1
|
Wynants L, Broers NJH, Platteel TN, Venekamp RP, Barten DG, Leers MPG, Verheij TJM, Stassen PM, Cals JWL, de Bont EGPM. Development and validation of a risk prediction model for hospital admission in COVID-19 patients presenting to primary care. Eur J Gen Pract 2024; 30:2339488. [PMID: 38682305 PMCID: PMC11060008 DOI: 10.1080/13814788.2024.2339488] [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: 05/02/2023] [Accepted: 04/02/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND There is a paucity of prognostic models for COVID-19 that are usable for in-office patient assessment in general practice (GP). OBJECTIVES To develop and validate a risk prediction model for hospital admission with readily available predictors. METHODS A retrospective cohort study linking GP records from 8 COVID-19 centres and 55 general practices in the Netherlands to hospital admission records. The development cohort spanned March to June 2020, the validation cohort March to June 2021. The primary outcome was hospital admission within 14 days. We used geographic leave-region-out cross-validation in the development cohort and temporal validation in the validation cohort. RESULTS In the development cohort, 4,806 adult patients with COVID-19 consulted their GP (median age 56, 56% female); in the validation cohort 830 patients did (median age 56, 52% female). In the development and validation cohort respectively, 292 (6.1%) and 126 (15.2%) were admitted to the hospital within 14 days, respectively. A logistic regression model based on sex, smoking, symptoms, vital signs and comorbidities predicted hospital admission with a c-index of 0.84 (95% CI 0.83 to 0.86) at geographic cross-validation and 0.79 (95% CI 0.74 to 0.83) at temporal validation, and was reasonably well calibrated (intercept -0.08, 95% CI -0.98 to 0.52, slope 0.89, 95% CI 0.71 to 1.07 at geographic cross-validation and intercept 0.02, 95% CI -0.21 to 0.24, slope 0.82, 95% CI 0.64 to 1.00 at temporal validation). CONCLUSION We derived a risk model using readily available variables at GP assessment to predict hospital admission for COVID-19. It performed accurately across regions and waves. Further validation on cohorts with acquired immunity and newer SARS-CoV-2 variants is recommended.
Collapse
Affiliation(s)
- Laure Wynants
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Natascha JH. Broers
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Tamara N. Platteel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roderick P. Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Dennis G. Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Mathie PG. Leers
- Dept. of Clinical Chemistry & Hematology, Zuyderland MC Sittard-Geleen/Heerlen, Heerlen, The Netherlands
| | - Theo JM. Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Patricia M. Stassen
- Department of Internal Medicine, School for Cardiovascular Diseases, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jochen WL. Cals
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Eefje GPM de Bont
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
2
|
Maas AFG, Wyers C, Dielis A, Barten DG, van Kampen VEM, van der Krieken TE, de Kruif M, Simsek S, Spaetgens B, van Haaps T, Appelman B, Gritters NC, Doornbos S, Moeniralam HS, Noordzij PG, Reidinga A, Douma RA, Nossent EJ, Beudel M, Elbers P, Middeldorp S, van Es N, van den Bergh JPW, van Osch FHM. The Incidence of Pulmonary Embolism in Hospitalized Non-ICU Patients with COVID-19 during the First Wave: A Multicenter Retrospective Cohort Study in the Netherlands. J Vasc Res 2024:1-8. [PMID: 38631294 DOI: 10.1159/000538312] [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: 12/10/2022] [Accepted: 03/05/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION During the first COVID-19 outbreak in 2020 in the Netherlands, the incidence of pulmonary embolism (PE) appeared to be high in COVID-19 patients admitted to the intensive care unit (ICU). This study was performed to evaluate the incidence of PE during hospital stay in COVID-19 patients not admitted to the ICU. METHODS Data were retrospectively collected from 8 hospitals in the Netherlands. Patients admitted between February 27, 2020, and July 31, 2020, were included. Data extracted comprised clinical characteristics, medication use, first onset of COVID-19-related symptoms, admission date due to COVID-19, and date of PE diagnosis. Only polymerase chain reaction (PCR)-positive patients were included. All PEs were diagnosed with computed tomography pulmonary angiography (CTPA). RESULTS Data from 1,852 patients who were admitted to the hospital ward were collected. Forty patients (2.2%) were diagnosed with PE within 28 days following hospital admission. The median time to PE since admission was 4.5 days (IQR 0.0-9.0). In all 40 patients, PE was diagnosed within the first 2 weeks after hospital admission and for 22 (55%) patients within 2 weeks after onset of symptoms. Patient characteristics, pre-existing comorbidities, anticoagulant use, and laboratory parameters at admission were not related to the development of PE. CONCLUSION In this retrospective multicenter cohort study of 1,852 COVID-19 patients only admitted to the non-ICU wards, the incidence of CTPA-confirmed PE was 2.2% during the first 4 weeks after onset of symptoms and occurred exclusively within 2 weeks after hospital admission.
Collapse
Affiliation(s)
- Arno F G Maas
- VieCuri Medical Center, Department of Internal Medicine, Venlo, The Netherlands
| | - Caroline Wyers
- VieCuri Medical Center, Department of Internal Medicine, Venlo, The Netherlands
| | - Arne Dielis
- VieCuri Medical Center, Department of Internal Medicine, Venlo, The Netherlands
| | - Dennis G Barten
- VieCuri Medical Center, Department of Emergency Medicine, Venlo, The Netherlands
| | | | | | - Martijn de Kruif
- Zuyderland Hospital, Department of Pulmonology, Heerlen, The Netherlands
| | - Suat Simsek
- Northwest Clinics, Department of Internal Medicine, Alkmaar, The Netherlands
- Department of Internal Medicine/Endocrinology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Bart Spaetgens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Thijs van Haaps
- Amsterdam University Medical Center, Department of Vascular Medicine, Amsterdam, The Netherlands
| | - Brent Appelman
- Center for Experimental and Molecular Medicine, Amsterdam UMC Location University of Amsterdam, Department(s), Amsterdam, The Netherlands
| | - Niels C Gritters
- Treant Zorggroep, Department of Intensive Care, Emmen, The Netherlands
| | - Stefan Doornbos
- Treant Zorggroep, Department of Intensive Care, Emmen, The Netherlands
| | - Hazra S Moeniralam
- St Antonius Hospital, Department of Internal Medicine, Nieuwegein, The Netherlands
| | - Peter G Noordzij
- St Antonius Hospital, Department of Intensive Care, Nieuwegein, The Netherlands
| | - Auke Reidinga
- Department of Intensive Care, Martini Ziekenhuis, Groningen, The Netherlands
| | - Renée A Douma
- Flevo Hospital, Department of Internal Medicine, Almere, The Netherlands
| | - Esther J Nossent
- Department of Pulmonary Medicine, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam, The Netherlands
| | - Paul Elbers
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Institute for Infection and Immunity, Vrije Universiteit, Amsterdam, The Netherlands
| | - Saskia Middeldorp
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Nick van Es
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Joop P W van den Bergh
- VieCuri Medical Center, Department of Internal Medicine, Venlo, The Netherlands
- Maastricht University, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Frits H M van Osch
- Maastricht University, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- VieCuri Medical Center, Department of Clinical Epidemiology, Venlo, The Netherlands
| |
Collapse
|
3
|
van Boven LS, Kusters RWJ, Tin D, van Osch FHM, De Cauwer H, Ketelings L, Rao M, Dameff C, Barten DG. Hacking Acute Care: A Qualitative Study on the Health Care Impacts of Ransomware Attacks Against Hospitals. Ann Emerg Med 2024; 83:46-56. [PMID: 37318433 DOI: 10.1016/j.annemergmed.2023.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/16/2023] [Accepted: 04/25/2023] [Indexed: 06/16/2023]
Abstract
STUDY OBJECTIVE Cyberattacks are an increasing threat to health care institutions which potentially impair patient outcomes. Current research is limited and focuses mainly on the technical consequences, whereas little is known about health care staff experiences and the effect on emergency care. This study aimed to explore the acute care effect of several large ransomware attacks against hospitals that occurred in Europe and the United States between 2017 and 2022. METHODS This interview-based qualitative study assessed the experiences of emergency health care professionals and information technology (IT) staff and investigated the challenges during the acute and recovery phase of hospital ransomware attacks. The semistructured interview guideline was based on relevant literature and cybersecurity expert consultation. Transcripts were anonymized, and traceable information regarding participants and/or their organizations was removed for privacy purposes. RESULTS Nine participants were interviewed, including emergency health care providers and IT-focused staff. Five themes were constructed from the data: effects and challenges regarding patient care continuity, challenges during the recovery process, personal effect on health care staff, preparedness and lessons identified, and future recommendations. CONCLUSIONS According to the participants of this qualitative study, ransomware attacks have a significant effect on emergency department workflow, acute care delivery, and the personal well-being of health care providers. Preparedness for such incidents is limited, and many challenges are encountered during the acute and recovery phase of attacks. Although there was profound hesitancy among hospitals to participate in this study, the limited number of participants provided valuable information that can be used to develop response strategies for hospital ransomware attacks.
Collapse
Affiliation(s)
| | - Renske W J Kusters
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Derrick Tin
- Department of Disaster Medicine, Beth Israel Deaconess Medical Center, Boston, MA Harvard Medical School, Boston, MA
| | - Frits H M van Osch
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, the Netherlands
| | - Harald De Cauwer
- Department of Neurology, Sint-Dimpna Regional Hospital, Geel, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Linsay Ketelings
- Maastricht University, Maastricht, Netherlands; Maastricht University Food Claims Centre Venlo, Venlo, The Netherlands
| | - Madhura Rao
- Maastricht University, Maastricht, Netherlands; Maastricht University Food Claims Centre Venlo, Venlo, The Netherlands
| | - Christian Dameff
- Department of Emergency Medicine, University of California San Diego, San Diego, CA
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands.
| |
Collapse
|
4
|
Al-Wathinani AM, Barten DG, Alsahli H, Alhamid A, Alghamdi W, Alqahtani W, Alghamdi R, Aljuaid M, Albaqami NA, Goniewicz K. The Right to Refuse: Understanding Healthcare Providers' Perspectives on Patient Autonomy in Emergency Care. Healthcare (Basel) 2023; 11:1756. [PMID: 37372874 DOI: 10.3390/healthcare11121756] [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: 04/29/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Healthcare providers in prehospital care and emergency departments are often at the frontline of medical crises, facing a range of ethical dilemmas, particularly when it comes to patients refusing treatment. This study aimed to delve into the attitudes of these providers toward treatment refusal, unearthing the strategies they employ in navigating such challenging situations while actively working in prehospital emergency health services. Our findings showed that, as the participants' age and experience increased, so did their inclination to respect patient autonomy and avoid persuading them to change their decision about treatment. It was noted that doctors, paramedics, and emergency medical technicians demonstrated a deeper understanding of patients' rights than other medical specialists. However, even with this understanding, the prioritization of patients' rights tended to diminish in life-threatening situations, giving rise to ethical dilemmas. This underlines the complexity of balancing the healthcare professionals' responsibilities and the patients' autonomy, which can generate ethically challenging scenarios for those working in emergency healthcare. By investigating these attitudes and experiences, this study seeks to foster a more profound understanding of the ethical quandaries faced by emergency healthcare providers. Our ultimate aim is to contribute to the development of effective strategies that support both patients and professionals in managing these tough circumstances.
Collapse
Affiliation(s)
- Ahmed M Al-Wathinani
- Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, 5912 BL Venlo, The Netherlands
| | - Hind Alsahli
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Anfal Alhamid
- Primary Care Clinic and Emergency Department, Dental University Hospital-KSUMC, King Saud University, Riyadh 11451, Saudi Arabia
| | - Waad Alghamdi
- Department of Respiratory Services, King Abdulaziz Medical City, Ministry of National Guard, Riyadh 1154, Saudi Arabia
| | - Wadha Alqahtani
- Department of Respiratory Services, King Abdulaziz Medical City, Ministry of National Guard, Riyadh 1154, Saudi Arabia
| | - Raghad Alghamdi
- Department of Respiratory Services, King Abdulaziz Medical City, Ministry of National Guard, Riyadh 1154, Saudi Arabia
| | - Mohammad Aljuaid
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh 11541, Saudi Arabia
| | - Nawaf A Albaqami
- Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia
| | - Krzysztof Goniewicz
- Department of Security Studies, Polish Air Force University, 08-521 Dęblin, Poland
| |
Collapse
|
5
|
De Cauwer H, Granholm F, Khorram-Manesh A, Barten DG, Tin D, Mortelmans LJ, Somville F, Ciottone GR. An Epidemiological Analysis of Terrorist Attacks in the Nordic and Baltic Countries from 1970 through 2020. Prehosp Disaster Med 2023; 38:401-408. [PMID: 37264951 DOI: 10.1017/s1049023x23005794] [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] [Indexed: 06/03/2023]
Abstract
BACKGROUND Russia's annexation of Crimea in 2014, and the recent Russo-Ukrainian war that started in 2022, were triggers that radically changed the perception of security in the Nordic and Baltic countries. The on-going Russian hybrid war has resulted in a renewed global interest in the safety and security of many countries (eg, the Nordic-Baltic Eight). The prospective North Atlantic Treaty Organization (NATO) membership of Finland and Sweden may drastically change the regional military and political landscape.The objective of this study was to identify and characterize all documented terrorist attacks in this region as reported to the Global Terrorism Database (GTD) from 1970 through 2020. METHODS The GTD was searched using the internal database functions for all terrorism incidents in the Nordic-Baltic states: Denmark, Estonia, Finland, Iceland, Latvia, Lithuania, Norway, and Sweden.Temporal factors, location, target type, attack and weapon type, perpetrator type, number of casualties, and property value loss were collated. Results were exported into an Excel spreadsheet for analysis. RESULTS There were 298 terrorism-related incidents from 1970 through 2020. Most attacks occurred in Sweden, followed by Norway and Finland. No entries were recorded for the Baltic states prior to their independency in 1991. The 298 incidents resulted in a total of 113 fatalities and 277 injuries.Facility/infrastructure attacks were the most frequently identified attack type (35.0%), followed by bombings and explosions (30.9%). Armed assaults were responsible for 80 fatalities and 105 injuries, followed by bombings/explosions with 15 fatalities and 72 injuries. The predominant target types were immigrants and refugee shelters (64/298 incidents). In only 33.6% of the incidents, perpetrators were known. Right-wing assailants represented the largest group, accounting for 27 incidents. CONCLUSION From 1970 through 2020, there were 298 terrorist attacks in the Nordic-Baltic Eight. Sweden accounted for 50% of incidents.The profile of terrorist attacks was very diverse, as were the perpetrators and targets. Every country had its own incident characteristics. The surge of right-wing extremism must be closely monitored.
