Wednesday 05 October
08:30

Wednesday 05 October

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A41
08:30 - 10:00

State of the Art
Neurological

Moderators: Harald HERKNER (Austria), Christian HOHENSTEIN (PHYSICIAN) (Bad Berka, Germany)
08:30 - 09:00 How to perform a rapid neuro-exam as an emergency physician. Greg HENRY (USA)
09:00 - 09:30 Seizures versus syncope: diagnosis and management. Christian HOHENSTEIN (PHYSICIAN) (Bad Berka, Germany)
09:30 - 10:00 Hyperacute Stroke Management. Carsten KLINGNER (Germany)
Room A-FESTSAAL

Wednesday 05 October

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B41
08:30 - 10:00

Austria, Germany, Switzerland Invites
Journal Club: Literaturhighlights für Notfallmediziner aus…

Moderators: Gabriela SCHREIBER (Münchwilen, Switzerland), Mathias ZÜRCHER (Switzerland)
08:30 - 09:00 Kardiologie. Peter STRATIL (VIENNA, Austria)
09:00 - 09:30 Intensivmedizin. Michael CHRIST (Director) (Lucerne, Switzerland)
09:30 - 10:00 Notfallmedizin. Christian WREDE (Head of Department) (Berlin, Germany)
08:30 - 10:00 Präklinik. Stephan BECKER (Switzerland)
Room B-ZEREMONIENSAAL

Wednesday 05 October

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C41
08:30 - 10:00

Philosophy & Controversies
P&C Women in Emergency Medicine

Moderators: Katrin HRUSKA (Emergency Physician) (Stockholm, Sweden), Karin RHODES (USA)
08:30 - 09:00 Every Challenge is an Opportunity – Empathy? Overrated. Maaret CASTREN (Professor) (HELSINKI, Finland)
09:00 - 09:30 Every Challenge is an Opportunity - and other half truths of academia. Karin RHODES (USA)
08:30 - 10:00 Every Challenge is an Opportunity - what is the reality in Emergency Medicine? Dr Barbara HOGAN (Past President of the European Society for Emergency Medicine, EuSEM) (HAMBURG, Germany)
09:30 - 10:00 Every Challenge is an Opportunity – Women in EM research; its about patient care. Christien VAN DER LINDEN (Clinical Epidemiologist) (The Hague, The Netherlands)
Room C-PRINZ EUGEN SAAL

Wednesday 05 October

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D41
08:30 - 10:00

EUSEM meets IFEM

Moderators: Roberta PETRINO (Head of department) (Italie, Italy), Marc SABBE (Medical staff member) (Leuven, Belgium)
08:30 - 09:00 From Club of Leuven to IFEM. Juliusz JAKUBASZKO (Chair) (Wroclaw, Poland)
09:00 - 09:30 Facing the grand challenges of this age in Emergency Medicine. Timothy HUDSON RAINER (Cardiff, United Kingdom)
09:30 - 10:00 Panel Discussion: The Big Questions for International Emergency Medicine in 2016. Timothy HUDSON RAINER (Cardiff, United Kingdom), Juliusz JAKUBASZKO (Chair) (Wroclaw, Poland), Roberta PETRINO (Head of department) (Italie, Italy)
Room D-FORUM

Wednesday 05 October

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E41
08:30 - 10:00

Research
Philosophy General EM

Moderators: Helen ASKITOPOULOU (Chair Ethics Committee) (Heraklion, Greece), Laurie MAZURIK (TORONTO, Canada)
08:30 - 09:00 Ethical Issues of Emergency Care for Elderly Patients. Helen ASKITOPOULOU (Chair Ethics Committee) (Heraklion, Greece)
09:00 - 09:30 Legal and ethical issues of involuntary hospitalization. Miljan JOVIC (Zajecar, Serbia)
09:30 - 10:00 Weighing benefit and harm in Emergency Medicine. Basar CANDER (Turkey)
Room E-GEHEIME RATSTUBE

Wednesday 05 October

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F41
08:30 - 10:00

YEMD
After the terrorist attacks

Moderators: Youri YORDANOV (Médecin) (Paris, France), Sabina ZADEL (Slovenia)
08:30 - 09:00 The young EM doctors and the new threats: are we prepared? Youri YORDANOV (Médecin) (Paris, France)
09:00 - 09:30 When to hand over the command to our young consultant? Mathieu RAUX (Responsable d'unité) (PARIS, France)
09:30 - 10:00 Disaster Management: Is training by simulation the new trend? Luca RAGAZZONI (Scientific Coordinator) (Novara, Italy)
Room F-RITTERSAAL

Wednesday 05 October

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OP41
08:30 - 10:00

Oral Papers 41

Moderators: Mehmet Akif KARAMERCAN (Chair of EuSEM Research Committee) (ANKARA, Turkey), Door LAUWAERT (Manager) (BRUSSELS, Belgium)
08:30 - 08:40 #4586 - OP100 Cerebral Oximetry monitoring during 3%HTS infusion in intubated pediatric patients with isolated Head Trauma in a PED.
OP100 Cerebral Oximetry monitoring during 3%HTS infusion in intubated pediatric patients with isolated Head Trauma in a PED.

Altered cerebral physiology, pathology, and Increase ICP can be detected by cerebral oximetry in numerous pediatric ED studies.  In intubated pediatric ED traumatic brain injury  (TBI)patients detecting & response to treatment for the  alter cerebral physiology and ICP is solely by cardiovascular monitoring  and GCS which has major flaws.  In pediatric TBI  head trauma patients with increased ICP, 3%HTS therapy is a standard therapy for increased ICP but assessing its effect on intubated pediatric TBI patient's cerebral physiology by cerebral oximetry has never been reported.

Objective: In isolated pediatric TBI PED patients who received 3% HTS (5 ml/kg), analyze their cerebral oximetry changes in correlation to their 10 minutes before  and 10, 20 minutes post 3% HTS infusion.

Methods

ED observational convenience study of intubated pediatric isolated TBI patients with positive cerebral pathology by CT-scan( epidural, subdural, TBI) , 3% HTS infusion and cerebral oximetry monitoring. Patient's left and right cerebral oximetry readings 10 minutes before 3%HTS infusion and 10 & 20 minutes after 3%HTS infusion. Patients were further sub-group by their  rSO2 initial readings left, right or both rSO2 initial readings:  abnormal cerebral physiology rSO2 80 & normal cerebral physiology rSO2 60-80

Results

207 patients enrolled, age 2.9(1.14,6.9), epidural 28.5%, subdural 84.5%, TBI only 7%, GCS 7(6,8), time to first 15% rSO2 change was 1.1 minute (0.5,1.8). Figure 1

Conclusions

3%HTS infusion produced  significant cerebral oximetry changes in isolated pediatric intubated TBI patients with abnormal cerebral physiology, increased ICP and pathology.  Changes in Cerebral Oximetry readings from the 3%HTS was rapid 1.1 minutes (0.5,1.8). In intubated isolated pediatric TBI  ED patients with increased ICP from brain injury, cerebral oximetry can detect the effects of 3%HTS on these patient's  increase ICP and abnormal hemispheric cerebral physiology. Further investigation is warranted.


Dr Thomas ABRAMO MD (Apex, USA), Lydia WASHER MD, Gregory ALBERT MD, Todd MAXSON, Jon ORSBORN MD, Nicholas PORTER MD, Elizabeth STORM MD, Zhuopei HU MS
08:40 - 08:50 #7033 - OP101 Effects of Silk Sericin on Incision Wound Healing in a Dorsal Skin Flap Wound Healing Rat Model.
OP101 Effects of Silk Sericin on Incision Wound Healing in a Dorsal Skin Flap Wound Healing Rat Model.

Background: The wound healing process is complex and still poorly understood. Sericin is a silk protein synthesized by silk worms (Bombyx mori). The objective of this study was to evaluate in vivo wound healing effects of sericin containing gel formulation in an incision wound model in rats. 

Material&Methods: Twenty-eight Wistar-Albino rats were divided into 4 groups (n=7). No intervention or treatment was applied to the Intact control group. For other groups, a dorsal skin flap (9x3 cm) was drawn and pulled up with sharp dissection. The Sham operated group received no treatment. Also the placebo group received placebo gel without sericin and the sericin group received 1% gel. Both gels applied to the incision area once a day, from day 0 to day 9. Hematoxylin and eosin stain was applied for histological analysis and Mallory-Azan staining was applied. For histoimmunochemical analysis of antibodies and iNOS (inducible nitric oxide synthase) and desmin was applied to paraffin sections of skin wound specimens. Parameters of oxidative stress were measured in the wound area.

Results: Epidermal thickness and vascularization were increased, and hair root degeneration, edema, cellular infiltration, collagen discoloration and necrosis were decreased in Sericin group in comparision to the Placebo group and the Sham operated group. Malonydialdehyde (MDA) is an important oxidative stress marker which appears after lipid peroxidation, MDA levels were decreased, but activites of important antioxidative defense enzymes such as superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) were found to be as increased in the Sericin group.

Conclusions: We found that Sericin had significant positive effects on wound healing and antioxidant activity. Sericin-based formulations can improve healing of incision wounds.      


Pr Murat ERSEL (IZMIR, Turkey), Yigit UYANIKGIL, Funda KARBEK AKARCA, Enver OZCETE, Yusuf Ali ALTUNCI, Fatih KARABEY, Turker CAVUSOGLU, Ayfer MERAL, Gurkan YIGITTURK, Emel Oyku CETIN
08:50 - 09:00 #7436 - OP102 Comparison of the effects of hypericum perforatum (St John's Wort) treatment and alpina officinarum (galangal) treatment on the wound healing in experimental contact burns.
OP102 Comparison of the effects of hypericum perforatum (St John's Wort) treatment and alpina officinarum (galangal) treatment on the wound healing in experimental contact burns.

e Purpose:Topical agents are commonly used for burn treatment.There is not any agent or a method in the treatment that adopted as an effective and common method.St. John’s wort and galangal has been used for the treatment of numerous disorders for many years. It was aimed to determine whether H.Perforatum and A.officinarum which have been regarded to be effective on burn and wound healing are effective on experimental contact type burns in terms of wound healing,or not and compare their effects with each other.METHOD:35 healthy albino Wistar rats were subjected. Rats were separated into 5 groups. Burns were formed by contacting the 1x1 cm copper end, which was kept at 100°C constant temperature, of the device designed with the aim of forming burn model to the shaved areas for 10 seconds without applying extra pressure..Any procedure or treatment was not applied to Group 1. In Group 2, burns were only irrigated with 100cc SF for 2 minutes and covered with drug-free dressing after burn application and any other treatment was not applied. In Group 3, the gel prepared from galangal plant was applied for one time after burn application. In Group 4, the gel prepared from St John's wort was applied for one time after burn application.In Group 5, plain gel was applied for one time after burn application.FINDINGS:Hour 0 (before burn) and hour 24 (after burn) weights were measured and assessed.Edema amount was seen to be reduce in all groups with time.In this study, the procedures of vein, hair root and degenerated hair root count were performed on all preparates obtained from each animal of each group.Degenerated hair root number increased step by step in burn control group. When galangal and St John's wort were compared in terms of the effect on the degenerated hair root number, any statistically different value could not be obtained. St John's wort had a statistically meaningful difference (p<0.05) in terms of degenerated hair root number. 10 randomized histological sections was taken from each biopsy materials obtained from all animals of each group and tissues of each animal, and in each preparate, epidermis thicknesses of 20 randomized different areas were taken, arithmetic mean results were written and they were assessed statistically. RESULT:it was observed that the topical H.perforatum treatment that was applied for one time in acute contact type experimental burns reduced edema and damages of hair root and glandula sebacea, and was effective both for the protection of hair root number, vein number and epidermis thickness, and lowering the degenerated hair root number.It was understood that A.officinarum treatment had also effects reducing the edema, glandula sebacea damage and was effective for the protection of epidermis thickness and lowering the degenerated hair root number. However when the treatment applications were compared, the effects of H.Perforatum treatment was more prominent than topical A.officinarum treatment for wound healing regarding the contact type burns. It can be said that H.Perforatum topical treatment is going to givmore positive results for acute period burns when compared to A.officinarum treatment.


Halil Uğur SAVAŞ (GAZİANTEP, Turkey), Selahattin KIYAN, Yiğit UYANIKGİL
09:00 - 09:10 #7514 - OP103 Analysis of prognostic factors for surgical patients with traumatic acute subdural hematomas.
OP103 Analysis of prognostic factors for surgical patients with traumatic acute subdural hematomas.

Background:

Acute subdural hematoma (ASDH) is a common traumatic brain injury with a relatively high mortality rate. However, few studies have examined the factors on admission predicting the outcome of traumatic ASDH. This clinical study analyzed the prognostic factors on admission in patients treated surgically for traumatic ASDH.

