2.37 and -LR 0.30. OR 7.84 (95% CI 3.08-19.99)(p<0.001).
Conclusion: The score with the best ability to predict EM in patient with electrocardiogram compatible with atrial fibrillation at the time of EMS care has been the NEWS2, with an area under the curve similar to that of qSOFA but with better OR.
Rodrigo ENRIQUEZ DE SALAMANCA, GAMBARA. (Valladolid, Spain), Irene SÁNCHEZ SOBERÓN, Bolaños PACHECO, Francisco MARTÍN-RODRÍGUEZ, Raul LOPEZ IZQUIERDO, Maria Del Carmen GOEZ SANZ, Juan F. DELGADO BENITO, M.a. CASTRO VILLAMOR, Enrique CASTRO PORTILLO
09:10 - 10:35
#30434 - Effect of Community First Responder presence on ambulance ‘on scene’ time in patients with suspected strokes: a retrospective cohort service evaluation.
Effect of Community First Responder presence on ambulance ‘on scene’ time in patients with suspected strokes: a retrospective cohort service evaluation.
Background:
Community First Responders (CFRs) are uniformed volunteers who respond to emergency calls and can provide life-saving interventions prior to ambulance arrival[1]. In the United Kingdom, CFRs commonly manage patients with suspected strokes before the arrival of ambulance staff. Anecdotal evidence suggests that CFRs can reduce the time spent on scene by ambulance staff with a patient, which may decrease the onset-to-treatment time in patients with true strokes. This service evaluation aimed to assess the effect of CFR presence on ambulance ‘on scene’ time in patients with suspected strokes.
Methods:
In this retrospective cohort service evaluation, all patients categorised by 999/111 telephone triage as suspected strokes and then attended by four UK ambulance services between 1st January 2021 and 31st December 2021 were included. Patients were stratified according to the presence of CFRs or not, which occurred depending on incident location and CFR availability. Outcome variables were CFR and ambulance staff response time (call-to-arrival time), and the time spent on scene by ambulance staff with a patient (i.e., the length of patient assessment by a clinician). As CFRs are more likely to attend incidents in rural areas, time taken for patients to reach hospital was not analysed. The study met the criteria for service evaluation so ethical approval was not required.
Results:
96,312 patients with suspected strokes were identified. CFRs attended 3.9% of incidents (n = 3,763) with a mean response time of 24.52 minutes (95% CI [23.75, 25.28]). When CFRs were present, mean ambulance response time was 34.27 minutes (95% CI [33.38, 35.16]) and mean ambulance on scene time was 38.92 minutes (95% CI [38.27, 39.56]). In the remaining 91.1% of patients (n = 92,549) managed only by ambulance staff, mean ambulance response time was 28.83 minutes (95% CI [28.64, 29.03]) and mean ambulance on scene time was 40.86 minutes (95% CI [40.73 ,41.00]). CFR presence was therefore associated with a 117 second reduction in time spent on scene by ambulance staff.
Discussion:
In patients with suspected strokes, CFRs arrive faster than ambulance staff and are associated with a small but significant decrease in time spent on scene by ambulance staff. This may translate into a decrease in onset-to-treatment time for some patients, which has proven health benefit for even marginal improvements[2]. CFRs may decrease the time spent on scene by ambulance staff by initiating essential tasks prior to ambulance arrival (e.g., establishing time of symptom onset). It may be possible to increase this effect with specific training. As patients were included based on telephone triage, this sample is unlikely to be fully representative.
References:
1 - Phung, et al. ‘Community First Responders and Responder Schemes in the United Kingdom: Systematic Scoping Review’. Scand J Trauma Resusc Emerg Med, vol. 25, no. 1, 2017, p. 58
2 – Meretoja, et al. ‘Stroke Thrombolysis’. Stroke, vol. 45, no. 4, 2014, pp. 1053–58
N/A
Adam WATSON (Oxford, )
09:10 - 10:35
#30796 - Effect of designated team response on favourable neurological recovery of out-of-hospital cardiac arrest by initial rhythm: nationwide propensity matched cohort study.
Effect of designated team response on favourable neurological recovery of out-of-hospital cardiac arrest by initial rhythm: nationwide propensity matched cohort study.
Objectives
This study aimed to investigate the effect of operating designated team response (DTR) on the favourable neurological outcome for out-of-hospital cardiac arrest (OHCA) patients.
Methods
A cross-sectional observational study was conducted for emergency medical service (EMS)-treated adult OHCA with cardiac aetiology from July 2019 to December 2020. In July 2019, a DTR pilot study was implemented to provide EMS providers with 3-day advanced cardiac life support (ACLS) training and to dispatch them to suspected OHCA patients first. Exposure was whether or not the DTR was dispatched; DTR and non-DTR. The primary outcome was favourable neurological outcome. Eligible OHCA patients were classified as shockable/non-shockable group according to the initial rhythm assessed by EMS providers. For each rhythm population (non-matched cohort), a matched cohort for DTR cases was constructed by the propensity score matching (PSM) method (matching variable: age, sex, quarter of year, and urbanization level of arrest location) and a total of 4 study populations were constructed. A multivariable logistic regression analysis was conducted for each population to investigate the effect of DTR on study outcome adjusting for confounding factors.
Results
Among 19,052 eligible patients, 2,946 (15.5%) were shockable (DTR 1,009, and non-DTR 1,937) and 16,033 (84.2%) were non-shockable rhythm (DTR 5,424 and non-DTR 10,609). Shockable to matched cohort was 1,062 cases, and non-shockable to matched cohort were 694 cases. In all 4 study populations, DTR provided more ACLS such as intravenous line insertion, epinephrine administration, and advanced airway management and showed longer scene time than non-DTR (all p-value < 0.01). In the final logistic model, compared to non-DTR, the DTR had a lower probability of favourable neurological outcome in all populations (AOR (95% CI): shockable unmatched 0.73 (0.61-0.87), shockable matched 0.58 (0.44-0.77, non-shockable unmatched 0.50 (0.33-0.76), and non-shockable matched cohort 0.58 (0.44-0.77)).
Conclusion
The operating a designated team response for OHCA did not associate with better favourable neurological outcome in despite of higher provision rate of ACLS. Further research is needed to find the optimal population in which DTR can be effective to improve survival outcome.
Sun Young LEE (Seoul, Republic of Korea), Jeong Ho PARK
09:10 - 10:35
#31173 - Epidemiology of ambulance attended adults who fall in Western Australia 2015-2021: a retrospective cohort study.
Epidemiology of ambulance attended adults who fall in Western Australia 2015-2021: a retrospective cohort study.
Background: Globally, 37 million falls are severe enough to require medical attention annually, with adults >60 years of age having the greatest number of fatal falls. Western Australia’s (WA) increasing population has resulted in high demand for emergency ambulance attendances to falls. The aim of this study was to describe the characteristics of ambulance attended patients who fall in WA. The specific objectives of this study were: 1) to describe the characteristics of patients; 2) to estimate the crude and age-standardised incidence rates of ambulance attended falls; and 3) to identify the frequency and describe: injuries sustained from falls; interventions used and patient disposition.
Methods: A retrospective cohort study was conducted of electronic patient care records (ePCR) for adults (>18 years) who fell and required St John Western Australia (SJWA) ambulance attendance between 1st Jan 2015 – 31st Dec 2021. Data collected from the ePCR were: patient characteristics (e.g. age, sex and observations), injuries sustained (i.e. injury location and type), prehospital interventions (i.e. medication and treatment delivered) and disposition (e.g. transported to hospital). Falls were identified either by dispatch code or through examination text, before excluding injuries resulting from motor vehicles, assault, syncope or suicide. Age was summarised as median with interquartile range and categorical variables as count and percentage.
Results: There were 188,720 patients (female = 107,811, 57%) attended by ambulances after falls, 139,857 (74%) within Perth metropolitan region and 48,863 (26%) in rural WA. Median age was 80 years [IQR 67-87]. The age-standardised incident rate of ambulance attended falls increased from 1,011 in females and 743 in males per 100,000 person-years in 2015, to, 1315 in females and 1015 in males per 100,000 person-years in 2021. The overall age-standardised incidence rate of ambulance attended falls increased from 876 to 1165 per 100,000 person-years from 2015 to 2021.
Of the cohort, 89,140 (47%) patients sustained a suspected injury, 45% of patients reported pain, 31% had tenderness recorded, 27% had lacerations recorded, and 12% had suspected fractures. Regarding interventions, 50,372 (27%) patients received >=1 medication e.g. analgesia, and 31,203 (17%) patients received >=1 treatment e.g. oxygen. Following assessment and treatment, 148,050 (78%) patients were transported to hospital and 40,670 (22%) were not transported. Patients were transported via the following urgency level (time-critical emergency level): 2,371 (2%) were transported via the highest urgency with lights and siren (urgency one), 27,882 (19%) via urgency two, 93,447 (63%) via urgency three and 22,929 (15%) via urgency four-Six, (<1% unknown urgency).
Conclusions: The majority of patients who fell were female, and the proportion in rural WA was in keeping with the distribution of WA’s population. Nearly half of injuries resulted in pain, many involved lacerations or suspected fractures, and a quarter of patients were given analgesia. After treatment 2% of patients were transported to hospital via the highest urgency with lights and sirens, reflecting the seriousness of their condition. The frequency and incidence rates of falls requiring ambulance attendances have increased over time.
Trial registration/Funding: NA
Ethical approval: Curtin University [HR128/2013-85, 09/Mar/2022] and SJWA Research Governance Committee approval [11/Mar/2022].
Paige WATKINS (Victoria Park, Australia), Peter BUZZACOTT, Paul BRAYBROOK, Anne-Marie HILL, Hideo TOHIRA, Deon BRINK, Steven BALL
09:10 - 10:35
#31075 - Keep it simple – simple early warning scores are as good and bad as other scores in ambulance patients – a population-based registry study.
Keep it simple – simple early warning scores are as good and bad as other scores in ambulance patients – a population-based registry study.
Background
Early prediction of serious outcome is important in emergency care - the earlier, the better - ideally as soon as the vital signs are taken on scene by the paramedics. Triage and early warning scores based on vital signs were designed for use in the emergency department and have only to some extent been tested in prehospital use and with various conclusions.
The aim of this study was to investigate the standard clinical score’s ability to predict serious outcome in prehospital use among all ambulance patients.
Methods
The was a historic observational study based on the prehospital electronic medical record data from North Denmark Region 1 July 2016 to 31 December 2020, linked to regional administrative registries of hospital admissions and date of death. In Denmark, patients call the emergency number 112 or, in less severe cases, the general practitioner. We included patients aged 18 years or older stratified into 112-patients/non-112 patients. We calculated the RETTS-Swedish triage score, NEWS2-National Early Warning core, mNEWS score (modified NEWS score without temperature), DEPT-Danish triage score, and qSOFA. For each score, the highest score during before arrival at hospital was used as a predictor. Missing data were assumed to be normal. Outcomes were 30-day-mortality and admission to intensive care unit.
Descriptive statistics grouped according to 112-call status. Receiver operating characteristic (ROC) and precision-recall curves (APR) were plotted using standard clinical scores and discrimination assessed using Area under the ROC curve (AUROC) and Average Precision (APR).
Ethics: As patients’ consent to achieve medical record data was not possible, we, according to Danish Law, applied for and got permission to analyzing medical record data from the regional authority (2021-012621)
Results
We included data from 106.926 unique patients with 218,972 medical records, 54.5 % concerned 112-patients. Among 112-patients 46.0 % were women versus 49.7% among non-112 patients. There were three age peaks: at 1 year (infants), 21 years (young adults) and 73 years (elderly). 112-patients were younger, median (IQR) 64 (47-77) years versus 74 (61-83) in non-112-patients.
The clinical scores performed similarly concerning 30-day mortality, with AUROCs of 0.75-0.80 in 112-patients and 0.62-0.66 in non-112-patients, and low APRs of 0.15-0.21 and 0.16-21, with no differences between NEWS, mNEWS and DEPT. All scores also performed similarly for prediction of admission to intensive care unit with AUROCs from 0.71-0.77 in 112-patients and 0.63-0.69 in nin-112 patients with low APRs of 0.05-0.12.
Discussion and conclusion
In this largescale population-based prehospital study, the RETTS, NEWS2, mNEWS, the DEPT, and qSOFA score all performed almost similarly in prediction of serious outcome. Especially, NEWS and mNEWS performed similarly, which suggests the temperature component of the score has little predictive value for mortality in this population. However, all scores performed poorly in accuracy due to the high number of false positives. The next step is to investigate whether machine-learning methods may improve prediction and accuracy.
Acknowledgement: Thanks to Thomas Mulvad, North Denmark Region for assisting with data management.
None – this was a registry-based study based on medical record data. As patients’ consent to achieve medical record data was not possible, we, according to Danish Law, applied for and got permission to analyzing medical record data from the regional authority (ID 2021-012621).
Funding: The European Union’s European Fund for Regional Development through Life-Science Innovation North Denmark’s programme “Sundhedsteknologisk Serviceprogram (SSP)”. projectID 036.
Tim LINDSKOU, Erika Frischknecht CHRISTENSEN (DENMARK, Denmark), Logan WARD, Mads Lause MOGENSEN, Martin ROSTGAARD-KNUDSEN, Morten Breinholt SØVSØ
09:10 - 10:35
#30842 - Relationship among transfusion therapy, emergency surgery and 2-day in-hospital mortality with prehospital application of the pelvic belt in suspected pelvic trauma patients.
Relationship among transfusion therapy, emergency surgery and 2-day in-hospital mortality with prehospital application of the pelvic belt in suspected pelvic trauma patients.
Background: On many occasions, the presence of pelvic fractures or unstable pelvises is associated with significant blood loss, with the consequent resulting hypovolemic shock. Sometimes it is very difficult to discriminate which patients may potentially present a pelvic fracture in prehospital care, so a high level of suspicion, the study of the injury mechanism and the use of early warning scores can help practitioners to identify high-risk cases.
The goal of this report is to analyze the relationship between the use of the prehospital pelvic belt and blood administration, emergency surgery and 2-day in-hospital mortality.
evaluate the ability of the Rapid Acute Physiology Score (RAPS) to predict the necessity of prehospital pelvic belt.
Methods: Prospective, multicentric, EMS-delivery, ambulance-based, pragmatic cohort study of adults with prehospital pelvic trauma, referred to five hospitals (Spain), between January 2020, and December 2021. Any patient treated consecutively by EMS with prehospital diagnosis of pelvis trauma and transferred by ambulance to the ED was included in the study. Patients under 18 years of age, non-traumatic patients, pregnant women, and patients discharged on site were excluded.
Results: 62 patients with prehospital pelvic trauma were transferred to the ED and finally included in the study. The median age was 50 years (IQR: 39-61), between 18 to 95 years, with 33.9% females (321 cases). 31 cases required prehospital pelvic belt (50 %).
Analyzing the patients by subgroups, we can observe that the cases that did not require a prehospital pelvic belt had a rate of blood transfusion, emergency surgery and 2-day in-hospital mortality of 48.4 % (15 cases), 71 % (22 cases), and 25.8% (8 cases) respectively; vs prehospital pelvic belt, 35.5 (11 cases), 54,8 % (17 cases), and 12.9 % (4 cases). Despite the obvious quantitative discrepancies, no statistically significant differences are evident, with p=0.215, p=0.311 and p=0.195, respectively for blood transfusion, emergency surgery and 2-day in-hospital mortality
Conclusions: Pelvic belt use is a standard in prehospital care, which should be used in all cases of suspected pelvic trauma. However, our preliminary results did not show a significant relationship between the use of this device and an improvement in morbi-mortality. The limited sample size may be the reason for these results, but it is clear that patients with the pelvic belt had lower rates of transfusion, surgery and early mortality. These data could indicate an insufficient use of the device, or that the pelvic belt is very effective and improves the results, in both cases, in prehospital care, the use of the pelvic belt should be a routine procedure at the slightest suspicion of pelvic trauma.
This work was supported by the Gerencia Regional de Salud, Public Health System of Castilla y León (Spain) [grant number GRS 1903/A/19 and GRS 2131/A/20]
Francisco MARTÍN-RODRÍGUEZ, Rodrigo ENRIQUEZ DE SALAMANC GAMBARA (Valladolid, Spain), Cristina VÁZQUEZ DONIS, Rocio VARAS MANOVEL, Irene SÁNCHEZ SOBERON, M. Cristina RAMOS ORTEGA, Santiago OTERO DE LA TORRE, Carlos NAVARRO GARCÍA, Arancha MORATE BENITO, Almudena MORALES SÁNCHEZ, Jesús MINGUEZ BRAVO, Victor MENÉNDEZ GUTIÉRREZ, Laura MELERO GUIJARRO, Francisco Tomás MARTÍNEZ FERNÁNDEZ, Rafael MARTÍN SÁNCHEZ, Isabel JULIÁN CRESPO, M. Teresa HERRERO DE FRUTOS, María GRAÑEDA IGLESIAS, Emma GARCÍA TARRERO, Laura M. GARCÍA SANZ, Esther FRAILE MARTÍNEZ, J. José FERNÁNDEZ CARBAJO, Juan Francisco DELGADO BENITO, Carlos DEL POZO VEGAS, Pablo DEL BRIO IBAÑEZ, Miguel Angel CASTRO VILLAMOR, Enrique CASTRO PORTILLO, Rafael CALDEVILLA ROMERA, M. Teresa BLAZQUEZ GARCÍA, Raúl LÓPEZ-IZQUIERDO
09:10 - 10:35
#31192 - The use of an interactive voice server reduces the workload of a medical dispatch center in case of an influx of calls.
The use of an interactive voice server reduces the workload of a medical dispatch center in case of an influx of calls.
Introduction:
During the first wave of the COVID-19 epidemic, emergency medical services (EMS) were suddenly overwhelmed with calls. To better control the flow of calls and reduce the workload of the staff, we experimented an Interactive Voice Server (IVS).
The objective of this study was to describe the use of the IVS in an EMS during periods of call influx and to determine whether it contributed to reducing the workload of operators.
Methodology:
Between March 19th, 2020, and April 26th, 2020, an IVS was activated daily from 8:00 AM to midnight. After dialing the emergency number, the caller was connected to an IVS with a message suggesting to "press zero" if their call was about COVID and they did not have a life-threatening distress. If the caller made this choice (IVS Yes), the call was directed to a specific "COVID crisis" control room, staffed by operators specially trained to handle COVID cases. In the opposite case (IVS No), the call was distributed to the operators of the usual circuit who received all the emergency calls. All Medical Regulation Records (MRRs) with a single call during IVS hours were included. Reason for call, IVR use, age and gender of the patient, caller’s profile (patient or third party), and number of operators required to fully process the call were recorded.
Results
23534 MRR were included, of which 19793 (84%) were during IVS hours.
Of these calls, 9044 (45.70%) had a suspected COVID infection as the reason for the call.
2846 (14.38%) patients were “IVS Yes”.
The age of “IVS Yes” was 41.35 years (SD 23.08) and “IVS No” 44.81 years (SD 23.65) p<10-3. The sex ratio was 0.8 for both groups. 2340 (82.31%) of the “IVS Yes” were the subject himself vs 9681 (57.13%) for “IVS No” (p<10-3).
2513 (88.3%) of IVS Yes” were handled by a single operator vs 989 (5.84%) for “IVS No” which required up to 8 callers.
Conclusion:
The use of an IVS allowed, during an epidemic period, 15% of calls to be taken out of the conventional emergency call queue to be directed into a specific flow. Unlike "conventional" calls which, in our system, required the intervention of at least 2 operators, calls through an IVS can be handled by a single operator, specialized and trained specifically for the current crisis. The use of an IVS contributed to reduce the workload of a medical regulation center in case of an influx of calls.
n/a
Margot CASSUTO (Garches), Marin BOYET, Jérémie BOUTET, Guillaume DOUGE, Gaelle LE BAIL, Anna OZGULER, Michel BAER, Thomas LOEB
09:10 - 10:35
#31470 - Use of urgent, emergency and acute care by mental health service users: A record-level cohort study.
Use of urgent, emergency and acute care by mental health service users: A record-level cohort study.
Background
People with serious mental illness (SMI) are more likely to have multiple long-term physical health conditions, but are less likely to access primary care and preventive interventions. A 2015 Nuffield study showed that people with SMI use urgent and emergency care (UEC) services more frequently than hospital users without mental ill health. However, this study did not examine UEC usage among the general population. The aim of the present research was to compare UEC usage among people with SMI and the general population.
Methods
This was an observational study utilising routinely collected patient data from 2013-2016. This was taken from the CUREd research database, which holds record-level data from UEC services in the Yorkshire & Humber region. We defined two groups for each year of the study: those with SMI (anyone receiving care from Sheffield Health and Social Care NHS Foundation Trust during that year); and those without SMI (all other service users). Using ONS population estimates to approximate the local population from which the sample of non-SMI UEC service users was drawn, we calculated annual age- and sex-standardised usage rates for NHS 111 calls, ambulance callouts, A&E attendances and acute hospital admissions. We used logistic regressions to explore differences in the clinical characteristics of the SMI and non-SMI cohorts.
Results
During the full study period there were 256,596 NHS 111 calls by 123,315 patients; 179,786 ambulance callouts by 102,007 patients; 452,343 A&E attendances by 206,620 patients; and 211,327 provider spells by 103,099 patients.
The SMI cohort made greater use of all UEC services across all study years. Usage rates per 1000 population were approximately 7 times higher in the SMI cohort for ambulance callouts, approximately 6 times higher for NHS 111 calls, and approximately 5 times higher for A&E attendance and acute hospital admissions. The proportion of the SMI group using UEC services was 3-4 times higher than the non-SMI group for all UECs.
People with SMI were more likely to require a call back from NHS 111, and to be referred to a clinically trained advisor. They were more likely to receive the highest or lowest acuity recommendation from NHS 111. Patients with SMI were more likely to be admitted to a hospital bed after attending A&E, and more likely to arrive via ambulance, but were also more likely to attend with a low-acuity problem that could have been dealt with in alternative non-emergency settings. For patients experiencing an acute hospital admission, those with SMI were more likely to experience a long and/or multi-episode stay.
Conclusions
This study suggests that those with SMI tend to experience more serious and complex urgent healthcare problems not necessarily related to mental health, but that they also use UEC services for non-urgent healthcare needs more than those without SMI.
This is independent research funded by the National Institute for Health Research, Yorkshire and Humber Applied Research Collaborations. The views expressed in this work are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the work.
Jennifer LEWIS (Sheffield, ), Scott WEICH, Colin O'KEEFFE, Tony STONE, Joe HULIN, Nicholas BELL, Mike DOYLE, Mike LUCOCK, Lesley BUTTERWORTH, Suzanne MASON
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EPOSCB4SC1
10:40 - 11:00
Coffee Break 4 - EPoster session - Screen 1
Moderator:
Dr Firas ABOU-AUDA (Consultant) (Moderator, London)
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EPOSCB4SC4
10:40 - 11:00
Coffee Break 4 - EPoster session - Screen 4
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10:40 - 11:00
Coffee Break 4 - EPoster session - Screen 3
Moderator:
Nancy VAN DER WAARDEN (Nurse practitioner emergency care) (Moderator, Rotterdam-Rijnmond, The Netherlands)
10:50 - 10:55
Monocyte/lymphocyte ratio is an independent predictor for in-hospital major adverse cardiac events in patients with acute coronary syndrome: observational study.
Chiraz BEN SLIMANE (DOCTOR) (Eposter Presenter, TUNISIA, Tunisia)
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10:40 - 11:00
Coffee Break 4 - EPoster session - Screen 2
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Rianne OOSTENBRINK (pediatrician) (Moderator, Rotterdam, The Netherlands)
10:55 - 11:00
Repeated emergency department visits among children that are admitted to an intensive care unit.
Borja GOMEZ (Pediatric Emergency Physician) (Eposter Presenter, Barakaldo, Spain)
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10:40 - 11:00
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10:40 - 11:00
Coffee Break 4 - EPoster session
10:40 - 11:00
#31092 - Association between physician clinical experience and prehospital discharge without transportation – A retrospective cohort study.
Association between physician clinical experience and prehospital discharge without transportation – A retrospective cohort study.
Background: Ambulance transports to emergency departments (ED) might be inappropriate for up to 30% of patients. Prehospital physicians can help paramedics to take appropriate clinical and medico-legal decisions, such as discharging patients on-site, without transportation. Currently, studies assessing the impact of the physician’s level of experience on patient disposition are scarce. Therefore, our goal was to determine whether the rate of discharge without transportation was associated with clinical experience.
Methods: We retrospectively studied 48’368 adult patients taken care of by a physician-staffed emergency mobile unit from 01.01.2010 to 31.12.2019 and compared outcomes according to the physicians’ clinical experience. This level of experience was defined as the number of months since graduation at the time of the intervention and was dichotomized into low (less than 3 years) and high (more than 3 years). The main outcome was the rate of patients discharged without transportation. The secondary outcome was the rate of patients discharged to paramedics. To describe the association, we reported relative risk reductions (RRR) with their 95% confidence intervals. We performed a subgroup analysis looking based on patient severity. Finally, the association between exposure and outcomes was graphically represented using restricted cubic splines and logistic regression.
Results: The overall rate of discharge without transportation was 7.8%. While there was no statistically significant difference between a low and a high level of experience (RRR=1.4%, 95%CI [-7.1 – 9.4], p=0.732), logistic regression using restricted cubic splines clearly showed a non-linear association between level of experience and discharge without transportation (Wald test p<0.001). Physicians with a high level of experience were also more likely to discharge severely ill patients without transportation than their less experienced colleagues (2.0% versus 1.5%, RRR=25.2%, 95%CI [5.0 – 41.1], p=0.017). No such difference was found in less severely ill patients (20.4% versus 20.7%, RRR=1.2%, 95%CI [-7.4 – 9.2], p=0.771). Regardless of illness severity, patients were more often discharged to paramedics when physicians had a high level of experience (35.5% versus 31.8%, RRR=10.2%, 95%CI [6.9 – 13.5], p<0.001).
Discussion and conclusion: In this retrospective cohort study, we found an association between clinical experience and discharge without transportation to the ED, especially among severely ill patients. This could be explained by physicians being globally more confident regarding the absence of risk for the patients or not perceiving the added value of an ED visit for patients in an end-of-life situation. We also found that experienced physicians were more likely to discharge patients to paramedics. This can be explained by a more comprehensive knowledge of the skills and aptitudes of paramedics. In conclusion, there is a significant association between level of experience and prehospital patient orientation.
Trial registration: This retrospective cohort study was not registered (no appropriate register).
Funding: No funding was provided for this study.
Ethics approval: This study was approved on 27.08.2020 by the institutional ethics committee of Geneva, Switzerland (Project ID 2020-01807). Patient consent was waived by this committee.
Romain BETEND, Laurent SUPPAN, Michèle CHAN, Simon REGARD, Francois SARASIN, Christophe A. FEHLMAMN (Geneva, Switzerland)
10:40 - 11:00
#31666 - Development of learning program contents for non-face-to-face CPR training.
Development of learning program contents for non-face-to-face CPR training.
Background: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, major changes in educational methods have been required to shift from face-to-face (FF) training to a non-face-to-face (NFF) format. The application of NNF methods for cardiopulmonary resuscitation (CPR) education is a specific issue of interest in medical education as CPR instruction should allow learners to practice key skills until they attain mastery. With the need for a shift to NFF formats of education, different educational methods have been studied, including the use of video-based and virtual reality training, as well as e-learning modules. In this study, the NFF learning program contents on CPR was established and pilot operated. And we tried to find the deficiencies in education and improve them.
Methods: The learning scenario for NFF CPR training addressed single-person CP, consisting of chest compression only, excluding breathing. The Kahoot! application was used for NFF. CPR training in FF or NFF format was randomly provided to third-year medical students at two university hospitals. Between-group comparisons for class participation and CPR skills were based on video recordings.
Between-group comparisons for class participation and CPR skills were based on video recordings. Class participation and performance were evaluated for each learning content.