Collapse
Affiliation(s)
- Harald De Cauwer
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Department of Neurology, Sint-Dimpna Regional Hospital, Geel, Belgium
| | | | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, Sweden; Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Derrick Tin
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Luc J Mortelmans
- Center for Research and Education in Emergency Care, University of Leuven, Leuven; REGEDIM, Free University Brussels, Brussels; Department of Emergency Medicine, ZNA Camp Stuivenberg, Antwerp, Belgium
| | - Francis Somville
- Department of Emergency Medicine, Sint-Dimpna Regional Hospital, Geel, Belgium; Faculty of Medicine and Health Sciences. University of Antwerp, Wilrijk, Belgium
| | - Gregory R Ciottone
- Director, BIDMC Disaster Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Zaalberg T, Barten DG, van Heugten CM, Klijnsma P, Knarren L, Hiemstra Y, Kurvers RAJ, Lekx AW, Mooijaart SP, Janssen-Heijnen M. Prevalence and risk factors of burden among caregivers of older emergency department patients. Sci Rep 2023; 13:7250. [PMID: 37142628 PMCID: PMC10160020 DOI: 10.1038/s41598-023-31750-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/16/2023] [Indexed: 05/06/2023] Open
Abstract
The number of older individuals that live independently at home is rising. These older individuals often rely on caregivers who have a similar age and health status. Therefore, caregivers may experience a high burden. We determined the prevalence and associating factors of burden among caregivers of older patients in the emergency department (ED). A cross-sectional study of primary caregivers of patients aged ≥ 70 years visiting the ED of a Dutch teaching hospital was performed. Structured interviews were conducted with patients and their caregivers. Caregiver burden was measured using the caregiver strain index (CSI). Additionally, data from questionnaires and medical records were extracted to determine potential associating factors. Univariate and multivariate regression analyses were conducted to identify independent determinants for burden. Seventy-eight caregivers (39%) experienced a high burden. Multivariate analysis showed a significant association between high caregiver burden and patients with cognitive impairment or dependency for instrumental activities of daily living (IADL) and more self-reported hours of care per day. Almost 40% of older patients in the ED have a caregiver who experiences a high burden. Formal assessment in the ED may help provide adequate care to the patients and their caregivers.
Collapse
Affiliation(s)
- Tessel Zaalberg
- Department of Emergency Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands.
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
| | - Caroline M van Heugten
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
- Limburg Brain Injury Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Petra Klijnsma
- Department of Geriatric Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Lieve Knarren
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Ytje Hiemstra
- Caregiver Representative, MantelzorgNL, Zeist, The Netherlands
| | - Roel A J Kurvers
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands
| | - Anita W Lekx
- Department of Emergency Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maryska Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, The Netherlands
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
7
|
De Cauwer H, Barten DG, Tin D, Mortelmans LJ, Ciottone GR, Somville F. 50 Years of Terrorism against the Nuclear Industry: A Review of 91 Incidents in the Global Terrorism Database. Prehosp Disaster Med 2023; 38:199-206. [PMID: 36647742 PMCID: PMC10067068 DOI: 10.1017/s1049023x2300002x] [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] [Indexed: 01/18/2023]
Abstract
BACKGROUND The on-going Russo-Ukrainian war has resulted in a renewed global interest in the safety and security of nuclear installations and the possibility of nuclear disasters caused by warfare and terrorism.The objective of this study was to identify and characterize all documented terrorist attacks against nuclear transport, nuclear facilities, and nuclear scientists as reported to the Global Terrorism Database (GTD) over a 50-year period. METHODS The GTD was searched for all terrorist attacks against nuclear facilities, nuclear scientists, nuclear transport, and other nuclear industry-related targets in the period from 1970-2020. Analyses were performed on temporal factors, location, target type, attack and weapon type, perpetrator type, number of casualties, and property value loss. RESULTS Ninety-one incidents that occurred from 1970 through 2020 were included. Incidents took place in 25 countries and nine world regions, with most (42; 46.1%) occurring in Western Europe.During these 50 years, 91 incidents resulted in 19 fatalities and 117 injuries. One perpetrator was killed during an incident and one other assailant was injured.Bombings and explosions were the most frequently identified attack type (n = 40; 44.0%), followed by facility/infrastructure damage (n = 24; 26.4%) and armed assaults and assassinations (both n = 7; 7.7%).Nuclear power plants and reactors under construction were targeted in 13 (14.3%) and eight (8.8%) incidents, respectively. Most of the attacks took place on other nuclear industry-related sites. CONCLUSION Terrorist attacks carried out by non-state perpetrators against nuclear facilities, nuclear scientists, nuclear transport, and other nuclear industry-related targets are rare, with only 91 incidents in a 50-year period. None of the attacks resulted in radioactive fallout or environmental contamination. Most of the attacks took place outside a nuclear power plant.
Collapse
Affiliation(s)
- Harald De Cauwer
- Department of Neurology, Sint-Dimpna Regional Hospital, Geel, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Derrick Tin
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsUSA; Harvard Medical School, Boston, Massachusetts USA
| | - Luc J Mortelmans
- Center for Research and Education in Emergency Care, University of Leuven, Leuven, Belgium; REGEDIM, Free University Brussels, Belgium; Department of Emergency Medicine, ZNA Camp Stuivenberg, Antwerp, Belgium
| | - Gregory R Ciottone
- Director, BIDMC Disaster Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, MassachusettsUSA
| | - Francis Somville
- Department of Emergency Medicine, Ziekenhuis Geel, Geel, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Faculty of Medicine, University of Leuven, Leuven, Belgium; CREEC (Center for Research and Education in Emergency Care), University of Leuven, Leuven, Belgium
| |
Collapse
|
8
|
Besenyő J, Barten DG, De Cauwer HG, Tin D, Gulyás A. A Review of Ambulance Terrorism on the African Continent. Prehosp Disaster Med 2023; 38:237-242. [PMID: 36847135 DOI: 10.1017/s1049023x23000213] [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] [Indexed: 03/01/2023]
Abstract
BACKGROUND In recent decades, an increasing number of terrorist attacks have been carried out against medical institutions, hospitals, and health care workers. These attacks, that often result in high numbers of casualties and impaired access to health services, have a more significant impact on people's sense of security than attacks against military and police targets. Attacks on ambulances - especially on the African continent - have been sparsely studied. This study examines attacks on ambulances on the African continent during the period from 1992-2022 (until December 31, 2021). METHODS Reports of ambulance terrorism were extracted from the Global Terrorism Database (GTD), RAND Database of Worldwide Terrorism Incidents (RDWTI), United Nation's Safeguarding Health in Conflict Coalition (SHCC) database, Armed Conflict Location and Event Data Project (ACLED), Surveillance System for Attacks on Health Care (SSA) database, and Aid Worker Security Database (AWSD). Furthermore, a grey literature search was performed. The date and location of the attacks, perpetrators, weapon and attack types, and the number of victims (dead and wounded) and hostages were collected. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis. RESULTS During the 30-year study period, 166 attacks were observed in 18 African countries. The number of attacks significantly increased since 2016, with 81.3% of the attacks taking place from 2016 to 2022. In total, 193 people died and another 208 were injured. Attacks with firearms were most frequently noted (92 cases; 55.4%), followed by attacks with explosive devices (26 cases; 15.7%). A significant number of ambulances were hijacked (26 cases; 15.7%) and subsequently used for other terrorist attacks. In seven attacks, ambulances were used as vehicle-born improvised explosive devices (VBIEDs). CONCLUSION In this database study on ambulance terrorism in Africa, it was found that the reported occurrence of attacks increased from 2013 onwards, including the rise of ambulances used as VBIEDs. These findings suggest that ambulance terrorism represents a real, significant risk that both governments and health care institutions must address.
Collapse
Affiliation(s)
- János Besenyő
- African Research Institute, Donát Bánki Faculty of Mechanical and Safety Engineering, Óbuda University, Budapest, Hungary
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Harald G De Cauwer
- Department of Disaster Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsUSA; Harvard Medical School, Boston, Massachusetts USA
| | - Derrick Tin
- Department of Neurology, Sint-Dimpna Regional Hospital, Geel, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Attila Gulyás
- Doctoral School for Safety and Security Sciences, Óbuda University, Budapest, Hungary
| |
Collapse
|
9
|
Tin D, Barten DG, Granholm F, Kovtonyuk P, Burkle FM, Ciottone GR. Hybrid warfare and counter-terrorism medicine. Eur J Trauma Emerg Surg 2023; 49:589-593. [PMID: 36763156 PMCID: PMC9913017 DOI: 10.1007/s00068-023-02230-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/13/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION March 9, 2022. An airstrike by Russian forces destroying a maternity hospital in Mariupol, Ukraine. The image of a severely injured pregnant woman covered in blood being stretchered away against the backdrop of destroyed buildings. Mutterings of the use of chemical weapons. This paper is a primer for healthcare personnel and health systems on hybrid warfare and counter-terrorism medicine. DISCUSSION While recent events and images arising from conflicts around the world represent a cruel hallmark in today's history, attacks against healthcare facilities and innocent civilians are not new and continue to be perpetrated around the world. In war, the Geneva Convention protects civilians and healthcare institutions from harm but when war crimes are being committed and civilians knowingly targeted, parallels from a healthcare perspective can be drawn with terrorism events. Increasingly, civilian institutions and in particular the healthcare sector, are drawn into such conflicts and understanding the health system impact of hybrid warfare and other asymmetrical attack methods is of great importance. CONCLUSION The field of Counter-Terrorism Medicine (CTM) explores the healthcare impacts of intentional, man-made attacks and much recent research and discussions around this topic are extremely relevant and applicable not just to the ongoing hybrid war in Ukraine, but to today's threat climate all around us.
Collapse
Affiliation(s)
- Derrick Tin
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
- Department of Critical Care Medicine, University of Melbourne, Melbourne, Australia
| | - Dennis G. Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Fredrik Granholm
- Department of Emergency Medicine and EMS, Sundsvall County Hospital, Sundsvall, Sweden
| | | | | | - Gregory R. Ciottone
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| |
Collapse
|
10
|
Wirken B, Barten DG, De Cauwer H, Mortelmans L, Tin D, Ciottone G. Terrorist Attacks against Health Care Targets that Provide Abortion Services. Prehosp Disaster Med 2023:1-6. [PMID: 36942568 DOI: 10.1017/s1049023x23000341] [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] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Terrorist attacks against hospitals and health care providers have disproportionally increased during the last decades. A significant proportion of these attacks targeted abortion clinics and abortion providers. In the light of the overturning of Roe v. Wade in 2022, an increase of anti-abortion terrorist attacks is anticipated. Therefore, it becomes imperative to gain further insight into the risk and characteristics of past terrorist attacks. This study aimed to review terrorist attacks against health care targets providing abortion services from 1970 through 2020. METHODS Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database functions for all terrorist attacks against abortion health care providers from January 1, 1970 - December 31, 2020. Temporal factors, location, attack and weapon type, and number of casualties or hostages were analyzed using descriptive statistics. RESULTS In total, 262 terrorist attacks were identified in five different countries. The majority (96.6%) occurred in the United States, with the highest counts during the last 20 years of the 20th century. Facility and infrastructure attacks were the most common attack types, followed by bombings and explosions. The attacks resulted in 34 injuries and nine fatalities. Kidnapping took place in three incidents. Of all successful attacks, 96.9% resulted in property damage. CONCLUSION Abortion-related health care facilities and providers have repeatedly been the target of terrorists over the past decades. Nearly all of these attacks took place in the United States, with the highest counts during the last 20 years of the 20th century.
