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Swiss Emergency Research collection

2012

  • Guessous, I., Bochud, M., Theler, J. M., Gaspoz, J. M., and Pechere-Bertschi, A. “1999-2009 Trends In Prevalence, Unawareness, Treatment And Control Of Hypertension In Geneva, Switzerland”. Plos One 7, no. 6: e39877. doi:10.1371/journal.pone.0039877.
    Abstract: BACKGROUND: There are no time trends in prevalence, unawareness, treatment, and control of hypertension in Switzerland. The objective of this study was to analyze these trends and to determine the associated factors. METHODS/FINDINGS: Population-based study conducted in the Canton of Geneva, Switzerland, between 1999 and 2009. Blood pressure was measured thrice using a standard protocol. Hypertension was defined as mean systolic or diastolic blood pressure >/= 140/90 mmHg or self-reported hypertension or anti-hypertensive medication. Unawareness, untreated and uncontrolled hypertension was determined by questionnaires/blood pressure measurements. Yearly age-standardized prevalences and adjusted associations for the 1999-2003 and 2004-2009 survey periods were reported. The 10-year survey included 9,215 participants aged 35 to 74 years. Hypertension remained stable (34.4%). Hypertension unawareness decreased from 35.9% to 17.7% (P<0.001). The decrease in hypertension unawareness was not paralleled by a concomitant absolute increase in hypertension treatment, which remained low (38.2%). A larger proportion of all hypertensive participants were aware but not treated in 2004-2009 (43.7%) compared to 1999-2003 (33.1%). Uncontrolled hypertension improved from 62.2% to 40.6% between 1999 and 2009 (P = 0.02). In 1999-2003 period, factors associated with hypertension unawareness were current smoking (OR = 1.27, 95%CI, 1.02-1.59), male gender (OR = 1.56, 1.27-1.92), hypercholesterolemia (OR = 1.31, 1.20-1.44), and older age (OR 65-74 yrs vs 35-49 yrs = 1.56, 1.21-2.02). In 1999-2003 and 2004-2009, obesity and diabetes were negatively associated with hypertension unawareness, high education was associated with untreated hypertension (OR = 1.45, 1.12-1.88 and 1.42, 1.02-1.99, respectively), and male gender with uncontrolled hypertension (OR = 1.49, 1.03-2.17 and 1.65, 1.08-2.50, respectively). Sedentarity was associated with higher risk of hypertension and uncontrolled hypertension in 1999-2003. CONCLUSIONS: Hypertension prevalence remained stable since 1999 in the canton of Geneva. Although hypertension unawareness substantially decreased, more than half of hypertensive subjects still remained untreated or uncontrolled in 2004-2009. This study identified determinants that should guide interventions aimed at improving hypertension treatment and control.
    Tags: *Awareness, Adult, Aged, Humans, Hypertension/*epidemiology/prevention & control/therapy, Income, Middle Aged, Prevalence, Switzerland/epidemiology.
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  • Carron, P. N., Taffe, P., and Hugli, O. “Use Of Epinephrine For Cardiac Arrest Prior To Hospital Arrival”. Jama 308, no. 1: 29-30; author reply 30-1. doi:10.1001/jama.2012.5942.
    Tags: Adrenergic beta-Agonists/*adverse effects, Epinephrine/*adverse effects, Female, Humans, Male, Out-of-Hospital Cardiac Arrest/*drug therapy/*mortality.
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  • Que, Y. A., Delodder, F., Guessous, I., Graf, R., Bain, M., Calandra, T., Liaudet, L., and Eggimann, P. “Pancreatic Stone Protein As An Early Biomarker Predicting Mortality In A Prospective Cohort Of Patients With Sepsis Requiring Icu Management”. Crit Care 16, no. 4: R114. doi:10.1186/cc11406.
    Abstract: INTRODUCTION: Biomarkers, such as C-reactive protein [CRP] and procalcitonin [PCT], are insufficiently sensitive or specific to stratify patients with sepsis. We investigate the prognostic value of pancreatic stone protein/regenerating protein (PSP/reg) concentration in patients with severe infections. METHODS: PSP/reg, CRP, PCT, tumor necrosis factor-alpha (TNF-alpha), interleukin 1 beta (IL1-beta), IL-6 and IL-8 were prospectively measured in cohort of patients >/= 18 years of age with severe sepsis or septic shock within 24 hours of admission in a medico-surgical intensive care unit (ICU) of a community and referral university hospital, and the ability to predict in-hospital mortality was determined. RESULTS: We evaluated 107 patients, 33 with severe sepsis and 74 with septic shock, with in-hospital mortality rates of 6% (2/33) and 25% (17/74), respectively. Plasma concentrations of PSP/reg (343.5 vs. 73.5 ng/ml, P < 0.001), PCT (39.3 vs. 12.0 ng/ml, P < 0.001), IL-8 (682 vs. 184 ng/ml, P < 0.001) and IL-6 (1955 vs. 544 pg/ml, P < 0.01) were significantly higher in patients with septic shock than with severe sepsis. Of note, median PSP/reg was 13.0 ng/ml (IQR: 4.8) in 20 severely burned patients without infection. The area under the ROC curve for PSP/reg (0.65 [95% CI: 0.51 to 0.80]) was higher than for CRP (0.44 [0.29 to 0.60]), PCT 0.46 [0.29 to 0.61]), IL-8 (0.61 [0.43 to 0.77]) or IL-6 (0.59 [0.44 to 0.75]) in predicting in-hospital mortality. In patients with septic shock, PSP/reg was the only biomarker associated with in-hospital mortality (P = 0.049). Risk of mortality increased continuously for each ascending quartile of PSP/reg. CONCLUSIONS: Measurement of PSP/reg concentration within 24 hours of ICU admission may predict in-hospital mortality in patients with septic shock, identifying patients who may benefit most from tailored ICU management.
