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Coisy F, Olivier G, Ageron FX, Guillermou H, Roussel M, Balen F, Grau-Mercier L, Bobbia X. Do emergency medicine health care workers rate triage level of chest pain differently based upon appearance in simulated patients? Eur J Emerg Med 2024; 31:188-194. [PMID: 38100643 DOI: 10.1097/mej.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND IMPORTANCE There seems to be evidence of gender and ethnic bias in the early management of acute coronary syndrome. However, whether these differences are related to less severe severity assessment or to less intensive management despite the same severity assessment has not yet been established. OBJECTIVE To show whether viewing an image with characters of different gender appearance or ethnic background changes the prioritization decision in the emergency triage area. METHODS The responders were offered a standardized clinical case in an emergency triage area. The associated image was randomized among eight standardized images of people presenting with chest pain and differing in gender and ethnic appearance (White, Black, North African and southeast Asian appearance). OUTCOME MEASURES AND ANALYSIS Each person was asked to respond to a single clinical case, in which the priority level [from 1 (requiring immediate treatment) to 5 (able to wait up to 2 h)] was assessed visually. Priority classes 1 and 2 for vital emergencies and classes 3-5 for nonvital emergencies were grouped together for analysis. RESULTS Among the 1563 respondents [mean age, 36 ± 10 years; 867 (55%) women], 777 (50%) were emergency physicians, 180 (11%) emergency medicine residents and 606 (39%) nurses. The priority levels for all responses were 1-5 : 180 (11%), 686 (44%), 539 (34%), 131 (9%) and 27 (2%). There was a higher reported priority in male compared to female [62% vs. 49%, difference 13% (95% confidence interval; CI 8-18%)]. Compared to White people, there was a lower reported priority for Black simulated patients [47% vs. 58%, difference -11% (95% CI -18% to -4%)] but not people of southeast Asian [55% vs. 58%, difference -3% (95% CI -10-5%)] and North African [61% vs. 58%, difference 3% (95% CI -4-10%)] appearance. CONCLUSION In this study, the visualization of simulated patients with different characteristics modified the prioritization decision. Compared to White patients, Black patients were less likely to receive emergency treatment. The same was true for women compared with men.
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Affiliation(s)
- Fabien Coisy
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, CHU de Nimes, University of Montpellier, Nimes, France
| | - Guillaume Olivier
- Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
| | | | - Hugo Guillermou
- IDESP, University of Montpellier and INSERM, Montpellier, France
| | - Mélanie Roussel
- Emergency Department, Rouen University Hospital, Rouen, France
| | - Frédéric Balen
- Emergency Department, Toulouse University Hospital, Toulouse, France
| | - Laura Grau-Mercier
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, CHU de Nimes, University of Montpellier, Nimes, France
| | - Xavier Bobbia
- Montpellier University, UR UM 103 (IMAGINE), Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
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L'Hermitte N, Markarian T, Grau-Mercier L, Coisy F, Muller L, Saadi L, Claret PG, Krebs H, Bobbia X. Diagnostic performance of a clinical ultrasound-based algorithm for acute heart failure in patients presenting to the emergency department with dyspnea. Emergencias 2024; 36:109-115. [PMID: 38607306 DOI: 10.55633/s3me/011.2024] [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] [Indexed: 04/13/2024]
Abstract
OBJECTIVES To study the diagnostic performance of an ultrasound-based algorithm that includes the deceleration time (DT) of early mitral filling to establish a diagnosis of acute heart failure (AHF) in patients who come to an emergency department because of dyspnea. MATERIAL AND METHODS Prospective analysis in a convenience sample of patients who came to a hospital emergency department with acute dyspnea. The algorithm included ultrasound findings and 4 echocardiographic findings as follows: mitral annular plane systolic excursion, Doppler mitral flow velocity, tissue Doppler imaging measure of the lateral annulus, and the DT of early mitral filling. The definitive diagnosis was made by 2 physicians blinded to each other's diagnosis and the ultrasound findings. RESULTS A total of 166 adult patients with a mean (SD) age of 76 (13) years were included; 79 (48%) were women. AHF was the definitive diagnosis in 62 patients (37%). Diagnostic agreement was good between the 2 physicians (κ = 0.71). The algorithm classified all the patients, and there were no undetermined diagnoses. Diagnostic performance indicators for the ultrasound-based algorithm integrating early DT findings were as follows: area under the receiver operating characteristic curve, 0.91 (95% CI, 0.86-0.96); sensitivity, 87% (95% CI, 76%-94%); specificity, 95% (95% CI, 89%-98%); positive likelihood ratio, 18.1 (95% CI, 7.7-42.8); and negative likelihood ratio, 0.14 (95% CI, 0.07-0.26). CONCLUSION The ultrasound-based algorithm integrating the DT of early mitral filling performs well for diagnosing AHF in emergency patients with dyspnea. The inclusion of early DT allows all patients to be diagnosed.
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Affiliation(s)
- Nicolas L'Hermitte
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Nîmes University Hospital, Nîmes, Francia
| | - Thibaut Markarian
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia. UMR 1263 Center of Cardiovascular and Nutrition Research (C2VN), Aix-Marseille University, INSERM, INRAE, Marsella, Francia
| | - Laura Grau-Mercier
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Nîmes University Hospital, Nîmes, Francia
| | - Fabien Coisy
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Nîmes University Hospital, Nîmes, Francia
| | - Laurent Muller
- Montpellier University, EA2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Laysa Saadi
- Montpellier University, EA2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Pierre-Géraud Claret
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Nîmes University Hospital, Nîmes, Francia
| | - Hugo Krebs
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Nîmes University Hospital, Nîmes, Francia
| | - Xavier Bobbia
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Montpellier University Hospital, Montpellier, Francia
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Dupriez F, Niset A, Couvreur C, Marissiaux L, Gendebien F, Peyskens L, Germeau B, Fasseaux A, Rodrigues de Castro B, Penaloza A, Vanpee D, Bobbia X. Evaluation of point-of-care ultrasound use in the diagnostic approach for right upper quadrant abdominal pain management in the emergency department: a prospective study. Intern Emerg Med 2024; 19:803-811. [PMID: 38041765 DOI: 10.1007/s11739-023-03480-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/04/2023] [Indexed: 12/03/2023]
Abstract
Point-of-care ultrasound (PoCUS) is commonly used at the bedside in the emergency department (ED) as part of clinical examinations. Studies frequently investigate PoCUS diagnostic accuracy, although its contribution to the overall diagnostic approach is less often evaluated. The primary objective of this prospective, multicenter, cohort study was to assess the contribution of PoCUS to the overall diagnostic approach of patients with right upper quadrant abdominal pain. Two independent members of an adjudication committee, who were blind to the intervention, independently evaluated the diagnostic approaches before and after PoCUS for the same patient. The study included 62 patients admitted to the ED with non-traumatic right upper quadrant abdominal pain from September 1, 2022, to March 6, 2023. The contribution of PoCUS to the diagnostic approach was evaluated using a proportion test assuming that 75% of diagnostic approaches would be better or comparable with PoCUS. Wilcoxon signed-rank tests evaluated the impact of PoCUS on the mean number of differential diagnoses, planned treatments, and complementary diagnostic tests. Overall, 60 (97%) diagnostic approaches were comparable or better with PoCUS (χ2 = 15.9, p < 0.01). With PoCUS, the mean number of differential diagnoses significantly decreased by 2.3 (95% CI - 2.7 to - 1.5) (p < 0.01), proposed treatments by 1.3 (95% CI - 1.8 to - 0.9) (p < 0.01), and complementary diagnostic tests by 1.3 (95% CI - 1.7 to - 1.0) (p < 0.01). These findings show that PoCUS positively impacts the diagnostic approach and significantly decreases the mean number of differential diagnoses, treatments, and complementary tests.
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Affiliation(s)
- Florence Dupriez
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium.
| | - Alexandre Niset
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Claire Couvreur
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Laurent Marissiaux
- Emergency Department, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Félix Gendebien
- Emergency Department, Hôpital de Jolimont, Lobbes, Lobbes, Belgium
| | - Laurent Peyskens
- Emergency Department, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Boris Germeau
- Emergency Department, Cliniques Saint-Pierre Ottignies, Ottignies, Belgium
| | - Antoine Fasseaux
- Emergency Department, Hôpital de Jolimont, Lobbes, Haine Saint Paul, Belgium
| | | | - Andrea Penaloza
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Dominique Vanpee
- Institute of Health and Society and CHU UCL Namur, UCLOUVAIN, Ottignies-Louvain-la-Neuve, Belgium
| | - Xavier Bobbia
- Emergency Department, CHU Montpellier, Montpellier, France
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Sanchez T, Coisy F, Grau-Mercier L, Occelli C, Ajavon F, Claret PG, Markarian T, Bobbia X. Is the shock index correlated with blood loss? An experimental study on a controlled hemorrhagic shock model in piglets. Am J Emerg Med 2024; 75:59-64. [PMID: 37922831 DOI: 10.1016/j.ajem.2023.10.026] [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: 06/13/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION The quantification of blood loss in a severe trauma patient allows prognostic quantification and the engagement of adapted therapeutic means. The Advanced Trauma Life Support classification of hemorrhagic shock, based in part on hemodynamic parameters, could be improved. The search for reproducible and non-invasive parameters closely correlated with blood depletion is a necessity. An experimental model of controlled hemorrhagic shock allowed us to obtain hemodynamic and echocardiographic measurements during controlled blood spoliation. The primary aim was to demonstrate the correlation between the Shock Index (SI) and blood depletion volume (BDV) during the hemorrhagic phase of an experimental model of controlled hemorrhagic shock in piglets. The secondary aim was to study the correlations between blood pressure (BP) values and BDV, SI and cardiac output (CO), and pulse pressure (PP) and stroke volume during the same phase. METHODS We analyzed data from 66 anesthetized and ventilated piglets that underwent blood spoliation at 2 mL.kg-1.min-1 until a mean arterial pressure (MAP) of 40 mmHg was achieved. During this bleeding phase, hemodynamic and echocardiographic measurements were performed regularly. RESULTS The correlation coefficient between the SI and BDV was 0.70 (CI 95%, [0.64; 0.75]; p < 0.01), whereas between MAP and BDV, the correlation coefficient was -0.47 (CI 95%, [-0.55; -0.38]; p < 0.01). Correlation coefficient between SI and CO and between PP and stroke volume were - 0.45 (CI 95%, [-0.53; -0.37], p < 0.01) and 0.62 (CI 95%, [0.56; 0.67]; p < 0.01), respectively. CONCLUSIONS In a controlled hemorrhagic shock model in piglets, the correlation between SI and BDV seemed strong.
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Affiliation(s)
- Thomas Sanchez
- University of Montpellier, Research Unit IMAGINE, Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France.
| | - Fabien Coisy
- University of Montpellier, Research Unit IMAGINE, Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Laura Grau-Mercier
- University of Montpellier, Research Unit IMAGINE, Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Céline Occelli
- University of Côte d'Azur, Faculty of Medecine, Transporter in Imaging and Radiotherapy in Oncology Laboratory, Basic Research Direction - Department of Emergency Medicine, Nice University Hospital, Nice, France
| | - Florian Ajavon
- University of Montpellier, Research Unit IMAGINE, Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Pierre-Géraud Claret
- University of Montpellier, Research Unit IMAGINE, Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Thibaut Markarian
- University of Aix-Marseille, UMR 1263 Center of Cardiovascular and Nutrition Research (C2VN), INSERM, INRAE - Department of Emergency Medicine, Timone University Hospital, Marseille, France
| | - Xavier Bobbia
- University of Montpellier, Research Unit IMAGINE, Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
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Stralec G, Fontaine C, Arras S, Omnes K, Ghomrani H, Lecaros P, Le Conte P, Balen F, Bobbia X. Is a Positive Prehospital FAST Associated with Severe Bleeding? A Multicenter Retrospective Study. PREHOSP EMERG CARE 2023; 28:572-579. [PMID: 37874044 DOI: 10.1080/10903127.2023.2272196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Severe hemorrhage is the leading cause of early preventable death in severe trauma patients. Delayed diagnosis is a poor prognostic factor, and severe hemorrhage prediction is essential. The aim of our study was to investigate if there was an association between the detection of peritoneal or pleural fluid on prehospital sonography for trauma and posttraumatic severe hemorrhage. METHODS We retrospectively studied data from records of thoracic or abdominal trauma patients managed in mobile intensive care units from January 2017 to December 2021 in four centers in France. Severe hemorrhage was defined as a condition necessitating transfusion of at least four packed red blood cells or surgical intervention/radioembolization for hemostasis within the first 24 h. Using a multivariate analysis, we investigated the predictive performance of focused assessment with sonography for trauma (FAST) alone or in combination with the five Red Flags criteria validated by Hamada et al. RESULTS Among the 527 patients analyzed, 371 (71%) were men, the mean age was 41 ± 19 years, and the Injury Severity Score was 11 (Interquartile range = [5; 22]). Seventy-three (14%) patients had severe hemorrhage - of whom 28 (38%) had a positive FAST, compared to 61 (13%) without severe hemorrhage (p < 0.01). For severe hemorrhage prediction, FAST had a sensitivity of 38% (95%CI = [27%; 50%]) and a specificity of 87% (95%CI = [83%; 90%]) (AUC = 0.62, 95%CI = [0.57; 0.68]). The comparison of the other outcomes between positive and negative FAST was: hemostatic procedure, 22 (25%) vs 28 (6%), p < 0.01; intensive care unit admission 71 (80%) vs 190 (43%), p < 0.01; mean length of hospital stay 11 [4; 27] vs 4 [0; 14] days, p = 0.02; 30-day mortality 13 (15%) vs 22 (5%), p < 0.01. CONCLUSION A positive FAST performed in the prehospital setting is associated with severe hemorrhage and all prognostic criteria we studied.
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Affiliation(s)
- Grace Stralec
- University of Montpellier, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Camille Fontaine
- Emergency Department, Toulouse University Hospital, Toulouse, France
| | - Sarah Arras
- University of Montpellier, Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
| | - Keryann Omnes
- Faculté de médecine, Nantes Université & Service des urgences, CHU de Nantes, France
| | - Hamza Ghomrani
- University of Montpellier, Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
| | - Pablo Lecaros
- University of Montpellier, Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
| | - Philippe Le Conte
- Faculté de médecine, Nantes Université & Service des urgences, CHU de Nantes, France
| | - Frederic Balen
- Emergency Department, Toulouse University Hospital, Toulouse, France
- Emergency Department, Toulouse University Hospital, CERPOP - EQUITY, INSERM, Toulouse, France
| | - Xavier Bobbia
- University of Montpellier, UR UM 103 (IMAGINE), Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
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Claret PG, Bobbia X, Renia R, Stowell A, Crampagne J, Flechet J, Czeschan C, Sebbane M, Landais P, de La Coussaye JE. Prescription errors by emergency physicians for inpatients are associated with emergency department length of stay. Therapie 2023; 78:S59-S65. [PMID: 27793421 DOI: 10.2515/therapie/2015049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 07/10/2015] [Indexed: 10/15/2023]
Abstract
OBJECTIVES Adverse drug events are the sixth-leading cause of death in Western countries and are also more frequent in emergency departments (EDs). In some hospitals or on some occasions, ED physicians prescribe for patients who they have admitted. These prescriptions are then followed by the wards and can persist for several days. Our objectives were to determine the frequency of prescription errors for patients over 18years old hospitalized from ED to medical or surgical wards, and whether there exists a relationship between those prescription errors and ED LOS. METHODS This was a single center retrospective study that was conduct in the ED of a university hospital with an annual census of 65 000 patients. The population studied consisted of patients over 18years old hospitalized from ED to medical or surgical wards between January 1st, 2012 and January 21st, 2012. RESULTS Six hundred eight patients were included. One hundred fifty-four (25%) patients had prescription errors. Prescription errors were associated with increased ED length of stay (OR=2.47; 95% CIs [1.58; 3.92]) and polypharmacy (OR=1.78; 95% CIs [1.20; 2.66]). Fewer prescription errors were found when the patient was examined in the ED by a consultant (OR=0.61; 95% CIs [0.41; 0.91]) and when the medical history was known (OR=0.28; 95% CIs [0.10; 0.88]). CONCLUSION Prescription errors occurred frequently in the ED. We assume that a clear communication and cooperation between EPs and consultants may help improve prescription accuracy.