Results: Seventy students participated in our study, with 35 randomly allocated to the FF and NFF groups. There were no between-group differences in terms of age, sex, previous basic life support training, and willingness and confidence in performing CPR. Compared to the FF group, the NFF group demonstrated significant differences during CPR, including fewer calling for assistance and using of defibrillator (AED) (p=0.006), as well as fewer checks for breathing for a minimum of 5 s (p=0.007), and fewer counting during chest compression (p=0.006). As well, <30% of learners in the NFF group completed rhythm analysis after the last AED shock delivery and resumed immediate chest compression (p<0.001). All students in both groups passed the post-training assessment.
Conclusion: The post-education outcomes for CPR were comparable between the FF and NFF group, although class participation was significantly lower in the FF than NFF groups. In order to improve the CPR performance by the method of NFF, it is necessary to further improve the educational content on the use of AED.
Choung Ah LEE (Hwaseong, Republic of Korea), Hyeji PARK
10:40 - 11:00
#30921 - Effects of intravenous versus intraosseous adrenalin administration on morbidity and mortality after out-of-hospital-cardiac-arrest: A systematic review.
Effects of intravenous versus intraosseous adrenalin administration on morbidity and mortality after out-of-hospital-cardiac-arrest: A systematic review.
Background
Out-of-hospital cardiac arrest (OHCA) is a common manifestation of heart disease and a leading cause of death in western societies with an overall survival rate of 10%. Guidelines generally prefer the peripheral intravenous access (IV) as the first option for OHCA patients, leaving the intraosseous route (IO) for patients in which IV access is not feasible or unsuccessful. This systematic review will purely focus on the clinical differences between adrenaline administered via IO route compared to IV route and its effects on morbidity and mortality after OHCA.
Materials and methods
A multi-database (PubMed, Medline, Embase, and The Cochrane Library) was performed and was searched between the earliest date of each database and the 30th of October 2021. For data extraction, a structured checklist was used, including type of the study, the number of patients, age, gender, Return of Spontaneous Circulation (ROSC), associated morbidity, mortality, neurological and general outcome.
Results
The initial literature search produced 1772 results. After screening for title and abstract, a total of nine studies were included in our systematic review. Of these studies, six were retrospective cohort studies, one prospective study, and two subanalysis of previous randomized trials. Due to significant heterogeneity, a meta-analysis was not performed.
Conclusion
In our systematic review we have found a small number of studies comparing IV and IO administration of adrenaline during cardiac arrest. Due to significant heterogeneity, a meta-analysis was not performed and no firm conclusions could be drawn about which route of adrenalin administration leads to better outcomes.
Sjaak POUWELS, Emschka JOHANNES (Curaçao, ), Juan Pablo SCARANO PEREIRA
10:40 - 11:00
#30968 - Emergency department markers of complicated pediatric pneumonia.
Emergency department markers of complicated pediatric pneumonia.
Background: Pneumonia is common in children and most patients respond well to outpatient therapy. However, in some, pneumonia may be complicated by significant respiratory distress, pleural effusions requiring hospitalization, drainage, and intensive care. We aimed to explore differences in the initial laboratory results between uncomplicated and complicated disease.
Methods: A retrospective cohort study at a tertiary children’s hospital. We extracted the medical records of all previously healthy children admitted to the hospital with pneumonia from June 2016 to June 2020. Patients were classified into three groups: Uncomplicated pneumonia (UP), pleuropneumonia (PLP) and severe complicated pneumonia (SCP) defined as sepsis, need for drainage or intensive care. We explored differences in blood count, C-reactive protein, albumin and phosphor on initial presentation to the ED.
Results: During the study period, 4,419 children were diagnosed with pneumonia in the ED and 887 children were admitted. 353 were excluded due to comorbidities or lack of radiographic evidence. The average age was 3.7 years [3.5±SD], 57% were male. Of the 534 patients, 329(61.5%) had UP, 133 (25%) had PLP and 72 (13.5%) had SCP. The WBC was 20.45 [10.14 ±SD], 19.13 [9.65 ±SD] and 21.16 [10.29 ±SD] (p=0.31) and the ANC was 14.8 [9.3 ±SD], 14.33 [8.7 ±SD] and 16.3 [9.67 ±SD] for UP, PLP and SCP respectively, (p=0.27). The CRP was 15.8 [12.9 ±SD], 20.4 [13.8 ±SD] and 23.4 [11.6 ±SD] (p<0.01) and phosphor was 4.18 [0.99 ±SD], 3.85 [0.89 ±SD] and 3.8 [0.95 ±SD] for UP, PLP and SCP, respectively (P<0.01). Albumin was 3.96 [0.43 ±SD], 3.72 [0.43 ±SD] and 3.54 [0.54 ±SD] for UP, PLP and SCP respectively (p<0.01).
Conclusions: We found ED CRP, phosphor and albumin levels to be associated with complicated pediatric pneumonia. In addition to clinical assessment, these markers may aid decision making regarding further referral and management.
This study did not recive any specific funding.
Zafnat PROKOCIMER YAIR (Petah Tikva, Israel), Ron BERANT, Roi FELDMAN, Nir SAMUEL
10:40 - 11:00
#31552 - heart score in the emergency department : what outcome for the low-risk group ?
heart score in the emergency department : what outcome for the low-risk group ?
Chest pain ( CP ) is a common cause of presentation to the emergency department (ED ), identifying the patients who may be safely discharged without further testing remains challenging. Clinical risk scores are discussed, one of them is the HEART score : It objectvively risk-stratifies patients into low , moderate , and high-risk categories.
We aimed to identify the incidence of reconsultation after 4 weeks in patients classified by the HEART score as « low risk group » and discharged from the ED.
Methods :
A prospective observational study between december 2021 and february 2022 was conducted. We included adult patients presenting to the ED with CP.The heart score was calculated for patients at presentation. We collected: medical history, semiology of pain, time of onset and associated signs ,electrical and biological data , and further orientation of the patient. The main endpoint point was reconsultation within 30 days in the same hospital for CP in low risk group.
Results :
we included 100 patients , sex ratio= 2.7. the average age was 60+/-16 years .
Cardiovascular risk factors were majorly n : hypertension 52 , diabetes 41 , coronaropathy 32 , smoking 38 , dyslipidemia 18 . Population was then devised into : low risk group (LRG) : heart score0-3 n=27 , intermidiate risk group ( IRG) : heart score 4-6 n=41 , high risk group (HRG) : heart score 7-10 n=32. Were diagnosed acute coronary syndrom with ST segment elevation 14 patients and without ST segment elevation 36. Were complicated in acute heart failure 14 patients. Mortality was 2% (n=2).
In low risk group : CP was majorly described as tightness (55.5%) with a significant p compared to IRG (p=0.022) and to HRG (p=0.006) . 92% (n=25) of LRG had normal electrocardiogram and 8% (n=2) had non specific repolarisation disorders with significant p compared to IRG (p=0.001) and to HRG (p=0.0001). Troponines ultra sensible were less than upper normal limit in 96.2% (n=26). The incidence of re-visiting in the same ED in following 30 days in low risk group was 3.7%, and none of them presented an ACS in the same period . in comparison to IRG patients reviseted the same ED within the following 30 days in 24,3% ( p=0.025) , and in HRG patients revisited in 12.5% ( p=0.020) .
Conclusion :
The HEART score provides the clinician with a quick predictor of outcome . The incidence of reconsultation was 3,7% with significant p compared to intermediate and high risk groups , and without any patients identified for early discharge suffering ACS in 30 days
Badra BAHRI (Tunis, Tunisia), Feryel BOUSNINA
10:40 - 11:00
#31630 - Impact of body mass index change on the risk of cardiac arrest occurrence: a population-based nested case-control study.
Impact of body mass index change on the risk of cardiac arrest occurrence: a population-based nested case-control study.
Background: Body weight is a modifiable demographic factor; however, the correlation between weight status and out-of-hospital cardiac arrest (OHCA) risk remains unclear. This study aimed to evaluate the association between OHCA occurrence and weight status including longitudinal weight changes.
Methods: This was a population-based nested case-control study using claims data of the National Health Insurance Service of Korea. In all, 24,465 patients with non-traumatic out-of-hospital cardiac arrest (OHCA) between 2010 and 2018, who underwent national health check-up twice (one within a year and the other within 2-4 years before the cardiac arrest) and 32,434 controls without OHCA, were matched for age, sex and the alive state at the particular age of cardiac arrest. The participants were categorized into five weight status groups based on the body mass index (BMI), and the percent change in BMI based on health check-up data was calculated.
Results: Among 56,899 population, the association between BMI levels and OHCA occurrence risk was the highest in underweight followed by obese II individuals and lowest in overweight individuals. The associations between longitudinal BMI percent changes and OHCA occurrence risk showed a reverse J-shaped association. Compared to individuals with a stable weight, those with severe (>15%) BMI decrease had the highest odds ratio (OR) of 4.29 (95% confidence intervals [CI], 3.72 – 4.95) for OHCA occurrence followed by those with moderate (10% to 15%) BMI decrease (OR, 2.80; 95% CI, 2.55 – 3.08) and those with severe BMI increase (OR, 2.24; 95% CI, 1.96 – 2.57), respectively. The association between severe BMI decrease and increased OHCA occurrence risk is stronger in the male population compared to the female population. The subgroup analysis after stratifying the previous weight status showed individuals with previous normal to obese I weight status (BMI, 18.5 to 29.9 kg/m2) showed increased OHCA occurrence risk even with mild weight loss (BMI decrease > 5%).
Conclusions: Both weight loss and gain were significantly associated with an increased cardiac arrest risk. Significant weight loss may be a warning sign for cardiac arrest regardless of weight status. Maintaining stable weight would be a reliable public health strategy for preventing OHCA.
Sources of Funding: This research was supported by 2021 science research program through the Korean Association of Cardiopulmonary Resuscitation (KACPR) (No. 2021-006) and a grant (2021IT0007-1) from Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea. The funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; or the decision to submit the manuscript for publication.
Hong Jun BAE (Seoul, Republic of Korea), Youn-Jung KIM, Min-Ju KIM, Ye-Jee KIM, Won Young KIM
10:40 - 11:00
#31559 - Length of hospital stay in patients with acute heart failure during the COVID-19 State of Alarm.
Length of hospital stay in patients with acute heart failure during the COVID-19 State of Alarm.
Acute heart failure (AHF) is the main reason for hospitalization in people over 65 years of age. The high associated costs are mainly caused by admissions and these are closely related to the length of hospital stay (LOS). The state of alarm can condition the length of stay in these patients.
Objetives: to know if the state of alarm situation can condition LOS in patients admitted for AHF in a Spanish hospital.
Methods: Retrospective descriptive study. Inclusion criteria: Patients older than 18 years treated from March 15 to June 21, 2020, in an ED with a discharge diagnosis of AHF and the same period of 2019. Review of computerized clinical history. Demographic variables, personal history and length of hospital stay were collected. Descriptive study: median, interquartile range (IQR); mean and standard deviation (SD). Percentages. Quantitative: T-student. Statistical program: SPSS 26.0. Confidence interval at 95%. Significance <0.05. Results: n=135. Overall median age: 84 (IQR=77-90) years. Women 56.5%. Median age women: 85.5 (IQR=81.25-91) years. Median age men: 81 (IQR=74-85) years, p=0,107.
Hospitalization: 82.2%. Overall median age: 85 (IQR 78-90) years. Hospitalization men: 44.1%. Hospitalization women: 45.93%. p=0,027. Median age of hospitalized men: 83 (IQR 74-87) years. Median age hospitalized women: 86 (IQR 82.75-91.25) years, p=0.027.
Median LOS state of alarm: 8,43 ± 6,6 days. Woman 9,19± 6,60 days; Men 8,43± 7,95 days (p=0,683). LOS internal medicine: 9,38± 8,18; cardiology: 7,11± 3,80 (p=0,661).
Media LOS during during the same period of 2019: 10,22±7,57 days (p=0,131).
Conclusion: length of hospital stay of patients admitted for AHF during the alarm state was similar to that of these patients before the SARS-CoV-2 pandemic. The majority of patients treated for AHF in an ED are admitted, but neither gender nor the admission department will determine the length of hospital stay.
Virginia CARBAJOSA RODRÍGUEZ, Pablo GONZÁLEZ GARCINUÑO, Carlos DEL POZO VEGAS (Valladolor, Spain), Daniel ZALAMA SÁNCHEZ, Leyre Teresa PINILLA ARRIBAS, Inmaculada GARCÍA RUPÉREZ, Pablo GONZALEZ IZQUIERDO, Tony Giancarlo VÁSQUES DEL ÁGUILA, Pedro DE SANTOS CASTRO, Marta MOYA DE LA CALLE, Francisco MARTIN RODRÍGUEZ, Raquel TALEGÓN MARTÍN, Maria Jesús GIRALDO PÉREZ, Rocío RUIZ MERINO, Isabel GONZÁLEZ MANZANO, Daniel SERRANO HERRERO, Patricia BUSTAMANTE MARCOS, Berta TIJERO RODRÍGUEZ, Jesus Ángel MOCHE LOERI, Raul LOPEZ IZQUIERDO, Abel Ermer ESPINAL PAPUICO, Rubén PÉREZ GARCÍA, Mario PRIETO DEHESA, Fernando GARCIA MARTÍN, Pablo ROYUELA RUÍZ
10:40 - 11:00
#31032 - LEVEL OF KNOWLEDGE ABOUT FIRST AID AND BASIC LIFE SUPPORT IN A SAMPLE OF INHABITANTS OF THE SPANISH LEVANTE.
LEVEL OF KNOWLEDGE ABOUT FIRST AID AND BASIC LIFE SUPPORT IN A SAMPLE OF INHABITANTS OF THE SPANISH LEVANTE.
INTRODUCTION:
Deaths from Cardiac Arrest are a major health problem. 80% of people who die suddenly are with a close relative or acquaintance. Despite this, in less than 25% of witnessed PCR, witnesses initiate CPR. What reduce the possibility of injury prevention and recovery for many of these patients.
OBJECTIVES:
To evaluate the level of knowledge of a sample of inhabitants of the Valencian Community (Spain) about first aid and basic life support (BLS).
MATERIAL AND METHODS:
Observational, descriptive and cross-sectional study in the population of the Valencian Community (CV) in February 2021 of knowledge in CPR and first maneuvers.
For the calculation of the sample size (390 inhabitants), the Spanish National Institute of Statistics was used as a reference source, where the total population of the CV over 18 years was 3.048.244 inhabitants.
An ad-hoc online data collection form was designed that included personal data of the respondents, their experience and level of knowledge in first and BLS.
RESULTS: 73,1% of those surveyed were women; 60% with ages between 18 and 29 years. 45%with university studies.
83,9% reported never having attended a victim and accident and 69,6% did not feel able to do so.
95,1% considered that knowledge about first aid by the population can help improve the prognosis of the patient in the out-of-hospital setting;however, 93,1% stated that the training provided is insufficient.
Only 26,1% of those interviewed showed a high knowledge of first aid BLS.
CONCLUSIONS:
The results of the present work show the need to train the general population in first aid and BLS so that they can properly care for an accident victim.
M José ESQUER PERIS, Paula BALAGUER ESCUTIA, María CUENCA TORRES (alzira, Spain), Jose Luis RUIZ LÓPEZ, Pedro GARCIA BERMEJO, Luisa TARRASÓ GÓMEZ, Luis MANCLÚS MONTOYA
10:40 - 11:00
#31585 - Monocyte/lymphocyte ratio is an independent predictor for in-hospital major adverse cardiac events in patients with acute coronary syndrome: observational study.
Monocyte/lymphocyte ratio is an independent predictor for in-hospital major adverse cardiac events in patients with acute coronary syndrome: observational study.
Introduction:
Inflammation plays an important role in pathophysiology of the acute coronary syndrome (ACS) as well as in the process of atherosclerosis in general. Multiple studies have cleared that inflammatory biomarkers are an independent risk predictor of cardiovascular events. In recent years, more and more attention has been attracted to MLR’s (Monocyte/lymphocyte ratio) applications for cardiovascular diseases and clinical outcomes in patients with ACS.
Objective:
Our study aimed to assess the relationship of the MLR with coronary risk factors and the major adverse cardiac events (MACE) defined as cardiac death, cardiac arrest, cardiogenic shock, acute congestive heart failure, malignant arrhythmic events during hospitalization in emergency department (during the first 48 hours)
Method:
It was a retrospective study conducted between august 2021 and may 2022, including patients admitted for ACS (STEMI or NSTEMI). Exclusion criteria were hematologic disease, severe liver or renal dysfunction, stroke, tumor, thyroid disease, autoimmune disease, acute and chronic infectious disease and chronic obstructive pulmonary disease. Blood samples were collected at admission and all patients received therapy according to the current guidelines.
Results:
We included 97 patients admitted for STEMI (63.9%, n=62) and NSTEMI (36.1%, n=35). Mean age was 62.8 ± 11 years old, with a sex ratio= 4.7. There was no past medical history in 26.8 % of patient (n=26), 44.3% (n=43) were diabetic, 49.5% (n=48) had hypertension, 29.9% (n=29) dyslipidemia, 53.6% (n=52) were chronic smokers and 22.7 % (n=22) were weaned. GRACE score was high in 26.8% (n= 26). 32 patients had in-hospital MACE, including 23 patients with acute left heart failure, 13 patients with cardiac arrest, 6 patients with malignant arrhythmia, and 12 patients with cardiogenic shock. Mean MLR was 0.456 ± 0.345 [0.03 – 2.54] so patients were followed in two groups according to the average MLR tertile (60.8%, n=59 low MLR; 39.2%, n=38 high MLR). There was no significant difference in several coronary risk factors contrary to age (60±10, 67±11, p= 0.005), respiratory rate (20±3,22±4, p=0.028), GRACE score (112±39, 134±49, p= 0.01) and CRUSADE score (27±13, 34±18, p= 0.03) among the two groups. Interestingly, high MLR group had higher value of CRP (17, 50, p=0 .001), leukocytes (11287, 21052, p=0.03), hs-troponin T (8945, 60401, p= 0.002) and creatinine (93.4, 115.5, p= 0.029). The frequency of in-hospital MACE significantly increases among the 2 groups (22% low MLR vs 50% high MLR, p=0.004).
Conclusion:
During ACS, MLR inflammatory biomarker is significantly correlated with the in-hospital MACE. So that, it can be useful to improve the predictive value of the GRACE risk score, to help for the management of high-risk patients and therefore to reduce the in-hospital mortality.
Safa MADHBOUH, Touj HAGER (manouba, Tunisia), Khalil AOUINI, Ghofrane BEN MESSOUD, Ines SEDGHIANI, Nebiha BORSALI FALFOUL
10:40 - 11:00
#30346 - Observation Unit In Emergency Department: a Strategy to Improve Adherence to International Guidelines in Cases of Pulmonary Embolism in Elderly.
Observation Unit In Emergency Department: a Strategy to Improve Adherence to International Guidelines in Cases of Pulmonary Embolism in Elderly.
Premises: Pulmonary embolism is a disease still characterized by high mortality. Despite a great development of the guidelines it is not clear what adherence to them is in real life, especially in the emergency room. Some international studies have actually shown that adherence to guidelines is quite low in both primary and secondary care and, depending on the studies, between 40 and 60%. For the ERs, an organized, care-intensive layout with a holding area to stabilize the most critical patients proved to be more functional to the role played by the Emergency Departments in the last 10 years and the needs arising from this. In addition to receiving priority at the medical examination, patients in Triage also receive assignment to an area of low or medium-high intensity of care. From both areas, patients can then be referred to the holding area (in Italy OBI) for diagnostic completion, observation or stabilization. Patients can be discharged or hospitalized either directly from the areas of care or from the holding unit.
Purpose of the study: see if and how, in the real life of an Emergency Department, adherence to the Guidelines varies according to the area to which the patient is addressed.
Methods: monocentric retrospective observational study, on a group of geriatric patients (<75 y) that include all the people accessed to our ED, where they received acute PE dignosis. Enrolment started on 2016 and finished on 2019. We collected data from medical history, physical examination, lab tests, imaging; we calculated characteristic scores from the diagostic/therapeutic algorhitm, both regarding PE risk (Wells, Geneva and Years), and the 30-day mortality risk presentazione (sPESI). We then analized guidelines adherence in three decision-making turning-points: 1 Correct applicarion of decisional scores examined, which classify the patient in low, intermediate or high risk of PE, calculated with Wells and simplified Geneva score; 2 Correct therapy administration since the ED as suggested by the guidelines; 3 The eventual observation in the medium-intensity care area with close monitoring for the subpopulation of patients with finding of right ventricular dilation or myocardial enzymes impairement (considered at high risk of short-term shock and mortality).
Results: we enrolled 249 patients, with a mean age of 83 years and female prevalence (F = 62%). Of these, 69% were referred by Triage to medium-high intensity of care, the remaining 31% was directed to low intensity of care. 42.5% of the total patients were referred to OBI. The two areas of intensity of care showed similar adherence to guidelines (approximately 50%) without there being a statistically significant difference between the two areas (p > 0.05) Adherence to guidelines was higher in the holding area - OBI (75 %) compared to that of those managed in theaters (50%) in a statistically significant way (p <0.001)
Conclusions: The study suggests that holding areas located in Emergency Departments can considerably increase adherence to international guidelines.
Dr Gabriele SAVIOLI, Iride Francesca CERESA, Viola NOVELLI, Sara CUTTI, Dr Alba MUZZI, Amedeo MUGELLINI, Alessandra MARTIGNONI, Enrico ODDONE, Giovanni RICEVUTI, Massimiliano LAVA, Lorenzo PREDA, Giacomo ALUNNO, Antonio LO BELLO, Alessandra FUSCO, Luigi COPPOLA, Giovanni RIGANO, Aurora CECCO, Giulia BELLINI, Davide DIONISI, Maria Antonietta BRESSAN, Alessandro VENTURI, Federica FUMOSO (Pavia, Italy)
10:40 - 11:00
#30246 - Pediatric pain assessment and management in the ED – are we making a difference?
Pediatric pain assessment and management in the ED – are we making a difference?
Background: Pediatric patients present to the Emergency Department (ED) with pain from various causes. Appropriate assessment and management of pain is an important part of treatment in the ED.
Objective: The purpose of this study was to identify pain assessment at triage and the time to administering the first dose of analgesia.
Method: This was a multi-site retrospective study of pediatric patients (<18 years) who presented to the ED with pain or injury from February 2018 to May 2018. Initial pain assessment at triage, reason for visit, and time for analgesia were determined. For patients that received analgesia, the type and route were also identified.
Results: There were 4,128 patients with an average age of 9.6 years, and 49.1% were female. Only 74.2% had their pain assessed at triage, and 757 patients (18.3%) received analgesia. The median time to analgesia was 95 min (IQR: 49-154 min). Most patients presented with head/ neck (36.1%), upper limb (21.6%) and lower limb pain (19.9%). The oral route was the most common delivery method for analgesia (67.4%), of which ibuprofen and acetaminophen were the main agents.
Conclusion: Although pain assessment at triage has improved for pediatric patients, there is still a major shortfall in the adequate treatment of these patients with pain.
Funding: This study did not receive any specific funding.
Ethics approval and informed consent: This study was approved by the Hamilton Integrated Research Ethics Board.
Fazila KASSAM, Shauna JOSE, Mario HANNA, Jhanahan SRIRANJAN, Umairah BOODOO, Yazad BHATHENA, Aashna AGARWAL, Kevin Yixi REN, Suneel UPADHYE, Shira BROWN, Dr Rahim VALANI (Toronto, Canada)
10:40 - 11:00
#30745 - Point of Care Ultrasound for the Diagnosis of Transient Synovitis in a Pediatric Emergency Department. Pediatric Emergency Medicine Physicians Versus Pediatric Residents.
Point of Care Ultrasound for the Diagnosis of Transient Synovitis in a Pediatric Emergency Department. Pediatric Emergency Medicine Physicians Versus Pediatric Residents.
Point of Care Ultrasound for the Diagnosis of Transient Synovitis in a Pediatric Emergency Department. Pediatric Emergency Medicine Physicians Versus Pediatric Residents.
Elina Gelman1, Gilad Chayen2, Ron Jacob2
1 Department of Pediatrics, HaEmek Medical Center, Afula, Israel
2Pediatric Emergency Department, HaEmek Medical center, Afula, Israel
Introduction:
Point of care ultrasound (POCUS) is widely used by Pediatric Emergency Medicine Physicians (PEMP) for the evaluation of a limping child. It was previously shown to be accurate and was suggested as part of a decision support algorithm for the diagnosis of transient synovitis (TS). Brief educational intervention was shown to be an effective method of introducing hip POCUS to novices. Our aim was to compare the length of stay (LOS) in the Pediatric Emergency department (PED), need for additional workup, admission rates and return visits rate when hip POCUS was performed by a PEMP versus a pediatric trainee (PT).
Methods:
This was a single center retrospective study between 1.6.2016 and 30.6.2021. All patients who presented to the PED with a discharge diagnosis of TS and a recorded bedside hip POCUS were included. We compared the patients who were evaluated by a PEMP, and patients evaluated by a PT (who underwent a brief targeted training during their PEM rotation which included 8 recorded hip POCUS, reviewed by a PEM physician). Outcome measures were LOS in the ED, additional diagnostic workup (labs, orthopedic consult, hip x-ray or ultrasound performed by a radiologist), admission rates and return visits.
Results:
Overall, 211 children were included. Their median (IQR) age was 5 years (3.6-7) with 73% males. 46% were evaluated by PEMPs, and 54% by PTs. There was no difference in median (IQR) LOS, between patients evaluated by PEMPs and PTs (92 (51,150) and 95 (61,131) minutes respectively, p=0.7). There were similar rates of labs acquired (26.8% and 28.9% respectively; p=0.73), orthopedic consults (12.4% and 11.4% respectively; p=0.82), hip x-rays (24.7% and 24.6% respectively; p=0.97) and ultrasound performed by a radiologist (6.2% and 7.9% respectively; p=0.63). Admission rates and return visits were also similar between patients evaluated by PEMPs and PTs (4.1% and 2.7%, p=0.55; 13.5% and 15.9%, p=0.62; respectively).
Conclusion:
In our study, hip POCUS for TS performed by PT after a brief targeted training resulted in similar PED LOS and similar rates of ancillary testing, admission rates and return visits when compared to hip POCUS performed by PEMP.
None
Elina GELMAN (Afula, Israel), Gilad CHAYEN, Ron JACOB
10:40 - 11:00
#31064 - Predictors of delayed throughput during emergency department work-up - observational cohort study.
Predictors of delayed throughput during emergency department work-up - observational cohort study.
Background
Throughput times are key performance indicators to emergency departments (ED). Optimal throughput times largely depend on the patients’ presentations, their vital parameters and presumptive disposition. Therefore, optimal throughput times and corresponding delays can best be determined by experts (emergency physicians, EP). EPs are able to determine reasons for delays during ED work-up, such as waiting for imaging, clinical chemistry results, specialists’ consultations, or transfer. As EDs have different sectors in order to stream patients (e.g. trauma bay, minors, majors, geriatrics, etc.), it could be helpful to identify predictors for delayed throughput, as the attribution of resources depends on acuity, prognosis, and expected throughput times.
Purpose
We have designed this observation for the identification of parameters available at triage, associated with delays during ED work-up. Secondary aims were EP determined reasons for delays and outcomes in patients with and without delays.
Methods
Secondary analysis of an observational cohort study including all patients presenting to the ED of the University Hospital of Basel from 30th January 2017-19th February 2017, and 18th March 2019-20th May 2019. Patients were included by a designated study team 24h a day, 7 days a week. In order to reduce inclusion bias, only oral consent was required and documented. Patients refusing general research consent were not included.
Baseline demographics, length of stay (LOS), admission and Emergency Severity Index (ESI) were imported from the electronic health record database. Mobility, symptoms, Clinical Frailty Scale (CFS) in patients aged 65 and older, and trauma (yes/no) were assessed at presentation. Responsible emergency physicians were asked for delays and their reasons at discharge or transfer (pre-defined categories “resident”, “senior physician”, “consultation”, “imaging”, “clinical chemistry”, “transfer/hospitalization”, or “other”).
