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Freund Y, Chauvin A, Jimenez S, Philippon AL, Curac S, Fémy F, Gorlicki J, Chouihed T, Goulet H, Montassier E, Dumont M, Lozano Polo L, Le Borgne P, Khellaf M, Bouzid D, Raynal PA, Abdessaied N, Laribi S, Guenezan J, Ganansia O, Bloom B, Miró O, Cachanado M, Simon T. Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial. JAMA 2021; 326:2141-2149. [PMID: 34874418 PMCID: PMC8652602 DOI: 10.1001/jama.2021.20750] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Uncontrolled studies suggest that pulmonary embolism (PE) can be safely ruled out using the YEARS rule, a diagnostic strategy that uses varying D-dimer thresholds. OBJECTIVE To prospectively validate the safety of a strategy that combines the YEARS rule with the pulmonary embolism rule-out criteria (PERC) rule and an age-adjusted D-dimer threshold. DESIGN, SETTINGS, AND PARTICIPANTS A cluster-randomized, crossover, noninferiority trial in 18 emergency departments (EDs) in France and Spain. Patients (N = 1414) who had a low clinical risk of PE not excluded by the PERC rule or a subjective clinical intermediate risk of PE were included from October 2019 to June 2020, and followed up until October 2020. INTERVENTIONS Each center was randomized for the sequence of intervention periods. In the intervention period (726 patients), PE was excluded without chest imaging in patients with no YEARS criteria and a D-dimer level less than 1000 ng/mL and in patients with 1 or more YEARS criteria and a D-dimer level less than the age-adjusted threshold (500 ng/mL if age <50 years or age in years × 10 in patients ≥50 years). In the control period (688 patients), PE was excluded without chest imaging if the D-dimer level was less than the age-adjusted threshold. MAIN OUTCOMES AND MEASURES The primary end point was venous thromboembolism (VTE) at 3 months. The noninferiority margin was set at 1.35%. There were 8 secondary end points, including chest imaging, ED length of stay, hospital admission, nonindicated anticoagulation treatment, all-cause death, and all-cause readmission at 3 months. RESULTS Of the 1414 included patients (mean age, 55 years; 58% female), 1217 (86%) were analyzed in the per-protocol analysis. PE was diagnosed in the ED in 100 patients (7.1%). At 3 months, VTE was diagnosed in 1 patient in the intervention group (0.15% [95% CI, 0.0% to 0.86%]) vs 5 patients in the control group (0.80% [95% CI, 0.26% to 1.86%]) (adjusted difference, -0.64% [1-sided 97.5% CI, -∞ to 0.21%], within the noninferiority margin). Of the 6 analyzed secondary end points, only 2 showed a statistically significant difference in the intervention group compared with the control group: chest imaging (30.4% vs 40.0%; adjusted difference, -8.7% [95% CI, -13.8% to -3.5%]) and ED median length of stay (6 hours [IQR, 4 to 8 hours] vs 6 hours [IQR, 5 to 9 hours]; adjusted difference, -1.6 hours [95% CI, -2.3 to -0.9]). CONCLUSIONS AND RELEVANCE Among ED patients with suspected PE, the use of the YEARS rule combined with the age-adjusted D-dimer threshold in PERC-positive patients, compared with a conventional diagnostic strategy, did not result in an inferior rate of thromboembolic events. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04032769.
