EMresearch.ch

Wildi, K., Boeddinghaus, J., Nestelberger, T., Haaf, P., Koechlin, L., Ayala Lopez, P., Walter, J., et al. “External Validation Of The Clinical Chemistry Score”. Clin Biochem 91: 16-25. doi:10.1016/j.clinbiochem.2021.02.006.

Abstract: BACKGROUND: Combining high-sensitivity cardiac troponin (hs-cTn) with estimated glomerular filtration rate and glucose within the Clinical Chemistry Score (CCS) could help in the assessment of patients with suspected acute myocardial infarction (AMI). METHODS: In patients presenting with suspected AMI to the emergency department, we aimed to externally validate the performance of the CCS in a prospective international multicenter study and to directly compare the diagnostic and prognostic performance of the CCS with hs-cTnT and hs-cTnI baseline levels alone using a single cut-off approach. The diagnostic endpoint was diagnostic accuracy for AMI as centrally adjudicated by two independent cardiologists including cardiac imaging and serial hs-cTnT/I measurements. The prognostic endpoint was 30-day AMI or death. RESULTS: AMI was the final diagnosis in 620/3827 patients (16.2%) adjudicated with hs-cTnT and 599 patients (15.7%) adjudicated with hs-cTnI. The CCS resulted in high diagnostic accuracy for AMI and prognostic accuracy for 30-days AMI/death as quantified by the area under the receiver-operating characteristic curve (AUC), using hs-cTnT 0.90 (95%CI 0.89-0.91) and 0.89 (95%CI 0.88-0.90), using hs-cTnI 0.91 (95%Cl 0.90-0.92) and 0.90 (95%CI 0.89-0.91) respectively. E.g. a CCS of 0 points resulted in a sensitivity of 99.8% (95%CI 99.1-100%) for rule-out of index AMI and 99.5% (95%CI 98.5-100%) for AMI/death at 30 days for hs-cTnT and 99.8% (95%CI 98.9-100%) and 99.6% (95%CI 98.6-100%) using hs-cTnI. Overall, the single hs-cTnT/I measurement approach provided comparable diagnostic (sensitivity 99.5-99.7%) and prognostic (sensitivity 98.9-99.5%) performance versus the CCS. INTERPRETATION: The CCS provided high diagnostic and prognostic performance also in this independent large validation cohort. A single hs-cTnT/I measurement approach for rule-out MI yielded similar estimates.

Tags: Acute myocardial infarction, Adult, Aged, Aged, 80 and over, Clinical chemistry score, Death at 30 days, Disease-Free Survival, ESC 0/1h-algorithm, Female, High-sensitivity cardiac troponin, Humans, Male, Middle Aged, Myocardial Infarction/*blood/*mortality, Prospective Studies, Revascularization, Rule-out and rule-in algorithm, Survival Rate, Troponin C/*blood.

Pasquier, M., Cools, E., Zafren, K., Carron, P. N., Frochaux, V., and Rousson, V. “Vital Signs In Accidental Hypothermia”. High Alt Med Biol 22, no. 2: 142-147. doi:10.1089/ham.2020.0179.

Abstract: Pasquier, Mathieu, Evelien Cools, Ken Zafren, Pierre-Nicolas Carron, Vincent Frochaux, and Valentin Rousson. Vital signs in accidental hypothermia. High Alt Med Biol. 22: 142-147, 2021. Background: Clinical indicators are used to stage hypothermia and to guide management of hypothermic patients. We sought to better characterize the influence of hypothermia on vital signs, including level of consciousness, by studying cases of patients suffering from accidental hypothermia. Materials and Methods: We retrospectively included patients aged >/=18 years admitted to the hospital with a core temperature below 35 degrees C. We identified the cases from a literature review and from a retrospective case series of hypothermic patients admitted to the hospital between 1994 and 2016. Patients who experienced cardiac arrest, as well as those with potential confounders such as concomitant diseases or intoxications, were excluded. Relationships between core temperature and heart rate, systolic blood pressure, respiratory rate, and level of consciousness were explored via correlations and regression. Results: Of the 305 cases reviewed, 216 met the criteria for inclusion. The mean temperature was 29.7 degrees C +/- 4.2 degrees C (range 19.3 degrees C-34.9 degrees C). The relationships between temperature and each of the four vital signs were generally linear and significantly positive, with Spearman correlations for respiratory rate, heart rate, systolic blood pressure, and Glasgow Coma Score (GCS) of 0.29 (p = 0.024), 0.44 (p < 0.001), 0.47 (p < 0.001), and 0.78 (p < 0.001), respectively. Based on linear regression, the mean decrease of a vital sign associated with a 1 degrees C decrease of temperature was estimated to be 0.50 minute(-1) for respiratory rate, 2.54 minutes(-1) for heart rate, 4.36 mmHg for systolic blood pressure, and 0.88 for GCS. Conclusions: There is a significant positive correlation between core temperature and heart rate, systolic blood pressure, respiratory rate, and GCS. The relationship between vital signs and temperature is generally linear. This knowledge might help clinicians make appropriate decisions when determining whether the clinical condition of a patient should be attributed to hypothermia. This could enhance clinical care and help to guide future research.

Tags: *Heart Arrest/therapy, *Hypothermia/therapy, Adolescent, Adult, Blood Pressure, core temperature, emergency medicine, Glasgow Coma Score, heart rate, Humans, hypothermia, respiratory rate, Retrospective Studies, Rewarming, Vital Signs.

Schertel, A., Geiser, T., and Hautz, W. E. “Man Or Machine? Impact Of Tutor-Guided Versus Simulator-Guided Short-Time Bronchoscopy Training On Students Learning Outcomes”. Bmc Med Educ 21, no. 1: 123. doi:10.1186/s12909-021-02526-w.

Abstract: BACKGROUND: Simulation based medical education is efficient for the acquisition of flexible bronchoscopy navigational skills and the knowledge of the tracheobronchial anatomy. However, bronchoscopy simulator training is not routinely integrated into pneumologic fellowship programs or undergraduate medical education for time and/or cost reasons. Our study compares the effect of self-guided bronchoscopy simulator training versus tutor guided training on the acquisition of navigational skills and knowledge of the bronchial anatomy. METHODS: Third-year undergraduate medical students were randomized to either a tutor- or simulator guided bronchoscopy simulator training focusing on the acquisition of navigational skills and the knowledge of the tracheobronchial anatomy. Every student performed a baseline bronchoscopy followed by a structured bronchoscopy simulator training and finally an assessment bronchoscopy at the end of the training program. Groups were compared by means of a repeated measurement ANOVA and effect sizes calculated as Cohens' d. RESULTS: Fifty-four eligible students participated in the study. Knowledge of the tracheobronchial anatomy significantly increased from pre- to post training (all p < 0.001; all d > 2), navigational skills significantly decreased (all p < 0.005; all d < 1). There were no significant differences between groups. Instruction by the simulator as well as by the tutor was rated as helpful by the students. Twenty-two (84.6%) of the participants of the simulator guided group would have appreciated an additional instruction by a tutor. CONCLUSION: Short-time simulator guided bronchoscopy training improves knowledge of the tracheobronchial anatomy in novice bronchoscopists as much as tutor guided training, but navigational skills seem to worsen in both groups. Further studies assessing transfer to clinical practice are needed to find the optimal teaching method for basic flexible bronchoscopy.

Tags: *Education, Medical, Undergraduate, *Students, Medical, Bronchoscopy, Clinical Competence, Education. All other authors declare that they have no competing interests., Germany, the Swiss National Science Foundation and Leardal foundation Norway and, Humans, Learning, Male, research support in kind from Prytime Medical, USA and provided paid consultancy, services to AO foundation Switzerland. WEH is associate editor at BMC Medical, Simulator training, Supervision, Teaching method, Tutor.

Koechlin, L., Boeddinghaus, J., Nestelberger, T., Miro, O., Fuenzalida, C., Martinez-Nadal, G., Lopez, B., et al. “Clinical Presentation Of Patients With Prior Coronary Artery Bypass Grafting And Suspected Acute Myocardial Infarction”. Eur Heart J Acute Cardiovasc Care 10, no. 7: 746-755. doi:10.1093/ehjacc/zuaa020.

Abstract: AIMS: Diagnosis of acute myocardial infarction (AMI) can be challenging in patients with prior coronary artery bypass grafting (CABG). METHODS AND RESULTS: Final diagnoses were adjudicated by two independent cardiologists using the universal definition of AMI among patients presenting to the emergency department (ED) with suspected AMI. Diagnostic accuracy of 34 chest pain characteristics (CPCs) and four electrocardiogram (ECG) signatures stratified according to the presence or absence of prior CABG were prospectively quantified. Among 4015 patients (no prior CABG: n = 3686; prior CABG: n = 329), prevalence of AMI and unstable angina were higher in patients with prior CABG (35% vs. 18%; 26% vs. 8%; both P < 0.001). Three CPCs (9%) and two electrocardiographic findings (50%) showed a different diagnostic performance (interaction P < 0.05) with loss of diagnostic value in patients with prior CABG. The diagnostic accuracy as quantified by the area under the curve (AUC) of the integrated clinical judgement was moderate to good in patients with prior CABG, and significantly lower compared to patients without prior CABG [AUC 0.80 (95% confidence interval (CI) 0.75-0.84) vs. AUC 0.87 (95% CI 0.86-0.89); P = 0.004]. Time to discharge from the ED was significantly longer in patients with prior CABG [359 (215-525) min vs. 300 (192-435) min; P < 0.001]. Key findings were confirmed in a large independent external validation cohort (n = 13 653). CONCLUSIONS: Patients with prior CABG presenting with suspected AMI have a high prevalence of AMI and unstable angina and lower diagnostic accuracy of CPCs and the ECG, possibly justifying liberal use of early coronary angiography in these vulnerable patients. CLINICALTRIALS.GOV REGISTRY: Number NCT00470587.