The study was approved by the local ethic committee (http://eknz.ch, Ref. No 263/13) and funded by scientific funds from the University Hospital of Basel.
Results
The final study population included 9822 patients. Patients with delays were older (57.6y, SD 21.6 vs. 50.8y, SD 21.5) and more often female (48.4% vs. 46.7%), as compared to patients without delays. Patients with delays suffered more likely from impaired mobility (37.5% vs. 26.2%), nonspecific complaints (NSC, weakness or fatigue) (6.5% vs. 4.0%), and frailty (19.4% vs. 13.8%), as compared to patients without delays.
According to EPs, the main reasons for delays were residents (20.4%), consultations (20.2%), and imaging (19.4%).
ED LOS was significantly longer in patients with ED determined delays, and mortality was higher in patients with delays.
Conclusions
At triage, parameters such as age, sex, immobility, NSC, and frailty can identify patients at risk of delays during ED work-up. Internal reasons (resident delays) and external reasons (imaging and consult delays) are equally important and may highlight possible underlying factors, such as discrimination of older, immobile, frail and female patients, or the complexity aversion as indicated by the presence of NSC. This hypothesis generating observation will allow to design studies aimed at the identification and elimination of possible throughput obstacles.
The study was approved by the local ethic committee (http://eknz.ch, Ref. No 263/13) and funded by scientific funds from the University Hospital of Basel.
Isabelle ARNOLD (Basel, Switzerland), Jeannette-Marie BUSCH, Artur STICKEL, Christian NICKEL, Roland BINGISSER
10:40 - 11:00
#31604 - Prognostic value of the National Early Warning Score and lactic acid in the ER.
Prognostic value of the National Early Warning Score and lactic acid in the ER.
Prognostic value of the National Early Warning Score and lactic acid in the ER
Background:
One of the main problems faced by Emergency Rooms ER are time-dependent pathologies, which require early screening and immediate aggressive therapeutic measures to avoid fatal outcomes within hours-days. In this sense, various scales such as NEWS 2 and analytical parameters such as lactic acid have emerged in recent years that aim to serve as a guide and identify patients with risk of short-term mortality.
Objectives
1) Evaluate the capacity of the NEWS2 scale and the ALc to predict early mortality (before one month) from the index event (visit to the Emergency Department).
2) Analyze the mortality of patients with triage level 2 and 3 and clarify whether the established cut-off points have sufficient sensitivity and specificity.
Methods:
An observational, prospective, longitudinal study has been carried out during 3 months on patients attended in the ER, to whom the taking of vital signs in triage and the measurement of capillary lactate have been recorded. Subsequently, the results of the complementary tests, admission to specialties and ICU, and mortality during the first month were added. The main variable was all-cause mortality at 30 days.
Enrolled patients should have prior signed and informed consent form.
Patients under 18y, pregnant women, psycho-social consults, trauma consults and terminal patients were excluded.
Results:
A total of 367 patients met inclusion criteria. Mean age 67y, IQR (53-83), women 190(51,7%), 30 day survival 353(96,19%).
Vitals in the group of survivors / deads were: mean RR (20 vs 27 breaths per minute) p<0,05, mean Sat O2% (97 vs 93%) p<0,05, mean SBP (136 vs 121 mmHg) p<0,05, mean HR (84 vs 86 beats per minute) p 0,12, altered mental status (11 vs 4) p<0,05, temperature (36,4 vs 36,1) p<0,08.
Comorbidities, risk an LAc levels in the group of survivors / deads were: CHARLSON score (4 vs 6) p<0,05, NEWS2 score (5 vs 8) p<0,05, LAc levels (2,46 vs 3,44) p<0,05.
In the analysis of the NEWS2 scale, it was observed that the best cut-off point for 30-day mortality was 7 points, with a sensitivity of 0.71 (95% CI 0.47-0.95) and a specificity of 0.71 (95% CI 0.67-0.76) with a NPV of 0.98 (95% CI 0.85-0.99)
For LAc, it is observed that the cut-off point of 1.7 offers the best values of sensitivity 1 (95% CI 1-1) and specificity 0.39 (95% CI 0.34-0.44) with a NPV of 1 (95% CI (0.89-1).
Conclusion:
Both NEWS2 and ACL can be useful tools to be used in the ERs at triage to detect high-risk patients. Both tools can be used due to their ease of handling, rapid acquisition and predictive capacity. In addition, they can enable ER providers to carry out a more efficient and appropriate response in the shortest possible time.
Carlos DEL POZO VEGAS, Miguel Ángel MARTÍN ARENA (Valladolid, Spain), Pedro DE SANTOS CASTRO, Tony Giancarlo VÁSQUEZ DEL ÁGUILA, Iratxe MORO MANGAS, Francisco MARTÍN RODRÍGUEZ, Dr Raúl LÓPEZ IZQUIERDO, Virginia CARBAJOSA RODRÍGUEZ, Ana Belén LÓPEZ TARAZAGA, Daniel ZALAMA SÁNCHEZ, Leyre PINILLA ARRIBAS, Pablo GONZÁLEZ IZQUIERDO, Pilar VELASCO DIAZ-SALAZAR, Ana GIL CONTRERAS, Caterina LÓPEZ VILLAR, Miriam Alicia DE LA PARTE NANCLARES, Raúl ALONSO AVILÉS, Alberto GÓMEZ DE DIEGO, Luis ALONSO VILLALOBOS, Ángel Aurelio ÁLVAREZ HURTADO, Soledad BARBERO BAJO, Mar BLANCO MAGDALENO, Teresa RODRÍGUEZ NOVOA, Jaldún Nabil CHEHAYEB MORÁN, Marta CELORRIO SAN MIGUEL, Susana DE FRANCISCO ANDRÉS, Armen HAMBARDZUMYAN, Inmmaculada GARCÍA RUPÉREZ, Jesús ÁLVAREZ MANZANARES, Nuria DIEZ MONGE, José Vicente ESTEBAN VELASCO, Marta MOYA DE LA CALLE, Maria Luisa LÓPEZ GRIMA, Sara DE SANTOS SÁNCHEZ, Susana GARCÍA DE COCA, Cristina BOLADO JIMÉNEZ, Mª José FORA ROMERO, Ana María GARCÍA RODRÍGUEZ, Susana SÁNCHEZ RAMÓN, Noelia CARRIÓN SERRANO
10:40 - 11:00
#31027 - Quality improvement project assessing doctors taking breaks in the emergency department.
Quality improvement project assessing doctors taking breaks in the emergency department.
Title: Quality improvement project assessing doctors taking breaks in the emergency department
Authors: Grace Newton-Livens MBBS BSc, Henry Somers MB BChir, Robynne George BM BCh, Heidi Edmundson MB ChB
Background
Since the COVID-19 pandemic there has been a positive change towards ensuring the wellbeing of our healthcare staff. However, working in the NHS is still demanding with stress, or even complete burnout amongst staff on the increase. Commonly, staff often sacrifice breaks to keep up with clinical workload. This not only affects the individual’s health, but also has a knock-on effect on the quality of care provided to patients. This quality improvement project focuses on improving the percentage of doctors taking the suggested break allowance as per the BMA Junior Doctors Contract 2016 and ensuring a long-term positive change in the break-taking culture in the emergency department (ED).
Methods
Pre- and post-intervention data was collected from all ED junior doctor grades, looking at break habits for different shift patterns and the break-taking culture within the department.
Interventions were implemented across a 2-month period. Interventions included: teaching sessions, posters and regular email reminders all of which focused on the importance and encouragement of taking breaks. A central theme: ‘10 at a time is fine’ was introduced - the aim was to encourage staff to at least take shorter breaks, rather than no break, if they felt not to have capacity to take a full 30-minute break. As missed breaks often go unnoticed, a further aim was to focus on exception reporting to raise awareness to departmental seniors and management about staff missing breaks.
Results
Results showed that break-taking improved across all types of shift-patterns. In particular, there were statistically significant improvements (p<0.05) in staff taking their 30-minute break in a shift under 9 hours (84.8% to 93.4%) and staff taking their third 30-minute break in a 12-hour nightshift (7.6% to 25.7%).
There was an improvement in the break-taking culture in the ED with a statistically significant increase (p<0.05) in the percentage of staff knowing how to exception report (34.8% to 64.7%) along with an improvement in the percentage of staff submitting exception reports (4.3% to 11.8%). Finally, the percentage of staff who felt encouraged to take their break whilst working in the department increased from 80.4% to 88.2%.
Qualitative feedback from doctors highlighted: seniors not taking breaks, nightshifts and busy department/long waiting-times, were the most common reasons for not taking breaks.
Discussion
Taking breaks during shifts is important in maintaining the wellbeing of doctors in both the short- and long-term. This project increased the uptake of doctors taking breaks across all shift-types in the ED and has increased positivity of the culture surrounding breaks, as well as reducing stigma surrounding exception reporting for missed breaks. Continuous reinforcement of the importance of breaks, even if shorter than recommended, is essential in preventing tired doctors and ensuring long-lasting change. To ensure we are always delivering high quality care to our patients, the NHS needs to continue to promote the wellbeing of its staff.
Grace NEWTON-LIVENS, Henry SOMERS (London, United Kingdom), Robynne GEORGE, Heidi EDMUNDSON
10:40 - 11:00
#30944 - Redirection process of low-acuity ED patients to nearby medical clinics through electronic medical support system: effects on ED performance indicators.
Redirection process of low-acuity ED patients to nearby medical clinics through electronic medical support system: effects on ED performance indicators.
Study hypothesis
Overcrowding Emergency Departments (EDs) is associated to higher morbi-mortality and suboptimal quality of care for ED patients. Management strategies have mostly focused on the early identification and redirection of low-acuity patients to primary care settings; however, impacts are non-conclusive and the generalizability of the identification strategies in other care settings is low.
Objective
The purpose of this study is to assess the impacts of a redirection process using an electronic clinical decision support system on ED performance indicators.
Methods
We performed a retrospective observational study in a ED of tertiary trauma center where a redirection process of low-acuity patients was implemented. The process was based on a clinical decision support system relying on an algorithm based on chief complaint, performed by nurses at triage and not involving physician assessment. All patients visiting the ED from January 2014 to December 2016 were included. We compare ED performance indicators before and after the implementation of the redirection process (June 1st 2015). We performed an interrupted time series analysis adjusted for age, gender, month, day of visit, time of day, triage category and congestion.
Results
Over the 468,140 ED visits 9,546 patients have been redirected to a nearby primary health clinic (8% of post-intervention ED visits). After the implementation of the redirection process, the median length-of-triage was similar, median time-to-initial assessment decreased by 14 minutes ([-17;-12], p<0.001), the median length-of-stay increased by 33 minutes ([17;48], p<0.001), the proportion of patients that left without being seen by an emergency physician decreased by 2% ([-3;-2], p<0.001).
Conclusions
The implementation of a redirection process of low-acuity ED patients based on a clinical support system is associated with the improvement of different ED performance indicators aside from the ED length-of-stay.
Anne-Laure FERAL-PIERSSENS (Bobigny), Isabelle GABOURY, Clément CARBONNIER, Mylaine BRETON
10:40 - 11:00
#31136 - Repeated emergency department visits among children that are admitted to an intensive care unit.
Repeated emergency department visits among children that are admitted to an intensive care unit.
Background: Promptidentification of children requiring admission to an Intensive Care Unit (ICU)may be difficult. To our knowledge, no study has analysed the characteristics and outcome of patients admitted to the ICU with repeated emergency department (ED) visits. The objective of the study was to evaluate the impact on theoutcome of children admitted to ICUafter repeated ED visits.
Methodology: Prospective registry-based cohort study including all children less than 14 years old admitted to the ICU from an ED between 2011 and 2019. We compared the characteristics and outcome of patients admitted in their first or repeated visits. We carried out a multivariable analysis to identify independent risk factors for poor prognosis or severe outcome. Poor prognosis was defined as patient who receivedinotropic support, invasive mechanical ventilation (IMV) or admission > 72 hours. Severe outcomecorresponded to children who died or had sequelae.
Results: During the study period, we registered 485.806 episodes in the pediatric ED. Of these, 928 (0.2%) corresponded to children admitted to pediatric ICU, 142 (15.3%) after repeated ED visits.
Most of them were boys (521, 56.1%), 437 (47.1%) less than2 years old and 221 (23.8%) appeared wellon arrival at ED. One hundred and seventeen (12.6%) were admitted to the ICU due to an unintentional injury and 811 (87.4%) due to medical disease (respiratory disease 397, 42.8%; non-infectious neurological disease128, 13.8%; infectious disease111, 12%; cardiac disease55, 5.9%, and others 120, 12.9%). Four hundred and three (45.3%) had poor prognosis: 104 (11.2%) received inotropic support, 163 (17.6%)IMV and 324(34.9%) remained in the PICU for more than 3 days. One hundred and twenty six (13.6%) had a severe outcome: 33 (3.6%) died and 93 (10.0%) showed permanent sequelae.
Those admitted after repeated ED visitswere more frequently younger than 2 years (61.3% vs 44.3%, p<0.01), non-well appearingon arrival at the ED (83.8% vs 74.8. 0%, p=0.02), and had medical disease (95.7% vs 85.7%, p<0.01).
In the multivariable regression,not identifying the child who requires intensive care in the first visit was an independent risk factor for receiving inotropic support (OR:2.8,95% CI 1.5-5.2). Not identifying children with infectious diseases in the first visit was an independent risk factor for receiving IMV(OR:3.9,95% CI 1.2-12.4) and having a more severe outcome (OR:4.1,95% CI 1.1-15.3).
Conclusions: An important amount of children requiring intensive care are admitted after repeated visits to the ED. Best practices need to be implementedfor the early identification of children requiring intensive care, mainly those with infectious diseases.
Yolanda BALLESTERO (Bilbao, Spain), Oihane MORIENTES, Ainhoa ZORRILLA, Garazi MARTÍN-IRAZABAL, Anne CONGET, Santiago MINTEGI
10:40 - 11:00
#31138 - Risk stratification and decision-making in patients with a transient loss of consciousness by ambulance professionals: a qualitative study.
Risk stratification and decision-making in patients with a transient loss of consciousness by ambulance professionals: a qualitative study.
Background: Transient loss of consciousness (T-LOC) is a common symptom of patients seeking prehospital emergency medical care. Ambulance professionals face the difficult task of identifying the underlying etiology of the T-LOC and differentiating between potentially high and low-risk patient factors for short-term adverse events. Following the risk stratification, ambulance professionals are responsible for the (non)conveyance decision of these patients. The objective of our study was to explore the experiences of ambulance professionals in the risk stratification and decision-making in patients with a T-LOC in current practice.
Method: A qualitative design with semi-structured individual interviews and focus group interviews was performed. First, ambulance professionals were interviewed based on a self-experienced scenario of a patient with a T-LOC. The individual interviews provided themes that were further in-depth explored in focus group interviews. The study took place in two regional emergency medical services (EMS) in the Netherlands. The medical managers of the EMS approached participants, and purposive sampling was used to include ambulance professionals with different backgrounds (e.g., bachelor – master’s education). The interviews took place in November and December 2019, and the focus group interviews in October 2020. The (focus group) interviews were audio- or videotaped and verbally transcribed and were analyzed through thematic analysis using Atlas.ti version 9.
Results: A total of 24 ambulance professionals participated in the study, 13 professionals participated in the individual interviews, and 11 other professionals participated in the focus group interviews divided into two groups. Four themes emerged: (1) Methodology. This theme covers the (initial) steps taken by ambulance professionals during care provision on scene, with underlying clinical reasoning processes and experienced difficulties. (2) Complexity. This theme describes the difficulties experienced with the symptom T-LOC and contextual factors on scene. (3) Collaboration. This theme describes the difficulties and facilitating factors in ambulance professionals’ collaboration with other healthcare professionals in the chain of emergency care (e.g., general practitioners, emergency physicians, etc.), patients, and loved ones. (4) Professionality. This theme describes the influence of professionals’ experiences, the sense of responsibility of the ambulance professionals, and their need for reflection moments.
Conclusion: T-LOC and syncope are considered complex symptoms by ambulance professionals. They follow a certain methodology for the risk stratification. Nevertheless, decision-making is not solely based on high and low-risk patient factors but is influenced by contextual factors, such as the collaboration with other healthcare professionals and the possibility of arranging follow-up care for the patient. In addition, ambulance professionals have a great sense of responsibility and consider conveyance decision-making precarious. Risk stratification tools could support ambulance professionals in the care of patients with a T-LOC.
According to the current Dutch legislation, the study did not need formal ethical approval from the Medical Research Ethics Committee. The authors take responsibility that the Helsinki Declaration and the General Data Protection Regulation are followed in the study. Informed consent was obtained from all participants.
Funding: Regieorgaan SIA
Lucia UIT HET BROEK (Nijmegen, The Netherlands), Bastiaan ORT, Remco EBBEN, Hester VERMEULEN, Lilian VLOET, Sivera BERBEN
10:40 - 11:00
#31617 - THE EFFICIENCY OF EDUCATIONAL TOOLS INVESTIGATION OF THORACOSTOMY IN THE IMPLEMENTATION OF HEALTHCARE PROFESSIONAL TRAINING-PILOT EXAMINATION.
THE EFFICIENCY OF EDUCATIONAL TOOLS INVESTIGATION OF THORACOSTOMY IN THE IMPLEMENTATION OF HEALTHCARE PROFESSIONAL TRAINING-PILOT EXAMINATION.
Objective: Nowadays, pre-hospital providers have a key role to play in caring for the severely injured. Successful and timely completion of advanced interventions is essential for the recovery of the injured after hospitalization. The aim of our study was to examine different teaching methodology techniques efficacy in performing thoracostomy.
Data and methods:
We conducted a prospective research among the second- and third-year paramedic students Bsc of University of Pecs. A sub-sample was formed using the educational technology tool. In one of our subsamples we showed a short video before the intervention, in the other subsample we had to perform the intervention without a video. Both groups completed a theoretical test prior to the intervention and had no practical knowledge. During the survey, we examined the marking of the correct position, the time of hesitation, the duration of the whole intervention and the outcome. For both groups, we used a tool called SAMThoraSite that was not used by either group before.
Results:
In our study, 21 people were selected for our video subsample (R1) and 22 people for the videoless group (R2). The total theoretical score for the R1 group was 5.26 points (66%), while that for the R2 group was 5.56 (70%). The R1 group performed the intervention in an average of 1 min and 1 second, and the R2 group performed in an average of 57 seconds. No difference was found in the successful outcome (12 vs. 11; p = 0.26). The hesitation time of our R2 group was shorter than that of our R1 group (p = 0.03).
Conclusions:
Fast, accurate, successful thoracostomy is essential for good quality traumatic care. The SAMThoraSite tool is easy to use in the hands of inexperienced providers. The educational tool (video) used in the study did not affect the successful implementation, however, it prolonged the time of hesitation.
Nothing to declare.
Antonia KESZTHELYI, Attila PANDUR (Pecs, Hungary), Gabor PRISKIN, Balazs TOTH, Jozsef BETLEHEM, Bence SCHISZLER, Balazs RADNAI
10:40 - 11:00
#31008 - Underuse of Glucagon for the Treatment of hypoglycemia in the Prehospital Setting.
Underuse of Glucagon for the Treatment of hypoglycemia in the Prehospital Setting.
Background:
Severe hypoglycaemia is a life-threatening condition. Its key management is rapid diagnosis and prompt administration sugar and if appropriate intramuscular or intranasal glucagon. There are many barriers to glucagon use.
Objective:
To assess the performance of dispatchers at suspecting hypoglycaemia, proposing glucagon treatment and helping bystanders to use it.
Methods:
This is a retrospective study. Calls classified as “hypo(-glycaemia)” by dispatchers or containing the words “diabetes” or “glucagon” within the free text were included and voice recordings were reviewed. Clinical, environmental and operational variables were collected. Hypoglycaemia was suspected in cases of unconsciousness or altered consciousness, abnormal breathing, sweating or abnormal movements were present, by patients suspected to present diabetes. Severe hypoglycaemia was suspected when patients were unconscious or with altered consciousness.
Results:
The dispatch centre handled 66’393 dispatch calls during the study period. Dispatchers suspected 100 (0.15%) cases of hypoglycaemia, including 48 cases of severe hypoglycaemia. Among those, four patients received glucagon prior to the dispatcher’s advice and dispatchers proposed the use of glucagon to 18 of them. Glucagon was available in five situations, and relatives agreed in its use in each case. The injection worked in three cases. The median time between the proposal to use glucagon by the dispatcher and the injection was 6 minutes.
Conclusion:
Trained dispatchers are able to suspect hypoglycaemia, decide when to treat and provide guidance on using IM glucagon, although absolute number of cases are low. Arrival of intranasal glucagon may become a game changer.
no funding
Fabrice DAMI (LAUSANNE, Switzerland), Estelle PRONGUE
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A33
11:05 - 12:30
Prehospital Emergencies - Trauma and the problem with evidence
Moderators:
Simon CARLEY (Consultant in Emergency Medicine) (Moderator, Manchester, United Kingdom), Caroline LEECH (Moderator, Coventry)
11:05 - 11:30
Prehospital management of the multi-trauma patient.
Alasdair CORFIELD (Consultant in Emergency Medicine) (Speaker, Glasgow, United Kingdom)
11:30 - 11:55
How to prevent prehospital deaths from noncompressible torso haemorrhage?
Dr Zaffer QASIM (Speaker) (Speaker, Philadelphia, USA)
11:55 - 12:20
Prehospital blood product resuscitation and calcium replacement.
Caroline LEECH (Speaker, Coventry)
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A6-7 |
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B33
11:05 - 12:30
Emergency Radiology - Let's talk about controversies
Moderators:
Bernard DANNENBERG (Emergency Physician) (Moderator, Palo Alto, USA), Beatrice HOFFMANN (Moderator, Boston, USA)
11:05 - 11:30
Easily missed fractures in the paediatric population - What the ER physician needs to be aware of.
Afshin ALAVI (Speaker, london)
11:05 - 11:30
Easily missed fractures in the paediatric population - What the ER physician needs to be aware of.
11:30 - 11:55
Contrast induced nephropathy - shall we use contrast or not? Yes.
Elizabeth DICK (Speaker, United Kingdom)
11:30 - 11:55
Contrast induced nephropathy - shall we use contrast or not? No.
Christian WREDE (Head of Department) (Speaker, Berlin, Germany)
11:55 - 12:20
Can USS replace conventional radiology for emergencies of the head and neck region?
Beatrice HOFFMANN (Speaker, Boston, USA)
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C33
11:05 - 12:30
Hematologic and Oncologic Emergencies
Moderator:
Tim COOKSLEY (Moderator, Manchester, United Kingdom)
11:05 - 12:30
11:05 - 11:30
Transfusion reactions - What the ER physician needs to know.
Andy NEILL (Doctor) (Speaker, Dublin, Ireland)
11:30 - 11:55
Approach to sickle cell crisis in the ED.
Joseph BONNEY (Specialist) (Speaker, Kumasi, Ghana)
11:55 - 12:20
Recognition and management of toxicities related to immune checkpoint inhibitors.
Tim COOKSLEY (Speaker, Manchester, United Kingdom)
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D33
11:05 - 12:30
Emergency Nursing - Research
11:05 - 11:25
How to get your research published.
Petra BRYSIEWICZ (Speaker, South Africa)
11:25 - 12:25
How to review a paper - workshop.
11:25 - 12:25
How to review a paper - workshop.
Dr Thordis K. THORSTEINSDOTTIR (Professor) (Speaker, Reykjavik, Iceland)
11:25 - 12:25
How to review a paper - workshop.
Jochen BERGS (Speaker, Hasselt, Belgium)
11:25 - 12:25
How to review a paper - workshop.
Florian GROSSMANN (Clincal Nurse Specialist) (Speaker, BASEL, Switzerland)
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E33
11:05 - 12:30
Abdominal catastrophies and mishaps
Moderator:
Anna SPITERI (Consultant) (Moderator, Malta, Malta)
11:05 - 11:25
Appendicitis.
Michael GLEENBERG (Attending, Residency Program Director) (Speaker, Ashdod, Israel)
11:25 - 11:40
Anal pain.
Ruth BROWN (Speaker) (Speaker, London, United Kingdom)
11:40 - 11:55
Anorectal syndromes.
Ruth BROWN (Speaker) (Speaker, London, United Kingdom)
11:55 - 12:15
Small and large bowel obstruction.
Nikolas SBYRAKIS (Consultant Emergency Physician) (Speaker, Heraklion, Greece)
12:15 - 12:30
diverticulitis.
Adela GOLEA (Associate Professor) (Speaker, Cluj Napoca, Romania)
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F33
11:05 - 12:30
Research
Moderator:
Michela CASCIO (Trainee doctor) (Moderator, ROME, Italy)
11:05 - 11:30
The virtual Journal Club.
Robert HIRST (ST4 EM Trainee) (Speaker, Bristol)
11:30 - 11:55
James Lind Alliance and RCEM Research Prioritisation.
Laura COTTEY (PhD student) (Speaker, Salisbury)
11:30 - 11:55
James Lind Alliance and RCEM Research Prioritisation.
Thomas SHANAHAN (NIHR Academic Clinical Fellow, Honorary Clinical Research Fellow and Emergency Medicine Trainee) (Speaker, Manchester, United Kingdom)
11:55 - 12:20
Bringing research to every patient: How can it be achieved over the next decade.
Tom ROBERTS (Doctor) (Speaker, Bristol, United Kingdom)
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G33
11:05 - 12:30
Chancengleichheit in der Notfallmedizin
Moderators:
Lydia HOTTENBACHER (Head of Department) (Moderator, Berlin, Germany), Sylvia SCHACHER (Attending) (Moderator, sankt Augustin, Germany)
11:05 - 11:30
rztinnen un der Notfallmedizin: It's a men's world?
Christine HIDAS (Speaker, Germany)
11:30 - 11:55
Welche Strukturen un Manahmen sind erforderlich, um nderungen zu erzielen?
Sabine JOBMANN (Speaker, Germany)
11:55 - 12:20
Mentorinnennetzwerke - ein Erfolgskonzept auch fr die Notfallmedizin?
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H33
11:05 - 12:30
Sepsis-infectious
Moderators:
Dr Federico CAPRILES (Médico adjunto) (Moderator, Reus, Spain), Said LARIBI (PU-PH, chef de pôle) (Moderator, Tours, France)
11:05 - 12:30
#31680 - A descriptive analysis of all in-hospital deaths in adults with possible sepsis in a Norwegian hospital trust during two consecutive years.
A descriptive analysis of all in-hospital deaths in adults with possible sepsis in a Norwegian hospital trust during two consecutive years.
Study objective: To describe in-depth patient features in sepsis-related, in-hospital deaths.
Methods: A retrospective, descriptive analysis from in-depth medical chart reviews, for all deceased adult patients within a Norwegian hospital trust, comprised of two local and one regional hospital, with a primary or secondary diagnosis of infection, during two consecutive years (2018-2019). The diagnosis of infection was identified by administrative coding supplemented by brief chart reviews for all in-hospital deaths. Premorbid function was assessed with the Clinical Frailty Scale (CFS), and number of admittances and days spent in hospital the year prior to the last hospital stay were recorded. Comorbidity was classified with Charlson’s Comorbidity Index (CCI) as well as the presence of end stage disease , immunosuppression, polypharmacy etc. The last hospital stay was assessed regarding the relevant infection, wherein Sequential Organ Failure Assessment (SOFA) was performed retrospectively, and care given, including patients’ preferences and potential restrictions in care. Ultimately, the likeliness of sepsis as cause of death was evaluated using a five-point scale, including very likely, likely, plausible, cannot be excluded and surely not sepsis as cause of death. Evaluations were performed by medical doctors in internal and emergency medicine, obtaining excellent rater’s agreement with Cronbach’s alpha.