Collapse
Affiliation(s)
- Bart Wirken
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Harald De Cauwer
- Department of Neurology, Dimpna Regional Hospital, Geel, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Luc Mortelmans
- Center for Research and Education in Emergency Care, University of Leuven, Leuven, Belgium; REGEDIM, Free University Brussels, Brussels, Belgium; Department of Emergency Medicine, ZNA Camp Stuivenberg, Antwerp, Belgium
| | - Derrick Tin
- Faculty, BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MassachusettsUSA
| | - Gregory Ciottone
- Director, BIDMC Disaster Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
11
|
Goniewicz K, Barten DG. Disaster preparedness differences in emergency departments in Poland and the Netherlands. Am J Emerg Med 2023; 67:191. [PMID: 36914487 DOI: 10.1016/j.ajem.2023.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Affiliation(s)
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| |
Collapse
|
12
|
Adang EAMC, Strous MTA, van den Bergh JP, Gach D, van Kampen VEM, van Zeeland REP, Barten DG, van Osch FHM. Association of Heart Rate Variability with Pulmonary Function Impairment and Symptomatology Post-COVID-19 Hospitalization. Sensors (Basel) 2023; 23:s23052473. [PMID: 36904676 PMCID: PMC10007596 DOI: 10.3390/s23052473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 06/12/2023]
Abstract
The persistence of symptoms beyond three months after COVID-19 infection, often referred to as post-COVID-19 condition (PCC), is commonly experienced. It is hypothesized that PCC results from autonomic dysfunction with decreased vagal nerve activity, which can be indexed by low heart rate variability (HRV). The aim of this study was to assess the association of HRV upon admission with pulmonary function impairment and the number of reported symptoms beyond three months after initial hospitalization for COVID-19 between February and December 2020. Follow-up took place three to five months after discharge and included pulmonary function tests and the assessment of persistent symptoms. HRV analysis was performed on one 10 s electrocardiogram obtained upon admission. Analyses were performed using multivariable and multinomial logistic regression models. Among 171 patients who received follow-up, and with an electrocardiogram at admission, decreased diffusion capacity of the lung for carbon monoxide (DLCO) (41%) was most frequently found. After a median of 119 days (IQR 101-141), 81% of the participants reported at least one symptom. HRV was not associated with pulmonary function impairment or persistent symptoms three to five months after hospitalization for COVID-19.
Collapse
Affiliation(s)
- Estelle A. M. C. Adang
- Department of Emergency Medicine, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands
| | - Maud T. A. Strous
- Department of Internal Medicine, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands
| | - Joop P. van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Debbie Gach
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Clinical Epidemiology, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands
| | | | | | - Dennis G. Barten
- Department of Emergency Medicine, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands
| | - Frits H. M. van Osch
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Clinical Epidemiology, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands
- Department of Epidemiology, Maastricht University, 6229 ER Maastricht, The Netherlands
| |
Collapse
|
13
|
van Son JE, Kahn ECP, van der Bol JM, Barten DG, Blomaard LC, van Dam C, Ellerbroek J, Jansen SWM, Lekx A, van der Linden CMJ, Looman R, Maas HAAM, Mattace-Raso FUS, Mooijaart SP, van Munster BC, Peters A, Polinder-Bos HA, Smits RAL, Spies PE, Wassenburg A, Wassenburg N, Willems HC, Schouten HJ, Robben SHM. Atypical presentation of COVID-19 in older patients is associated with frailty but not with adverse outcomes. Eur Geriatr Med 2023; 14:333-343. [PMID: 36749454 PMCID: PMC9902812 DOI: 10.1007/s41999-022-00736-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/24/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE Older patients with COVID-19 can present with atypical complaints, such as falls or delirium. In other diseases, such an atypical presentation is associated with worse clinical outcomes. However, it is not known whether this extends to COVID-19. We aimed to study the association between atypical presentation of COVID-19, frailty and adverse outcomes, as well as the incidence of atypical presentation. METHODS We conducted a retrospective observational multi-center cohort study in eight hospitals in the Netherlands. We included patients aged ≥ 70 years hospitalized with COVID-19 between February 2020 until May 2020. Atypical presentation of COVID-19 was defined as presentation without fever, cough and/or dyspnea. We collected data concerning symptoms on admission, demographics and frailty parameters [e.g., Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS)]. Outcome data included Intensive Care Unit (ICU) admission, discharge destination and 30-day mortality. RESULTS We included 780 patients, 9.5% (n = 74) of those patients had an atypical presentation. Patients with an atypical presentation were older (80 years, IQR 76-86 years; versus 79 years, IQR 74-84, p = 0.044) and were more often classified as severely frail (CFS 6-9) compared to patients with a typical presentation (47.6% vs 28.7%, p = 0.004). Overall, there was no significant difference in 30-day mortality between the two groups in univariate analysis (32.4% vs 41.5%; p = 0.173) or in multivariate analysis [OR 0.59 (95% CI 0.34-1.0); p = 0.058]. CONCLUSIONS In this study, patients with an atypical presentation of COVID-19 were more frail compared to patients with a typical presentation. Contrary to our expectations, an atypical presentation was not associated with worse outcomes.
Collapse
Affiliation(s)
- Joy E. van Son
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Location ETZ Elisabeth, Post Office Box 90151, 5000 LC Tilburg, The Netherlands
| | - Elisabeth C. P. Kahn
- Department of Geriatric Medicine and Centre of Excellence for Old Age Medicine, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
| | | | - Dennis G. Barten
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Laura C. Blomaard
- Section Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Carmen van Dam
- Division of Geriatric Medicine, Department of Internal Medicine, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Jacobien Ellerbroek
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Steffy W. M. Jansen
- Department of Geriatric Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Anita Lekx
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | | | - Roy Looman
- Division of Geriatric Medicine, Department of Internal Medicine, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Huub A. A. M. Maas
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Location ETZ Elisabeth, Post Office Box 90151, 5000 LC Tilburg, The Netherlands
| | - Francesco U. S. Mattace-Raso
- Department of Internal Medicine, Division of Geriatric Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Simon P. Mooijaart
- Section Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Barbara C. van Munster
- Department of Internal Medicine and Geriatrics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Annefleur Peters
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Harmke A. Polinder-Bos
- Department of Internal Medicine, Division of Geriatric Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Rosalinde A. L. Smits
- Section Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Petra E. Spies
- Department of Geriatric Medicine and Centre of Excellence for Old Age Medicine, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
| | - Anna Wassenburg
- Department of Geriatric Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Nora Wassenburg
- Department of Geriatric Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Hanna C. Willems
- Section Geriatrics, Department of Internal Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
| | - Henrike J. Schouten
- Department of Geriatric Medicine and Centre of Excellence for Old Age Medicine, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
| | - Sarah H. M. Robben
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Location ETZ Elisabeth, Post Office Box 90151, 5000 LC Tilburg, The Netherlands
| |
Collapse
|
14
|
Kusters RWJ, Peters NALR, van Osch FHM, Simons PCG, Hulsbosch MHHM, Janzing HMJ, Barten DG. Primary care access to radiology: Characteristics of trauma patients referred to the emergency department. J Eval Clin Pract 2023; 29:101-107. [PMID: 35851516 PMCID: PMC10084186 DOI: 10.1111/jep.13738] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 01/18/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Low-urgent Emergency Department (ED) attendances are a known contributing factor to ED crowding. In the Netherlands, general practitioners (GPs) have direct access to radiology facilities during office hours. Patients with radiographically confirmed traumatic injuries are subsequently referred to the ED. We analysed these ED trauma patients' characteristics, provided treatments and ED discharge diagnoses to identify the possibility of alternative care pathways. METHODS Single-centre retrospective observational study of trauma patients referred to the ED by the radiology department during office hours (January 2017-December 2017). Data were obtained from patient records. Descriptive statistics were used to analyse the extracted data. RESULTS A total of 662 patients were included. The median age was 42 years (range: 1-100, interquartile range (IQR): 15-63) and patients presented to the ED with a median delay of 1 day (range: 0-112 days, IQR: 0-5). Most patients were referred for injuries involving the upper extremities (61.5%) and lower extremities (30%). A total of 48 additional diagnoses were made in the ED. The majority of injuries was classified as 'minor' (29.5%) or 'moderate' (68.3%) on the Abbreviated Injury Scale (AIS). The median length of stay in the ED was 65 min (range: 7-297 min, IQR: 43-102). CONCLUSION Most patients presented with low acuity injuries and often with a notable delay to the ED. This suggests that the majority of these patients do not necessarily need ED treatment, which may provide an opportunity to counter ED crowding.
Collapse
Affiliation(s)
- Renske W J Kusters
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | | | - Frits H M van Osch
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, The Netherlands.,Department of Epidemiology, Maastricht University, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Petra C G Simons
- Department of Radiology, VieCuri Medical Center, Venlo, The Netherlands
| | - Mark H H M Hulsbosch
- Department of Orthopedic Surgery, VieCuri Medical Center, Venlo, The Netherlands
| | | | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| |
Collapse
|
15
|
van der Baaren R, Barten DG, van Osch F, van Barneveld KWY, Janzing HMJ, Cals JWL. Minor traumatic injuries in the emergency department pre- and post-implementation of an emergency care access point. J Eval Clin Pract 2023; 29:32-38. [PMID: 35599366 DOI: 10.1111/jep.13705] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE In the Netherlands, out-of-hours General Practice Cooperatives (GPCs) increasingly collaborate with Emergency Departments (EDs) to form an Emergency Care Access Point (ECAP). ECAPs aim to decrease the number of low-urgent ED attendances, of which many compromise minor traumatic injuries. In this study, we evaluated the impact of ECAP implementation on the incidence of minor traumatic injuries in the ED. METHODS We evaluated a total of 2772 ED patients who presented with a minor traumatic injury (categorized into traumatic wounds and isolated extremity injuries) 1 year before and 1 year after ECAP implementation. We compared patient characteristics, throughput, diagnosis, treatment and follow-up before and after ECAP implementation. RESULTS ECAP implementation was associated with a reduction in ED volume for minor traumatic injuries: -12.4% for isolated extremity injuries (1249 vs. 1094) and -74.6% for traumatic wounds (342 vs. 87). Multivariable logistic regression analysis controlling for patient characteristics showed that ECAP implementation was associated with higher rates of substantial injuries in the ED (OR 1.20, 95% CI = 1.01-1.43), and more patients requiring outpatient follow-up. CONCLUSION Implementation of an ECAP was associated with a reduction of ED utilization by patients with minor traumatic injuries, traumatic wounds in particular. This healthcare intervention may therefore help to reduce ED utilization for low-urgent complaints.
Collapse
Affiliation(s)
- Rens van der Baaren
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Frits van Osch
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, The Netherlands
| | | | | | - Jochen W L Cals
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
16
|
De Cauwer H, Barten DG, Tin D, Mortelmans LJ, Lesaffre B, Somville F, Ciottone GR. Terrorist Attacks Against COVID-19-Related Targets during the Pandemic Year 2020: A Review of 165 Incidents in the Global Terrorism Database. Prehosp Disaster Med 2022; 38:1-7. [PMID: 36539346 PMCID: PMC9885425 DOI: 10.1017/s1049023x22002394] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/10/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic enabled a situational type of terrorism with mixed racist, anti-government, anti-science, anti-5G, and conspiracy theorist backgrounds and motives. OBJECTIVE The objective of this study was to identify and characterize all documented COVID-19-related terrorist attacks reported to the Global Terrorism Database (GTD) in 2020. METHODS The GTD was searched for all COVID-19-related terrorist attacks (aimed at patients, health care workers, and at all actors involved in pandemic containment response) that occurred world-wide in 2020. Analyses were performed on temporal factors, location, target type, attack and weapon type, attacker type, and number of casualties or hostages. Ambiguous incidents were excluded if there was doubt about whether they were exclusively acts of terrorism. RESULTS In total, 165 terrorist attacks were identified. With 50% of incidents, Western Europe was the most heavily hit region of the world. Nonetheless, most victims were listed in Southeast Asia (19 fatalities and seven injured). The most frequent but least lethal attack type concerned arson attacks against 5G telephone masts (105 incidents [60.9%] with only one injured). Armed assaults accounted for most fatalities, followed by assassinations. Incendiary and firearms were the most devastating weapon types. CONCLUSION This analysis of the GTD, which identified 165 COVID-19-related terrorist attacks in 2020, demonstrates that the COVID-19 pandemic truly resulted in new threats for COVID-19 patients, aid workers, hospitals, and testing and quarantine centers. It is anticipated that vaccination centers have become a new target of COVID-19-related terrorism in 2021 and 2022.
Collapse
Affiliation(s)
- Harald De Cauwer
- Department of Neurology, Sint-Dimpna Regional Hospital, Geel, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Dennis G. Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Derrick Tin
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Luc J. Mortelmans
- Center for Research and Education in Emergency Care, University of Leuven, Leuven; REGEDIM, Free University Brussels, Brussels; Department of Emergency Medicine, ZNA Camp Stuivenberg, Antwerp, Belgium
| | - Bart Lesaffre
- Department of Emergency Medicine, AZ Sint Jan, Bruges/Oostende, Belgium and HoWest, Bruges, Belgium
| | - Francis Somville
- Department of Emergency Medicine, Sint-Dimpna Regional Hospital, Geel, Belgium; Faculty of Medicine and Health Sciences. University of Antwerp, Wilrijk, Belgium; Faculty of Medicine, University of Leuven, Leuven, Belgium; CREEC (Center for Research and Education in Emergency Care). University of Leuven, Leuven, Belgium
| | - Gregory R. Ciottone
- Director, BIDMC Disaster Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
17
|
De Cauwer H, Barten DG, Tin D, Mortelmans LJ, Ciottone GR, Somville F. Terrorist Attacks against Concerts and Festivals: A Review of 146 Incidents in the Global Terrorism Database. Prehosp Disaster Med 2022; 38:1-8. [PMID: 36541015 PMCID: PMC9885432 DOI: 10.1017/s1049023x22002382] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/08/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mass gatherings are vulnerable to terrorist attacks and are considered soft targets with potential to inflict high numbers of casualties. The objective of this study was to identify and characterize all documented terrorist attacks targeted at concerts and festivals reported to the Global Terrorism Database (GTD) over a 50-year period. METHODS The GTD was searched for all terrorist attacks against concerts and festivals that occurred world-wide from 1970 through 2019. Analyses were performed on temporal factors, location, target type, attack and weapon type, attacker type, and number of casualties or hostages. Ambiguous incidents were excluded if there was doubt about whether they were exclusively acts of terrorism. Chi-square tests were performed to evaluate trends over time and differences in attack types. RESULTS In total, 146 terrorist attacks were identified. In addition to musical concerts, festivals included religious, cultural, community, and food festivals. With 53 incidents, South Asia was the most heavily hit region of the world, followed by the Middle East & North Africa with 25 attacks. Bombings and explosions were the most common attack types. The attacks targeted attendees, pilgrims, politicians, or police/military members who secured the concerts and festivals. CONCLUSION This analysis of the GTD, which identified terrorist attacks aimed at concerts and festivals over a 50-year period, demonstrates that the threat is significant, and not only in world regions where terrorism is more prevalent or local conflicts are going on. The findings of this study may help to create or enhance contingency plans.