Tags: *Coronary Artery Bypass, *Myocardial Infarction/diagnosis/epidemiology, Angina, Unstable, Chest Pain, Coronary artery bypass grafting, Electrocardiogram, Electrocardiography, Humans, Myocardial infarction.

Muller, M., Schechter, C. B., Hautz, W. E., Sauter, T. C., Exadaktylos, A. K., Stock, S., and Birrenbach, T. “The Development And Validation Of A Resource Consumption Score Of An Emergency Department Consultation”. Plos One 16, no. 2: e0247244. doi:10.1371/journal.pone.0247244.

Abstract: BACKGROUND: Emergency Department (ED) visits and health care costs are increasing globally, but little is known about contributing factors of ED resource consumption. This study aims to analyse and to predict the total ED resource consumption out of the patient and consultation characteristics in order to execute performance analysis and evaluate quality improvements. METHODS: Characteristics of ED visits of a large Swiss university hospital were summarized according to acute patient condition factors (e.g. chief complaint, resuscitation bay use, vital parameter deviations), chronic patient conditions (e.g. age, comorbidities, drug intake), and contextual factors (e.g. night-time admission). Univariable and multivariable linear regression analyses were conducted with the total ED resource consumption as the dependent variable. RESULTS: In total, 164,729 visits were included in the analysis. Physician resources accounted for the largest proportion (54.8%), followed by radiology (19.2%), and laboratory work-up (16.2%). In the multivariable final model, chief complaint had the highest impact on the total ED resource consumption, followed by resuscitation bay use and admission by ambulance. The impact of age group was small. The multivariable final model was validated (R2 of 0.54) and a scoring system was derived out of the predictors. CONCLUSIONS: More than half of the variation in total ED resource consumption can be predicted by our suggested model in the internal validation, but further studies are needed for external validation. The score developed can be used to calculate benchmarks of an ED and provides leaders in emergency care with a tool that allows them to evaluate resource decisions and to estimate effects of organizational changes.

Tags: Benchmarking, Emergency Medical Services/*classification/*economics, Emergency Service, Hospital/*economics, Health Care Costs, Health Care Surveys, Humans, Linear Models, Retrospective Studies, Switzerland, Universities.

Pietsch, U., Berger, Y., Schurter, D., Theiler, L., Wenzel, V., Meuli, L., Grunenfelder, A., and Albrecht, R. “Nasal Nalbuphine Analgesia In Prehospital Trauma Managed By First-Responder Personnel On Ski Slopes In Switzerland: An Observational Cohort Study”. Scand J Trauma Resusc Emerg Med 29, no. 1: 36. doi:10.1186/s13049-021-00852-y.

Abstract: BACKGROUND: Pain is one of the major symptoms complained about by patients in the prehospital setting, especially in the case of trauma. When there is mountainous topography, as in Switzerland, there may be a time delay between injury and arrival of professional rescuers, in particular on ski slopes. Administration of a safe opioid by first responders may improve overall treatment. We therefore assessed administration of nasal nalbuphine as an analgesic treatment for trauma patients in Switzerland. METHODS: This observational cohort study examined 267 patients who were treated with nasal nalbuphine by first responders in six ski resorts in Switzerland. All first responders were instructed to begin treatment by assessing the feasibility of using nalbuphine to treat pain in the patient. A treatment algorithm was developed and distributed to assure that nalbuphine was only administered following a strict protocol. Data regarding pain scores and pain reduction after administration of nalbuphine were collected on-site. Refills were handed out to the first responders with the return of each completed questionnaire. RESULTS: Nalbuphine provided effective pain relief, with the median level of pain on the numeric rating scale for pain reduced by 3 units on average, from 8 points (p < 0.001). The multivariate regression model showed that pain reduction was more pronounced in patients with higher initial pain levels. Nalbuphine was more effective in adolsecents than in patients aged 20 to 60 years (p = 0.006). No major side effects were observed. CONCLUSION: Nasal administration of nalbuphine by first responders is a presumably safe and effective noninvasive pain management strategy for acutely injured patients in the prehospital setting. This may be an alternative, especially in the case of severe pain and prolonged time between arrival of the first responders and arrival of EMS/HEMS personnel on scene.

Tags: *Emergency Medical Services/methods, *Emergency Responders, Aged, Analgesics, Opioid/*administration & dosage, Cohort Studies, Emergency medicine, Female, Humans, Male, Middle Aged, Nalbuphine, Nalbuphine/*administration & dosage, Pain, Pain/*drug therapy, Prehospital analgesia, Prospective Studies, Skiing/*injuries, Switzerland, Trauma, Wilderness medicine, Wounds and Injuries/physiopathology.

Lange-Herr, N., Rindlisbacher, A., Romano, F., and Jackowski, C. “"Guboow"-Child Abuse Or Traditional Medical Treatment? A Case Report”. Int J Legal Med 135, no. 4: 1537-1540. doi:10.1007/s00414-021-02513-2.

Abstract: The examination of children suspected of being abused poses a great challenge for forensic pathologists. The risk of misjudgment is high and can have serious consequences for the child and the family. In unclear cases, an assessment should always be carried out on an interdisciplinary basis with the involvement of the relevant disciplines such as pediatrics, dermatology, or radiology. We present the case of a 2.5-year-old boy who was presented by his parents at the Pediatric Emergency Department of a Swiss University Hospital due to fever and weight loss. During the physical examination, conspicuous findings on the abdomen were present, and the responsible emergency physicians informed the child protective services. A clinical forensic examination occurred on behalf of the child protection services. The abdomen of the child showed several symmetrical scars. The initial questioning of the parents did not provide clear information about the origin of the injuries. Further professional questioning of the family by the child protective services concluded that the injuries were the result of a traditional medical treatment in Somalia, which occurred several weeks before.

Tags: *Medicine, African Traditional, *Physical Examination, Burn injury, Case report, Child abuse, Child Abuse/diagnosis/prevention & control, Child, Preschool, Cicatrix/*etiology, Guboow, Humans, Male, Somalia/ethnology, Switzerland/epidemiology, Traditional medical treatment.

Sahyoun, C., Cantais, A., Gervaix, A., Bressan, S., Lollgen, R., Krauss, B., Pediatric Emergency Medicine, Comfort, and Analgesia Research in Europe group of the Research in European Pediatric Emergency Medicine, network. “Correction To: Pediatric Procedural Sedation And Analgesia In The Emergency Department: Surveying The Current European Practice”. Eur J Pediatr 180, no. 6: 1815-1816. doi:10.1007/s00431-021-03980-w.

Abstract: In the Acknowledgement section of the original published version of the above article, the complete list of the Country Lead Research Coordinators of PemCARE group of the REPEM network were not ment ioned thus the Acknowledgments has been corrected as follows: © 2021, Springer-Verlag GmbH Germany, part of Springer Nature.

Tags: erratum.

Muller, M., Huembelin, M., Baechli, C., Wagner, U., Schuetz, P., Mueller, B., and Kutz, A. “Association Of In-Hospital Multimorbidity With Healthcare Outcomes In Swiss Medical Inpatients”. Swiss Med Wkly 151, no. 5-6: w20405. doi:10.4414/smw.2021.20405.

Abstract: IMPORTANCE: Multimorbidity poses a worldwide health- and socio-economic challenge, exacerbated by changing demographics. The association of multimorbidity with healthcare outcomes in hospitalised medical inpatients remains incompletely understood. OBJECTIVE: To examine the prevalence and burden of in-hospital multimorbidity over a 6-year time period and its association with in-hospital mortality, intensive care unit admission, length of hospital stay and readmission rates. DESIGN: This cross-sectional study analysed Swiss hospital discharge records from 1 January 2012 to 31 December 2017. SETTING: The study used population-based, administrative data from the Swiss Federal Statistical Office to investigate all adult medical cases in Switzerland. PARTICIPANTS: 2,220,000 population-based medical discharge records from 1,463,781 anonymised patients were included in the analysis. Multimorbidity was defined according to the World Health Organization as the presence of at least two chronic conditions. We applied the “Chronic Condition Indicator for the International Classification of Diseases (ICD-10-CM)”, which divides all ICD-10 codes into chronic and acute conditions, to define the number of chronic conditions. MAIN MEASURES: Time- and age-stratified prevalence of multimorbidity and its association with in-hospital mortality, ICU admission rate, length of stay, 30-day and 1-year all-cause readmission rates. RESULTS: Of the 2,220,000 cases, 51.3% were male with a mean age of 68.0 years (standard deviation 17.4). A total of 1,769,530 (79.7%) were multimorbid with a median of 4 (interquartile range 2–6) chronic conditions. The prevalence of multimorbidity increased by about 1.0% per year over the 6-year study period from 76.1% (2012) to 82.2% (2017). Multimorbidity was associated with higher odds of in-hospital mortality (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.28 to 1.34), ICU admission rate (OR 3.29, 95% CI 3.23 to 3.34), length of stay (+2.7 days, 95% CI 2.6 to 2.7), 30-day- (OR 1.92, 95% CI 1.89 to 1.94) and 1-year all-cause readmission rates (OR 1.70, 95% CI 1.68 to 1.71). The associations with in-hospital mortality and readmission were strongest in younger patients. CONCLUSIONS: Multimorbidity is highly prevalent in medical inpatients and has a relevant association with poor healthcare outcomes. Further investigation is needed to specify risk factors as well as to optimise the management of multimorbid patients to improve outcomes.