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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, Paris, France
| | - Anthony Chauvin
- Emergency Department, Hôpital Lariboisière, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Sonia Jimenez
- Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, University of Barcelona, Catalonia, Spain
| | - Anne-Laure Philippon
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Emergency Department, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Sonja Curac
- Emergency Department, Hôpital Beaujon, Assistance Publique–Hôpitaux de Paris, Clichy, France
| | - Florent Fémy
- Emergency Department, Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris, Paris University, Paris, France
- Toxicology and Chemical Risks Department, French Armed Forces Biomedical Institute, Bretigny-Sur-Orges, France
| | - Judith Gorlicki
- Emergency Department, Hôpital Avicenne, Assistance Publique–Hôpitaux de Paris, INSERM U942-MASCOT, Bobigny, France
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, Université de Lorraine, UMR_S 1116, Nancy, France
| | - Hélène Goulet
- Emergency Department, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
| | | | - Margaux Dumont
- Emergency Department, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Laura Lozano Polo
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Mehdi Khellaf
- Emergency Department, CHU Henri Mondor, INSERM U955, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Donia Bouzid
- Université de Paris, INSERM, IAME, F-75006 Paris, France
- Emergency Department, Bichat-Claude Bernard University Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Pierre-Alexis Raynal
- Emergency Department, Hôpital St-Antoine, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Nizar Abdessaied
- Emergency Department, Centre Hospitalier de St Denis, St Denis, France
| | - Saïd Laribi
- Tours University, Emergency Medicine Department, Tours University Hospital, Tours, France
| | - Jeremy Guenezan
- Emergency Department, University Hospital of Poitiers, Poitiers, France
| | - Olivier Ganansia
- Emergency Department, Groupe Hospitalier Paris–St Joseph, Paris, France
| | - Ben Bloom
- Emergency Department, Barts Health NHS Trust, London, United Kingdom
| | - Oscar Miró
- Emergency Department, Hôpital Lariboisière, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Marine Cachanado
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), Assistance Publique–Hôpitaux de Paris, Sorbonne University, St Antoine Hospital, Paris, France
| | - Tabassome Simon
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), Assistance Publique–Hôpitaux de Paris, Sorbonne University, St Antoine Hospital, Paris, France
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Montassier E, Javaudin F, Moustafa F, Nandjou D, Maignan M, Hardouin JB, Annoot C, Ogielska M, Orer PL, Schotté T, Bouget J, Agha Babaei S, Raynal PA, Eche A, Duc AT, Cojocaru RA, Benaouicha N, Potel G, Batard E, Talan DA. Guideline-Based Clinical Assessment Versus Procalcitonin-Guided Antibiotic Use in Pneumonia: A Pragmatic Randomized Trial. Ann Emerg Med 2019; 74:580-591. [PMID: 30982631 DOI: 10.1016/j.annemergmed.2019.02.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/05/2019] [Accepted: 02/19/2019] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Efforts to reduce unnecessary and unnecessarily long antibiotic treatment for community-acquired pneumonia have been attempted through use of procalcitonin and through guidelines based on serial clinical assessment. Our aim is to compare guideline-based clinical assessment- and procalcitonin algorithm-guided antibiotic use among patients with community-acquired pneumonia. METHODS We performed a pragmatic, randomized, multicenter trial from November 2012 to April 2015 at 12 French hospitals. We included emergency department (ED) patients older than 18 years with community-acquired pneumonia. Patients were randomly assigned to either the procalcitonin-guided or clinical assessment group. In accordance with past studies, we hypothesized that serial clinical assessment would be superior to procalcitonin-guided care. The primary outcome was antibiotic duration, and secondary outcomes included rates of antibiotic duration less than or equal to 5 days, and clinical success and combined serious adverse outcomes at 30 days in the intention-to-treat population. RESULTS Of 370 eligible patients, 285 (77%) were randomly assigned to either clinical assessment- (n=143) or procalcitonin-guided care (n=142). Median age was 67 years (range 18 to 93 years) and 40% of patients were deemed to have Pneumonia Severity Index class IV or V. Procalcitonin algorithm adherence was 76%. Antibiotic duration was not significantly different between clinical assessment- and procalcitonin-guided groups (median 9 versus 10 days, respectively). Clinical success rate was 92% in each group and serious adverse outcome rates were similar (15% versus 20%, respectively). CONCLUSION Guideline-based serial clinical assessment did not reduce antibiotic exposure compared with procalcitonin-guided care among ED patients with community-acquired pneumonia. The strategies were similar in terms of duration of antibiotic use and clinical outcomes.
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Affiliation(s)
- Emmanuel Montassier
- Department of Emergency Medicine, Centre Hospitalier Universitaire, Nantes University Hospital, Nantes, France.