Participants and methods:

A total of 74 surgical patients for traumatic ASDH between January 2008 and October 2014 were retrospectively reviewed. If surgical evacuation of an ASDH in patient is indicated, it should be performed using a craniotomy with or without bone flap removal and duraplasty. Glasgow outcome score (GOS) was used for prognostic evaluations and favorable prognosis was defined as 4-5 points. We used univariate and multivariate logistic regression analysis to evaluate the influence of clinical variables on prognosis.

Results:

The majority were male (66.2%) and the mean age was 59 years. The percentage of patients with favorable prognosis was 25.7% and the mortality 36.5%. Age (OR = 0.874), Glasgow Coma Score on admission (OR = 1.851), D-dimer (OR = 0.756) and Rotterdam CT score (OR = 0.137) were independent predictors, while no independent association was observed between prognosis and platelet count, thickness of hematoma, although these variables were correlated with prognosis in univariate analyses. Sex, pupil abnormalities, light reflex, PT-INR, fibrinogen, glucose, electrolytes, arterial blood gas data were no correlated with prognosis in univariate analysis.

Discussion/Conclusion:

This study identified the risk factors for poor prognosis in patients who underwent surgical treatment for traumatic ASDH. Poor outcome in traumatic acute subdural hematoma is higher in elderly patients even after surgical intervention. There is a high incidence of coagulopathy following TBI. The presence of elevated D-dime as well as of severity of TBI are strong predictors of prognosis in these patients. The Rotterdam classification including compressed basal cistern, midline shift >5mm, absent of epidural hematoma mass, present of intraventricular blood or subarachnoid hemorrhage seems to be appropriate for describing the evolution of the injuries on the CT scans and contributes in predicting of outcome in surgical ASDH patients. In conclusion, older patients, lower Glasgow Coma Score on admission, elevated D-dimer, higher Rotterdam CT score tend to have poor prognosis. The findings might help clinicians determine management criteria and improve survival.

Acknowledgement: On behalf of all authors, the first author states that there is no financial other conflict of interests


Hiroshi YATSUSHIGE (Tokyo, Japan), Takanori HAYAKAWA, Kyoko SUMIYOSHI, Keigo SHIGETA, Toshiya MOMOSE, Masaya ENOMOTO, Shin SATO, Jiro AOYAMA
09:10 - 09:20 #7678 - OP104 Budesonide Nebulization Added to Systemic Prednisolone in the Treatment of Severe Acute Asthma in adults.
OP104 Budesonide Nebulization Added to Systemic Prednisolone in the Treatment of Severe Acute Asthma in adults.

Introduction:

Inhaled corticosteroids, known to be effective as a maintenance medication in chronic asthma, have also been suggested as a therapy for acute asthma when given at high doses in children. The role of inhaled corticosteroids in the treatment of acute asthma exacerbations in adults is controversial.

Aim of study: to study the efficacy of high dose nebulized budesonide (BUD) in the treatment of severe acute asthma in adults.

Methods:

A double-blind, randomized, placebo-controlled trial conducted over six months. Inclusion: Age ˃18 and ˂45 years with a peak expiratory flow (PEF) <50% of predicted value. Patients were assigned to receive 0.5 mg Budesonide (BUD) nebulized or placebo isotonic saline serum (ISS), in addition to Terbutaline 5mg and 0.5mg Ipratropuim bromide every 20 minutes the first hour. All patients received single oral dose of prednisolone 1 mg/kg given at the beginning of therapy. The primary outcome was the delta PEF in the first hour (H1).The secondary outcome was hospital admission rate within 4 h and length of stay in the emergency department (ED).

Results:

A total of 108 visits by adults with severe acute asthma were evaluated.Mean age = 36 ± 9 years. Sex ratio = 0.43. On admission, the two BUD groups (n = 49) and placebo (n = 55) were similar. The delta PEF in H1 was 25% in the BUD group versus 20% in the placebo group (p = 0.01, OR = 3.4) . The hospitalization rate was 47% in the BUD group against 53% in the placebo group (p = 0.97). The average length of stay was 7 ± 5 hours in the BUD group versus 11 ± 9 hours in the ISS group (p = 0.04, OR = 1.9). No major complications were observed in both groups.Conclusion :The addition of high repetitive budesonide nebulization improve the lung function and decrease the admission rate of adults with severe acute asthma.


Wided BOUSSLIMI, Anware YAHMADI, Rania JEBRI (Lyon), Hanane GHAZALI, Houssem AOUNI, Chaabani GHZELA, Monia NAGUECH, Sami SOUISSI
09:20 - 09:30 #7843 - OP105 Venous thromboembolism prophylaxis in the emergency department: a new score.
OP105 Venous thromboembolism prophylaxis in the emergency department: a new score.

Objectives: Venous thromboembolism (VTE) prophylaxis is less frequent in emergency medicine (EM) than in internal medicine (IM) department. The aim of the present study is a critically revue of thromboembolism criteria and score in the medical patient, in EM and IM department. Particularly we hope find a score more suitable for acute patient but with high sensibility and specificity.
Methods: Double case-control observational study, with enrollment, for each case of VTE, of two consecutive patients without VTE, of equal sex and age group (18–50, 50–55, 55–60, 60–65, 65–70, 70–75, 75–80, >80 years).The study involved EM and IM department of 23 hospital/university of Lazio and Umbria, in Italy.

Results: We analyzed data pertaining to 1215 patients, 409 with VTE (50% – deep venous thrombosis (DVT), 9.9% – pulmonary embolism (PE), 40.1% – PE+DVT) and 806 case-control. 222 patients (30%) were in charge to EM department while 520 patients (70%) to IM department. The TEV risk factors at more statistical significance (p<0.01) were: previous VTE, active cancer, known thrombophilic condition, immobilization, chronic venous insufficiency, hyperhomocysteinemia, central venous catheter, recent hospitalization. Obesity, recent surgery, family history of VTE, hormone therapy and treatment with drugs that stimulate hematopoiesis were resulted at intermediate statistical significance (p<0.05 but >0.01). Multiple logistic regression was used with robust standard errors and forward selection of candidate variables using the Bayesian information criterion to develop a new score: the " TEvere Score" This score shows the highest specificity and sensitivity, (respectively 43.3and 87.5 with accuracy 72.1) compared with Padua, Kuscer and Chopard scores. Tevere score had predictive validity for risk of thromboembolism(AUROC 0.7266; 95% CI, 0.71 to 0.73) than was greater than Kuscer score(AUROC 0.6891; 95% CI, 0.67 to 0.70)(p =0.0093).

Conclusions: The TEVERE score  has shown to have a higher accuracy than the other scores most commonly used in clinical practice to stratify the risk of thromboembolism.In particular, in our study, we were taken into exams also patients from the Department of Emergency, which appear to have, for a variety of factors, different characteristics than patients hospitalized in medical wards.This makes the TEVERE a good score to use, fast, also in the Emergency Departments.



Giovanni Maria VINCENTELLI (Rome, Italy), Manuel MONTI, Francesco Rocco PUGLIESE, Maria Pia RUGGIERI, Giuseppe MURDOLO, Francesco BORGOGNONI, Giuliano BERTAZZONI
09:30 - 09:40 #8138 - OP106 Non-Invasive Ventilation for acute hypoxic and hypercapnic respiratory failure: determinants of in-hospital mortality.
OP106 Non-Invasive Ventilation for acute hypoxic and hypercapnic respiratory failure: determinants of in-hospital mortality.

OBJECTIVES: To determine the in-hospital outcome and the factors associated with a prolonged treatment (<48 hours) in a group of patients with acute respiratory failure (ARF), treated with noninvasive ventilation (NIV).

METHODS: This was a retrospective study including all patients with ARF requiring NIV over a eleven-month period, admitted in an Emergency Department High-Dependency Observation Unit (ED-HDU). Clinical data were collected at baseline, 1 hour, and 24 hours; Sequential Organ Failure Assessment (SOFA score) was calculated with the worst clinical parameters during the first 24 hours. The patients were classified into 2 groups: acute hypoxic respiratory failure (ARF1) and acute hypercapnic respiratory failure (ARF2). The primary outcome was in-hospital mortality.

RESULTS: During the study period (April, 2015-March, 2016), 150 patients underwent NIV; in 59 patients NIV was maintained beyond 48 hours and in-hospital mortality was 22% (including 7% ED-HDU mortality); only 1 patient was intubated during ED-HDU staying. Persistence of hypoxia (PaO2/FiO2<200) 1 hour (59 vs 38%, p=0.029)and 24 hours (65 vs 35%, p=0.012) after NIV beginning, tachypnea (RR>29 per minute) at 1 hour evaluation (30 vs 10%, p=0.017) and a depressed level of consciousness (Glasgow Coma Scale, GCS<15) at all evaluation points(before NIV 46 vs 25%; 1 hour: 48 vs 22%; 24 hours: 41 vs 20%, all p<0.05) were more frequent in non-survivors compared with survivors. Persistence of acidosis (pH<7.30) and tachypnea at 24-hour evaluation were more frequent in patients who underwent NIV beyond 48 hours (respectively 10 vs 1% and 20 vs 5%, all p <0.05).

ARF1 group included 101 patients (67%) and ARF2 49 (33%). Mean age was similar in the two groups (77±13 vs 79±9 years, p=NS), while ARF1 patients showed a higher SOFA score than ARF2 (4.6±2.4 vs 3.3±1.8, p=0.036). NIV was considered the ceiling treatment in 26 (26%) ARF1 and in 11 (22%) ARF2 patients (p=NS). In-hospital mortality was 28% among ARF1 and 9% among ARF2 patients (p=0.005); all but one ARF2 non-survivors and 17/28 ARF1 non-survivors underwent NIV as ceiling treatment. Among ARF1 patients, non survivors showed more frequently than survivors persistence of tachypnea at 1-hour and 24-hour interval (respectively 33 vs 9% and 36 vs 7%, all p<0.05); a 1-hour reduced GCS (46 vs 24%, p=0.05) and hypoxemia at 24-hour interval (71 vs 45%, p=0.063) only tended to be more frequent. No parameter significantly predicted NIV prolonged duration. Among ARF2 patients, only an altered level of consciousness at 1-hour and 24-hour interval was significantly more frequent among non-survivors than survivors (respectively 67 vs 18% and 67 vs 15%, p<0.05); a reduced GCS before NIV beginning and at 24-hour interval was more frequent among patients undergoing NIV beyond 48 hours (37 vs 9% and 33 vs 5%, all p<0.05).

CONCLUSIONS: In this experience reported from a real clinical scenario, mortality rate was comparable with previous reports despite the presence of a significant proportion of patients undergoing NIV as ceiling treatment. Among ARF1 patients, who showed the highest mortality, persistence of tachypnea despite NIV implementation was the most significant predictor of a bad outcome. 


Simona GUALTIERI (Florence, Italy), Laura GIORDANO, Arianna GANDINI, Lucia TAURINO, Chiara GIGLI, Francesca INNOCENTI, Riccardo PINI
09:40 - 09:50 #8145 - OP107 Platelet-lymphocyte ratio has a high prognostic significance in patients with multitrauma.
OP107 Platelet-lymphocyte ratio has a high prognostic significance in patients with multitrauma.

Backgrounds: Prognostic parameters to differentiate injuries that may cause fatality gain extra importance to save this group of patients on time.

Aim: To determine the predictive significance of haematological markers (neutrophil, lymphocyte and platelet counts, NLR and platelet lymphocyte ratio [PLR]) for mortality in patients with multitrauma.

Methods: Data of all consecutive trauma patients according to ICD-10 that admitted to our ED were taken from database of our hospital retrospectively. The following ICD codes were scanned for this aim: S00 to T88, V00 to Y99, R58, Z04. Of 46,497 records in 6 years, 6,917 patients with available completed records and initial complete blood count (CBC) studied in ED within 30 minutes were included: 5,984 patients who were discharged from the hospital were evaluated as the control group and 933 patients who died at the hospital were evaluated as the study group.

Results: Of the patients, 68%(n=4685) were men and mean age was 42.6± 20.4. The ROC curves to discriminate mortal cases among all trauma patients for PLR, PLT, NLR, and RDW were 0.803 [95% confidence interval (CI). 0.784–0.823], 0.763 (95%CI: 0.741–0.784), 0.412 (95%CI: 0.390–0.435), and 0.380 (95%CI: 0.360–0.399), respectively. When the diagnostic value of the cut-off value of the PLR was taken as 74.18, sensitivity, specificity, +LR and- LR of in patients with mortal trauma were 85.4, 66.7, 2.6 and 0.2, respectively.

Conclusion: We found that PLR is a statistically significant independent predictor of mortality with high sensitivity and specificity in patients with trauma.


Atıf BAYRAMOGLU (Erzurum, Turkey), Mucahit EMET, Necati SALMAN
09:50 - 10:00 #8153 - OP108 More time spent on the scene in trauma is associated with increased morbidity and mortality.
OP108 More time spent on the scene in trauma is associated with increased morbidity and mortality.

Background: Despite compelling evidence for better outcome with a shorter pre-hospital time in trauma, there continues to be debate surrounding different approaches used on the scene. North America advocates the “scoop and run” principle comprising basic life support, minimal intervention and rapid transfer to definitive care. However Europe continues to employ a “stay and play” practice with advanced life support and multiple complex procedures being commonplace.