Tags: *Inpatients, *Multimorbidity, Adult, Aged, Cross-Sectional Studies, Delivery of Health Care, Hospitals, Humans, Male, Switzerland/epidemiology.

Thorson, A. E., Deen, G. F., Bernstein, K. T., Liu, W. J., Yamba, F., Habib, N., Sesay, F. R., et al. “Persistence Of Ebola Virus In Semen Among Ebola Virus Disease Survivors In Sierra Leone: A Cohort Study Of Frequency, Duration, And Risk Factors”. Plos Med 18, no. 2: e1003273. doi:10.1371/journal.pmed.1003273.

Abstract: BACKGROUND: Sexual transmission chains of Ebola virus (EBOV) have been verified and linked to EBOV RNA persistence in semen, post-recovery. The rate of semen persistence over time, including the average duration of persistence among Ebola virus disease (EVD) survivors, is not well known. This cohort study aimed to analyze population estimates of EBOV RNA persistence rates in semen over time, and associated risk factors in a population of survivors from Sierra Leone. METHODS AND FINDINGS: In this cohort study from May 2015 to April 2017 in Sierra Leone, recruitment was conducted in 2 phases; the first enrolled 100 male participants from the Western Area District in the capital of Freetown, and the second enrolled 120 men from the Western Area District and from Lungi, Port Loko District. Mean age of participants was 31 years. The men provided semen for testing, analyzed by quantitative reverse transcription PCR (qRT-PCR) for the presence of EBOV RNA. Follow-up occurred every 2 weeks until the endpoint, defined as 2 consecutive negative qRT-PCR results of semen specimen testing for EBOV RNA. Participants were matched with the Sierra Leone EVD case database to retrieve cycle threshold (Ct) values from the qRT-PCR analysis done in blood during acute disease. A purposive sampling strategy was used, and the included sample composition was compared to the national EVD survivor database to understand deviations from the general male survivor population. At 180 days (6 months) after Ebola treatment unit (ETU) discharge, the EBOV RNA semen positive rate was 75.4% (95% CI 66.9%-82.0%). The median persistence duration was 204 days, with 50% of men having cleared their semen of EBOV RNA after this time. At 270 days, persistence was 26.8% (95% CI 20.0%-34.2%), and at 360 days, 6.0% (95% CI 3.1%-10.2%). Longer persistence was significantly associated with severe acute disease, with probability of persistence in this population at 1 year at 10.1% (95% CI 4.6%-19.8%) compared to the probability approaching 0% for those with mild acute disease. Age showed a dose-response pattern, where the youngest men (</=25 years) were 3.17 (95% CI 1.60, 6.29) times more likely to be EBOV RNA negative in semen, and men aged 26-35 years were 1.85 (95% CI 1.04, 3.28) times more likely to be negative, than men aged >35 years. Among participants with both severe acute EVD and a higher age (>35 years), persistence remained above 20% (95% CI 6.0%-50.6%) at 1 year. Uptake of safe sex recommendations 3 months after ETU discharge was low among a third of survivors. The sample was largely representative of male survivors in Sierra Leone. A limitation of this study is the lack of knowledge about infectiousness. CONCLUSIONS: In this study we observed that EBOV RNA persistence in semen was a frequent phenomenon, with high population rates over time. This finding will inform forthcoming updated recommendations on risk reduction strategies relating to sexual transmission of EBOV. Our findings support implementation of a semen testing program as part of epidemic preparedness and response. Further, the results will enable planning of the magnitude of testing and targeted counseling needs over time.

Tags: Adult, Aged, Cohort Studies, Ebolavirus/*genetics/pathogenicity, Hemorrhagic Fever, Ebola/*epidemiology/virology, Humans, Male, Middle Aged, Real-Time Polymerase Chain Reaction, Risk Factors, RNA, Viral/*genetics, Semen/*virology, Survivors/statistics & numerical data.

Korda, A., Sauter, T. C., Caversaccio, M. D., and Mantokoudis, G. “Quantifying A Learning Curve For Video Head Impulse Test: Pitfalls And Pearls”. Front Neurol 11: 615651. doi:10.3389/fneur.2020.615651.

Abstract: Objective: The video head impulse test (vHIT) is nowadays a fast and objective method to measure vestibular function. However, its usability is controversial and often considered as a test performed by experts only. We sought to study the learning curve of novices and to document all possible mistakes and pitfalls in the process of learning. Methods: In a prospective cohort observational study, we included 10 novices. We tested their ability to perform correctly horizontal head impulses recorded with vHIT. We assessed vHITs in 10 sessions with 20 impulses per session giving a video instruction after the first session (S1) and individual feedback from an expert for session 2 (S2) up to session 10 (S10). We compared VOR gain, the HIT acceptance rate by the device algorithm, mean head velocity, acceleration, excursion, and overshoot between sessions. Results: A satisfying number of accepted HITs (80%) was reached after an experience of 160 vHITs. Mean head velocity between sessions was always in accepted limits. Head acceleration was too low at the beginning (S1) but improved significantly after the video instruction (p = 0.001). Mean head excursion and overshoot showed a significant improvement after 200 head impulses (p < 0.001 each). Conclusions: We showed that novices can learn to perform head impulses invHIT very fast provided that they receive instructions and feedback from an experienced examiner. Video instructions alone were not sufficient. The most common pitfall was a low head acceleration.

Tags: commercial or financial relationships that could be construed as a potential, conflict of interest., emergency department, head impulse test, learning curve, vertigo, video head impulse test (vHIT).

Haag, E., Gregoriano, C., Molitor, A., Kloter, M., Kutz, A., Mueller, B., and Schuetz, P. “Does Mid-Regional Pro-Adrenomedullin (Mr-Proadm) Improve The Sequential Organ Failure Assessment-Score (Sofa Score) For Mortality-Prediction In Patients With Acute Infections? Results Of A Prospective Observational Study”. Clin Chem Lab Med 59, no. 6: 1165-1176. doi:10.1515/cclm-2020-1566.

Abstract: OBJECTIVES: Risk stratification in patients with infection is usually based on the Sequential Organ Failure Assessment-Score (SOFA score). Our aim was to investigate whether the vasoactive peptide mid-regional pro-adrenomedullin (MR-proADM) improves the predictive value of the SOFA score for 30-day mortality in patients with acute infection presenting to the emergency department (ED). METHODS: This secondary analysis of the prospective observational TRIAGE study included 657 patients with infection. The SOFA score, MR-proADM, and traditional inflammation markers were all measured at time of admission. Associations of admission parameters and 30-day mortality were investigated by measures of logistic regression, discrimination analyses, net reclassification index (NRI), and integrated discrimination index (IDI). RESULTS: MR-proADM values were higher in non-survivors compared with survivors (4.5+/-3.5 nmol/L vs. 1.7 +/- 1.8 nmol/L) with an adjusted odds ratio of 26.6 (95% CI 3.92 to 180.61, p=0.001) per 1 nmol/L increase in admission MR-proADM levels and an area under the receiver operator curve (AUC) of 0.86. While the SOFA score alone revealed an AUC of 0.81, adding MR-proADM further improved discrimination (AUC 0.87) and classification within predefined risk categories (NRI 0.075, p-value <0.05). An admission MR-proADM threshold of 1.75 nmol/L provided the best prognostic accuracy for 30-day mortality; with a sensitivity of 81% and a specificity of 75%, and a negative predictive value of 98%. CONCLUSIONS: MR-proADM improved the mortality risk stratification in patients with infection presenting to the ED beyond SOFA score alone and may further improve initial therapeutic site-of-care decisions. TRIAL REGISTRATION: ClinicalTrials.gov NCT01768494. Registered January 15, 2013.

Tags: *Infections, *Organ Dysfunction Scores, Adrenomedullin, biomarker, Biomarkers, Humans, infection, MR-proADM, Prognosis, Prospective Studies, Protein Precursors, risk-stratification, sepsis, SOFA score.

Schoning, V., Liakoni, E., Baumgartner, C., Exadaktylos, A. K., Hautz, W. E., Atkinson, A., and Hammann, F. “Development And Validation Of A Prognostic Covid-19 Severity Assessment (Cosa) Score And Machine Learning Models For Patient Triage At A Tertiary Hospital”. J Transl Med 19, no. 1: 56. doi:10.1186/s12967-021-02720-w.

Abstract: BACKGROUND: Clinical risk scores and machine learning models based on routine laboratory values could assist in automated early identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients at risk for severe clinical outcomes. They can guide patient triage, inform allocation of health care resources, and contribute to the improvement of clinical outcomes. METHODS: In- and out-patients tested positive for SARS-CoV-2 at the Insel Hospital Group Bern, Switzerland, between February 1st and August 31st ('first wave', n = 198) and September 1st through November 16th 2020 ('second wave', n = 459) were used as training and prospective validation cohort, respectively. A clinical risk stratification score and machine learning (ML) models were developed using demographic data, medical history, and laboratory values taken up to 3 days before, or 1 day after, positive testing to predict severe outcomes of hospitalization (a composite endpoint of admission to intensive care, or death from any cause). Test accuracy was assessed using the area under the receiver operating characteristic curve (AUROC). RESULTS: Sex, C-reactive protein, sodium, hemoglobin, glomerular filtration rate, glucose, and leucocytes around the time of first positive testing (- 3 to + 1 days) were the most predictive parameters. AUROC of the risk stratification score on training data (AUROC = 0.94, positive predictive value (PPV) = 0.97, negative predictive value (NPV) = 0.80) were comparable to the prospective validation cohort (AUROC = 0.85, PPV = 0.91, NPV = 0.81). The most successful ML algorithm with respect to AUROC was support vector machines (median = 0.96, interquartile range = 0.85-0.99, PPV = 0.90, NPV = 0.58). CONCLUSION: With a small set of easily obtainable parameters, both the clinical risk stratification score and the ML models were predictive for severe outcomes at our tertiary hospital center, and performed well in prospective validation.