Collapse
Affiliation(s)
- Harald De Cauwer
- Department of Neurology, Sint-Dimpna Regional Hospital, Geel, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Dennis G. Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Derrick Tin
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Luc J. Mortelmans
- Center for Research and Education in Emergency Care, University of Leuven, Leuven, Belgium; REGEDIM, Free University Brussels, Belgium; Department of Emergency Medicine, ZNA Camp Stuivenberg, Antwerp, Belgium
| | - Gregory R. Ciottone
- Director, BIDMC Disaster Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, Massachusetts, USA
| | - Francis Somville
- Department of Emergency Medicine, Ziekenhuis Geel, Geel, Belgium; Faculty of Medicine and Health Sciences. University of Antwerp, Wilrijk, Belgium; Faculty of Medicine, University of Leuven, Leuven, Belgium; CREEC (Center for research and education in Emergency Care). University of Leuven, Leuven, Belgium
| |
Collapse
|
18
|
van Stekelenburg BCA, De Cauwer H, Barten DG, Mortelmans LJ. Attacks on Health Care Workers in Historical Pandemics and COVID-19. Disaster Med Public Health Prep 2022; 17:e309. [PMID: 36474406 PMCID: PMC9947042 DOI: 10.1017/dmp.2022.275] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Previous pandemics have been (mis)used for (geo)political reasons, for terrorism purposes, and in times of conflict. Coronavirus disease (COVID-19) has been no exception with populist politicians challenging the relations with China, calling it the "Chinese virus," certain state actors setting up cyberterrorist actions against health care organizations in the United States and Europe, and a reported increase of violent acts against health care workers.Aside from state-driven factors, both left- and right-wing activists and anti-vaccination activists adhering to conspiracy theories are a threat for health care organizations. Furthermore, socioeconomic, religious, and cultural factors play a role in why health care is a possible target of violence. Fear of viral pathogens, fury about financial losses due to the pandemic and governmental measures such as lockdowns, anger because of mandatory quarantines, and the disruption of burial rituals are among the reasons for people to revolt against health care providers.Here, we provide a narrative review of the impact of violence against health care workers during the COVID-19 pandemic and earlier pandemics, and suggest preventive strategies.
Collapse
Affiliation(s)
| | - Harald De Cauwer
- Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Corresponding author: Harald De Cauwer,
| | - Dennis G. Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Luc J. Mortelmans
- ZNA, Camp Stuivenberg, Antwerp, Belgium
- Center for Research and Education in Emergency Care, University of Leuven, Leuven, Belgium
- Research Group on Emergency and Disaster Medicine (ReGEDiM), VUB, Brussels, Belgium
| |
Collapse
|
19
|
Kroon B, Beishuizen SJE, van Rensen IHT, Barten DG, Mehagnoul‐Schipper JJ, van der Bol JM, Ellerbroek JLJ, Festen J, van de Glind EMM, Hempenius L, van der Jagt M, Jansen SWM, van der Linden CJM, Mooijaart SP, van Munster BC, Oosterwijk LLE, Smit L, Urlings‐Strop LC, Willems HC, Mattace‐Raso FUS, Polinder‐Bos HA. Delirium in older COVID-19 patients: Evaluating risk factors and outcomes. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5810. [PMID: 36052424 PMCID: PMC9538581 DOI: 10.1002/gps.5810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/20/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES A high incidence of delirium has been reported in older patients with Coronavirus disease 2019 (COVID-19). We aimed to identify determinants of delirium, including the Clinical Frailty Scale, in hospitalized older patients with COVID-19. Furthermore, we aimed to study the association of delirium independent of frailty with in-hospital outcomes in older COVID-19 patients. METHODS This study was performed within the framework of the multi-center COVID-OLD cohort study and included patients aged ≥60 years who were admitted to the general ward because of COVID-19 in the Netherlands between February and May 2020. Data were collected on demographics, co-morbidity, disease severity, and geriatric parameters. Prevalence of delirium during hospital admission was recorded based on delirium screening using the Delirium Observation Screening Scale (DOSS) which was scored three times daily. A DOSS score ≥3 was followed by a delirium assessment by the ward physician In-hospital outcomes included length of stay, discharge destination, and mortality. RESULTS A total of 412 patients were included (median age 76, 58% male). Delirium was present in 82 patients. In multivariable analysis, previous episode of delirium (Odds ratio [OR] 8.9 [95% CI 2.3-33.6] p = 0.001), and pre-existent memory problems (OR 7.6 [95% CI 3.1-22.5] p < 0.001) were associated with increased delirium risk. Clinical Frailty Scale was associated with increased delirium risk (OR 1.63 [95%CI 1.40-1.90] p < 0.001) in univariable analysis, but not in multivariable analysis. Patients who developed delirium had a shorter symptom duration and lower levels of C-reactive protein upon presentation, whereas vital parameters did not differ. Patients who developed a delirium had a longer hospital stay and were more often discharged to a nursing home. Delirium was associated with mortality (OR 2.84 [95% CI1.71-4.72] p < 0.001), but not in multivariable analyses. CONCLUSIONS A previous delirium and pre-existent memory problems were associated with delirium risk in COVID-19. Delirium was not an independent predictor of mortality after adjustment for frailty.
Collapse
Affiliation(s)
- Bart Kroon
- Department of Geriatric MedicineErasmus MC, University Medical Center RotterdamThe Netherlands
| | | | | | - Dennis G. Barten
- Department of Emergency MedicineVieCuri Medical CenterVenloThe Netherlands
| | | | | | | | | | | | - Liesbeth Hempenius
- Department of Geriatric MedicineMedical Center LeeuwardenLeeuwardenThe Netherlands
| | | | | | | | | | | | - Leanne L. E. Oosterwijk
- Department of Geriatric MedicineErasmus MC, University Medical Center RotterdamThe Netherlands
| | - Lisa Smit
- Intensive Care DepartmentErasmus Medical CenterRotterdamThe Netherlands
| | | | - Hanna C. Willems
- Department of Internal Medicine and GeriatricsAmsterdam University Medical CentersAmsterdamThe Netherlands
| | | | - Harmke A. Polinder‐Bos
- Department of Geriatric MedicineErasmus MC, University Medical Center RotterdamThe Netherlands
| |
Collapse
|
20
|
van Bergen KM, van Kooten L, Eurlings CG, Foudraine NA, Lameijer H, Meeder JG, Rahel BM, Versteegen MG, van Osch FH, Barten DG. Prognostic value of the shock index and modified shock index in survivors of out-of-hospital cardiac arrest: A retrospective cohort study. Am J Emerg Med 2022; 58:175-185. [DOI: 10.1016/j.ajem.2022.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 12/09/2022] Open
|
21
|
Abstract
BACKGROUND Many capital cities around the world have been subjected to terrorist attacks on their transport systems with devastating consequences. Large crowds in small enclosed spaces, disruption to people movement, and the psychosocial and financial repercussions of attacks are some of the many soft target vulnerabilities of mass-transit systems.This study is an epidemiological examination of all terrorism-related events targeting air, sea, and ground transport modalities sustained from 1970-2019, comparing the rates of fatal injuries (FI) and non-fatal injuries (NFI). METHOD The Global Terrorism Database (GTD) was downloaded and searched using the internal database search functions for all events that occurred from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. "Transportation," "Airport and Aircraft," and "Maritime" as primary target types were selected for the purpose of this study, and events were further sub-classified by region, weapon type used, and by suicide attack (SA). "Airport personnel" were excluded. All classifications and sub-classifications were pre-determined by the GTD. RESULTS There were 8,729 transportation-related (air, sea, and ground) attacks documented during the study period with 19,020 fatalities and 45,218 NFI. This accounted for 5.2% of all terrorist attacks (168,003 total events), 5.6% of all FI (total 339,435), and 9.1% of all NFI (total 496,225). The mean FI was 2.2 per event and the mean NFI was 5.2 per attack.South Asia (28.4%), Middle East and North Africa (18.2%), and South America (14.9%) accounted for 61.5% of all transport related attacks. Attacks on subways inflicted a disproportionately high 51.5 NFI per attack. Suicide attacks recorded the highest ratios for both FI (13.71 per attack) and NFI (139.00 per attack). CONCLUSION Transport modalities are vulnerable terrorist soft targets. The repercussions of attacks on public transport modalities represent a significant and unique psychosocial and economical risk to the affected communities. Suicide attacks on subways represent a unique and significantly higher casualty risk than other transport modalities. Risk mitigation strategies should be regularly revisited by Counter-Terrorism Medicine (CTM) specialists.
Collapse
Affiliation(s)
- Derrick Tin
- Senior Fellow, BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Cambridge, MassachusettsUSA
| | - Dennis G Barten
- Emergency Physician, Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Harald De Cauwer
- Department of Neurology, Dimpna Regional Hospital, Geel, Belgium and Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Gregory R Ciottone
- Director, BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, MassachusettsUSA
| |
Collapse
|
22
|
Barten DG, van Zijl R, Körver FWJ, Peters NALR. Simultaneous interfacility transfer of multiple non-critically ill COVID-19 patients using a single vehicle: the ambulance bus experience. Int J Emerg Med 2022; 15:10. [PMID: 35247962 PMCID: PMC8897726 DOI: 10.1186/s12245-022-00415-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/09/2022] [Indexed: 11/15/2022] Open
Abstract
Background During the COVID-19 pandemic, hospital capacity in the Netherlands has been pushed to its limits. In order to prevent hospitals from collapse due to capacity issues, hospitalized COVID-19 patients were redistributed throughout the country. The numerous individual interfacility transfers further increased the pressure on emergency medical services (EMS), which simultaneously had to serve the community during the pandemic. In this report, we evaluate the interfacility transport of multiple non-critically ill COVID-19 patients using one single vehicle: a coach converted into an ambulance bus. Discussion Between March 28, 2020, and July 17, 2021, the ambulance bus was dispatched 22 times. In total, 102 patients were transferred over a mean distance of 79.6 km. No technical or patient-related adverse events were reported. The primary benefits of the ambulance bus were its time and staff reducing potential, as well as the ability to provide relief to overwhelmed hospitals. Furthermore, it could be assembled from existing equipment in a relatively short time span. However, the efficiency of dispatches and matching between hospitals could be improved. Conclusion The simultaneous interfacility transfer of multiple non-critically ill COVID-19 patients using an ambulance bus was feasible. No technical or patient-related adverse events were reported during 22 dispatches, involving a total of 102 patients. This mode of transport may also be useful in non-pandemic situations, such as hospital and nursing home evacuations.
Collapse
Affiliation(s)
- Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, P.O. Box 1926, 5900, BX, Venlo, The Netherlands.
| | | | | | - Nathalie A L R Peters
- Department of Emergency Medicine, VieCuri Medical Center, P.O. Box 1926, 5900, BX, Venlo, The Netherlands.,AmbulanceZorg Limburg-Noord, Venlo, The Netherlands
| |
Collapse
|
23
|
Smits RAL, Trompet S, van der Linden CMJ, van der Bol JM, Jansen SWM, Polinder-Bos HA, Willems HC, Barten DG, Blomaard LC, de Boer MGJ, van Deudekom FJA, Ellerbroek JLJ, Festen J, van de Glind EMM, Kampschreur LM, Karimi O, Kroon B, van Lanen MGJA, Lucke JA, Maas HAAM, Mattace-Raso FUS, van Munster BC, Reijerse L, Robben SHM, Ruiter R, Schouten HJ, Spies PE, Wassenburg A, Wijngaarden MA, Mooijaart SP. Characteristics and outcomes of older patients hospitalised for COVID-19 in the first and second wave of the pandemic in The Netherlands: the COVID-OLD study. Age Ageing 2022; 51:6540140. [PMID: 35235650 PMCID: PMC8890695 DOI: 10.1093/ageing/afac048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Indexed: 12/15/2022] Open
Abstract
Background as the coronavirus disease of 2019 (COVID-19) pandemic progressed diagnostics and treatment changed. Objective to investigate differences in characteristics, disease presentation and outcomes of older hospitalised COVID-19 patients between the first and second pandemic wave in The Netherlands. Methods this was a multicentre retrospective cohort study in 16 hospitals in The Netherlands including patients aged ≥ 70 years, hospitalised for COVID-19 in Spring 2020 (first wave) and Autumn 2020 (second wave). Data included Charlson comorbidity index (CCI), disease severity and Clinical Frailty Scale (CFS). Main outcome was in-hospital mortality. Results a total of 1,376 patients in the first wave (median age 78 years, 60% male) and 946 patients in the second wave (median age 79 years, 61% male) were included. There was no relevant difference in presence of comorbidity (median CCI 2) or frailty (median CFS 4). Patients in the second wave were admitted earlier in the disease course (median 6 versus 7 symptomatic days; P < 0.001). In-hospital mortality was lower in the second wave (38.1% first wave versus 27.0% second wave; P < 0.001). Mortality risk was 40% lower in the second wave compared with the first wave (95% confidence interval: 28–51%) after adjustment for differences in patient characteristics, comorbidity, symptomatic days until admission, disease severity and frailty. Conclusions compared with older patients hospitalised in the first COVID-19 wave, patients in the second wave had lower in-hospital mortality, independent of risk factors for mortality. The better prognosis likely reflects earlier diagnosis, the effect of improvement in treatment and is relevant for future guidelines and treatment decisions.