Results: Of a total of 638 in-hospital deaths among adults, 318 had a primary or secondary diagnosis of infection. Sepsis as cause of death were evaluated as very likely or likely for 178 (57%), plausible or cannot be excluded for 135 (43%), and as surely not for 5 (2%), which were excluded. Of all 313 cases of possible sepsis-related deaths, 229 patients (73.2%) were either 85 years or older, had a preexisting end stage condition or severe frailty with CFS 7 or higher, with no significant difference between sepsis likeliness groups of very likely and likely vs. plausible or cannot be excluded. Among the 84 patients (26.8%) who were younger than 85, not severely frail and without preexisting end stage conditions, there was still a high prevalence of advanced age, frailty, and comorbidity: 20 patients (6.4%) were younger than 75 years old, not frail (CFS less than 5) and without severe comorbidity (CCI less than 5). 7 patients (2.2%) where younger than 70, not frail and without moderate comorbidity (CCI less than 3). One of these 7 patients had no comorbidity. Overall, 223 (71.2%) had at least one hospital stay the year prior to the last, with means of 4.2 stays and 21.9 days in hospital, if any. 87 (27.8%) had active cancer. Polypharmacy was present in 205 cases (65.5%), immunosuppression in 54 (17.3%), and other advanced conditions, e.g., neuromuscular disease, in 53 (16.9%).
Conclusion: The prevalence of advanced age, frailty and comorbidity is prominent in our cohort. This knowledge is of importance for both clinicians evaluating patients with these features, and health authorities when applying sepsis-related mortality as a metric for the quality of sepsis care in similar populations.
Funded in full by the Helse Nord, Northern Norwegian health authorities
Marianne TORVIK (Bodø, Norway)
11:05 - 12:30
#30961 - Characteristics and predictors of in-hospital death or transfer to intensive care unit in patients with suspected bacterial infection and without fulfilling the sepsis criteria on admission.
Characteristics and predictors of in-hospital death or transfer to intensive care unit in patients with suspected bacterial infection and without fulfilling the sepsis criteria on admission.
Background:
The sepsis diagnosis is based on consensus clinical criteria, and vital signs are the key elements in the criteria. Several studies have shown sub-optimal discriminative performances of the suggested sepsis criteria to identify infectious patients with an increased risk of poor outcomes (death or transfer to intensive care unit (ICU)). Consequently, patients with serious infections may present without meeting the sepsis criteria. Data on characteristics and determinants of outcomes for patients with serious infections without sepsis criteria are sparse.
Aim:
To describe baseline characteristics and to examine predictors of serious outcomes among emergency department (ED) patients with suspected bacterial infections without meeting the sepsis criteria on admission to the ED.
Methods:
A prospective observational study of patients with suspected bacterial infection admitted to the emergency department during 1.10.2017–31.03.2018. A National Early Warning Score (NEWS2) ≥5 within the first four hours in the ED was assumed to be compatible with sepsis with a high risk for serious outcomes defined as the composite endpoint (primary outcome) of in-hospital death or transfer to the ICU. Patients achieving the primary outcome were grouped according to fulfillment of the NEWS2 ≥5 criteria and compared to baseline characteristics. We used logistic regression analysis to estimate unadjusted and adjusted odds for the composite endpoint per unit increase of different covariates among patients with either a NEWS2 score < 5 (NEWS2÷) or a NEWS2 score ≥5 (NEWS2+).
Results:
A total of 2,055 with a median age of 73 years were included. A total of 198(9.6%) achieved the composite endpoint, 59(29.8%) NEWS2÷ patients and 139(70.2%) NEWS2+ patients, respectively. Compared to NEWS2+ patients, we found that NEWS2÷ patients were older, more likely to be female, and suffer from diabetes. The proportion with Sequential Organ Failure Assessment Score (SOFA) ≥2 and new-onset atrial fibrillation on admission was lower in the NEWS2÷ group and they also had lower values of leucocytes, bilirubin, lactate, and glucose. Urinary tract infections were more commonly the source of infection among NEWS2÷ patients. The median time to antibiotic treatment was lower in the NEWS2÷ group (4.2 vs 6.7 hours). The Do-not-attempt-cardiopulmonary- resuscitation order (DNACPR) was registered on admission among 16.9% and 27% of NEWS2÷ and NEWS2+ patients, respectively.
The final regression model for NEWS2÷ patients showed that diabetes (OR 2.23;1.23-4.0%), a SOFA score of ≥2 (OR 2.57;1.37-4.79), and a DNACPR order on admission (OR 3.70;1.75-7.79) were predictive variables for the composite endpoint (goodness-of-fit test p-value 0.291; AUROC for the model 0.72). A final regression model for NEWS2+ patients revealed that a SOFA score ≥2 (OR 2.93;1.68-5.13), hypothermia (OR 2.48;1.30-4.75), and a DNACPR order on admission were predictive variables for the composite endpoint (goodness-of-fit test p value 0.62, AUROC for the model 0.70).
Conclusions:
Almost one-third of patients with suspected bacterial infections and serious outcomes during hospitalization did not meet the NEWS2 sepsis criteria. Our study has identified some factors with independent predictive values for the development of serious outcomes which should be tested in future prediction models.
This work was supported by Region Zealand Health Research Foundation, Naestved, Slagelse and Ringsted Hospitals Research Fund, and
the Department of Emergency Medicine, Copenhagen University Hospital,Bispebjerg and Frederiksberg, Denmark.
Lana CHAFRANSKA, Osama Bin ABDULLAH, Rune SØRENSEN, Finn Erland NIELSEN (Aarhus, Denmark)
11:05 - 12:30
#31290 - Effect of albumin on the outcomes in septic patients with hypoalbuminemia in the emergency department : A propensity score-matched retrospective cohort study.
Effect of albumin on the outcomes in septic patients with hypoalbuminemia in the emergency department : A propensity score-matched retrospective cohort study.
Objectives: Low albumin concentration is known to be associated with poor prognosis in sepsis, and the effect of administration of albumin is controversial. This study was performed to investigate the effect of albumin on the outcomes of patients with sepsis or septic shock.
Methods: This was a retrospective, propensity score-matched cohort study of septic patients with an initial serum level < 3.0 g/dL at an emergency department of an urban tertiary university hospital. Patients who received 20% albumin within 24 hours of emergency department (ED) admission, were compared with those who did not. We performed a 1:1 propensity score-matched analysis. The primary outcome was 28-day mortality rate and the secondary outcomes were the Sequential Organ Failure Assessment (SOFA) score at 24, 48, and 72 hours, the need for mechanical ventilation and renal replacement therapy (RRT), and admission to intensive care unit (ICU).
Results: A total of 1,284 patients were included, and the overall mortality rate was 29.4%. After propensity score matching, 192 albumin group and 192 control group were included in the final analysis. There was no significant difference in 28-day mortality. The SOFA scores at 24, 48, and 72 hours were higher in the albumin group than in the control group, respectively. The rate of RRT and admission to the ICU was also higher in the albumin group than in the control group.
Conclusions: In patients with sepsis with hypoalbuminemia, albumin replacement was not associated with 28-day mortality, but was associated with SOFA score, the application of RRT, and admission to the ICU.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Byun GUNGDO (Bundang, Republic of Korea), Ji Eun HWANG, Lee JAEHYUK, Kim JOONGHEE, Park INWON
11:05 - 12:30
#31058 - Factors associated with 30-day mortality in elderly patients attended to the Emergency Department for infection.
Factors associated with 30-day mortality in elderly patients attended to the Emergency Department for infection.
Introduction: Infections account for 15% of the visits attended in the hospital emergency departments (ED) and the prevalence has increased in the last decade, especially in the elderly population. Beyond the severity of the infection, the comorbidity of elderly patients is a very important factor in assessing the intensity of treatment administered in the ED and the final destination of these patients.
Objective: To assess the value of comorbidity at the ED visit in predicting 30-day mortality among elderly patients with acute infection.
Methodology: Prospective observational multicenter cohort study of elderly patients (≥75 years) with a diagnosis of acute infection in 69 Spanish EDs over 3 seasonal periods of 2 days each (spring, autumn and winter) before the COVID outbreak. Demographic data, comorbidities, functional status according to Barthel Index (BI), clinical and analytical data, the site of infection and all-cause 30-day mortality were collected. The qualitative variables were expressed as frequencies and percentages and the quantitative variables as mean and standard deviation. For comparison, the Chi square test was used for the first, and the Student’s t test was used for independent samples for the second. The SPSS 24.0 (Inc, Chicago, IL) statistical program was used for the statistical analyses.
Results: A total of 1,634 patients were included in the study with a mean age of 84.7 years and 51.7% female. Focus of infection was respiratory in 958 patients (58%), urinary in 371 (22%), abdominal in 189 (11%), skin and soft tissue in 114 (7%) and other focus in 30 (1.8%). The mortality recorded at 30 days was 10.16% (166 episodes). Patients who died at 30 days, respect to the survivors, were significantly (p < 0,05 for all) older (years ± SD 86,40 ± 6,33 vs 84,50 ± 5,83), predominantly male (12,17% men vs 8,22% women), more likely to be institutionalized (17,97% vs 8,36%), with a greater Charlson index (2,93 ± 2,02 vs 2,26 ± 1,93 points), with a history of dementia (13,83% vs 8,95%), lower BI (38,93 ± 35,73 vs 68,32 ± 36,48 points) and BI < 60 points (18,3% vs 5,32%) and lower score on the Glasgow coma scale on arrival at the ED (12,99 ± 2,47 vs 14,39 ± 1,42 points). When comparing the different infection models, we did not find significant differences between them, although the respiratory model compared to the others models had a higher mortality with a tendency towards statistical significance (p = 0,057).
Conclusions: For elderly patients with acute infection, a high comorbidity on ED visit appears to be a strong predictor of mortality at 30 days regardless of the type of infection.
Ferran LLOPIS (Barcelona, Spain), Carles FERRE, Sebastia QUETGLAS, Marta MARISTANY, Manel TUELLS, Javier JACOB, Pierre MALCHAIR
11:05 - 12:30
#31681 - Optimal combination of early biomarkers for infection and sepsis diagnosis in the emergency department: The BIPS study.
Optimal combination of early biomarkers for infection and sepsis diagnosis in the emergency department: The BIPS study.
Introduction: The recent update in sepsis definitions have reinforced sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Because clinical signs at admission are often non-specific, sepsis biomarkers have been intensively investigated in order to improve sepsis identification and to promote the implementation of early therapeutic strategies. However, most patients with sepsis are admitted at hospitals through emergency departments. The emergency department has therefore a crucial role for the early identification of sepsis. Currently, due to complex and multimodal pathophysiological pathways, no individual biomarker of infection and/or sepsis is sufficiently discriminating to allow proper diagnosis, CRP and PCT included.
Objective: To define the best combination of biomarkers for the diagnosis of infection and sepsis in the emergency room.
Methods: In this cohort, prospective, single-center, non interventional study, consecutive patients with a suspicion of infection in the emergency room were included. Eighteen different biomarkers measured in plasma, and twelve biomarkers measured on monocytes, neutrophils, B and T- lymphocytes were studied and the best combinations determined by a gradient tree boosting approach. Clinical and biological data are described as frequencies and percentages for categorical variables and as means and standard deviations or medians and interquartile ranges for continuous variables, as appropriate. To identify the biomarkers which may discriminate pre-defined groups of patients (bacterial infection, viral infection, sepsis) a gradient boosting tree approach (xgbTree function from the caret R package v6.0.3.81, http://cran.r-project.org) was applied.
Results: Overall, 291 patients were included from March 2016 to July 2017,and analyzed, 148 with bacterial infection, and 47 with viral infection. The best biomarker combination which first allowed the diagnosis of bacterial infection, included HLA-DR (human leukocyte antigen DR) on monocytes, MerTk (Myeloid-epithelial-reproductive tyrosine kinase) on neutrophils and plasma metaloproteinase-8 (MMP8) with an area under the curve (AUC)=0.94 [95% confidence interval (IC95): 0.91;0.97]. Among patients in whom a bacterial infection was excluded, the combination of CD64 expression, and CD24 on neutrophils and CX3CR1 on monocytes ended to an AUC=0.98 [0.96;1] to define those with a viral infection.
Conclusion: In a convenient cohort of patients admitted with a suspicion of infection, two different combinations of plasma and cell surface biomarkers were performant to identify bacterial and viral infection.
ClinicalTrials.gov Identifier: NCT02707718
Laëtitia VELLY (Paris), Stevenn VOLANT, Catherine FITTING, Daniel Aiham GHAZALI, Florian SALIPANTE, Julien MAYAUX, Gentiane MONSEL, Jean-Marc CAVAILLON, Pierre HAUSFATER
11:05 - 12:30
#31106 - Predictive scores for clinical outcomes of cryptococcal fugemia in emergency department.
Predictive scores for clinical outcomes of cryptococcal fugemia in emergency department.
Objectives:
Cryptococcal infection is usually diagnosed in immunocompromised individual and meningeal involvement can account for mostly cryptococcosis. Cryptococcemia indicates poor prognosis and prolonged course of treatment. This study is aimed to investigate the scoring systems and risk factors to predict the mortality risk of patients with diagnosis of cryptococcal fungemia.
Methods:
It was single hospital-based retrospective study on patients with diagnosis of cryptococcal fungemia confirmed by at least one blood culture collected from emergent department or during hospitalization. Patients’ characteristics, including general data, vital signs, comorbidities and laboratory investigations were collect between January 2012 and September 2020 from electronic data bank in Taichung Veterans General Hospital. The scoring systems were used to predict the mortality risk of cryptococcal fungemia.
Results:
Of all, 43 patients were enrolled into this study and one was excluded due to transferring to other hospital before confirmed fungemia. There were 28 (66.7%) males and 14 (33.3%) females with mean age of 63.00±19.69 years. Total hospital stay ranged from 1 to 170 days (mean 44.38 days) and 27 patients (64.28%) expired or discharged under critical condition during hospital stay. In univariate analysis, higher scores of MEWS with ROC of 0.833, RAPS with ROC of 0.842, qSOFA with ROC of 0.848, MEWS plus GCS with ROC of 0.846, REMS with ROC of 0.846, NEWS with ROC of 0.878 and MEDS with ROC of 0.905 could have good performance to predict the in-hospital mortality risk of patients with cryptococcal fungemia. In multivariate cox regression model, all of higher scores of scoring systems, older age or higher lactate, and lower MAP or DBP significantly indicated higher mortality rate.
Conclusion:
These scoring systems can be apply in predicting dismal outcome of patients with cryptococcal fungemia and the MEDS score has the best performance. Further large-scale prospective study will be needed for patients with cryptococcal fungemia.
Taichung Veterans General Hospital
Weikai LIAO (Taichung, Taiwan), Sung-Yuan HU, Yi-Chun TSAI
11:05 - 12:30
#31460 - Risk scores and outcome in acute infectious meningitis in adults presenting to the emergency department.
Risk scores and outcome in acute infectious meningitis in adults presenting to the emergency department.
Introduction :Acute infectious meningitis have had a various clinical presentations. The non-specificity of the clinical signs and even the power discriminating of the lumbar puncture between bacterial or viral origin, that several scores, validated in pediatrics, have been tested in the adult population.
Aim of the study :To analyse the discriminating contribution of the Bacterial Meningitest Score (BMS) and the Meningitest score in determining the bacterial or viral origin of infectious acute meningitis in the emergency room.
Methods:A retrospective study,from January 2017 to February 2022, including cases of acute meningitis admitted to the emergency room. The BMS and the Meningitest scores were calculated, with analyses of the ROC curve, sensitivity, specificity, PPV and VPN.
Results :Seventy-one cases of meningitis with a median age of 36 years, the 25th and 75th percentiles of 22 and 54 years and a sex ratio (M/F) of 1.2. Clinical evaluation revealed fever in 84.5% of cases, neck stiffness in 67.9% of cases, vomiting in 54.7%, photophobia in 37.3%, headache in 70.4%, visual blurring in 9.4% of cases and a seizure in 5.6% of cases. Meningeal syndrome with positive Brudzinski and Kernig signs respectively in 32.4% and 22.5% of cases. Meningeal stiffness was found in 62% of cases. Lumbar puncture showed clear cerebrospinal fluid in 42 patients (59.2%), cloudy in 16 patients (22.5%) and purulent appearance in 7 patients (9.9%). Hypoglycorachia was noted in 29.6% and hyperproteinorachia in 54 cases (76%). CSF culture was negative in 43 cases (60.6%). Bacterial origin was retained in 37.3% of cases. Median BMS=1, AUC=0.730 [0.566; 0.894], median Meningitest score=2.5, AUC=0.808, [0.686; 0.930]. BMS: Specificity at 76%, sensitivity at 68.8%, VPP at 52.1% and VPN at 85.7%, Meningitest score: specificity at 78% and sensitivity at 81.3%, VPP at 52.1% and VPN at 87.7%.
Conclusion :The AUC scores, especially the Meningitest score, were good, but they lacked specificity. Negative scores have better predictive value.
Chadha BEN HMIDA, Nessrine FTIRICH, Safia OTHMANI (TUNIS, Tunisia), Houyem ZOUARI, Asma JENDOUBI, Amine ABRI, Alaeddine ZOUARI, Sarra JOUINI
11:05 - 12:30
#31312 - Systematic pretreatment blood cultures collection substantially alters the management of antibiotics in suspected sepsis patients.
Systematic pretreatment blood cultures collection substantially alters the management of antibiotics in suspected sepsis patients.
Background: The Surviving Sepsis Campaign recommends performing pretreatment blood cultures for all patients hospitalized with suspected sepsis, providing it does not delay the start of antibiotics. Nevertheless, the literature has shown an overall low yield in the emergency department and less than 15% were used to guide the treatment, regardless of the source of infection.
Study objectives
We aim to analyze the impact of systematic blood cultures drawn to screen for bacteremia on adjusting antibiotic prescription and patient-level exposure to antibiotics. Furthermore, we aim to identify predictors for blood culture positivity.
Methods
We conducted a retrospective cohort, enrolling patients admitted to the Emergency Department with suspected sepsis between October and December 2021 in a tertiary academic hospital in São Paulo, Brazil. Patients with signs of infection were considered with suspected sepsis after a nursing triage endorsed by a first medical evaluation at the emergency room by the physician on duty. The sample was divided into two groups: positive vs. negative blood cultures. The outcomes were days of therapy (DOTs) and modification in antibiotic prescription. Data were collected through electronic medical records, and the databases were built on REDCap® software. Analyses were performed on R software version 4.1.2. Numerical variables were analyzed using the Mann-Whitney-Wilcoxon test and categorical variables through the chi-square method. A p-value<0.05 was considered significant.
Results
Fifty-three patients were included. Overall, patients in our sample had high in-hospital mortality (18,88%) and incidence of sepsis (92.45%), septic shock (33.96%), and need for intensive care unit admission (52.56%). Moreover, we found a much higher yield of blood cultures than previously published (37.73%). These findings might be related to a notably sicker population (11.32% of transplanted patients, 13.2% with chronic kidney disease, 15.09% with indwelling venous catheters, and 18.86% with recent hospitalization). Patients with positive blood cultures had their antibiotic prescription more often modified than those with no microorganism isolated in the bloodstream (45% vs. 6.06%; p<0.01). De-escalation of antibiotics was the most common change in prescription (82%). Notwithstanding, there was no significant association between DOTs and blood culture positivity. We could not identify useful predictors of bacteremia for clinical use at the bedside, apart from the male sex (OR 3.45; CI 1.065 - 10.7). Surprisingly, there was no statistical difference in clinical presentation, including chronic or acute organ dysfunctions, between patients with positive and negative blood cultures. These findings must be explained by the limitation of the sample size and the short analysis period.
Conclusion
Although the overuse of blood cultures may be costly and ineffective for most patients with community-acquired infection with documented sources, systematic collection is definitely the safest approach in an environment with such a high incidence of bacteremia. In brief, positive blood cultures are deemed associated with the need for adjustment in antibiotic prescription and don't seem to enhance the patient-level exposure to antibiotics.
Funding: FAPESP
Ethical approval and informed consent: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068), which also waived the need for written informed consent. We adhere to STROBE guidelines.
Lucas MARINO, Ian MAIA (São Paulo, Brazil), Matias SALOMÃO, Juliana STERNLICHT, Eduardo SORICE, Luisa BARINI, Giovanna OLIVEIRA, Hian BETONI, Gabriel SILVA, Julio MARCHINI, Julio ALENCAR, Rodrigo BRANDÃO, Luz MARINA, Heraldo SOUZA
11:05 - 12:30
#31261 - Usefulness of internal carotid artery doppler measurement as a predictor of early mortality of sepsis patients visiting the emergency room: a prospective study.
Usefulness of internal carotid artery doppler measurement as a predictor of early mortality of sepsis patients visiting the emergency room: a prospective study.
Background: The hemodynamic key feature of sepsis is cerebral microcirculation may be significant changed in cerebral blood flow (CBF). Because of this feature, sepsis patients develop brain dysfunction and increase mortality. Nevertheless, there is a lack of methods to measure and monitor CBF in the emergency department (ED). So, the aim of this study was to verify the validity as an early death prediction tool by measuring the blood flow velocity and diameter of the internal carotid artery (ICA) by Doppler imaging and to compare the mortality prediction.
Methods: This study was conducted as a prospective clinical trial targeting sepsis patients who visited a one regional emergency medical center from August 2020 to February 2022 in Busan city, South Korea. A study was conducted on 1,026 out of a total of 1,071 recruited patients, excluding 45 patients. To compare early death predictions with Doppler of ICA group (331 patients), we measured quick Sequential Organ Failure Assessment(qSOFA) group (335 patients), systemic inflammatory response syndrome(SIRS)criteria group (260 patients) that a popular early death risk recognition tools were used. A primary outcome was to verify the usefulness of ICA Doppler ultrasound as a predictive tool of early mortality accuracy to assess by measuring blood flow velocity and the diameter in sepsis patients with hypotension in the ED. To compare the tools on predictive mortality accuracy, Cox proportional regression analysis was performed and hazard ratios(HRs), 95% confidence intervals were presented.
Results: As a result of analyzing the mortality prediction accuracy, the HRs (95% CI) of peak systolic velocity(PSV)of ICA group was significant difference as 1.020 (1.004-1.036) (p<0.05). The HRs of qSOFA was 3.871 (2.526-5.931), indicating a significant correlation (p<0.05). HRs (95% CI) of SIRS was 1.002 (0.995-1.009), showing no significant difference. The PSV in ICA was presented receiver operating characteristic (ROC) curve of. Area under the curve (AUC) was 0.891 (95% confidence interval 0.826~0.956, p<0.001).
Discussion & Conclusions: We could verify that PSV in sepsis patients by measured Doppler may be predicting mortality. So, PSV in ICA is measured using Doppler in sepsis patients who have visited the emergency department, it will be possible to predict and prevent early death from brain dysfunction. We propose using Doppler to measure PSV in ICA for sepsis patients in ED. Then it may be useful predict the risk of early mortality in sepsis patients visiting ED.
None.
Yang Weon KIM, Jae Gu JI (Busan, Republic of Korea), Young Jin JEON, Ji Hun KANG, Yun Deok JANG
11:05 - 12:30
#31351 - Usefulness of the PSI and CURB-65 scales for the prognostic assessment of patients infected with Covid-19 based on their vaccination status.
Usefulness of the PSI and CURB-65 scales for the prognostic assessment of patients infected with Covid-19 based on their vaccination status.
Background.
The PSI and CURB-65 severity scales are widely used in the assessment of community-acquired pneumonia. Its use also spread among patients infected with Covid-19. However, it is unknown if its usefulness is maintained among patients vaccinated against COVID-19.
Aim
Know the usefulness of the PSI and CURB-65 scales for the prognostic assessment of the patient infected by Covid-19 based on their vaccination status
Material and methods.
Retrospective descriptive study. Patients diagnosed with Pneumonia by Covid-19 in emergency department (ED) and admitted in hospital. Months: August 2021-February 2022 and vaccination status against Covid-19 was known (0 doses vs one or more doses). Independent variables: age, sex, Charlson comorbidity index (CCI). Dependent variable: 30 days mortality (30M). Descriptive study: quantitative variables: median and interquartile range (IQR), qualitative variables: absolute and relative frequency. Univariate study, comparison of quantitative variables: Mann-Whitney U, qualitative variables: Chi-square. Area under curve (AUC) of receiver operating characteristic curve (ROC) of scores were calculated. All statistical analyzes were performed using the SPSS 24.0. software package. p<0.05. 95% confidence interval (CI).
Results
N: 402; median age: 64 (IQR: 52-80); female: 40.8%. 30M: 9.2%. Vaccinated: 67.2%. 30M and Vaccinated: 8.9%, Not vaccinated: 9.8% (p>0.05). Total median PSI 30M: 130 (105-155), survivors: 67 (53-94); Total median CURB-65: 30M: 3 (2-4); survivors: 1 (0-2).
30M PSI in Vaccinated: 0-90 points: 2.1%, >90 points: 22.4% (p<0.0001), 30 PSI in Not Vaccinated: 0-90 points: 1.2%, >90 points: 38.7% (p <0.0001); 30M CURB-65 in Vaccinated: 0-1 points: 2.2%, >1 points: 20.4% (p<0.0001), Not Vaccinated: 0-1 points: 0%, >1 points: 36.1% (p< 0.0001); AUC FINE: Total: 0.885 (95% CI 0.835-0.935, p<0.0001), Non-Vaccinated: 0.952 (95% CI 0.901-1, p<0.0001), Vaccinated: 0.846 (95% CI 0.772-0.920, p< 0.0001). CURB-65 AUC: Total: 0.853 (95% CI 0.792-0.913, p<0.0001), non-Vaccinated: 0.923 (95% CI 0.872-975, p<0.0001), Vaccinated: 0.808 (95% CI 0.719-0.898, p<0.0001).
Logistic regression (age, sex, PSI): Vaccinated: age and sex (p>0.05); PSI: OR: 1026 (1008-1044); Non-Vaccinated: Sex (p>0.05), age: OR: 1.218 (1.047-1416, p<0.05), PSI: OR 1.058 (1.017-1.100, p<0.05). Logistic regression (age, sex, CURB-65): Vaccinated: sex (p>0.05); Age: OR: 1062 (1009-1118, p<0.05), CURB-65: 2223 (1273-3882); Non-Vaccinated: Sex (p>0.05), age: 1.247 (1.073-1450, p<0.05), CURB-65: 4.228 (1.180-15.151, p<0.05).
Discussion and conclusion
Both the PSI and the CURB-65 have a similar ability to predict mortality. Both seem to perform better among the unvaccinated population than among the vaccinated, with better results on the PSI scale. Both scales can be good tools to assess the prognosis among patients infected with Covid-19.
Dr Raul LOPEZ IZQUIERDO (Valladolid, Spain), Virginia CARBAJOSA RODRIGUEZ, Del Campo FELIX, Jesus ALVAREZ MANZANARES, Moreno FERNANDO, Jose Maria EIROS, Enriquez De Salamanca Gambara RODRIGO, Antonio DEL REY VIEIRA, Laura MELERO GUIJARRO, Pablo GONZALEZ GARCINUÑO, Ramos Rodriguez ANA, Patricia BUSTAMANTE MARCOS, Beatriz CALVO ANTON, Mª Antonia UDAONDO CASCANTE, Francisco MARTÍN RODRIGUEZ
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11:10 |
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11:10 - 11:40
Meet the Presidents
11:10 - 11:40
EUSEM President.
Abdo KHOURY (PROFESSEUR ASSOCIE) (Panelist, Besançon, France)
11:10 - 11:40
EUSEM President Elect.
James CONNOLLY (Consultant) (Panelist, Newcastle-Upon-Tyne, United Kingdom)
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12:30 - 14:00
General Assembly (EUSEM Members only)
12:30 - 12:35
Welcome.
Abdo KHOURY (PROFESSEUR ASSOCIE) (Chairperson, Besançon, France)
12:40 - 12:45
Matters arising from the minutes not included elsewhere on the agenda .
Abdo KHOURY (PROFESSEUR ASSOCIE) (Besançon, France)
13:40 - 14:00
Incoming President.
James CONNOLLY (Consultant) (Speaker, Newcastle-Upon-Tyne, United Kingdom)
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12:45 - 14:15
DGINA Poster Session: Basic and clinical research
Moderators:
Eva DIEHL-WIESENECKER (Physician) (Moderator, Berlin, Germany), Patrick DORMANN (Teammember) (Moderator, Köln, Germany)
12:45 - 12:53
Prognostische Aussagekraft der initialen Blutgasanalyse aus der Schockraumversorgung von kritisch kranken, nicht-traumatologischen Patienten.