Tags: *Machine Learning, *Severity of Illness Index, *Tertiary Care Centers, *Triage, Aged, Area Under Curve, Artificial intelligence, Cohort Studies, COVID-19/*virology, Critical illness, Female, Humans, Male, Middle Aged, Prognosis, Risk Assessment, Risk stratification, ROC Curve, SARS-CoV-2, SARS-CoV-2/*physiology, Statistical learning.

Rueegg, M., Nickel, C. H., and Bingisser, R. “Disagreements Between Emergency Patients And Physicians Regarding Chief Complaint - Patient Factors And Prognostic Implications”. Int J Clin Pract 75, no. 5: e14070. doi:10.1111/ijcp.14070.

Abstract: INTRODUCTION: The predictive power of chief complaints reported at presentation to the emergency department (ED) is well known. However, there is a lack of research on the coherence of patient versus physician reported chief complaints. The aim of this study was to determine the rate of disagreement between patients and physicians regarding chief complaint and its significance for the prediction of the outcomes number of resources used during ED work-up, hospitalisation, ICU admission, in-hospital mortality and hospital length of stay. METHODS: In this secondary analysis of a study conducted over a time course of 9 weeks, consecutive emergency patients and their physicians were independently asked to report the chief complaint upon presentation. The two reports were assessed for pair-wise agreement. RESULTS: Of 6722 emergency patients (mean age 53.3, 46.8% female), the median number of symptoms reported by patients was two and one reported by physicians. The rate of disagreement on chief complaints was 32.6%. Disagreement was associated with a higher number of resources (beta = 0.24; CI, 0.18, 0.31, P <.001) and hospitalisation (OR = 1.31; CI, 1.16, 1.48, P <.001), using multivariable analyses. Patient factors associated with disagreement were age (OR = 1.01; CI, 1.01, 1.01, P <.001), number of patient reported symptoms (OR = 1.27; CI, 1.23, 1.32, P <.001) and male gender (OR = 1.12; 1.01, 1.25, P =.0285). CONCLUSION: Disagreement on chief complaint between patient and physician may be an early marker for a complex work-up, requiring more resources and hospitalisations. The relevance of this finding is the newly identified signal of chief complaint replacement. It is easy to identify and should generate attention, as it affects a certain phenotype (older male patients with higher numbers of complaints).

Tags: *Emergency Service, Hospital, *Physicians, Female, Hospital Mortality, Humans, Male, Middle Aged, Prognosis.

Khorram-Manesh, A., Phattharapornjaroen, P., Mortelmans, L. J., Goniewicz, K., Verheul, M., Sorensen, J. L., Pereira, I., et al. “Current Perspectives And Concerns Facing Hospital Evacuation: The Results Of A Pilot Study And Literature Review”. Disaster Med Public Health Prep 16, no. 2: 650-658. doi:10.1017/dmp.2020.391.

Abstract: OBJECTIVE: To analyze the evacuation preparedness of hospitals within the European Union (EU). METHOD: This study consisted of 2 steps. In the first step, a systematic review of the subject matter, according to the PRISMA flow diagram, was performed. Using Scopus (Elsevier, Amsterdam, Netherlands), PubMed (National Library of Medicine, Bethesda, MD), and Gothenburg University s search engine, 11 questions were extracted from the review and were sent to representatives from 15 European Union (EU)- and non-EU countries. RESULTS: The findings indicate that there is neither a full preparedness nor a standard guideline for evacuation within the EU or other non-EU countries in this study. A major shortcoming revealed by this study is the lack of awareness of the untoward consequences of medical decision-making during an evacuation. Some countries did not respond to the questions due to the lack of relevant guidelines, instructions, or time. CONCLUSION: Hospitals are exposed to internal and external incidents and require an adequate evacuation plan. Despite many publications, reports, and conclusions on successful and unsuccessful evacuation, there is still no common guide for evacuation, and many hospitals lack the proper preparedness. There is a need for a multinational collaboration, specifically within the EU, to establish such an evacuation planning or guideline to be used mutually within the union and the international community.

Tags: *Disaster Planning, *Hospitals, disaster planning guidelines, emergency services, hospital evacuation, Humans, Netherlands, Pilot Projects, surge capacity, triage.

Ambrosetti, J., Macheret, L., Folliet, A., Wullschleger, A., Amerio, A., Aguglia, A., Serafini, G., et al. “Impact Of The Covid-19 Pandemic On Psychiatric Admissions To A Large Swiss Emergency Department: An Observational Study”. Int J Environ Res Public Health 18, no. 3: 1-10. doi:10.3390/ijerph18031174.

Abstract: The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency with profound mental health consequences. The psychiatric emergency department (ED) plays a key role during this mental health crisis. This study aimed to investigate differences in admissions at a Swiss psychiatric ED from 1 April to 15 May during a "pandemic-free" period in 2016 and a "during-pandemic" period in 2020. The study included 579 consultations at psychiatric ED in the "during-pandemic" period and 702 in the "pandemic-free" period. Sociodemographic and clinical characteristics were compared, and logistic regression analysis was performed to identify variables associated with psychiatric admissions during the pandemic. A reduction in total psychiatric ED admissions was documented during COVID-19. Logistic regression analysis predicted the independent variable (ED admission during the pandemic) and estimated odds ratio (OR) for being unmarried/not in a relationship, arrival in an ambulance, suicidal behavior, behavioral disorders and psychomotor agitation. Though only statistically significant in bivariate analysis, patients were also more likely to be involuntarily hospitalized. This picture appears to be reversed from a sociodemographic and clinical point of view to our observation of psychiatric ED consultation in 2016. These findings highlight that the reduction in psychiatric ED admissions during the pandemic seems to be associated with living alone and more severe psychopathologies, which must alert psychiatrists to ensure access to mental health care in times of pandemic.

Tags: *Pandemics, coronavirus, COVID-19 pandemic, COVID-19/*psychology, depression, emergency department, Emergency Service, Hospital/*statistics & numerical data, Hospitalization/*statistics & numerical data, Humans, Mental Health, psychiatric admissions, Psychiatric Department, Hospital/*statistics & numerical data, psychotic episode, public mental health, substance use disorder, suicidal behavior, suicide, Switzerland/epidemiology.

Esteves Pereira, M., Bocksrucker, C., Kremer Hovinga, J. A., Mueller, M., Daskalakis, M., Mansouri Taleghani, B., and Nagler, M. “Immunoadsorption For The Treatment Of Acquired Hemophilia: New Observational Data, Systematic Review, And Meta-Analysis”. Transfus Med Rev 35, no. 2: 125-134. doi:10.1016/j.tmrv.2021.01.001.

Abstract: The treatment of patients with acquired hemophilia is challenging due to life-threatening hemorrhages, delayed response, and adverse effects to immunosuppressive agents. Even though immunoadsorption (IA) rapidly removes autoantibodies against factor VIII, this intervention's effectiveness is still a matter of debate. We aimed to study important outcomes of IA as adjunctive treatment in patients with acquired hemophilia. We performed comprehensive literature searches in MEDLINE and EMBASE databases. Clinical and laboratory data of all patients treated in our institution were additionally included. Literature searching yielded 498 records, of which 10 studies describing 106 patients were finally included. The number of patients varied from 1 to 65, and patients' ages ranged between 14 and 89. Treatment criteria in most patients were (1) failed response to immunosuppressive treatment alone, and/or (2) uncontrollable bleeding episodes, and/or (3) high inhibitor titer. Methodological quality was moderate. The number of IA sessions varied from 1 to 24. Within our institution, 12 patients have been treated since 2002; median age was 76 years (range 34-86); median titer of factor VIII inhibitor was 20 Bethesda units (range 3-214). Pooled estimates, modeling a random-effect binominal distribution incorporating the Freeman-Tukey double arcsine transformation, were 86% in case of factor VIII recovery (95% confidence interval 76%-94%), 95% for reduction of factor VIII inhibitor (83%, 100%), and 7% in case of death (0%, 18%). Our data suggest that IA might be a beneficial adjunctive treatment in patients with high-risk acquired hemophilia, but future studies shall confirm this observation.

Tags: *Hemophilia A/therapy, Acquired, Adolescent, Adult, Aged, Aged, 80 and over, Autoantibodies, Blood Coagulation Tests, Factor VIII, Factor VIII deficiency, Hemorrhage, Hemorrhage/drug therapy, Hemostatics/therapeutic use, Humans, Immunosorbent techniques, Immunosuppressive Agents, Middle Aged, Therapeutics, Young Adult.

Banholzer, S., Dunkelmann, L., Haschke, M., Derungs, A., Exadaktylos, A., Krahenbuhl, S., and Liakoni, E. “Retrospective Analysis Of Adverse Drug Reactions Leading To Short-Term Emergency Hospital Readmission”. Swiss Med Wkly 151: w20400. doi:10.4414/smw.2021.20400.