Objective: The purpose of this study was to assess the impact of on scene time on morbidity and mortality for major trauma patients.

Methods: A retrospective analysis of ambulance sheets and trauma proformas for patients presenting to Queen Elizabeth Hospital Birmingham (major trauma centre) was performed from June 2014 to June 2015 from a prospectively maintained database. A complete set of pre-hospital times was defined as call-time, time-on-scene, time-left-scene and time-at-destination. Basic demographics, injury severity score (ISS), length of stay (LoS) and mortality were recorded. Rapid sequence induction (RSI) and advanced life support (ALS) procedures were also documented.

Outcomes were assessed using SPSS software. Multiple linear regression was used to assess how on scene time impacts LoS in hospital with log LoS as the dependent variable. Multivariable binary logistic regression was performed to calculate the effect of on scene time on mortality. Both of these were corrected for age, ISS and remaining pre-hospital time defined as the sum of call-time to time-on-scene and time-left-scene to time-at-destination.

Results: A total of 494 patients presented to the Emergency Department. 363 patients (median age 52 [range 13-101] M275:F88) had a complete set of pre-hospital times. Median on scene time was 39 minutes (range 6 minutes-2 hours 13 minutes) and the median for remaining pre-hospital time was 28 minutes (range 2 minutes-2 hours 14 minutes).Median ISS was 16 (range 1-75) and there was a 14-day median LoS (range 2-128 days). 42 patients (12%) died. RSI was performed on 53 counts (15%) and 14 patients (4%) underwent pre-hospital ALS.

Multiple linear regression revealed that for every additional hour spent on the scene there was a 70% increase in LoS (95% confidence interval 31-123%) with a strong statistical significance after correcting for age, ISS and remaining pre-hospital time (p < 0.001).

Multivariable binary logistic regression similarly showed an odds ratio of 3.19 for mortality (95% confidence interval 1.17-8.68) with every additional hour spent on the scene. This was again statistically significant after correcting for age, ISS and remaining pre-hospital time (p = 0.023).

Conclusion: Trauma networks are established to provide rapid transfer to a tertiary centre for definitive treatment. Pre-hospital medics must be mindful that a longer on scene time negatively effects morbidity and mortality for polytrauma patients. The authors of this study therefore advocate the “scoop and run” approach.


Vittorio DECARO (Northampton, United Kingdom), Indervir BHARJ, Azam MAJEED, Peter NIGHTINGALE
Room OP-SCHATZKAMMERSAAL
10:05

Wednesday 05 October

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PH6-S1
10:05 - 10:25

Poster Highlight Session 6 - Screen 1

10:05 - 10:10 #7670 - Quality of life after a mild to moderate trauma in old patients: a long-term follow-up.
Quality of life after a mild to moderate trauma in old patients: a long-term follow-up.

Background: To evaluate long-term reduction in health-related quality of life (HRQOL) after a mild to moderate trauma in old patients admitted to an Emergency Department High Dependency Unit (ED-HDU), and to study possible determinants of the HRQOL reduction.

Methods: We performed a follow-up study of a cohort of 662 trauma patients admitted to the ED-HDU of the University Hospital of Florence from July, 2008 to December, 2014; 247 subjects were lost at the follow-up. Anamnestic and main clinical data were obtained for each patient, in order to evaluate the organ dysfunction index Sequential Organ Failure Assessment (SOFA) score at ED entrance (T0) and after 24 hours of ED-HDU stay (T1). Injury Severity Score (ISS) was calculated using the 2005 updated version of the Abbreviated Injury Score. A follow-up based on telephone interviews using the Physical (PCS) and Mental (MCS) Health Composite Score (SF12) was conducted in the period October, 2015-January, 2016.

Results: Overall mortality rate was 9% (2% in-hospital mortality and 7% mortality rate during follow-up). The study population included 344 patients, 223 aged ≤65 years (G1) and 121 >65 years (G2). Male gender was more frequent in G2 compared to G1, (47 vs 23%, p<0.001) and prevalence of comorbidity was disproportionately higher in G2 compared to G1 (79 vs 24%, p<0.001). Trauma severity was comparable between the two groups (ISS: G1 12±8 vs G2 13±9; major trauma 30 vs 35%, all p=NS), while T0 and T1 SOFA scores were higher in G2 compared to G1 (T0: 2.2±1.7 vs 1.4±1.4; T1: 2.2±1.5 vs 1.6±1.3, all p<0.001). All but one non-survivors belonged to G2. PCS and MCS scores were significantly lower in G2 than in G1 (PCS: 38±12 vs 47±10, p<0.001; MCS 47±13 vs 50±12, p=0.03). After categorization of the scores into four disability levels, G1 and G2 distribution of subjects across levels was different both for PCS (normal 54% vs 25%, mild disability 19% vs 17%, moderate disability 20% vs 23%, severe disability 6% vs 35%, p<0.001) and MCS scores (normal 62% vs 52%, mild disability 19% vs 15%, moderate disability 9% vs 22%, severe disability 10% vs 12%, p=0.014). Among G1, subjects with an abnormal (<39) PCS score were older (48±13 vs 41±15 years, p=0.001), had a higher prevalence of comorbidities (43 vs 19%, p<0.001) and developed a higher degree of organ damage in the acute phase (T1 SOFA 2.0±1.4 vs 1.5±1.2, p=0.015) compared with subjects with a normal score. G1 patients with an abnormal MCS score were older (49±12 vs 42±15 years, p=0.001) and had a higher prevalence of comorbidities (39 vs 21%, p=0.018) compared with G1 subjects with a normal score. Among G2 patients, older patients had higher PCS and MCS scores (PCS: 79±7 vs 75±7; MCS 80±6 vs 76±7, all p<0.05) and, only for PCS, a higher prevalence of comorbidities (87 vs 70%, p=0.029).

Conclusions: mild to moderate trauma carries a significantly worse prognosis among old subjects compared with their younger counterpart, both in term of mortality and quality of life.


Chiara GIGLI (Sesto Fiorentino, Italy), Federica TRAUSI, Alessandro COPPA, Rita AUDISIO, Stefano CALCAGNO, Francesca INNOCENTI, Riccardo PINI
10:10 - 10:15 #8001 - Validation of a belgian prediction model for patient encounters at music mass gatherings.
Validation of a belgian prediction model for patient encounters at music mass gatherings.

Purpose: A Belgian Medical Resource Model, Plan Risk Manifestations (PRIMA), for the prediction of the number of patient encounters at mass gatherings has recently been developed in addition to the existing models of Arbon and Hartman.

Relevance: Several predictive models have been published but all of these models have their limitations. The PRIMA model is a versatile predictive medical resource tool suitable for application across various types of MG. The purpose of our study was to validate the PRIMA during music mass gatherings in the province of Antwerp, Belgium.

Participants: All patients who sought medical help at one of the first aid stations on-site of the selected events were included in our study.

 Methods: a retrospective study was conducted using data gathered from music mass gatherings in the province of Antwerp (Belgium) during the period of 2012 – 2014. Data from 48 music mass gatherings was used for the study.

 Analysis: The forecast of medical resources for these events were determined by entering the characteristics of individual events into the Arbon, Hartman and PRIMA models. The data gathered was retrospectively compared to the predicted number of resources needed using the aforementioned models. This triple comparison was used to determine whether the PRIMA model was over- or under predictive for medical resources needed.

 Results:  Our study showed that all three models had an acceptable rate of overprediction of number of patient encounters (Arbon 11,66%; Hartman 10,42%; PRIMA 25%), but an high rate of under-prediction of number of patient encounters (Arbon 77,08%; Hartman 89,58%; PRIMA 70,83%). Only our PRIMA model succeeded in the correct prediction of the number of patient encounters on two occasions (4.17%).

 Conclusion: the PRIMA model is a more accurate tool in predicting the number of patient encounters and for medical resources needed at music mass gatherings.


Kris SPAEPEN (Willebroek, Belgium), Winne HAENEN, Leonard KAUFMAN, Ives HUBLOUE
10:15 - 10:20 #8032 - Health-Related Quality Of Life (HRQOL) in patients with moderate and severe trauma in Hong Kong: 4 year prospective multicentre cohort study.
Health-Related Quality Of Life (HRQOL) in patients with moderate and severe trauma in Hong Kong: 4 year prospective multicentre cohort study.

Introduction

Trauma care systems aim to reduce death and to improve quality of life and functional outcome in trauma patients. The long term quality of life has not been well documented in Chinese patients with moderate to severe trauma. The aim of this study was to evaluate post-injury health-related quality of life (HRQOL) in patients with moderate and major trauma over four years in Hong Kong.

 

Participants and methods

This was a multicentre, prospective cohort study using data from the trauma registries of three regional trauma centres in Hong Kong. Trauma patients with an ISS≥9 and aged≥18 years were included. Main outcome measures included the number of patients with physical component summary (PCS) score and mental component summary (MCS) scores of the Short-Form 36 (SF36) for health status. Good outcomes were defined as patients reaching the Hong Kong norm for PCS, namely >52.83.

 

Results

From 1st January 2010 to 30th September 2010, 400 patients were recruited to the study (mean age 53.3 years; range 18-106; 70% male; ISS 9-5, N=139; ISS≥16, N=261). The proportion of surviving responders (66/143) reaching a PCS equivalent to the Hong Kong population norm was 46.2%, and 16.5% (66/400) of the total original patients.  As there were no statistically significant differences between surviving responders and non-responders at baseline, it is reasonable to assume that 46.2% of the 179 surviving non-responders (N=83) also reached the HK population norm.  If so, then the total number of cases reaching the HK population norm for PCS is 66+83=149, i.e. 37.2% of the original 400 patients. 

 

Conclusion

Four years after injury, patients with moderate and major trauma have a 17 to 37% chance of reaching the Hong Kong normal PCS (52.83).

 

Acknowledgement

This study was supported by Health and Health Services Research Grant 07080261 and Health and Medical Research Fund Grant 10110251.


Colin A GRAHAM, Dr Kevin Kc HUNG (Hong Kong, Hong Kong), Janice Hh YEUNG, Wai S POON, Hiu F HO, Chak W KAM, Timothy H RAINER
10:20 - 10:25 #8107 - Cars kill, bikes thrill. The spectrum of cycling trauma presenting to an Irish Emergency Department.
Cars kill, bikes thrill. The spectrum of cycling trauma presenting to an Irish Emergency Department.

Introduction

Cycling has been shown to have significant health and environmental benefits. Public rental bicycle and tax incentive schemes have been introduced in Ireland in recent times and the Central Statistics Office (CSO) reported in the 2011 census that there was a 9.6% increase in the number of people cycling to work when compared to 2006. As the number of cyclists increases, this may lead to more cycling injuries presenting to hospital.

St. Vincent’s University Hospital (SVUH) participates in the Trauma Audit and Research Network (TARN). This database aims to enhance trauma care by auditing and researching injury and systems of care and by integrating trauma services within and between hospitals. A trauma case must meet strict inclusion criteria to be included in TARN encompassing: trauma (irrespective of age), length of stay criteria and isolated injury criteria. Currently there is little published research on the prevalence of cycling injuries presenting to emergency departments (EDs) and specifically relating to the traumatic injuries that cyclists may present to hospital with.

The aim of this study is describe the cycling related traumas that have presented to this hospital from September 2013 to May 2015.

 Methods

This is a retrospective review of patients with a cycling-related injury presenting to the ED of St. Vincent’s University Hospital (SVUH) from September 2013 to May 2015. Subjects were identified by interrogating the TARN database in SVUH. Only cases that met the inclusion criteria for TARN were included in this study.

Results

Demographics

During the study period there were a total of 87 cycling traumas that presented to SVUH. 65 patients (74.7%) were male. The mean age of the patients was 37 years (Standard deviation (SD) 2.0; range 3-85). 79 cyclists (90.1%) visited ED for their trauma.

 Injury

The mean ISS was 14.5 (SD 10.5; 4-43). An ISS between 1-8 was recorded in 15 patients (17.2%), 9-15 in 25 patients (28.7%) and 47 patients (54.0%) had an ISS greater than 15. The mean GCS was 10 (SD 5; 3-15). The mean probability of survival (Ps) was 93.9 (SD 15.1; 1.6-99.8).

Outcomes

There were 3 mortalities in this group. The mean LOS was 16.3 days (SD 27.7; 1-198). 16 patients (18.4%) were admitted to the ICU with a mean LOS of 7.8 days (SD 9.7; 1-31). 9 cyclists (10.3%) were transferred in from other facilities to this ED, 2 cyclists (2.3%) were transferred in and subsequently transferred out to another facility while 14 cyclists (16.1%) were transferred out to other facilities for further care.

Conclusion

This study highlights the significant trauma that cyclists can endure with over half the patients sustaining an ISS of greater than 15. There was significant demand placed on resusictative care both in ED and in the ICU due to the severity of the injuries. More research is required to fully evaluate the extent of cycling injuries in Ireland and this data may guide injury prevention strategies in the future.