    Tags: *Intensive Care Units, Biomarkers/*blood, C-Reactive Protein/metabolism, Calcitonin Gene-Related Peptide, Calcitonin/blood, Female, Health Status Indicators, Hospital Mortality, Humans, Interleukin-1beta/blood, Interleukin-6/blood, Interleukin-8/blood, Lithostathine/*blood, Male, Middle Aged, Pancreatitis/blood/mortality, Predictive Value of Tests, Prospective Studies, Protein Precursors/blood, Sepsis/*blood/mortality, Shock, Septic/blood/mortality, Tumor Necrosis Factor-alpha/blood.
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  • Hudelson, P., Perneger, T., Kolly, V., and Perron, N. J. “Self-Assessed Competency At Working With A Medical Interpreter Is Not Associated With Knowledge Of Good Practice”. Plos One 7, no. 6: e38973. doi:10.1371/journal.pone.0038973.
    Abstract: BACKGROUND: Specific knowledge and skills are needed to work effectively with an interpreter, but most doctors have received limited training. Self-assessed competency may not accurately identify training needs. PURPOSES: The purpose of this study is to explore the association between self-assessed competency at working with an interpreter and the ability to identify elements of good practice, using a written vignette. METHODS: A mailed questionnaire was sent to 619 doctors and medical students in Geneva, Switzerland. RESULTS: 58.6% of respondents considered themselves to be highly competent at working with a professional interpreter, but 22% failed to mention even one element of good practice in response to the vignette, and only 39% could name more than one. There was no association between self-rated competency and number of elements mentioned. CONCLUSIONS: Training efforts should challenge the assumption that working with an interpreter is intuitive. Evaluation of clinicians' ability to work with an interpreter should not be limited to self-ratings. In the context of large-scale surveys, written vignettes may provide a simple method for identifying knowledge of good practice and topics requiring further training.
    Tags: *Clinical Competence, *Communication Barriers, *Education, Medical, Continuing, *Language, *Self-Assessment, *Surveys and Questionnaires, Adult, Female, Humans, Male.
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  • Lindner, G., Zapletal, B., Schwarz, C., Wisser, W., Hiesmayr, M., and Lassnigg, A. “Acute Hyponatremia After Cardioplegia By Histidine-Tryptophane-Ketoglutarate--A Retrospective Study”. J Cardiothorac Surg 7, no. 1: 52. doi:10.1186/1749-8090-7-52.
    Abstract: BACKGROUND: Hyponatremia is the most common electrolyte disorder in hospitalized patients and is known to be associated with increased mortality. The administration of antegrade single-shot, up to two liters, histidine-tryptophane-ketoglutarate (HTK) solution for adequate electromechanical cardiac arrest and myocardial preservation during minimally invasive aortic valve replacement (MIAVR) is a standard procedure. We aimed to determine the impact of HTK infusion on electrolyte and acid-base balance. METHODS: In this retrospective analysis we reviewed data on patient characteristics, type of surgery, arterial blood gas analysis during surgery and intra-/postoperative laboratory results of patients receiving surgery for MIAVR at a large tertiary care university hospital. RESULTS: A total of 25 patients were included in the study. All patients were normonatremic at start of surgery. All patients developed hyponatremia after administration of HTK solution with a significant drop of serum sodium of 15 mmol/L (p < 0.01). Measured osmolality did not change during all times of surgery compared to start of surgery (p = 0.28 - p = 0.79), indicating isotonic hyponatremia. After administration of HTK solution pH fell significantly due to development of metabolic acidosis. CONCLUSIONS: Acute hyponatremia during cardioplegia with HTK solution is isotonic and should probably not be corrected without presence of hypotonicity as confirmed by measurement of serum osmolality.
    Tags: Aged, Cardioplegic Solutions/*adverse effects/therapeutic use, Female, Glucose/adverse effects/therapeutic use, Heart Arrest, Induced/*methods, Heart Valve Prosthesis Implantation, Humans, Hyponatremia/*chemically induced, Male, Mannitol/adverse effects/therapeutic use, Middle Aged, Osmolar Concentration, Potassium Chloride/adverse effects/therapeutic use, Procaine/adverse effects/therapeutic use, Retrospective Studies.
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  • Heymann, E. P., Kassimatis, T. I., and Goldsmith, D. J. “Dyslipidemia, Statins, And Ckd Patients' Outcomes - Review Of The Evidence In The Post-Sharp Era”. J Nephrol 25, no. 4: 460-72. doi:10.5301/jn.5000154.
    Abstract: Hyperlipidemia in the general population is strongly associated with an increased incidence of major adverse cardiovascular (CV) events (MACE). It is well established that HMG-CoA reductase inhibitors (statins) reduce CV and all-cause mortality in the general population, as well as in patients with CV disease (CVD). However, such a finding has not been definitively confirmed in patients with chronic kidney disease (CKD). Given that CV risk gradually increases with increasing stages of CKD (and is even higher in dialysis patients), it is of major relevance and importance to identify whether CKD patients might also benefit from alteration of lipid fractions, and how this might best be achieved. Bearing in mind that animal model and preclinical evidence suggests dyslipidemia might also be a factor promoting worsening renal function, it could legitimately be asked whether treating it may also therefore have a nephroprotective effect.
    Tags: Animals, Cardiovascular Diseases/etiology/prevention & control, Chronic Disease, Disease Progression, Dyslipidemias/blood/complications/*drug therapy/physiopathology, Evidence-Based Medicine, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use, Kidney Diseases/blood/*complications/physiopathology, Kidney/*drug effects/physiopathology, Risk Assessment, Risk Factors, Treatment Outcome.