Abstract: AIMS OF THE STUDY: Adverse drug reactions (ADRs) are an important cause of hospital admissions. Insufficient data are available about the frequency and characteristics of ADR-related emergency readmissions in Switzerland. The aim of this retrospective study was to characterise ADRs related to short-term emergency readmissions in a large Swiss University Hospital and to assess their reporting frequency. METHODS: Electronic records of all patients discharged from the University Hospital Bern within a 12-month period (1 January to 31 December 2012) and emergency readmission within 30 calendar days were reviewed. Case inclusion required a known ADR. Cases with intentional overdosing, lack of compliance or insufficient documentation were excluded. Identified ADR-related readmission cases were searched in the Swiss ADR reporting system to assess reporting rate. RESULTS: There were 1294 emergency readmissions among the 4792 readmissions (14% of all admissions) within 30 days after discharge. We identified 270 cases of ADR-related readmissions, corresponding to 21% of emergency readmissions and 6% of all readmissions within 30 days. The most frequent ADRs were gastrointestinal disorders (26%), infections and infestations (19%), and nervous system disorders (10%). The most frequent drug classes leading to ADRs were antineoplastic/immunomodulating (35%) and antithrombotic agents (25%). Only 8 (3%) of the 270 cases were reported to the Swiss ADR reporting system. CONCLUSION: ADR-related readmissions constituted a considerable part of short-term emergency readmissions. Despite being a relevant cause for rehospitalisation, only a minority of the ADRs were reported to the regulatory authorities. Strategies to prevent ADR-related readmissions and to improve reporting rates are needed.

Tags: *Drug-Related Side Effects and Adverse Reactions/epidemiology, *Patient Readmission, Adverse Drug Reaction Reporting Systems, Emergency Service, Hospital, Hospitalization, Humans, Retrospective Studies.

Sahyoun, C., Cantais, A., Gervaix, A., Bressan, S., Lollgen, R., Krauss, B., Pediatric Emergency Medicine, Comfort, and Analgesia Research in Europe group of the Research in European Pediatric Emergency, Medicine. “Pediatric Procedural Sedation And Analgesia In The Emergency Department: Surveying The Current European Practice”. Eur J Pediatr 180, no. 6: 1799-1813. doi:10.1007/s00431-021-03930-6.

Abstract: Procedural sedation and analgesia outside the operating theater have become standard care in managing pain and anxiety in children undergoing diagnostic and therapeutic procedures. The objectives of this study are to describe the current pediatric procedural sedation and analgesia practice patterns in European emergency departments, to perform a needs assessment-like analysis, and to identify barriers to implementation. A survey study of European emergency departments treating children was conducted. Through a lead research coordinator identified through the Research in European Pediatric Emergency Medicine (REPEM) network for each of the participating countries, a 30-question questionnaire was sent, targeting senior physicians at each site. Descriptive statistics were performed. One hundred and seventy-one sites participated, treating approximately 5 million children/year and representing 19 countries, with a response rate of 89%. Of the procedural sedation and analgesia medications, midazolam (100%) and ketamine (91%) were available to most children, whereas propofol (67%), nitrous oxide (56%), intranasal fentanyl (47%), and chloral hydrate (42%) were less frequent. Children were sedated by general pediatricians in 82% of cases. Safety and monitoring guidelines were common (74%), but pre-procedural checklists (51%) and capnography (46%) less available. In 37% of the sites, the entire staff performing procedural sedation and analgesia were certified in pediatric advanced life support. Pediatric emergency medicine was a board-certified specialty in 3/19 countries. Physician (73%) and nursing (72%) shortages and lack of physical space (69%) were commonly reported as barriers to procedural sedation and analgesia. Nurse-directed triage protocols were in place in 52% of the sites, mostly for paracetamol (99%) and ibuprofen (91%). Tissue adhesive for laceration repair was available to 91% of children, while topical anesthetics for intravenous catheterization was available to 55%. Access to child life specialists (13%) and hypnosis (12%) was rare.Conclusion: Procedural sedation and analgesia are prevalent in European emergency departments, but some sedation agents and topical anesthetics are not widely available. Guidelines are common but further safety nets, nurse-directed triage analgesia, and nonpharmacologic support to procedural sedation and analgesia are lacking. Barriers to implementation include availability of sedation agents, staff shortage, and lack of space. What is Known: * Effective and prompt analgesia, anxiolysis, and sedation (PSA) outside the operating theatre have become standard in managing pain and anxiety in children undergoing painful or anxiogenic diagnostic and therapeutic procedures. * We searched PubMed up to September 15, 2020, without any date limits or language restrictions, using different combinations of the MeSH terms "pediatrics," "hypnotics and sedatives," "conscious sedation," and "ambulatory surgical procedures" and the non-MeSH term "procedural sedation" and found no reports describing the current practice of pediatric PSA in Europe. What is New: * This study is, to the best of our knowledge, the first to shed light on the pediatric PSA practice in European EDs and uncovers important gaps in several domains, notably availability of sedation medications and topical anesthetics, safety aspects such as PSA provider training, availability of nonpharmacologic support to PSA, and high impact interventions such as nurse-directed triage analgesia. * Other identified barriers to PSA implementation include staff shortage, control of sedation medications by specialists outside the emergency department, and lack of space.

Tags: *Analgesia, Ambulatory surgical procedures, Child, Conscious Sedation, Emergency medicine, Emergency Service, Hospital, Europe, Humans, Hypnotics and Sedatives, Non-pharmacological approaches, Pain/drug therapy/etiology, Pediatrics, Procedural sedation and analgesia, Surveys and Questionnaires.

Zimmermann, T., du Fay de Lavallaz, J., Walter, J. E., Strebel, I., Nestelberger, T., Joray, L., Badertscher, P., et al. “Development Of An Electrocardiogram-Based Risk Calculator For A Cardiac Cause Of Syncope”. Heart 107, no. 22: 1796-1804. doi:10.1136/heartjnl-2020-318430.

Abstract: OBJECTIVE: To develop an ECG-based tool for rapid risk assessment of a cardiac cause of syncope in patients >/=40 years. METHODS: In a prospective international multicentre study, 2007 patients >/=40 years presenting with syncope were recruited in the emergency department (ED) of participating centres ranging from large university hospitals to smaller rural hospitals in eight countries from May 2010 to July 2017. 12-Lead ECG recordings were obtained at ED presentation following the syncopal event. The primary diagnostic outcome, a cardiac cause of syncope, was centrally adjudicated by two independent cardiologists using all available clinical information including 12-month follow-up. ECG predictors for a cardiac cause of syncope were identified using penalised backward selection and a continuous-scale likelihood was calculated based on regression analysis coefficients. Findings were validated in an independent US multicentre cohort including 2269 patients. RESULTS: In the derivation cohort, a cardiac cause of syncope was adjudicated in 267 patients (16%). Seven ECG criteria were identified as predictors for this outcome: heart rate and QTc-interval (continuous predictors), rhythm, atrioventricular block, ST-segment depression, bundle branch block and ventricular extrasystole/non-sustained ventricular tachycardia (categorical predictors). Diagnostic accuracy of these combined predictors for a cardiac cause of syncope was high (area under the curve 0.80, 95% CI 0.77 to 0.83). Overall, 138 patients (8%) were rapidly triaged towards rule-out and 181 patients (11%) towards rule-in of a cardiac cause of syncope. External validation showed similar performance. CONCLUSION: In patients >/=40 years with a syncopal event, a combination of seven ECG criteria enabled rapid assessment of the likelihood that syncope was due to a cardiac cause. TRIAL REGISTRATION NUMBER: NCT01548352 (BASEL IX), NCT01802398 (SRS study).

Tags: (PASMP3-136995), the Swiss Heart Foundation, the Professor Max Cloetta, Abbott, AstraZeneca, Bayer, Beckman, Boehrhinger-Ingelheim, Ischemia Care, Dx,, Aged, Aged, 80 and over, Akademische Gesellschaft Basel (Switzerland). JEW reports a research grant from, Alere, grants from Beckman, grants and personal fees from Roche, outside the, analysis. All authors have read and approved the manuscript. The sponsors had no, and Siemens, having provided expert testimony for Johnson and Johnson, and having, and the Freiwillige Akademische Gesellschaft Basel. LC reports grants and, arrhythmias, Bangerter Foundation (YTCR 23/17). PB has received research funding from the, Bohringer-Ingelheim, outside the submitted work. TR has received research grants, cardiac, Cardiovascular Research Foundation Basel, the University Basel, the University, Coulter, grants and personal fees from Siemens, outside the submitted work. MT, Daiichi-Sankyo, personal fees from Pfizer-BMS, personal fees from, data, vouch for the data and analysis, wrote the paper and decided to publish., Diagnostics, Idorsia, Novartis, Ortho Clinical Diagnostics, Roche, Sanofi,, e-print servers. TZ has received research support from the Freiwillige, electrocardiography, Electrocardiography/*methods, Emergency Service, Hospital, Female, Fisher, Cardiorentis, Sanofi, and research grants from the Spanish Ministry of, Follow-Up Studies, Foundation, the Swiss Heart Foundation, the European Union, the KTI, the, Foundation, the University of Basel and the University Hospital Basel as well as, from Acon, Amgen, Bayer, BMS, Boehringer Ingelheim, Idorsia, Medtronic, Novartis,, from the Goldschmidt-Jacobson Foundation, the Swiss National Science Foundation, Health and FEDER, Mapfre, Novartis, Bayer, MSD, Abbot and Orion-Pharma, outside, Heart Rate/*physiology, Hospital Basel, Abbott, AstraZeneca, Beckman Coulter, BRAHMS, Critical, Humans, Immunarray, Instrument Labs, Janssen, Ortho Clinical Diagnostics, Relypsa, Roche, Immunarray, Janssen, Roche and ZS Pharma, having served as a consultant for, Male, Medicine, Ischemia DX. MK reports personal fees from Bayer, personal fees from, Middle Aged, Novartis, MSD, Bristol-Myers Squibb, Pfizer, The Medicine Company, Otsuka, Thermo, Osler, Roche, Sanofi, Siemens and Singulex., ownership interests in Comprehensive Research Associates, and Emergencies in, personal fees from Abbott Diagnostics, grants and personal fees from Beckman, Prospective Studies, published previously and are not being considered for publications elsewhere in, reports grants and personal fees from Abbott, grants and personal fees from, responsibility for the integrity of the data and the accuracy of the data, Risk Assessment/*methods, Risk Factors, Roche. BS has received consulting honoraria from Medtronic, outside the submitted, role in designing or conducting the study and no role in gathering or analysing, Siemens and Singulex, as well as speaker/consulting honoraria or travel support, speaker honoraria from Abbott, Bayer, Biosense, Brahms, Medtronic, Pfizer-BMS and, submitted work. FJM-S received speaker, advisory or consulting fees from, Syncope/*diagnosis/epidemiology/etiology, the data or writing the manuscript. The manuscript and its contents have not been, the submitted work. WFP reports research grants from Abbott, Braincheck,, the Swiss Heart Foundation, the Swiss Academy of Medical Sciences and the, Time Factors, TZ, JD and CM had full access to all the data in the study and take, University of Basel, the "Stiftung fur Herzschrittmacher und Elektrophysiologie", whole or in part in any language, including publicly accessible websites or, work. CM has received research support from the Swiss National Science.