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Affiliation(s)
- Pierre-Géraud Claret
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France; EA 2415, Clinical Research University Institute, centre hospitalier universitaire de Montpellier, 34000 Montpellier, France.
| | - Xavier Bobbia
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France
| | - Rhoda Renia
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France
| | - Andrew Stowell
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France
| | - Jacques Crampagne
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France
| | - Jean Flechet
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France
| | - Christian Czeschan
- Département informatique médicale, centre hospitalier universitaire de Nîmes, 30029 Nîmes, France
| | - Mustapha Sebbane
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France
| | - Paul Landais
- EA 2415, Clinical Research University Institute, centre hospitalier universitaire de Montpellier, 34000 Montpellier, France; Département de biostatistique, épidémiologie, santé publique et informatique médicale, centre hospitalier universitaire de Nîmes, 30029 Nîmes, France
| | - Jean-Emmanuel de La Coussaye
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France
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Boulet N, Bobbia X, Gavoille A, Louart B, Lefrant JY, Roger C, Muller L. Axillary vein catheterization using ultrasound guidance: A prospective randomized cross-over controlled simulation comparing standard ultrasound and new needle-pilot device. J Vasc Access 2023; 24:1042-1050. [PMID: 34965763 DOI: 10.1177/11297298211063705] [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: 11/16/2022] Open
Abstract
BACKGROUND Real-time ultrasound (US) guidance facilitates central venous catheterization in intensive care unit (ICU). New magnetic needle-pilot devices could improve efficiency and safety of central venous catheterization. This simulation trial was aimed at comparing venipuncture with a new needle-pilot device to conventional US technique. METHODS In a prospective, randomized, simulation trial, 51 ICU physicians and residents cannulated the right axillary vein of a human torso mannequin with standard US guidance and with a needle-pilot system, in a randomized order. The primary outcome was the time from skin puncture to successful venous cannulation. The secondary outcomes were the number of skin punctures, the number of posterior wall puncture of the axillary vein, the number of arterial punctures, the number of needle redirections, the failure rate, and the operator comfort. RESULTS Time to successful cannulation was shorter with needle-pilot US-guided technique (22 s (interquartile range (IQR) = 16-42) vs 25 s (IQR = 19-128); median of difference (MOD) = -9 s (95%-confidence interval (CI) -5, -22), p < 0.001). The rates of skin punctures, posterior wall puncture of axillary vein, and needle redirections were also lower (p < 0.01). Comfort was higher in needle-pilot US-guided group on a 11-points numeric scale (8 (IQR = 8-9) vs 6 (IQR = 6-8), p < 0.001). CONCLUSIONS In a simulation model, US-guided axillary vein catheterization with a needle-pilot device was associated with a shorter time of successful cannulation and a decrease in numbers of skin punctures and complications. The results plea for investigating clinical performance of this new device.
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Affiliation(s)
- Nicolas Boulet
- Intensive Care Unit, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Xavier Bobbia
- EA 2992 IMAGINE, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Antoine Gavoille
- Department of Biostatistics-Bioinformatic, Hospices Civils de Lyon, Lyon, France
| | - Benjamin Louart
- Intensive Care Unit, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Jean Yves Lefrant
- Intensive Care Unit, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Claire Roger
- Intensive Care Unit, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Laurent Muller
- Intensive Care Unit, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
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Gil-Jardiné C, Payen JF, Bernard R, Bobbia X, Bouzat P, Catoire P, Chauvin A, Claessens YE, Douay B, Dubucs X, Galanaud D, Gauss T, Gauvrit JY, Geeraerts T, Glize B, Goddet S, Godier A, Le Borgne P, Rousseau G, Sapin V, Velly L, Viglino D, Vigue B, Cuvillon P, Frasca D, Claret PG. Management of patients suffering from mild traumatic brain injury 2023. Anaesth Crit Care Pain Med 2023; 42:101260. [PMID: 37285919 DOI: 10.1016/j.accpm.2023.101260] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To develop a multidisciplinary French reference that addresses initial pre- and in-hospital management of a mild traumatic brain injury patient. DESIGN A panel of 22 experts was formed on request from the French Society of Emergency Medicine (SFMU) and the French Society of Anaesthesiology and Critical Care Medicine (SFAR). A policy of declaration and monitoring of links of interest was applied and respected throughout the process of producing the guidelines. Similarly, no funding was received from any company marketing a health product (drug or medical device). The expert panel had to respect and follow the Grade® (Grading of Recommendations Assessment, Development and Evaluation) methodology to evaluate the quality of the evidence on which the recommendations were based. Given the impossibility of obtaining a high level of evidence for most of the recommendations, it was decided to adopt a "Recommendations for Professional Practice" (RPP) format, rather than a Formalized Expert Recommendation (FER) format, and to formulate the recommendations using the terminology of the SFMU and SFAR Guidelines. METHODS Three fields were defined: 1) pre-hospital assessment, 2) emergency room management, and 3) emergency room discharge modalities. The group assessed 11 questions related to mild traumatic brain injury. Each question was formulated using a PICO (Patients Intervention Comparison Outcome) format. RESULTS The experts' synthesis work and the application of the GRADE® method resulted in the formulation of 14 recommendations. After two rounds of rating, strong agreement was obtained for all recommendations. For one question, no recommendation could be made. CONCLUSION There was strong agreement among the experts on important, transdisciplinary recommendations, the purpose of which is to improve management practices for patients with mild head injury.
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Affiliation(s)
- Cédric Gil-Jardiné
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, Service des Urgences-Adultes, Population Health, INSERM U1219, équipe aHeAD, Université de Bordeaux, Bordeaux, France.
| | - Jean-François Payen
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000 Grenoble, France
| | - Rémy Bernard
- Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Xavier Bobbia
- Montpellier University, UR UM 103 (IMAGINE), Department of Emergency Medicine, CHU Montpellier, Montpellier, France
| | - Pierre Bouzat
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000 Grenoble, France
| | - Pierre Catoire
- Emergency Consultant, Academic Clinical Fellow (Pitié-Salpétrière University, General Emergency Department, Paris) - Tactical Ultrasound Course for Ukraine (TUSC-UA) Course Director - Mehad, France
| | - Anthony Chauvin
- Service d'Accueil des Urgences/SMUR, CHU Lariboisière, Université de Paris - Inserm U942 MASCOT, Université de Paris, Paris, France
| | - Yann-Erick Claessens
- Département de Médecine d'urgence, Centre Hospitalier Princesse Grace, Avenue Pasteur, MC-98002, Monaco
| | - Bénédicte Douay
- SMUR/Service des Urgences, Hôpital Beaujon, AP-HP Nord, Clichy, France
| | - Xavier Dubucs
- Emergency Departement, Centre Hospitalo-Universitaire de Toulouse, Place du Docteur Baylac, 31300 Toulouse, France
| | - Damien Galanaud
- Service de Neuroradiologie, GH Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Tobias Gauss
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000 Grenoble, France
| | - Jean-Yves Gauvrit
- Service de Neuroradiologie, Hôpital Pontchaillou, CHU Rennes, Rennes, France
| | - Thomas Geeraerts
- Pole Anesthesie Réanimation et INSERM Tonic, CHU de Toulouse et Universite Toulouse 3, Toulouse, France
| | - Bertrand Glize
- PMR Department, CHU de Bordeaux, ACTIVE Team, BPH INSERM U1219, University of Bordeaux, France
| | - Sybille Goddet
- Samu-21, CHU de Dijon, SAU-Smur, CH du Creusot, Dijon, France
| | - Anne Godier
- Université Paris Cité, APHP, Hôpital Européen Georges Pompidou, Service d'anesthésie Réanimation and Inserm UMRS_1140, Paris, France
| | - Pierrick Le Borgne
- Emergency Department, University Hospitals of Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France - INSERM UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), Faculté de Médecine, Université de Strasbourg, 4 rue Kirschleger, 67085 Strasbourg Cedex, France
| | | | - Vincent Sapin
- Service de Biochimie et de Génétique Moléculaire, Centre de Biologie, CHU de Clermont-Ferrand, France
| | - Lionel Velly
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille University, Marseille, France
| | - Damien Viglino
- University Grenoble-Alpes, Emergency Department, CHU Grenoble-Alpes, Grenoble, France - HP2 Laboratory INSERM U1300, Grenoble, France
| | - Bernard Vigue
- Département d'Anesthésie Réanimation, Hôpital Universitaire de Bicêtre, Le Kremlin Bicêtre, France
| | - Philippe Cuvillon
- EA 2992 IMAGINE, Prévention et Prise en Charge de la Défaillance Circulatoire des Patients en état de Choc, Anaesthesiology Department, CHU Nîmes, University Montpellier, 30000 Nîmes, France
| | - Denis Frasca
- Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France, Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France, INSERM U1246, Methods in Patients-Centered Outcomes and Health Research - SPHERE, Nantes, France
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Dupriez F, de Castro BR, Gendebien F, Fasseaux A, Gensburger M, Marissiaux L, Penaloza A, Bobbia X, Jarman R. Is gallbladder PoCUS diagnostic accuracy accessible to medical students after PoCUS training exclusively on healthy volunteers? A pilot randomized control trial. Ultrasound J 2023; 15:18. [PMID: 37036612 PMCID: PMC10086079 DOI: 10.1186/s13089-023-00317-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 03/22/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Point-of-care ultrasound (PoCUS) is increasingly used in clinical practice and is now included in many undergraduate curricula. Here, we aimed to determine whether medical students who participated in a PoCUS teaching program with several practical training sessions involving healthy volunteers could achieve a good level of diagnostic accuracy in identifying gallbladder pathologies. The intervention group (IG) was trained exclusively on volunteers with a healthy gallbladder, whereas the control group (CG) had access to volunteers with a pathological gallbladder as recommended in most PoCUS curricula. MATERIALS AND METHODS Twenty medical students were randomly assigned to the IG and CG. After completing the training program over 2 months, students were evaluated by three independent examiners. Students and examiners were blind to group allocation and study outcome. Sensitivity and specificity of students' PoCUS gallstone diagnosis were assessed. Secondary outcomes were students' confidence, image quality, acquisition time, and PoCUS skills. RESULTS Sensitivity and specificity for gallstone diagnosis were, respectively, 0.85 and 0.97 in the IG and 0.80 and 0.83 in the CG. Areas under the curve (AUC) based on the receiver operating characteristic curve analysis were 0.91 and 0.82 in the IG and CG, respectively, with no significant difference (p = 0.271) and an AUC difference of -0.092. No significant between-group difference was found for the secondary outcomes. CONCLUSIONS Our pilot study showed that medical students can develop PoCUS diagnostic accuracy after training on healthy volunteers. If these findings are confirmed in a larger sample, this could favor the delivery of large practical teaching sessions without the need to include patients with pathology, thus facilitating PoCUS training for students.
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Affiliation(s)
- Florence Dupriez
- Emergency Department, Cliniques Universitaires Saint Luc, Av Hippocrate 10, 1200, Brussels, Belgium.
| | | | - Félix Gendebien
- Emergency Department, Cliniques Universitaires Saint Luc, Av Hippocrate 10, 1200, Brussels, Belgium
- Emergency Department, Hôpital de Jolimont - Lobbes, Lobbes, Belgium
| | - Antoine Fasseaux
- Emergency Department, Hôpital de Jolimont - Lobbes, Haine-Saint-Paul, Belgium
| | - Matthieu Gensburger
- Emergency Department, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Laurent Marissiaux
- Emergency Department, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Andrea Penaloza
- Emergency Department, Cliniques Universitaires Saint Luc, Av Hippocrate 10, 1200, Brussels, Belgium
| | - Xavier Bobbia
- Emergency Department, CHU Montpellier, Montpellier, France
| | - Robert Jarman
- Emergency Department, Royal Victoria Infirmary, Newcastle, UK
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10
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Ajavon F, Coisy F, Grau-Mercier L, Fontaine J, Perez Martin A, Claret PG, Bobbia X. ARTERIAL DIAMETER VARIATIONS AS A NEW INDEX FOR STROKE VOLUME ASSESSMENT: AN EXPERIMENTAL STUDY ON A CONTROLLED HEMORRHAGIC SHOCK MODEL IN PIGLETS. Shock 2023; 59:637-645. [PMID: 36669228 DOI: 10.1097/shk.0000000000002085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
ABSTRACT Background: The assessment of cardiac output (CO) is a major challenge during shock. The criterion standard for CO evaluation is transpulmonary thermodilution, which is an invasive technique. Speckle tracking is an automatized method of analyzing tissue motion using echography. This tool can be used to monitor pulsed arterial diameter variations with low interobserver variability. An experimental model of controlled hemorrhagic shock allows for multiple CO variations. The main aim of this study is to show the correlation between the femoral arterial diameter variations (fADVs) and the stroke volume (SV) measured by thermodilution during hemorrhagic shock management and the resuscitation of anesthetized piglets. The secondary objective is to explore the respective correlations between SV and subaortic time-velocity index, abdominal aorta ADV, carotid ADV, and subclavian ADV. Methods : Piglets were bled until mean arterial pressure reached 40 mm Hg. Controlled hemorrhage was maintained for 30 minutes before randomizing the piglets to three resuscitation groups-the fluid-filling group (reanimated with saline solution only), NEph group (norepinephrine + saline solution), and Eph group (epinephrin + saline solution). Speckle tracking, echocardiographic, and hemodynamic measures were performed at different stages of the protocol. Results : Thirteen piglets were recruited and included for statistical analysis. Of all the piglets, 164 fADV measures were attempted and 160 were successful (98%). The correlation coefficient between fADV and SV was 0.71 (95% confidence interval [CI], 0.62 to 0.78; P < 0.01). The correlation coefficient between SV and abdominal aorta ADV, subclavian ADV, and carotid ADV was 0.30 (95% CI, 0.13 to 0.46; P < 0.01), 0.56 (95% CI, 0.45 to 0.66, P < 0.01), and 0.15 (95% CI, -0.01 to 0.30, P = 0.06), respectively. Conclusions : In this hemorrhagic shock model using piglets, fADV was strongly correlated with SV.