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  • Rohacek, M., Buatsi, J., Szucs-Farkas, Z., Kleim, B., Zimmermann, H., Exadaktylos, A., and Stoupis, C. “Ordering Ct Pulmonary Angiography To Exclude Pulmonary Embolism: Defense Versus Evidence In The Emergency Room”. Intensive Care Med 38, no. 8: 1345-51. doi:10.1007/s00134-012-2595-z.
    Abstract: PURPOSE: To identify reasons for ordering computed tomography pulmonary angiography (CTPA), to identify the frequency of reasons for CTPA reflecting defensive behavior and evidence-based behavior, and to identify the impact of defensive medicine and of training about diagnosing pulmonary embolism (PE) on positive results of CTPA. METHODS: Physicians in the emergency department of a tertiary care hospital completed a questionnaire before CTPA after being trained about diagnosing PE and completing questionnaires. RESULTS: Nine hundred patients received a CTPA during 3 years. For 328 CTPAs performed during the 1-year study period, 140 (43 %) questionnaires were completed. The most frequent reasons for ordering a CTPA were to confirm/rule out PE (93 %), elevated D-dimers (66 %), fear of missing PE (55 %), and Wells/simplified revised Geneva score (53 %). A positive answer for "fear of missing PE" was inversely associated with positive CTPA (OR 0.36, 95 % CI 0.14-0.92, p = 0.033), and "Wells/simplified revised Geneva score" was associated with positive CTPA (OR 3.28, 95 % CI 1.24-8.68, p = 0.017). The proportion of positive CTPA was higher if a questionnaire was completed, compared to the 2-year comparison period (26.4 vs. 14.5 %, OR 2.12, 95 % CI 1.36-3.29, p < 0.001). The proportion of positive CTPA was non-significantly higher during the study period than during the comparison period (19.2 vs. 14.5 %, OR 1.40, 95 % CI 0.98-2.0, p = 0.067). CONCLUSION: Reasons for CTPA reflecting defensive behavior-such as "fear of missing PE"-were frequent, and were associated with a decreased odds of positive CTPA. Defensive behavior might be modifiable by training in using guidelines.
    Tags: *Defensive Medicine, Diagnostic Errors/prevention & control, Emergency Service, Hospital, Female, Fibrin Fibrinogen Degradation Products/analysis, Humans, Male, Middle Aged, Practice Patterns, Physicians'/*statistics & numerical data, Pulmonary Artery/*diagnostic imaging, Pulmonary Embolism/*diagnosis, Surveys and Questionnaires, Tomography, X-Ray Computed.
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  • Finardi, P., Nickel, C. H., Koller, M. T., and Bingisser, R. “Accuracy Of Self-Reported Weight In A High Risk Geriatric Population In The Emergency Department”. Swiss Med Wkly 142, no. MAY: w13585. doi:10.4414/smw.2012.13585.
    Abstract: QUESTIONS UNDER STUDY/PRINCIPLES: Weight is important information in the emergency department (ED). Weight loss leads to an increase of mortality and is suggestive of morbidity. Correct weight is important for dosing of drugs to avoid toxicity and lack of effectiveness. Objective body weight measurement is often not possible in the emergency department. Especially in elderly ED patients, acute disease might have an impact on weight reporting. The objective of this study was to determine whether body weight reported by elderly patients presenting to the ED with non-specific symptoms is accurate. METHODS: In 233 patients, measured weight was detected within patients' medical record and was compared to reported weight at presentation in the ED. RESULTS: The median age of the observed population was 74 years (IQR 72, 86). Comparison between estimated and measured weight showed a good agreement between the two measures (Pearson's correlation coefficient r = 0.94). The mean difference between estimated and measured weight was small (+0.1 kg) whereas the range of the estimation error was between -10.9 and 11.1 kg. Age had no influence on the accuracy to predict the measured weight. Also, the correlation did not differ in patients with and without acute morbidity or between men and women. CONCLUSIONS: Neither old age nor acute disease status impaired the strong correlation of reported and measured weight. Therefore, self reported weight can be used as approximation for real body weight in elderly ED patients presenting with non-specific complaints.
    Tags: *Body Weight, *Self Report, Age Factors, Aged, Aged, 80 and over, Emergency Service, Hospital, Female, Humans, Male.
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  • Ruedinger, J. M., Nickel, C. H., Maile, S., Bodmer, M., Kressig, R. W., and Bingisser, R. “Diuretic Use, Raas Blockade And Morbidity In Elderly Patients Presenting To The Emergency Department With Non-Specific Complaints”. Swiss Med Wkly 142, no. MAY: w13568. doi:10.4414/smw.2012.13568.
    Abstract: QUESTIONS UNDER STUDY: Up to 20% of elderly patients present to the emergency department (ED) with non-specific complaints (NSC), such as "generalised weakness", the majority suffering from serious conditions requiring timely intervention. Little is known about the use and influence of diuretics and renin-angiotensin-aldosterone (RAAS) blockade on morbidity in those patients. The hypothesis was tested that the use of diuretics and RAAS blockade could be associated with an increased incidence of serious conditions in those patients. METHODS: During a 23-month period, all adult non-trauma patients with an Emergency Severity Index (ESI) of 2 or 3 were prospectively enrolled. Serious conditions were defined as potentially life-threatening conditions or conditions requiring early intervention to prevent further morbidity and mortality. RESULTS: Study population consisted of 633 patients with median age 82 years, median Charlson comorbidity index 2. 59% of all subjects suffered from a serious condition. 299 subjects (47.2%) used diuretics, of which 65.6% suffered from a serious condition. Combination therapy of RAAS blockade and diuretics was found in 158 subjects (24.9%), 70.3% of which suffered from a serious condition. The intake of two or more diuretics, loop diuretics and a combination therapy with diuretics and RAAS blockade were associated with an increased risk for serious condition (p = 0.036; p = 0.021; p = 0.004). CONCLUSIONS: Treatment with two or more diuretics, loop diuretics, or a combination therapy with RAAS blockade and diuretics are independently associated with serious condition and therefore should be recognized as "red flags" in elderly patients presenting to the ED with NSC.
