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Niset A, El Hadwe S, Barrit S. Did GPT-4 really perform electrocardiography assessment? Am J Emerg Med 2024:S0735-6757(24)00163-3. [PMID: 38604875 DOI: 10.1016/j.ajem.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Alexandre Niset
- Emergency Medicine, Université Catholique de Louvain, Belgium; Pediatric Intensive Care, Cliniques Universitaires Saint-Luc, Belgium; Sciense, New York, United States.
| | - Salim El Hadwe
- Sciense, New York, United States; Neurosurgery, Université Libre de Bruxelles, Belgium; Clinical Neuroscience, University of Cambridge, United Kingdom
| | - Sami Barrit
- Sciense, New York, United States; Neurosurgery, Université Libre de Bruxelles, Belgium; Neurosurgery, CHU Tivoli, La Louvière, Belgium
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Dupriez F, Niset A, Couvreur C, Marissiaux L, Gendebien F, Peyskens L, Germeau B, Fasseaux A, Rodrigues de Castro B, Penaloza A, Vanpee D, Bobbia X. Evaluation of point-of-care ultrasound use in the diagnostic approach for right upper quadrant abdominal pain management in the emergency department: a prospective study. Intern Emerg Med 2024; 19:803-811. [PMID: 38041765 DOI: 10.1007/s11739-023-03480-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/04/2023] [Indexed: 12/03/2023]
Abstract
Point-of-care ultrasound (PoCUS) is commonly used at the bedside in the emergency department (ED) as part of clinical examinations. Studies frequently investigate PoCUS diagnostic accuracy, although its contribution to the overall diagnostic approach is less often evaluated. The primary objective of this prospective, multicenter, cohort study was to assess the contribution of PoCUS to the overall diagnostic approach of patients with right upper quadrant abdominal pain. Two independent members of an adjudication committee, who were blind to the intervention, independently evaluated the diagnostic approaches before and after PoCUS for the same patient. The study included 62 patients admitted to the ED with non-traumatic right upper quadrant abdominal pain from September 1, 2022, to March 6, 2023. The contribution of PoCUS to the diagnostic approach was evaluated using a proportion test assuming that 75% of diagnostic approaches would be better or comparable with PoCUS. Wilcoxon signed-rank tests evaluated the impact of PoCUS on the mean number of differential diagnoses, planned treatments, and complementary diagnostic tests. Overall, 60 (97%) diagnostic approaches were comparable or better with PoCUS (χ2 = 15.9, p < 0.01). With PoCUS, the mean number of differential diagnoses significantly decreased by 2.3 (95% CI - 2.7 to - 1.5) (p < 0.01), proposed treatments by 1.3 (95% CI - 1.8 to - 0.9) (p < 0.01), and complementary diagnostic tests by 1.3 (95% CI - 1.7 to - 1.0) (p < 0.01). These findings show that PoCUS positively impacts the diagnostic approach and significantly decreases the mean number of differential diagnoses, treatments, and complementary tests.
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Affiliation(s)
- Florence Dupriez
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium.