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Affiliation(s)
| | | | | | - Jules Fontaine
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Montpellier University, Nîmes, France
| | | | - Pierre-Géraud Claret
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Montpellier University, Nîmes, France
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Legros J, Besnard N, Bobbia X. Découverte d’un syndrome catastrophique des antiphospholipides au cours de douleurs intenses des membres. Ann Fr Med Urgence 2023. [DOI: 10.3166/afmu-2022-0471] [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] [Indexed: 02/23/2023]
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Planquart F, Marcaggi E, Blondonnet R, Clovet O, Bobbia X, Boussat B, Pottecher J, Gauss T, Zieleskiewicz L, Bouzat P. Appropriateness of Initial Course of Action in the Management of Blunt Trauma Based on a Diagnostic Workup Including an Extended Ultrasonography Scan. JAMA Netw Open 2022; 5:e2245432. [PMID: 36477480 PMCID: PMC9856525 DOI: 10.1001/jamanetworkopen.2022.45432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE The extended Focused Assessment With Sonography for Trauma (E-FAST) has become a cornerstone of the diagnostic workup in patients with trauma. The added value of a diagnostic workup including an E-FAST to support decision-making remains unknown. OBJECTIVE To determine how often an immediate course of action adopted in the resuscitation room based on a diagnostic workup that included an E-FAST and before whole-body computed tomography scanning (WBCT) in patients with blunt trauma was appropriate. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted at 6 French level I trauma centers between November 5, 2018, and November 5, 2019. Consecutive patients treated for blunt trauma were assessed at the participating centers. Data analysis took place in February 2022. EXPOSURES Diagnostic workup associating E-FAST (including abdominal, thoracic, pubic, and transcranial Doppler ultrasonography scan), systematic clinical examination, and chest and pelvic radiographs. MAIN OUTCOMES AND MEASURES The main outcome criterion was the appropriateness of the observed course of action (including abstention) in the resuscitation room according to evaluation by a masked expert panel. RESULTS Of 515 patients screened, 510 patients (99.0%) were included. Among the 510 patients included, 394 were men (77.3%), the median (IQR) age was 46 years (29-61 years), and the median (IQR) Injury Severity Score (ISS) was 24 (17-34). Based on the initial diagnostic workup, no immediate therapeutic action was deemed necessary in 233 cases (45.7%). Conversely, the following immediate therapeutic actions were initiated before WBCT: 6 emergency laparotomies (1.2%), 2 pelvic angioembolisations (0.4%), 52 pelvic binders (10.2%), 41 chest drains (8.0%) and 16 chest decompressions (3.1%), 60 osmotherapies (11.8%), and 6 thoracotomies (1.2%). To improve cerebral blood flow based on transcranial doppler recordings, norepinephrine was initiated in 108 cases (21.2%). In summary, the expert panel considered the course of action appropriate in 493 of 510 cases (96.7%; 95% CI, 94.7%-98.0%). Among the 17 cases (3.3%) with inappropriate course of action, 13 (76%) corresponded to a deviation from existing guidelines and 4 (24%) resulted from an erroneous interpretation of the E-FAST. CONCLUSIONS AND RELEVANCE This prospective, multicenter cohort study found that a diagnostic resuscitation room workup for patients with blunt trauma that included E-FAST with clinical assessment and targeted chest and pelvic radiographs was associated with the determination of an appropriate course of action prior to WBCT.
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Affiliation(s)
- Fanny Planquart
- Service d’Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | | | - Raiko Blondonnet
- Pôle de Médecine Périopératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Clovet
- Département d’Anesthésie-Réanimation et Médecine Péri-Opératoire, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Xavier Bobbia
- Université de Montpellier, Département Urgences CHU Montpellier, Montpellier, France
| | - Bastien Boussat
- Service d’épidémiologie et évaluation médicale, CHU Grenoble-Alpes, laboratoire TIMC-IMAG, UMR 5525 Joint Research Unit, Centre National de Recherche Scientifique, Université Grenoble-Alpes, France
| | - Julien Pottecher
- Service d’Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
- Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, UR3072, Strasbourg, France
| | - Tobias Gauss
- Pôle d’Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Laurent Zieleskiewicz
- Service d’anesthésie réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, Centre de recherche en Cardiovasculaire et Nutrition, Aix-Marseille Université, France
| | - Pierre Bouzat
- University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
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Markarian T, Grau-Mercier L, Occelli C, Ajavon F, Claret PG, Coisy F, Bobbia X. Evaluation of a New Echocardiographic Tool for Cardiac Output Monitoring: An Experimental Study on A Controlled Hemorrhagic Shock Model in Anesthetized Piglets. J Clin Med 2022; 11:jcm11185420. [PMID: 36143066 PMCID: PMC9503332 DOI: 10.3390/jcm11185420] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/18/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Cardiac output (CO) monitoring is recommended in patients with shock. The search for a reliable, rapid, and noninvasive tool is necessary for clinical practice. A new echocardiographic CO flow index (COF) is the automatic calculation of the sub-aortic VTI multiplied by the automatic calculation of the heart rate (HR). The primary objective of this study was to show the correlation between COF and CO measured by thermodilution (COth) in a controlled hemorrhagic shock model in anesthetized piglets. Secondary objectives were to show the correlation between COth and CO calculated from left outflow tract (LVOT) measurement and manual VTI (COman), and CO measured by LVOT measurement and VTIauto (COauto). Methods: Prospective interventional experimental study. In seventeen ventilated and anesthetized piglets, a state of hemorrhagic shock was induced, maintained, then resuscitated and stabilized. The gold standard for CO and stroke volume measurement was thermodilution (COth). Results: 191 measurements were performed. The correlation coefficients (r) between COth and COF, COman, and COauto were 0.73 [0.62; 0.81], 0.66 [0.56; 0.74], and 0.73 [0.63; 0.81], respectively. Conclusions: In this study, the COF appears to have a strong correlation to the COth. This automatic index, which takes into account the HR and does not require the measurement of LVOT, could be a rapidly obtained index in clinical practice.
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Affiliation(s)
- Thibaut Markarian
- Emergency Department, Timone University Hospital, Aix-Marseille University, 13005 Marseille, France
- Correspondence:
| | - Laura Grau-Mercier
- Emergency Department, Nîmes University Hospital, Montpellier University, UR UM 103 IMAGINE, 30029 Nîmes, France
| | - Céline Occelli
- Emergency Department, Pasteur 2 University Hospital, Nice Côte-d’Azur University, 06000 Nice, France
| | - Florian Ajavon
- Emergency Department, Nîmes University Hospital, Montpellier University, UR UM 103 IMAGINE, 30029 Nîmes, France
| | - Pierre-Géraud Claret
- Emergency Department, Nîmes University Hospital, Montpellier University, UR UM 103 IMAGINE, 30029 Nîmes, France
| | - Fabien Coisy
- Emergency Department, Nîmes University Hospital, Montpellier University, UR UM 103 IMAGINE, 30029 Nîmes, France
| | - Xavier Bobbia
- Emergency Department, Montpellier University Hospital, Montpellier University, UR UM 103 IMAGINE, 34295 Montpellier, France
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Addala TE, Greffier J, Hamard A, Snene F, Bobbia X, Bastide S, Belaouni A, de Forges H, Larbi A, de la Coussaye JE, Beregi JP, Claret PG, Frandon J. Early results of ultra-low-dose CT-scan for extremity traumas in emergency room. Quant Imaging Med Surg 2022; 12:4248-4258. [PMID: 35919065 PMCID: PMC9338366 DOI: 10.21037/qims-21-848] [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: 09/08/2021] [Accepted: 05/16/2022] [Indexed: 12/01/2022]
Abstract
Background Ultra-low dose computed tomography (ULD-CT) was shown to be a good alternative to digital radiographs in various locations. This study aimed to assess the diagnostic sensitivity and specificity of ULD-CT versus digital radiographs in patients consulting for extremity traumas in emergency room. Methods Digital radiography and ULD-CT scan were performed in patients consulting at the emergency department (February–August 2018) for extremity traumas. Fracture detection was evaluated retrospectively by two blinded independent radiologists. Sensitivity and specificity were evaluated using best value comparator (BVC) and a Bayesian latent class model (LCM) approaches and clinical follow-up. Image quality, quality diagnostic and diagnostic confidence level were evaluated (Likert scale). The effective dose received was calculated. Results Seventy-six consecutive patients (41 men, mean age: 35.2±13.2 years), with 31 wrists/hands and 45 ankles/feet traumas were managed by emergency physicians. According to clinical data, radiography had 3 false positive and 10 false negative examinations, and ULD-CT, 2 of each. Radiography and ULD-CT specificities were similar; sensitivities were lower for radiography, with BVC and Bayesian. With Bayesian, ULD-CT and radiography sensitivities were 90% (95% CI: 87–93%) and 76% (95% CI: 71–81%, P<0.0001) and specificities 96% (95% CI: 93–98%) and 93% (95% CI: 87–97%, P=0.84). The inter-observer agreement was higher for ULD-CT for all subjective indexes. The effective dose for ULD-CT and radiography was 0.84±0.14 and 0.58±0.27 µSv (P=0.002) for hand/wrist, and 1.50±0.32 and 1.44±0.78 µSv (P=NS) for foot/ankle. Conclusions With an effective dose level close to radiography, ULD-CT showed better detection of extremities fractures in the emergency room and may allow treatment adaptation. Further studies need to be performed to assess impact of such examination in everyday practice. Trial Registration ClinicalTrials.gov Identifier: NCT04832490.
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Affiliation(s)
- Taki Eddine Addala
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Joël Greffier
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Aymeric Hamard
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Fehmi Snene
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Xavier Bobbia
- IMAGINE Research Unit 103, Emergency Department, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Sophie Bastide
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nimes, Univ Montpellier, Nîmes, France
| | - Asmaa Belaouni
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Hélène de Forges
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Ahmed Larbi
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Jean-Emmanuel de la Coussaye
- IMAGINE Research Unit 103, Emergency Department, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Jean-Paul Beregi
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Pierre-Géraud Claret
- IMAGINE Research Unit 103, Emergency Department, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Julien Frandon
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
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Tazarourte K, Ageron FX, Avondo A, Barnard E, Bobbia X, Cesareo E, Chollet-Xemard C, Curac S, Desmettre T, Khoury CEL, Gauss T, Gil-Jardine C, Harris T, Heidet M, Lapostolle F, Pradeau C, Renard A, Sapir D, Tourtier JP, Travers S. Prehospital trauma flowcharts - Concise and visual cognitive aids for prehospital trauma management from the French Society of Emergency Medicine (SFMU) and the French Society of Anaesthesia and Intensive Care Medicine (SFAR). Anaesth Crit Care Pain Med 2022; 41:101070. [PMID: 35504522 DOI: 10.1016/j.accpm.2022.101070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Karim Tazarourte
- Université Claude Bernard Lyon 1, INSERM U1290 (RESHAPE), 69003 Lyon, France; SAMU 69/Service des Urgences, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France.
| | | | - Aurélie Avondo
- Service des Urgences, Hôpital Ambroise Paré, APHP, Boulogne Billancourt 92000, France
| | - Edward Barnard
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Clinical Innovation), Birmingham, United Kingdom; Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Department of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Hangar E, Gambling Close, Norwich Airport, Norwich, United Kingdom
| | - Xavier Bobbia
- Faculté de médecine Montpellier/Nîmes, Montpellier 34000, France
| | - Eric Cesareo
- SAMU 69/Service des Urgences, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France
| | - Charlotte Chollet-Xemard
- Assistance-Publique-Hôpitaux de Paris (APHP), SAMU 94 et service des urgences, Hôpital Henri Mondor, Créteil 94000, France
| | - Sonja Curac
- Service d'urgences - SMUR Hital Erasme, Hôpitaux Universitaires de Bruxelles - HUB- 808 1070, Bruxelles, Belgique
| | - Thibaut Desmettre
- Université De Franche-Comté UMR 6249 CNRS UFC, 25000 Besançon, France; Pôle Urgences SAMU/médecin intensive CHU de Besançon, 25030 Besançon, France
| | - Carlos E L Khoury
- Service des urgences Medipôle, Hôpital mutualiste, Villeurbanne 69000, France
| | - Tobias Gauss
- Anesthésie-Réanimation, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Tim Harris
- Emergency Medicine, Blizzard institute, Queen Mary University London, United Kingdom; Department Emergency Medicine, Hamad Medical Corporation, Qatar
| | - Matthieu Heidet
- Assistance-Publique-Hôpitaux de Paris (APHP), SAMU 94 et service des urgences, Hôpital Henri Mondor, Créteil 94000, France; Université Paris-Est Créteil (UPEC), EA 3956 (CIR), Créteil 94000, France
| | - Frédéric Lapostolle
- UF Recherche-Enseignement-Qualité, Hôpital Avicenne, AP-HP, Université Paris, Urgences - Samu 93, 13, Inserm U942, 93000, Bobigny, France
| | | | - Aurélien Renard
- Service médical du Bataillon des marins Pompiers, 13003 Marseille, France
| | - David Sapir
- SAMU 77- département de médecine d'urgence, GHSIF Centre hospitalier de Melun 77000, France
| | | | - Stéphane Travers
- Ecole de santé du Val-de-Grâce Paris, Service Médical de la brigade des sapeurs-pompiers de Paris, Paris 75000, France
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16
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Grau-Mercier L, Coisy F, Markarian T, Muller L, Roger C, Lefrant JY, Claret PG, Bobbia X. Can blood loss be assessed by echocardiography? An experimental study on a controlled hemorrhagic shock model in piglets. J Trauma Acute Care Surg 2022; 92:924-930. [PMID: 34991127 DOI: 10.1097/ta.0000000000003518] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Assessment of the volemic loss is a major challenge during the management of hemorrhagic shock. Echocardiography is an increasingly used noninvasive tool for hemodynamic assessment. In mechanically ventilated patients, some studies suggest that respiratory variations of mean subaortic time-velocity integral (∆VTI) would be predictive of fluid filling response. An experimental model of controlled hemorrhagic shock provides a precise approach to study correlation between blood volume and cardiac ultrasonographic parameters. OBJECTIVES The main objective was to analyze the ∆VTI changes during hemorrhage in an anesthetized-piglet model of controlled hemorrhagic shock. The secondary objective was to evaluate ∆VTI during the resuscitation process after hemorrhage and other echocardiographic parameters changes during the whole protocol. METHODS Twenty-four anesthetized and ventilated piglets were bled until mean arterial pressure reached 40 mm Hg. Controlled hemorrhage was maintained for 30 minutes before randomizing the piglets to two resuscitation groups: fluid filling group resuscitated with saline solution and noradrenaline group resuscitated with saline solution and noradrenaline. Echocardiography and hemodynamic measures, including pulsed pressure variations (PPV), were performed at different stages of the protocol. RESULTS The correlation coefficient between ΔVTI and PPV with the volume of bleeding during the hemorrhagic phase were respectively 0.24 (95% confidence interval, 0.08-0.39; p < 0.01) and 0.57 (95% CI, 0.44-0.67; p < 0.01). Two parameters had a moderate correlation coefficient with hemorrhage volume (over 0.5): mean subaortic time-velocity index (VTI) and mitral annulus diastolic tissular velocity (E'). CONCLUSION In this hemorrhagic shock model, ΔVTI had a low correlation with the volume of bleeding, but VTI and E' had a correlation with blood volume comparable to that of PPV.
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Affiliation(s)
- Laura Grau-Mercier
- From the Division of Anesthesiology, Critical Care, Pain and Emergency Medicine (L.G.-M., F.C., L.M., C.R., J.-Y.L., P.-G.C.), Nîmes University Hospital, Prévention et prise en charge de la défaillance circulatoire des patients en état de choc (IMAGINE), University of Montpellier, Nîmes; Department of Emergency Medicine (T.M.), Timone University Hospital, Marseille; and Department of Emergency Medicine (X.B.), Montpellier University Hospital Université de Montpellier, Prévention et prise en charge de la défaillance circulatoire des patients en état de choc (IMAGINE), University of Montpellier, Montpellier, France
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Cande C, Sebbane M, Bobbia X, Claret PG, Le Guillou C, Tchalla A, Blain H. Risk factors for readmission to the emergency department in patients aged 75 or older: a systematic review. Geriatr Psychol Neuropsychiatr Vieil 2021:pnv.2021.0986. [PMID: 34933840 DOI: 10.1684/pnv.2021.0986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A systematic literature review was carried out to assess the risk factors for readmission to the emergency department in people aged 75 and over. This review shows that certain socio-demographic factors (older age, male gender, not being single), certain underlying conditions (cardio-respiratory diseases, diabetes, cognitive impairment, cancer, depression), a recent history of falling, and impaired autonomy prior to admission are risk factors for readmission to the emergency department more than the cause of admission itself or its severity in people aged 75 and over. The best predictive score for readmission to the emergency department for elderly patients remains to be determined, as does the systematic identification of risk factors associated with specific management in the oldest at-risk group to reduce their readmission after a first visit to the emergency department.