    Tags: Acute Kidney Injury/chemically induced, Aged, Aged, 80 and over, Cardiovascular Diseases/diagnosis, Chi-Square Distribution, Comorbidity, Confidence Intervals, Cross-Sectional Studies, Dehydration/chemically induced, Diuretics/adverse effects/*therapeutic use, Emergency Service, Hospital/*statistics & numerical data, Emergency Treatment/methods, Endocrine System Diseases/diagnosis, Female, Humans, Hypokalemia/chemically induced, Hyponatremia/chemically induced, Infections/diagnosis, Male, Odds Ratio, Renin-Angiotensin System/*drug effects, Severity of Illness Index, Sodium Potassium Chloride Symporter Inhibitors/adverse effects/*therapeutic use.
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  • Jeger, V., Willi, S., Liu, T., Yeh, D. D., De Moya, M., Zimmermann, H., and Exadaktylos, A. K. “The Rapid Teg Alpha-Angle May Be A Sensitive Predictor Of Transfusion In Moderately Injured Blunt Trauma Patients”. Scientificworldjournal 2012: 821794. doi:10.1100/2012/821794.
    Abstract: BACKGROUND: To guide the administration of blood products, coagulation screening of trauma patients should be fast and accurate. The purpose of this study was to identify the correlation between CCT and TEG in trauma, to determine which CCT or TEG parameter is most sensitive in predicting transfusion in trauma, and to define TEG cut-off points for trauma care. METHODS: A six-month, prospective observational study of 76 adult patients with suspected multiple injuries was conducted at a Level 1 trauma centre of a university hospital. Physicians blinded to TEG results made the decision to transfuse based on clinical evaluation. RESULTS: The study results showed that conventional coagulation tests correlate moderately with Rapid TEG parameters (R: 0.44-0.61). Kaolin and Rapid TEG were more sensitive than CCTs, and the Rapid TEG alpha-Angle was identified as the single parameter with the greatest sensitivity (84%) and validity (77%) at a cut-off of 74.7 degrees. When the Rapid TEG alpha-Angle was combined with heart rate >75 bpm, or haematocrit < 41%, sensitivity (84%, 88%) and specificity (75%, 73%) were improved. CONCLUSION: Cutoff points for transfusion can be determined with the Rapid TEG alpha-Angle and can provide better sensitivity than CCTs, but a larger study population is needed to reproduce this finding.
    Tags: *Blood Transfusion, Adult, Aged, Female, Humans, Male, Middle Aged, Point-of-Care Systems, Prospective Studies, Wounds, Nonpenetrating/*therapy.
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  • Jackson, Y., Castillo, S., Hammond, P., Besson, M., Brawand-Bron, A., Urzola, D., Gaspoz, J. M., and Chappuis, F. “Metabolic, Mental Health, Behavioural And Socioeconomic Characteristics Of Migrants With Chagas Disease In A Non-Endemic Country”. Trop Med Int Health 17, no. 5: 595-603. doi:10.1111/j.1365-3156.2012.02965.x.
    Abstract: OBJECTIVES: Chronic Chagas disease causes cardiopathy in 20-40% of the 8-10 million people affected. The prevalence of atherogenic factors increases rapidly in Latin America. Somatic, mental, behavioural and social characteristics of the 80,000 Latino migrants with Chagas disease in Europe are not known. We postulate that they may accumulate these factors for poor health--notably cardiovascular-outcomes. METHODS: This study took place at the Geneva University Hospitals in 2011. Latin American migrants with Chagas disease diagnosed in Geneva since 2008 were contacted. Interviews and blood tests assessed behavioural, socioeconomic, metabolic and cardiovascular factors. RESULTS: One hundred and thirty-seven patients (women: 84.7%; median age: 43 years) with chronic Chagas disease were included in the study. The majority were Bolivians (94.2%), undocumented (83.3%), uninsured (72.3%) and living below the Swiss poverty line (89.1%). Prevalence of obesity was 25.5%, of hypertension 17.5%, of hypercholesterolemia 16.1%, of impaired fasting glucose 23.4%, of diabetes 2.9%, of metabolic syndrome 16.8%, of anxiety 58.4%, of depression 28.5%, of current smoking 15.4% and of sedentary lifestyle 62.8%. High (>10%) 10-year cardiovascular risk affected 12.4%. CONCLUSIONS: Latin American migrants with Chagas disease accumulate pathogenic chronic conditions of infectious, non-transmissible, socioeconomic and behavioural origin, putting them at high risk of poor health, notably cardiovascular, outcomes. This highlights the importance of screening for these factors and providing interventions to tackle reversible disorders; facilitating access to care for this hard-to-reach population to prevent delays in medical interventions and poorer health outcomes; and launching prospective studies to evaluate the long-term impact of these combined factors on the natural course of Chagas disease.
    Tags: *Health Behavior, Adolescent, Adult, Bolivia/ethnology, Cardiovascular Diseases/*epidemiology/psychology, Chagas Disease/*epidemiology/physiopathology/psychology, Cohort Studies, Comorbidity, Cross-Sectional Studies, Emigrants and Immigrants/psychology/*statistics & numerical data, Europe/epidemiology, Female, Humans, Latin America/ethnology, Male, Mental Disorders/*epidemiology/psychology, Metabolic Diseases/*epidemiology/psychology, Middle Aged, Prevalence, Risk Factors, Sedentary Behavior, Smoking/epidemiology/psychology, Socioeconomic Factors, Young Adult.