Collapse
Affiliation(s)
- Rosalinde A L Smits
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
- Address correspondence to: Rosalinde A. L. Smits, Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2 2333 ZA Leiden. Tel: 071-5261850; Fax: 071-5266881.
| | - Stella Trompet
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Steffy W M Jansen
- Department of Geriatrics, Catharina Hospital, Eindhoven, The Netherlands
| | - Harmke A Polinder-Bos
- Department of Internal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Hanna C Willems
- Section Geriatrics, Department of Internal Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Laura C Blomaard
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mark G J de Boer
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - Floor J A van Deudekom
- Department of Internal Medicine and Geriatrics, OLVG Hospital, Amsterdam, The Netherlands
| | | | | | | | - Linda M Kampschreur
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Ouafae Karimi
- Department of Geriatric Medicine, St Jansdal Hospital, Harderwijk, The Netherlands
| | - Bart Kroon
- Department of Internal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Marc G J A van Lanen
- Department of Pulmonary Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Jacinta A Lucke
- Department of Emergency Medicine, Spaarne Hospital, Haarlem, The Netherlands
| | - Huub A A M Maas
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Francesco U S Mattace-Raso
- Section Geriatrics, Department of Internal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Barbara C van Munster
- Department of Internal Medicine and Geriatrics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Lisette Reijerse
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Sarah H M Robben
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Rikje Ruiter
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Henrike J Schouten
- Department of Geriatric Medicine and Centre of Excellence for Old Age Medicine, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
| | - Petra E Spies
- Geriatrician and Clinical Pharmacologist, Department of Geriatric Medicine and Centre of Excellence for Old Age Medicine Gelre Hospitals, Apeldoorn & Zutphen, The Netherlands
| | - Anna Wassenburg
- Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Marjolein A Wijngaarden
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Simon P Mooijaart
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
24
|
Schmeitz CTJ, Barten DG, van Barneveld KWY, De Cauwer H, Mortelmans L, van Osch F, Wijnands J, Tan EC, Boin A. Terrorist Attacks Against Emergency Medical Services: Secondary Attacks are an Emerging Risk. Prehosp Disaster Med 2022; 37:1-7. [PMID: 35105401 DOI: 10.1017/s1049023x22000140] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Terrorists increasingly aim at so-called soft targets, such as hospitals. However, little is known about terrorist attacks against Emergency Medical Services (EMS). OBJECTIVE This study aims to review all documented terrorist attacks against EMS that occurred world-wide from 1970-2019 using the Global Terrorism Database (GTD). METHODS Reports of terrorist attacks against EMS were extracted from the GTD from 1970-2019. Data collection included temporal factors, attack and weapon type, number of casualties, and if it was a primary or secondary attack (secondary attack: deliberate attack against the first responders of an initial terrorist attack). Reports were excluded if EMS were not a target or if it was unclear whether they were a target. Chi-square tests were performed to evaluate trends over time. RESULTS There were 184 terrorist attacks against EMS, resulting in 748 deaths and 1,239 people injured. Terrorist attacks against EMS significantly increased over the past two decades. The "Middle East & North Africa" was the most frequently affected region with 81 attacks (44.0%) followed by "South Asia" with 41 attacks (22.3%). Bombings and explosions were the most common attack type (85 incidents; 46.2%) followed by armed assaults (68 incidents; 35.3%). Combined prehospital and hospital attacks were first reported in 2005 and occurred seven times. The first secondary attack against EMS dates from 1997, after which an increase was observed from 10 to 39 incidents in the periods 2000-2009 and 2010-2019, respectively. CONCLUSIONS This analysis of the GTD, which identified 184 terrorist attacks against EMS over a 50-year period, demonstrates that terrorist attacks against EMS have significantly increased during the years and that secondary attacks are an emerging risk. Bombings and explosions are the most common attack type. Terrorist attacks against EMS are most prevalent in countries with high level of internal conflicts, however, they have also occurred in western countries. These incidents may hold valuable information to prevent future attacks.
Collapse
Affiliation(s)
- Cindy T J Schmeitz
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
- Department of Intensive Care Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | | | - Harald De Cauwer
- Department of Neurology, Dimpna Regional Hospital, Geel, Belgium
| | - Luc Mortelmans
- Center for Research and Education in Emergency Care, University of Leuven, Leuven, Belgium
- Department of Emergency Medicine, ZNA Camp Stuivenberg, Antwerp, Belgium
| | - Frits van Osch
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, The Netherlands
| | | | - Edward C Tan
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arjen Boin
- Department of Political Science, Leiden University, Leiden, The Netherlands
| |
Collapse
|
25
|
Barten DG, Latten GH, van Osch FH. Reduced Emergency Department Utilization During the Early Phase of the COVID-19 Pandemic: Viral Fear or Lockdown Effect? Disaster Med Public Health Prep 2022; 16:36-39. [PMID: 32782063 PMCID: PMC7503047 DOI: 10.1017/dmp.2020.303] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Since the beginning of the coronavirus disease (COVID-19) pandemic, several frontline workers have expressed their concerns about reduced emergency department (ED) utilization. We aimed to examine the changes in ED utilization during the early phase of the COVID-19 pandemic, in a country with a well-developed primary care system. METHODS A retrospective analysis of ED utilization was performed in 3 Dutch hospitals during a 60-day period, starting on February 15, 2020. The identical period in 2019 was used as a reference. ED visits were labeled as COVID-related (defined as COVID-19 suspected) or non-COVID-related. Admission rates were compared using chi-square tests, and the reduction in ED visits was assessed descriptively. RESULTS During the study period, daily ED volume was 18% lower compared to that of 2019. ED utilization further declined (-29%) during lockdown. Combined admission rates were higher in 2020 compared to those in 2019 (P < 0.001), and they were higher for COVID-19 versus non-COVID-19 ED visits (P < 0.001). CONCLUSIONS ED utilization was markedly reduced during the local rise of COVID-19 in a region with a well-developed primary care system and relatively low ED self-referral rates. Although it cannot directly be concluded from the findings of our study, this observation likely reflects a complex interaction between pure lockdown effects and viral fear, which warrants further research.
Collapse
Affiliation(s)
- Dennis G. Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, Netherlands
| | - Gideon H.P. Latten
- Department of Emergency Medicine, Zuyderland Hospital, Heerlen & Sittard-Geleen, Netherlands
| | - Frits H.M. van Osch
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, Netherlands
| |
Collapse
|
26
|
Barten DG, Klokman VW, Boin A. Emergency department preparedness for internal hospital crises and disasters: should we do better? Eur J Emerg Med 2022; 29:14-15. [PMID: 34456296 DOI: 10.1097/mej.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo
| | - Vincent W Klokman
- Department of Emergency Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch
| | - Arjen Boin
- Department of Political Science, Leiden University, Leiden, the Netherlands
| |
Collapse
|
27
|
Abstract
BACKGROUND The rapid popularization of unmanned aerial vehicles (UAVs; also referred to as drones), in both the recreational and industrial sectors, has paved the way for rapid developments in drone capabilities. Although the threat of UAVs used by terrorists has been recognized by specialists in both Counter-Terrorism and Counter-Terrorism Medicine (CTM), there are limited data on the extent and characteristics of drone use by terrorist organizations. METHODS Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database search functions for all terrorist attacks using UAVs from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. Primary weapon type, number and type of UAVs used, related attacks, location (country, world region), and number of deaths and injuries were collated. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis. RESULTS There were 76 terrorist attacks using UAVs. The first attack occurred in 2016, and the number of attacks per year varied considerably (range: 4-36). Forty-seven of the 76 attacks (70%) were successful. Twenty-seven individually listed events (36%) were related and part of nine coordinated, multi-part incidents. A total of 50 deaths and 132 injuries were recorded, which equated to 1.09 deaths (range: 0-6) and 2.89 injuries (range: 0-20) per successful attack. The mean number of UAVs used in an attack was 1.28 (range: 1-5) and multiple UAVs were used in 22% of attacks. CONCLUSION The use of UAVs to carry out terrorist attacks is on the rise. Seventy-six terrorist attacks using this novel method were recorded since 2016, killing 50 and injuring 132 people. While the use of UAV-related explosives appears less lethal than traditional explosive attacks, advancing technologies and swarming capabilities, increasing ability to carry larger payloads, and the possibility of UAVs to disperse chemical, biological, radiological, and nuclear (CBRN) weapons will likely increase UAV lethality in the future, requiring CTM specialists be more proactive.
Collapse
Affiliation(s)
- Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Derrick Tin
- BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MassachusettsUSA
| | - Harald De Cauwer
- Department of Neurology, Dimpna Regional Hospital, Geel, Belgium and Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | | | - Gregory R Ciottone
- BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MassachusettsUSA
| |
Collapse
|
28
|
Peters A, Versteegen MGJ, van Osch F, Janzing HMJ, Barten DG. Mechanism and severity of mobility scooter-related injuries. Traffic Inj Prev 2022; 23:112-117. [PMID: 35044287 DOI: 10.1080/15389588.2021.1998469] [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] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE As a result of an aging population, mobility scooter use is increasing in Western countries. Consequently, an increase in mobility scooter-related injuries (MSRIs) is observed. Yet there is a paucity of studies in the literature assessing MSRIs. The purpose of this study was to investigate mechanism, severity, and localization of injury of MSRIs in the emergency department (ED) of a Dutch level 2 trauma center over a 9-year period. METHODS This was a retrospective study of MSRIs in the ED of a teaching hospital in the Netherlands between January 2010 and December 2019. All patients with an MSRI were included, as long as they were the driver of the vehicle. Data were collected from electronic patient files. The primary outcomes were severity of injury, defined by the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS), and mechanism and localization of injury. RESULTS A total of 382 patients were identified. Of these, 208 (54.3%) were female and the median age was 76 years (interquartile range [IQR] = 67.0-83.0). The median Charlson Comorbidity Index (CCI) was 5.0 (IQR = 4.0-6.0). Three (0.8%) patients had an ISS ≥ 16. The median ISS was 3.0 (IQR = 1.0-5.0). The lower extremity was the most commonly injured body region (46.5%), followed by head injury (36.3%), external injury (31.6%), and upper extremity injuries. Fractures were most commonly observed in the shoulder (10.2%), hip (8.9%), and ankle (6.3%). Most crashes were single-vehicle accidents (87.2%) and the most common mechanism of injury was rollover of mobility scooter (49.3%). Almost half of the patients (44.1%) had a fracture and the admission rate was 28.2% with a median length of stay (LOS) of 10 days. Fifty (13.1%) patients required surgery, of which 58% were hip repair surgery. CONCLUSION In this cohort of MSRIs, mobility scooter users had a median age of 76 years and severe comorbidity was common. Based on ISS, patients had a mild injury profile. However, the relatively high admission and surgery rates reflect the potential serious consequences of MSRIs and the obvious vulnerability of this population.
Collapse
Affiliation(s)
- Annefleur Peters
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | | | - Frits van Osch
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
- School of Nutrition and Translation Research in Metabolism (NUTRIM), Maastricht University (UM), Maastricht, The Netherlands
| | - Heinrich M J Janzing
- Department of (General/Trauma) Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| |
Collapse
|
29
|
van Dijk MM, Veldman HD, Aarts F, Barten DG, van den Bergh JP, Dielis AW. A case of unusual mild clinical presentation of COVID-19 vaccine-induced immune thrombotic thrombocytopenia with splanchnic vein thrombosis. Ann Hepatol 2022; 27:100590. [PMID: 34843991 PMCID: PMC8626153 DOI: 10.1016/j.aohep.2021.100590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/30/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Merel M.H. van Dijk
- VieCuri Medical Center Venlo, Department of Emergency Medicine, Tegelseweg 210, NL-5912 BL Venlo, the Netherlands,Corresponding author at: Genovevalaan 136, NL-5625 AL Eindhoven, the Netherlands
| | - Hidde D. Veldman
- VieCuri Medical Center Venlo, Department of Surgery, Tegelseweg 210, NL-5912 BL Venlo, the Netherlands
| | - Frits Aarts
- VieCuri Medical Center Venlo, Department of Surgery, Tegelseweg 210, NL-5912 BL Venlo, the Netherlands
| | - Dennis G. Barten
- VieCuri Medical Center Venlo, Department of Emergency Medicine, Tegelseweg 210, NL-5912 BL Venlo, the Netherlands
| | - Joop P van den Bergh
- VieCuri Medical Center Venlo, Department of Internal Medicine, Tegelseweg 210, NL-5912 BL Venlo, the Netherlands
| | - Arne W.J.H. Dielis
- VieCuri Medical Center Venlo, Department of Emergency Medicine, Tegelseweg 210, NL-5912 BL Venlo, the Netherlands
| |
Collapse
|
30
|
Knapen FMFM, Laumer SJM, Van Osch FHM, Barten DG. The impact of the COVID-19 pandemic on alcohol-related emergency department visits in the Netherlands: The ALCOVID study. Drug Alcohol Rev 2021; 41:476-483. [PMID: 34806251 PMCID: PMC9011601 DOI: 10.1111/dar.13410] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The ongoing COVID-19 pandemic has a profound impact on society and healthcare utilisation. Some studies found that alcohol consumption increased. While declines in non-COVID emergency department (ED) visits have been observed worldwide, little is known about the impact of the COVID-19 pandemic on the number of alcohol-related ED visits. We aimed to examine the changes in alcohol-related ED utilisation during the first year of the pandemic in the Netherlands. We assessed whether lockdowns, closure of the catering industry and alcohol bans were associated with changes in ED utilisation for alcohol-related emergencies. METHODS We performed a retrospective analysis of alcohol-related ED visits in a Dutch trauma level 2 centre, comparing the pandemic year 2020 and using the year 2019 as a reference. Alcohol-related ED visits were categorised as alcohol intoxication, alcohol-related trauma or a combination of both. RESULTS There was an absolute decline of 23.3% in alcohol-related ED visits during 2020 compared to 2019. The decline was most distinct during the second lockdown period (-60%, P ≤ 0.001), which included an alcohol ban. No significant differences were found in the type of alcohol-related ED visits. The proportion of alcohol-related ED visits remained similar (2.2% vs. 2%). DISCUSSION AND CONCLUSIONS Despite reports of higher alcohol consumption, we observed a reduction of alcohol-related ED visits during the COVID-19 pandemic. The decline was most distinct during the second lockdown period, which included an alcohol ban. Further prospective studies are warranted to examine this possible association.