| | - Alexandre Niset
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Claire Couvreur
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Laurent Marissiaux
- Emergency Department, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Félix Gendebien
- Emergency Department, Hôpital de Jolimont, Lobbes, Lobbes, Belgium
| | - Laurent Peyskens
- Emergency Department, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Boris Germeau
- Emergency Department, Cliniques Saint-Pierre Ottignies, Ottignies, Belgium
| | - Antoine Fasseaux
- Emergency Department, Hôpital de Jolimont, Lobbes, Haine Saint Paul, Belgium
| | | | - Andrea Penaloza
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Dominique Vanpee
- Institute of Health and Society and CHU UCL Namur, UCLOUVAIN, Ottignies-Louvain-la-Neuve, Belgium
| | - Xavier Bobbia
- Emergency Department, CHU Montpellier, Montpellier, France
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Pehlivan J, Douillet D, Jérémie R, Perraud C, Niset A, Eveillard M, Chenouard R, Mahieu R. A clinical decision rule to rule out bloodstream infection in the emergency department: retrospective multicentric observational cohort study. Emerg Med J 2023; 41:20-26. [PMID: 37940371 DOI: 10.1136/emermed-2022-212987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND We aimed to identify patients at low risk of bloodstream infection (BSI) in the ED. METHODS We derived and validated a prediction model to rule out BSI in the ED without the need for laboratory testing by determining variables associated with a positive blood culture (BC) and assigned points according to regression coefficients. This retrospective study included adult patients suspected of having BSI (defined by at least one BC collection) from two European ED between 1 January 2017 and 31 December 2019. The primary end point was the BSI rate in the validation cohort for patients with a negative Bacteremia Rule Out Criteria (BAROC) score. The effect of adding laboratory variables to the model was evaluated as a second step in a two-step diagnostic strategy. RESULTS We analysed 2580 patients with a mean age of 64 years±21, of whom 46.1% were women. The derived BAROC score comprises 12 categorical clinical variables. In the validation cohort, it safely ruled out BSI without BCs in 9% (58/648) of patients with a sensitivity of 100% (95% CI 95% to 100%), a specificity of 10% (95% CI 8% to 13%) and a negative predictive value of 100% (95% CI 94% to 100%). Adding laboratory variables (creatinine ≥177 µmol/L (2.0 mg/dL), platelet count ≤150 000/mm3 and neutrophil count ≥12 000/mm3) to the model, ruled out BSI in 10.2% (58/570) of remaining patients who had been positive on the BAROC score. The BAROC score with laboratory results had a sensitivity of 100% (95% CI 94% to 100%), specificity of 11% (95% CI 9% to 14%) and negative predictive value of 100% (95% CI 94 to 100%). In the validation cohort, there was no evidence of a difference in discrimination between the area under the receiver operating characteristic for BAROC score with versus without laboratory testing (p=0.6). CONCLUSION The BAROC score safely identified patients at low risk of BSI and may reduce BC collection in the ED without the need for laboratory testing.
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Affiliation(s)
- Jonathan Pehlivan
- Service de maladies infectieuses et tropicales, Centre hospitalier universitaire d'Angers, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Delphine Douillet
- Emergency Department, Angers University Hospital, CHU Angers, Angers, France
- UMR MitoVasc CNRS 6015-INSERM 1083, University of Angers, Angers, France
| | - Riou Jérémie
- Micro et Nano médecines translationnelles, MINT, UMR INSERM 1066, UMR CNRS 6021, University of Angers, Angers, France
- Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, CHU Angers, Angers, France
| | - Clément Perraud
- Emergency Department, Angers University Hospital, CHU Angers, Angers, France
| | - Alexandre Niset
- Emergency Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Hopital à Bruxelles-Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Matthieu Eveillard
- Laboratoire de Bactériologie, Institut de Biologie en Santé-PBH, CHU Angers, Angers, France
| | - Rachel Chenouard
- Laboratoire de Bactériologie, Institut de Biologie en Santé-PBH, CHU Angers, Angers, France
| | - Rafael Mahieu
- Service de maladies infectieuses et tropicales, Centre hospitalier universitaire d'Angers, CHU Angers Maladies infectieuses et tropicales, Angers, France
- Faculty of Medicine, Université de Nantes, Inserm, CRCINA, SFR ICAT, University of Angers, Angers, France
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Barrit S, El Hadwe S, Al Barajraji M, Torcida N, Bogossian EG, André J, Niset A, Carron R, Taccone FS, Madsen J. Complications of Intracranial Multimodal Monitoring for Neurocritical Care: A Systematic Review and Meta-Analysis. Neurocrit Care 2023:10.1007/s12028-023-01885-0. [PMID: 37991675 DOI: 10.1007/s12028-023-01885-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/19/2023] [Indexed: 11/23/2023]
Abstract
Intracranial multimodal monitoring (iMMM) is increasingly used for neurocritical care. However, concerns arise regarding iMMM invasiveness considering limited evidence in its clinical significance and safety profile. We conducted a synthesis of evidence regarding complications associated with iMMM to delineate its safety profile. We performed a systematic review and meta-analysis (PROSPERO Registration Number: CRD42021225951) according to the Preferred Reporting Items for Systematic Review and Meta-Analysis and Peer Review of Electronic Search Strategies guidelines to retrieve evidence from studies reporting iMMM use in humans that mention related complications. We assessed risk of bias using the Newcastle-Ottawa Scale and funnel plots. The primary outcomes were iMMM complications. The secondary outcomes were putative risk factors. Of the 366 screened articles, 60 met the initial criteria and were further assessed by full-text reading. We included 22 studies involving 1206 patients and 1434 iMMM placements. Most investigators used a bolt system (85.9%) and a three-lumen device (68.8%), mainly inserting iMMM into the most injured hemisphere (77.9%). A total of 54 postoperative intracranial hemorrhages (pooled rate of 4%; 95% confidence interval [CI] 0-10%; I2 86%, p < 0.01 [random-effects model]) was reported, along with 46 misplacements (pooled rate of 6%; 95% CI 1-12%; I2 78%, p < 0.01) and 16 central nervous system infections (pooled rate of 0.43%; 95% CI 0-2%; I2 64%, p < 0.01). We found 6 system breakings, 18 intracranial bone fragments, and 5 cases of pneumocephalus. Currently, iMMM systems present a similar safety profile as intracranial devices commonly used in neurocritical care. Long-term outcomes of prospective studies will complete the benefit-risk assessment of iMMM in neurocritical care. Consensus-based reporting guidelines on iMMM use are needed to bolster future collaborative efforts.