James FOLEY (Wexford, Ireland), John CRONIN, John RYAN

Wednesday 05 October

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PH6-S2
10:05 - 10:25

Poster Highlight Session 6 - Screen 2

10:05 - 10:10 #8261 - cardiac arrest management in grey’s anatomy – is it compliant with advanced cardiac life support guidelines?
cardiac arrest management in grey’s anatomy – is it compliant with advanced cardiac life support guidelines?

 

Introduction

 Medical TV drama series have increased in popularity over the past 10-15 years with in excess of 20 million viewers for each episode of Grey’s Anatomy. Evidence suggests that viewers overestimate the survival chances of resuscitation in cardiac arrest. This effect increases with increasing amount of these medical dramas watched. Advanced Cardiac Life Support training has contributed to  the increased survival from cardiac arrest. (42.7% in 2000 to 54% in 2009). Cardiac arrest

 Aims:

The primary aim of this study was to determine if cardiac arrest management in Grey’s anatomy is compliant with Advanced Cardiac Life Support Guidelines.

 The secondary aim was to determine if outcomes of in-hospital cardiac arrest in Grey’s Anatomy were consistent with published outcomes.

 Results:

 This is the most comprehensive analysis of Grey’s anatomy available. All 246 episodes of Grey’s Anatomy in seasons 1-11 inclusive were watched separately by two of the authors and the findings were checked by the third author. Cardiac arrest was observed in 111 (45.1%) episodes. Of these 43.2% were traumatic, 42.3% cardiac, other 8.1% and was not stated in 6.3% of cardiac arrests.

 In excess of 60% of all cardiac arrests demonstrated significant deviation from ACLS guidelines.Significant

 

 The initial cardiac arrest rhythm was correct in 10.9%, incorrect in 4.1% and could either was not visible or not stated by the television characters in 85% of patients. Overall survival was 42.3%. 30.6% of patients died while outcome was not stated in 27% of cases.

 52 (46.8%) of cardiac arrest patients were defibrillated. Of these 20 (38.5%) were appropriate, 13 (25%), inappropriate and 22 (42.3%) insufficient information was available to determine appropriateness of  defibrillation.

 Conclusion

 Medical TV dramas demonstrate significant deviation from ACLS guidelines. Despite this survival rates are consistent with real life figures. No data regarding survival to discharge was available.


Louise BALLESTY (Longford, Ireland), Richard M. LYNCH, Breda WARD
10:10 - 10:15 #7881 - A multisource derivation of guidelines for education and screening for human trafficking in the emergency department.
A multisource derivation of guidelines for education and screening for human trafficking in the emergency department.

Trafficking in persons is a major problem that intersects many facets of society, including the legal system, law enforcement, and healthcare. While some elements of society have been active in improving awareness and action against trafficking in persons, healthcare has been slow to adopt standardized education and training about this population. There remains some ambiguity regarding how to identify these victims, but some understanding of screening can be correlated from literature surrounding intimate partner violence. An understanding of what is known of the epidemiology, combined with evidence of efficacy of screening techniques for other vulnerable populations, supports targeted screening. Emergency medicine as the front line of the healthcare system has a unique opportunity to access these vulnerable patients and connect them with services. With a review of easily accessible literature, training, and legal documents, we make a case for a comprehensive training program for emergency medicine residents. Our recommended training would include epidemiology of the populations involved, screening and interviewing, training and practice, understanding of ways to access local resources, and education around risk factors and indicators to help identify victims.

 

Because the literature on TIP traverses multiple social areas (legal, law enforcement, global and public health, economics, healthcare), a formatted comprehensive literature search was not possible. Therefore, the research team opted to utilize a combination of generalized Pub-Med searches and internet and lay-literature sources to gather the most prominent current literature that would be available to residency directors seeking to develop a program. While this non-traditional research method leaves the possibility of key components being missed, it represents a more practical approach to gaining an understanding of a subject that crosses multiple academic lines.

 

While the evidence on how to identify and manage the victims of human trafficking is inconclusive, what is clear is that there is a great unmet need with regard to healthcare providers awareness of and education on this subject. By utilizing and understanding the current literature on TIP, lessons learned in other realms, such as screening tools for intimate partner violence, interview techniques and practices from the legal and law enforcement literature, and what is known about the environment of the emergency department, we have constructed a guideline for the development of a curriculum on the subject for emergency medicine residents. This guideline, supplemented with an understanding of local epidemiology and available resources, can allow residency programs to fulfill a portion of the unmet educational need on this important subject.   


Stephen MORRIS (seattle, USA), Marlee HAHN, Brandy CLUCKA
10:15 - 10:20 #7980 - An Innovative Alternative to Audit Days in the Emergency Department: Serious Incident Learning Initiative (SILI) a study.
An Innovative Alternative to Audit Days in the Emergency Department: Serious Incident Learning Initiative (SILI) a study.

Introduction

Audit, or multidisciplinary meetings, are integral to the understanding and dissemination of information gained from review and analysis of adverse clinical incidents.  Such meetings are known to be educational, improve the quality of care, minimise litigious cost implications and allow an open forum for interaction of a multidisciplinary team.  The hectic nature of the Emergency Department (ED) (Mid Essex Hospitals population coverage of 320 000) does not permit the safe suspension of clinical practice to allow for audit or multidisciplinary meetings.  Therefore we devised an innovative and alternative meeting called the ‘Serious Incident Learning Initiative’ (SILI).

 

Material and Methods

SILI is two identical, interactive, 30 minute presentations of a chosen, previously investigated, serious incident chaired by an ED consultant, run back to back.  The meetings are open to all staff.  This optimises the number of staff that can attend without compromising continuous care.  We have assessed the practicality of meetings by evaluating the means of attendance in each category (doctors, nurses, administrators and GPs) against the number of staff present on the day between November 2014 and September 2015. A short, anonymous survey was conducted consisting of 5 questions both online and in paper format to maximise responses between February and March 2016.  Educational benefit was measured against two factors of beneficial versus non-beneficial and learning outcome versus no learning outcome. Sustainability was measured by a desire to attend further meetings or no desire to attend further meetings.  The outcome of the survey was subjected to a paired t test using IBM Statistical Package for the Social Sciences (SPSS version 20).  A p value of 0.05 or less at 95% confidence interval was considered statistically significant.

Results:

Of a total of 9 SILI meetings over a period of 10 months, 82% of doctors (n=96/117), 36% of administrators (n=15/42), 34% of nurses (n=122/360) and 25% of GPs (n=2/8) successfully attended the meeting. The overall mean attendance was 44.6% (n=235/527) (inclusive of all permanent and non-permanent staff).  The outcome of the survey demonstrated a statistically significant educational benefit of SILI meetings (versus non-educational) (95% CI, p<0.001).  This was also evident in the sustainability of SILI meetings (versus non-sustainability) (95% CI, p<0.001).

 

Conclusion:

The SILI meeting is an innovative, methodological approach to the morbidity and mortality meeting in a busy ED environment where the accepted standard is not feasible.  The regular attendance, attested educational benefit and sustainability demonstrated through this pilot study could serve as a model for any department or speciality seeking an alternative to the audit or multidisciplinary meetings.  This model could serve as a platform and be adapted to deliver any other clinical and educational workshops and/or meetings within the busy emergency department.


Karen RHODES (Chelmsford, United Kingdom), Pallav BHATNAGAR
10:20 - 10:25 #8095 - The development of the advanced clinical practitioner (ACP) curriculum and credentialing programme in the UK.
The development of the advanced clinical practitioner (ACP) curriculum and credentialing programme in the UK.

 

 

Emergency care globally, faces significant challenges with longevity and increasing patient attendances and a shortage of doctors choosing this specialty as a career choice. The UK is no exception and one of many initiatives to address this issue is the development of the advanced clinical practitioner role.(ACP) Over the past two decades emergency nurse practitioner roles with a focus on minor illnesses and injuries have become ubiquitous and in some areas nurses have further progressed their roles assessing a wide variety of acute illnesses and injuries to meet local needs.

Educational and professional regulatory frameworks in the UK have not kept pace with these developments and as a result practice will vary from place to place and there is no clear definition or understanding of what competences the ACP possesses. Higher Education Institutions provide high quality Masters level courses in advanced practice and many nurses undertaking these roles will undertake a Masters degree, but these programmes do not include specialty specific competences or nationally defined curricula. There is variation in the range of competences acquired, and no standardisation of the level of competence of the practitioner. In response to this, the Royal College of Emergency Medicine (RCEM) and Health Education England (HEE) set up an advanced clinical practitioner group (ACP) curriculum development group. Their intention was to establish and develop a national curriculum which would provide standardisation and consistency,ensure  patient safety, and allow transferability of competences from employer to employer. The long term aim is that employers will have a workforce consisting of qualified, credentialed ACPs multi-professional workforce to meet future demands for emergency care.

For the Credentialing process ACPs (predominantly nurses and paramedics working in emergency care) will use an e-portfolio to collect evidence against each requirement in the Emergency Care ACP curriculum. Trainee ACPs will be working within a learning environment, the quality of which is overseen 
by Health Education England under Local Education and Training Board (LETB) Quality 
Frameworks. It is anticipated that the learning environment in the ED for junior doctors and other learners will be 
strengthened by credentialed ACPs. A trained panel will assess the evidence to decide whether the trainee ACP has achieved the defined competences required in the curriculum. Those meeting the required standard will have a statement of competence which details what they as an ACP can do within a defined scope of practice; This presentation will describe the development of the curriculum and the progress,pitfalls, challenges and benefits to date. 


Mary DAWOOD (Windsor, United Kingdom)

Wednesday 05 October

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PH6-S3
10:05 - 10:25

Poster Highlight Session 6 - Screen 3

10:05 - 10:10 #7880 - The utility of inferior vena cava diameter (IVC) in patients with acute heart failure: review of ultrasound protocol.
The utility of inferior vena cava diameter (IVC) in patients with acute heart failure: review of ultrasound protocol.

Background: The ultrasound “point of care” can permit rapid, accurate, and noninvasive diagnosis of a broad range of acute critical situations in emergencies. Both inferior vena cava (IVC) diameter and the degree of inspiratory collapse are used in the estimation of right atrial pressure. This index correlated significantly with other markers of pulmonary congestion.

Objectives: The primary goal is to determine the utility of IVC diameter and collapsibility as a pulmonary congestion marker in patients with acute heart failure.

Patients and Methods: The cross-sectional study at Emergency Department of Hospital del Vinalopo prospectively evaluated 145 patients between February 2015 and February 2016 complaining of dyspnea in context of acute heart failure. The attending physician of emergency medicine evaluated the patients through NT-proBNP, lung ultrasound (LUS) with determination of B pattern and estimation of IVC diameter during inspiration. Finally, data were compared and quantitative and categorical variables were worked out along with other statistical analysis through estimated indicators. 

Results: The values of NT-proBNP were significantly higher among the patients with acute symptoms of pulmonary congestions and diameter of IVC more than 50% (P≤0.001). In the group of patients with IVC diameter less than 50% the medium value was 5300 (675-28324 P≤0.005).

The medium value of IVC diameter in both group of patients with acute heart failure was 20.4mm (sensitivity 90% and specificity 73%). The correlation between pattern of B lines in LUS, IVC diameter and IVC colapsability resulted significantly in all patients with acute heart failure. (r=0.886, p≤0.001).

The patients with highs values of NT-proBNP and the B pattern in LUS, high index of colapsability of IVC predicted a diagnosis of acute heart failure with a high mortality in a nearest future.

Conclusions:  This study demonstrates that ICV diameter and collapsibility in LUS correlated significantly with values of NT-proBNP in patients with heart failure. The use of estimators in both groups of patients may also enable to distinguished patients with a high risk of decompensated disease with a higher mortality.


Julio ARMAS CASTRO (Elche. Alicante, Spain), Blas GIMÉNEZ FERNÁNDEZ, Laura FERNÁNDEZ CALVO, Juan Carlos REAL LÓPEZ, Tamara MARTÍN CASQUERO
10:10 - 10:15 #8103 - CT brain imaging rates in aged care residents presenting to peninsula health.
CT brain imaging rates in aged care residents presenting to peninsula health.

ABSTRACT

Aim

The aim of the study was to clarify how many , the indications and the outcomes. Did the acute

service investigations change management or outcomes?

Methods

Data for the CT Brain scans performed in 2011 on over 75 y old patients in ED or as inpatients was

generated. From this the Aged care residents were identified, and 3 months from July to

September examined. The patient history was reviewed for premorbid mobility and cognitive

function and a basic Nursing home category of 1-4 allocated dependent on this assessment. Then

CT brain studies, and histories were reviewed for clinical indications, acute changes on scan,

change in management, interventions, or transfers to tertiary care. The focus of the study was

mainly on trauma , but data for ? stroke and delirium patients was also collected.