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Affiliation(s)
- Camille Cande
- Pôle gérontologie, CHU de Montpellier, Université de Montpellier, France
| | - Mustafa Sebbane
- Service des urgences - SAMU - SMUR, CHU de Montpellier, Université de Montpellier, France
| | - Xavier Bobbia
- Service des urgences - SAMU - SMUR, CHU de Nîmes, France
| | | | | | - Achille Tchalla
- CHU de Limoges, Pôle HU gérontologie clinique, Limoges, France, Université de Limoges ; IFR 145 GEIST ; Laboratoire de recherche sur le vieillissement et la santé digitale ; UR Unilim VieSante, Limoges, France
| | - Hubert Blain
- Pôle gérontologie, CHU de Montpellier, Université de Montpellier, France
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Vauthier C, Chabannon M, Markarian T, Taillandy Y, Guillemet K, Krebs H, Bazalgette F, Muller L, Claret PG, Bobbia X. Point-of-care chest ultrasound to diagnose acute heart failure in emergency department patients with acute dyspnea: diagnostic performance of an ultrasound-based algorithm. Emergencias 2021; 33:441-446. [PMID: 34813191] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Cardiopulmonary ultrasound imaging can be useful for diagnosing acute heart failure (AHF). We aimed to evaluate the diagnostic performance of an algorithm based on point-of-care ultrasound (POCUS) in patients coming to the emergency department with acute dyspnea. MATERIAL AND METHODS Prospective analysis of a convenience sample of patients with acute dyspnea in 2 hospital emergency departments. The POCUS algorithm included lung ultrasound findings and 3 echocardiographic measurements taken from an apical view of 4 chambers: mitral annular plane systolic excursion, Doppler mitral flow velocity, and tissue Doppler imaging of the lateral mitral annulus. The definitive diagnosis was made by 2 physicians blinded to the POCUS findings. RESULTS A total of 103 adult patients with a mean (SD) age of 73 (12) years were included; about half (51 patients) were women. Forty-two patients (41%) were finally diagnosed with AHF. Interindividual agreement on the physicians' diagnoses was good (k = 0.82). The POCUS algorithm assigned an AHF diagnosis to 76 patients (74%); 56 of them (85%) were in sinus rhythm. The diagnostic performance indicators for the algorithm were as follows: area under the receiver operating characteristic curve, 0.94 (95% CI, 0.88-1.00); sensitivity 96% (95% CI, 78%-100%); specificity, 93% (95% CI, 8%-98%); positive predictive value, 85% (95% CI, 67%-100%); negative predictive value, 98% (95% CI, 88%-100%). CONCLUSION The POCUS-based algorithm for diagnosing AHF performed well in patients coming to the emergency department with acute dyspnea.
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Affiliation(s)
- Candice Vauthier
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Margaux Chabannon
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Thibaut Markarian
- Emergency Department, Hôpital de la Timone, UMR MD2 P2COE, Aix-Marseille Université, Marsella, Francia
| | - Yann Taillandy
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Kevin Guillemet
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Hugo Krebs
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Florian Bazalgette
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Laurent Muller
- Montpellier university, EA 2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Pierre-Géraud Claret
- Montpellier university, EA 2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Xavier Bobbia
- Montpellier university, EA 2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
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Occelli C, Carrio G, Driessens M, Turquay C, Azulay N, Grau-Mercier L, Levraut J, Claret PG, Contenti J, Bobbia X. Focal cardiac ultrasound learning with pocked ultrasound device: A bicentric prospective blinded randomized study. J Clin Ultrasound 2021; 49:784-790. [PMID: 34322891 DOI: 10.1002/jcu.23047] [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: 03/01/2021] [Revised: 06/30/2021] [Accepted: 07/10/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Point-of-care ultrasound using a pocket-ultrasound-device (PUD) is increasing in clinical medicine but the optimal way to teach focused cardiac ultrasound is not clear. We evaluated whether teaching using a PUD or a conventional-ultrasound-device (CUD) is different when the final exam was conducted on a PUD. The primary aim was to compare the weighted total quality scale (WTQS, out of 100) obtained by participants in the two groups (CUD and PUD) on a live volunteer 2-4 weeks after their initial training. The secondary aims were to compare examination time and students' confidence levels (out of 50). METHODS This bicentric, prospective single-blind randomized trial included undergraduate medical students. After watching a 15 min video about echocardiography views, students had a 45 min hands-on training session with a live volunteer using a PUD or a CUD. The final examination was conducted with a PUD on a live volunteer. RESULTS Eighty-six comparable students were included, with 4 ± 1 years of medical training. In the PUD group, the mean WTQS was 65 ± 16 versus 60 ± 15 in the CUD group [p = 0.22; in multivariate analysis, OR 0.8 95% CI (0.1;1.6), p = 0.34]. The examination time was 10.0 [6.2-12.4] min in the PUD group versus 11.4 [7.3-13.2] in the CUD group (p = 0.39), while the confidence level was 27.9 ± 7.7 in the PUD group versus 27.4 ± 7.2 in the CUD group (p = 0.76). CONCLUSION There was no difference between teaching echocardiographic views using a PUD as compared to a CUD on the PUD image quality, exam time, or confidence level of students.
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Affiliation(s)
- Céline Occelli
- Department of Emergency Medicine (Pôle Urgences SAMU SMUR), Hopital Pasteur 2, School of Medicine, University of Nice côte d'azur, Nice, France
| | - Gauthier Carrio
- Montpellier University, EA 2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Morgan Driessens
- Department of Emergency Medicine (Pôle Urgences SAMU SMUR), Hopital Pasteur 2, School of Medicine, University of Nice côte d'azur, Nice, France
| | - Charlotte Turquay
- Montpellier University, EA 2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Nicolas Azulay
- Ultrasound Department, CHU Nice, Université Côte d'Azur, Nice, France
| | - Laura Grau-Mercier
- Montpellier University, EA 2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jacques Levraut
- Department of Emergency Medicine (Pôle Urgences SAMU SMUR), Hopital Pasteur 2, School of Medicine, University of Nice côte d'azur, Nice, France
| | - Pierre-Géraud Claret
- Montpellier University, EA 2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Julie Contenti
- Department of Emergency Medicine (Pôle Urgences SAMU SMUR), Hopital Pasteur 2, School of Medicine, University of Nice côte d'azur, Nice, France
| | - Xavier Bobbia
- Montpellier University, EA 2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
- Medical Faculty of Nîmes, SIMHU - University Hospital Unit of Simulation of Nîmes, Nîmes, France
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Dupriez F, Geukens P, Penaloza A, Vanpee D, Bekkering G, Bobbia X. Agreement of emergency physician-performed ultrasound versus RADiology-performed UltraSound for cholelithiasis or cholecystitis: a systematic review. Eur J Emerg Med 2021; 28:344-351. [PMID: 33758146 DOI: 10.1097/mej.0000000000000815] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cholecystitis secondary to gallstone migration is the most common suspected diagnosis for right upper quadrant pain in emergency departments, with radiology-performed ultrasound (RADUS) being the main diagnostic tool. The primary aim of this review was to assess the ability of emergency physicians to perform emergency ultrasound (EUS) compared to RADUS to diagnose cholelithiasis and cholecystitis. A systematic search was performed using Embase, Central (Cochrane library), Web of Science, MEDLINE, Google Scholar, prospective trial registries, and OpenSIGLE databases as well as hand-search of articles. Two physicians independently selected the articles. Assessment of methodological quality was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Clinical and methodological heterogeneity were qualitatively reported and discussed. Seven prospective studies were selected involving a total of 1061 subjects undergoing EUS. The included studies all used RADUS as the reference standard and emergency physician-performed EUS as the index test. Included studies mostly reported diagnostic accuracy for cholelithiasis diagnosis whereas only one study mentioned diagnostic accuracy for cholecystitis. Clinical and methodological heterogeneity between included studies prevented a meta-analysis. This review shows there is good agreement between EUS and RADUS to assess the gallbladder for cholelithiasis and therefore supports its use by emergency physicians for that matter. Nevertheless, this work identified clinical and methodological heterogeneity along with a poor description EUS operators' experience. In the future, larger studies should include a larger population of EUS operators, specify their background, and compare EUS to the final diagnosis to evaluate performances for gallbladder diagnostic accuracy.
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Affiliation(s)
- Florence Dupriez
- Emergency Department (ED), Cliniques Universitaires Saint-Luc (CUSL), Brussels
| | - Paul Geukens
- Intensive Care Unit, Hôpital de Jolimont, rue Ferrer 159, La Louvière
| | - Andrea Penaloza
- Emergency Department (ED), Cliniques Universitaires Saint-Luc (CUSL), Brussels
| | - Dominique Vanpee
- Institute of Health and Society and CHU UCL Namur, Université Catholique de Louvain, Brussels
| | - Geertruida Bekkering
- Center for Evidence-Based Medicine, Kapucijnenvoer
- Cochrane Belgium
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Belgium
| | - Xavier Bobbia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Montpellier University, EA 2992 CAFEDIVAS, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France
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Markarian T, Persico N, Roch A, Ahriz D, Taguet C, Birman G, Mahboubi A, Ducassou J, Bourenne J, Zieleskiewicz L, Bobbia X, Michelet P. Early assessment of patients with COVID-19 and dyspnea using lung ultrasound scoring. Emergencias 2021; 33:354-360. [PMID: 34581528] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The main objective was to evaluate the precision of the Modified Lung Ultrasound (MLUS score) for predicting the need for respiratory support in the first 48 hours in patients with dyspnea due to the coronavirus disease 2019 (COVID-19). The secondary objectives were 1) to compare the MLUS and National Early Warning Score 2 (NEWS2), as well as the combination of both scores, as predictors of severity according to the World Health Organization (WHO) Ordinal Scale for Clinical Improvement; and 2) to compare severity assessed by ultrasound scoring to severity assessed by lung computed tomography (CT). MATERIAL AND METHODS Multicenter prospective observational cohort study conducted from March 30 to April 30, 2020, in 2 university hospitals. Adult patients with dyspnea due to COVID-19 were included. An initial lung ultrasound was performed, and the results of MLUS, NEW2, and lung CT evaluations were recorded. Patients were classified by risk according to the WHO scale at 48 hours, as follows: low risk (score less than 5) or high risk (score of 5 or more). RESULTS A total of 100 patients were included: 35 (35%) were classified as low risk and 65 (65%) as high risk. The correlation between the MLUS and WHO assessments was positive and very high (Spearman rank correlation = 0.832; P .001). The area under the receiver operating characteristic curves of the MLUS, NEW2 and combined ultrasound scores, in relation to prediction of risk classification were, respectively, 0.96 (0.93-0.99), 0.89 (0.82-0.95) and 0.98 (0.96-1.0). The MLUS and lung CT assessments were correlated. CONCLUSION An early lung ultrasound score can predict clinical severity in patients with dyspnea due to COVID-19.
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Affiliation(s)
- Thibaut Markarian
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia. UMR 1263 Center of Cardiovascular and Nutrition Research (C2VN), Aix-Marseille University, INSERM, INRAE, Marsella, Francia
| | - Nicolas Persico
- Department of Emergency Medicine, North University Hospital, Marsella, Francia. Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279, CEReSS - Health Services Research and Quality of Life Center, Marsella, Francia
| | - Antoine Roch
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia. Department of Emergency Medicine, North University Hospital, Marsella, Francia. Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279, CEReSS - Health Services Research and Quality of Life Center, Marsella, Francia
| | - Dalia Ahriz
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia
| | - Chloe Taguet
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia
| | - Guillaume Birman
- Department of Emergency Medicine, North University Hospital, Marsella, Francia
| | - Adela Mahboubi
- Department of Emergency Medicine, North University Hospital, Marsella, Francia
| | - Justine Ducassou
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia
| | - Jeremy Bourenne
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279, CEReSS - Health Services Research and Quality of Life Center, Marsella, Francia. Medecine Intensive Réanimation, Réanimation des Urgences, Timone University Hospital, Marsella, Francia
| | - Laurent Zieleskiewicz
- UMR 1263 Center of Cardiovascular and Nutrition Research (C2VN), Aix-Marseille University, INSERM, INRAE, Marsella, Francia. Department of Anesthesiology and Intensive Care Medicine, North University Hospital, Marsella, Francia
| | - Xavier Bobbia
- Medecine Intensive Réanimation, Réanimation des Urgences, Timone University Hospital, Marsella, Francia
| | - Pierre Michelet
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia. Department of Emergency Medicine, North University Hospital, Marsella, Francia
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Cande C, Sebbane M, Bobbia X, Claret PG, Le Guillou C, Tchalla A, Blain H. [Risk factors of readmission into emergency department in patients aged 75 or older: a systematic review]. Geriatr Psychol Neuropsychiatr Vieil 2021; 19:253-260. [PMID: 34609291 DOI: 10.1684/pnv.2021.0950] [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] [Indexed: 06/13/2023]
Abstract
A systematic review of the literature was carried out to assess the risk factors for readmission to the emergency room in people aged 75 and over. This review shows that some socio-demographic factors (high age, male gender, not being single), some underlying conditions (cardio-respiratory diseases, diabetes, cognitive impairment, cancer, depression), a recent history of falling and an impaired autonomy before admission are risk factors for readmission to the emergency room more than the cause of admission itself or its severity in people aged 75 and over. It remains to determine the best predictive readmission score in the elderly and whether a systematic identification of risk factors associated with specific management in the at-risk oldest reduce their readmission after a first visit to the emergency room.
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Affiliation(s)
- Camille Cande
- Pôle gérontologie, CHU Montpellier, Université de Montpellier, France
| | - Mustafa Sebbane
- Service des urgences - SAMU - SMUR, CHU Montpellier, Université de Montpellier, France
| | - Xavier Bobbia
- Service des urgences - SAMU - SMUR, CHU Nîmes, France
| | | | | | - Achille Tchalla
- CHU de Limoges, Pôle HU gérontologie clinique, Limoges, France, Université de Limoges ; IFR 145 GEIST ; Laboratoire de recherche sur le vieillissement et la santé digitale ; UR Unilim VieSante, Limoges, France
| | - Hubert Blain
- Pôle gérontologie, CHU Montpellier, Université de Montpellier, France
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Grau-Mercier L, Chetioui A, Muller L, Roger C, Genre Grandpierre R, de La Coussaye JE, Cuvillon P, Claret PG, Bobbia X. Magnetic needle-tracking device for ultrasound guidance of radial artery puncture: A randomized study on a simulation model. J Clin Ultrasound 2021; 49:212-217. [PMID: 33196110 DOI: 10.1002/jcu.22945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/05/2020] [Revised: 09/10/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Ultrasound-guidance of radial artery catheter insertion improves the first attempt success and reduces the occurrence of hematomas. Needle-tracking devices optimize needle-ultrasound beam alignment by displaying in real-time the needle tip position. We compared the median time need by experienced physicians to achieve radial artery puncture using either a conventional ultrasonography device (CUD) or a magnetic needle-tracking ultrasound device (MUD) in a simulation training arm model. METHODS Fifty experienced residents and physicians performed two punctures in randomized order with the CUD and the MUD. The primary outcome was puncture duration; the secondary outcomes were puncture success, rate of accidental vein puncture, and practitioner's comfort (subjective scale 0-10). RESULTS The median [lower-upper quartile] puncture time was 10 [6-14] seconds when using CUD and 4 [3-7] seconds when using MUD (P < .01). In the multivariate analysis, MUD use was associated with decreased puncture duration whatever the puncture order (OR 1.13 [1.07-1.20], P < .01). The participants performed 99 (99%) successful punctures: 50 with the MUD (100%) and 49 with the CUD (98%). There was no accidental venous puncture. The practitioner's comfort level was 6.5 [6, 7] with the CUD and 8 [7-9] with the MUD (P < .01). CONCLUSION MUD reduced radial artery puncture time and improved physician comfort in a simulation training arm model.