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Affiliation(s)
- Sami Barrit
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
- Neurodynamics Laboratory, Department of Neurosurgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
- Institut Des Neurosciences du Système, Aix Marseille Université, INSERM - Timone Hospital (Assistance Publique - Hôpitaux de Marseille), Marseille, France.
- Neurocore, Consciense Foundation, Brussels, Belgium.
| | - Salim El Hadwe
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Neurocore, Consciense Foundation, Brussels, Belgium
| | - Mejdeddine Al Barajraji
- Neurocore, Consciense Foundation, Brussels, Belgium
- Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Nathan Torcida
- Neurocore, Consciense Foundation, Brussels, Belgium
- Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Elisa Gouvêa Bogossian
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Joachim André
- Neurocore, Consciense Foundation, Brussels, Belgium
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Niset
- Neurocore, Consciense Foundation, Brussels, Belgium
- Department of Emergency, Hôpital Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Romain Carron
- Institut Des Neurosciences du Système, Aix Marseille Université, INSERM - Timone Hospital (Assistance Publique - Hôpitaux de Marseille), Marseille, France
- Neurocore, Consciense Foundation, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Joseph Madsen
- Neurodynamics Laboratory, Department of Neurosurgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Neurocore, Consciense Foundation, Brussels, Belgium
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Niset A, Baert J, Dupriez F. Point-of-Care Ultrasound for the Diagnosis of Pediatric Foreign Body Ingestion: A Narrative Review and Illustrative Case Report. Pediatr Emerg Care 2023; 39:728-733. [PMID: 37339160 DOI: 10.1097/pec.0000000000002997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE Foreign body ingestion (FBI) is a frequent concern in emergency departments. Clinical guidelines recommend performing plain x-rays as the primary modality of diagnosis. Although point-of-care ultrasound (PoCUS) has increasingly been integrated into the daily practice of emergency medicine, it has been poorly investigated in the diagnostic approach for FBI.This review aims to highlight the current state of PoCUS use for pediatric FBI.The following research question was considered in this narrative review: Is PoCUS useful for FBI management? METHODS A literature search was conducted to identify articles reporting PoCUS use for the management of FBI. All articles were assessed for quality by 2 reviewers. MAIN RESULTS The 14 selected articles reported 52 FBI cases in which PoCUS successfully identified and located the ingested FB. Point-of-care ultrasound was used either as the primary imaging technique or after positive or negative x-ray findings. In 5 cases (9.6%), PoCUS was the only modality used for the diagnosis. Of these cases, 3 (60%) underwent a successful procedure to remove the FB and 2 (40%) received conservative treatment without complications. CONCLUSIONS This review suggests that PoCUS might be a reliable modality for the initial management of FBI. PoCUS can locate, identify, and evaluate the size of the FB in a wide range of materials and gastrointestinal locations. Point-of-care ultrasound could eventually become the go-to modality in the case of radiolucent FB, thus avoiding the use of radiation. Further studies are nevertheless required to validate PoCUS use for FBI management.
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Affiliation(s)
- Alexandre Niset
- From the Emergency Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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