Results

There were 2780 scans in 2011, 781 of which were on aged care residents. Only 14 - 18 % scans

showed acute changes, fewer changes in management and only 4 transfers. Number of repeat

scans on same patient confronting, age and frailty of patients would override benefit in many

cases, and the negative side to the process was understated with significant emotional and

physical morbidity for the patient and an emotional roller coaster for the family with little discernible

benefit. Mortality was the same across all groups and no different whether scan abnormal or not.

Conclusion

The status quo on management of this common problem needs to be reviewed and a variation on

the CT head guidelines developed.


Dr Fergus MCGEE (Frankston, Australia)
10:15 - 10:20 #8239 - Point of care ultrasound for the diagnosis of congenital lung malformation in newborns: a case series.
Point of care ultrasound for the diagnosis of congenital lung malformation in newborns: a case series.

Objectives

Respiratory distress in newborns often presents diagnostic and management challenges to the attending paediatrician. Many of these babies will require little or no intervention, but it is known
that early intervention in babies with acute respiratory distress often prevents further complications. Point of Care Ultrasound (POCUS) is a goal directed analysis integrated with the clinical examination of the critically ill patient. Its overall scope is to provide rapid dichotomous answers to questions that arise during the assessment to rule-in or rule-out the diagnosis. Between causes of respiratory distress in newborns, congenital diaphragmatic hernia (CDH) and congenital cystic adenomatous malformation (CCAM) are usually obvious on x-ray. We present the results of a consecutive case series of CCAM and CDH diagnosed with POCUS.  

Methods

This is a subanalysis of a prospective, single center, observational study with the aim to verify the diagnostic performance and reproducibility of chest ultrasound in the differential diagnosis of respiratory distress in newborn comparing this procedure with the standard approach in use (x-ray) in term of diagnostic accuracy.  Moreover we want to estimate the time needed to complete POCUS assessment compared to the x-ray assessment.  

The study was conducted on a consecutive sample of patients aged 0 - 29 days with respiratory distress for whom a chest x-ray was required because of respiratory distress. We compared the diagnosis of the chest x-ray with the diagnosis resulted by the POCUS performed by the researchers. The following outcome measures were used: 1) time to the diagnosis, 2) diagnostic accuracy of the two assessments.

Results

During the enrollment period of the parent study, a total of 8 patients with respiratory distress and final diagnosis of CCAM or CDH were evaluated (3 CCAM, 5 CDH). The average time for ultrasound examination 14’15” (range 7’-17’) was significantly lower than the time needed to make a diagnosis with chest x-ray 50’25” (range 27’-80’) (p=0.0001).

We couldn’t calculate sensibility and positive predictive values due to the low number of patients available. We found one false negative in the group of patient with CCAM and one false negative in the group of CDH. In the latter case the diagnosis was lung consolidation.

Conclusions

Although many pediatric thoracic conditions are adequately evaluated with plain radiographs, further imaging is sometimes required. US provides a more accurate and faster diagnosis and the clinically necessary information without radiation exposure. As with most US studies, US of the pediatric chest requires more physician involvement than other modalities to yield optimal results. Understanding proper US techniques and characteristic US imaging appearance of various thoracic diseases in pediatric patients have great potential for early and accurate diagnosis, which in turn, lead to optimal patient care.

 


Niccolò PARRI (Florence, Italy), Martina GIACALONE, Iuri CORSINI
10:20 - 10:25 #8241 - Polytrauma in the elderly : Predictors of the cause and time of death.
Polytrauma in the elderly : Predictors of the cause and time of death.

The aim of this study was to determine the epidemiology and clinical features of the trauma in elderly patients, to investigate the factors influencing mortality and to make a contribution to the national trauma data, METHODS We retrospectively investigated the medical records of three hundred nine trauma patients (143 males (46%); 166 females (54%); mean age 74,7 years +/- 8 aged 65 and older presenting to our hospital. Patients’ census data, diagnosis, dispositions, prognosis, trauma scores (GCS (Glasgow Coma Score), ISS (Injury Severity Score)), sites of injury were analyzed. RESULTS During the study period 103 000 patients were admitted to our emergency department (ED). A total of 40170 patients were trauma patients. There were 309 patients 65 years and older. Mean GCS, mean RTS and mean ISS were 13,64 +/-3,02, 6,97 +/-1,79 and 27,34 +/-29,48 respectively. A total of 18 patients were hospitalized in emergency room . Mean length of stay was 5h+/- 2H. Mortality rate was 14% (43/309). The mechanism of injury, injury severity, increasing age were predictors of mortality (p<0.001). Major injuries included head trauma (53%), extremity trauma ,and thoracic trauma (21%). Head trauma and abdominal trauma were significantly more frequent in the non survivors (p<0.001 and p=0.02 respectively). CONCLUSION Injury severity and increasing age were the predictors of mortality. Also pedestrian- vehicle collision patients were high mortality rate than the other trauma mechanisms. The most common injured organs were head and extremities.
Neila MAAROUFI (JENDOUBA, Tunisia), Mahassen DHAOUADI

Wednesday 05 October

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PH6-S4
10:05 - 10:25

Poster Highlight Session 6 - Screen 4

10:05 - 10:10 #7615 - Efficacy of apneic oxygenation with nasal cannula during emergency department tracheal intubation.
Efficacy of apneic oxygenation with nasal cannula during emergency department tracheal intubation.

Introduction:

Endotracheal intubation in critically ill patients admitted in emergency department(ED) is associated with severe life-threatening complications in about 20%, mainly due to hypoxemia (dysrhythmia, hemodynamic instability , hypoxic brain injury and death) [1]. It has been established that apneic oxygenation can extend the duration of safe apnea when used after the administration of sedatives and muscles relaxants [2].

Purpose: We evaluate the association between the introduction of apneic oxygenation and incidence of desaturation during rapid sequence intubation.

METHODS: A prospective randomized trial conducted in ED over Six months [July-December 2015]. Consecutive patients who underwent endotracheal intubation were included for analysis. In randomized order each patient received either oxygen through nasal cannula at 10 L/min (apneic oxygenation (+)) or no oxygen(apneic oxygenation (-)) until the airway is secured. Pulse oximeter (SpO2) was measured and desaturation was defined as a SpO2 below 90 % at any time during intubation regardless of any preexisting hypoxemia. We compared the incidence of desaturation between the two groups.

RESULTS:We enrolled eighty patients: forty patients in each group. Mean age =44 ± 19 years, 64% were male. Patients history (%): Hypertension (19); diabetes mellitus (1); chronic obstructive lung disease (8%). The main indication for rapid sequence intubation was trauma, which accounted for 59%. Sixty five patients (82%) were intubated in the first attempt. The apneic oxygenation group had significant decrease in desaturation rates (20%) than those with no apneic oxygenation (45%)[P value = 0.017, Hazards ratio (HR) =0.3, 95% confidence interval (CI) =0.11 – 0.82].

CONCLUSION: Apneic oxygenation during apnea at an intubation procedure markedly decreased the incidence of desaturation, suggesting that this technique might be useful when intubating critically ill patients in the emergency room.

REFERENCES:

[1] Mort TC. J Clin Anesth 2004;16:508-16

[2] Weingart SD, Levitan RM.  Ann Emerg Med 2012;59:165-175.


Hana HEDHLI, Houssem AOUNI (Tunis, Tunisia), Rym HAMED, Wided BAHRIA, Ines CHERMITI, Khaled SAIDI, Béchir BOUHAJJA
10:10 - 10:15 #8123 - Emergency department violence.
Emergency department violence.

Introduction:

Caregivers are exposed to bad treatment, threatening and annoyance when working especially those of the emergency department. We observe more violence in the emergency department. The purpose of this study was to identify the main causes and consequences of violent acts against nurses in the emergency department and to evaluate the prevalence and the role of the gender in the different types of violence.

Methods: We conducted an observational study based on a retrospective self-evaluative survey on the last twelve months.

Results:

We selected 45 nurses for the study. The response rate was 82.2%. 59.5% were aged between 25 and 35 years. 48.6% was working between 1 and 5 years. Violent acts had occurred in outpatient emergencies in the morning by a rate of 67.7%. 70.3% of cases occured at the vital emergency rooms and trauma unit. The aggressor was the accompanying (67.6%) and the couple accompanying- patient in 32.4% of cases. The main reasons were waiting (81.1%) and the lack of staff (45.9%). The attacks were mostly verbal (100%), insults (86.5), criticisms and threats (81.1%). Physical assault (78.4%) were mainly type of horseplay (67.6%) and kicking (32.4%). Immediate reactions of neurses were discussion with the aggressor (78.4%) and physical reaction (2.7%. Our study did not showed an effect of gender on the frequency and nature of the assault. 51.4% of nurses expressed a desire for the inclusion of gender in the distribution in the night shift. We founded psychological impact in 78.4%, these effects were showed as well in work and private life in 75.7% of nurses.

29.7% of incidents led to complaints. In 86.5%, the supervisor was informed. The solutions proposed by the staff were the constant need for a police officer in 75.7% and the increase of the number of caregivers in 62.2%.

Conclusions:

Emergency workers are frequently exposed to violence. Institutional solutions should be taken to improve working conditions and staff safety.


Maghraoui HAMIDA (Tunis, Tunisia), Ajala LOBNA, Mghirbi ABDELWAHEB, Kilani MOHAMED, Kallel MOHAMED AMINE, Majed KAMEL, Zaouche KHEDIJA, Hamouda CHOKRI, Borsali Falfoul NEBIHA
10:15 - 10:20 #8133 - Improving the governance of patient safety in emergency care: a systematic review of interventions.
Improving the governance of patient safety in emergency care: a systematic review of interventions.

Background

Executives of emergency healthcare services (EMS) are increasingly held accountable for patient safety, because emergency care involves high patient safety risks. Care is often delivered to high-acuity patients with unstable vital signs in a fast-paced setting under unpredictable conditions. Also, patient handovers between ambulance, helicopter EMS and the emergency department (ED) involve miscommunication and adverse events. Executives have a fundamental governance role in overseeing and managing safety risks within their service. However, insight in validity, reliability and feasibility of interventions that aim to improve the governance of patient safety within emergency care organizations is lacking.

Methods

We performed a systematic review of the literature. PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings.

Results

Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training program and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively.

Conclusion

Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS  and EDs. However, executives cannot rely on a robust set of evidence-based tools to govern patient safety within their emergency care organization. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an experimental design with valid outcome measures to strengthen the evidence base.


Gijs HESSELINK, Sivera BERBEN (Nijmegen, The Netherlands), Thimpe BEUNE, Lisette SCHOONHOVEN
10:20 - 10:25 #8271 - Prevalence of ambulatory care sensitive conditions and their association with patient characteristics in emergency department patients.
Prevalence of ambulatory care sensitive conditions and their association with patient characteristics in emergency department patients.

Introduction

Ambulatory care sensitive conditions (ACSC) consist of a subset of diagnoses (ICD10 codes) and are established to be potentially avoidable hospitalizations. ACSC are being used as a surrogate parameter for the quality of ambulatory care.

Objective

To investigate the prevalence of ACSC in ambulatory as well as hospitalized patients on the basis of diagnoses coded during the Emergency Department (ED) stay and in hospital.

Methods

 The study populations consisted on consented, non-surgical ED-patients with all symptoms and severity levels (n=1,152). All electronically documented routine data were retrieved from the hospital information system (HIS). A follow-up was performed after 1 year to obtain outcome measures. ACSC were defined according to Purdy et al. (Public Health; 2009).

Results

Of all patients, 57.5% (n=662) were discharged home after ED-visit (ambulatory patients) and 42.5% (n=490) were hospitalized (inpatients). ACSC were coded in 18.1% (n=208) of all patients as an ED-diagnosis and in 25.3% of all inpatients as hospital main diagnosis. ACSC showed an increasing trend with higher Manchester Triage Category (MTS) only in inpatients (red=37.5%, orange=30.0%, yellow=21.9%, green=20.6%, blue=0.0%; p=0.022) and ACSC in all patients were more frequent older patients (

Conclusions

Our results show a high prevalence of ACSC in the ED and especially in hospitalized patients with higher triage categories. According to the ACSC concept every fourth hospitalization of ED-patients could have been avoided by adequate treatment in the primary care setting. Thus prospective studies should focus on the identification of influencing factors and potential supply gaps, especially in vulnerable populations, in the German health care system.

 


Pr Anna SLAGMAN (Berlin, Germany), Johann FRICK, Julia SEARLE, Pr Möckel MARTIN

Wednesday 05 October

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PH6-S5
10:05 - 10:25

Poster Highlight Session 6 - Screen 5

10:05 - 10:10 #7555 - The Evaluation Of Reduction Success In The Patıents With Dıstal Radius Fracture Under The Guidance Of Ultrasonography.
The Evaluation Of Reduction Success In The Patıents With Dıstal Radius Fracture Under The Guidance Of Ultrasonography.

Introductİon

Distal radius fracture, which is most commonly seen in the upper extremity, comprises 1/6 of the fractures treated in the emergency department (1). In this study, it was primarily aimed that the effect of ultrasonography performed on the adult patients in the course of the closed reduction of distal radius fracture on reduction success be evaluated.