Constantin MAIER-STOCKER (physician) (Eposter Presenter, Regensburg, Germany)
12:53 - 13:01
Burnoutprvention bei Mediziner:innen: Meta-Analyse.
Lea KREBS (Medical Student) (Eposter Presenter, Jena, Germany)
13:01 - 13:09
Overcrowding in deutschen Notaufnahmen: Eine Flashmob-Umfrage zur Punktprvalenz.
Andreas Rudolf Johannes HÜFNER (Head of Department) (Eposter Presenter, Regensburg, Germany)
13:09 - 13:17
Retrospektive Studie zur Untersuchung der Einsatzfrequenz und Art der notrztlichen Rettungseinstze im soziokonomischen Kontext am Beispiel der Stadt Jena.
Ulrike DAMMANN (Medical student) (Eposter Presenter, Jena, Germany)
13:17 - 13:25
Verbesserung der Hygienekompetenz in der Notaufnahme Ergebnisse einer multimodalen Intervention.
Sonja HANSEN (Senior Hospital Epidemiologist) (Eposter Presenter, Berlin, Germany)
13:25 - 13:33
Kollaborative Statistiken zur Versorgungsforschung aus dem hessischen IVENA eine Erstvorstellung.
Jens Christoph STELTNER (Facharzt in Weiterbildung) (Eposter Presenter, Kassel, Germany)
13:33 - 13:41
Prfung der Schockraumindikation nach Unfallhergang in Korrelation zur Verletzungsschwere und hinsichtlich einer korrekten Anwendung durch den Rettungsdienst.
Martin HEINRICH (Eposter Presenter, Germany)
13:41 - 13:49
Die Breite Einwilligung Umsetzbarkeit in vier deutschen Notaufnahmen.
Antje FISCHER-ROSINSKÝ (senior research assoiciate) (Eposter Presenter, Berlin, Germany)
13:49 - 13:57
Weiterleitung niedrig triagierter pdiatrischer Patient:innen nach dem Manchester-Triage-System an externe medizinische Einrichtungen fr Kinder- und Jugendheilkunde.
Franziska LEEB (Paediatrician) (Eposter Presenter, Vienna, Austria)
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12:45 - 13:45
Gilead: Routine testing for blood-borne viruses in Emergency Departments: Opprtunities for EM societies advancing implementation
Speakers:
Juan GONZÁLEZ DEL CASTILLO (Speaker, Madrid, Spain), Laura HUNTER (Consultant) (Speaker, London)
12:45 - 13:45
12:45 - 13:45
The burden of blood-borne viruses (BBV): the need for increased routine testing.
Laura HUNTER (Consultant) (Speaker, London)
12:45 - 13:45
Best practice sharing: differing approaches in the UK and Spain.
Juan GONZÁLEZ DEL CASTILLO (Speaker, Madrid, Spain)
12:45 - 13:45
Best practice sharing: differing approaches in the UK and Spain.
Laura HUNTER (Consultant) (Speaker, London)
12:45 - 13:45
Implementing routine testing: improving health outcomes for people with undiagnosed infection.
12:45 - 13:45
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INDS11
12:45 - 13:45
Quidel: The time is now - accelerate ACS management at the point-of-care
Moderator:
Barbra BACKUS (Emergency Physician) (Moderator, Rotterdam, The Netherlands)
12:45 - 13:00
Future of high sensitive POC torponin in risk stratification in the pre-hospital setting.
Barbra BACKUS (Emergency Physician) (Rotterdam, The Netherlands)
13:00 - 13:15
Role of high sensitive POC troponin in risk stratification for acute coronary syndrome in the prehospital setting.
13:15 - 13:30
High sensitive POC troponin in the ED: what matters?
Michael WUNNING (Hamburg, Germany)
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14:00 - 14:30
Keynote lecture: Emergency Department Management of Chest Pain: Our time to shine
Speaker:
Deborah DIERKS (Speaker, DALLAS, USA)
Moderator:
Christian HOHENSTEIN (PHYSICIAN) (Moderator, BAD BERKA, Germany)
14:00 - 14:30
Emergency Department Management of Chest Pain: Our time to shine.
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110
14:30 - 15:00
Young Emergency Medicine Doctors; the future of the society
14:30 - 15:00
YEMD Section Chair.
Canberk Djan MESELI (EMERGENCY MEDICINE RESIDENT) (Moderator, DUBLIN, Ireland)
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A35
14:40 - 16:05
Airway Management
Moderators:
Christian HOHENSTEIN (PHYSICIAN) (Moderator, BAD BERKA, Germany), Bernd A. LEIDEL (Vice Head) (Moderator, Berlin, Germany)
14:40 - 15:05
The role of USS in upper airway management in the paediatric population.
Ron BERANT (Department Director) (Speaker, Petah Tikva, Israel)
15:05 - 15:30
Canadian Airway Focus Group updated consensus - Based recommendations for management of difficult airway: An Emergency Medicine Perspective.
George KOVACS (Speaker, Canada)
15:30 - 15:55
The first shot is the best shot!
Michael BERNHARD (Speaker, Meerbusch, Germany)
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14:40 - 16:05
Gastro-intestinal Emergencies - Black Box Belly
Moderator:
Luis GARCIA-CASTRILLO (ED director) (Moderator, ORUNA, Spain)
14:40 - 16:05
14:40 - 15:05
Approach to the upper GI bleed - initial steps the ED physician needs to take.
Youri YORDANOV (Médecin) (Speaker, Lyon, France)
15:05 - 15:30
Assesment and management of acute pancreatitis in the ED.
Rajan SOMASUNDARAM (Head of ED) (Speaker, Berlin, Germany)
15:30 - 15:55
Let's go fishing! - POCUS in abdominal pain in the ED.
Senad TABAKOVIC (Medical director emergency department) (Speaker, Zürich, Switzerland)
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14:40 - 16:05
COVID-tests, treatment and consequences
Moderator:
Mehmet Akif KARAMERCAN (Chair of EuSEM Research Committee) (Moderator, ANKARA, Turkey)
14:40 - 15:05
Impact of COVID-19 on hospital and ED organization and acute patient flow in Central Denmark Region.
Hans KIRKEGAARD (Professor) (Speaker, Aarhus, Denmark)
15:05 - 15:30
New tests in COVID.
Pr Rick BODY (Professor of Emergency Medicine) (Speaker, Manchester, United Kingdom)
15:30 - 15:55
Why anticoagulation treatment fails to prevent clotting in COVID.
Pr Martin MÖCKEL (Head of Department, Professor) (Speaker, Berlin, Germany)
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D35
14:40 - 16:05
Emergency Nursing - Care for older people
Moderators:
Florian GROSSMANN (Clincal Nurse Specialist) (Moderator, BASEL, Switzerland), Dr Thordis K. THORSTEINSDOTTIR (Professor) (Moderator, Reykjavik, Iceland)
14:40 - 15:05
Geriatric care in the ED: a literature update.
Pieter HEEREN (Nurse - PhD student) (Speaker, Leuven, Belgium)
15:05 - 15:30
The added value of an APN.
Karianne MELKERT (nurse practitioner) (Speaker, Amsterdam, The Netherlands)
15:30 - 15:55
Readmission and mortality among older adults who are acutely admitted and receive homecare.
Mette ELKJÆR (PhD Student) (Speaker, Aabenraa, Denmark)
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E35
14:40 - 16:05
Chest section
14:40 - 14:55
Pericardiocentesis.
Nejc GORENJAK (Speaker, Slovenia)
14:55 - 15:15
Thoracostomy (needle and tube).
Michael GLEENBERG (Attending, Residency Program Director) (Speaker, Ashdod, Israel)
15:15 - 16:05
Airway management.
Gregor PROSEN (EM Consultant) (Speaker, MARIBOR, Slovenia)
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F35
14:40 - 16:05
Let me tell you something II
Moderator:
Anastasia SPARTINOU (Emergency Medicine Trainee) (Moderator, HERAKLION, Greece)
14:40 - 15:05
Hook your audience.
Valentina PUGELJ (Em resident) (Speaker, Slovenia, Slovenia)
15:05 - 15:30
Trans specific healthcare considerations.
Bec MACGREGOR LEGGE
15:30 - 15:55
What can we learn from American Football for your Emergency team.
Lars MÜHLEN (Speaker, Krefeld, Germany)
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G35
14:40 - 16:05
Ökonomie
14:40 - 16:05
14:40 - 16:05
14:40 - 15:05
Erfahrungen mit den MD-Strukturprfungen.
Matthias BRACHMANN (Speaker, Ulm, Germany)
15:10 - 15:35
Finanzierung von Notaufnahmen in verschiedenen Gesundheitssystemen.
Timo SCHÖPKE (Director) (Speaker, Eberswalde (Berlin), Germany)
15:40 - 16:05
Qualittsindikatoren in der Notfallmedizin.
Werner WYRWICH (Speaker, Germany)
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H35
14:40 - 16:05
Toxicology
Moderators:
Kurt ANSEEUW (Medical doctor) (Moderator, Antwerp, Belgium), Marc SABBE (Medical staff member) (Moderator, Leuven, Belgium)
14:40 - 16:05
#31239 - A 10-year retrospective analysis of medication errors among adult patients characteristics and outcomes.
A 10-year retrospective analysis of medication errors among adult patients characteristics and outcomes.
Background: Increasing medication use could result in a higher incidence of medication errors (MEs). MEs are considered to be a global health problem and have been reported in many countries. MEs cause morbidity and mortality and affect patients, patients’ families, and health care providers. This study was performed to clarify the clinical characteristics of, outcomes of, and factors associated with medication errors (MEs) that cause harm to adult patients (>15 years of age) treated in the hospitals or health care facilities.
Methods: We performed a 10-year retrospective study (2011-2020) using data from the Poison Center, Thailand. MEs taxonomy developed by the National Coordinating Council for Medication Error Reporting and Prevention, was classified into categories A to I according to the severity of outcomes. ME
Results: A total of 112 patients were included in the study. Most patients (59.8%) were female. Their mean age was 50.5 years. Most MEs (89.3%) were reported from the government hospitals and most patients (53.6%) had underlying diseases. Most MEs occurred during the afternoon shift (51.8%) and in the outpatient department (85.7%%). The most common type of ME was a dose error (40.2%). Local anesthetics, antipsychotic drugs, and cardiovascular drugs were the three most common classes of ME drugs. The most common clinical effect when the ME occurred was neurologic symptoms (32.1%) such as alteration of consciousness and seizure. Eighty-one patients (72.3%) were admitted with the mean length of hospital stay of 2.4 days. Approximately half of patients had MEs categories F. Six patients died. We analyzed factors associated with MEs that caused harm including deaths (categories E–I) by comparing the clinical characteristics between patients with category C and D MEs (20 patients) and those with category E to I MEs (92 patients). The presence of underlying diseases was the only factor that was significantly different between the two groups of patients (p=0.20). The patients who had underlying diseases, had MEs that caused harm more than patients who did not. We also compared the clinical characteristics between patients aged 15-65 years and patients aged > 65 years. No statistically significant differences were found in sex, the presence of underlying diseases, the work shift that MEs occurred, type of MEs and outpatient/inpatient setting.
Discussion & Conclusion: MEs could cause harm and deaths in some adult patients. Local anesthetics were the most common drug that caused MEs in this study. A preventive measures and safety system should be emphasized and implemented to prevent or decrease the occurrence of MEs, especially in patients who had underlying diseases.
The study was not registered trial registration because of no patients involved and this is retrospective analysis.
This study did not receive any specific funding.
Phantakan TANSUWANNARAT (Bangkok, Thailand)
14:40 - 16:05
#31085 - Accuracy of pulse CO-oximetry to evaluate blood carboxyhemoglobin level: a systematic review and meta-analysis.
Accuracy of pulse CO-oximetry to evaluate blood carboxyhemoglobin level: a systematic review and meta-analysis.
Introduction: Carbon monoxide (CO) poisoning is one of the most common causes of poisoning death and its diagnosis is based primarily on the blood dosage of carboxyhemoglobin (COHb). Non-invasive pulse CO oximeters (SpCO) have been available since 2005, but their accuracy in determining blood COHb level is controversial. Our objective was to perform a meta-analysis to determine this accuracy.
Methods: MEDLINE, Embase, CENTRAL and OpenGrey databases were searched in January 2022. All studies published from 2000 evaluating the accuracy and reliability of SpCO measurement compared to blood COHb levels were included. The primary outcome was the sensitivity and specificity of SpCO for estimating COHb by blood sampling, and the secondary outcome was to estimate the limits of agreement (LOA). This systematic review was conducted according to the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) 2018 guidelines and has been registered on PROSPERO (CRD42020177940). We included studies evaluating the accuracy and reliability of multiple wavelength pulse CO oximeter (SpCO) measurement in human volunteers or ill patients, including children, compared to blood COHb levels. The analyses were performed using R software version 4.0.3 (2020-10-10). The meta-analysis was performed using the mada package version 0.5.10 (mada: Meta-Analysis of Diagnostic Accuracy), focusing on Se and Sp measures. LOA analyses were based on the method described by Tipton and Shuster (23). The analysis of publication bias was performed using a Deeks' funnel plot.
Results: Nineteen studies were eligible for the systematic review; 11 could be included for the quantitative analysis of the primary endpoint and 13 for the secondary endpoint. Three different devices were used to measure SpCO: Rad-57® (Masimo, Inc., Irvine, CA), Radical-7® (Masimo, Inc., Irvine, CA), and V-Spec™ Monitoring System (Senspec, Germany. The patient selection was the principal source of bias and concerns regarding applicability. No publication bias was found. The area under the summary ROC curve, estimated using the Rutter and Gatsonis method, was equal to 86%. The pooled sensitivity and specificity were 0.77, 95% CI [0.66–0.85] and 0.83, 95% CI [0.74–0.89], respectively (2089 subjects and 3381 observations). The mean bias was 0.95%, 95% CI [-5.16–7.07] and the LOA were -6.08% to 8.00%, 95% CI [-8.29; 10.19] (2090 subjects and 3942 observations).
Discussion & Conclusions: The false negative rate with SpCO was too high (23%) for the triage of subjects suspected of intoxication. Moreover, the consensus is that the acceptable LOA values are ±5%. Non-invasive measurement of COHb (SpCO) by current pulse CO oximeters is not accurate enough to estimate the blood COHb level and should not be used in clinical practice.
Trial Registration: PROSPERO (CRD42020177940)
Funding: This study did not receive any specific funding
Ethical approval and informed consent: Not needed
Trial Registration: PROSPERO (CRD42020177940)
Funding: This study did not receive any specific funding
Ethical approval and informed consent: Not needed
Mathilde PAPIN (Nantes), Chloé LATOUR, Brice LECLERE, François JAVAUDIN
14:40 - 16:05
#31385 - Diagnosis of carbon monoxide exposure in clinical practice and research: a scoping review.
Diagnosis of carbon monoxide exposure in clinical practice and research: a scoping review.
BACKGROUND
Carbon monoxide (CO) is a colourless, odourless gas produced from incomplete combustion of carbon-containing fuels. The effects of exposure to CO range from mild symptoms, such as headache, to neurotoxicity and death. When inhaled, CO binds to haemoglobin forming carboxyhemoglobin (COHb). Several methods exist to measure COHb but detection of exposure is made difficult by its short half-life. In this scoping review we aimed to establish the existing methods used in clinical practice and research to determine CO exposure and map the diagnostic cut-off values used.
METHOD
A scoping review was conducted according to the Arksey and O'Malley framework. EMBASE, Medline and CINAHL databases were searched for published articles in English from 2002 onwards using keywords “carbon monoxide”, “poisoning” and “diagnosis”. Reviews and papers relating to outdoor air pollution were excluded. Two reviewers independently screened published abstracts for inclusion, with a third arbiter where there was lack of agreement between reviewers. Full text papers were then reviewed, and data extracted on methods used to measure CO level, diagnostic cut-off values, and whether CO exposure was from a known or unknown source. Papers were grouped according to the diagnostic method.
RESULTS
The search identified 518 individual publications for which 63 met the inclusion criteria after removing duplicates. The predominant methodology of papers were single patient case studies and short case series. No interventional studies were identified. The most common methods identified for diagnosing CO exposure were blood measurement of COHb and spectrophotometrically by measuring COHb levels with a CO-oximeter. Exhaled CO levels using breath analysers and ambient CO measurement were also documented. Most papers did not describe the diagnostic cut-off values used to determine CO exposure but where present, a large variation was noted from 2% to 10%. Blood COHb measurements were predominantly taken in the Emergency Department as a screening tool when suspected CO cases were identified. Expired CO measurements and CO-oximetry were also used within the ED.
DISCUSSION AND CONCLUSION
Accurate diagnosis of CO exposure is an important factor in guiding treatment and in recognising patients at risk of long-term consequences of exposure. Current methods for diagnosis include carboxyhemoglobin, CO-oximetry and exhaled CO. The results of this scoping review suggest there is wide-spread variation in clinical practice in the cut-off values used to determine exposure. The differences in reported thresholds in research papers make comparison of populations across studies difficult. This scoping review highlights gaps in our current evidence base. Further research is required to identify the optimum measurement method and cut-off values for diagnosis of CO.
N/A
Phil MOSS (London, ), Ashik MOHAMED BABU, Heather JARMAN
14:40 - 16:05
#31357 - Epidemiology of hydrocodone exposures reported to the U.S. Poison Centers.
Epidemiology of hydrocodone exposures reported to the U.S. Poison Centers.
Epidemiology of hydrocodone exposures reported to the U.S. Poison Centers
Background: Drug overdoses are a leading cause of unintentional injury-associated death in the United States (U.S.) with 100,306 fatalities in 2021. Opioid dispensing rates continue to remain very high in certain areas across the country. According to the U.S Drug Enforcement Administration, 24.4 million individuals used hydrocodone for non-medical purposes. Emergency department (ED) visits for opioid* overdoses rose 30% in all parts of the US from July 2016 through September 2017. This study aims to examine the national trends in hydrocodone exposures reported to U.S. poison centers (PCs).
The National Poison Data System (NPDS) was queried for all closed, human exposures to hydrocodone from 01/01/15 through 12/31/21 using the American Association of Poison Control Center (AAPCC) generic code identifiers. We identified and descriptively assessed the relevant demographic and clinical characteristics. Reports from acute care hospitals and hospital based EDs (ACHs) were evaluated as a subset. Trends in hydrocodone exposure frequencies and rates (per 100,000 human exposures) were analyzed using Poisson regression methods. Percent changes from the first year of the study (2014) were reported with the corresponding 95% confidence intervals (95% CI).
Results: During the study period, there were 106,078 toxic exposures to hydrocodone that were reported to the PCs. The frequency of exposures decreased by approximately 50% (95% CI: 45.5%, 53.3%; p<0.001), and the rate of exposures significantly decreased by 57% (95% CI: 48.2%, 65.9%; p<0.001). Of the total hydrocodone calls, the proportion of calls from ACHs was approximately 55%, with this trend remaining constant through the study period. Multiple substance exposures accounted for 56.7% of the overall hydrocodone calls and 70.1% of calls from ACHs. Approximately 18% of the patients reporting hydrocodone exposures were admitted to the critical care unit (CCU), with 13% of patients being admitted to a psychiatric facility. Residence was the most common site of exposure (94.3%), and 62% of these cases were enroute to the hospital via EMS when the PC was notified. Cases were predominantly female (61.3%), with the most common age group being 20-29 years (16.2%) followed by 30 – 39 years (13.6%). Suspected suicides (45.2%) was the most common reason for exposure, followed by therapeutic errors (20.3%), with exposures for both reasons being higher in cases reported by ACH. Major effects and moderate effects were seen in 6.1% and 20.6% cases, respectively. There were over 600 deaths during the study. The most frequently co-occurring substances associated with the cases were benzodiazepines (17%) and alcohol (9.7%).
Conclusions: PC data demonstrated a decreasing trend of hydrocodone exposures, which may in part be attributed to the reformulation of this medication with abuse‐deterrent properties. However, the high proportion of calls from the acute-care hospitals and EDs indicates higher risk of such exposures which may be mediated by several clinical and demographic factors.
n/a
Saumitra REGE (Charlottesville, USA), Will GOODRICH, Christopher HOLSTEGE
14:40 - 16:05
#31009 - Higher 72-hour unscheduled emergency department revisit rate in severe mental illness patients with acute appendicitis.
Higher 72-hour unscheduled emergency department revisit rate in severe mental illness patients with acute appendicitis.
Background:
Acute appendicitis is one of the most common indications for emergency surgery worldwide. Patients with severe mental illness (SMI) have a shorter life expectancy and have been considered by the World Health Organization (WHO) as a vulnerable group. A higher perforation rate has been found among patients with SMI and was considered owing to delayed diagnosis. 72-hour unscheduled emergency department revisit was considered an indicator for evaluating delayed diagnosis and suboptimal management. Thus, the aim of this study is to evaluate the association of 72-hour unscheduled emergency department revisit rate in SMI patients with acute appendicitis via the use of multi-centre database.
Methods:
This is a retrospective case-control study derived the data from Chang Gung Research Database (CGRD) from January 1st, 2007 to December 31st, 2017. CGRD is the largest multi‐institutional electronic medical records (EMR) collection in Taiwan collecting data from seven Chang Gung Memorial Hospitals (CGMH), including two tertiary medical centres, two regional hospitals, and three district hospitals. The diagnoses of acute appendicitis were confirmed by the ICD codes in discharge medical records combined with the national health insurance declarations data. SMI including schizophrenia, bipolar disorder and major depressive disorder were defined by the psychiatric out-patient department diagnosis at least once before the diagnosis of acute appendicitis. The exclusion criteria were below 18 years of age, not admitted through ED, transferred from other health facility and incomplete medical records. A non-SMI patient group was matched at the ratio of 1:3 by using the Greedy algorithm. The outcomes were unscheduled 72-hr ED revisit, appendiceal perforation rate, ICU admission and in-hospital mortality.
Results: A total of 25,766 patients from seven hospitals over a span of 11 years were recruited; among them, 11,513 were excluded by criteria, with 14,253 patients left for analysis. SMI group was older (50.5 vs. 44.4 years, p < 0.01) and had a higher percentage of females (56.5 vs. 44.4%, p = 0.01) and Charlson Comorbidity Index. An analysis of the matched group has revealed that the SMI group has a higher unscheduled 72-hour revisit to ED (17.9 vs. 10.4%, p = 0.01). There was no significant difference in appendiceal perforation rate, ICU admission and in-hospital mortality.
Conclusions: Our study demonstrated a higher unscheduled 72-hour ED revisit rate prior to the diagnosis of acute appendicitis in the SMI group was found. ED health providers need to be cautious when it comes to SMI patients with vague symptoms or unspecified abdominal complaints.
Trial Registration: Not applicable for observational study.
Funding: This study did not receive any specific funding.
Ethical approval and informed consent: This study was approved by the Chang Gung Medical Foundation Institutional Review Board (IRB: 202001785B0), waiving the need for obtaining the informed consent of the study participants.
Shang-Kai HUNG (Taoyuan City, Taiwan)
14:40 - 16:05
#31067 - Intentional intoxications in the paediatric emergency department: a single-centre retrospective observational study.
Intentional intoxications in the paediatric emergency department: a single-centre retrospective observational study.
Background and aim:
Worldwide, many children under the age of 18 years die due to acute intoxications. Intoxications can occur unintentional or intentional. Intentional intoxications in adolescents are most common in females. Substantial underreporting of childhood intoxications and registration bias causes data scarcity and case details to be unknown. To optimise prevention strategies and training of emergency department (ED) personnel, increasing knowledge on intentional intoxications is crucial. Therefore, the aim of this study was to describe patient characteristics of children with intentional intoxications at the ED.
Methods:
We present preliminary data of a single-centre retrospective observational study at the Erasmus Medical Centre (Erasmus MC). We consecutively included all children under the age of 18 who were admitted at the ED for (a suspicion of) intoxication between 2015-2019. Exclusion criteria were ingestion of button cells, smoke, carbon monoxide, or natural gas. The total study population was divided into non-intentional and intentional intoxications (non-suicidal self-harm (NSSH) and suicide attempts (SA)). The outcome variables concerned patient characteristics (including vital signs), location of ingestion, intoxicant (type, dosage, intention), diagnostics, treatments and outcome. For descriptive statistics the chi-squared test and Fisher’s exact test were used.
Results:
305 patients with non-intentional (n=228; 74.8%) and intentional (n=77; 25.2%) intoxications were included. The median age was 14.0 years (SD 6.6; IQR 2.0-16.0). Intentional intoxications were divided into two subgroups: NSSH (n=19; 24.7%) and SA (n=58; 75.3%). In the group of intentional intoxications, 67 patients (87.0%) were female, and all patients (n=77; 100%) were over eleven years old. Most intoxications occurred at home (NSSH: n=11; 57.9% and SA: n=36; 62.1%). Therapeutic drugs were the most common intoxicant in both NSSH (n=67; 87.0%) and SA (n=52; 89.7%). In NSSH and SA, 33.8% (n=26) did not receive any treatment at the ED compared with 54.0% (n=123) in the non-intentional group. Most patients with an intentional intoxication were hospitalised (n=38; 49.4%). No death due to an intentional intoxication occurred.
Conclusion:
In our population, the majority of intentional paediatric intoxications concerned SA and occurred more often in female patients at home with therapeutic drugs as the most used intoxicant. Patients with intentional poisonings were more often severely ill than patients with non-intentional poisonings. As we performed a small single centered study, in order to gain more insights on this topic and further improve prevention programs and training of ED personnel, data should routinely be collected and monitored.
Funding: This study is part of a larger study which received funding from the “Spoedeisende Geneeskunde Onderzoeksfonds” and Stimuleringsprogramma Gezondheidsonderzoek (SGO).
Melissa GOUVERNANTE (Rotterdam, The Netherlands), Carolien VERHEIJ, Juanita A HAAGSMA, Pleunie P M ROOD, Corine BETHLEHEM, Dorien GEURTS
14:40 - 16:05
#31361 - Opioid exposures reported to the U.S. Poison Centers during the COIVD-19 Pandemic.
Opioid exposures reported to the U.S. Poison Centers during the COIVD-19 Pandemic.
Background: Misuse of prescription opioids continues to be a significant public health crisis globally. According to the Centers for Disease Control and Prevention (CDC), there were more than 72,000 overdose deaths in the United States (U.S.), with 49,068 involving an opioid. Preliminary reports from states and cities indicate that overdose death rates are further increasing during the COVID-19 pandemic. The present study sought to evaluate the recent trends in the severe outcomes to single substance opioid exposures (SSO) reported to the U.S. poison centers (PCs).
Methods: The National Poison Data System (NPDS) was queried for all closed, human exposures to opioids from 01/01/15 through 12/31/21 using the American Association of Poison Control Center (AAPCC) generic code identifiers. We identified and descriptively assessed the relevant demographic and clinical characteristics. Reports from acute care hospitals and hospital based EDs (ACHs) were evaluated as a subset. Trends in opioids exposure frequencies and rates (per 100,000 human exposures) were analyzed using Poisson regression methods. Percent changes from the first year of the study (2014) were reported with the corresponding 95% confidence intervals (95% CI).
Results: During the study period, there were 458,285 toxic exposures to opioids that were reported to the PCs. The frequency of exposures decreased by approximately 28% (95% CI: 25.5%, 30.4%; p<0.001), and the rate of exposures significantly decreased by 26% (95% CI: 23.2%, 31.7%; p<0.001). Of the total opioids calls, the proportion of calls from ACHs was approximately 56%, with this trend remaining constant through the study period. Multiple substance exposures accounted for 51.7% of the overall opioids calls and 59.9% of calls from ACHs. Approximately 17% of the patients reporting opioids exposures were admitted to the critical care unit (CCU), with 10% of patients being admitted to a psychiatric facility. Residence was the most common site of exposure (88.3%), and 66% of these cases were enroute to the hospital via EMS when the PC was notified. Cases were predominantly female (53.6%), with the most common age group being 20-29 years (18.2%) followed by 30 – 39 years (17.1%). Suspected suicides (33.2%) was the most common reason for exposure, followed by intentional abuse (20.3%), with exposures for both reasons being higher in cases reported by ACH. The proportion of cases reporting intentional abuse as the reason for exposure increased significantly during the study (12% to 22%). Major effects and moderate effects were seen in 11.6% and 23.2% cases, respectively. The case fatality rate was 1.3% and the proportion of fatalities increased significantly during the study period (491 to 792). The most frequently opioid was hydrocodone while benzodiazepines were the most commonly reported co-occurring substances.