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Affiliation(s)
- Laura Grau-Mercier
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Adrien Chetioui
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Laurent Muller
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Claire Roger
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Romain Genre Grandpierre
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Emmanuel de La Coussaye
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Philippe Cuvillon
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Pierre-Géraud Claret
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Xavier Bobbia
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
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Zieleskiewicz L, Lopez A, Hraiech S, Baumstarck K, Pastene B, Di Bisceglie M, Coiffard B, Duclos G, Boussuges A, Bobbia X, Einav S, Papazian L, Leone M. Bedside POCUS during ward emergencies is associated with improved diagnosis and outcome: an observational, prospective, controlled study. Crit Care 2021; 25:34. [PMID: 33482873 PMCID: PMC7825196 DOI: 10.1186/s13054-021-03466-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/12/2021] [Indexed: 01/27/2023]
Abstract
Background Rapid response teams are intended to improve early diagnosis and intervention in ward patients who develop acute respiratory or circulatory failure. A management protocol including the use of a handheld ultrasound device for immediate point-of-care ultrasound (POCUS) examination at the bedside may improve team performance. The main objective of the study was to assess the impact of implementing such a POCUS-guided management on the proportion of adequate immediate diagnoses in two groups. Secondary endpoints included time to treatment and patient outcomes. Methods A prospective, observational, controlled study was conducted in a single university hospital. Two teams alternated every other day for managing in-hospital ward patients developing acute respiratory and/or circulatory failures. Only one of the team used an ultrasound device (POCUS group). Results We included 165 patients (POCUS group 83, control group 82). Proportion of adequate immediate diagnoses was 94% in the POCUS group and 80% in the control group (p = 0.009). Time to first treatment/intervention was shorter in the POCUS group (15 [10–25] min vs. 34 [15–40] min, p < 0.001). In-hospital mortality rates were 17% in the POCUS group and 35% in the control group (p = 0.007), but this difference was not confirmed in the propensity score sample (29% vs. 34%, p = 0.53). Conclusion Our study suggests that protocolized use of a handheld POCUS device at the bedside in the ward may improve the proportion of adequate diagnosis, the time to initial treatment and perhaps also survival of ward patients developing acute respiratory or circulatory failure. Clinical Trial Registration NCT02967809. Registered 18 November 2016, https://clinicaltrials.gov/ct2/show/NCT02967809.
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Affiliation(s)
- Laurent Zieleskiewicz
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, 13015, Marseille, France. .,Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRA, Aix Marseille Université, 13005, Marseille, France.
| | - Alexandre Lopez
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Sami Hraiech
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive - Réanimation, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Karine Baumstarck
- Centre D'Etudes et de Recherches sur les Services de Santé et Qualité, Faculté de Médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Bruno Pastene
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Mathieu Di Bisceglie
- Assistance Publique Hôpitaux de Marseille, Service d'Imagerie Médicale, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Benjamin Coiffard
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive - Réanimation, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Gary Duclos
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Alain Boussuges
- Assistance Publique Hôpitaux de Marseille, Service des Explorations Fonctionnelles Respiratoires, Aix Marseille University, 13015, Marseille, France.,Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRA, Aix Marseille Université, 13005, Marseille, France
| | - Xavier Bobbia
- Intensive Care Unit, Department of Anesthesiology, Emergency and Critical Care Medicine, University Hospital Nîmes, 30000, Nîmes, France
| | - Sharon Einav
- Surgical Intensive Care Unit, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Laurent Papazian
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive - Réanimation, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Marc Leone
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
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Freund Y, Cachanado M, Delannoy Q, Laribi S, Yordanov Y, Gorlicki J, Chouihed T, Féral-Pierssens AL, Truchot J, Desmettre T, Occelli C, Bobbia X, Khellaf M, Ganansia O, Bokobza J, Balen F, Beaune S, Bloom B, Simon T, Mebazaa A. Effect of an Emergency Department Care Bundle on 30-Day Hospital Discharge and Survival Among Elderly Patients With Acute Heart Failure: The ELISABETH Randomized Clinical Trial. JAMA 2020; 324:1948-1956. [PMID: 33201202 PMCID: PMC7672513 DOI: 10.1001/jama.2020.19378] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Clinical guidelines for the early management of acute heart failure in the emergency department (ED) setting are based on only moderate levels of evidence, with subsequent low adherence to these guidelines. OBJECTIVE To test the effect of an early guideline-recommended care bundle on short-term prognosis in older patients with acute heart failure in the ED. DESIGN, SETTING, AND PARTICIPANTS Stepped-wedge cluster randomized trial in 15 EDs in France of 503 patients 75 years and older with a diagnosis of acute heart failure in the ED from December 2018 to September 2019 and followed up for 30 days until October 2019. INTERVENTIONS A care bundle that included early intravenous nitrate boluses; management of precipitating factors, such as acute coronary syndrome, infection, or atrial fibrillation; and moderate dose of intravenous diuretics (n = 200). In the control group, patient care was left to the discretion of the treating emergency physician (n = 303). Each center was randomized to the order in which they switched to the "intervention period." After the initial 4-week control period for all centers, 1 center entered in the intervention period every 2 weeks. MAIN OUTCOMES AND MEASURES The primary end point was the number of days alive and out of hospital at 30 days. Secondary outcomes included 30-day all-cause mortality, 30-day cardiovascular mortality, unscheduled readmission, length of hospital stay, and kidney impairment. RESULTS Among 503 patients who were randomized (median age, 87 years; 298 [59%] women), 502 were analyzed. In the intervention group, patients received a median (interquartile range) of 27.0 (9-54) mg of intravenous nitrates in the first 4 hours vs 4.0 (2.0-6.0) mg in the control group (adjusted difference, 23.8 [95% CI, 13.5-34.1]). There was a significantly higher percentage of patients in the intervention group treated for their precipitating factors than in the control group (58.8% vs 31.9%; adjusted difference, 31.1% [95% CI, 14.3%-47.9%]). There was no statistically significant difference in the primary end point of the number of days alive and out of hospital at 30 days (median [interquartile range], 19 [0- 24] d in both groups; adjusted difference, -1.9 [95% CI, -6.6 to 2.8]; adjusted ratio, 0.88 [95% CI, 0.64-1.21]). At 30 days, there was no significant difference between the intervention and control groups in mortality (8.0% vs 9.7%; adjusted difference, 4.1% [95% CI, -17.2% to 25.3%]), cardiovascular mortality (5.0% vs 7.4%; adjusted difference, 2.1% [95% CI, -15.5% to 19.8%]), unscheduled readmission (14.3% vs 15.7%; adjusted difference, -1.3% [95% CI, -26.3% to 23.7%]), median length of hospital stay (8 d in both groups; adjusted difference, 2.5 [95% CI, -0.9 to 5.8]), and kidney impairment (1% in both groups). CONCLUSIONS AND RELEVANCE Among older patients with acute heart failure, use of a guideline-based comprehensive care bundle in the ED compared with usual care did not result in a statistically significant difference in the number of days alive and out of the hospital at 30 days. Further research is needed to identify effective treatments for acute heart failure in older patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03683212.
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Affiliation(s)
- Yonathan Freund
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris (APHP), Paris, France
| | - Marine Cachanado
- Clinical Research Platform (URC-CRC-CRB), Hôpital Saint-Antoine, APHP, Paris, France
| | - Quentin Delannoy
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris (APHP), Paris, France
| | - Said Laribi
- Emergency Department, Hôpital Bretonneau, Tours, France
| | - Youri Yordanov
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Emergency Department, Hôpital Saint Antoine, APHP, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
| | - Judith Gorlicki
- Emergency Department, Hôpital Avicenne, APHP, Bobigny, France
| | - Tahar Chouihed
- Emergency Department, Hôpital CHRU Nancy, INSERM U1116, Université de Lorraine, Vandoeuvre les Nancy, France
| | | | | | | | | | | | - Mehdi Khellaf
- Emergency Department, Hôpital Henri Mondor, APHP, Université Paris Est – INSERM U955, Créteil, France
| | - Olivier Ganansia
- Emergency Department, Hôpital Paris Saint Joseph, Groupe Hospitalier Paris Saint Joseph
| | - Jérôme Bokobza
- Emergency Department, Hôpital Cochin, APHP, Paris, France
| | - Frédéric Balen
- Emergency Department, Centre hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sebastien Beaune
- Emergency Department, Hôpital Ambroise-Paré, APHP, Boulogne, Inserm U1144, Université de Paris, France
| | - Ben Bloom
- Emergency Department, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Tabassome Simon
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Clinical Research Platform (URC-CRC-CRB), Hôpital Saint-Antoine, APHP, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesia, Burn and Critical Care, Hôpitaux Universitaires Saint Louis Lariboisière, FHU PROMICE INI-CRCT, AP-HP, France
- Université de Paris, Paris, France
- U942 – MASCOT- Inserm, Paris, France
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Bobbia X, Markarian T. Intérêt de l'échographie dans la prise en charge des dyspnées en urgence. Méd Intensive Réa 2020. [DOI: 10.37051/mir-00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
La dyspnée est un motif de prise en charge fréquent en médecine d’urgence. Il y a une relation entre la mise en place du bon traitement étiologique et la morbi-mortalité. Le diagnostic étiologique est souvent cliniquement complexe, en particulier chez les patients âgés. L’échographie pulmonaire permet une excellente analyse lésionnelle pulmonaire. L’échocardiographie transthoracique permet souvent d’en comprendre le mécanisme. L’échographie de compression veineuse des membres inférieurs a un rôle dans la recherche d’embolie pulmonaire. L’articulation de ces outils avec l’examen clinique permet d’améliorer la pertinence clinique du médecin confronté à une situation de dyspnée aigue. L’échographie peut également avoir un rôle d’aide au triage des patients dyspnéiques. Une bonne connaissance des différents syndromes échographiques et de leur intégration dans le raisonnement diagnostique par tous les praticiens est nécessaire à l’amélioration de la prise en charge de ces patients.
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Zieleskiewicz L, Claret PG, Muller L, de La Coussaye JE, Lefrant JY, Schuster I, Roger C, Bobbia X. Global longitudinal strain changes during hemorrhagic shock: An experimental study. Turk J Emerg Med 2020; 20:97-104. [PMID: 32832728 PMCID: PMC7416855 DOI: 10.4103/2452-2473.290066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/29/2020] [Revised: 05/04/2020] [Accepted: 05/19/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Global longitudinal strain (GLS) appears sensitive and reproducible to identify left ventricular systolic dysfunction. The main objective was to analyze the GLS changes in an anesthetized-piglet model of controlled hemorrhagic shock (HS). The secondary objective was to evaluate if GLS changes was different depending on the expansion fluid treatment with or without norepinephrine. METHODS Eighteen anesthetized and ventilated piglets were bled until the mean arterial pressure reached 40 mmHg. Controlled hemorrhage was maintained for 30 min before randomizing the piglets to three resuscitation groups: control group, LR group (resuscitated with lactated ringer), and NA group (resuscitated with lactated ringer and norepinephrine). RESULTS There was no difference in the baseline hemodynamic, biological, and ultrasound data among the three groups. During the hemorrhagic phase, the GLS increased significantly from 25 mL/kg of depletion. During the resuscitation phase, the GLS decreased significantly from 20 mL/kg of fluid administration. There was no difference in GLS variation among the groups during the hemorrhagic, maintenance, and resuscitation phases. CONCLUSION In our HS model, GLS increased with hemorrhage and decreased during resuscitation, showing its preload dependence.
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Affiliation(s)
- Laurent Zieleskiewicz
- Department of Anesthesiology and Intensive Care, North Hospital, APHM, Aix Marseille Univ., INSERM, INRA, C2VN, Marseille, France
| | - Pierre-Géraud Claret
- Department of Anesthesiology, Critical Care, Montpellier University, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.,Faculty of Medicine, Montpellier-Nimes University,EA 2992, Nîmes, France
| | - Laurent Muller
- Department of Anesthesiology, Critical Care, Montpellier University, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.,Faculty of Medicine, Montpellier-Nimes University,EA 2992, Nîmes, France
| | - Jean Emmanuel de La Coussaye
- Department of Anesthesiology, Critical Care, Montpellier University, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.,Faculty of Medicine, Montpellier-Nimes University,EA 2992, Nîmes, France
| | - Jean Yves Lefrant
- Department of Anesthesiology, Critical Care, Montpellier University, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.,Faculty of Medicine, Montpellier-Nimes University,EA 2992, Nîmes, France
| | - Iris Schuster
- Department of Sports Medicine and Cardiology (CEMAPS 30), Nîmes University Hospital and PhyMedExp, INSERM U1046, CNRS UMR9214, Montpellier University, Montpellier, France
| | - Claire Roger
- Department of Anesthesiology, Critical Care, Montpellier University, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.,Faculty of Medicine, Montpellier-Nimes University,EA 2992, Nîmes, France
| | - Xavier Bobbia
- Department of Anesthesiology, Critical Care, Montpellier University, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.,Faculty of Medicine, Montpellier-Nimes University,EA 2992, Nîmes, France
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Clément A, Zieleskiewicz L, Bonnec JM, Occéan BV, Bastide S, Muller L, de La Coussaye JE, Boussuges A, Claret PG, Bobbia X. Diaphragmatic excursion measurement in emergency department patients with acute dyspnea to predict mechanical ventilation use. Am J Emerg Med 2020; 38:2081-2087. [PMID: 33142179 DOI: 10.1016/j.ajem.2020.06.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/26/2020] [Revised: 06/13/2020] [Accepted: 06/14/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Ultrasound is a feasible and reproducible method for measuring right diaphragmatic excursion (RDE) in ED patients with acute dyspnea (AD). In AD patients, the correlation between the RDE value and the need for mechanical ventilation (MV) is not known. MATERIALS This was a bicentric, observational prospective study. The RDE measurement was done at admission. The need for MV was defined by the use of MV within 4 h of AD management. An optimal threshold for RDE was determined as the value that minimized the incorrect predictions of the use of MV in the first 4 h as the highest Youden index. RESULTS We analyzed 102 patients (79 [70; 86] years), 38 (37%) of whom had been ventilated. The RDE value was 1.7 cm [1.4; 2.0] and 2.2 cm [1.8; 2.6] in the ventilated and non-ventilated groups, respectively (p = 0.06). The AUC was 0.68 95% CI [0.57; 0.80]. With a threshold of 2 cm, the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were 76% [60%; 89%], 59% [46%; 71%], 81% [67%; 91%], and 53% [39%; 66%], respectively. In the non-COPD patients, the RDE values were 1.5 cm [1.2; 1.9] and 2.2 cm [1.8; 2.6] (p < 0.01) in the ventilated and not-ventilated groups, respectively. The AUC was 0.77 95% CI [0.64; 0.90]. With a threshold of 2.18 cm, the sensitivity, specificity, NPV, and PPV were 91% [71%; 99%], 51% [36%; 66%], 92% [75%; 99%], and 54% [38%; 69%], respectively. CONCLUSION The RDE values at ED admission were unable to define a prognostic threshold value associated with subsequent MV need in the AD patients. In non-COPD patients, the NPV was 92%.