Collapse
Affiliation(s)
- Femke M F M Knapen
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, Netherlands
| | - Susanne J M Laumer
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, Netherlands
| | - Frits H M Van Osch
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, Netherlands
| |
Collapse
|
31
|
Mol MBA, Strous MTA, van Osch FHM, Vogelaar FJ, Barten DG, Farchi M, Foudraine NA, Gidron Y. Heart-rate-variability (HRV), predicts outcomes in COVID-19. PLoS One 2021; 16:e0258841. [PMID: 34710127 PMCID: PMC8553073 DOI: 10.1371/journal.pone.0258841] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/06/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients with COVID-19 present with a variety of clinical manifestations, ranging from mild or asymptomatic disease to severe illness and death. Whilst previous studies have clarified these and several other aspects of COVID-19, one of the ongoing challenges regarding COVID-19 is to determine which patients are at risk of adverse outcomes of COVID-19 infection. It is hypothesized that this is the result of insufficient inhibition of the immune response, with the vagus nerve being an important neuro-immuno-modulator of inflammation. Vagus nerve activity can be non-invasively indexed by heart-rate-variability (HRV). Therefore, we aimed to assess the prognostic value of HRV, as a surrogate marker for vagus nerve activity, in predicting mortality and intensive care unit (ICU) referral, in patients hospitalized with COVID-19. METHODS A retrospective cohort study including all consecutive patients (n = 271) diagnosed and hospitalized with COVID-19 between March 2020 and May 2020, without a history of cardiac arrhythmias (including atrial and ventricular premature contractions), pacemaker, or current bradycardia (heart rate <50 bpm) or tachycardia (heart rate >110 bpm). HRV was based on one 10s ECG recorded at admission. 3-week survival and ICU referral were examined. RESULTS HRV indexed as standard deviation of normal to normal heartbeat intervals (SDNN) predicted survival (H.R. = 0.53 95%CI: 0.31-0.92). This protective role was observed only in patients aged 70 years and older, not in younger patients. HRV below median value also predicted ICU referral within the first week of hospitalization (H.R = 0.51, 95%CI: 0.29-0.90, P = 0.021). CONCLUSION Higher HRV predicts greater chances of survival, especially in patients aged 70 years and older with COVID-19, independent of major prognostic factors. Low HRV predicts ICU indication and admission in the first week after hospitalization.
Collapse
Affiliation(s)
- Maartje B A Mol
- Department of Surgery, VieCuri Medical Centre Venlo, Venlo, The Netherlands
| | - Maud T A Strous
- Department of Surgery, VieCuri Medical Centre Venlo, Venlo, The Netherlands.,Department of Intensive Care, VieCuri Medical Centre Venlo, Venlo, The Netherlands
| | - Frits H M van Osch
- Department of Epidemiology, VieCuri Medical Centre Venlo, Venlo, The Netherlands
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Centre Venlo, Venlo, The Netherlands
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Centre Venlo, Venlo, The Netherlands
| | - Moshe Farchi
- School of Social Work, Tel-Hai College, Qiryat Shemona, Israël
| | - Norbert A Foudraine
- Department of Intensive Care, VieCuri Medical Centre Venlo, Venlo, The Netherlands
| | - Yori Gidron
- Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
| |
Collapse
|
32
|
Barten DG, Klokman VW, Cleef S, Peters NALR, Tan ECTH, Boin A. When disasters strike the emergency department: a case series and narrative review. Int J Emerg Med 2021; 14:49. [PMID: 34503447 PMCID: PMC8427145 DOI: 10.1186/s12245-021-00372-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Emergency departments (EDs) are reasonably well prepared for external disasters, such as natural disasters, mass casualty incidents, and terrorist attacks. However, crises and disasters that emerge and unfold within hospitals appear to be more common than external events. EDs are often affected. Internal hospital crises and disasters (IHCDs) have the potential to endanger patients, staff, and visitors, and to undermine the integrity of the facility as a steward of public health and safety. Furthermore, ED patient safety and logistics may be seriously hampered. METHODS Case series of 3 disasters within EDs. Narrative overview of the current IHCD-related literature retrieved from searches of PubMed databases, hand searches, and authoritative texts. DISCUSSION The causes of IHCDs are multifaceted and an internal disaster is often the result of a cascade of events. They may or may not be associated with a community-wide event. Examples include fires, floods, power outages, structural damage, information and communication technology (ICT) failures, and cyberattacks. EDs are particularly at-risk. While acute-onset disasters have immediate consequences for acute care services, epidemics and pandemics are threats that can have long-term sequelae. CONCLUSIONS Hospitals and their EDs are at-risk for crises and their potential escalation to hospital disasters. Emerging risks due to climate-related emergencies, infectious disease outbreaks, terrorism, and cyberattacks pose particular threats. If a hospital is not prepared for IHCDs, it undermines the capacity of administration and staff to safeguard the safety of patients. Therefore, hospitals and their EDs must check and where necessary enhance their preparedness for these contingencies.
Collapse
Affiliation(s)
- Dennis G. Barten
- Department of Emergency Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
| | - Vincent W. Klokman
- Department of Emergency Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
| | - Sigrid Cleef
- Department of Emergency Medicine, Laurentius Hospital, Roermond, The Netherlands
| | - Nathalie A. L. R. Peters
- Department of Emergency Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
| | - Edward C. T. H. Tan
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arjen Boin
- Department of Political Science, Leiden University, Leiden, The Netherlands
| |
Collapse
|
33
|
Hensgens KR, van Rensen IH, Lekx AW, van Osch FH, Knarren LH, Wyers CE, van den Bergh JP, Barten DG. Sort and Sieve: Pre-Triage Screening of Patients with Suspected COVID-19 in the Emergency Department. Int J Environ Res Public Health 2021; 18:9271. [PMID: 34501861 PMCID: PMC8431352 DOI: 10.3390/ijerph18179271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION To reduce the risk of nosocomial transmission, suspected COVID-19 patients entering the Emergency Department (ED) were assigned to a high-risk (ED) or low-risk (acute medical unit, AMU) area based on symptoms, travel and contact history. The objective of this study was to evaluate the performance of our pre-triage screening method and to analyse the characteristics of initially undetected COVID-19 patients. METHODS This was a retrospective, observational, single centre study. Patients ≥ 18 years visiting the AMU-ED between 17 March and 17 April 2020 were included. Primary outcome was the (correct) number of COVID-19 patients assigned to the AMU or ED. RESULTS In total, 1287 patients visited the AMU-ED: 525 (40.8%) AMU, 762 (59.2%) ED. Within the ED group, 304 (64.3%) of 473 tested patients were COVID-19 positive, compared to 13 (46.4%) of 28 tested patients in the AMU group. Our pre-triage screening accuracy was 63.7%. Of the 13 COVID-19 patients who were initially assigned to the AMU, all patients were ≥65 years of age and the majority presented with gastro-intestinal or non-specific symptoms. CONCLUSION Older COVID-19 patients presenting with non-specific symptoms were more likely to remain undetected. ED screening protocols should therefore also include non-specific symptoms, particularly in older patients.
Collapse
Affiliation(s)
- Kirsten R.C. Hensgens
- VieCuri Medical Centre, Department of Emergency Medicine, 5912 BL Venlo, The Netherlands; (I.H.T.v.R.); (A.W.L.); (D.G.B.)
- VieCuri Medical Centre, Department of Intensive Care, 5912 BL Venlo, The Netherlands
| | - Inge H.T. van Rensen
- VieCuri Medical Centre, Department of Emergency Medicine, 5912 BL Venlo, The Netherlands; (I.H.T.v.R.); (A.W.L.); (D.G.B.)
| | - Anita W. Lekx
- VieCuri Medical Centre, Department of Emergency Medicine, 5912 BL Venlo, The Netherlands; (I.H.T.v.R.); (A.W.L.); (D.G.B.)
| | - Frits H.M. van Osch
- VieCuri Medical Centre, Department of Clinical Epidemiology, 5912 BL Venlo, The Netherlands;
- School of Nutrition and Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.E.W.); (J.P.v.d.B.)
| | - Lieve H.H. Knarren
- VieCuri Medical Centre, Department of Internal Medicine, T5912 BL Venlo, The Netherlands;
| | - Caroline E. Wyers
- School of Nutrition and Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.E.W.); (J.P.v.d.B.)
- VieCuri Medical Centre, Department of Internal Medicine, T5912 BL Venlo, The Netherlands;
| | - Joop P. van den Bergh
- School of Nutrition and Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.E.W.); (J.P.v.d.B.)
- VieCuri Medical Centre, Department of Internal Medicine, T5912 BL Venlo, The Netherlands;
| | - Dennis G. Barten
- VieCuri Medical Centre, Department of Emergency Medicine, 5912 BL Venlo, The Netherlands; (I.H.T.v.R.); (A.W.L.); (D.G.B.)
| |
Collapse
|
34
|
Verberne DPJ, Ponds RWHM, Kroese MEAL, Wijenberg MLM, Barten DG, Pasmans R, Staals J, van Heugten CM. Correction to: Long-term psychosocial outcome following mild traumatic brain injury and minor stroke: a direct longitudinal comparison. J Neurol 2021; 268:4404-4405. [PMID: 34468801 PMCID: PMC8505383 DOI: 10.1007/s00415-021-10741-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Daan P J Verberne
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center, Maastricht University, P.O. 616 UNS 40, 6200 MD, Maastricht, The Netherlands.,Limburg Center for Brain Injury, Maastricht, The Netherlands
| | - Rudolf W H M Ponds
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center, Maastricht University, P.O. 616 UNS 40, 6200 MD, Maastricht, The Netherlands.,Limburg Center for Brain Injury, Maastricht, The Netherlands.,Department of Brain Injury Rehabilitation, Adelante Rehabilitation Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Medical Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Mariëlle E A L Kroese
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Melloney L M Wijenberg
- Limburg Center for Brain Injury, Maastricht, The Netherlands.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Raphaël Pasmans
- Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Caroline M van Heugten
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center, Maastricht University, P.O. 616 UNS 40, 6200 MD, Maastricht, The Netherlands. .,Limburg Center for Brain Injury, Maastricht, The Netherlands. .,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| |
Collapse
|
35
|
Hesselink G, Straten L, Gallée L, Brants A, Holkenborg J, Barten DG, Schoon Y. Holding the frontline: a cross-sectional survey of emergency department staff well-being and psychological distress in the course of the COVID-19 outbreak. BMC Health Serv Res 2021; 21:525. [PMID: 34051760 PMCID: PMC8164246 DOI: 10.1186/s12913-021-06555-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) outbreak has been associated with stress and challenges for healthcare professionals, especially for those working in the front-line of treating COVID-19 patients. This study aimed to: 1) assess changes in well-being and perceived stress symptoms of Dutch emergency department (ED) staff in the course of the first COVID-19 wave, and 2) assess and explore stressors experienced by ED staff since the COVID-19 outbreak. Methods We conducted a cross-sectional study. An online questionnaire was administered during June–July 2020 to physicians, nurses and non-clinical staff of four EDs in the Netherlands. Well-being and stress symptoms (i.e., cognitive, emotional and physical) were scored for the periods pre, during and after the first COVID-19 wave using the World Health Organization Well-Being Index (WHO-5) and a 10-point Likert scale. Stressors were assessed and explored by rating experiences with specific situations (i.e., frequency and intensity of distress) and in free-text narratives. Quantitative data were analyzed with descriptive statistics and generalized estimating equations (GEE). Narratives were analyzed thematically. Results In total, 192 questionnaires were returned (39% response). Compared to pre-COVID-19, the mean WHO-5 index score (range: 0–100) decreased significantly with 14.1 points (p < 0.001) during the peak of the first wave and 3.7 points (< 0.001) after the first wave. Mean self-perceived stress symptom levels almost doubled during the peak of the first wave (≤0.005). Half of the respondents reported experiencing more moral distress in the ED since the COVID-19 outbreak. High levels of distress were primarily found in situations where the staff was unable to provide or facilitate necessary emotional support to a patient or family. Analysis of 51 free-texts revealed witnessing suffering, high work pressure, fear of contamination, inability to provide comfort and support, rapidly changing protocols regarding COVID-19 care and personal protection, and shortage of protection equipment as important stressors. Conclusions The first COVID-19 wave took its toll on ED staff. Actions to limit drop-out and illness among staff resulting from psychological distress are vital to secure acute care for (non-)COVID-19 patients during future infection waves. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06555-5.