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  • Tabbara, M., Hatzigianni, P., Fux, C., Zimmermann, H., and Exadaktylos, A. K. “Human Bite Wounds: A Swiss Emergency Department Experience”. Wounds 24, no. 4: 85-90. https://www.ncbi.nlm.nih.gov/pubmed/25876244.
    Abstract: Human bites (HB) are the third most common bite wound diagnosed in emergency departments, after dog and cat bites. Management of HB can be challenging, given the high risk of infection associated with multiorganism-rich oral flora. Recognition and early aggressive treatment are essential steps in preventing infections and other associated complications. METHODS: A retrospective, 10-year electronic chart review was performed, which identified 104 HB. Diagnosis, treatment, and outcome were noted for each case. RESULTS: Most of the patients were male, with a male:female ratio of 4:1. A majority of patients (n = 53, 51%) presented with finger and hand injuries. Only 13.8% were bitten on the head or neck, and 25% on the upper limbs. The remainder (35.2%) of patients sustained injuries to other body parts. Twelve operations were necessary and performed by plastic and hand surgeons. More than half of the patients (60.5%) received antibiotic therapy, and 84.6% of the patients had their tetanus prophylaxis administered or received a booster by the time of treatment. Only 40.4% of patients had a post-bite serology test to rule out bloodborne viral infections, none of whom tested positive. The viral status of the biter was known in two cases. CONCLUSION: The goals of HB management are to minimize infection risk and its complications, and to prevent the transmission of systemic infections, such as hepatitis B/C and HIV. Accurate documentation and a management algorithm should be instituted in emergency departments in order to achieve these goals. .
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  • Pasquier, M., Ruffinen, G. Z., Brugger, H., and Paal, P. “Pre-Hospital Wrist Block For Digital Frostbite Injuries”. High Alt Med Biol 13, no. 1: 65-6. doi:10.1089/ham.2011.1072.
    Tags: *Autonomic Nerve Block, Amides, Emergency Medical Services, Finger Injuries/*therapy, Frostbite/*therapy, Humans, Male, Median Nerve, Middle Aged, Radial Nerve, Ropivacaine, Ulnar Nerve.
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  • Grossmann, F. F., Zumbrunn, T., Frauchiger, A., Delport, K., Bingisser, R., and Nickel, C. H. “At Risk Of Undertriage? Testing The Performance And Accuracy Of The Emergency Severity Index In Older Emergency Department Patients”. Ann Emerg Med 60, no. 3: 317-25 e3. doi:10.1016/j.annemergmed.2011.12.013.
    Abstract: STUDY OBJECTIVE: We test predictive validity, interrater reliability, and diagnostic accuracy of the Emergency Severity Index in older emergency department (ED) patients and identify reasons for inadequate triage. METHODS: We analyzed data of patients aged 65 years or older who were included in a prospective, single-center cohort study. Predictive validity was assessed by investigating associations of resources, disposition, length of stay, and mortality with Emergency Severity Index levels. Diagnostic accuracy was tested by calculating sensitivity and specificity of Emergency Severity Index level 1 for the prediction of a lifesaving intervention. For the assessment of interrater reliability, 2 experts independently reviewed the triage nurses' notes. Agreement was estimated as raw agreement and as Cohen's weighted kappa. RESULTS: In total, 519 older patients were included. Emergency Severity Index level was associated with resource consumption (Spearman's rho=-0.449; 95% confidence interval [CI] -0.519 to -0.379), disposition (Kendall's tau=-0.452; 95% CI -0.516 to -0.387), ED length of stay (Kruskal-Wallis chi(2)=92.5; df=4; P<.001), and mortality (log-rank chi(2)=37.04; df=3; P<.001). The sensitivity of the Emergency Severity Index to predict lifesaving interventions was 0.462 (95% CI 0.232 to 0.709), and the specificity was 0.998 (95% CI 0.989 to 1.000). Interrater reliability between experts was high (raw agreement 0.917, 95% CI 0.894 to 0.944; Cohen's weighted kappa(w)=0.934, 95% CI 0.913 to 0.954). Undertriage occurred in 117 cases. Main reasons were neglect of high-risk situations and failure to appropriately interpret vital signs. CONCLUSION: In our study, older patients were at risk for undertriage. However, our results suggest that the Emergency Severity Index is reliable and valid for triage of older patients.
    Tags: *Severity of Illness Index, Age Factors, Aged, Aged, 80 and over, Emergency Service, Hospital/*standards/statistics & numerical data, Female, Hospital Mortality, Humans, Male, Observer Variation, Prospective Studies, Reproducibility of Results, Sensitivity and Specificity, Triage/*standards/statistics & numerical data.
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  • Lindner, G., and Schwarz, C. “Electrolyte-Free Water Clearance Versus Modified Electrolyte-Free Water Clearance: Do The Results Justify The Effort?”. Nephron Physiol 120, no. 1: p1-5. doi:10.1159/000336550.
    Abstract: BACKGROUND: Calculation of electrolyte-free water clearance (EFWC) allows for quantification of renal losses of free water and was shown to be helpful in the differential diagnosis of dysnatremias and might help in the correction of the electrolyte disorders. A modified EFWC formula (MEFWC) was described to be more accurate than the conventional one; however, it has never been evaluated clinically. METHODS: In order to evaluate the performance of MEFWC compared to EFWC under clinical circumstances, we gathered data from a total of 912 patient days of 138 critically ill patients. EFWC and MEFWC were calculated on the basis of these data. Additionally, from data of critically ill patients, we calculated a prediction of serum sodium based on the Edelman equation using either EFWC or MEFWC and compared results. RESULTS: Altogether, 343 normonatremic, 124 hyponatremic and 445 hypernatremic days were analyzed. Results for EFWC and MEFWC correlated significantly (R = 0.98). In patients with hyponatremia, the absolute difference between EFWC and MEFWC was significantly larger than in patients with normonatremia (437 vs. 256 ml, p < 0.01). The absolute difference between EFWC and MEFWC correlated significantly with the level of serum sodium (R = -0.41). The mean difference in the prediction of serum sodium change as calculated based on the Edelman equation between the formula using EFWC and the formula using MEFWC was 0.7 mmol/l (SD 0.68) and was highest in hyponatremia and lowest in hypernatremia. CONCLUSION: Results of EFWC and MEFWC were comparable in critically ill patients. Under normal circumstances, the use of the more complicated MEFWC is not justified. In hyponatremia, the difference between EFWC and MEFWC is larger and thus might justify the use of the more complicated formula.