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Affiliation(s)
- Aude Clément
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France
| | - Laurent Zieleskiewicz
- Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Aix-Marseille University, Marseille C2VN, France.
| | - Jean-Marie Bonnec
- Emergency Department, General Hospital of Perpignan, Perpignan, France
| | - Bob-Valéry Occéan
- Department of Biostatistics, Nîmes University Hospital, Nîmes, France.
| | - Sophie Bastide
- Department of Biostatistics, Nîmes University Hospital, Nîmes, France.
| | - Laurent Muller
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Jean Emmanuel de La Coussaye
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Alain Boussuges
- UMR-MD2 Dysoxie Suractivité, Institut de Recherche Biomédicale des Armées and Aix-Marseille Université, Marseille, France.
| | - Pierre-Géraud Claret
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France
| | - Xavier Bobbia
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
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Chaptal M, Tendron L, Claret PG, Muller L, Markarian T, Mattatia L, Roger C, de la Coussaye JE, Pelaccia T, Bobbia X. Focused Cardiac Ultrasound: A Prospective Randomized Study of Simulator-Based Training. J Am Soc Echocardiogr 2020; 33:404-406. [DOI: 10.1016/j.echo.2019.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/19/2019] [Accepted: 10/15/2019] [Indexed: 12/29/2022]
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Abstract
L’échographie clinique en médecine d’urgence (ECMU) devient une pratique intégrée à l’exercice de la spécialité. Quatre étapes semblent nécessaires au déploiement de cet outil : l’existence de preuves scientifiques sur sa pertinence clinique, l’implantation d’échographes dans les structures d’urgences (SU), la formation des médecins et l’objectivation d’un impact secondaire à son utilisation. Les preuves sur la pertinence diagnostique des techniques utilisées datent des années 1990 pour la majorité des applications utilisées aujourd’hui. La disponibilité d’un échographe adapté est également nécessaire. Si la majorité des SU disposent aujourd’hui d’un échographe, selon les recommandations françaises, toutes le devraient. Des échographes de mieux en mieux adaptés à la pratique de l’ECMU arrivent sur le marché. L’objectif doit être de permettre des examens rapides et fiables. Pour cela, une ergonomie épurée et l’implication de techniques d’intelligence artificielle semblent être l’avenir. Les médecins doivent également être formés. En France, l’utilisation de l’ECMU va se généraliser grâce à la formation de tous les nouveaux internes de médecine d’urgence. Cependant, beaucoup d’urgentistes exerçant actuellement doivent encore être formés. Pour répondre à cette demande, de nombreuses formations sont aujourd’hui accessibles. Enfin, peu de données sur l’impact clinique secondaire à l’utilisation de cet outil dans les SU sont disponibles. Après avoir défini l’ECMU, l’objectif de ce texte est d’expliquer la place de l’échographie clinique dans la spécialité de médecine d’urgence. Des perspectives d’évolution de l’ECMU sont également proposées.
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Incagnoli P, Puidupin A, Ausset S, Beregi JP, Bessereau J, Bobbia X, Brun J, Brunel E, Buléon C, Choukroun J, Combes X, David JS, Desfemmes FR, Garrigue D, Hanouz JL, Plénier I, Rongieras F, Vivien B, Gauss T, Harrois A, Bouzat P, Kipnis E. Erratum to “Early management of severe pelvic injury (first 24 hours)” [Anaesth Crit Care Pain Med 38 (2019) 199–207. https://doi.org/10.1016/j.accpm.2018.12.003]. Anaesth Crit Care Pain Med 2019; 38:695-696. [DOI: 10.1016/j.accpm.2019.04.001] [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] [Indexed: 10/27/2022]
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Macri F, Greffier J, Khasanova E, Claret PG, Bastide S, Larbi A, Bobbia X, Pereira FR, de la Coussaye JE, Beregi JP. Minor Blunt Thoracic Trauma in the Emergency Department: Sensitivity and Specificity of Chest Ultralow-Dose Computed Tomography Compared With Conventional Radiography. Ann Emerg Med 2019; 73:665-670. [DOI: 10.1016/j.annemergmed.2018.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 10/08/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
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Thibon E, Bobbia X, Blanchard B, Masia T, Palmier L, Tendron L, de La Coussaye JE, Claret PG. Association entre mortalité et attente aux urgences chez les adultes à hospitaliser pour étiologies médicales. Ann Fr Med Urgence 2019. [DOI: 10.3166/afmu-2019-0151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : Notre objectif principal est de comparer, dans un centre hospitalier universitaire (CHU) français et chez les patients hospitalisés pour étiologies médicales à partir de la structure des urgences (SU), le taux de mortalité intrahospitalière entre ceux qui n’attendent pas faute de place en service et ceux en attente (boarding).
Méthode : Il s’agit d’une étude quasi expérimentale, monocentrique, observationnelle, rétrospective, par recueil d’informations à partir des dossiers patients informatisés. Nous avons appliqué un score de propension pour ajuster les critères de jugement aux variables mesurées dans les deux groupes, c’est-à-dire les données : 1) démographiques (âge et sexe) ; 2) médicales (niveau de triage) ; 3) biologiques (numération leucocytaire, hémoglobinémie, natrémie, kaliémie, taux sérique de CRP, créatininémie) ; 4) d’imageries (réalisation ou non de radiographie, d’échographie, d’imagerie par résonance magnétique, de tomodensitométrie).
Résultats : En 2017, la SU du CHU a admis 60 062 patients adultes. Sur les 15 496 patients hospitalisés après admission en SU, 6 997 l’ont été pour une étiologie médicale, dont 2 546 (36 %) sans attente et 4 451 (64 %) après une attente. Après pondération, le taux de mortalité intrahospitalière était plus important dans le groupe en attente : 7,8 vs 6,3 % ; p < 0,05. De même, la durée médiane d’hospitalisation était plus importante dans le groupe en attente : 7,6 [4,7– 12,0] vs 7,1 j [4,3–11,5] ; p < 0,01.
Discussion : Les taux de mortalité et de la durée de séjour intrahospitaliers sont plus importants chez les patients étudiés qui attendent en SU faute de place en service. Nos résultats sont concordants avec la littérature internationale. Il est nécessaire de trouver des solutions pour réduire cette surmortalité.
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Genre Grandpierre R, Bobbia X, Muller L, Markarian T, Occéan BV, Pommet S, Roger C, Lefrant JY, de la Coussaye JE, Claret PG. Ultrasound guidance in difficult radial artery puncture for blood gas analysis: A prospective, randomized controlled trial. PLoS One 2019; 14:e0213683. [PMID: 30893349 PMCID: PMC6426205 DOI: 10.1371/journal.pone.0213683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/18/2019] [Indexed: 01/21/2023] Open
Abstract
Background Ultrasound (US) guidance has yet to prove its applicability in radial arterial blood gas analysis (ABGA) punctures. The main objective of our study was to compare the number of first-attempt successes (NFAS) for radial arterial puncture in difficult patients with or without US guidance. The Secondary aims were to compare the number of punctures (NOP), puncture time, and patient pain. Methods In this single-center, randomized controlled trial, patients who required a radial ABGA and in whom the arterial puncture was assessed as difficult (because of non-palpable radial arteries or two previous puncture failures by a nurse) were assigned to the US group or no-US (NUS) group (procedure performed by a trained physician). Results Thirty-six patients were included in the US group and 37 in the NUS groups. The NFAS was 7 (19%) in the NUS group and 19 (53%) in the US group. The relative risk of success in the US group was 2.79 (95% CI,1.34 to 5.82), p = 0.01. In the NUS and US groups, respectively, the median NOP was 3 [2; 6] vs. 1 [1; 2], estimated difference −2.0 (95%CI, −3.4 to −0.6), p < 0.01; the respective puncture time was 3.1 [1.6; 5.4] vs. 1.4 [0.6; 3.1] min, estimated difference −1.45 (95%CI, −2.57 to −0.39), p = 0.01; the respective median patient pain was 6 [4; 8] vs. 2 [1; 4], estimated difference −4.0 (95%CI, −5.8 to −2.3); p < 0.01. Conclusion US guidance by a trained physician significantly improves the rate of success in difficult radial ABGA patients.
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Affiliation(s)
- Romain Genre Grandpierre
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Xavier Bobbia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France
- * E-mail:
| | - Laurent Muller
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Thibaut Markarian
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France
| | - Bob-Valéry Occéan
- Department of Biostatistics, Nîmes University Hospital, Nîmes, France
| | - Stéphane Pommet
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Claire Roger
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Yves Lefrant
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Emmanuel de la Coussaye
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Pierre-Géraud Claret
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
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Stowell A, Bobbia X, Cheret J, Genre Grandpierre R, Moreau A, Pommet S, Lefrant JY, de La Coussaye JE, Markarian T, Claret PG. Out-of-hospital Times Using Helicopters Versus Ground Services for Emergency Patients. Air Med J 2019; 38:100-105. [PMID: 30898280 DOI: 10.1016/j.amj.2018.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/25/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Minimizing out-of-hospital time reduces morbidity and mortality in patients with severe trauma, acute coronary syndrome, or acute stroke. Our objective was to compare out-of-hospital times by helicopter versus ground services when the estimated time of arrival on the scene was over 20 minutes. METHODS We proposed a retrospective observational monocentric study following 2 cohorts. The helicopter group and the ground group included patients with severe trauma, acute coronary syndrome, or acute stroke transported by helicopter or ground services. RESULTS Two hundred thirty-nine patients were included; 118 were in the ground group, and 121 were in the helicopter group. Distances for the helicopter group were higher (62.1 ± 22.5 km vs. 27.6 ± 10.4 km, P < .001). When distances were over 35 km, the helicopter group was faster. We identified distance, need for surgery, and intensive care hospitalization as 3 predicting factors for choosing helicopters over ground modes of transport. CONCLUSION In cases of severe trauma, acute coronary syndrome, or acute stroke, emergency medical helicopter transport can be chosen over ground transport when patients are in a severe state and when the distance is further than 35 km from the hospital.
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Affiliation(s)
- Andrew Stowell
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Xavier Bobbia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France; Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France.
| | - Julien Cheret
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Romain Genre Grandpierre
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Alexandre Moreau
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Stéphane Pommet
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean-Yves Lefrant
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Emmanuel de La Coussaye
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Thibaut Markarian
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France
| | - Pierre-Géraud Claret
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
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Cassignol A, Markarian T, Cotte J, Marmin J, Nguyen C, Cardinale M, Pauly V, Kerbaul F, Meaudre E, Bobbia X. Evaluation and Comparison of Different Prehospital Triage Scores of Trauma Patients on In-Hospital Mortality. PREHOSP EMERG CARE 2019; 23:543-550. [DOI: 10.1080/10903127.2018.1549627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chetioui A, Masia T, Claret PG, Markarian T, Muller L, Lefrant JY, de La Coussaye JE, Roger C, Bobbia X. Pocket-sized ultrasound device for internal jugular puncture: A randomized study of performance on a simulation model. J Vasc Access 2018; 20:404-408. [DOI: 10.1177/1129729818812733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Adrien Chetioui
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Thibaud Masia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Pierre-Géraud Claret
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Thibaut Markarian
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France
| | - Laurent Muller
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Yves Lefrant
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Emmanuel de La Coussaye
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Claire Roger
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Xavier Bobbia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France
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Krebs H, Perrin Bayard R, Bares A, Dahmani S, Story T, Claret PG, Bobbia X, de La Coussaye J. Délégation de l’évaluation et du traitement de la douleur à l’infirmier de Service mobile d’urgence et de réanimation : étude avant–après monocentrique. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : La prise en charge de la douleur en médecine d’urgence préhospitalière est encore insuffisante. Cette étude a pour objectif d’évaluer les effets d’une délégation de l’évaluation et du traitement de la douleur à l’infirmier diplômé d’État (IDE) en Service mobile d’urgence et de réanimation (Smur) sur le suivi des recommandations de la Société française de médecine d’urgence (SFMU).
Méthode : Étude rétrospective de type avant–après réalisée au Smur du centre hospitalier universitaire (CHU) de Nîmes de janvier à mai 2017. Les IDE ont été formés, entre les deux phases, à un protocole de délégation de l’évaluation et du traitement de la douleur fondé sur les dernières recommandations.
Résultats : Cent quatre-vingt-un patients ont été inclus dans chaque groupe, 74 (40 %) femmes (âge moyen de 60 ± 18 ans). Les groupes étaient comparables à l’exception de la proportion d’interventions traumatologiques (11 % dans le groupe « avant » vs 20 % dans le groupe « après » ; p = 0,02). Les recommandations ont été respectées pour 12 (7 %) patients dans le groupe « avant », 21 (12 %) dans le groupe « après » (p = 0,10). Le seul facteur indépendant de respect des recommandations est le type d’intervention traumatologique (odds ratio = 9,7 ; intervalle de confiance à 95 % : [2,3–53,3] ; p < 0,01). Le nombre de patients ayant bénéficié d’une administration d’antalgique était respectivement de 55 (30 %) dans le groupe « avant » et de 73 (40 %) dans le groupe « après » (p = 0,05). La réévaluation de l’intensité douloureuse en fin de prise en charge a été consignée dans 11 (6 %) cas de la phase avant vs 38 (21 %) dans la phase après (p < 0,01). Dans le sous-groupe des patients n’ayant pas bénéficié de trinitrine, les recommandations ont été respectées respectivement pendant les phases « avant » et « après » chez 7 (6 %) patients vs 17 (14 % ; p = 0,03).
Conclusion : Malgré une augmentation du taux de prescription d’antalgiques et de réévaluation de la douleur, le protocole de délégation IDE n’a pas permis un meilleur respect des recommandations. L’établissement de protocoles spécifiques en fonction du type d’intervention, notamment traumatologique, pourrait être une piste de réflexion.
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Jouffroy R, Bobbia X, Gauss T, Bouzat P, Pierre M. Process and organisation of in-hospital emergencies in France. Anaesth Crit Care Pain Med 2018; 37:629-631. [PMID: 30308243 DOI: 10.1016/j.accpm.2018.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Romain Jouffroy
- Intensive care unit, anaesthesiology department and SAMU of Paris, hospital Necker, assistance publique hôpitaux de Paris, Paris Descartes university, 75015 Paris, France; Department of Anesthesia & Clinical Epidemiology and Biostatistics; Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, Ontario, Canada.
| | - Xavier Bobbia
- Emergency department, Timone 2 hospital, Aix-Marseille university, 13000 Marseille, France
| | - Tobias Gauss
- Intensive care unit, anaesthesiology department, hôpital Beaujon, HUPNVS, AP-HP, 92100 Clichy, France
| | - Pierre Bouzat
- Grenoble Alps trauma centre, Grenoble university hospital, Grenoble Alps university, 38000, Grenoble, France
| | - Michelet Pierre
- Emergency department, Timone 2 hospital, Aix-Marseille university, 13000 Marseille, France
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Fasula C, Marchal A, Krebs H, Moser C, Genre-Grandpierre R, Bobbia X, de La Coussaye JE, Claret PG. Le syndrome postgarde de nuit chez les médecins urgentistes : caractéristiques et facteurs influençants. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : Les urgentistes connaissent une privation de sommeil en lendemain de garde. Beaucoup ont des perceptions ou des comportements inhabituels que nous appelons syndrome post-garde de nuit (PGN). L’objectif principal était de caractériser le syndrome PGN des urgentistes. Les objectifs secondaires étaient d’établir une note évaluant le syndrome PGN et de déterminer les facteurs influençant ce syndrome PGN.