Conclusion: opioid exposures reported to the poison centers during the study period decreased but exposures reported from ACHs increased significantly. Mortality due to opioid exposures also demonstrated an increase. The impact of COVID-19 on the opioid crisis needed further attention.
n/a
Saumitra REGE (Charlottesville, USA), Ryan COLE, Christopher HOLSTEGE
14:40 - 16:05
#31446 - Patients benefiting from State Medical Aid and consulting in emergency departments : what link with chronic pathologies ?
Patients benefiting from State Medical Aid and consulting in emergency departments : what link with chronic pathologies ?
Introduction : L’ « Aide Médicale d’Etat » or State Medical Aid (SMA) is a social protection system In France allowing foreigners in irregular situation in France to access healthcare. This plan cristallizes regularly the public debate, intermixing politics questions about migration and health policies. In 2019, a report by the « General Inspectorate of Social Affairs » about the comparison of European systems for access to healthcare for this population was published. He reported a rate of abuse and fraud at the SMA of more than 25%, considering that the existence of a pre-existing pathology was at the origin of the migration project. This report, witch was politically commissioned, had significants methodologicals bias. Our study aimed to analyze, for foreign patients in an irregular situation in France, the rate of emergency consultations for a pathology preexisting to migration.
Method : We conducted a retrospective single-center observational study in a University Hospital Center in a department with a large migrant population. All emergency consultations in 2019 were included. The data collected were : socio-demographics, comorbidities, reasons for consultation, emergency care, discharge procedures. The primary endpoint was the rate of consultations linked to a pre-existing pathology on arrival in France among patients receiving SMA or without social protection.
Results : 592 consultations in 2019 concerned 409 patients benefiting from SMA or without social protection. 72% had no history. The hospitalization rate for these precarious patients was 7.9%. 7 consultations (2%) were motivated by the existence of a pathology pre-existing the migration, particulary chronic renal failure (3 consultations) and tumor pathologies (2 consultations).
Conclusion : The reasons for consultation in the emergency departements of beneficiaries of the SMA or without health insurance are very rarely linked to a pathology existing before the migration.
Lucie LANDREAT, Lucie LANDREAT (Paris), Anne-Laure FERAL-PIERSSENS, Frederic ADNET
14:40 - 16:05
#31682 - Potentially Inappropriate Medications in the elderly. How do they affect the risk of fractures after a fall in a secondary hospital in Greece?
Potentially Inappropriate Medications in the elderly. How do they affect the risk of fractures after a fall in a secondary hospital in Greece?
Introduction. Falls combined with subsequent complications (injuries, fractures) are a common clinical phenomenon among vulnerable elderly patients. Polypharmacy in the elderly often leads to increased prescription of potentially inappropriate medications (PIMs), which are significant contributors to increased risk of falls in patients over 65. This study aimed to identify the percentage of patients over 65 years of age who visited the Emergency Department (ED) of a secondary hospital in Greece with a fall diagnosis, the prevalence of fractures in these cases, and the risk factors that lead to a fall with a concurrent fracture. We also studied the relation between polypharmacy and prescription of PIMs, with the incidence of fracture after a fall as an indicator of mechanically more dangerous accidents. Another question that we studied was whether ED physicians identify cases related to the prescription of potentially inappropriate medications and whether they intervene. Materials and Methods. This was a prospective observational study in patients over 65 years of age who presented to the ED of Venizelio General Hospital of Heraklion after a fall and provided consent to participate. The period studied was from 1/12/2020 to 30/3/2021. A questionnaire was used to record demographic data, medications, frailty score, Activities of Daily living performance score, and disease outcomes. The use of PIMs was defined based on the revised 2019 Beers criteria of the American geriatric society. Results. A total of 143 patients were included in the study, with a mean age of 79.5 ± 8 years. Forty-one patients were men, and 102 were women. Significantly more women experienced a fracture after a fall compared to men (74.5% vs. 43.9%, p = 0.001).In accordance with previous studies, fractures were more prevalent in patients with lower body weight and lower BMI. When patients had a fall with a fracture, physicians tended to more often identify PIMs as potential causing agents of the fall compared to patients that had no fractures. (86% vs. 54.8%, p <0.001). A significantly higher Frailty score was also associated with an increased possibility of a fracture after a call. Conclusions. The ED could be an important health unit for reviewing polypharmacy in the elderly. Such a policy could reduce the risk of adverse drug reactions from PIMs and decrease ED visits and hospitalizations for fall-related trauma.
N/A
Gryllou NIKI, Ilia STAVRINA, Briasoulis GEORGIOS, Dr George NOTAS (HERAKLION, Greece)
14:40 - 16:05
#31625 - Suicide attempt management among Turkish and American adolescents: A comparison of two pediatric emergency departments.
Suicide attempt management among Turkish and American adolescents: A comparison of two pediatric emergency departments.
Background and Objectives: This study aimed to compare the characteristics and short-term outcomes of Turkish and American adolescents with suicide attempts and determine the difference in the management and used resources among two different emergency departments in Turkey and the United States of America.
Methods: This retrospective observational study was conducted between October 2017 and September 2018. Characteristics and other information of 217 (131 American and 86 Turkish) suicide attempter adolescents were retrieved from medical records.
Results: Overall, 78% of adolescents were female. Abuse history (physical/sexual) was more common among American adolescents (p = 0.005, odds ratio [OR] 3, 95% confidence interval [CI]: 1.4–4.8), whereas uncontrolled psychiatric diseases were more evident in Turkish cases (p <0.001, OR: 5.3, 95% CI: 2.3–8.6). Proportions social worker assessment and hospitalization were significantly lower, with shorter mean follow-up duration after discharged among Turkish than American adolescents (respectively, p <0.001, OR: 9.2, 95% CI: 5.8–14.6; p<0.001, OR: 16.6, 95% CI: 8.3–33.3; and p=0.002, mean difference: –12.6; 95% CI: –20 to –5). Repeated suicide attempts were significantly higher in Turkish than American patients within 3 months after discharge (29% vs 8%, p < 0.001, OR: 4.9; 95% CI: 2.2–10.9). Social worker assessment, hospitalization, and longer mean duration of emergency department observation reduced the incidence of repeated suicide attempts (respectively, p < 0.001, OR: 4; 95% CI: 1.9–8.6; p= 0.003, OR: 3.3, 95% CI: 1.5–7.2; and p = 0.012, mean difference: − 6.2; 95% CI: −11.5 to −1).
Conclusions:Turkish adolescents had shorter observation time, with less social worker assessment, and hospitalization. Therefore, their high suicide re-attempt rate following discharge was related to the health care deficiencies.
Dr Ali YURTSEVEN (İzmir, Turkey), Caner TURAN, Deborah Mary ORT, Mehrin ISLAM, Sezen KÖSE, Eylem Ulas SAZ, Halim HENNES
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Research Network; how does it work and how can you join
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EPOSCB5EP
16:10 - 16:35
South East European Emergency and Disaster Medicine Congress Abstracts
16:10 - 16:15
Quality of medical clearance and assessment of patients presenting with mental health complaints in the Emergency Department: A 3-year retrospective study.
Jessica MCGINTY (Doctor) (Eposter Presenter, London, United Kingdom)
16:15 - 16:20
The broken heart of a sexual assault victim: A case report.
Emmanouil PETRAKIS (Eposter Presenter, Greece)
16:20 - 16:25
Emergency tracheal intubation without drugs in severely injured trauma patients.
Varvara (Barbara) FYNTANIDOU (Participant) (Eposter Presenter, Thessaloniki, Greece)
19:25 - 19:30
Potentially Inappropriate Medication sin the elderly. How do they affect the risk of fractures after falls in a secondary hospital Emegrency Department in Greece?
Dr George NOTAS (DOCTOR) (Eposter Presenter, HERAKLION, Greece)
18:30 - 18:35
Malnutrition and depression: a complex and independent relationship.
Ioannis MECHILLIS (Student) (Eposter Presenter, Atheus, Greece)
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16:10 - 16:30
Coffee Break 5 - EPoster session - Screen 1
16:15 - 16:20
Laboratory testing is indicated in older but not younger emergency department psychiatric patients.
Marielle DACLAN (Eposter Presenter, USA)
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EPOSCB5SC4
16:10 - 16:30
Coffee Break 5 - EPoster session - Screen 4
16:15 - 16:20
Barriers to implementing non-invasive ventilation prehospital and in two emergency departments in The North Denmark Region; an interview study.
Morten SØVSØ (Physician) (Eposter Presenter, Aalborg, Denmark)
16:20 - 16:25
A mixed methods study to explore whether the introduction of online NHS111 could enable a shift in demand from the NHS111 telephone service.
Fiona SAMPSON (Health Services Researcher) (Eposter Presenter, Sheffield, United Kingdom)
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EPOSCB5SC3
16:10 - 16:30
Coffee Break 5 - EPoster session - Screen 3
16:10 - 16:15
A.P.B. DUMBLEDORE study Algorithm Pecarne to Bowl over raDiation and brush Up Management of Brain injury inwardLy Emergency Department: Outcomes and cRowding improved. Part II: volume of head CT scans.
Federica FUMOSO (Resident) (Eposter Presenter, Pavia, Italy)
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EPOSCB5SC2
16:10 - 16:30
Coffee Break 5 - EPoster session - Screen 2
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EPOSCB5SC5
16:10 - 16:30
Coffee Break 5 - EPoster session - Screen 5
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EPOSCB5SC3bi
16:10 - 16:30
Coffee Break 5 - EPoster session
16:10 - 16:30
#30844 - A.P.B. DUMBLEDORE study Algorithm Pecarne to Bowl over raDiation and brush Up Management of Brain injury inwardLy Emergency Department: Outcomes and cRowding improved. Part II: volume of head CT scans.
A.P.B. DUMBLEDORE study Algorithm Pecarne to Bowl over raDiation and brush Up Management of Brain injury inwardLy Emergency Department: Outcomes and cRowding improved. Part II: volume of head CT scans.
Introduction : Head injuries represent one of the most important causes of morbidity and mortality in children, up to about 15 years of age, even if only a small number of patients have a poor prognosis. The latest studies carried out on trauma of the cranio-cephalic district indicate the annual prevalence of this event around 250 patients per 100,000 inhabitants, with a mortality of about 17 cases / 100,000 inhabitants. The Pediatric Emergency Care Applied Research Network (PECARN) is a useful decision support tool for the identification of traumatic brain injury with the potential to reduce the use of head CT among pediatric patients, as well as for the detection of intracranial injuries (ICI) and injuries requiring neurosurgery (NSI). In addition, reducing exposure to the emergency room environment must also be minimized given the young age of patients. Aims of the study: Evaluate the application of the PECARN TBI algorithm in the real life of our Emergency Department in all children who arrived for mild head trauma consecutively from 1 January 2016 to 31 December 2019 in term to have a low use of head CT among pediatric patients.. Material and methods: observational study was based on a retrospective review of the epidemiologic and clinical records of patients visiting Foundation IRCCS Policlinic San Matteo from January 1, 2016, to December 31, 2019. We analyzed all the ED-visits for traumatic mild brain injiury of pediatric people (< 15 years old). We therefore analyzed the group of children aged less than two years separately from those older than 2 years. By definition we have included as mild TBI all patients with a CGS of 14 or 15. Results Overall, a head CT was performed in 59 patients, 4% of patients. There was a prevalence of brain CT (50), but there were also 5 cervical and 1 massive facial CT scans. Some boys with multiple trauma had to perform x-ray of the skeletal segments. Only 7 patients presented bleeding and only 1 required an operating room in an emergency regime. There were no re-entries for bleeding. Conclusion: In our reality, the adoption of the PECARNE algorithm has allowed a low volume of CT scan compared to that reported in the literature. The algorithm is extremely safe
Dr Gabriele SAVIOLI, Iride Francesca CERESA (pavia, Italy), Angelica VARESI, Valentina FLORIS, Ginevra CAMBIÈ, Giovanni RICEVUTI, Mattia CONCA, Sabino LUZZI, Alice GIOTTA LUCIFERO, Christian ZANZA, Maria Antonietta BRESSAN, Abdelouahab BELLOU, Alessandro VENTURI
16:10 - 16:30
#31299 - Barriers to implementing non-invasive ventilation prehospital and in two emergency departments in The North Denmark Region; an interview study.
Barriers to implementing non-invasive ventilation prehospital and in two emergency departments in The North Denmark Region; an interview study.
Background: Chronic obstructive pulmonary disease (COPD) affects an estimated 400.000 people in Denmark and is one of the most common comorbidities for death. In 2008 national guidelines were implemented to ensure uniform treatment at all Danish hospitals. These included the usage of non-invasive ventilation (NIV) in acute exacerbation of COPD (AECOPD). However, the implementation of NIV is not uniform and not available in all emergency departments (ED) or ambulances. Therefore, this study aims to investigate to which extent NIV is used and how paramedics, nurses, and physicians, view the possibility of introducing prehospital treatment with NIV to patients affected by AECOPD in the North Denmark Region.
Method:
This is a qualitative study based on semi-structured interviews conducted with nine participants involved in the treatment of patients affected by AECOPD at Aalborg University Hospital and North Denmark Regional Hospital. These participants included experienced physicians and nurses working in the ED, specialists in pulmonary medicine, paramedics, and emergency medical technicians. The interview guide was developed on current literature as well as guidelines, with two additional questions added during the interview process. Interviews were transcribed and analysed by coding segments according to the principles of reflective thematic analyses. Codes were then clustered together into four main themes.
Results: NIV was not available in the ED’s of Aalborg University Hospital and the North Denmark Regional Hospital, and likewise unavailable in the ambulances. The participants described multiple situations where they felt NIV could have made a difference for patients affected by AECOPD. However, major barriers to implementing NIV were difficulties in the continuity of treatment at a pulmonary ward or intensive care unit. Furthermore, tradition in the treatment of patients affected by AECOPD were seen as a barrier of implementing NIV treatment outside of pulmonary wards and intensive care units. The participants expressed that training needed to be comprehensive to ensure that staff feels confident using NIV, thereby being able to deliver the best possible information and care to the patients.
Discussion and conclusion: Staff working prehospital and in the ED’s in The North Denmark Region currently feel the need for additional treatment options in patients suffering from acute respiratory failure and mention several situations where they feel NIV could make a difference. The process of admitting patients affected by AECOPD needs rethinking as continuity in treatment with NIV on the wards and intensive care units is a current barrier. Additionally, hospital management must prioritise the training of the staff along with the implementation of NIV.
Ethical approval and informed consent: Informed consent was obtained from all study participants prior to participation in the study.
Trial Registration: Not registered as no patients were involved.
Funding: This study did not receive any specific funding.
Nina IBSEN (VIBORG, Denmark), Camilla Hoffmann MERRILD, Erika Fischknecht CHRISTENSEN, Tim LINDSKOU, Morten Brienholt SØVSØ
16:10 - 16:30
#31125 - Characterization of analgesia requirements following ultrasound-guided serratus anterior plane block (SAPB) in patients with rib fractures.
Characterization of analgesia requirements following ultrasound-guided serratus anterior plane block (SAPB) in patients with rib fractures.
Objective: The serratus anterior plane block (SAPB) is an ultrasound-guided compartment block; our prior research has demonstrated that it can decrease pain in patients with rib fractures from trauma. We sought to characterize the adjunctive pain control required by patients who received SAPB. Methods: We enrolled a prospective cohort of adult patients with at least 2 unilateral rib fractures who were being admitted for pain control. SAPB was performed by trained emergency physicians. Following SAPB, patients were followed via chart review and the oral morphine milligram equivalents (MME) and adjunctive pain control they received were recorded. Results: 7 of 20 patients enrolled (35%) required no additional pain control during the 8 hours following SAPB. Among the 13 patients who received adjunctive analgesia during this period, median oral MME was 8. 6 of 20 patients enrolled (30%) ultimately had an epidural placed for rib fracture pain control. Mean and median time from SAPB performed to epidural placed was 26 and 19.5 hours, respectively, with 0 patients receiving an epidural prior to 8 hours following SAPB. Conclusion: In trauma patients with multiple rib fractures who received SAPB for pain control, a large percentage of patients required no additional pain control during the 8 hours following SAPB, and the adjunctive analgesia required by those who did receive additional pain control was minimal. SAPB may serve as an effective bridge to epidural placement for patients with significant pain from rib fractures.
Randy KRING (Portland, Maine, USA, USA), David MACKENZIE, Christina WILSON, Joseph RAPPOLD, Tania STROUT, Peter CROFT
16:10 - 16:30
#31109 - Comparative study of patients who consulted the emergency department of a regional hospital due to suicide attempt before and during the covid-19 pandemic.
Comparative study of patients who consulted the emergency department of a regional hospital due to suicide attempt before and during the covid-19 pandemic.
BACKGROUND:
The covid-19 pandemic has had consequences on people's mental health. The aim of the study was the prevalence and characteristics of patients who consulted for attempted suicide in the emergency room in 2021 and compare them with those carried out in the pre-covid period in 2019.
METHODS:
Retrospective cross-sectional study between January 1 and December 31, 2019 and 2021. Sociodemographic variables (sex, age), clinical (medical and psychiatric history, psychiatric medication, toxic abuse, mental health follow-up, previous suicide attempt) were included, and characteristics of the current autolytic episode (mechanism, triggering reason, patient's destination).
RESULTS:
A total of 125 patients consulted for suicide attempt in 2019 and 173 in 2021, mean age 38.8±15.2 and 37.9±18.5 years, 56.8% and 67.63% being women. The number of psychiatric medications per patient was 1.82±1.39 and 1.93±1.65. They followed up in psychiatry: 52.8% and 46.2%. Previous suicide attempt: 32% and 27.7% (men 20.3% and 19.6%, women 40.8% and 31.6%). Substance use disorder: men 51.8% and 46.4%, women 39.4% and 17.1%, alcohol being the most common toxicant (men 78.6% and 88.5%, women 82.1% and 70%), in men more frequently associated with other substances: 72.7% in 2019 and 73.9% in 2021, especially cocaine.
Mechanism of the episode: pharmacological: 68.8% in 2019, 69.4% in 2021, most used drug, benzodiazepines (81.3% and 70.2%); toxic (30.4%, 16.8%), alcohol (78.9%, 86.2%), drug more associated with alcohol, benzodiazepines (56.2% and 59.1%); self-harm: 11.2%, 8.7%. Present trigger: 35.2% and 32.9%, couple problems (45.4% and 43.8%), with an increase in family problems in 2021 (20.4% to 38.6%). Destination of the patients: outpatient psychiatric follow-up, 84.8% and 72.25%, hospital admission 8% and 10.4%.
DISCUSSION & CONCLUSIONS:
There was an increase in queries of 38.4%. Women presented a higher prevalence of previous suicide attempt and men more substance use disorder. The most frequent autolytic mechanism was by drugs, especially benzodiazepines. The most used toxicant was alcohol, most of the time associated with benzodiazepines. The most frequent trigger was couple problems with an increase in family problems in 2021. Most patients were referred to Mental Health.
Josep GUIL SÀNCHEZ (Mollet del Vallès, Spain)
16:10 - 16:30
#31164 - Diagnostic test accuracy of dipstick urinalysis for diagnosing urinary tract infection in febrile infants attending the emergency department in the UK and Ireland.
Diagnostic test accuracy of dipstick urinalysis for diagnosing urinary tract infection in febrile infants attending the emergency department in the UK and Ireland.
Background
Young febrile infants are at high risk of serious bacterial infections (SBI). The most commonly encountered SBI are urinary tract infections, accounting for 80% to 90% of all SBI in this age group. National Institute for Health and Care Excellence (NICE) CG54 recommends that infants under three months of age undergo urine laboratory microscopy analysis rather than point-of-care urine dipstick analysis. It has however, been demonstrated that point-of-care dipstick analysis can be highly sensitive and specific in this age group. Point-of-care urine dipstick testing has several advantages to laboratory microscopy. Urine dipstick testing is quicker, requires fewer resources and can be conducted at sites were laboratory access is not available 24 hours a day. As far as we are this is the only diagnostic test accuracy study to report the performance of point-of-care urine dipstick testing in UK and Irish Emergency Departments (ED).
Methods
The data for this diagnostic test accuracy study comes from the Febrile Infants Diagnostic assessment and Outcome (FIDO) study (www.clinicaltrials.gov). The FIDO study was a multicentre cohort study conducted on behalf of the Paediatric Emergency UK and Ireland (PERUKI) network at six PERUKI sites. Infants up to 90 days of age attending between 31/08/2018 - 01/09/2019 were screened for inclusion. Patients with a recorded fever (≥38°C) at triage were eligible for inclusion. There were no exclusion criteria. The index test in the study was the commercially available Siemens Multistix® point-of-care urine dipstick test. A positive urinalysis was defined as either the presence of leucocytes or nitrites. The reference standard was confirmation of UTI defined as growth of ≥100 000 cfu/mL of a single organism excluding likely contaminants. The diagnostic accuracy of urine dipstick testing was reported with sensitivity and specificity with 95% confidence intervals (CI).
Result
A total of 288 were included in the final analysis. The median age was 53 days (IQR 35-70; range 1-90), and there were 161/288 male participants (55.9%). In total 43 (14.9%) participants had a confirmed UTI. The most sensitive individual dipstick test for UTI was the presence of Leucocytes. Including “Trace” as positive resulted in a sensitivity of 0.74(CI:0.59 to 0.86) and a specificity of 0.73(CI: 0.67 to 0.78). The most specific individual dipstick test for UTI was the presence of Nitrites. Including “Trace” as positive, resulted in a specificity of 0.91(CI: 0.87 to 0.94) and a sensitivity of 0.37(CI: 0.23 to 0.53). Including “trace” of either Leucocytes or nitrites as positive resulted in a sensitivity of 0.74 (CI: 0.59 to 0.86) and specificity of 0.71(CI: 0.64 to 0.76) respectively.
Discussion
Point-of-care urinalysis with Siemens Multistix® is a moderately sensitive and highly specific test to diagnose UTI in febrile infants under 90 days of age. This could enable the rapid identification of patient with potential UTI particularly where microscopy is not available or delayed.
Etimbuk UMANA (Belfast, Ireland), Steven FOSTER, Rebecca PLATT, Michael BARRETT, Sheena DURNIN, Julie-Ann MANEY, Hannah MITCHELL, Lisa MCFETRIDGE, Damian ROLAND, Mark D LYTTLE, Thomas WATERFIELD, On Behalf Of PERUKI
16:10 - 16:30
#30676 - Do FFP2 facemasks withhold significantly more carbon dioxide during simulated cardiopulmonary resuscitation?
Do FFP2 facemasks withhold significantly more carbon dioxide during simulated cardiopulmonary resuscitation?
Background: Operating in a biohazardous environment, such as the ongoing COVID-19 pandemic, is complex, with considerable physical and psychological demands. The healthcare workers must be aware of the scenario in which they will have to work, but also the healthcare system itself must ensure the safety of its professionals and ensure that they perform their functions according to the strictest biosecurity level available.
The aim of the present research was to evaluate if during simulated cardiopulmonary resuscitation, the use of FFP2 facemasks increases expired carbon dioxide (ETCO2) levels compared to the same simulation performed without FFP2 facemasks, in rescuers.
Methods. Randomized, sham-controlled, blinded trial using a manikin between October 1, 2020 and January 15, 2021. The study was carried out at the Advanced Clinical Simulation Center, Faculty of Medicine, Valladolid University (Spain). The sample was recruited from all final year medical studies who participated in the advanced clinical simulation practice and showed interest in participating in the study. Exclusion criteria were age < 18 years or > 65 years, subjects who had participated in similar studies and lack of informed consent. Demographic data (age and sex), and ETCO2 were collected after 10 minuts of basic PCR. The ETCO2 was measured with the X Series® monitor/defibrillator (Zoll, Chelmsford, MA, USA) and the Real CPR Help® CPR system (Zoll, Chelmsford, MA, USA) that provides simultaneous real-time feedback on the depth and frequency of CPR.
Results. Twenty-four participants performed the two phases of the study, CPR both with and without facemask, and randomized the order of participation. The mean age was 22.12 years (SD: 3.79), ranging from 18 to 34 years, with 10 females (41.7%).
The means of ETCO2 between group 1 (CPR without PPE) and group 2 (CPR with PPE) were, respectively: 38.79 (SD: 4.92), and 38.38 (SD: 3.43); p=0.735: OR=0.976 (95%CI: 0.85-1.12).
Conclusions: our data showed no statistical significance between performing a simulated resuscitation with a FFP2 facemask or without a FFP2 facemask in terms of changes in ETCO2 concentrations. The data suggest that using PPE ( FFP2 facemask) neither increases nor decreases the user's ETCO2 level. This may be due to the fact that the resuscitation was performed for only 10 minutes; future studies should consider increasing the time and number of participants.
The study was approved by clinical research ethics committee (PI-033/18) of Hospital Universitario Rio Hortega de Valladolid (Spain).
The review protocol was registered as ISRCTN32132176 (doi.org/10.1186/ISRCTN32132176).
Francisco MARTÍN-RODRÍGUEZ, Carlos DEL POZO VEGAS (Valladolor, Spain), Daniel VIÑA GUERRA, Irene SÁNCHEZ SOBERON, Ana RAMAJO SANCHEZ, Raquel María PORTILLO RUBIALES, Elena MEDINA LOZANO, Raúl LÓPEZ-IZQUIERDO, Santiago LÓPEZ TORREZ, Álvaro GARCÍA ALDONZA, Miguel Angel CASTRO VILLAMOR, Juan Francisco DELGADO BENITO, Rodrigo ENRIQUEZ DE SALAMANC GAMBARA, Enrique CASTRO PORTILLO, Jonathan ALDEA SOTO
16:10 - 16:30
#31062 - Emergency nurses’ preference for tools to identify frailty in major trauma patients: a prospective multi-centre cohort study.
Emergency nurses’ preference for tools to identify frailty in major trauma patients: a prospective multi-centre cohort study.
Background
Early assessment of frailty is an important factor in guiding frailty-specific care in older major trauma patients. It is recommended this is performed in the Emergency Department (ED) but there are time and clinical challenges to doing this accurately. To increase rates of frailty screening in this group the measurement tool needs to be quick to complete and easy to use. This study aimed to ascertain the preference of nursing staff completing frailty assessment in older major trauma patients in the ED.
Methods
This prospective multi-centre study recruited from five UK Major Trauma Centres between June 2019 and March 2020. Eligible patients were aged 65 or over requiring ‘trauma team activation’ and admitted to hospital. Patients were assessed for frailty by nurses trained to use three different frailty screening tools – the Clinical Frailty Scale (CFS), the PRISMA-7 tool, and the Trauma Specific Frailty Index (TSFI). Completion rates for each of the tools were calculated and nurses were asked to rate their preference for each of the tools and the reasons for non-completion if relevant.
Results
Data were analysed from 370 patients. Completion rates for each of the tools varied with highest degree of compliance using the CFS (98.9%). TSFI was least likely to be completed with “lack of available information to complete questions” as the most cited reason. Nurses showed a clear preference for the CFS with 57.3% ranking this as first choice (PRISMA-7 32.16%; TSFI 10.54%). Both PRISMA-7 and CFS were both rated highly as ‘extremely easy to complete’ (PRISMA-7 58.5%, CFS 59.61%).
Conclusion
User acceptability is an important consideration in the selection of a frailty measurement tool for use in major trauma patients. Our study shows the Clinical Frailty Scale has high rates of completion and acceptability and can be implemented in practice for assessment of frailty in major trauma.