Fahrner, R., Bahler, S., and Lindner, G. “Covid-19 Lock-Down Significantly Reduced Number Of Surgical Presentations In An Emergency Department”. Wien Klin Wochenschr 133, no. 7-8: 399-402. doi:10.1007/s00508-021-01810-5.

Abstract: BACKGROUND: Coronavirus disease 2019 (COVID-19) is an acute virus infection, which was declared by the World Health Organization (WHO) as a pandemic. As a consequence, the Swiss government decreed a public lock-down to reduce and restrict further infections. The aim of this investigation was to provide the impact of the COVID-19 lock-down on the presentations of patients in an interdisciplinary emergency department (ED). PATIENTS, MATERIAL AND METHODS: A retrospective study was performed at an interdisciplinary Swiss ED during the lock-down period. All patients who presented to the ED were enrolled in this investigation and compared to a control cohort during the same time period in 2019. Data regarding patients' characteristics, medical specialty, time course of presentations during the observation period, outpatient or hospital admission were analyzed. RESULTS: In total 7072 patients were included in the final analysis. During the lock-down period the number of ED presentations significantly decreased by 29% in comparison to the control period in the previous year (p < 0.0001). The analysis of the time course revealed that in each week the number of patients was lower with 13-43% reduction. Irrespective of the medical specialty, the number of presentations decreased during the COVID-19 situation, whereas this decrease was higher in surgical diseases (31%, p < 0.0001) than in non-surgical presentations (3.6%, p = 0.4). CONCLUSION: The socioeconomic lock-down was associated with reduced number of presentations in an ED. Mainly, surgical diseases and injuries were affected in terms of a reduction of presentations during the COVID-19 lock-down period.

Tags: *covid-19, Communicable Disease Control, Covid-19, Emergency department, Emergency Service, Hospital, from Bayer, Fresenius Kabi, Otsuka, Daiichi Sankyo, GlaxoSmithKline, Otsuka, and Pierre Fabre). R. Fahrner and S. Bahler declare that, Humans, Medicine, Pandemic, Retrospective Studies, SARS-CoV-2, specific report., Surgery, they have no competing interests. None of the authors obtained funding for this, travel grants from.

Speidel, V., Conen, A., Gisler, V., Fux, C. A., and Haubitz, S. “Lung Assessment With Point-Of-Care Ultrasound In Respiratory Coronavirus Disease (Covid-19): A Prospective Cohort Study”. Ultrasound Med Biol 47, no. 4: 896-901. doi:10.1016/j.ultrasmedbio.2020.12.021.

Abstract: Lung ultrasound (LUS) has shown promising diagnostic potential in different pulmonary conditions. We evaluated the diagnostic accuracy of LUS for pulmonary COVID-19. In this prospective cohort study at a Swiss tertiary care center, patients hospitalized with suspected COVID-19 were scanned using a 12-zone protocol. Association of a summation score (0-36 points) with the final diagnosis was tested using the area under the receiver operating characteristic curve and sensitivity and specificity at different cutoff points. Of the 49 participants, 11 (22%) were later diagnosed with COVID-19. LUS score showed excellent diagnostic performance, with an odds ratio of 1.30 per point (95% confidence interval [CI], 1.09-1.54, p = 0.003) and an area under the curve of 0.85 (95% CI, 0.71-0.99). At a cutoff of 8/36 points, 10 of 11 participants later diagnosed with COVID-19 were correctly predicted (sensitivity 91%, 95% CI, 59%-100%), and 29 of the 38 who were not diagnosed with COVID-19 were correctly ruled out (specificity 76%, 95% CI, 60%-89%). LUS demonstrated promising discriminatory potential in people hospitalized with suspected COVID-19.

Tags: *Point-of-Care Systems, Adult, Aged, Aged, 80 and over, Cohort Studies, Coronavirus disease, Covid-19, COVID-19/*diagnostic imaging, Female, Humans, Interstitial syndrome, Lung ultrasound, Lung/*diagnostic imaging, Male, Middle Aged, Pleura ultrasound, Pneumonia, Point of care ultrasound, Prospective Studies, Reproducibility of Results, SARS-CoV-2, Sensitivity and Specificity, Ultrasonography/*methods.

Lavanchy, J. L., Delafontaine, L., Haltmeier, T., Bednarski, P., Schnuriger, B., and Swiss Trauma, Registry. “Increased Hospital Treatment Volume Of Splenic Injury Predicts Higher Rates Of Successful Non-Operative Management And Reduces Hospital Length Of Stay: A Swiss Trauma Registry Analysis”. Eur J Trauma Emerg Surg 48, no. 1: 133-140. doi:10.1007/s00068-020-01582-z.

Abstract: PURPOSE: First time analysis of the epidemiology, management and outcomes of patients with splenic injuries in Switzerland. This study aims to assess the effect of hospital treatment volume on successful non-operative management (NOM) in splenic injuries. METHODS: A multicentric registry-based study including all patients with splenic injuries entered into the Swiss Trauma Registry from 2015 to 2018 was conducted. Patients were stratified according to the hospitals treatment volume of splenic injuries. Primary outcome was the rate of successful NOM. RESULTS: During the 4-year study period, 652 patients with splenic injury were included in the study. Median age of the study population was 42 (IQR 27-59) years, and median ISS was 26 (20-34). The overall rate of successful NOM was 86.5%. Median HLOS was 13 (8-21) days. In-hospital mortality was 7.2% (n = 47). The mean number of patients with splenic injuries per center and year was 14. Five out of 12 Level I trauma centers treating more patients than the mean (>/= 15/year) were defined as high-volume centers. Multivariable analysis adjusting for differences in baseline and injury characteristics revealed treatment in a high-volume center as an independent predictor for successful NOM (OR 2.15, 95% CI 1.28-3.60, p = 0.004) and shorter HLOS (RC - 2.39, 95% CI - 4.91/- 0.48, p = 0.017), however, not for reduced in-hospital mortality (OR 0.92, 95% CI 0.39-2.18, p = 0.845). CONCLUSION: Higher hospital treatment volume was associated with a higher rate of NOM and shorter HLOS, but not lower mortality. These results constitute the basis for further quality improvement in the care of splenic injury patients within the trauma system in Switzerland.

Tags: *Abdominal Injuries, *Wounds, Nonpenetrating/therapy, Adult, Hospitals, Humans, Injury Severity Score, Length of Stay, Middle Aged, Non-operative management, Outcomes, Registries, Retrospective Studies, Splenic injury, Swiss trauma registry, Switzerland/epidemiology, Trauma Centers, Treatment Outcome, Treatment volume.

Kottmann, A., Strapazzon, G., Pasquier, M., Blancher, M., and Brugger, H. “Reply To Letter: Adaptation To The 2017 Icar Medcom Avalanche Victim Resuscitation Checklist”. Resuscitation 160: 66-67. doi:10.1016/j.resuscitation.2021.01.005.

Tags: *Avalanches, Checklist, Humans, Iron-Dextran Complex, Rescue Work, Resuscitation.

Chandna, A., Tan, R., Carter, M., Van Den Bruel, A., Verbakel, J., Koshiaris, C., Salim, N., Lubell, Y., Turner, P., and Keitel, K. “Predictors Of Disease Severity In Children Presenting From The Community With Febrile Illnesses: A Systematic Review Of Prognostic Studies”. Bmj Glob Health 6, no. 1. doi:10.1136/bmjgh-2020-003451.