Méthode : Étude prospective de cohorte, observationnelle, multicentrique, auprès des urgentistes du Gard et de l’Hérault entre janvier et juin 2017. Deux questionnaires informatiques anonymes étaient diffusés aux structures d’urgences du Gard et de l’Hérault. En journée normale, hors sortie de garde, un questionnaire colligeait les symptômes ressentis habituellement en lendemain de garde, à coter entre 0 et 10. En sortie de garde, un autre questionnaire s’intéressait au ressenti de la garde réalisée et aux caractéristiques de cette garde. Les médecins étaient encouragés à répondre aux deux questionnaires.
Résultats : Cent treize médecins (45 %) ont répondu, 67 (59 %) à distance d’une garde et 46 (41 %) en post-garde immédiat. Le syndrome PGN comprend des symptômes somatiques (échelle visuelle analogique (EVA) = 5 [2–8]), comportementaux (EVA = 7 [3–8]), liés à l’humeur (EVA = 7[5–8]) et psychiques (EVA = 6 [4–8]). Ces symptômes en post-garde immédiat étaient ressentis de manière moins importante que lorsque décrit à distance (respectivement p = 0,001, p <0,001, p < 0,001, p = 0,002). Les gardes de SMUR (service mobile d’urgence et de réanimation) et de traumatologie étaient associées à un syndrome PGN moins marqué (respectivement p =0,035 et p = 0,02) que les gardes des filières médico-chirurgicales.
Conclusion : Il s’agit de la première évaluation du syndrome PGN chez les urgentistes français. Les symptômes en sont moins importants en post-garde immédiat. Les gardes de traumatologie et de SMUR semblent mieux tolérées.
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Argaud L, Cour M, Dubien PY, Giraud F, Jossan C, Riche B, Hernu R, Darmon M, Poncelin Y, Tchénio X, Quenot JP, Freysz M, Kamga C, Beuret P, Usseglio P, Badet M, Anette B, Chaulier K, Alasan E, Sadoune S, Bobbia X, Zéni F, Gueugniaud PY, Robert D, Roy P, Ovize M. Effect of Cyclosporine in Nonshockable Out-of-Hospital Cardiac Arrest: The CYRUS Randomized Clinical Trial. JAMA Cardiol 2018; 1:557-65. [PMID: 27433815 DOI: 10.1001/jamacardio.2016.1701] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Experimental evidence suggests that cyclosporine prevents postcardiac arrest syndrome by attenuating the systemic ischemia reperfusion response. OBJECTIVE To determine whether early administration of cyclosporine at the time of resuscitation in patients with out-of-hospital cardiac arrest (OHCA) would prevent multiple organ failure. DESIGN, SETTING, AND PARTICIPANTS A multicenter, single-blind, randomized clinical trial was conducted from June 22, 2010, to March 13, 2013 (Cyclosporine A in Out-of-Hospital Cardiac Arrest Resuscitation [CYRUS]). Sixteen intensive care units in 7 university-affiliated hospitals and 9 general hospitals in France participated. A total of 6758 patients who experienced nonshockable OHCA (ie, asystole or pulseless electrical activity) were assessed for eligibility. Analyses were performed according to the intention-to-treat analysis. INTERVENTIONS Patients received an intravenous bolus injection of cyclosporine, 2.5 mg/kg, at the onset of advanced cardiovascular life support (cyclosporine group) or no additional intervention (control group). MAIN OUTCOMES AND MEASURES The primary end point was the Sequential Organ Failure Assessment (SOFA) score, assessed 24 hours after hospital admission, which ranges from 0 to 24 (with higher scores indicating more severe organ failure). Secondary end points included survival at 24 hours, hospital discharge, and favorable neurologic outcome at discharge. RESULTS Of the 6758 patients screened, 794 were included in intention-to-treat analysis (cyclosporine, 400; control, 394). The median (interquartile range [IQR]) ages were 63.0 (54.0-71.8) years for the cyclosporine group and 66.0 (57.0-74.0) years for the control group. The cohorts included 293 men (73.3%) in the treatment group and 288 men (73.1%) in the control group. At 24 hours after hospital admission, the SOFA score was not significantly different between the cyclosporine (median, 10.0; IQR, 7.0-13.0) and the control (median, 11.0; IQR, 7.0-15.0) groups. Survival was not significantly different between the 98 (24.5%) cyclosporine vs 101 (25.6%) control patients at hospital admission (adjusted odds ratio [aOR], 0.94; 95% CI, 0.66-1.34), at 24 hours for 67 (16.8%) vs 62 (15.7%) patients (aOR, 1.08; 95% CI, 0.71-1.63), and at hospital discharge for 10 (2.5%) vs 5 (1.3%) patients (aOR, 2.00; 95% CI, 0.61-6.52). Favorable neurologic outcome at discharge was comparable between the cyclosporine and control groups: 7 (1.8%) vs 5 (1.3%) patients (aOR, 1.39; 95% CI, 0.39-4.91). CONCLUSION AND RELEVANCE In patients presenting with nonshockable cardiac rhythm after OHCA, cyclosporine does not prevent early multiple organ failure. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01595958; EudraCT Identifier: 2009-015725-37.
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Affiliation(s)
- Laurent Argaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Réanimation Médicale, Lyon, France2Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1060, Carmen, Equipe Cardioprotection, Lyon, France3Université de Lyon, Uni
| | - Martin Cour
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Réanimation Médicale, Lyon, France2Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1060, Carmen, Equipe Cardioprotection, Lyon, France3Université de Lyon, Uni
| | - Pierre-Yves Dubien
- Hospices Civils de Lyon, Service d'Aide Médicale Urgente 69, Lyon, France
| | - François Giraud
- Centre Hospitalier Universitaire de Saint-Etienne, Service d'Aide Médicale Urgente 42A, Saint-Etienne, France
| | - Claire Jossan
- Hospices Civils de Lyon, Hôpital Louis Pradel, Explorations Fonctionnelles Cardiovasculaires et Centre d'Investigation Clinique de Lyon, Lyon, France
| | - Benjamin Riche
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France7Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Biostatistique, Lyon, France8Centre National de la Recherche Scientifique Unité Mixte de Recherche 5558, Laboratoire de Bio
| | - Romain Hernu
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Réanimation Médicale, Lyon, France
| | - Michael Darmon
- Centre Hospitalier Universitaire de Saint-Etienne, Hôpital Nord, Service de Réanimation Polyvalente, Saint-Etienne, France
| | - Yves Poncelin
- Centre Hospitalier de Bourg-en-Bresse, Hôpital Fleyriat, Service d'Aide Médicale Urgente 01, Bourg-en-Bresse, France
| | - Xavier Tchénio
- Centre Hospitalier de Bourg-en-Bresse, Hôpital Fleyriat, Service de Réanimation Polyvalente, Bourg-en-Bresse, France
| | - Jean-Pierre Quenot
- Centre Hospitalier Universitaire de Dijon, Hôpital François Mitterand, Service de Réanimation Médicale, Dijon, France
| | - Marc Freysz
- Centre Hospitalier Universitaire de Dijon, Service d'Aide Médicale Urgente 21, Dijon, France
| | - Cyrille Kamga
- Centre Hospitalier de Roanne, Service d'Aide Médicale Urgente 42B, Roanne, France
| | - Pascal Beuret
- Centre Hospitalier de Roanne, Service de Réanimation et Soins Continus, Roanne, France
| | - Pascal Usseglio
- Centre Hospitalier Métropole Savoie, Service d'Aide Médicale Urgente 73, Chambéry, France
| | - Michel Badet
- Centre Hospitalier Métropole Savoie, Service de Réanimation Polyvalente, Chambéry, France
| | - Bastien Anette
- Centre Hospitalier de Villefranche-sur-Saône, Service Mobile d'Urgence et de Réanimation de Villefranche-sur-Saône, Villefranche-sur-Saône, France
| | - Kevin Chaulier
- Centre Hospitalier de Villefranche-sur-Saône, Service de Réanimation, Villefranche-sur-Saône, France
| | - Emel Alasan
- Centre Hospitalier d'Ardèche Nord, Service Mobile d'Urgence et de Réanimation d'Annonay, Annonay, France
| | - Sonia Sadoune
- Centre Hospitalier Régional Universitare, Service d'Aide Médicale Urgente 54, Nancy, France
| | - Xavier Bobbia
- Centre Hospitalier Universitaire de Nîmes, Pôle Anesthésie Réanimation Douleur Urgences, Nîmes, France
| | - Fabrice Zéni
- Centre Hospitalier Universitaire de Saint-Etienne, Service d'Aide Médicale Urgente 42A, Saint-Etienne, France9Centre Hospitalier Universitaire de Saint-Etienne, Hôpital Nord, Service de Réanimation Polyvalente, Saint-Etienne, France
| | - Pierre-Yves Gueugniaud
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France4Hospices Civils de Lyon, Service d'Aide Médicale Urgente 69, Lyon, France
| | - Dominique Robert
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Réanimation Médicale, Lyon, France3Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Pascal Roy
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France7Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Biostatistique, Lyon, France8Centre National de la Recherche Scientifique Unité Mixte de Recherche 5558, Laboratoire de Bio
| | - Michel Ovize
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1060, Carmen, Equipe Cardioprotection, Lyon, France3Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France6Hospices Civils de Lyon, Hôpital Louis Pradel, Explo
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Bouzat P, Ageron FX, Charbit J, Bobbia X, Deras P, Nugues JBD, Escudier E, Marcotte G, Leone M, David JS. Modelling the association between fibrinogen concentration on admission and mortality in patients with massive transfusion after severe trauma: an analysis of a large regional database. Scand J Trauma Resusc Emerg Med 2018; 26:55. [PMID: 29986757 PMCID: PMC6038237 DOI: 10.1186/s13049-018-0523-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 04/04/2018] [Accepted: 06/28/2018] [Indexed: 01/06/2023] Open
Abstract
Background The relationship between fibrinogen concentration and traumatic death has been poorly explored after severe trauma. Existing studies analysed this relationship in unselected trauma population, often considering fibrinogen concentration as a categorical variable. The aim of our study was to model the relationship between fibrinogen concentration and in-hospital mortality in severe trauma patients requiring massive transfusion using fibrinogen on admission as a continuous variable. Methods We designed a retrospective observational study based on prospectively collected data from 2009 to 2015 in seven French level-I trauma centres. All consecutive patients requiring a transfusion of at least 10 packed red blood cells (RBC) within 24 h were included. To assess the relationship between in-hospital death and fibrinogen concentration on admission, we performed generalized linear and additive models with death as a dependent variable. We also assessed the relationship between fibrinogen concentration below 1.5 g.L− 1 and potential predictors. Results Within the study period, 366 patients were included. A non-linear relationship was found between fibrinogen concentration and death. Graphical modelling of this relationship depicted a negative association between fibrinogen levels and death below a fibrinogen concentration of 1.5 g.L− 1. Predictors of low fibrinogen concentration (< 1.5 g.L− 1) were systolic blood pressure, Glasgow coma scale and haemoglobin concentration on admission. Conclusions A complex and robust approach for modelling the relationship between fibrinogen and mortality revealed a critical fibrinogen threshold of 1.5 g.L− 1 for severe trauma patients requiring massive transfusion. This trigger may guide the administration of procoagulant therapies in this context.
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Affiliation(s)
- Pierre Bouzat
- Grenoble Alps Trauma center, Department of anesthesiology and intensive care medicine, Grenoble University Hospital, F-38000, Grenoble, France. .,Grenoble Alps University, F-38000, Grenoble, France. .,Pôle d'Anesthésie-Réanimation, Hôpital Albert Michallon, 217, F-38043, Grenoble, BP, France.
| | - François-Xavier Ageron
- RENAU Northern French Alps Emergency Network, Public Health department, Annecy Hospital, F-74000, Annecy, France.,Department of emergency medicine and intensive care, Annecy Hospital, F-74000, Annecy, France
| | - Jonathan Charbit
- Department of anesthesiology and intensive care, Montpellier University Hospital, F-34000, Montpellier, France
| | - Xavier Bobbia
- Department of emergency medicine, Nimes University Hospital, F-30000, Nimes, France
| | - Pauline Deras
- Department of anesthesiology and intensive care, Montpellier University Hospital, F-34000, Montpellier, France
| | - Jennifer Bas Dit Nugues
- Grenoble Alps Trauma center, Department of anesthesiology and intensive care medicine, Grenoble University Hospital, F-38000, Grenoble, France
| | - Etienne Escudier
- Department of emergency medicine and intensive care, Annecy Hospital, F-74000, Annecy, France
| | - Guillaume Marcotte
- Department of anesthesiology and intensive care, Lyon-Edouard Herriot University Hospital, F-69000, Lyon, France
| | - Marc Leone
- Aix Marseille University, Nord Hospital, Department of anesthesiology and intensive medicine, APHM, F-13000, Marseille, France
| | - Jean-Stéphane David
- Hospices Civils de Lyon, Lyon-Sud University Hospital, Department of anesthesiology and intensive care, F-69495, Pierre-Bénite, France.,Claude Bernard Lyon 1 University, F-69008, Lyon, France
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Martinez M, Duchenne J, Bobbia X, Brunet S, Fournier P, Miroux P, Perrier C, Pès P, Chauvin A, Claret PG. Deuxième niveau de compétence pour l’échographie clinique en médecine d’urgence. Recommandations de la Société française de médecine d’urgence par consensus formalisé. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
La Société française de médecine d’urgence a élaboré en 2016 des recommandations formalisées d’experts définissant le premier niveau de compétence en échographie clinique en médecine d’urgence. Ce niveau est maintenant complété par un deuxième niveau correspondant à une pratique plus avancée utilisant des techniques non envisagées dans le premier niveau comme l’utilisation du Doppler et nécessitant aussi une pratique et une formation plus poussées. Des champs déjà présents dans le premier référentiel sont complétés, et de nouveaux champs sont envisagés. La méthodologie utilisée est issue de la méthode « Recommandations par consensus formalisé » publiée par la Haute Autorité de santé et de la méthode Delphi pour quantifier l’accord professionnel. Ce choix a été fait devant l’insuffisance de littérature de fort niveau de preuve dans certaines thématiques et de l’existence de controverses. Ce document présente les items jugés appropriés et inappropriés par les cotateurs. Ces recommandations définissent un deuxième niveau de compétence en ECMU.
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Bobbia X, Chabannon M, Chevallier T, de La Coussaye JE, Lefrant JY, Pujol S, Claret PG, Zieleskiewicz L, Roger C, Muller L. Assessment of five different probes for lung ultrasound in critically ill patients: A pilot study. Am J Emerg Med 2018; 36:1265-1269. [DOI: 10.1016/j.ajem.2018.03.077] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/20/2018] [Accepted: 03/29/2018] [Indexed: 11/25/2022] Open
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Bobbia X, Abou-Badra M, Hansel N, Pes P, Petrovic T, Claret PG, Lefrant JY, de La Coussaye JE. Changes in the availability of bedside ultrasound practice in emergency rooms and prehospital settings in France. Anaesth Crit Care Pain Med 2018; 37:201-205. [PMID: 28826982 DOI: 10.1016/j.accpm.2017.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 01/31/2017] [Revised: 05/25/2017] [Accepted: 06/01/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Ensuring the availability of ultrasound devices is the initial step in implementing clinical ultrasound (CUS) in emergency services. In France in 2011, 52% of emergency departments (EDs) and only 9% of mobile intensive care stations (MICS) were equipped with ultrasound devices. The main goal of this study was to determine the movement of these rates since 2011. METHODS We conducted a cross-sectional, descriptive, multicentre study in the form of a questionnaire. To estimate the numbers of EDs and MICS equipped with at least one ultrasound system with a confidence level of 95% and margin of error of 5%, 170 responding EDs and 145 MICS were required. Each service was solicited three times by secure online questionnaire and then by phone. RESULTS Three hundred and twenty-eight (84%) services responded to the questionnaire: 179 (86%) EDs and 149 (82%) MICS. At least one ultrasound machine was available in 127 (71%, 95% CI [64; 78]) EDs vs. 52% in 2011 (P<0.01). 42 (28%, 95% CI [21; 35]) MICS were equipped vs. 9% in 2011 (P<0.01). In 97 (76%) EDs and 24 (55%) MICS, less than a half of physicians were trained. CUS was used at least three times a day in 52 (41%) EDs and in 8 (19%) MICS. CONCLUSION Our study demonstrates improved access to ultrasound devices in French EDs and MICS. Almost three-quarters of EDs and nearly one-third of MICS are now equipped with at least one ultrasound device. However, the rate of physicians trained per service remains insufficient.