    Tags: *Mathematical Computing, *Water-Electrolyte Balance, Female, Humans, Hypernatremia/blood/*physiopathology/urine, Hyponatremia/blood/*physiopathology/urine, Male, Potassium/urine, Retrospective Studies, Sodium/blood/urine.
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  • Lacroix, L., Manzano, S., Galetto, A., and Gervaix, A. “Procalcitonin Measurement For Detection Of Serious Bacterial Infection In Febrile Children: Comparison Between Two Automated Immunoassays”. Clin Biochem 45, no. 7-8: 593-5. doi:10.1016/j.clinbiochem.2012.02.011.
    Abstract: OBJECTIVES: To assess the concordance of procalcitonin values at 3 cut-off ranges in a cohort of pediatric samples presenting with fever without source, using two different automated immunoassays. DESIGN AND METHODS: 65 frozen samples from children presenting with fever without source were thawed, tested on both Kryptor and VIDAS systems, and compared using a regression analysis, a Bland-Altman difference plot, and analysis of concordance at the clinically relevant cut-off points. RESULTS: Kryptor and VIDAS PCT results correlated remarkably well (r=0.952), with no significant difference in the frequency distribution over the 3 cut-off ranges (p=0.1384). The strength of the agreement was good (kappa=0.759) with an overall concordance of 84.6%. CONCLUSION: Correlation and concordance of PCT values measured by both systems were good. This finding allows clinical implementation of both techniques with the same nominal PCT cut-off values for detection of serious bacterial infection in children presenting with fever without source.
    Tags: Bacterial Infections/*diagnosis, Calcitonin Gene-Related Peptide, Calcitonin/*blood, Child, Preschool, Cohort Studies, Fever/pathology, Humans, Immunoassay/*methods, Infant, Protein Precursors/*blood, Randomized Controlled Trials as Topic, Reagent Kits, Diagnostic, Regression Analysis, Reproducibility of Results.
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  • Albers, C. E., Haefeli, P. C., Zimmermann, H., de Moya, M., and Exadaktylos, A. K. “Can Handheld Micropower Impulse Radar Technology Be Used To Detect Pneumothorax? Initial Experience In A European Trauma Centre”. Injury 44, no. 5: 650-4. doi:10.1016/j.injury.2012.02.001.
    Abstract: BACKGROUND: Pneumothoraces are a common injury pattern in emergency medicine. Rapid and safe identification can reduce morbidity and mortality. A new handheld, battery powered device, the Pneumoscan (CE 561036, PneumoSonics Inc., Cleveland, OH, USA), using micropower impulse radar (MIR) technology, has recently been introduced in Europe for the rapid and reliable detection of PTX. However, this technology has not yet been tested in trauma patients. This is the first quality control evaluation to report on emergency room performance of a new device used in the trauma setting. MATERIAL AND METHODS: This study was performed at a Level I trauma centre in Switzerland. All patients with thoracic trauma and undergoing chest X-ray and CT-scan were eligible for the study. Readings were performed before the chest X-ray and CT scan. The patients had eight lung fields tested (four on each side). All readings with the Pneumoscan were performed by two junior residents in our department who had previously received an instructional tutorial of 15min. The qualitative MIR results were blinded, and stored on the device. We then compared the results of the MIR to those of the clinical examination, chest X-ray and CT-scan. RESULTS: 50 patients were included, with a mean age of 46 (SD 17) years. Seven patients presented with PTX diagnosed by CT; six of these were detected by Pneumoscan, leading to an overall sensitivity of 85.7 (95% confidence interval 42.1-99.6)%. Only two of seven PTX were found during clinical examination and on chest X-ray (sensitivity 28.6 (95% CI 3.7-71.0)%). Of the remaining 43 of 50 patients without PTX, one false-positive PTX was found by the Pneumoscan, resulting in a specificity of 97.7 (95% CI 87.7-99.9)%. DISCUSSION: The Pneumoscan is an easy to use handheld technology with reliable results. In this series, the sensitivity to detect a PTX by the Pneumoscan was higher than by clinical examination and chest X-ray. Further studies with higher case numbers and a prospective study design are needed to confirm our findings.
    Tags: *Radar/instrumentation, Adolescent, Adult, Aged, Aged, 80 and over, Early Diagnosis, Emergency Medicine/*instrumentation/methods, Female, Humans, Male, Microcomputers, Middle Aged, Monitoring, Physiologic/*instrumentation/methods, Pneumothorax/*diagnosis/etiology/mortality, Prospective Studies, Reproducibility of Results, Sensitivity and Specificity, Switzerland/epidemiology, Thoracic Injuries/complications/*diagnosis/mortality, Tomography, X-Ray Computed, Trauma Centers.
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  • Barnett, Peter, and Stocker, Sergio. “Starting Anew: Returning To The Pediatric Emergency Department As The First And Only Trained Pediatric Emergency Medicine Specialist”. Clinical Pediatric Emergency Medicine 13, no. 1: 12-17. doi:10.1016/j.cpem.2011.12.001.