| | - François Javaudin
- Department of Emergency Medicine, Centre Hospitalier Universitaire, Nantes University Hospital, Nantes, France
| | - Farès Moustafa
- Department of Emergency Medicine, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Demeno Nandjou
- Department of Emergency Medicine, Centre Hospitalier Agen Agen, France
| | - Maxime Maignan
- University Grenoble Alps, Emergency Department and Mobile Intensive Care Unit, Centre Hospitalier UniversitaireGrenoble Alps, Grenoble, France
| | | | - Caroline Annoot
- Department of Emergency Medicine, Centre Hospitalier la Roche sur Yon, la Roche sur Yon, France
| | - Maja Ogielska
- Service de maladies infectieuses, Centre Hospitalier Universitaire Tours, Tours, France
| | - Pascal-Louis Orer
- Department of Emergency Medicine, Assistance Publique Hopitaux de Paris, Hôpital Avicenne, Bobigny, France
| | - Thibault Schotté
- Department of Emergency Medicine, Centre Hospitalier Universitaire Angers, Institut Mitovasc, Université d'Angers, Angers, France
| | - Jacques Bouget
- Department of Emergency Medicine, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Syamak Agha Babaei
- Department of Emergency Medicine, Centre Hospitalier Universitaire Strasbourg, Strasbourg, France
| | - Pierre-Alexis Raynal
- Department of Emergency Medicine, Assistance Publique Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France
| | - Antoine Eche
- Department of Emergency Medicine, Assistance Publique Hôpitaux de Paris, Hôpital Hôtel Dieu, Paris, France
| | - Albert Trinh Duc
- Department of Emergency Medicine, Centre Hospitalier Agen Agen, France
| | - Ruxandra-Aimée Cojocaru
- Department of Emergency Medicine, Centre Hospitalier Universitaire Strasbourg, Strasbourg, France
| | - Nesrine Benaouicha
- Department of Emergency Medicine, Centre Hospitalier Universitaire, Nantes University Hospital, Nantes, France
| | - Gilles Potel
- Department of Emergency Medicine, Centre Hospitalier Universitaire, Nantes University Hospital, Nantes, France
| | - Eric Batard
- Department of Emergency Medicine, Centre Hospitalier Universitaire, Nantes University Hospital, Nantes, France
| | - David A Talan
- Department of Emergency Medicine and Department of Medicine, Division of Infectious Diseases, Olive View-University of California, Los Angeles Medical Center, Sylmar, California; David Geffen School of Medicine at University of California, Los Angeles.
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Freund Y, Cachanado M, Aubry A, Orsini C, Raynal PA, Féral-Pierssens AL, Charpentier S, Dumas F, Baarir N, Truchot J, Desmettre T, Tazarourte K, Beaune S, Leleu A, Khellaf M, Wargon M, Bloom B, Rousseau A, Simon T, Riou B. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. JAMA 2018; 319:559-566. [PMID: 29450523 PMCID: PMC5838786 DOI: 10.1001/jama.2017.21904] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [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: 01/13/2023]
Abstract
IMPORTANCE The safety of the pulmonary embolism rule-out criteria (PERC), an 8-item block of clinical criteria aimed at ruling out pulmonary embolism (PE), has not been assessed in a randomized clinical trial. OBJECTIVE To prospectively validate the safety of a PERC-based strategy to rule out PE. DESIGN, SETTING, AND PATIENTS A crossover cluster-randomized clinical noninferiority trial in 14 emergency departments in France. Patients with a low gestalt clinical probability of PE were included from August 2015 to September 2016, and followed up until December 2016. INTERVENTIONS Each center was randomized for the sequence of intervention periods. In the PERC period, the diagnosis of PE was excluded with no further testing if all 8 items of the PERC rule were negative. MAIN OUTCOMES AND MEASURES The primary end point was the occurrence of a thromboembolic event during the 3-month follow-up period that was not initially diagnosed. The noninferiority margin was set at 1.5%. Secondary end points included the rate of computed tomographic pulmonary angiography (CTPA), median length of stay in the emergency department, and rate of hospital admission. RESULTS Among 1916 patients who were cluster-randomized (mean age 44 years, 980 [51%] women), 962 were assigned to the PERC group and 954 were assigned to the control group. A total of 1749 patients completed the trial. A PE was diagnosed at initial presentation in 26 patients in the control group (2.7%) vs 14 (1.5%) in the PERC group (difference, 1.3% [95% CI, -0.1% to 2.7%]; P = .052). One PE (0.1%) was diagnosed during follow-up in the PERC group vs none in the control group (difference, 0.1% [95% CI, -∞ to 0.8%]). The proportion of patients undergoing CTPA in the PERC group vs control group was 13% vs 23% (difference, -10% [95% CI, -13% to -6%]; P < .001). In the PERC group, rates were significantly reduced for the median length of emergency department stay (mean reduction, 36 minutes [95% CI, 4 to 68]) and hospital admission (difference, 3.3% [95% CI, 0.1% to 6.6%]). CONCLUSIONS AND RELEVANCE Among very low-risk patients with suspected PE, randomization to a PERC strategy vs conventional strategy did not result in an inferior rate of thromboembolic events over 3 months. These findings support the safety of PERC for very low-risk patients presenting to the emergency department. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02375919.