Trial registration: ISRCTN12345678
Funding: this work was supported by The Burdett Trust for Nursing.
Heather JARMAN (Londres, ), Robert CROUCH, Mark BAXTER, Chao WANG, Elaine COLE
16:10 - 16:30
#31146 - Mirror, mirror, on the wall, why am I supposed to be the cutest in the world?
Mirror, mirror, on the wall, why am I supposed to be the cutest in the world?
Summa 112 is notified by a 56-year-old woman with no relevant history with decreased level of consciousness. Upon our arrival she is prostrate in an armchair and has a GCS of 8. She has a BP of 60/40, 121 mg/dl of glycaemia, oxygen saturation at 96% and a sinus bradycardia at 50 bpm. There is no neurological focality and pupils are isochoric, medium and reactive. The cardiopulmonary auscultation is normal and we observe a slight edema of the lower limbs. We question her son and he tell us his mother drinks a lot of herbal teas and that goes to the gym everyday and so has lost 20 kg in the last 4 months. While channeling VVP, a colleague in the kitchen evidences some roots infused in a large pot, to which her son answers us that it is ginger and it is mainly what his mother feeds on. IV infusion is started with 500 cc of 0.9% physiological saline. We monitorizate BP every 5-10 minutes and observe a good response to water replacement, achieving blood pressure of 120/80. Now she is able to open her eyes spontaneously and to verbalize (bradypsychic and bradybalic) that she is following a weight loss diet in which she has to drink a large amount of ginger infusion.
Despite being well known what are the most effective and safe dietary measures for the prevention and management of prevalent diseases as well as the amount of existing scientific literature, according to a report published in 2016 (The Lancet), 6 out of 10 major risk factors for loss of active life years are attributable, directly or indirectly, to following unhealthy food consumption patterns and other lifestyle factors. Although there are few studies in this regard, according to a 2018 descriptive study 2 out of 10 Spaniards acknowledge having done any, and 45% ensure that someone in their close environment has ever followed them. In addition to all the side effects, as well as economic and psychological due to the non-achievement of objectives, it is estimated that the expenditure in Spain attributable to this type of diets is more than 2,000 million euros annually.
Ginger is a spice and medicinal plant used since ancient times from Asia whose medicinal properties lie mainly in the substances known as gingerols and shogaols. The European Medicines Agency accepts its use in the prevention of traveler's nausea and vomiting or motion sickness, as well as abdominal distension and flatulence. Due to their chemical structure and action, gingerols are similar to acetylsalicylic acid and therefore have an analgesic effect and have been associated with changes in prothrombin time, generally related to INR prolongations. Some cases of increased risk of haemorrhage have been described after ingestion of high doses of ginger preparations when platelet aggregation inhibitors and oral anticoagulants were administered simultaneously, due to a decrease in thromboxane synthesis.
Conclusions:
Herbal medicines are thought to be harmless but they have many secundary effects so they must be taken into account in patient’s evaluation.
Blanca GUERRERO MOÑÚS (Madrid, Spain), María REDONDO LOZANO, Julián TORREJÓN PULIDO, Miriam UZURIAGA MARTÍN, Cristina BARREIRO MARTÍNEZ, Santiago BLANCO REY, Miryam GONZÁLEZ BAREA, Ana TORRES POZA
16:10 - 16:30
#31205 - Modelling paediatric emergency department attendance and admissions: can we usefully predict the future?
Modelling paediatric emergency department attendance and admissions: can we usefully predict the future?
Background: The number of children attending the emergency department in England has been increasing over the last decade, contributing to longer waiting times and increasing pressures on staff. Being able to predict emergency department attendance and admissions could improve patient flow. Existing literature suggests that linear models perform equally or better than sophisticated machine learning methods. However, no studies have specifically applied this to paediatric data. Our study aimed to determine if it is possible to predict attendance and admissions to the emergency department of paediatric tertiary centres using linear regression models.
Methods: We performed a retrospective modelling study using anonymised administrative data from two tertiary level paediatric hospitals in the United Kingdom (UK). Daily attendance and admissions to the emergency department between January 2017 and December 2019 (pre-pandemic) were used to train models against our hypothesised predictors. Predictors included month, weekday, season, national bank holidays, local school holidays, and weather forecasts. Initial training of the model involved data from one hospital. We then validated our model by comparing data from January to May 2022 (mid to post-pandemic), and at a second hospital.
Results: We found noticeable seasonal and monthly variation at both hospitals during 2017 to 2019. Autumn and Winter recorded the highest number of attendances and admissions, with a considerable decline in August each year. Monday and Sunday were the busiest weekdays. The best performing model produced a Mean Absolute Percentage Error (MAPE) of 6.3% (95% Confidence Interval (CI) 13.7% to -18.9%) during initial training with the pre-pandemic dataset. For validation with the 2022 dataset, this corresponded to a MAPE of 8.0% (95% CI 17.2% to -19.8%), and 6.5% (95% CI 12.3% to -19.3%) for the second centre.
Conclusions: Even with complex models accurate forecasting of attendance is difficult, with substantial unexplained random variation. Although it precludes long term forecasting, the use of 3-day rolling averages was the best predictor for attendance. Other useful predictors included school holidays, month, weekday, and seasonal variation. We found substantial differences both between hospitals, and as a result of the pandemic. Whilst a universal model that can be applied to all departments is unlikely, it is simple to derive tailored models from routine data. Our work is now focusing on developing models on other hospital’s datasets and assessing the new normal of post-pandemic paediatric emergency department behaviour.
Funding: This study did not receive any specific funding.
Ethical approval and informed consent: Not required.
Chloe FAIRBROTHER (Bristol, ), Dr Robin MARLOW, Professor Damian ROLAND
16:10 - 16:30
#31353 - National Estimates of antidepressant-related Poison Center Calls.
National Estimates of antidepressant-related Poison Center Calls.
Background: Approximately 92,000 persons in the U.S. died from drug-involved overdose in 2020. It has been estimated that the rates of depressive and anxiety symptoms among adults have increased in recent years. According to a recent study, more than 20 million antidepressants were prescribed between October and December 2020. The objective of our study was to evaluate the trends in antidepressant-related calls to the U.S. poison centers (PCs).
Methods: The National Poison Data System (NPDS) was queried for all closed, human exposures to antidepressants from 01/01/15 through 12/31/21 using the American Association of Poison Control Center (AAPCC) generic code identifiers. We identified and descriptively assessed the relevant demographic and clinical characteristics. Reports from acute care hospitals and hospital based EDs (ACHs) were evaluated as a subset. Trends in antidepressant frequencies and rates (per 100,000 human exposures) were analyzed using Poisson regression methods. Percent changes from the first year of the study (2014) were reported with the corresponding 95% confidence intervals (95% CI).
Results: During the study period, there were 836,045 toxic exposures to antidepressants that were reported to the PCs. The frequency of exposures increased by 20.3% (95% CI: 16.1%, 23.9%; p<0.001), and the rate of exposures decreased by 22.3% (95% CI: 17.8%, 25.9%; p<0.001). Of the total antidepressant calls, the proportion of calls from ACHs decreased from 38.3% to 34.8%, with the percentage of calls from the general public increasing. Multiple substance exposures accounted for 52.4% of the overall antidepressant calls and 56% of calls from ACHs. Approximately 18% of the patients reporting antidepressant exposures were admitted to the critical care unit (CCU), with 17% of patients being admitted to a psychiatric facility. Residence was the most common site of exposure (93.8%), and 67% of these cases were enroute to the hospital via EMS when the PC was notified. Cases were predominantly female (65.3%), with the most common age group being 20-29 years (14.9%). The proportion of such cases (28.7% to 34.1%) increased during the study period. Suspected suicides (57.2%) was the most common reason for exposure, with the proportions of suspected suicides being higher in cases reported by ACH (12.1% vs 14.9%). During the study period, the proportion of reported antidepressant exposures due to therapeutic errors increased (18.5% to 22.3%), while suspected suicides decreased (58.6% to 54.2%). Major effects were seen in 8.2% cases and case fatality rate was 0.3%, with 169 fatalities reported for single substance antidepressant exposures. The most frequently co-occurring substances associated with the cases were alcohol (12%) and marijuana (9.7%). Tachycardia (42.8%) and agitation (35.5%) were commonly observed clinical effects.
Conclusions: Our study results demonstrate a significant increase in the reports of antidepressant exposures made to the PCs. The exposures in the young age groups were common and the most frequent reason for exposure was suspected suicides. Continued surveillance and public health prevention efforts are key to track the population effects of antidepressant exposures.
n/a
Saumitra REGE (Charlottesville, USA), Will GOODRICH, Christopher HOLSTEGE
16:10 - 16:30
#31286 - Prediction of pain intensity after 15 and 30min post analgesia: a pilot study in PED.
Prediction of pain intensity after 15 and 30min post analgesia: a pilot study in PED.
Background: Pain management is one of the biggest challenges in paediatrics. Depending on their personal characteristics and level of pain tolerance, each patient needs different help or treatment. Pain is one of the main reasons for presenting to PED. The aim of this study was to compare pain assessment between gender and according changes in vital signs. Also, we wanted to check if there is any biomarker to predict pain level in 15 or 30min with or without pain medication.
Methods: We conducted a pilot perspective observational study in LSMU KK PED. 30 patients that complained of acute pain (<48h) were included. Patients having chronic conditions, fever, dehydration were excluded. We recorded patient's gender, age, vital sign, pain characteristics. Saliva samples were collected and stored in -80°C conditions until analysis was performed. Samples were analysed using NGF, opiorphin and cortisol ELISA kit.
Results: Data of 30 patients were analysed (20 male and 10 female). Boys were more common to complain of trauma (n=20), while girls complained of other origins of pain (n=8) (p<0.001). Children, complaining of average pain levels, refused treatment more often compared to those, who suffer from severe pain (p=0.004). Half of the male patients refused treatment, while in 80% of the female patients preferred medical pain relief (p>0.05). Boys were more likely to receive opioid analgesia, while girls were more likely to receive NSAIDS (p<0.05). Pain was monitored throughout the visit and effective pain relief was assessed if the VAS scored was at least (-3) points in pain intensity. Effective analgesia was achieved after 30 minutes in 36.7%. There were no differences in pain relief with age, sex, time of pain or cause (p>0.05). An increase HR wasn‘t associated with a greater need for medication (p>0.05), but patients with a background of pain and elevated BP were more likely to use painkillers (p<0.05). To determine the effect of analgetics on the levels of the hormones studied, the test substance was re-tested at 15 and 30 minutes after the administration of the medication. No differences were observed in the analysis of changes in hormone concentrations over time at 15 and 30min after analgesia. Despite adequate analgesia, there was no change in hormone concentrations in patients with at least a 3-point reduction in pain on VAS at 30 min. Patients who reported lower pain score after 15min had lower HR and higher NGF value compared to those who reported moderate or severe pain after 15min (p<0,05). NGF was higher if patients complained of mild pain after 30min, and opiorphin values were lower in these patients at the first time point (before analgesia or at time of the first examination) (p<0.05).
Conclusions: Girls were more likely to receive painkillers then boys, however boys were more likely to receive opioid analgetics. In a multilogistic regression, no single biomarker was able to predict pain level at 15min or 30min.
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Kristina GANZIJEVA (Kaunas, Lithuania, Lithuania), Andrius DAUGELA, Laura STENDELYTE, Lina JANKAUSKAITE
16:10 - 16:30
#31481 - Psychological support of healthcare workers and their mental health during the COVID-19: Mixed-method study.
Psychological support of healthcare workers and their mental health during the COVID-19: Mixed-method study.
Background:
The COVID-19 pandemic brought about a challenge for mental health of healthcare workers due to unprecedented demands of caring for patients, changing work conditions, fear regarding personal safety and the health of their families. The overarching aim of this study was to describe psychological support needs of healthcare workers and their relation to mental health. Specifically, we aimed to examine the associations of support needs and receiving support with psychological distress, depressive symptoms and suicide ideation during the COVID-19 pandemic in the Czech Republic.
Methods:
We leverage a prospective cohort study and employ mixed method design. Specifically, our respondents were Czech healthcare workers (physicians, nurses, paramedics, and social workers) enrolled in two waves of an on-line survey conducted in summer 2020 (n=929) and spring 2021 (n=1206). Eligible respondents were workers in healthcare or social services invited through medical professional organizations and hospitals. Independent variables in the quantitative analysis were self-reported psychological support needs during the pandemic, and variable about receiving support. Dependent variables were three indicators of mental health: 1) psychological distress, 2) depressive symptoms, and 3) suicide ideation. Odds ratios (ORs) were calculated from logistic regression for each wave and all models were adjusted for age, sex, occupation, and a psychological support needs before the pandemic. Qualitative analysis involved open-ended responses from the same survey. Qualitative data were processed in Atlas.ti software by using standard procedures.
Results:
In spring 2021 up to 23.3% of healthcare workers in our sample expressed a need of psychological support. However, only 11.3% received it. Further, endorsement of psychological support needs nearly doubled from summer 2020 (11.8%). There was an indication that the need of psychological support was associated with increased risk of moderate level of depressive symptoms (OR: 1.17), and suicidal ideation (OR: 1.99), but not moderate level of psychological distress (OR: 0.50) among those who needed psychological support. On the contrary, healthcare workers who received psychological help reported better mental health outcomes: depressive symptoms (OR: 0.81), psychological distress (OR: 0.83), and suicidal ideation (OR: 0.73). However, none of the associations were statistically significant, likely due to the small sample size. The analysis of qualitative data revealed that while the beginning of pandemic was represented by feelings of insecurity and anxiety, fear of infection, lack of information and rapidly changing work and life conditions, the answers in spring 2021 expressed immense long-term stress by overwork, exposure to suffering, worsened health conditions, limited social contacts and leisure time activities that lead to increased need for psychological support. Healthcare workers expected their managers to provide them with both informal and formal psychological support, however often they did not receive it.
Conclusions:
The need of psychological support was associated with increased depressive symptoms and suicidal ideation. Obtaining psychological support may contribute to better mental health. Psychological support should be provided at a workplace in a form of psychological counselling, supervision, mobile apps or informal peer-to-peer support. Also adequate rest, encouragement, and acknowledgement by managers might be helpful.
Funding: The research has been funded by the Ministry of Health of the Czech Republic (grant NU22J-09-00064)
Miroslava JANOUŠKOVÁ (Prague, Czech Republic), Jana ŠEBLOVÁ, Marie KUKLOVÁ, Pavla ČERMÁKOVÁ, Jaroslav PEKARA, Matěj KUČERA, Dominika ŠEBLOVÁ
16:10 - 16:30
#31583 - Relevance of Vittel criteria to determine the need for whole body scanning in severe trauma patients.
Relevance of Vittel criteria to determine the need for whole body scanning in severe trauma patients.
Introduction: Serious injuries are the fifth leading cause of death in the general population. It’s management is a real socio-economic issue, it requires a rapid and in-depth lesion assessment. Imaging is the basis and consists of a scan of the whole body (WBS). However, numerous entire bodyscan that indications were based on Vittel criteria were normal.
Objective : To evaluate the use of the Vittel criteria in practice to determine the need for a WBS in a patient with severe trauma in the emergency department (ED).
Methods: We carried out a study over a period of 4 months (January to April 2022), patients with an age ≥14 years and at least one Vittel criterion were prospectively evaluated with a WBS. The following data were collected: the age of the patient, the history, Vittel criteria noted, circumstances of the accident, clinical examination, time between the trauma, the reception of the patient at the resuscitation room and the realization of the WBS and traumatic lesions on the WBS. The indication of a WBS, based on clinical signs and Vittel criteria, was assigned.
Results: 146 severe trauma patients were included. The average age was 42±17 years with a sex ratio of 3. Transport was carried out in 86.2% of cases by the civil protection, 2.8% by emergency medical services, 0.7% by private ambulance, while 10.3% of patients reached ED by their own means. For the accident mechanism: road accident: 72.4%, domestic accident: 6.9%, work accident: 2.8%, assault: 3.4% and fall in 14.5% of cases of which only 59.7% are ≥6m. For road accident; 38.1% of patients were pedestrians, 28.6% were motorcyclists and 33.3% were passengers. Post traumatic lesions were diagnosed in 48.6% of WBS. Predictive factors of severe damage on the WBS: GCS<13 (p=0.001; OR=6.8; 95% CI 1.9 to 24.8), peripheral signs of shock (p=0.006), drunkenness (p=0.022; OR =5.3; 95% CI 1.1 to 25). The indication of 71% of WBS that were normal was based on kinetic criteria.
Conclusion: The use of Vittel criteria to determine the need for a WBS in a severe trauma patients makes it possible to find serious post traumatic lesions not suspected on clinical examination, but at the cost of an increased number of normal scans and irradiation. The kinetic criterion have had a weak relevance to predict post traumatic lesions in WBS.
Marouane SANAI, Safia OTHMENI (tunis, Tunisia), Houyem ZOUARI, Hana HEDHLI, Ala ZOUARI, Hanedi KDEYMI, Sarra JOUINI
16:10 - 16:30
#31596 - Reusable Suture Kits for the Future.
Reusable Suture Kits for the Future.
Background:
In UK Emergency Departments single-use suture kits have become commonplace, whilst our surgical colleagues in theatre have reusable kits that are sterilised between uses. As part of Greener NHS goals, we are aiming to reduce the environmental impact of our services and one of our largest hotspots in acute services is medical instruments and equipment.
Therefore we compared the single use vs reusable kits in cost, carbon and quality and instigated a product switch to reusables.
Methods:
This is an sustainable product switch case report carried out in a Major Trauma Centre in the south east coast of the UK starting in August 2021 with ongoing follow up.
We conducted baseline assessments of the procurement and disposal of the current single use suture kits used in the department. We then compared the financial costs, carbon costs and quality against the reusable kits made up by our sterile services department.
We canvassed staff opinion of the product switch and what staff would like included in the reusable kits, or any problems they foresaw.
With this quantitative and qualitative data we approached our Emergency Department Management to make the case for a product switch.
We then developed a multi-pronged staff education program before the roll-out of the new reusable kit.
Results:
We found that between April-June 2021 we used 560 suture packs, we did not take the 12 month sample due to covid lockdowns causing significant changes in our trauma attendances. Estimating a similar use across the year we totalled 2240 kits used at a cost of £5893.44 to buy and £963.2 to dispose. This would come out as £3.061
Procuring one reusable set of instruments would cost £188.17 (incl. VAT), however when determining cost per use over the instruments’ life span that would come out as £0.12 per use. Our Emergency Department is not charged for sterilisation processing.
There are complexities when comparing like for like and without doing a full lifecycle analysis for each of the different kits, there will be missing costs, however a modelling study has recently concluded that single use kits use 1 kilo CO2e than the reusable kit.
The quality of the reusable kit is demonstrated in photographs comparisons and staff feedback.
Discussion & Conclusions:
Moving away from the throwaway culture in healthcare will inevitably help reduce our carbon footprint, improve patient care and staff satisfaction, the financial comparisons are difficult to compare without conducting life cycle analysis. We hope that this project encourages other emergency departments to look at their single use instruments and drive the medical procurement market towards high quality, reusable instruments.
This study did not receive any specific funding.
Ethical approval not needed.
Hannah WEBB (Brighton, ), Donna PEEL
16:10 - 16:30
#31195 - Short-term outcome of residents living in a retirement home and for whom an emergency call was done.
Short-term outcome of residents living in a retirement home and for whom an emergency call was done.
Introduction
Hospitalizing highly dependent patients with deteriorating health conditions in the emergency room (ER) is often non-beneficial.
Emergency Medical Services (EMS) handle many calls from retirement homes but there is very little data on residents for whom a call to an EMS has been made. Studying these cases would allow the implementation of a collective reflection on the optimization of procedure and orientation of these patients.
The aim of this study was to describe residents living in a retirement home for whom an emergency call was received.
Method
All calls from a retirement home in June 2021 were included.
Following data were routinely collected: age, gender, main chief complaint, level of loss of autonomy called Iso-Resource Group (IGR) divided into 6 groups (from IGR 1 (confined to bed with severely impaired mental functions) to IGR 6 (autonomous for activities of daily life)), pre-existing advance directive; decision of the EMS dispatcher (sending a Basic Life Support (BLS) or Advanced Life Support (ALS) ambulance, decision to send a GP or giving a medical advice while patient stays at home) and outcome of the patients during the following 48 hours.
Results
One hundred and one patients were included. Sex ratio was 0.55; mean age 86.9 [extremes 59 – 100]. Main chief complaints were respiratory (45%), cardiovascular (17%) and neurological (16%) distress.
Sixty-three patients (62%) were highly dependent (IGR 1 or 2). Nine patients had pre-existing advance directive and denied resuscitation.
Sixty-eight BLS ambulances were sent, out of which 66 patients were then transported to an ER and 2 left on scene. Twenty ALS ambulances were sent, out of which 17 patients were transported to hospital and 3 left on scene. The others stayed “at home” with referral to GP or telephone advices.
The more dependent residents (group 1 and 2) were significantly more often left at home (22%) versus 6% for residents with higher IGR (p-value=0.03).
Among the 84 patients referred to hospital, 6 (7%) died in the next 48 hours and 28 returned to their retirement home within 48 hours. The remainder stayed in hospital more than 2 days. Among the 17 left on scene, 4 (23.5%) died within 48 hours. Highly dependent residents (IGR1 & 2) tended to die more often (12%) compared to less dependent residents, although there was non-statistical association.
Conclusion
The decision to deny transportation to ER and leave a patient at his place was significantly associated to the short-term outcome of the patient. These results suggest that EMS were able to avoid unnecessary hospitalization for end of life and thus these practices are in accordance with international recommendations. Further studies are needed to clarify this result.
n/a
Cecile URSAT (GARCHES), Charriere MARION, Jérémie BOUTET, Anna OZGULER, Michel BAER, Thomas LOEB
16:10 - 16:30
#31190 - The compliance and accuracy of prehospital EMTs with FASTroke protocol: Retrospective Cross-sectional multi-center study.
The compliance and accuracy of prehospital EMTs with FASTroke protocol: Retrospective Cross-sectional multi-center study.
Background
Acute ischemic stroke often leads to permanent neurological deficits even with proper initial treatment. For shortening the time in the stroke chain of survival, we implemented a responsive web-based prehospital stroke alert system, named FASTroke (FAst and Safe Transport for stroke) in a city of 2.5 million population. We aimed to investigate how EMTs activate the FASTroke application in accordance with protocol and calculate the concordance of neurological examination between Pre and In-hospital stage.
Method
We conducted a retrospective and multi-center study of FASTroke data in patients with acute ischemic stroke who visited ED by EMS at five major hospitals in Daegu metropolitan city from June 2020 to May 2021. Patients with decreased mentality (P and U of the AVPU system) were excluded. The criteria for activation of the FASTroke system were neurological symptoms (face drop, arm weakness, leg weakness, and oral impairment), onset time <6 hours, blood sugar level > 60 mg/dL. We calculated the ratio of FASTroke activation to patients who were enrolled for measuring the compliance of FASTroke system, and we measured the consistency of neurological examination results between EMS personnel and physicians using Kappa coefficients.
Results
Of the 970 patients diagnosed with acute ischemic stroke, 731 patients were enrolled. FASTroke activation ratio was 59.1%. The ratio was the lowest at 25.0% in June 2020, and the highest at 78.4% in April 2021. The compliance of the FASTroke system showed an increasing trend by month. The Kappa coefficient was 0.22 in facial drop(p<0.001), 0.49 in arm weakness(p<0.001), 0.44 in leg weakness(p<0.001), and 0.34 in dysarthria(p<0.001), with the highest concordance in the arm weakness and with the lowest in the facial drop. Kappa coefficient of dysarthria tended to increase overall, but did not show a certain trend in others.
Conclusion
The FASTroke system has been developed and gradually settled for rapid recognition and proper hospital transfer of patients with acute ischemic stroke in the prehospital stage, and the concordance of neurological examination results between EMS personnel and physicians is also improving.
Chanhong MIN (South Korea, Republic of Korea), Yun Jeong KIM, Hyun Wook RYOO, Jung Ho KIM, Sang Hun LEE, Jong-Yeon KIM, Jinyoung YANG
16:10 - 16:30
#31175 - The epidemiology and severity of medical events sustained by ambulance-attended mountain bikers and hikers in Western Australia from 2015-2020: a retrospective cohort study.
The epidemiology and severity of medical events sustained by ambulance-attended mountain bikers and hikers in Western Australia from 2015-2020: a retrospective cohort study.
Background
Trail use through mountain biking and hiking is increasing in popularity. The epidemiology and severity of mountain biking injuries has previously been described; however, it has not been investigated from an emergency medical service (EMS) perspective and compared with other trail users. This study aimed to compare the epidemiology and severity of medical events sustained by mountain bikers and hikers requiring EMS within Western Australia.
Methods
This retrospective cohort study included all ambulance-attended mountain bikers and hikers within Western Australia from Jan 2015 to Dec 2020. Included were patients requiring an ambulance while mountain biking or hiking on a trail. Patients not on trails and not mountain biking or hiking were excluded. Non-parametric variables are described with medians and inter-quartile ranges. The primary outcome of interest was NEWS2 calculated using vital signs obtained by the prehospital clinician at the first point of contact. NEWS2 was dichotomized into low risk (≤4 overall and <3 for any single vital sign) or above low risk (≥5 or 3 within any vital sign). Logistic regression was used to determine factors associated with having NEWS2 above low risk with a significance level of 0.05. Model optimisation was achieved by post hoc variable backwards elimination.
Results
A total of 610 patients sustained a medical event requiring ambulance attendance whilst mountain biking (n=329, 54%) or hiking (n=281, 46%) on a trail. Males comprised 274 (83%) of mountain bikers, and 115 (41%) of hikers. The median the age of mountain bikers and hikers was 38 (24-48) and 49 (32-63), respectively. Median prehospital time from ambulance dispatch to hospital arrival was 90 minutes (63-117) for mountain bikers and 111 (77-177) minutes for hikers. Ambulance personnel reported a suspected fracture or dislocation in 92 (28%) mountain bikers and 78 (28%) hikers. Considering aetiology, 304 (92%) of ambulance-attended mountain bikers were from traumatic rather than medical causes compared with 154 (55%) for hikers.
Univariate analysis showed a significant association between the primary outcome (NEWS2) and the activity being undertaken, aetiology of the condition, dispatch priority of the ambulance and age category; however, only aetiology and age remained in the optimised model. Medical (non-traumatic) aetiology was significantly more likely (OR = 2.5, 95% confidence interval 1.7-3.8) to result in higher NEWS2. Relative to patients under 20 years, patients aged 20-39 were less likely (OR = 0.5, 95% confidence interval 0.3-1.0) to demonstrate higher NEWS2.
Conclusions
Mountain bikers requiring ambulances were more likely male and younger than hikers. The type of activity being undertaken (mountain biking or hiking) did not appear to impact the severity of the patient’s condition. Mountain bikers or hikers who required an ambulance for a medical aetiology were more likely to present with higher NEWS2 than traumatic causes. These findings help inform EMS of the severity of medical complaints and injuries sustained by trail users.
N/A
Paul BRAYBROOK, Paige WATKINS (Victoria Park, Australia), Hideo TOHIRA, Deon BRINK, Stephen BALL, Peter BUZZACOTT
16:10 - 16:30
#31150 - Unscheduled return visits to the pediatric emergency department during the SARS-CoV-2 pandemic - a national study.
Unscheduled return visits to the pediatric emergency department during the SARS-CoV-2 pandemic - a national study.
Background:
During the SARS-CoV2 pandemic, most pediatric emergency department (PED) in Israel witnessed a severe decline in number of visits that are not related to SARS-CoV2. However, return visits (RV) to the PED were still witnessed. Several factors may contribute to this phenomenon including failure to recognize warning signs in the initial visit, natural disease progression, inappropriate medical ambulatory follow-up and lacking patient education upon discharge. Different factors have been suggested as possible contributors to RV including young age, late-night visit, and infectious disease. Formulating a better understanding of this phenomenon is important to improve patient care and it could have implications on public health policies and treatment protocols.
