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Abback PS, Brouns K, Moyer JD, Holleville M, Hego C, Jeantrelle C, Bout H, Rennuit I, Foucrier A, Codorniu A, Jurcisin I, Paugam-Burtz C, Gauss T. ISS is not an appropriate tool to estimate overtriage. Eur J Trauma Emerg Surg 2021; 48:1061-1068. [PMID: 33725158 DOI: 10.1007/s00068-021-01637-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this work is to study a cohort of patients of ISS < 15 admitted to a TC, and to determine the number of patients that ultimately benefited from the skills and resources specific of a level 1 trauma center. METHODS Retrospective study from a prospective cohort of patients admitted to TC (Beaujon Hospital, APHP) for suspected severe trauma from January 2011 to December 2017. The main outcome criterion was the use of surgery or interventional radiology within the first 24 h after admission of patients with ISS < 15. The secondary outcomes were stratified into severe (mortality, resuscitation care, length of stay in intensive care units) and non-severe criteria (mild head injury, hospital discharge or transfer within 24 h). RESULTS Of 3035 patients admitted during the study period, 1409 with an ISS < 15 were included, corresponding to a theoretical overtriage rate of 46.4%. Among these, 611 patients (43.4%) underwent emergency intervention within the first 24 h (586 surgical interventions, 19 direct transfers to the operating theater and 6 acts of interventional radiology), 238 (16.9%) of patients presented with severe and 531 (38%) with non-severe outcome criteria. CONCLUSION This work demonstrates that in a cohort of patients classified as ISS < 15 admitted to a TC, a considerable amount of TC-specific resources are required, and patients present with severe outcome criteria despite being classified as overtriaged. These results suggest that triage of trauma patients should be based on resource use and clinical outcome rather than anatomic criteria.
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Affiliation(s)
- Paër-Sélim Abback
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France.
| | - Kelly Brouns
- Department of Anaesthesia and Intensive Care, Robert-Debré University Hospital, APHP, Paris, France
| | - Jean-Denis Moyer
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Mathilde Holleville
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Camille Hego
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Caroline Jeantrelle
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Hélène Bout
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Isabelle Rennuit
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Arnaud Foucrier
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Anaïs Codorniu
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Igor Jurcisin
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Catherine Paugam-Burtz
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France.,Université de Paris, Paris, France
| | - Tobias Gauss
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
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Lukaszewicz AC, Faivre V, Bout H, Gayat E, Lagergren T, Damoisel C, Bresson D, Paugam C, Mantz J, Payen D. Multicenter testing of the rapid quantification of radical oxygen species in cerebrospinal fluid to diagnose bacterial meningitis. PLoS One 2015; 10:e0128286. [PMID: 26011286 PMCID: PMC4444193 DOI: 10.1371/journal.pone.0128286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 07/22/2014] [Accepted: 04/27/2015] [Indexed: 01/26/2023] Open
Abstract
Purpose Meningitis is a serious concern after traumatic brain injury (TBI) or neurosurgery. This study tested the level of reactive oxygen species (ROS) in cerebrospinal fluid (CSF) to diagnose meningitis in febrile patients several days after trauma or surgery. Methods Febrile patients (temperature > 38°C) after TBI or neurosurgery were included prospectively. ROS were measured in CSF within 4 hours after sampling using luminescence in the basal state and after cell stimulation with phorbol 12-myristate 13-acetate (PMA). The study was conducted in a single-center cohort 1 (n = 54, training cohort) and then in a multicenter cohort 2 (n = 136, testing cohort) in the Intensive Care and Neurosurgery departments of two teaching hospitals. The performance of the ROS test was compared with classical CSF criteria, and a diagnostic decision for meningitis was made by two blinded experts. Results The production of ROS was higher in the CSF of meningitis patients than in non-infected CSF, both in the basal state and after PMA stimulation. In cohort 1, ROS production was associated with a diagnosis of meningitis with an AUC of 0.814 (95% confidence interval (CI) [0.684–0.820]) for steady-state and 0.818 (95% CI [0.655–0.821]) for PMA-activated conditions. The best threshold value obtained in cohort 1 was tested in cohort 2 and showed high negative predictive values and low negative likelihood ratios of 0.94 and 0.36 in the basal state, respectively, and 0.96 and 0.24 after PMA stimulation, respectively. Conclusion The ROS test in CSF appeared suitable for eliminating a diagnosis of bacterial meningitis.