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Affiliation(s)
- X Bobbia
- Pôle anesthésie réanimation douleur urgence, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes, France.
| | - M Abou-Badra
- Pôle anesthésie réanimation douleur urgence, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes, France.
| | - N Hansel
- Pôle anesthésie réanimation douleur urgence, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes, France.
| | - P Pes
- Samu-Smur urgence (PHU3), CHU de Nantes, 1, Quai Moncousu, 44093 Nantes cedex 01, France.
| | - T Petrovic
- Samu-Smur, CHU Avicenne, 125, rue de Stalingrad, 93009 Bobigny cedex, France.
| | - P G Claret
- Pôle anesthésie réanimation douleur urgence, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes, France.
| | - J Y Lefrant
- Pôle anesthésie réanimation douleur urgence, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes, France.
| | - J E de La Coussaye
- Pôle anesthésie réanimation douleur urgence, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes, France.
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Grandpierre RG, Bobbia X, de La Coussaye JE, Claret PG. Intérêt clinique des concentrations sériques de la protéine S100β dans l’évaluation des patients traumatisés crâniens. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les recommandations de la Société française de médecine d’urgence concernant la prise en charge des patients traumatisés crâniens légers ont été éditées en 2012, complétées par des recommandations sur la bonne utilisation du biomarqueur S100β deux ans plus tard. Grâce à son excellente valeur prédictive négative, la protéine S100β utilisée à travers des règles strictes de prescription a été définie comme une alternative solide à la tomodensitométrie. Cependant, plusieurs questions restent en suspens concernant le délai maximum de réalisation du prélèvement par rapport à l’heure du traumatisme, l’impact médicoéconomique, les variations en rapport avec l’âge du patient, l’impact des agents anticoagulants ou antiagrégants plaquettaires et l’utilité du dosage sérique de cette protéine dans d’autres cadres nosologiques.
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Gauss T, Balandraud P, Frandon J, Abba J, Ageron FX, Albaladejo P, Arvieux C, Barbois S, Bijok B, Bobbia X, Charbit J, Cook F, David JS, Maurice GDS, Duranteau J, Garrigue D, Gay E, Geeraerts T, Ghelfi J, Hamada S, Harrois A, Kobeiter H, Leone M, Levrat A, Mirek S, Nadji A, Paugam-Burtz C, Payen JF, Perbet S, Pirracchio R, Plenier I, Pottecher J, Rigal S, Riou B, Savary D, Secheresse T, Tazarourte K, Thony F, Tonetti J, Tresallet C, Wey PF, Picard J, Bouzat P. Strategic proposal for a national trauma system in France. Anaesth Crit Care Pain Med 2018; 38:121-130. [PMID: 29857186 DOI: 10.1016/j.accpm.2018.05.005] [Citation(s) in RCA: 17] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 11/26/2022]
Abstract
In this road map for trauma in France, we focus on the main challenges for system implementation, surgical and radiology training and upon innovative training techniques. Regarding system organisation: procedures for triage, designation and certification of trauma centres are mandatory to implement trauma networks on a national scale. Data collection with registries must be created, with a core dataset defined and applied through all registries. Regarding surgical and radiology training, diagnostic-imaging processes should be standardised and the role of the interventional radiologist within the trauma team and the trauma network should be clearly defined. Education in surgery for trauma is crucial and recent changes in medical training in France will promote trauma surgery as a specific sub-specialty. Innovative training techniques should be implemented and be based on common objectives, scenarios and evaluation, so as to improve individual and team performances. The group formulated 14 proposals that should help to structure and improve major trauma management in France over the next 10 years.
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Affiliation(s)
- Tobias Gauss
- Department of anaesthesia and intensive care, Beaujon hospital, hôpitaux-Paris-Nord-Val-De-Seine, AP-HP, 92110 Clichy, France
| | - Paul Balandraud
- Department of Surgery, French Military Medical Academy, école du Val-de-Grâce, 75000 Paris, France
| | - Julien Frandon
- Department of radiology, Nîmes University Hospital, 30029 Nîmes, France
| | - Julio Abba
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Francois Xavier Ageron
- Northern French Alps Emergency Network (RENAU), Annecy Genevois hospital, 74374 Epagny-Annecy, France
| | - Pierre Albaladejo
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Catherine Arvieux
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Sandrine Barbois
- Northern French Alps Emergency Network (RENAU), Annecy Genevois hospital, 74374 Epagny-Annecy, France
| | - Benjamin Bijok
- Emergency department, Lille university hospital, 59000 Lille, France
| | - Xavier Bobbia
- Department of Anaesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr-Debré, 30029 Nîmes, France
| | - Jonathan Charbit
- Trauma Intensive and Critical Care Unit, Department of Anaesthesiology and Critical Care, Lapeyronie Hospital, Montpellier I University, 75000 Montpellier, France
| | - Fabrice Cook
- Department of Anaesthesiology and Intensive Care, Henri Mondor Hospital and University Paris-Est, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France
| | - Jean-Stephane David
- Department of anaesthesia and intensive care, Lyon Sud hospital, 69495 Pierre-Bénite cedex, France
| | - Guillaume De Saint Maurice
- Intensive care and Anaesthesiology department, Percy Military Teaching Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - Jacques Duranteau
- Department of Anaesthesiology and Critical Care, Paris Saclay university AP-HP, Bicêtre hôpitaux universitaires Paris-Sud, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Delphine Garrigue
- Emergency department, Lille university hospital, 59000 Lille, France
| | - Emmanuel Gay
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Thomas Geeraerts
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, University Toulouse 3, Paul Sabatier, UMR 1214, Inserm/UPS, ToNIC: Toulouse NeuroImaging Center, 75000 Toulouse, France
| | - Julien Ghelfi
- Emergency department, Lille university hospital, 59000 Lille, France
| | - Sophie Hamada
- Department of Anaesthesiology and Critical Care, Paris Saclay university AP-HP, Bicêtre hôpitaux universitaires Paris-Sud, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Anatole Harrois
- Department of Anaesthesiology and Critical Care, Paris Saclay university AP-HP, Bicêtre hôpitaux universitaires Paris-Sud, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Hicham Kobeiter
- Medical imaging, CHU Henri-Mondor, Assistance publique-Hôpitaux de Paris (AP-HP), 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - Marc Leone
- Department of anaesthesia and intensive care, Assistance publique-Hôpitaux de Marseille, hôpital Nord, 13000 Marseille, France
| | - Albrice Levrat
- Department of anaesthesia and intensive care, Annecy Genevois hospital, 74374 Epagny-Annecy, France
| | - Sebastien Mirek
- Department of anaesthesia and intensive care, Dijon university hospital, BP 77908, 21709 Dijon, France
| | - Abdel Nadji
- Department of anaesthesia and intensive care, Dijon university hospital, BP 77908, 21709 Dijon, France
| | - Catherine Paugam-Burtz
- Department of anaesthesia and intensive care, Beaujon hospital, Assistance publique-Hôpitaux de Paris, 92110 Clichy, France; Hôpitaux-Paris-Nord-Val-De-Seine, université Paris-Diderot, 75018 Paris, France
| | - Jean Francois Payen
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Sebastien Perbet
- Adult intensive care & continuing care unit, Perioperative medicine, Clermont-Ferrand university hospital, 75000 Clermont-Ferrand, France; Anaesthesiology and Intensive Care Department, European Hospital Georges-Pompidou, 75015 Paris, France
| | - Romain Pirracchio
- Paris Descartes University, Sorbonne Paris Cité, 75000 Paris, France
| | - Isabelle Plenier
- Department of Anaesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr-Debré, 30029 Nîmes, France
| | - Julien Pottecher
- Strasbourg university hospital, Hautepierre hospital, Department of anaesthesia and surgical intensive care-Strasbourg university, faculté de médecine, Fédération de médecine translationnelle de strasbourg (FMTS), Strasbourg, France
| | - Sylvain Rigal
- Department of Surgery, French Military Medical Academy, école du Val-de-Grâce, 75000 Paris, France
| | - Bruno Riou
- Sorbonne University, UMR Inserm 1166, IHU ICAN, Assistance publique-Hôpitaux de Paris, Emergency department, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Dominique Savary
- Northern French Alps Emergency Network (RENAU), Annecy Genevois hospital, 74374 Epagny-Annecy, France
| | - Thierry Secheresse
- CEnSIM, Centre d'enseignement par simulation, centre hospitalier Metropole Savoie, 73000 Chambéry, France; LaRAC-laboratoire de recherche sur les apprentissages en contexte, University Grenoble Alpes, 38000 Grenoble, France
| | - Karim Tazarourte
- Emergency medicine department, Hospices civils de Lyon, Lyon university, HESPER EA 7425, centre hospitalier Herriot, 69003 Lyon, France
| | - Frederic Thony
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Jerome Tonetti
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Christophe Tresallet
- Department of general, visceral and endocrinous surgery, hôpital de la Pitié-Salpêtrière, Sorbonne university, UMR CNRS-Inserm U678, Assistance publique des Hôpitaux de Paris (AP-HP), 75013 Paris, France
| | - Pierre-Francois Wey
- Intensive Care & Anaesthesia Department-Desgenettes Teaching Military Hospital, 69003 Lyon, France
| | - Julien Picard
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Pierre Bouzat
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France.
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Pujol S, Laurent J, Markarian T, Claret PG, Lefrant JY, Roger C, Muller L, de La Coussaye JE, Perez-Martin A, Bobbia X. Compression with a pocket-sized ultrasound device to diagnose proximal deep vein thrombosis. Am J Emerg Med 2018; 36:1262-1264. [PMID: 29653786 DOI: 10.1016/j.ajem.2018.03.076] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Compression ultrasonography (CUS) is a validated technique for the diagnosis of deep venous thrombosis (DVT), but has never been studied with pocket-sized ultrasound device (PUD). The main objective of this study was to assess the diagnostic performance of CUS made by emergency physicians (EPs) using a PUD. MATERIALS This was a prospective, diagnostic test assessment, single-center study. Patients underwent VCU performed by a trained EP with PUD (CUS-PUD) for searching proximal DVT (PDVT) and were then seen by an expert vascular physician who blindly performed a duplex venous ultrasound, which was the criterion standard. CUS-PUD's diagnostic performance was evaluated by sensitivity (Se), specificity (Sp), and positive and negative predictive values (PPV and NPV). RESULTS The sample included 57 patients of whom 56 were analyzed. Eleven (20%) PDVT were diagnosed with CUS-PUD: 7 (64%) femoral and 4 (36%) popliteal. The CUS-PUD's Se was 100% [72%; 100%], Sp 100% [92%; 100%]. The PPV was 100% [74%; 100%], and the NPV was 100% [90%; 100%]. CONCLUSION CUS-PUD performed with a pocket-sized ultrasound appears to be feasible in emergency practice for the diagnosis of proximal DVT. A study with a larger sample size will have to describe the accuracy.
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Affiliation(s)
- Sarah Pujol
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Jeremy Laurent
- Department of Vascular Medicine and Laboratory, CHU de Nîmes, hôpital Caremeau, place du Pr-Debré, 30029 Nîmes cedex 9, France.
| | - Thibaut Markarian
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France.
| | - Pierre-Géraud Claret
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Jean Yves Lefrant
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Claire Roger
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Laurent Muller
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Jean Emmanuel de La Coussaye
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Antonia Perez-Martin
- Department of Vascular Medicine and Laboratory, CHU de Nîmes, hôpital Caremeau, place du Pr-Debré, 30029 Nîmes cedex 9, France.
| | - Xavier Bobbia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France; Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France.
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Pommet S, Claret PG, de La Coussaye JE, Bobbia X. Échographie et prise en charge de l’arrêt cardiaque. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’arrêt cardiorespiratoire (ACR) est une situation fréquente pour les structures d’urgences et de réanimation, et l’utilisation de l’échographie y est recommandée par les sociétés savantes. Elle doit impérativement se faire sans augmentation des temps d’interruption du massage cardiaque externe. Après formation, elle permet de détecter rapidement et facilement la présence d’une contractilité myocardique qui est un élément pronostique important pouvant aider dans la décision d’arrêter la RCP. Le recours à des protocoles bien établis avec des équipes entraînées permet d’éviter une interruption prolongée de la RCP. Cependant, aucune étude humaine de grande ampleur n’a permis de décrire de manière fiable pendant l’ACR la sémiologie échographique des causes curables que constituent l’hypovolémie, l’embolie pulmonaire, la tamponnade et le pneumothorax compressif.
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Pontis E, Claret PG, Markarian T, Javaudin F, Flacher A, Roger C, Muller L, de La Coussaye JE, Bobbia X. Integration of lung ultrasound in the diagnostic reasoning in acute dyspneic patients: A prospective randomized study. Am J Emerg Med 2018; 36:1597-1602. [PMID: 29366658 DOI: 10.1016/j.ajem.2018.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/13/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Misdiagnosis in acute dyspneic patients (ADP) has consequences on their outcome. Lung ultrasound (LUS) is an accurate tool to improve diagnostic performance. The main goal of this study was to assess the determinants of increased diagnostic accuracy using LUS. MATERIALS Multicentre, prospective, randomized study including emergency physicians and critical care physicians treating ADP on a daily basis. Each participant received three difficult clinical cases of ADP: one with only clinical data (OCD), one with only LUS data (OLD), and one with both. Ultrasound video loops of A, B and C profiles were associated with the cases. Which physician received what data for which clinical case was randomized. Physicians assessed the diagnostic probability from 0 to 10 for each possible diagnosis. The number of uncertain diagnoses (NUD) was the number of diagnoses with a diagnostic probability between 3 and 7, inclusive. RESULTS Seventy-six physicians responded to the study cases (228 clinical cases resolved). Among the respondents, 28 (37%) were female, 64 (84%) were EPs, and the mean age was 37±8 years. The mean NUDs, respectively, when physicians had OCD, OLD, and both were 2.9±1.8, 2.2±1.7, 2.2±1.8 (p = 0.02). Ultrasound data and ultrasound frequency of use were the only variables related to the NUD. Higher frequency of ultrasound use by physicians decreased the number of uncertain diagnoses in difficult clinical cases with ultrasound data (OLD or associated with clinical data). CONCLUSION LUS decreases the NUD in ADP. The ultrasound frequency of use decreased the NUD in ADP clinical cases with LUS data.
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Affiliation(s)
- Emmanuel Pontis
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France
| | - Pierre-Géraud Claret
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France
| | - Thibaut Markarian
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France.
| | - Francois Javaudin
- Emergency Department, Nantes University Hospital, 44093 Nantes, France.
| | | | - Claire Roger
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France
| | - Laurent Muller
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Jean Emmanuel de La Coussaye
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Xavier Bobbia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France; Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France.
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