Collapse
Affiliation(s)
- Gijs Hesselink
- Department of Emergency Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. .,IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 114 IQ healthcare, 6500 HB, Nijmegen, The Netherlands.
| | - Lise Straten
- Department of Emergency Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lars Gallée
- Department of Emergency Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne Brants
- Department of Emergency Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Joris Holkenborg
- Department of Emergency Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Yvonne Schoon
- Department of Emergency Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
36
|
van Rensen IHT, Hensgens KRC, Lekx AW, van Osch FHM, Knarren LHH, van Kampen-van den Boogaart VEM, Mehagnoul-Schipper JDJ, Wyers CE, van den Bergh JP, Barten DG. Early detection of hospitalized patients with COVID-19 at high risk of clinical deterioration: Utility of emergency department shock index. Am J Emerg Med 2021; 49:76-79. [PMID: 34087575 PMCID: PMC8137356 DOI: 10.1016/j.ajem.2021.05.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/02/2021] [Accepted: 05/16/2021] [Indexed: 12/31/2022] Open
Abstract
Background The COVID-19 outbreak has put an unprecedented strain on Emergency Departments (EDs) and other critical care resources. Early detection of patients that are at high risk of clinical deterioration and require intensive monitoring, is key in ED evaluation and disposition. A rapid and easy risk-stratification tool could aid clinicians in early decision making. The Shock Index (SI: heart rate/systolic blood pressure) proved useful in detecting hemodynamic instability in sepsis and myocardial infarction patients. In this study we aim to determine whether SI is discriminative for ICU admission and in-hospital mortality in COVID-19 patients. Methods Retrospective, observational, single-center study. All patients ≥18 years old who were hospitalized with COVID-19 (defined as: positive result on reverse transcription polymerase chain reaction (PCR) test) between March 1, 2020 and December 31, 2020 were included for analysis. Data were collected from electronic medical patient records and stored in a protected database. ED shock index was calculated and analyzed for its discriminative value on in-hospital mortality and ICU admission by a ROC curve analysis. Results In total, 411 patients were included. Of all patients 249 (61%) were male. ICU admission was observed in 92 patients (22%). Of these, 37 patients (40%) died in the ICU. Total in-hospital mortality was 28% (114 patients). For in-hospital mortality the optimal cut-off SI ≥ 0.86 was not discriminative (AUC 0.49 (95% CI: 0.43–0.56)), with a sensitivity of 12.3% and specificity of 93.6%. For ICU admission the optimal cut-off SI ≥ 0.57 was also not discriminative (AUC 0.56 (95% CI: 0.49–0.62)), with a sensitivity of 78.3% and a specificity of 34.2%. Conclusion In this cohort of patients hospitalized with COVID-19, SI measured at ED presentation was not discriminative for ICU admission and was not useful for early identification of patients at risk of clinical deterioration.
Collapse
Affiliation(s)
- Inge H T van Rensen
- VieCuri Medical Center, Department of Emergency Medicine, Venlo, the Netherlands.
| | - Kirsten R C Hensgens
- VieCuri Medical Center, Department of Emergency Medicine, Venlo, the Netherlands; VieCuri Medical Center, Intensive Care Unit, Venlo, the Netherlands.
| | - Anita W Lekx
- VieCuri Medical Center, Department of Emergency Medicine, Venlo, the Netherlands.
| | - Frits H M van Osch
- VieCuri Medical Center, Department of Epidemiology, Venlo, the Netherlands; Maastricht University Medical Center, School of Nutrition and Metabolism (NUTRIM), Maastricht, the Netherlands.
| | - Lieve H H Knarren
- VieCuri Medical Center, Department of Internal Medicine, Venlo, the Netherlands.
| | | | | | - Caroline E Wyers
- Maastricht University Medical Center, School of Nutrition and Metabolism (NUTRIM), Maastricht, the Netherlands; VieCuri Medical Center, Department of Internal Medicine, Venlo, the Netherlands; Maastricht University Medical Center, Department of Internal Medicine, Maastricht, the Netherlands.
| | - Joop P van den Bergh
- Maastricht University Medical Center, School of Nutrition and Metabolism (NUTRIM), Maastricht, the Netherlands; VieCuri Medical Center, Department of Internal Medicine, Venlo, the Netherlands; Maastricht University Medical Center, Department of Internal Medicine, Maastricht, the Netherlands.
| | - Dennis G Barten
- VieCuri Medical Center, Department of Emergency Medicine, Venlo, the Netherlands.
| |
Collapse
|
37
|
Blomaard LC, van der Linden CMJ, van der Bol JM, Jansen SWM, Polinder-Bos HA, Willems HC, Festen J, Barten DG, Borgers AJ, Bos JC, van den Bos F, de Brouwer EJM, van Deudekom FJA, van Dijk SC, Emmelot-Vonk MH, Geels RES, van de Glind EMM, de Groot B, Hempenius L, Kamper AM, Kampschreur LM, de Koning MMM, Labots G, Looman R, Lucke JA, Maas HAAM, Mattace-Raso FUS, el Moussaoui R, van Munster BC, van Nieuwkoop C, Oosterwijk L(BLE, Regtuijt M(EM, Robben SHM, Ruiter R, Salarbaks AM, Schouten HJ, Smit OM, Smits RAL, Spies PE, Vreeswijk R, de Vries OJ, Wijngaarden MA, Wyers CE, Mooijaart SP. Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands: the COVID-OLD study. Age Ageing 2021; 50:631-640. [PMID: 33951156 PMCID: PMC7929372 DOI: 10.1093/ageing/afab018] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Indexed: 01/04/2023] Open
Abstract
Background During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, older patients had an increased risk of hospitalisation and death. Reports on the association of frailty with poor outcome have been conflicting. Objective The aim of the present study was to investigate the independent association between frailty and in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands. Methods This was a multicentre retrospective cohort study in 15 hospitals in the Netherlands, including all patients aged ≥70 years, who were hospitalised with clinically confirmed COVID-19 between February and May 2020. Data were collected on demographics, co-morbidity, disease severity and Clinical Frailty Scale (CFS). Primary outcome was in-hospital mortality. Results A total of 1,376 patients were included (median age 78 years (interquartile range 74–84), 60% male). In total, 499 (38%) patients died during hospital admission. Parameters indicating presence of frailty (CFS 6–9) were associated with more co-morbidities, shorter symptom duration upon presentation (median 4 versus 7 days), lower oxygen demand and lower levels of C-reactive protein. In multivariable analyses, the CFS was independently associated with in-hospital mortality: compared with patients with CFS 1–3, patients with CFS 4–5 had a two times higher risk (odds ratio (OR) 2.0 (95% confidence interval (CI) 1.3–3.0)) and patients with CFS 6–9 had a three times higher risk of in-hospital mortality (OR 2.8 (95% CI 1.8–4.3)). Conclusions The in-hospital mortality of older hospitalised COVID-19 patients in the Netherlands was 38%. Frailty was independently associated with higher in-hospital mortality, even though COVID-19 patients with frailty presented earlier to the hospital with less severe symptoms.
Collapse
Affiliation(s)
- Laura C Blomaard
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Steffy W M Jansen
- Department of Geriatrics, Catharina Hospital, Eindhoven, the Netherlands
| | - Harmke A Polinder-Bos
- Section Geriatrics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hanna C Willems
- Section Geriatrics, Department of Internal Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | | | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Anke J Borgers
- Department of Geriatrics, Deventer Hospital, Deventer, the Netherlands
| | - Jeannet C Bos
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Frederiek van den Bos
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Floor J A van Deudekom
- Department of Internal Medicine and Geriatrics, OLVG Hospital, Amsterdam, the Netherlands
| | - Suzanne C van Dijk
- Department of Geriatric Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | | | - Raya E S Geels
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Department of Geriatrics, Alrijne Hospital, Leiderdorp, the Netherlands
| | | | - Bas de Groot
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Liesbeth Hempenius
- Department of Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Ad M Kamper
- Department of Internal Medicine, Isala Hospital, Zwolle, the Netherlands
| | - Linda M Kampschreur
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Marre M M de Koning
- Department of Geriatric Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Geert Labots
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands
| | - Roy Looman
- Section Geriatrics, Department of Internal Medicine, Zaans Medical Center, Zaandam, the Netherlands
| | - Jacinta A Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Huub A A M Maas
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | | | | | - Barbara C van Munster
- Department of Internal Medicine and Geriatrics, University Medical Center Groningen, Groningen, the Netherlands
| | - Cees van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands
| | - Leanne (B L E) Oosterwijk
- Section Geriatrics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Sarah H M Robben
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Rikje Ruiter
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Aisha M Salarbaks
- Department of Geriatrics, Hospital Group Twente, Almelo, the Netherlands
| | - Henrike J Schouten
- Department of Geriatric Medicine, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Orla M Smit
- Section Geriatrics, Department of Internal Medicine, Zaans Medical Center, Zaandam, the Netherlands
| | - Rosalinde A L Smits
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Petra E Spies
- Department of Geriatric Medicine, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Ralph Vreeswijk
- Department of Geriatrics, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Oscar J de Vries
- Department of Internal Medicine and Geriatrics, OLVG Hospital, Amsterdam, the Netherlands
| | - Marjolein A Wijngaarden
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Simon P Mooijaart
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
38
|
Klokman VW, Barten DG, Peters NALR, Versteegen MGJ, Wijnands JJJ, van Osch FHM, Gaakeer MI, Tan ECTH, Boin A. A scoping review of internal hospital crises and disasters in the Netherlands, 2000-2020. PLoS One 2021; 16:e0250551. [PMID: 33901248 PMCID: PMC8075216 DOI: 10.1371/journal.pone.0250551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Internal hospital crises and disasters (IHCDs) are events that disrupt the routine functioning of a hospital while threatening the well-being of patients and staff. IHCDs may cause hospital closure, evacuations of patients and loss of healthcare capacity. The consequences may be ruinous for local communities. Although IHCDs occur with regularity, information on the frequency and types of these events is scarcely published in the medical literature. However, gray literature and popular media reports are widely available. We therefore conducted a scoping review of these literature sources to identify and characterize the IHCDs that occurred in Dutch hospitals from 2000 to 2020. The aim is to develop a systematic understanding of the frequency of the various types of IHCDs occurring in a prosperous nation such as the Netherlands. METHODS A systematic scoping review of news articles retrieved from the LexisNexis database, Google, Google News, PubMed and EMBASE between 2000 and 2020. All articles mentioning the closure of a hospital department in the Netherlands were analyzed. RESULTS A total of 134 IHCDs were identified in a 20-year time period. Of these IHCDs, there were 96 (71.6%) emergency department closures, 76 (56.7%) operation room closures, 56 (41.8%) evacuations, 26 (17.9%) reports of injured persons, and 2 (1.5%) reported casualties. Cascading events of multiple failures transpired in 39 (29.1%) IHCDs. The primary causes of IHCDs (as reported) were information and communication technology (ICT) failures, technical failures, fires, power failures, and hazardous material warnings. An average of 6.7 IHCDs occurred per year. From 2000-2009 there were 32 IHCDs, of which one concerned a primary ICT failure. Of the 102 IHCDs between 2010-2019, 32 were primary ICT failures. CONCLUSIONS IHCDs occur with some regularity in the Netherlands and have marked effects on hospital critical care departments, particularly emergency departments. Cascading events of multiple failures transpire nearly a third of the time, limiting the ability of a hospital to stave off closure due to failure. Emergency managers should therefore prioritize the risk of ICT failures and cascading events and train hospital staff accordingly.
Collapse
Affiliation(s)
- Vincent W. Klokman
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Dennis G. Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | | | | | | | - Frits H. M. van Osch
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, The Netherlands
| | - Menno I. Gaakeer
- Department of Emergency Medicine, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - Edward C. T. H. Tan
- Department of Trauma Surgery and Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arjen Boin
- Department of Political Science, Leiden University, Leiden, The Netherlands
| |
Collapse
|
39
|
Janzing HMJ, Bessems SAM, Ligthart MAP, Van Lieshout EMM, Theeuwes HP, Barten DG, Verhofstad MHJ. Treatment of dorsally dislocated distal radius fractures with individualized 3D printed bracing: an exploratory study. 3D Print Med 2020; 6:22. [PMID: 32809083 PMCID: PMC7437166 DOI: 10.1186/s41205-020-00075-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this work was to develop a three-dimensionally (3D) printed brace for the acute treatment of dorsally dislocated and correctly reduced distal radius fractures (DRF). The hypothesis was that a brace shaped to the mirror image of the contralateral (non-fractured) wrist will have an optimal anatomical fit, resulting in improved comfort and lower rates of secondary fracture displacement. Method Validation: the circumference of both wrists and comfort of the brace were studied in healthy volunteers and effectiveness of the brace was evaluated in an ex vivo fracture model. Clinical study: the brace was tested for comfort and effectiveness in patients with a well reduced unstable DRF. Results Validation: the circumference of both wrists may be different, the brace retained the reduction in the ex vivo fracture model and was well tolerated in the volunteers. Clinical study: in DRF patients comfort scores were lower and pain scores higher compared to the healthy volunteers. After 3 and 5 weeks all patients were independent in ADL according to the Katz-index. Posttraumatic swelling subsided in the first week. In two of the five patients secondary fracture dislocation occurred. Conclusions Treatment of a dislocated DRF in the acute setting (day one) with a custom-made 3D printed brace, anatomically modelled from a 3D scan of the contralateral wrist, is possible. Difference between both wrists and posttraumatic swelling must be adapted for. The high rate of secondary fracture displacement led to early discontinuation of the study and a small sample size. Trial registration Name of the registry: ClinicalTrials.Gov Trial registration number: NCT03848702 Date of registration: 02/21/2019, retrospectively registered
Collapse
Affiliation(s)
- H M J Janzing
- Department of Surgery, VieCuri Medical Center, Venlo, The Netherlands.
| | - S A M Bessems
- Department of Surgery, VieCuri Medical Center, Venlo, The Netherlands
| | - M A P Ligthart
- Department of Surgery, VieCuri Medical Center, Venlo, The Netherlands
| | - E M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H P Theeuwes
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - D G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - M H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
40
|
Janssen J, Kamps MJA, Joosten TMB, Barten DG. Spontaneous pneumomediastinum in a male adult with COVID-19 pneumonia. Am J Emerg Med 2020; 40:228.e3-228.e5. [PMID: 32800430 PMCID: PMC7390819 DOI: 10.1016/j.ajem.2020.07.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/22/2020] [Indexed: 12/28/2022] Open
Abstract
Spontaneous pneumomediastinum is a rare complication of viral pneumonia. Here we report a case of a 52 year old male who presented with a spontaneous pneumomediastinum in COVID-19 pneumonia, followed by a severe course of disease. We discuss the pathophysiological mechanisms underlying this association as well as its possible clinical implications as a marker of disease severity in COVID-19.