Objective:
The primary objective of our study is to examine whether there was a difference in the incidence of RV during the first year of the pandemic comparing to a previous period. The secondary objective is to identify any patient-related factors contributing to RV.
Methods:
This is a national, multicenter retrospective study of the return visits to several PED in Israel, including both secondary- and tertiary care hospitals. The study cohort included 376079 PED visits of patients between 0-18 years of age presenting to the PED between March 2019 to March 2021. For each visit we collected visit time and date, patient age and gender, visit outcome (admission/discharge), diagnosis at visit outcome and mean of referral to the PED. We compared the data between patients who returned to the hospital (within 3- and 7- days period) and between two different periods - March 2019 till Feb 2020 ("pre-pandemic") and March 2020 till Feb 2021 ("pandemic"). We have calculated the average, median, and standard deviation of each of the numeric parameters and compared between the different subgroups using T-Test or Mann-Whitney statistical analysis. To check independence in contingency tables we conducted Chi-Square test.
Results:
Initial statistical analysis has shown that the RV rate within 3 days is 11.6% vs 9.9% for pre-pandemic and pandemic period, respectively (p-value<0.00001). The RV rate within 7 days is 12.6% vs 10.7% for pre-pandemic and pandemic periods, respectively (p-value <0.00001). Further analysis for identification of parameters correlated with RV are underway.
Conclusions:
To our knowledge, this is the first study to investigate the impact of the pandemic on RV to the PED. We report on significance decrease of RV to the PED during the pandemic period; this could be attributed to several factors including quarantines and change in population behavior (return to the PED only on extreme cases requiring emergent care). The results of the study may have important implications on primary physicians, hospitals, health organizations, and public health policy setters.
Ethical approval:
The study was approved by the local ethics committee at the Emek Hospital.
Trial Registration:
No appropriate register
Funding:
The study did not receive any specific funding
Ferass ABU HANNA (Afula, Israel), Ron JACOB
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A36
16:35 - 18:00
Resuscitation
Moderators:
Wilhelm BEHRINGER (Chair) (Moderator, Vienna, Austria), Abdo KHOURY (PROFESSEUR ASSOCIE) (Moderator, Besançon, France)
16:35 - 17:00
Management of critically ill non-traumatic patients in the resuscitation room: Old wine in new bottles?
Michael BERNHARD (Speaker, Meerbusch, Germany)
17:00 - 17:25
Post Cardiac Arrest Care - Disturbances of electrolytes and acid/base.
Hans KIRKEGAARD (Professor) (Speaker, Aarhus, Denmark)
17:25 - 17:50
The importance of leadership in CPR teams.
Koen MONSIEURS (Director) (Speaker, Antwerp, Belgium)
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B36
16:35 - 18:00
True Stories from the Emergency Department
Moderators:
Stevan BRUIJNS (Honorary Associate Professor) (Moderator, Yetminster), Senad TABAKOVIC (Medical director emergency department) (Moderator, Zürich, Switzerland)
16:35 - 16:55
Speaker.
Bernard DANNENBERG (Emergency Physician) (Speaker, Palo Alto, USA)
17:00 - 17:20
Speaker.
Stevan BRUIJNS (Honorary Associate Professor) (Speaker, Yetminster)
17:20 - 17:40
Speaker.
Joseph BONNEY (Specialist) (Speaker, Kumasi, Ghana)
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C36
16:35 - 18:00
Psychiatric Emergencies - Suicide, agitation and drug abuse
Moderators:
Andy NEILL (Doctor) (Moderator, Dublin, Ireland), Basak YILMAZ (Faculty) (Moderator, BURDUR, Turkey)
16:35 - 17:00
Alcohol - a tonic for disaster - things not to miss in the ED.
Zul MIRZA (Consultant in EM) (Speaker, London. UK)
17:00 - 17:25
Stabilization and management of the acutely agitated patient.
Andy NEILL (Doctor) (Speaker, Dublin, Ireland)
17:25 - 17:50
Assessment of the suicidal patient in the ED.
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D36
16:35 - 18:00
Emergency Nursing - Open space, a network event to discuss challenges and solutions in emergency nursing
Moderators:
Jochen BERGS (Moderator, Hasselt, Belgium), Dr Thordis K. THORSTEINSDOTTIR (Professor) (Moderator, Reykjavik, Iceland)
16:35 - 17:00
Intimate partner violence against women.
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E36
16:35 - 18:00
Ventilation and perimortem C-section
Moderator:
Eric REVUE (Chef de Service) (Moderator, Paris, France)
16:35 - 17:10
Invasive mechanical ventilation.
Nejc GORENJAK (Speaker, Slovenia)
17:10 - 17:25
Lumbal puncture (technique).
Pr Cem OKTAY (FACULTY) (Speaker, ANTALYA, Turkey)
17:25 - 18:00
Emergency delivery incl. perimortem.
Eric DRYVER (Consultant) (Speaker, Lund, Sweden)
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F36
16:35 - 18:00
Do not get snapped
Moderator:
Dr Heidi EDMUNDSON (Consultant) (Moderator, London)
16:35 - 17:00
How clinicians can recognise and manage outr emotionat state at work in the ED.
Tom BANNISTER (Speaker, Manchester, United Kingdom)
17:00 - 17:25
The craft of Emergency Medicine.
Julian DONOVAN (Speaker, NEWCASTLE)
17:25 - 17:50
Wellbeing.
Kathryn MAGUIRE (Speaker, Ireland)
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A5 |
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G36
16:35 - 18:00
Klimawandel und Notfallmedizin
Moderators:
Stefan SUDMANN (Head of department / senior consultant) (Moderator, Hamburg, Germany), Michael WUNNING (Moderator, Hamburg, Germany)
16:35 - 17:00
Infektiologie in Zeiten der Klimavernderungen - auf was mssen wir uns einstellen?
Clarissa PRAZERES DA COSTA (Speaker, Muenchen, Germany)
17:00 - 17:25
Auswirkungen des Klimawandels auf die (Notfall)Medizin.
Tobias SCHILLING (ÄD) (Speaker, Stuttgart, Germany)
17:25 - 17:50
Krankenhausarchitektur unter Klimaaspekten.
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H36
16:35 - 18:00
Trauma
Moderators:
Bulut DEMIREL (Clinical Development Fellow) (Moderator, Glasgow), Luc J M MORTELMANS (PHYSICIAN) (Moderator, Antwerp, Belgium)
16:35 - 18:00
#31181 - Assessment of burden on the Osaka City disaster medical care system in a Nankai Trough megathrust earthquake model: A geographic information system-based analysis.
Assessment of burden on the Osaka City disaster medical care system in a Nankai Trough megathrust earthquake model: A geographic information system-based analysis.
Background The Osaka prefectural government has publicized a damage estimation for a Nankai Trough quake, with a recurrence probability of about 70% in the next 30 years. Although there are designated “disaster coping” hospitals in Osaka Prefecture, it remains unclear whether the city’s medical care system can manage the high number of casualties. As the burden on medical systems differs markedly depending on individual hospitals’ capacities, which reflect factors such as bed numbers and operating rates, and earthquake and tsunami victims’ behaviors, we investigated manageability of the disaster medical care system in Osaka City by using the inpatient care capacities of each disaster coping hospital, and casualty distributions for cases of high and low tsunami evacuation rates.
Methods There are seven disaster base hospitals (DBHs) and 94 disaster cooperative hospitals (DCHs). In this geographic information system (GIS)-based analysis, we calculated the number of available beds based on total number of beds and monthly operating rates and displayed inpatient care capacities on a map. Subsequently, we calculated detailed distributions of severely and moderately injured patients based on damage estimations in two conditions: high and low evacuation rates from the tsunami-affected zone. We ran a simulation in which severely injured patients were assigned and transported to DBHs directly, and moderately injured patients were transported to DCHs. Moderately injured patients who could not be accommodated in DCHs were then transported to the nearest DBHs (Scenario 1) or were transported to DCHs with available beds in the same region first, and then surplus patients were transported to DBHs (Scenario 2).
Results In the low evacuation rate condition, 16,528 severely injured patients were transported to DBHs (minimal 22-maximal 4,506), with the highest number being admitted to a DBH in northeastern Osaka City. In Scenario 1, 59,316 excess moderately injured patients were transported to DBHs (0-16,015) versus 32,411 (61-22,739) patients in Scenario 2; again, the highest number were admitted at a DBH in the northeastern area. In the high evacuation rate condition, 839 severely injured patients were transported to DBHs (22-288), whereas 1,367 excess moderately injured patients were transported to DBHs (0-636) in Scenario 1 versus 550 (0-294) patients in Scenario 2.
Discussion & Conclusions A GIS allows visualization of the manageability of the disaster medical care system in Osaka City and provides directions for improving the medical care system. To date, countermeasures against a major Nankai Trough earthquake are focused mainly in coastal areas, but this study revealed that any problems in medical care would most greatly impact the northeastern area. Our results showed that the burden on medical systems differed markedly depending on whether the evacuation rate was high or low, thus underscoring the importance of providing sufficient education to citizens. To decrease the burden on DBHs, moderately injured patients should be transported to DCHs with available beds in the region first by using an Internet of Things system such as the Emergency Medical Information System in Japan.
This work was supported by JSPS KAKENHI Grant Number JP20K09292.
Pr Hiromasa YAMAMOTO (Osaka, Japan), Yoshinari KIMURA, Yasumitsu MIZOBATA
16:35 - 18:00
#31144 - Differences in abusive and non-abusive head trauma in children under 24 months at the intensive care: a retrospective study.
Differences in abusive and non-abusive head trauma in children under 24 months at the intensive care: a retrospective study.
Background
Traumatic brain injury (TBI) is a frequent cause for admission to the pediatric intensive care in young children. Over a quarter of the hospitalizations and half of the deaths due to TBI are caused by abusive head trauma (AHT). The effects of AHT on neurocognitive, motor and psychological development are especially detrimental. Differentiating between AHT and non-abusive head trauma (nAHT) is important to ensure appropriate care. The aim of our study is to describe the differences in characteristics of AHT and nAHT and examine the use of ancillary diagnostics in screening for inflicted injury.
Methods
Retrospective data on presentation, history, examinations and outcome were collected on children aged 0-24 months who were admitted with TBI to the pediatric intensive care unit of the Erasmus Medical Center (Rotterdam, the Netherlands) from 2011 through 2021 and had no previous history of brain- or skull injury. Cases were categorized as AHT or nAHT according to Hymel’s criteria. The data were analyzed descriptively and tested using Fisher exact tests.
Results
60 children (median age 4.0 months, 65% boys) were included. AHT was identified in 27% (n=16). There was no statistical difference in symptoms at presentation or delay of presentation between AHT and nAHT. Children with AHT did present more often without history of trauma (50% =8/16 vs 7% =3/44, p-value 0.001) and when accidental trauma was reported this more often was a fall from height <1m (63% =5/8 vs 14% =5/36, p-value 0.009). Skin abnormalities in the urogenital area (31% =5/16 vs 9% =4/44, p-value 0.048) and on extremities (56% =9/16 vs 14% =6/44, p-value 0.002) were significantly more frequent in AHT compared to nAHT. An abnormal fontanel (50% =8/16 vs 18% =8/44, p-value 0.021) and abnormal tonus (31% =5/16 vs 4% =2/44, p-value 0.011) were also found more often in AHT. All children underwent imaging of the brain by CT (n=56) and/or MRI (n=21). No differences in types of injuries on imaging were found between AHT and nAHT. An initial skeletal survey was performed in 37% (n=22) of children and fundoscopy in 52% (n=31). Not all children categorized as AHT by Hymel’s criteria underwent complete top-toe examination (n=13/16) or had a skeletal survey (n=11/16) performed. In 63% (n=10) of AHT cases advise from the Dutch Expertise Center for Child Abuse was sought. In 42% (n=25) of all children suspected child maltreatment was reported to the Safe at Home centre (national child safety organization). Mortality was higher in AHT compared to nAHT (25% =4/16 vs 4% =2/44, p-value 0.038).
Conclusion
This study shows that differences in presentation, physical symptoms and outcome between AHT and nAHT in children admitted to the pediatric intensive care unit can help to identify inflicted injury. Screening for signs of inflicted injury with top-toe examination and skeletal survey should be performed in children with possible AHT. Strict adherence to protocols and assistance by a child abuse expert team could improve the recognition of child maltreatment in young children with TBI.
n/a
Annelotte PRIES (Rotterdam, The Netherlands), Marie Eline MORITZ, Maayke HUNFELD, Patrycja PUIMAN
16:35 - 18:00
#31627 - Evaluating hospital disaster preparedness of Antwerp hospitals using the who hospital emergency response checklist.
Evaluating hospital disaster preparedness of Antwerp hospitals using the who hospital emergency response checklist.
The Antwerp metropolitan region is at risk for disasters. It hosts the world second petrochemical port including a nuclear power plant. It’s on a traffic crossroad for transport on the road, by train, by air or on the water. It hosts a huge Jewish community and an important show arena with great international stars performing.
Are the hospitals in this city prepared to deal with these kind of incidents. To evaluate this preparedness in 5 acute hospitals from the 2 major hospital associations we used the Hospital Emergency Response Checklist of the World Health Organisation. This checklist evaluates 92 subsets of 9 major components of hospital preparedness scoring each item from 0 (absent) over 1 (to work on) to 2 (completed). A total score between 0 and 64 out of 184 results in an unacceptable situation. Between 65 up to 129/184 gives a certain preparedness but is insufficient for a good reaction on incidents. A score of 130 and higher states a sufficient overall preparedness.
The checklist was completed by one of the authors in cooperation with 2 respondents per hospital (a disaster coordinator and a responsible of the Emergency Department.
2 hospitals scored 150/184 given a good preparedness level , 1 scored 128/184 and 2 scored 126/184 giving some work to be done in the latter 3 hospitals. Sections with the highest need on improvement were surge capacity (4/5 hospitals), human resources (3/5 hospitals) and command and control, continuity of essential services and post disaster recovery (2/5 hospitals).
With a sufficient score in only 2 hospitals and an intermediate score in the other 3 hospitals there is some work to be done to optimize the hospital disaster preparedness in Antwerp. As the responsibles know the key points they can act on it and a re-evaluation should be planned.
In conclusion we can state that the studied Antwerp hospitals aren’t optimally prepared to possible disastrous situations.
No funding for this study
Vick SCHELLEKENS, Luc MORTELMANS (Antwerp, Belgium), Bram DISPA, Marc SABBE
16:35 - 18:00
#31485 - Evaluation of practices concerning the management of severe and moderate traumatic brain injury in prehospital emergency medicine.
Evaluation of practices concerning the management of severe and moderate traumatic brain injury in prehospital emergency medicine.
Introduction
In cranial trauma patients, a lack of monitoring can be responsible for Secondary Cerebral Aggression of Systemic Origin which is harmful for the patient. In addition, the post-trauma transport period is a delicate moment which could conditioning immediate mortality or even the subsequent prognosis.
The objective of our study was to evaluate professional practices concerning the prehospital management of severe and moderate traumatic brain injury and to assess their influence on the prognosis of patients at 3 months and 6 months.
Material and method
We carried out a monocentric and retrospective descriptive study. Between October 1, 2016 and December 31, 2020, we included all adult patients treated by the pre-hospital emergency medical service of a university hospital for severe or moderate head trauma.
Results
Of the 129 patients included, 87 (67%) had severe head injuries and 40 (31%) died. The mean age was 50+/-22 years old. Road accidents accounted for half of the causes of death, 24% of patients had a positive blood alcohol level and 19.4% benefited from antiplatelet or anticoagulant treatment. The median duration of prehospital treatment was 39 minutes (IQR: 29-56). Of all treatments, 41% of patients had no blood sugar value and 76% had no temperature value. Regarding ventilation, 95% of patients were adequately oxygenated with saturation > 90%. Of the 35 patients who showed signs of cerebral involvement, 10 (28.6%) did not benefit from osmotherapy. Blood pressure was controlled for 66% of the population in our study, but only 18% of patients had normal temperature and blood sugar values. The Glasgow Outcome Scale was overall more unfavorable for patients whose Secondary Cerebral Aggression of Systemic Origin had not been corrected and/or monitored.
Conclusion
These results should encourage us to find solutions to optimize the management of head trauma (improvement of procedures, computerization, checklist) during the prehospital time, as we shows an impact of the pre-hospital management of Secondary Cerebral Aggression of Systemic Origin on morbidity and mortality.
Charlène MOURIER, Farès MOUSTAFA (Clermont-Ferrand), Apolline GUILMAIN, Rémi JUAREZ, Thibault DEROSIER, Ana BOLOGAN, Jeannot SCHMIDT, Daniel PIC
16:35 - 18:00
#31669 - Silver Trauma Are we learning anything?
Silver Trauma Are we learning anything?
Advancing age is a well-known risk factor for poor outcomes in trauma. Thus, strategies and policies to prevent and minimise injuries must be developed. There has been a rapid increase in the elderly population over the last century with the number under 65 tripling and that over 65 increasing by a factor of 11. Although the number of dependent elderly have increased; many still maintain active independent lifestyles requiring assessment and care in the event of trauma related injuries. Many elderly patients live alone in large double storey homes, many have multiple co-morbidities and are on multiple medications, often these have not been reviewed. Increasing age puts a trauma patient into a higher risk category. It is known that elderly who sustain major trauma have a higher complication and mortality rate; minor injuries should not be overlooked. This retrospective audit of consecutive patients 65 and over presenting to the Emergency Department with trauma over the period of October to December 2021 showed the need to improve preventative strategies against trauma, the need to ensure a robust system of medication review and that strategies should include means that would be more patient centered and there should be improvement of community-based care focused on minimising travel to access healthcare. More study around accessible primary care and planning for life after 65 is warranted with the increased demands on health care and rising costs.
Kiren GOVENDER, David Samouil Charmduch BERTLLA (Ballinasloe, Ireland), Arshia NOOR
16:35 - 18:00
#31087 - The association between major trauma centre care and outcomes of adult patients injured by low falls in England and Wales.
The association between major trauma centre care and outcomes of adult patients injured by low falls in England and Wales.
Background
Disability and death due to low falls is a growing problem worldwide which disproportionately affects older adults. Optimising the management of these patients carries significant implications for the health of individuals and the performance of healthcare systems. However, studies concerning the benefit of higher-level trauma centre care have not yielded consistent, high-quality evidence of the role of higher-level care in patients injured by falls. This study assessed the effectiveness of major trauma centre care in adult patients injured by low falls in England and Wales.
Methods
Data were obtained from the Trauma Audit and Research Network (TARN) on adult patients (age over 16 years) injured by falls from <2 metres between 2017-2019 in England and Wales. Binary logistic regression and Cox Regression were used to control for casemix. 30-day survival, length of hospital stay and discharge destination were compared between major trauma centres (MTCs) and trauma units or local emergency hospitals (TU/LEHs).
Results
127,334 patients were included of whom 35,175 (27.6%) attended an MTC. The median age was 79.4 years (IQR 64.5-87.2 years), and 74.2% of patients were aged >65 years. Unadjusted 30-day survival was lower in MTCs (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.66-0.73). After adjusting for casemix, MTC care was not associated with improved survival (adjusted odds ratio [AOR] 0.91, 95% CI 0.87-0.96). Transferred patients had a significant impact upon the results. After excluding transferred patients, the AOR for survival in MTCs was 1.056 (95% CI 1.001-1.113). The association between improved survival and MTC care was greatest in patients who suffered major trauma (AOR 1.126, 95% CI 1.044-1.215) and was absent in patients aged >65 (AOR 1.038, 95% CI 0.982-1.097). MTC care was associated with longer length of hospital stay (adjusted hazard ratio 0.906, 95% CI 0.894-0.918) and higher odds of discharge home (AOR 1.066, 95% CI 1.033-1.101).
Conclusion
TU/LEH care is at least as effective as MTC care due to the facility for secondary transfer from TU/LEHs to MTCs. In patients who are not transferred, MTCs are associated with greater odds of 30-day survival in the whole cohort and in the most severely injured patients. There is no association between MTC care and improved 30-day survival in patients aged >65 years. Future research must determine the optimum way to identify patients in need of higher-level care, the components of care which improve patient outcomes, and develop patient-focused outcomes which reflect the characteristics and priorities of contemporary trauma patients.
Dr Michael Tonkins was supported by a grant from the National Institute for Health Research (NIHR). The NIHR played no role in the design or conduct of the study.
Michael TONKINS (Rotherham, ), Omar BOUAMRA, Fiona LECKY
16:35 - 18:00
#31328 - Traumatic brain injury quality indicators from an emergency room in a level III trauma centre: one year retrospective analysis.
Traumatic brain injury quality indicators from an emergency room in a level III trauma centre: one year retrospective analysis.
Introduction: Trauma is a major contributor to disease burden especially in the younger population. Traumatic brain injury (TBI) has notable impact in patient’s autonomy and life expectancy. It is possible to reduce trauma burden with good quality care and a systematic approach. In 2003, the Portuguese general medical council (GMC) published the standards of good practice in trauma, defining quality indicators (QI) for TBI.
Aim: To audit the quality of care provided to TBI patients admitted to the emergency room (ER) of a tertiary hospital according to the QI defined by the Portuguese GMC.
Methods: Retrospective cohort study including all trauma patients admitted in our ER between January 1st and December 31st, 2021. Demographic data, type and mechanism of injury, trauma and physiological severity, probability of survival, pre-hospital medical approach, destination after ER and early and late mortality were evaluated. The QI analysed were: patients with Glasgow coma scale (GCS)<9 received endotracheal intubation, patients with GCS<13 had a CT-scan in less than 4 hours, patients with surgical lesion were transferred to the operating room in less than 4 hours after hospital admission and patients with GCS <9 had placement of an intracranial pressure (ICP) sensor.
Results: During the study period there were 135 trauma patients admitted to the ER, 87 (64%) presented with TBI. The median±SD age of the TBI group was 57±20 years-old and 70 (80%) patients were male. According with the type of trauma, 38 (44%) presented as isolated TBI being 72 cases of blunt trauma. The most frequent cause of TBI was falls in 47 patients (54%) followed by road traffic accidents in 29 cases (33%). Injury severity score (ISS) median±SD was 15±11 and 48% of the cases had an ISS ≥16 with an overall mortality rate of 16%, with similar rates for early and late in-hospital mortality. Considering de QI, 94% of patients with GCS < 9 received endotracheal intubation, 98% of the patients with a GCS<13 had a CT-scan in less than 4 hours, 75% (9 in 12) were transferred to the operating room in less than 4 hours after hospital admission, 35% patients with GCS <9 had placement of an ICP sensor. In this group, patients not submitted to ICP sensor placement presented an ISS average of 20 and an in-hospital mortality rate of 45%.
Discussion&Conclusion: Like in most series, TBI comprised the principal type of trauma admitted to the ER. Blunt trauma was the most frequent type of injury as the falls were the most common cause as described in medical literature. The compliance to TBI QI was extremely high in our hospital except the indicator related to the placement of the ICP sensor in patients with GCS<9. Patients that did not had an ICP sensor placed had a severer TBI and higher mortality. This study identifies an area of improvement in TBI, an internal protocol will be developed along with the neurosurgery to improve this parameter.
n/a
Tiago GAMA RAMIRES (Amadora - Lisbon, Portugal), Rita PASSOS, Ana Sofia TOMÁS, Hugo MOREIRA, Teresa CARDOSO, Irene ARAGÃO
16:35 - 18:00
#30677 - Vitamin D Deficiency and Prognosis after Traumatic Brain Injury with Intracranial Injury: A Multicenter Observational Study.
Vitamin D Deficiency and Prognosis after Traumatic Brain Injury with Intracranial Injury: A Multicenter Observational Study.
Background
Vitamin D may be important for neuroprotection after traumatic brain injury (TBI) by modifying inflammatory responses. The objective of this study was to evaluate the association between vitamin D deficiency and functional/survival outcomes among TBI patients with intracranial injury.
Methods
This study was a prospective multicenter cohort study, conducted on adult TBI patients admitted in 5 participating emergency departments (EDs) from December 2018 to June 2020, and who had intracranial hemorrhage or diffuse axonal injury confirmed by radiological examination. The study outcomes were good functional recovery at hospital discharge and survival at 6-months after injury. The main exposure was serum vitamin D deficiency (0–10 ng/ml). Multilevel logistic regression analysis was performed to estimate the association between vitamin D deficiency and study outcomes.
Results
Among 606 patients, 101 (16.7%) patients had vitamin D deficiency at the time of ED arrival. Good functional recovery was observed in 65.2% (395/606) of total population, and the proportion was significantly lower in the vitamin D deficiency group than the non-deficiency group (56.4 vs. 66.9%, p=0.04, adjusted OR (95% CI): 0.56 (0.37–0.84)). Overall survival rate at 6-months after injury was 79.5% (434/546), and patients with vitamin D deficiency had significantly lower likelihoods of survival at 6-months than patients without deficiency (75.0 vs. 80.3%, adjusted OR (95% CI): 0.58 (0.39–0.86)).
Conclusions
Vitamin D deficiency is associated with poor functional outcomes at hospital discharge and mortality at 6-months after injury for TBI patients with intracranial hemorrhage or diffuse axonal injury.
n/a
Eujene JUNG (Gwangju, Republic of Korea), Young Sun RO
16:35 - 18:00
#31301 - Women’s intimate partner violence versus community violence; Comparing injuries as presented in Iceland’s largest emergency department.
Women’s intimate partner violence versus community violence; Comparing injuries as presented in Iceland’s largest emergency department.
Abstract
Background: Intimate partner violence (IPV) is a widespread, often unidentified and
hidden public health problem, which has serious consequences. The purpose of this study
was to describe and compare the clinical characteristics of women’s violence inflicted
physical injuries, as presented at Iceland’s largest Emergency Department (ED). Three
groups were created based on registered reason of injury: (1) IPV, (2) community
violence (CV) with a history of IPV (HIPV), and (3) CV with no history of IPV.
Methods: Data was collected retrospectively by using the Nomesco classification system
of external causes of injuries. Participants were adult women, residing in the capital area,
visiting the ED during 2005-2019.
Results: IPV inflicted ED visits declined by 45% during the research period and CV visits
declined by 61%. Women in the IPV group had the highest prevalence of repeated new
ED visits per 1,000 women in the capital area. The majority of IPV occurred in residential
areas (86.4%), inflicted by a current partner (54.7%), and included only one perpetrator
(95.3%). Women involved in CV were most likely to visit the ED on weekends (p=0.003)
and IPV women were most likely to visit between 08:00-16:00 (p<0.001). The most
common type of injuries resulting from IPV were superficial injuries (69.4%) with IPV
women being twice as likely (7.1%) to have injuries on their neck than CV women
(3.5%). IPV women were most likely to be admitted (3.0%).
Conclusion: Time of ED visit, number of perpetrators and location of assault can be
indicators of IPV inflicted injuries, as opposed to otherwise inflicted injuries. Repeated
visits, superficial injuries and neck injuries might also be an indicator of IPV, however
wounds and sprains and injuries on head and upper limbs are more likely to be non-IPV
inflicted
Landspitali University Hospital Science Fund [A-2021-071, 2021].
University of Iceland Research Fund [2020]. The Icelandic Gender Equality Fund [2018].
Reykjavík City Council’s Human Rights and Democracy Office [R15060027, 2015].
Drífa JÓNASDÓTTIR, Dr Thordis THORSTEINSDOTTIR (Reykjavik, Iceland), Tinna ÁSGEIRSDÓTTIR, Eirikur ARNARSSON, Eleni ASHIKALI, Brynjólfur MOGENSEN
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M1-2-3 |
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INDS6
18:10 - 18:50
Baxter: The vital role of the Emergency Department in the Patient's Sepsis Pathway
Chairperson:
James CONNOLLY (Consultant) (Chairperson, Newcastle-Upon-Tyne, United Kingdom)
18:10 - 18:50
18:10 - 18:50
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18:10 - 18:50
Fisher & Paykel: Nasal high-flow therapy in the Emergency Department
Speaker:
Christoph DODT (Head of the Department) (Speaker, München, Germany)
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M4-5 |
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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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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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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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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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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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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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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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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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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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
n/a
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.
n/a
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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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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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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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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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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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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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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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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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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