Abstract: INTRODUCTION: Early identification of children at risk of severe febrile illness can optimise referral, admission and treatment decisions, particularly in resource-limited settings. We aimed to identify prognostic clinical and laboratory factors that predict progression to severe disease in febrile children presenting from the community. METHODS: We systematically reviewed publications retrieved from MEDLINE, Web of Science and Embase between 31 May 1999 and 30 April 2020, supplemented by hand search of reference lists and consultation with an expert Technical Advisory Panel. Studies evaluating prognostic factors or clinical prediction models in children presenting from the community with febrile illnesses were eligible. The primary outcome was any objective measure of disease severity ascertained within 30 days of enrolment. We calculated unadjusted likelihood ratios (LRs) for comparison of prognostic factors, and compared clinical prediction models using the area under the receiver operating characteristic curves (AUROCs). Risk of bias and applicability of studies were assessed using the Prediction Model Risk of Bias Assessment Tool and the Quality In Prognosis Studies tool. RESULTS: Of 5949 articles identified, 18 studies evaluating 200 prognostic factors and 25 clinical prediction models in 24 530 children were included. Heterogeneity between studies precluded formal meta-analysis. Malnutrition (positive LR range 1.56-11.13), hypoxia (2.10-8.11), altered consciousness (1.24-14.02), and markers of acidosis (1.36-7.71) and poor peripheral perfusion (1.78-17.38) were the most common predictors of severe disease. Clinical prediction model performance varied widely (AUROC range 0.49-0.97). Concerns regarding applicability were identified and most studies were at high risk of bias. CONCLUSIONS: Few studies address this important public health question. We identified prognostic factors from a wide range of geographic contexts that can help clinicians assess febrile children at risk of progressing to severe disease. Multicentre studies that include outpatients are required to explore generalisability and develop data-driven tools to support patient prioritisation and triage at the community level. PROSPERO REGISTRATION NUMBER: CRD42019140542.

Tags: *Hospitalization, *Models, Statistical, Bias, Child, child health, diseases, disorders, Humans, infections, injuries, paediatrics, Prognosis, public health, Severity of Illness Index, systematic review.

Kaegi-Braun, N., Mueller, M., Schuetz, P., Mueller, B., and Kutz, A. “Evaluation Of Nutritional Support And In-Hospital Mortality In Patients With Malnutrition”. Jama Netw Open 4, no. 1: e2033433. doi:10.1001/jamanetworkopen.2020.33433.

Abstract: IMPORTANCE: Malnutrition affects a considerable proportion of patients in the hospital and is associated with adverse clinical outcomes. Recent trials found a survival benefit among patients receiving nutritional support. OBJECTIVE: To investigate whether there is an association of nutritional support with in-hospital mortality in routine clinical practice. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted from April 2013 to December 2018 among a population of patients from Swiss administrative claims data. From 114 264 hospitalizations of medical patients with malnutrition, 34 967 patients (30.6%) receiving nutritional support were 1:1 propensity score matched to patients with malnutrition in the hospital who were not receiving nutritional support. Patients in intensive care units were excluded. Data were analyzed from February 2020 to November 2020. EXPOSURES: Receiving nutritional support, including dietary advice, oral nutritional supplementation, or enteral and parenteral nutrition. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause in-hospital mortality. Secondary outcomes were 30-day all-cause hospital readmission and discharge to a postacute care facility. Poisson and logistic regressions were used to estimate incidence rate ratios (IRRs) and odds ratios (ORs) of outcomes. RESULTS: After matching, the study identified 69 934 hospitalizations of patients coded as having malnutrition in the cohort (mean [SD] age, 73.8 [14.5] years; 36 776 [52.6%] women). Patients receiving nutritional support, compared with those not receiving nutritional support, had a lower in-hospital mortality rate (2525 of 34 967 patients died [7.2%] vs 3072 of 34 967 patients died [8.8%]; IRR, 0.79 [95% CI, 0.75-0.84]; P < .001) and a reduced 30-day readmission rate (IRR, 0.95 [95% CI, 0.91-0.98]; P = .002). In addition, patients receiving nutritional support were less frequently discharged to a postacute care facility (13 691 patients [42.2%] vs 14 324 patients [44.9%]; OR, 0.89 [95% CI, 0.86-0.91]; P < .001). CONCLUSIONS AND RELEVANCE: These findings suggest that nutritional support was associated with reduced mortality among patients in the medical ward with malnutrition. The results support data found by randomized clinical trials and may help to inform patients, clinicians, and authorities regarding the usefulness of nutritional support in clinical practice.

Tags: *Hospital Mortality, *Hospitalization, Aged, Female, Humans, Male, Malnutrition/*diet therapy/*mortality, Nutritional Support/*methods, Patient Readmission/statistics & numerical data, Propensity Score, Subacute Care/statistics & numerical data, Switzerland.

Atila, C., Sailer, C. O., Bassetti, S., Tschudin-Sutter, S., Bingisser, R., Siegemund, M., Osswald, S., et al. “Prevalence And Outcome Of Dysnatremia In Patients With Covid-19 Compared To Controls”. Eur J Endocrinol 184, no. 3: 409-418. doi:10.1530/EJE-20-1374.

Abstract: OBJECTIVE: The pandemic of coronavirus disease (COVID-19) has rapidly spread globally and infected millions of people. The prevalence and prognostic impact of dysnatremia in COVID-19 is inconclusive. Therefore, we investigated the prevalence and outcome of dysnatremia in COVID-19. DESIGN: The prospective, observational, cohort study included consecutive patients with clinical suspicion of COVID-19 triaged to a Swiss Emergency Department between March and July 2020. METHODS: Collected data included clinical, laboratory and disease severity scoring parameters on admission. COVID-19 cases were identified based on a positive nasopharyngeal swab test for SARS-CoV-2, patients with a negative swab test served as controls. The primary analysis was to assess the prognostic impact of dysnatremia on 30-day mortality using a cox proportional hazard model. RESULTS: 172 (17%) cases with COVID-19 and 849 (83%) controls were included. Patients with COVID-19 showed a higher prevalence of hyponatremia compared to controls (28.1% vs 17.5%, P < 0.001); while comparable for hypernatremia (2.9% vs 2.1%, P = 0.34). In COVID-19 but not in controls, hyponatremia was associated with a higher 30-day mortality (HR: 1.4, 95% CI: 1.10-16.62, P = 0.05). In both groups, hypernatremia on admission was associated with higher 30-day mortality (COVID-19 - HR: 11.5, 95% CI: 5.00-26.43, P < 0.001; controls - HR: 5.3, 95% CI: 1.60-17.64, P = 0.006). In both groups, hyponatremia and hypernatremia were significantly associated with adverse outcome, for example, intensive care unit admission, longer hospitalization and mechanical ventilation. CONCLUSION: Our results underline the importance of dysnatremia as predictive marker in COVID-19. Treating physicians should be aware of appropriate treatment measures to be taken for patients with COVID-19 and dysnatremia.

Tags: Adult, Aged, Case-Control Studies, Cohort Studies, COVID-19/complications/*diagnosis/*epidemiology/therapy, Critical Care/statistics & numerical data, Female, Hospital Mortality, Hospitalization/statistics & numerical data, Humans, Hypernatremia/complications/*diagnosis/*epidemiology/therapy, Hyponatremia/complications/*diagnosis/*epidemiology/therapy, Length of Stay/statistics & numerical data, Male, Middle Aged, Mortality, Pandemics, Prevalence, Prognosis, Prospective Studies, SARS-CoV-2, Switzerland/epidemiology, Triage.

Gravel, J., Manzano, S., Nault, M. L., Vallieres, E., Rallu, F., and Renaud, C. “Oropharyngeal Carriage Of Kingella Kingae And Transient Synovitis Of The Hip In Young Children: A Case-Control Study”. Pediatr Infect Dis J 40, no. 3: 182-185. doi:10.1097/INF.0000000000002944.

Abstract: BACKGROUND: Transient synovitis of the hip affects mostly preschool children, and its etiology is unknown. Kingella kingae has been identified recently as a common etiologic agent of osteoarticular infections (OAI) in young children and could potentially be associated to transient synovitis of the hip. The main objective of this study was to evaluate the association between transient synovitis of the hip and oropharyngeal carriage of K. kingae among preschool children. METHODS: This was a prospective case-control study conducted at a tertiary care pediatric emergency department. Cases were children between 6 and 71 months of ages with a diagnosis of transient synovitis of the hip. For each transient synovitis case, an age-matched control was recruited among children presenting for a trauma. A second control group included children with any OAI. The independent variable was the presence of oropharyngeal K. kingae identified by a specific polymerase chain reaction assay. The primary analysis was the association between oropharyngeal K. kingae carriage and final diagnosis. RESULTS: A total of 73 children were included in the study. Among them, 25 had a transient synovitis, 16 an OAI, and 22 controls. Baseline demographics were similar between the groups. There was no difference in oropharyngeal carriage of K. kingae for children with transient synovitis (5/25; 0.20) in comparison to controls (3/22; 0.14), while it was higher for children with OAI (10/16; 0.63). CONCLUSIONS: There is no association between oropharyngeal K. kingae and transient synovitis of the hip among preschool children.

Tags: *Carrier State, *Kingella kingae, Case-Control Studies, Child, Child, Preschool, Female, Hip Joint/*microbiology/pathology, Humans, Male, Neisseriaceae Infections/*microbiology, Oropharynx/*microbiology, Synovitis/*microbiology.

Chastonay, O. J., Lemoine, M., Grazioli, V. S., Canepa Allen, M., Kasztura, M., Moullin, J. C., Daeppen, J. B., Hugli, O., and Bodenmann, P. “Health Care Providers' Perception Of The Frequent Emergency Department User Issue And Of Targeted Case Management Interventions: A Cross-Sectional National Survey In Switzerland”. Bmc Emerg Med 21, no. 1: 4. doi:10.1186/s12873-020-00397-w.