Collapse
Affiliation(s)
- Joris Janssen
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands.
| | - Marlijn J A Kamps
- Department of Intensive Care, Catharina Hospital, Eindhoven, the Netherlands
| | - Tamara M B Joosten
- Department of Pulmonary Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| |
Collapse
|
41
|
Dirks NPM, Mestrom M, van der Lugt M, van Osch F, Peters NALR, Elshof JWM, Barten DG. Utility of Shock Index for Suspected Rupture of Abdominal Aortic Aneurysms. PREHOSP EMERG CARE 2020; 25:496-503. [DOI: 10.1080/10903127.2020.1796184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
42
|
Barten DG, Latten GHP. Re: 'Non-COVID-19 visits to emergency departments during the pandemic: the impact of fear'. Public Health 2020; 185:47. [PMID: 32540610 PMCID: PMC7275175 DOI: 10.1016/j.puhe.2020.05.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/31/2020] [Indexed: 11/16/2022]
Affiliation(s)
- D G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands.
| | - G H P Latten
- Department of Emergency Medicine, Zuyderland Hospital, Heerlen, the Netherlands
| |
Collapse
|
43
|
Verstappen EMJ, Vy DT, Janzing HM, Janssen L, Vos R, Versteegen MGJ, Barten DG. Bicycle-related injuries in the emergency department: a comparison between E-bikes and conventional bicycles: a prospective observational study. Eur J Trauma Emerg Surg 2020; 47:1853-1860. [PMID: 32306122 DOI: 10.1007/s00068-020-01366-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/18/2019] [Accepted: 04/03/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the mechanisms and severity of injuries of e-bikers compared with conventional bicycle (CB) users at the emergency department (ED) of a level 2 trauma center in the Netherlands. METHODS We performed a prospective observational study. All patients ≥ 16 years who presented at the ED with an e-bike or conventional bicycle accident were eligible for inclusion. Primary outcomes were mechanisms and severity of injury. Injury severity was defined by the abbreviated injury score and the injury severity score (ISS). Data were analyzed using SPSS (IBM version 24). RESULTS A total of 78 e-bikers and 91 CB, were included. The mean age of the e-bikers was 66.9 ± 13.6 years (CB 45.2 ± 20.5 years, P < 0.001). The Charlson comorbidity index was higher in e-bikers (3.1 vs. 1.2, P < 0.001). Mechanism of injury and ISS did not differ between the groups (median ISS 4.0), even though two e-bikers were severely injured (ISS ≥ 16). Alcohol was consumed twice as frequently in CB-related injuries (40% vs. 19.2%, P < 0.01). CONCLUSION In this cohort of bicycle injuries in the ED of a level 2 trauma center, e-bikers were older and had more comorbidities than CB users. Except for a higher rate of thoracic and soft-tissue trauma in e-bikers, no differences were found in the mechanism and severity of injury. While it is important to note that helmet use and alcohol avoidance have demonstrable health benefits for bicyclists, further studies to quantify these benefits are recommended.
Collapse
Affiliation(s)
- Elke M J Verstappen
- Department of Emergency Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL, Venlo, The Netherlands.
| | - Dan Thao Vy
- Department of Emergency Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL, Venlo, The Netherlands
| | - Heinrich M Janzing
- Department of (General/Trauma) Surgery, VieCuri Medical Center, Tegelseweg 210, 5912 BL, Venlo, The Netherlands
| | - Loes Janssen
- Department of Clinical Epidemiology, VieCuri Medical Center, Tegelseweg 210, 5912 BL, Venlo, The Netherlands
| | - Rein Vos
- Department of Methodology and Statistics, Maastricht University Medical Center, Postbus 616, 6200 MD, Maastricht, The Netherlands
| | - Marieke G J Versteegen
- Department of Emergency Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL, Venlo, The Netherlands
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL, Venlo, The Netherlands
| |
Collapse
|
44
|
Verhaegh MTH, Snijders F, Janssen L, Peters NALR, Mol Y, Kamerman-Celie F, van Galen LS, Nanayakkara PWB, Barten DG. Perspectives on the preventability of emergency department visits by older patients. Neth J Med 2019; 77:330-337. [PMID: 31814587] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Older people increasingly demand emergency department (ED) care. ED visits have a profound impact on older patients, including high risk of adverse outcomes and loss of independency. In this study, we evaluated the opinions of patients, caregivers, general practitioners, and ED physicians on the preventability of ED visits. METHODS Prospective, mixed-method observational and qualitative study of 200 patients aged ≥ 70 years visiting a teaching hospital ED in the Netherlands. Semi-structured interviews were performed with patients, caregivers, and general practitioners. ED physicians were provided with written surveys. Patient data were extracted to determine vulnerability. RESULTS The mean age of the patients was 79.6 years; 49.5% were male. Ninety-five percent lived independently before the ED visit. Most patients reported domiciliary care (23%), a caregiver (21.5%), or both (29.5%). Patients considered 12.2% of visits potentially preventable, caregivers 9%, general practitioners 20.7%, and ED physicians 31.2%. Consensus on preventability was poor, especially among patients and professionals. While patients most frequently blamed themselves, healthcare providers predominantly mentioned lack of communication and organisational issues as contributing factors. CONCLUSION Patients and caregivers consider an ED visit preventable less frequently than professionals do. Little consensus was found among patients and healthcare providers, and the perspectives on contributing factors to a preventable visit differ between groups. To help improve geriatric emergency care, future studies should focus on why these perspectives are so different and aim to align them.
Collapse
Affiliation(s)
- M T H Verhaegh
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, the Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Platter MEM, Kurvers RAJ, Janssen L, Verweij MMJ, Barten DG. The impact of an emergency care access point on pediatric attendances at the emergency department: An observational study. Am J Emerg Med 2019; 38:191-197. [PMID: 30745074 DOI: 10.1016/j.ajem.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/21/2018] [Revised: 02/03/2019] [Accepted: 02/03/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Crowding is a growing concern in general and pediatric Emergency Departments (EDs). The Emergency Care Access Point (ECAP) - a collaboration between general practitioners and the ED - has been established to reduce the number of self-referrals and non-urgent ED visits. The aim of this study was to determine the impact of an ECAP on pediatric attendances in the ED. METHODS Retrospective analysis of 3997 pediatric patients who visited the ED of a regional teaching hospital in the Netherlands, one year before and one year after the implementation of an ECAP. Patient characteristics, presented complaints and diagnoses, throughput times, and follow-up between the study groups were compared, both during office hours and after-hours. RESULTS After ECAP implementation, a 16.3% reduction in pediatric ED visits was observed. ECAP implementation was associated with a decline in self-referrals by 97.2%. Presented complaints, ED diagnoses and acuity were similar pre- and post-ECAP. However, consultations and follow-up were required more frequently. The admission rate during nights increased (49.3% versus 64.0%). Overall admission rates were similar. CONCLUSIONS The implementation of an ECAP was associated with a reduction of pediatric ED use, including a considerable but expected decline in pediatric self-referrals. Patient acuity pre- and post-ECAP was similar. Our results suggest that this primary care intervention might help reduce the workload in a pediatric ED. Future studies are warranted to further investigate this hypothesis and to evaluate the impact of an ECAP in other healthcare settings. These future efforts need to include patient oriented outcomes.
Collapse
Affiliation(s)
- Mireille E M Platter
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands; Department of Pediatrics, VieCuri Medical Center, Venlo, the Netherlands
| | - Roel A J Kurvers
- Department of Pediatrics, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Loes Janssen
- Department of Epidemiology, VieCuri Medical Center, Venlo, the Netherlands
| | | | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands.
| |
Collapse
|
46
|
van Hooff L, Barten DG, Potjewijd J, van Paassen P. Necrotizing vasculitis in immediate response to a shoulder dislocation. Am J Emerg Med 2018; 36:1523.e1-1523.e3. [PMID: 29691104 DOI: 10.1016/j.ajem.2018.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/17/2018] [Indexed: 12/01/2022] Open
Abstract
The shoulder is one of the most commonly dislocated joints in the human body. Complications usually represent local damage. However, it is unclear whether joint dislocations can have systemic sequellae as wSell. Here we present the case of an 86-year-old female who developed necrotizing cryoglobulinaemic vasculitis in immediate response to a shoulder dislocation. We hypothesize there might be a link between trauma and systemic disease.
Collapse
Affiliation(s)
- Loes van Hooff
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands.
| | - Judith Potjewijd
- Department of Internal Medicine, Division of Clinical and Experimental Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - P van Paassen
- Department of Internal Medicine, Division of Clinical and Experimental Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
47
|
Houtman D, Barten DG, Laurent-de Gast AN. [A woman with inguinal pain after a bone marrow biopsy]. Ned Tijdschr Geneeskd 2017; 161:D952. [PMID: 28247833] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Haemorrhaging after a bone marrow biopsy is a rare but possibly life-threatening event. We describe a case of a retroperitoneal haemorrhage after a routine bone marrow biopsy in a 77-year-old woman who presented the day after the procedure with inguinal pain.
Collapse
|
48
|
Thijssen WAMH, Kraaijvanger N, Barten DG, Boerma MLM, Giesen P, Wensing M. Impact of a well-developed primary care system on the length of stay in emergency departments in the Netherlands: a multicenter study. BMC Health Serv Res 2016; 16:149. [PMID: 27117479 PMCID: PMC4845371 DOI: 10.1186/s12913-016-1400-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/18/2016] [Indexed: 11/10/2022] Open
Abstract
Background The Netherlands has a well-developed primary care system, which increasingly collaborates with hospital emergency departments (EDs). In this setting, insight into crowding in EDs is limited. This study explored links between patients’ ED Length of Stay (LOS) and their care pathways. Methods Observational multicenter study of 7000 ED patient records from 1 February 2013. Seven EDs spread over the Netherlands, representing overall Dutch EDs, were included. This included three EDs with and four EDs without an integrated primary-care-physician (PCP) cooperative, forming one Emergency Care Access Point (ECAP). The main outcome was LOS of patients comparing different care pathways (origin and destination of ED attenders). Results The median LOS of ED attenders was 130.0 min (IQR 79.0–140.0), which increased with patients’ age. Random coefficient regression analysis showed that LOS for patients referred by medical professionals was 32.9 min longer compared to self-referred patients (95 % CI 27.7–38.2 min). LOS for patients admitted to hospital was 41.2 min longer compared to patients followed-up at the outpatient clinic (95 % CI 35.3–46.6 min), 49.9 min longer compared to patients followed-up at the PCP (95 % CI 41.5–58.3 min) and 44.6 min longer compared to patients who did not receive follow-up (95 % CI 38.3–51.0 min). There was no difference in LOS between hospitals with or without an ECAP. Conclusions With 130 min, the median LOS in Dutch EDs is relatively short, comparing to other Western countries, which ranges from 176 to 480 min. Although integration of EDs with out-of-hours primary care was not related to LOS, the strong primary care system probably contributed to the overall short LOS of ED patients in the Netherlands.
Collapse
Affiliation(s)
- Wendy A M H Thijssen
- Emergency Department, Catharina Hospital, Michelangelolaan 2, Postbus 1350, 5602ZA, Eindhoven, The Netherlands. .,Radboud University Medical Centre, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands.
| | | | - Dennis G Barten
- Emergency Department, VieCuri Medical Center, Venlo, The Netherlands
| | | | - Paul Giesen
- Radboud University Medical Centre, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands
| | - Michel Wensing
- Radboud University Medical Centre, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands
| |
Collapse
|
49
|
Barten DG, Gulikers DEJ, Versteegen MGJ, Thimister WPWL, de Mast Q, Bleeker-Rovers CP. Iliopsoas abscess associated with endovascular infection: an acute case of chronic Q fever. Am J Emerg Med 2014; 33:862.e1-3. [PMID: 25601161 DOI: 10.1016/j.ajem.2014.12.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 12/28/2022] Open
Abstract
fever is a zoonosis caused by Coxiella burnetii, which occurs worldwide. After acute Q fever infection, 1% to 5% of patients develop chronic Q fever. Chronic Q fever usually presents as endocarditis or endovascular infection. The diagnosis and localization of chronic Q fever are challenging, as most patients present with nonspecific symptoms. Moreover, it often occurs in patients without a known episode of acute infection.
Collapse
Affiliation(s)
- Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, PO Box 1926, 5900 BX Venlo, The Netherlands.
| | - Donné E J Gulikers
- Department of Internal Medicine, VieCuri Medical Center, PO Box 1926, 5900 BX, Venlo, The Netherlands.
| | - Marieke G J Versteegen
- Department of Emergency Medicine, VieCuri Medical Center, PO Box 1926, 5900 BX Venlo, The Netherlands.
| | - Willie P W L Thimister
- Department of Nuclear Medicine, VieCuri Medical Center, PO Box 1926, 5900 BX Venlo,The Netherlands.
| | - Quirijn de Mast
- Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Chantal P Bleeker-Rovers
- Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands; Radboud Expertise Center for Q fever, Radboud University Medical Center, Nijmegen, the Netherlands.
| |
Collapse
|