Materıal And Method

Our randomized, controlled, prospective and cross-sectional research was carried out in the university hospital. After we received an approval from the local ethics committee, the patients aged over 18, who had wrist (carpus) trauma and in whose direct graphies a displaced distal radius fracture was detected, which required a reduction process, were examined between the periods, March 2014 and April 2015. The patients in whose graphies a distal radius fracture was detected were randomized as case and control groups according to the application order. The patients in question were informed about sedation and analgesia to be applied before and during the reduction process to be performed, and their informed consent forms were received, as well. Ultrasonography was performed on the patients comprising the case group in which distal radius fracture was detected through the use of a 7,5 Mhz-linear probe on two planes as dorsal and lateral by the assistants of emergency medicine.

Results

A hundred twenty patients comprising the inclusion criteria of the research were incorporated into the study; however, one of the patients was excluded from the study later on because of treatment rejection; for this reason, the study population consisted of 119 patients. The case group to which ultrasonography was applied comprised 60 patients, whereas the control group on which standard approach was performed consisted of 59 patients. No difference was observed between the case and control groups.

In our research, it was determined that when the use of ultrasonography and the standard approach were compared, the reduction success in the ultrasonography group had showed an increase in the reduction of the patients with distal radius fractures. Separately, the requirement for re-reduction in the patients in whom reduction was provided through ultrasonography was determined as 25% in the case group and 45,8% in the control group. When compared with X-Ray, which is currently the golden standard approach in evaluating the status of post-reduction success, it was ascertained that the reduction success could be evaluated through ultrasonography with 97,7%, 86,6%, 95,6%, and 92,8% sensitivity, specificity, ppv and npv.

Dıscussıon

In conclusion; ultrasonography promotes the reduction success of the patients with distal radius fractures in the practice of emergency medicine. With the use of ultrasonography, fewer re-reduction processes are required in this patient population. In the prospective studies, the effect of ultrasonography on reduction success can be scrutinized in the patients with instable radius fractures.


Ercüment UMDU, Funda KARBEK AKARCA (Izmir, Turkey), Sercan YALCINLI, Ozgur BOZKURT, Levent KUCUK
10:10 - 10:15 #7654 - Efficacy of therapeutic hypothermia combined with fasciotomy on experimental compartment syndrome in a rat model.
Efficacy of therapeutic hypothermia combined with fasciotomy on experimental compartment syndrome in a rat model.

Objective: Acute limb compartment syndrome is a surgical emergency due to raised pressure within the facial area and if not treated within the first six hours can cause irreversible muscle and nerve injuries. The goal of the treatment in compartment syndrome is lowering the intracompartmental pressure to prevent tissue necrosis and loss of function. Recently, alternative methods to fasciotomy that is a surgical emergent intervention or other methods may contribute to treatment are to be investigated. Supposing that hypothermia would be effective in reducing the tissue damage, we planned to compare fasciotomy and hypothermia.

Material & Methods: This study was carried out with forty rats which were randomly divided into four groups: control, fasciotomy, hypothermia and fasciotomy including hypothermia. Compartment model was created by a method including compression by tourniquet applied to one hindlimb of all rats followed by 2 hours of reperfusion. Hypothermia and fasciotomy including hypothermia groups were applied water at temperature of 8-10 º C for 4 hours. Lower limbs of all groups were amputated and examined histopathologically. Subsequently Creatine Kinase, Lactate Dehydrogenase, Myoglobine and Potassium levels were measured from the blood samples obtained from all groups.  During the evaluation of the results obtained, statistically significant differences were found.

Conclusion: It is determined that hypothermia is effective on reducing tissue edema, congestion, inflammation and intracompartmental pressure. According to the results of our study; due to all of these features, hypothermic treatment provide time and contribution to fasciotomy.


Cengiz KAYA, Mehmet ERYILMAZ, Ibrahim ARZIMAN, Umit KALDIRIM, Murat DURUSU, Guclu AYDIN, Emre CAVANA, Ali Fuat CICEK, Salim Kemal TUNCER, Saban Mehmet YASAR (Ankara, Turkey)
10:15 - 10:20 #7779 - Characteristics of First time seizure in adults presenting to the emergency department.
Characteristics of First time seizure in adults presenting to the emergency department.

Seizures are a common pattern for seeking care in the Emergency Department (ED). Up to 5% of the population will experience at least 1 nonfebrile seizure at some point during their lifetime (Emerg Med Clin North Am. 2011). The management of a patient who has had a first-time seizure is driven by the history and physical examination and can be a challenge for the emergency physician.

Objective: to identify the epidemiological, clinical and prognostic factors of adult patients presenting to the ED with first time seizure.

Methods and design:

A prospective observational study, conducted over two years. Were included all patients aged>18 years old who presented to the ED with first time seizure. The epidemiological, clinical, biological, therapeutic, and evolution criteria were collected. The prognosis was evaluated on day 7, day 30 and 6 months. Multivariate analysis by multiple logistic regression was performed.

Results:

During the study period, 272 patients with seizures were admitted in the ED. Among them 155 presented with first time seizure and were included in the study. Mean age 48±20 years. Sex-ratio 1.38. Comorbidities: diabetes N = 30 (19%), history of systemic disease N = 8 (5.2 %), history of neonatal pain N = 3 (1%) history of Alzheimer's disease n = 2 (1.2%), psychiatric disease n = 4 (2.5%), stroke N = 12 (7.7%), hypertension n = 19 ( 12%), heart disease n = 4 (2.5%), thyroid dysfunction n = 2 (1.2%), chronic renal failure n = 4 (2.5%), history of neoplasia n = 2 (1.2% ), and one patient with drug addiction. 135 (87%) had generalized tonic-clonic crisis. 31 (20%) patients had neurological deficits. Mean lactate level was 5,4 ± 3,9. The diagnosis of accompanied seizures was made in 103 (66%) patients. In 51 (44%) patients the diagnostic of simple attack was made. Etiology of seizures: 16 patients (10%) had a head injury, 5 (3.2%) had a documented infection, 11 (7%) had intoxication. stroke was found in 33 patients (14 hemorrhagic and ischemic 19). 7 cases of intra cranial expansive process have been identified, 2 cases of hydrocephalus, and a case of cerebral thrombophlebitis. No obvious cause found in 51% of cases. Eight percent had poor prognosis and were admitted to the ICU. The overall mortality was 9%. The recurrence of seizures was 7% at day 7, 22% at day 30 and 20% at 6 months.

Conclusion: the First time adult seizure is a challenge for the emergency physician. He should seek for reversible causes and epileptogenic lesion that can have an impact on the diagnosis, prognosis, and treatment of new-onset seizures


Rania JEBRI (Lyon), Anware YAHMADI, Aymen ZOUBLI, Hanane GHAZALI, Mohamed Ali GHARBI, Hayet MELKI, Mohamed MGUIDICH, Sami SOUISSI
10:20 - 10:25 #8152 - Factors affecting the time to admission to the emergency department in patients with acute stroke.
Factors affecting the time to admission to the emergency department in patients with acute stroke.

Introduction:

Acute ischemic Stroke is a neurovascular emergency. We must act on all the factors influencing the different stages from recognition until the end of the treatment to improve the prognosis of this pathology.

Objective:

To analyse the factors influencing the time of admission of patients presenting an acute stroke in the emergency department (ED).

Methods:

Prospective, monocentric, observational study conducted over four years. Inclusion: patient (age ≥ 18 years) with neurological signs suggestive of acute stroke. Report of socio-demographic, epidemiological, clinical and scanner criteria. Stroke severity was evaluated with the National Institutes of Health Stroke Scale (NIHSS). Two groups were identified depending on the time between the appearance of functional signs and emergency department visit: Group (time < 3 hours), Group (time ≥ 3h). Univariate and multivariate analysis by multiple logistic regression to identify factors influencing the admission period.

Results:

Inclusion of 245 patients. Mean age = 66 ± 14 years. Sex ratio = 2.85. Group (time <3 hours): n = 139. Group (time ≥ 3h): n = 106. Cardiovascular risk factors (%): hypertension (64), diabetes (34), history of stroke (24), atrial fibrillation (12). Ischemic Stroke: 75% of cases. Average NIHSS = 8 ± 6. Average Glasgow coma scale (CGS) = 13 ± 2.

Univariate analysis identified the occurrence of the deficit at home and in the public areas , facial involvement , CGS ≤13, systolic blood pressure (SBP ) ≥ 160 mmHg and diastolic blood pressure (DBP ) ≥ 100mmHg , NIHSS ≥ 10 as significantly related to a time < 3 hours.

In multivariate analysis : facial involvement( adjusted OR = 1.25 , 95% CI [ 1,3-1.6] , p = 0.05) and CGS≤13 ( adjusted OR = 1.13 , 95% CI [ 1.03 - 1.26 ] , p = 0.016 ) was independently associated with an admission period < 3h.

Conclusion:

The facial involvement and CGS ≤13 were independently associated with admission time < 3h.               

 


Syrine KESKES, Hanen GHAZALI (Ben Arous, Tunisia), Ahmed SOUYAH, Anware YAHMADI, Farah RIAHI, Najla ELHENI, Sawsen CHIBOUB, Sami SOUISSI
10:30

Wednesday 05 October

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A42
10:30 - 12:00

State of the Art
Hot Topic - EBM

Moderators: Christian HOHENSTEIN (PHYSICIAN) (Bad Berka, Germany), Bas DE GROOT (Amsterdam, The Netherlands)
10:30 - 11:00 Creating a national network for clinical research. Alasdair GRAY (Edinburgh, United Kingdom)
11:00 - 11:30 How and when to teach evidence-based Emergency Medicine. Sandra VIGGERS (Medical Student) (Copenhagen, Denmark)
11:30 - 12:00 Why is symptom-oriented research important ? Roland BINGISSER (Basel, Switzerland)
Room A-FESTSAAL

Wednesday 05 October

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B42
10:30 - 12:00

Austria, Germany, Switzerland Invites
Ärzte / Pflege innerklinisch - Change Management & Umsetzung

Moderators: Philip EISENBURGER (Head) (Vienna, Austria), Michael WÜNNING (Germany)
10:30 - 11:00 Patientenflow in der Notaufnahme verbessern. Michael HILLEBRAND (Germany)
11:00 - 11:30 Medizinische Ausbildung für die Generation Y. Martin FANDLER (Consultant) (Bamberg, Germany, Germany)
11:30 - 12:00 Die Fachweiterbildung Notfallpflege - Charité, Aktueller Stand und Perspektiven. Mareen MACHNER (Germany)
10:30 - 12:00 Führungsakademie DGINA. Michael WÜNNING (Germany)
Room B-ZEREMONIENSAAL

Wednesday 05 October

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C42
10:30 - 12:00

Philosophy & Controversies
P&C Mountain Medicine

Moderators: Damian MACDONALD (Canada), Peter STRATIL (VIENNA, Austria)
10:30 - 11:00 Mountain Medicine: evidence based management of common conditions. Philip SCOTT (Anaesthetic Registrar) (Bristol, UK)
11:00 - 11:30 Cardiovascular Disorders at Altitude. Stephen PETTIT (United Kingdom)
11:30 - 12:00 Hypothermia. Peter PAAL (Head of Department) (Salzburg, Austria)
Room C-PRINZ EUGEN SAAL

Wednesday 05 October

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D42
10:30 - 12:00

EUSEM Meets EM Global Leaders

Moderators: Dr John HEYWORTH (Consultant) (Southampton), Dr Barbara HOGAN (Past President of the European Society for Emergency Medicine, EuSEM) (HAMBURG, Germany)
10:30 - 11:00 Diary of a wimpy journal - lessons from navigating publication adolescence. Stevan BRUIJNS (Senior lecturer) (Cape Town, South Africa)
11:00 - 11:30 The challenge of developing Emergency Medicine. Katrin HRUSKA (Emergency Physician) (Stockholm, Sweden)
11:30 - 12:00 Quality, equality and development of Emergency Medicine in Europe. Roberta PETRINO (Head of department) (Italie, Italy)
Room D-FORUM

Wednesday 05 October

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E42
10:30 - 12:00

Research
Hot off the press

Moderators: Helen ASKITOPOULOU (Chair Ethics Committee) (Heraklion, Greece), Basar CANDER (Turkey)
10:30 - 11:00 A randomised controlled trial of oxygen for patients with acute myocardial infarction. Ardavan KHOSHNOOD (Lund, Sweden)
11:00 - 11:30 Prednisolone for the treatment of acute gout. Timothy HUDSON RAINER (Cardiff, United Kingdom)
11:30 - 12:00 Update from the RAPID-CTCA trial. Alasdair GRAY (Edinburgh, United Kingdom)
Room E-GEHEIME RATSTUBE

Wednesday 05 October

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F42
10:30 - 12:00

YEMD
Simulation for education

Moderators: Antoine TESNIERE (Paris, France), Jennifer TRUCHOT (MEDECIN) (Paris, France)
10:30 - 11:00 Simulation for teaching soft skills. Simon CARLEY (Consultant in Emergency Medicine) (Manchester)
11:00 - 11:30 Serious gaming for education. Jennifer TRUCHOT (MEDECIN) (Paris, France)
11:30 - 12:00 Crisis resource management education with simulation. Antoine TESNIERE (Paris, France)
Room F-RITTERSAAL

Wednesday 05 October

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OP42
10:30 - 12:00

Oral Papers 42

Moderators: John HOLCOMB (USA), Mehmet Akif KARAMERCAN (Chair of EuSEM Research Committee) (ANKARA, Turkey)
10:30 - 10:40 #8087 - OP109 Major trauma presenting to a tertiary centre in Ireland.
OP109 Major trauma presenting to a tertiary centre in Ireland.