    Abstract: Formal pediatric emergency medicine training did not exist in Australia in the late 1980s, so I ventured overseas to gain experience and knowledge from the then leaders in the field. I completed my fellowship and returned to an emergency department (ED) in Australia as the only pediatric emergency medicine-trained attending. This article describes my experiences in transforming an ED run solely by residents into one with now 14 full-time consultants and our own fellows. Imbedded in this story is the experience of one of our first fellows who came from Switzerland, where even emergency medicine was not yet a recognized specialty. On his return home, he too transformed his ED. © 2012.
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  • Gervaix, A. “Commentary: Procalcitonin To Detect Invasive Bacterial Infection In Febrile Infants”. Pediatr Infect Dis J 31, no. 6: 647-8. doi:10.1097/INF.0b013e31824c000b.
    Tags: Bacteremia/*diagnosis, Biomarkers/*blood, Calcitonin Gene-Related Peptide, Calcitonin/*blood, Child, Preschool, Female, Humans, Infant, Male, Meningitis, Bacterial/*diagnosis, Protein Precursors/*blood, Sepsis/diagnosis.
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  • Hasler, R. M., Bach, P., Brodmann, M., Heim, D., Spycher, J., Schotzau, A., Evangelopoulos, D. S., Zimmermann, H., and Exadaktylos, A. K. “A Pilot Case-Control Study Of Behavioral Aspects And Risk Factors In Swiss Climbers”. Eur J Emerg Med 19, no. 2: 73-6. doi:10.1097/MEJ.0b013e328348b460.
    Abstract: BACKGROUND: Climbing is a popular sport in Switzerland, with approximately 100 000 active participants. There is an inherent risk of falls, overuse and stress-related trauma, with a reported injury rate of 4.2 injuries per 1000 climbing hours. OBJECTIVE: Comparison of possible risk factors in patients and noninjured controls. METHODS: A case-control survey was conducted. Climbers admitted to three trauma units between June and October 2008 were surveyed using a questionnaire evaluating nine potential risk factors. The same questionnaire was distributed to noninjured climbers during the same time period. Logistic regression was performed. RESULTS: Fifty patients and 63 controls were included in this survey. Variables significant for patients were: more than 10 years versus less than 1 year of climbing experience (odds ratio: 5.34; confidence interval: 1.16-17.76; P=0.006) and no previous experiences of the climbing route (odds ratio: 2.72; confidence interval: 1.15-6.39; P=0.022). No statistical significance was detected for age, sex, difficulty level of the climbing route, warm-up, readiness for risk and abstinence from alcohol and drugs. CONCLUSION: Climbers with higher experience seem to be more prone to injuries. Larger studies on this subgroup are warranted, to identify typical risk profiles and to develop preventive strategies. Furthermore, climbers should be advised about the increased injury risk when trying new climbing routes and specific information should be given.
    Tags: *Health Knowledge, Attitudes, Practice, Accidental Falls/statistics & numerical data, Adolescent, Adult, Age Distribution, Athletic Injuries/*epidemiology/prevention & control/*psychology, Case-Control Studies, Confidence Intervals, Emergency Service, Hospital, Female, Hospitals, Public, Humans, Incidence, Injury Severity Score, Logistic Models, Male, Middle Aged, Mountaineering/*injuries/*psychology/statistics & numerical data, Odds Ratio, Pilot Projects, Reference Values, Risk Factors, Sex Distribution, Switzerland/epidemiology, Trauma Centers, Young Adult.
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  • Rohacek, M., Albrecht, M., Kleim, B., Zimmermann, H., and Exadaktylos, A. “Reasons For Ordering Computed Tomography Scans Of The Head In Patients With Minor Brain Injury”. Injury 43, no. 9: 1415-8. doi:10.1016/j.injury.2012.01.001.
    Abstract: BACKGROUND: Minor brain injury is a frequent condition. Validated clinical decision rules can help in deciding whether a computed tomogram (CT) of the head is required. We hypothesized that institutional guidelines are not frequently used, and that psychological factors are a common reason for ordering an unnecessary CT. METHODS: Physicians at the emergency department of a tertiary care hospital completed an anonymous questionnaire before ordering a CT of the head for a patient presenting with a GCS of 13-15 after a head trauma. RESULTS: Over a period of 10 months, 1018 CTs of the head were performed in patients presenting with a GCS of 13-15 after a head trauma; 168 (16.5%) questionnaires were completed. The most four common reasons for ordering a CT were "to confirm/rule out traumatic intracranial lesion" (in 94% of all questionnaires), "to expedite diagnosis" (63%) "guidelines" (58%) and "fear of missing a traumatic intracranial lesion" (50%). A positive answer for "fear of being sued" was declared in 21%, and "pressure from the patient or his relatives" in 8% of all questionnaires. Of 71 questionnaires without "guidelines" as a positive answer, there were 40 (56%) positive answers of "fear of missing a traumatic cerebral lesion". CONCLUSION: Besides guidelines, fear of missing a traumatic intracranial lesion played a role in ordering head CTs. Although the physicians had been instructed in the use of guidelines, including validated clinical decision rules, this did not prevent them from ordering unnecessary CTs.
    Tags: *Practice Patterns, Physicians'/standards, Adolescent, Adult, Aged, Aged, 80 and over, Brain Injuries/*diagnostic imaging/etiology, Brain/*diagnostic imaging, Craniocerebral Trauma/complications/*diagnostic imaging, Decision Making, Female, Glasgow Coma Scale, Guideline Adherence/*statistics & numerical data, Humans, Male, Middle Aged, Practice Guidelines as Topic, Switzerland, Tertiary Healthcare, Tomography, X-Ray Computed/*statistics & numerical data, Unnecessary Procedures, Young Adult.
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  • Nickel, C. H., Bingisser, R., and Morgenthaler, N. G. “The Role Of Copeptin As A Diagnostic And Prognostic Biomarker For Risk Stratification In The Emergency Department”. Bmc Med 10: 7. doi:10.1186/1741-7015-10-7.