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Affiliation(s)
- Anne-Claire Lukaszewicz
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
- * E-mail:
| | - Valérie Faivre
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Hélène Bout
- Department of Anesthesiology and Critical Care, Beaujon Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Tina Lagergren
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Charles Damoisel
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Damien Bresson
- Department of Neurosurgery, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Catherine Paugam
- Department of Anesthesiology and Critical Care, Beaujon Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jean Mantz
- Department of Anesthesiology and Critical Care, Beaujon Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Didier Payen
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
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Belghiti J, Tassin M, Raiffort C, Zappa M, Poujade O, Bout H, Mandelbrot L. [Uterine necrosis after arterial embolization for postpartum hemorrhage]. ACTA ACUST UNITED AC 2012; 42:126-128. [PMID: 22342505 DOI: 10.1016/j.gyobfe.2011.07.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 03/27/2011] [Accepted: 05/31/2011] [Indexed: 11/15/2022]
Abstract
Radiologic embolization of the uterine arteries is increasingly used to treat severe postpartum hemorrhage, as an alternative to surgical procedures. Guidelines have been published in order to standardize the indications as well as the technique. An important objective was to limit severe complications such as uterine necrosis. We report a case of a uterine necrosis after arterial embolization for severe postpartum hemorrhage due to uterine atony on a uterus with fibroids. This complication occurred despite the use of the recommended technique.
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Affiliation(s)
- J Belghiti
- Hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92701 Colombes, France
| | - M Tassin
- Hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92701 Colombes, France
| | - C Raiffort
- Hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92701 Colombes, France
| | - M Zappa
- Hôpital Beaujon, AP-HP, hôpitaux universitaires Paris Nord Val de Seine, université Paris-Diderot, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - O Poujade
- Hôpital Beaujon, AP-HP, hôpitaux universitaires Paris Nord Val de Seine, université Paris-Diderot, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - H Bout
- Hôpital Beaujon, AP-HP, hôpitaux universitaires Paris Nord Val de Seine, université Paris-Diderot, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - L Mandelbrot
- Hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92701 Colombes, France.
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Alvarez A, Mourvillier B, Bout H, Bruel C, Ferreira L, Lakhal K, Pajot O, Bouadma L, Regnier B, Wolff M. P1206 Repeated lumbar puncture in patients with pneumococcal meningitis: practical or anxiolytic relevance? Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71046-4] [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: 11/16/2022]
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Sauval P, Bout H, Ohanessian A, Danchin N, Monsegu J, Varenne O, Carli P, Spaulding C. [Management of chest pain by the Emergency Ambulance Service: the DOLORES register]. Arch Mal Coeur Vaiss 2005; 98:1095-9. [PMID: 16379105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Pre-hospital management of chest pain is a difficult problem. The emergency doctor has to take triage decisions based on instantaneous data whereas the decisional rationale of the many pathologies concerned, including acute coronary syndromes, is often based on observation over several hours. There have been few studies of the efficacy of pre-hospital management of chest pain by an emergency ambulance service. Therefore, the DOLORES register was set up to assess this problem over a 6 month period by the emergency ambulance service of Necker Hospital in Paris. Between January and June 2004, the Necker emergency ambulance service was called out on 205 occasions for chest pain. Forty-three patients had acute coronary syndromes (ACS) with ST elevation. Of the remaining 162 patients, 32 stayed at home, 2 were admitted the following day by cardiologists for coronary angiography, 52 were admitted for observation to the emergency unit and 76 were admitted to the coronary care unit. In the latter two groups, the final diagnosis of ACS without ST elevation was retained in 11/52 and 57/76 patients respectively. Finally, 2 patients were admitted directly to the catheter laboratory. The clinical and paraclinical data noted by the emergency ambulance service and at hospital admission was concordant in all cases. Pre-hospital triage by the emergency ambulance service seems to be effective. These results require confirmation with a large scale study.
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Affiliation(s)
- P Sauval
- SAMU de Paris, SMUR Necker hôpital Necker, université Paris 5 René Descartes.
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