Abstract: BACKGROUND: Frequent users of emergency departments (FUEDs) (>/=5 ED visits/year) represent a vulnerable population with complex needs accounting for a significant number of emergency department (ED) consultations, thus contributing to EDs overcrowding. Research exploring ED staff perceptions of FUEDs is scarce. OBJECTIVES: The current study aimed to evaluate in ED staff a) the extent to which FUEDs are perceived as an issue; b) their perceived levels of knowledge and understanding of FUEDs; c) levels of perceived usefulness of case management (CM) and interest in implementing this intervention in their ED service. METHODS: Head physicians of the EDs at all public hospitals in Switzerland (of various level of specialization) were sent a 19-item web-based survey, pilot tested prior to its dissemination. The head physicians were asked to forward the survey to ED staff members from different health professional backgrounds. RESULTS: The hospital response rate was 81% (85/106). The exploitable hospital response rate was 71% (75/106 hospitals) including 208 responding health professionals. Issues and difficulties around FUEDs were perceived as important by 64% of respondents. The perceived frequency of being confronted with FUEDs was higher among nurses in more specialized EDs. In total, 64% of respondents felt poorly informed about FUEDs, nurses feeling less informed than physicians. The understanding of FUEDs was lower in the French-Italian-speaking parts (FISP) of Switzerland than in the German-speaking part. Eighty-one percent of respondents had no precise knowledge of FUED-related interventions. The perceived usefulness of CM interventions after receiving explanations about it was high (92%). However, the overall level of interest for CM implementation was 59%. The interest in CM by physicians was low across all regions and ED categories. Nurses, on the other hand, showed more interest, especially those in EDs of high specialization. CONCLUSIONS: The majority of ED staff reported being confronted with FUEDs on a regular basis. Staff perceived FUEDs as a vulnerable population, yet, they felt poorly informed about how to manage the issue. The majority of ED staff thought a CM intervention would be useful for FUEDs, however there appears to be a gap in their desire or willingness to implement such interventions.

Tags: *Attitude of Health Personnel, *Case Management, Acceptability, Case management, Cross-Sectional Studies, Emergency department, Emergency Service, Hospital, Equity, Evidence-based practice, Frequent user, Health Personnel, Health professionals' perception, Humans, Implementation, Perception, Switzerland.

Brandenberger, J., Pohl, C., Vogt, F., Tylleskar, T., and Ritz, N. “Health Care Provided To Recent Asylum-Seeking And Non-Asylum-Seeking Pediatric Patients In 2016 And 2017 At A Swiss Tertiary Hospital - A Retrospective Study”. Bmc Public Health 21, no. 1: 81. doi:10.1186/s12889-020-10082-z.

Abstract: BACKGROUND: Asylum-seeking children represent an increasing and vulnerable group of patients whose health needs are largely unmet. Data on the health care provision to asylum-seeking children in European contexts is scarce. In this study we compare the health care provided to recent asylum-seeking and non-asylum-seeking children at a Swiss tertiary hospital. METHODS: We performed a cross-sectional retrospective study in a pediatric tertiary care hospital in Basel, Switzerland. All patients and visits from January 2016 to December 2017 were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed and the patients were allocated accordingly in the two study groups. RESULTS: A total of 202,316 visits by 55,789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) individuals. The emergency department recorded the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64,315/200,642) respectively. The median number of visits per patient was 1 (IQR 1-2) in the asylum-seeking and 2 (IQR 1-4) in the non-asylum-seeking children. Hospital admissions were more common in asylum-seeking compared to non-asylum-seeking patients with 11% (184/1674) and 7% (14,692/200,642). Frequent visits (> 15 visits per patient) accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49,886/200,642) of total visits in non-asylum-seeking patients. CONCLUSIONS: Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Frequent care suggests that asylum-seeking patients also present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity.

Tags: *Refugees, Child, Children, Cross-Sectional Studies, Delivery of Health Care, Europe, health care delivery, Humans, Migrant and refugee health, Migration patterns, Retrospective Studies, Switzerland, Tertiary Care Centers, Use of health care.

Ageron, F. X., Coats, T. J., Darioli, V., and Roberts, I. “Validation Of The Batt Score For Prehospital Risk Stratification Of Traumatic Haemorrhagic Death: Usefulness For Tranexamic Acid Treatment Criteria”. Scand J Trauma Resusc Emerg Med 29, no. 1: 6. doi:10.1186/s13049-020-00827-5.

Abstract: BACKGROUND: Tranexamic acid reduces surgical blood loss and reduces deaths from bleeding in trauma patients. Tranexamic acid must be given urgently, preferably by paramedics at the scene of the injury or in the ambulance. We developed a simple score (Bleeding Audit Triage Trauma score) to predict death from bleeding. METHODS: We conducted an external validation of the BATT score using data from the UK Trauma Audit Research Network (TARN) from 1st January 2017 to 31st December 2018. We evaluated the impact of tranexamic acid treatment thresholds in trauma patients. RESULTS: We included 104,862 trauma patients with an injury severity score of 9 or above. Tranexamic acid was administered to 9915 (9%) patients. Of these 5185 (52%) received prehospital tranexamic acid. The BATT score had good accuracy (Brier score = 6%) and good discrimination (C-statistic 0.90; 95% CI 0.89-0.91). Calibration in the large showed no substantial difference between predicted and observed death due to bleeding (1.15% versus 1.16%, P = 0.81). Pre-hospital tranexamic acid treatment of trauma patients with a BATT score of 2 or more would avoid 210 bleeding deaths by treating 61,598 patients instead of avoiding 55 deaths by treating 9915 as currently. CONCLUSION: The BATT score identifies trauma patient at risk of significant haemorrhage. A score of 2 or more would be an appropriate threshold for pre-hospital tranexamic acid treatment.

Tags: *Emergency Medical Services, Adolescent, Adult, Aged, Antifibrinolytic Agents/*therapeutic use, Bleeding, could appear to have influenced the submitted work., Female, financial relationships with any organisations that might have an interest in the, Hemorrhage/*mortality/*prevention & control, Humans, Injury Severity Score, Male, Middle Aged, no other relationships or activities that, Patient Selection, Predictive Value of Tests, Prognostic model, Risk Assessment, Score, submitted work in the previous 3 years, Tranexamic acid, Tranexamic Acid/*therapeutic use, Trauma, Wounds and Injuries/complications/*mortality/therapy, Young Adult.

Kohns Vasconcelos, M., Meyer Sauteur, P. M., Keitel, K., Santoro, R., Heininger, U., van den Anker, J., and Bielicki, J. A. “Strikingly Decreased Community-Acquired Pneumonia Admissions In Children Despite Open Schools And Day-Care Facilities In Switzerland”. Pediatr Infect Dis J 40, no. 4: e171-e172. doi:10.1097/INF.0000000000003026.

Tags: Child, Child Day Care Centers/*statistics & numerical data, Community-Acquired Infections/diagnosis/*epidemiology/microbiology, Covid-19, Hospitalization/*statistics & numerical data, Humans, Pneumonia/diagnosis/*epidemiology/*microbiology, Respiratory Tract Infections/epidemiology/virology, Schools/*statistics & numerical data, Switzerland/epidemiology.

Brabrand, M., Bogh, S. B., Flojstrup, M., Kellett, J., Cooksley, T., and Nickel, C. H. “Routine Measurement Of D-Dimers On Suspected Sars-Cov2-Infected Patients Does Not Lead To Significant Increase In Radiological Investigations”. Intern Emerg Med 16, no. 4: 1097-1098. doi:10.1007/s11739-020-02568-w.

Tags: Adolescent, Adult, Aged, Biomarkers/blood, COVID-19/*blood/*diagnostic imaging, Denmark, Diagnostic Imaging/*statistics & numerical data, Female, Fibrin Fibrinogen Degradation Products/*metabolism, Humans, Male, Middle Aged, Registries, SARS-CoV-2.

Michel, Janet, Stuber, Raphael, Müller, Martin, Mettler, Annette, Furrer, Hansjakob, Ferrand, Rashida A., Exadaktylos, Aristomenis K., Hautz, Wolf E., and Sauter, Thomas C. “Covid-19 And Hiv Testing: Different Viruses But Similar Prejudices And Psychosocial Impacts”. Journal Of Global Health Reports 5. doi:10.29392/001c.21403.

Abstract: Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) high infectivity and perceived substantial fatality rates are causing negative psychosocial effects, including the increased psychiatric and economic burden. Research has demonstrated that a severe diagnosis triggers various responses in a person, including depression, sense of hopelessness, shame, and self-destructive behaviours. This manuscript explores the reasons why people did not follow the recommendations to be tested for SARS-CoV-2. Methods A mixed study design, sequential explanatory study was carried out from March-Dec 2020, based on an online COVID-19 symptom checker. Quantitative and qualitative data were collected. Video interviews were held with Key Informants (n=19), who were selected purposefully from the online tool users’ group that consented to the study. Results Among 176 users of the online triage tool, 150 (85%) followed the recommendations and 26 (15%) did not. The reasons people did not test for SARS-CoV-2 emerged as fivefold: i) improved symptoms, ii) the cost of test, iii) fear of a painful test procedure, iv) test kit shortages, and v) fear of a positive SARS-CoV-2 test result. Conclusions Of the reasons why people did not test, fear of a positive SARS-CoV-2 result remains unaddressed in our view. Integrating pre- and post-test counselling into SARS-CoV-2 testing strategies, similarly as done for HIV-testing, seems warranted to address this problem. © 2021, Journal of Global Health Reports. All rights reserved.

Swiss Emergency Research collection

2021

2020