Major trauma presenting to a tertiary centre in Ireland.

 

Background

Traditionally major trauma has been viewed as a disease of young men involved in high energy transfer mechanisms. With the aging population in Europe the face of major trauma is changing.

 

Aim

The aim of this study was to describe the demographics of major trauma presenting to a tertiary urban university hospital in Ireland over a 48-month period.

 

Methods

St. Vincent’s University Hospital (SVUH) was the first institution in Ireland to contribute to the Trauma Audit & Research Network (TARN) database and has been doing so since September 2013Demographics, mechanism of injury, Injury Severity Score (ISS), length of stay (LOS) and time to CT are presented in this study.

 

Results

A total of 862 patients were included from September 1st 2013 to August 31st 2015. Of this population 52.3% were male. The mean age at presentation was 62.6 years (SD 22.4). 449 patients (52.0%) were >65 years, with a strong female preponderance (160 males (35.6%) and 289 females (64.3%) over 65 years). The most common mechanism of injury was “fall less than 2 metres” (n=511, 59.3%), followed by vehicle collision (n=145, 16.8%). In the over-65 population, 81.7% (n=367) suffered a fall less than 2 metres. 65.5% had an ISS of 1-14 and 34.4% a score of greater than >15. The median ISS was 9 (range 1-57). The mean length of stay was 21.0 days (SD 33.8). 51 patients (5.9%) died, of whom 39 were over the age of 65 (i.e. 8.7% of this group).

 

Conclusion

Our trauma database included more patients over the age of 65 than under, and the predominant mechanism of injury was one of low energy, i.e. fall from less than 2 metres. Our data is in keeping with other recent studies from large trauma databases.(1) It highlights the need to tailor our major trauma services to specific needs of the elderly.

 

References

  1. The changing face of major trauma in the UK. Kehoe A, et al. Emerg Med J 2015; 32:911–915.

 


Justine JORDAN (Dublin, Ireland), Marie Therese COONEY, Rachael DOYLE, David MENZIES, John CRONIN
10:40 - 10:50 #7050 - OP110 Clinical features and outcomes of patients with organophosphate poisoning: a five-year retrospective analysis in a medical center.
OP110 Clinical features and outcomes of patients with organophosphate poisoning: a five-year retrospective analysis in a medical center.

Background:Organophosphorus pesticides are widely used in Taiwan. These insecticides include more than one hundred varieties and have large impact on human and animals. According to the statistical information of World Health Organization, there are about 30 million people with pesticide posioning every year, in which the majority of these patients have organophosphate poisoning. Regardless of the exposure pathways in organophosphate poisoning, it is likely to cause serious outcomes or irreversible harm, even death. Therefore, the purpose of this study was to identify determinants of prognosis in patients with organophosphate poisoning. 

Methods: This retrospective study was conducted at a medical center. Consecutive patients having organophosphate poisoning who visited the Emergency Room between January 2008 and December 2012 were retrospectively enrolled. Data which were collected from the medical record of every patient included demographic information, details of medical history, clinical information, the treatment modalities and outcomes. Logistic regression was performed to determine independent corelates of mortality in patients with organophosphate poisoning.

Results:Of the 46 patients with organophosphate poisoning recruited, their mean age was 57 +/- 18.7 years, in which 80.4% were male and 63.0% were admitted to the intensive care unit. The most common comorbidities in these patients were psychiatric disorder(32.6%), followed by cardiovascular disorders(19.6%) During the study period, 5 of the 46 patients died, giving an overall case fatality rate of 10.9%. In multivariate analysis, an increased Acute Physiology and Chronic Health Evaluation(APACHE) II score (p=0.031) was associated with ICU mortality.

Conclusion:The APACHE II score on ICU admission is a significant prognostic indicator in patients with organophsphate poisoning. A further prospective study to strengthen this point is required.

Key Words:Organophosphate poisoning, risk factor, mortality, APACHEII.


Po-Sung LI (Taichung, Taiwan, China), Cheng-Han TSAI
10:50 - 11:00 #7222 - OP111 Pre-hospital times and clinical characteristics of multi-system trauma patients: A comparison between mountain and urban areas.
OP111 Pre-hospital times and clinical characteristics of multi-system trauma patients: A comparison between mountain and urban areas.

Objective: Time from accident to hospital admission in trauma patients is expected to be longer in mountain as compared to urban areas. The aim of this study was to investigate pre-hospital times and clinical characteristics of multi-system trauma patients in mountainous areas and compare them with urban centres.

Methods: Pre-hospital and in-hospital data of trauma victims included in the prospective International Alpine Trauma Register (IATR) hosted in Bolzano, Italy, were compared with published data of trauma victims from rural and suburban areas included in the TraumaRegister DGU® (TR-DGU) of the German Trauma Society. Only patients aged 16 to 80 years with ISS≥16 were included.

Results: A total of 94 patients from IATR and 11020 patients from TR-DGU met the inclusion criteria. Although helicopter rescue was more frequent in mountain compared to urban areas (92% vs. 40%, Fisher’s exact test p<0.001), the mean prehospital time was significantly longer in mountain areas (117.4±143.9 vs. 68.7±28.6min, Welch’s t-test p=0.002) with 38% of patients having a pre-hospital time of >90min. Mean ISS was higher in ITAR patients as compared to DGU® TraumaRegister patients (38.5±15.8 vs. 28.6±12.2, p<0.001). Moreover, patients presenting with a low systolic blood pressure (≤90mmHg) at scene were more frequent in ITAR (41% vs. 19%, Fisher’s exact test p<0.001), yet less patients from IATR as compared to TR-DGU® received pre-hospital volume therapy (82% versus 92%, p=0.001). The rate of unconscious patients with GCS≤8 (34% vs. 33%, p=0.917) as well as pre-hospital intubation rate (44% vs. 54%, p=0.077) were similar in mountain and urban areas. At hospital arrival mean haemoglobin was comparable (12.0 vs. 12.1g/dl, p=0.774), whereas mean base excess was lower in mountain than urban areas (-5.4±4.1 vs. -3.3±5.1, p<0.001). Furthermore, patients with a low systolic blood pressure (≤90mmHg) at hospital arrival were more frequent in IATR as compared to DR-DGU® (27% vs. 15%, p=0.003). No significant difference in hospital mortality was observed between patients from the two registries (11.1% vs. 17%, p=0.163).

Conclusion: Multi-system trauma in mountain areas has some distinctive characteristics and is associated with a significantly increased pre-hospital time despite helicopter rescue in over 90% of cases.


Simon RAUCH (Ora, Italy), Tomas DAL CAPPELLO, Giacomo STRAPAZZON, Francesco BONSANTE, Martin PALMA, Elisabeth GRUBER, Matthias STRÖHLE, Alberto TRINCANATO, Andreas FRASNELLI, Peter MAIR, Hermann BRUGGER
11:00 - 11:10 #7256 - OP112 Prediction of hospital mortality according to the lactate level taken after the prehospital interventions in polytrauma patients.
OP112 Prediction of hospital mortality according to the lactate level taken after the prehospital interventions in polytrauma patients.

INTRODUCTION:
The predictive value of a single elevated blood lactate or blood lactate clearance on mortality in trauma patients has been demonstrated in a number of studies. The aim of this study was to evaluate the lactate level on the arrival to the hospital after our prehospital interventions in polytrauma patients and subsequent hospital mortality.
METHODOLOGY:
We have retrospectively evaluated 51 polytrauma patients who were evacuated by the helicopter emergency service and admitted to the clinics of anaesthesiology and intensive care of 2 trauma centres in a period from 2010 to 2014. These patients were divided into 3 groups according to the lactate level, which had to be taken immediately on the arrival to the hospital. Into the first group the patients with lactate ≤2.5 mmol/l (L1), were enrolled, into the second group the patients with the lactate level of 2.6-4.0mmol/l (L2), and the third group was formed by the patients with the lactate level ≥ 4.1 mmol/l, (L3). These groups were compared taking into account the age, duration of HEMS mission from the first alert to the admission to the hospital, the prehospital amount of intravenous fluids, the intake haemoglobin, and mortality. For statistical analysis ANOVA, Tukey Kramer test and Kruskal –Wallis with Dunn test were used. The differences in numbers of individual categories were tested using the 3x2 contingency table. P value <0.05 was significant for all statistical tests.
RESULTS:
The average age of all patients was 38.3 years, without significant difference among the groups (L1:36.0, L2:40.8, L3:40.3, ANOVA, p=0.63). The average time from the first alert to admission was 69.7 minutes without significant difference among the groups (L1:69.54, L2:64.3, L3:73.31). We prehospitaly administered in average 1260 ml of intravenous fluids. The amount of fluids was increasing with elevating lactate. (L1:1110ml, L2:1230ml, L3:1510ml, with statistical significance between the groups L1 and L3. The intake haemoglobin was significantly lower in the third group (L1:119g/l, L2:121 g/l, L3:89g/l). The hospital mortality rose with increased lactate (L1:16%, L2:20%). In the third group the mortality reached 43.75%. In this last group 75% of patients had at least in one prehospital measurement the systolic blood pressure less than 90mmHg and 62.5% were continuously administered Norepinephrine during the mission.
CONCLUSION:
We have confirmed the growing hospital mortality with increasing lactate, but this study has been limited by the small number of patients. We have observed quite high hospital mortality in the group with lactate ≥ 4.1 mmol/l, despite the higher prehospital amount of intravenous fluids, early intubation and artificial lung ventilation if there was an indication. What could help to decrease mortality in these patients is the further shortening of prehospital phase even though our transport
times are comparable with another helicopter emergency system (London´s Air Ambulance: 66 min). The next thing could be administration of blood products on board of a helicopter.


Terezia PASTEKOVA (Trnava, Slovakia), Katarina BRSTIAKOVA
11:10 - 11:20 #8034 - OP113 Functional outcome in patients with moderate and severe trauma in Hong Kong: 4 year prospective multicentre cohort study.
OP113 Functional outcome in patients with moderate and severe trauma in Hong Kong: 4 year prospective multicentre cohort study.

Introduction

Trauma care systems aim to reduce death and to improve quality of life and functional outcome in trauma patients. It is well documented that trauma systems result in improved survival after injury, yet there is little data on post-trauma functional outcome. Such evaluation of functional recovery is important as this will allow comparison with other settings, will help evaluate the impact and effectiveness of trauma systems as a whole, and may provide prognostic information for healthcare workers and patients. The aim of this study was to evaluate baseline, discharge, six month and 1, 2, 3 and 4 year post-trauma functional outcome and predictors of optimal functional outcome in Hong Kong.

 

Participants and methods

From 1st January to 30th September 2010 patients were recruited to a prospective multi-centre cohort study of trauma patients and then followed up for four years to 30th September 2015.  The study was conducted in three trauma centres in Hong Kong. Adult patients aged ≥18 years with ISS≥9, entered into the trauma registry, and who survived the first 48 hours of injury were included. The main outcome measures included theextended Glasgow Outcome Scale (GOSE) and SF36.

 

Results

During the study, 400 patients (mean age 53.3 years; range 18-106; 69.5% male) were recruited. There were no statistically significant differences in baseline characteristics between responders (N=143) and surviving non-responders (N=179). Only 81/400 (20.3%) cases reported a GOSE≥7.  If non-responders had similar outcomes to responders, then the percentages for GOSE≥7 would rise from 20.3% to 45.6%. Univariate analysis showed that poor functional outcome at 48 months was significantly associated with admission to ICU (OR 2.267), ISS 26-40 (OR 3.231), baseline PCS on SF36 testing (OR 0.940), one-month PCS (OR 0.933), 6-month PCS (OR 0.904) and 6-month MCS on SF36 testing (OR 0.96).

  

Conclusions

At 48 months after injury, 45% of patients sustaining moderate or major trauma in Hong Kong had an excellent recovery. Admission to ICU, ISS 26-40, baseline PCS, one-month PCS, 6-month PCS and 6-month MCS predict 4-year functional outcome.

 

Acknowledgement

This study was supported by Health and Health Services Research Grant 07080261 and Health and Medical Research Fund Grant 10110251.


Colin A GRAHAM, Dr Kevin Kc HUNG (Hong Kong, Hong Kong), Janice Hh YEUNG, Wai S POON, Hiu F HO, Chak W KAM, Timothy H RAINER
11:20 - 11:30 #8035 - OP114 Probability of return to work after moderate and severe trauma in Hong Kong: 4 year prospective multicentre cohort study.
OP114 Probability of return to work after moderate and severe trauma in Hong Kong: 4 year prospective multicentre cohort study.