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Affiliation(s)
- Yonathan Freund
- Sorbonne Université, INSERM UMRS 1166, IHU ICAN, Paris, France
- Emergency Department, Hôpital Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Marine Cachanado
- Clinical Research Platform (URC-CRC-CRB), AP-HP Hôpital Saint-Antoine, Paris, France
| | - Adeline Aubry
- Emergency Department, Hôpital Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | | | | | - Sandrine Charpentier
- Université Toulouse III Paul Sabatier, INSERM UMR 1027, CHU Toulouse, Toulouse, Emergency Department, Toulouse, France
| | - Florence Dumas
- Université Paris Descartes, INSERM UMR970, APHP, Emergency Department, Hôpital Cochin, Paris, France
| | - Nacera Baarir
- Emergency Department, Hôpital Tenon, APHP, Paris, France
| | | | - Thibaut Desmettre
- Université Bourgogne Franche-Comté, Emergency Department, CHRU Minjoz, Besançon, France
| | - Karim Tazarourte
- Université Claude Bernard Lyon1, HESPER EA 7425, Hospices Civils de Lyon, Emergency Department, Hôpital Edouard Herriot, Lyon, France
| | - Sebastien Beaune
- Emergency Department, Hôpital Ambroise-Paré, APHP, Boulogne, France
| | - Agathe Leleu
- Emergency Department, Hôpital Bichat, APHP, Paris, France
| | - Mehdi Khellaf
- Université Paris Est, INSERM U955, APHP, Emergency Department, Hôpital Henri Mondor, Créteil, France
| | - Mathias Wargon
- Emergency Department, Hôpital Saint Camille, Bry sur Marne, France
| | - Ben Bloom
- Emergency Department, Barts Health NHS Trust, London, United Kingdom
| | - Alexandra Rousseau
- Clinical Research Platform (URC-CRC-CRB), AP-HP Hôpital Saint-Antoine, Paris, France
| | - Tabassome Simon
- Sorbonne Université, INSERM UMRS 1166, IHU ICAN, Paris, France
- Clinical Research Platform (URC-CRC-CRB), AP-HP Hôpital Saint-Antoine, Paris, France
| | - Bruno Riou
- Sorbonne Université, INSERM UMRS 1166, IHU ICAN, Paris, France
- Emergency Department, Hôpital Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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6
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Feral-Pierssens AL, Aubry A, Truchot J, Raynal PA, Boiffier M, Hutin A, Leleu A, Debruyne G, Joly LM, Juvin P, Riou B, Freund Y. Emergency Care for Homeless Patients: A French Multicenter Cohort Study. Am J Public Health 2016; 106:893-8. [PMID: 26985613 DOI: 10.2105/ajph.2015.303038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine whether homeless patients experience suboptimal care in the emergency department (ED) by the provision of fewer health care resources. METHODS We conducted a prospective multicenter cohort study in 30 EDs in France. During 72 hours in March 2015, all homeless patients that visited the participating EDs were included in the study. The primary health care service measure was the order by the physician of a diagnostic investigation or provision of a treatment in the ED. Secondary measures of health care services included ED waiting time, number and type of investigations per patient, treatment in the ED, and discharge disposition. RESULTS A total of 254 homeless patients and 254 nonhomeless patients were included. After excluding homeless patients that attended the ED for the sole purpose of housing, we analyzed 214 homeless and 214 nonhomeless. We found no significant difference between the 2 groups in terms of health care resource consumption, and for our secondary endpoints. CONCLUSIONS We did not find significant differences in the level of medical care delivered in French EDs to homeless patients compared with matched nonhomeless patients.
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Affiliation(s)
- Anne-Laure Feral-Pierssens
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Adeline Aubry
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Jennifer Truchot
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Pierre-Alexis Raynal
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Mathieu Boiffier
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Alice Hutin
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Agathe Leleu
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Geraud Debruyne
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Luc-Marie Joly
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Philippe Juvin
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Bruno Riou
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Yonathan Freund
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
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