Introduction

The aim of this study was to provide preliminary data on RTW status for patients in Hong Kong with moderate and major trauma.

 

Participants and methods

A multi-centre prospective cohort study of trauma patients was conducted in three trauma centres in Hong Kong: the Prince of Wales Hospital (PWH), Queen Elizabeth Hospital (QEH) and Tuen Mun Hospital (TMH). Patients were included if they were in the trauma registry, aged≥18 years, had moderate or major trauma (ISS≥9), and answered ‘yes’ to question 5c of GOSE which specifically asks about whether the patient was working or seeking work prior to injury. Patients were followed up for 48 months. The primary outcome was 48-month post-injury RTW.

 

Results

From 1st January  to 31st September 2010, 400 patients recruited to the study (mean age 53.3 years; range 18-106; 69.5% male), of which 197 (49.3%) met the inclusion criteria (mean age 42.9 years; range 18-87; 78.7% male).  Of these patients, 31 (21.1%[C1] ) had RTW at 1-month, 39 (37.5%) at 12-months and 46 (52.3%) at 48 months. Return to work within four years was significantly associated with shorter total length of hospital stay, head injury AIS <3, abdominal injury AIS <3, and multiple injury sites, and higher PCS at one month post injury. After multivariate analysis, one-month PCS on SF36 testing (OR 1.068, P=0.039) significantly predicted 48 month RTW.

 

Conclusion

The 48-month post-trauma RTW rate in patients with ISS≥9 was 52.3%. One month PCS post injury may be used to predict 48 month RTW.

 

 

Acknowledgement

This study was supported by Health and Health Services Research Grant 07080261 and Health and Medical Research Fund Grant 10110251.


Colin A GRAHAM, Dr Kevin Kc HUNG (Hong Kong, Hong Kong), Janice Hh YEUNG, Wai S POON, Hiu F HO, Chak W KAM, Timothy H RAINER
11:30 - 11:40 #4587 - OP115 Cerebral oximetry monitoring in assessing Cerebral Physiology changes in non-intubated pediatric isolated TBI ED patients receiving 3% HTS.
OP115 Cerebral oximetry monitoring in assessing Cerebral Physiology changes in non-intubated pediatric isolated TBI ED patients receiving 3% HTS.

In altered traumatic brain injury (TBI) patients, the current ED monitoring skills for detecting and assessing increased ICP and therapeutic response is inconsistent due healthcare provider's clinical assessment variability. Cerebral oximetry can detect acute changes in cerebral physiology, pathology, and ICP changes. . Pediatric Cerebral rcSO2 normal ranges 60- 80%. rcSO2 < 60%, or rcSO2 >80%, and interhemispheric side differences > 10% reflect abnormal cerebral physiology & increase ICP. 3% HTS therapy has been used in ED non-intubated TBI showing clinical benefit but no objective cerebral physiology effect change. Assessing HTS effect on intubated TBI cerebral physiology changes is done only invasively in ICU.ref 1 Assessing 3% HTS effects in altered non-intubated ED-TBI patients with cerebral pathology (epidural or subdural) or without by cerebral oximetry has never been investigated.

Objective: Assessing in altered non-intubated isolated TBI patients who received therapeutic doses of 3% HTS (5 ml/kg) with simultaneously cerebral oximetry readings ( rcSO2) and GCS changes compared to their pre & post 3% HTS infusion times.

Methods: PED observational convenience study of altered (GCS < 14) non-intubated TBI patients with CT-scan and clinical decisions for 3% HTS infusion had simultaneous cerebral oximetry monitoring during their 3%HTS infusion. Patient's cerebral oximetry & GCS changes were compared at 10 min before, and 10, 20 min after 3%HTS infusions. Patients were subgroup and analyzed by their rSO2 initial readings:
1. Abnormal Cerebral Pathology: rSO2 < 60 or >80,
2. Normal Cerebral Pathology: rSO2 60-80.

Results: Age 3.96(2.3, 8.4), All TBI groups GCS changes before & after 3%HTS were 10( 9,10) & 13( 13,14) , GCS difference 4(3,4) p < 0.0001. 3%HTS infusion time from start to the first 15% change in Left & Right rSO2 was 1.5 minutes( 1.1, 2.0). Table 1

Conclusions: This preliminary study has demonstrated the ability of Cerebral Oximetry to detect the real-time effects of 3%HTS on the altered non-inutbated TBI patient's cerebral physiology in an ED. In isolated non-intubated altered TBI PED patients with or without abnormal cerebral pathology (epidural and or subdural) the 3%HTS effect on their cerebral physiology as defined by cerebral oximetry changes were highly significant and correlated with GCS changes. Cerebral Oximetry monitoring has shown its capabilities as an objective neuro-assessment and monitoring tool in altered non-intubated TBI patient's cerebral physiology and response to therapy. This study along with our prior studies further substantiate cerebral oximetry’s utilization in euro-emergencies and neuroresuscitation and a standard neuro-monitoring tool in the ED.


1.Lumba-Brown.: 3%HTS as a therapy for pediatric concussive pain: a randomized controlled trial of symptom treatment in the emergency department Pediatr Emerg Care. 2014 Mar;30(3):139-45


Dr Thomas ABRAMO MD (Apex, USA), Shane MCKINNEY MD, Gregory ALBERT MD, Todd MAXSON, Jon ORSBORN MD, Nicholas PORTER MD, Elizabeth STORM MD, Zhuopei HU MS
11:40 - 11:50 #8197 - OP116 Extraordinary mobilizations of antidotes from the National Stockpile to the hospital’s emergency departments: an example of versatility and integration of national functions and systems.
OP116 Extraordinary mobilizations of antidotes from the National Stockpile to the hospital’s emergency departments: an example of versatility and integration of national functions and systems.

Objective: Since 2005, the Italian State has established an extraordinary endowment of antidotes for terrorists chemical and radio-nuclear events (Scorta Nazionale Antidoti-SNA). Charged by the Ministry of Health, the Pavia Poison Control Centre (PPCC) is the clinical unit responsible for (i) the diagnostic-therapeutic specialist consultation for non-conventional attacks, (ii) the SNA operational management (e.g. upgrade, distribution planning), and (iii) the continuous training of the Italian NHS. SNA is organized on national scale (regional and national stockpiles, located in hospitals and in State’s deposits, respectively), and is an intangible stockpile whose integrity is essential to fulfill its functions. However, when an absolute shortage of an antidote occurs in the NHS hospitals and the antidotal treatment of intoxicated patients is necessary, a quote of the SNA stockpile can be extraordinarily mobilized. Operational procedure need a clinical evaluation by the PPCC first, and then an on-time authorization by the Ministry of Health. Rapid replacement of the mobilized amounts by the requiring hospital is a procedural obligation. To evaluate the SNA’s extraordinary mobilizations (SNA-EM) in a seven-year period. Methods: We investigated all SNA-EM authorized/made in the period 2008-2014. For each mobilization (i) the cause of the extraordinary request (clinical indications, antidotes availability/shortage in neighboring hospital and Poison Centers), (ii) the time required for the antidotes arrival to the requiring hospital and (iii) the SNA stockpile involved were assessed. Results: Exceptional mobilizations from the SNA to the NHS hospitals were performed 25 times (for 28 patients), always linked to single/multiple poisoning from conventional causes/events. The mobilized antidotes were pralidoxime (n=17), DMSA (n=3), DMPS (n=2), hydroxocobalamin (n=1), methylene-blue (n=1) and Prussian-blue (n=1). In 21 cases, SNA-EM occurred to hospitals located in the same region of the SNA deposit and in 4 toward different regions. In some cases, the mobilized antidotes (DMPS, prussian-blue and DMSA) are rarely used and difficult to find in the NHS hospitals. Conclusions: SNA is an essential facility in each country in order to have the necessary antidotes in case of exceptional events. The Italian current organization of SNA, considered highly important in EU, combine clinical toxicological expertise and antidotes supply in order to obtain diagnostic and therapeutic appropriateness. Nevertheless, this organization has proven useful and able to overcome the hospital shortcomings of normal/rare antidotes in cases where toxic agents are unusual or the need for antidotes exceed the normal hospital availability. Acknowledgements: Support of Ministry of Health (4393/2013-CCM).


Eleonora BUSCAGLIA, Valeria Margherita PETROLINI, Virgilio COSTANZO, Loredana VELLUCCI, Giulia SCARAVAGGI, Marta CREVANI, Sarah VECCHIO, Davide LONATI, Carlo Alessandro LOCATELLI (Travacò Siccomario, Italy)
11:50 - 12:00 #8198 - OP117 Antivenom treatment in viper envenomation in Italy: a 3 years experience.
OP117 Antivenom treatment in viper envenomation in Italy: a 3 years experience.

Objective: EU marketed viper antivenoms differ for pharmaceutical characteristics (e.g. Fab/F(ab’)2, equine/ovine, viper spp. neutralizing activity), dosage and registered route of administration. A different availability in Italian hospitals offers the opportunity to preliminary evaluate the relative frequency of use and the clinical response to treatment with 4 different antivenom.

Methods: All viper bitten patients treated with antivenom referred to Pavia Poison Control Centre from 2013-Oct2015 were retrospectively assessed for sex, age, site of bite, time elapsed between bite and ED admission/antivenom administration, type of antivenom and number of vials, GSS and clinical response (improvement/worsening during 6 hours), need of adjunctive doses, adverse effects. Clinical manifestations were evaluated according to the Grading-Severity-Score (GSS).

Results: 50 patients (age 44,3±27,2 y-o; male 70%) were included; 13 were paediatric (1-13 y-o). Considering geographical distribution, vipera aspis spp. was mainly involved. Upper and lower limbs were involved in 88% and 12% of cases, respectively. Average time between bite and ED-admission was 4 hours (15min-23hours), and 9 hours (40min-26hours) between bite and antivenom administration, that occurred in patients with GSS 2 or 3 (76% and 24%, respectively). The 4 antivenom were administered intravenously: Viper Venom Antiserum-European® (VVAE) (30/50;60%) [7=1 vial, 23=2 vials], Viper Venom Antitoxin® (VVA) (16/50;32%) [11=1 vial, 5=2 vials], ViperaTab® (3/50;6%) [2 vials] and Viekvin® (1/50;2%) [1 vial]. Clinical improvement was observed after 1 and 2 vials of VVAE administration in 86% and 96% of cases, respectively, and after 1 and 2 vials of VVA in 55% and 80% of cases. ViperaTab treated patients (n=3) improved in 66.6%; 1 patient treated with Viekvin (9 years-old) promptly ameliorated. Adjunctive doses of antivenom were needed in 6 patients (12%) aging (except one, 49 y-o) from 2 to 6 years that received only 1 vial of VVAE (1/6;16%) and VVA (5/6;83%). Acute adverse reactions occurred after VVAE (2 cases; angioedema, pruritus) and VVA administration (1 case; mild hypotension). Serum sickness (3 weeks later) occurred in 1 case (VVA). Statistical evaluation requires a greater number of cases.

Conclusions: A different availability of 4 antivenoms is observed in Italian hospitals, with a prevalence of those that declare neutralizing activity against vipera aspis spp. Intravenous administration is usually safe, even if adverse reactions are observed. An initial dose of 2 vials of all formulation is suitable to reduce the probability of worsening and the need of adjunctive doses, especially in paediatric patients.


Valeria Margherita PETROLINI, Davide LONATI, Azzurra SCHICCHI, Marta CREVANI, Mara GARBI, Giulia SCARAVAGGI, Eleonora BUSCAGLIA, Francesca CHIARA, Sarah VECCHIO, Carlo Alessandro LOCATELLI (Travacò Siccomario, Italy)
Room OP-SCHATZKAMMERSAAL
12:00

Wednesday 05 October

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12:00 - 12:30

Hot Topic Conference

Moderator: Dr Barbara HOGAN (Past President of the European Society for Emergency Medicine, EuSEM) (HAMBURG, Germany)
12:00 - 12:30 Simultaneous Terrorist attacks across Europe: are we prepared? Pierre CARLI (Chef de Service) (Paris, France)
Room A-FESTSAAL
12:30

Wednesday 05 October

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CC
12:30 - 13:30

Congress Closing Ceremony

Moderator: Wilhelm BEHRINGER (Director) (Jena, Germany)
12:30 - 12:50 Austrian/German/Swiss Host Representative.
12:50 - 13:10 Immediate Past President EUSEM. Dr Barbara HOGAN (Past President of the European Society for Emergency Medicine, EuSEM) (HAMBURG, Germany)
13:10 - 13:20 EUSEM President. Roberta PETRINO (Head of department) (Italie, Italy)
13:20 - 13:30 Introduction of EuSEM congress 2017 in Athens. Helen ASKITOPOULOU (Chair Ethics Committee) (Heraklion, Greece)
Room A-FESTSAAL