    Abstract: The hypothalamic-pituitary-adrenal axis is activated in response to stress. One of the activated hypothalamic hormones is arginine vasopressin, a hormone involved in hemodynamics and osmoregulation. Copeptin, the C-terminal part of the arginine vasopressin precursor peptide, is a sensitive and stable surrogate marker for arginine vasopressin release. Measurement of copeptin levels has been shown to be useful in a variety of clinical scenarios, particularly as a prognostic marker in patients with acute diseases such as lower respiratory tract infection, heart disease and stroke. The measurement of copeptin levels may provide crucial information for risk stratification in a variety of clinical situations. As such, the emergency department appears to be the ideal setting for its potential use. This review summarizes the recent progress towards determining the prognostic and diagnostic value of copeptin in the emergency department.
    Tags: *Emergency Service, Hospital, Biomarkers/*blood, Glycopeptides/*blood, Heart Failure/*diagnosis/physiopathology, Humans, Hypothalamo-Hypophyseal System/physiology, Pituitary-Adrenal System/physiology, Prognosis, Risk, Stroke/*diagnosis/physiopathology.
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  • Slama, S. “The Role Of Public University Hospitals In A Globalized World”. World Hosp Health Serv 48, no. 4: 7-10. https://www.ncbi.nlm.nih.gov/pubmed/23484426.
    Abstract: Globalization has increased interdependence between countries and highlighted the importance of international cooperation for improving global health outcomes. International hospital partnerships aimed at expanding education, research opportunities or improving services are increasingly being shaped by globalization processes. Focusing on public university hospitals, this article calls for a critical review of the motives, processes and impact of international hospital partnerships in a changing landscape characterized by economic uncertainty and a global power shift to emerging economies.
    Tags: *Hospitals, Public, *Hospitals, University, *International Cooperation, Global Health, Organizational Objectives, Role.
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2011

  • Nowak, A., Breidthardt, T., Christ-Crain, M., Bingisser, R., Meune, C., Tanglay, Y., Heinisch, C., et al. “Direct Comparison Of Three Natriuretic Peptides For Prediction Of Short- And Long-Term Mortality In Patients With Community-Acquired Pneumonia”. Chest 141, no. 4: 974-982. doi:10.1378/chest.11-0824.
    Abstract: BACKGROUND: Early and accurate risk stratification for patients with community-acquired pneumonia (CAP) is an unmet clinical need. METHODS: We enrolled 341 unselected patients presenting to the ED with CAP in whom blinded measurements of N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregional pro-atrial natriuretic peptide (MR-proANP), and B-type natriuretic peptide (BNP) were performed. The potential of these natriuretic peptides to predict short- (30-day) and long-term mortality was compared with the pneumonia severity index (PSI) and CURB-65 (confusion, urea plasma level, respiratory rate, BP, age over 65 years). The median follow-up was 942 days. RESULTS: NT-proBNP, MR-proANP, and BNP levels at presentation were higher in short-term (median 4,882 pg/mL vs 1,133 pg/mL; 426 pmol/L vs 178 pmol/L; 436 pg/mL vs 155 pg/mL, all P < .001) and long-term nonsurvivors (3,515 pg/mL vs 548 pg/mL; 283 pmol/L vs 136 pmol/L; 318 pg/mL vs 103 pg/mL, all P < .001) as compared with survivors. Receiver operating characteristics analysis to quantify the prognostic accuracy showed comparable areas under the curve for the three natriuretic peptides to PSI for short-term (PSI 0.76, 95% CI, 0.71-0.81; NT-proBNP 0.73, 95% CI, 0.67-0.77; MR-proANP 0.72, 95% CI, 0.67-0.77; BNP 0.68, 95% CI, 0.63-0.73) and long-term (PSI 0.72, 95% CI, 0.66-0.77; NT-proBNP 0.75, 95% CI, 0.70-0.80; MR-proANP 0.73, 95% CI, 0.67-0.77, BNP 0.70, 95% CI, 0.65-0.75) mortality. In multivariable Cox-regression analysis, NT-proBNP remained an independent mortality predictor (hazard ratio 1.004, 95% CI, 1.00-1.01, P = .02 for short-term; hazard ratio 1.004, 95% CI, 1.00-1.01, P = .001 for long-term, increase of 300 pg/mL). A categorical approach combining PSI point values and NT-pro-BNP levels adequately identified patients at low, medium, and high short- and long-term mortality risk. CONCLUSIONS: Natriuretic peptides are simple and powerful predictors of short- and long-term mortality for patients with CAP. Their prognostic accuracy is comparable to PSI.
    Tags: Aged, Aged, 80 and over, Atrial Natriuretic Factor/*blood, Biomarkers/blood, Community-Acquired Infections/blood/*mortality, Female, Follow-Up Studies, Humans, Male, Middle Aged, Natriuretic Peptide, Brain/*blood, Peptide Fragments/*blood, Pneumonia/blood/*mortality, Prognosis, Regression Analysis, Severity of Illness Index.
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  • Dami, F., Rossetti, A. O., Fuchs, V., Yersin, B., and Hugli, O. “Proportion Of Out-Of-Hospital Adult Non-Traumatic Cardiac Or Respiratory Arrest Among Calls For Seizure”. Emerg Med J 29, no. 9: 758-60. doi:10.1136/emermed-2011-200234.
    Abstract: OBJECTIVES: To measure the proportion of adult non-traumatic cardiac or respiratory arrest among calls for seizure to an emergency medical dispatch centre and to record whether known epileptic patients present cardiac or respiratory arrest together with seizure. METHODS: This 2-year prospective observational investigation involved the collection of tape recordings of all incoming calls to the emergency medical dispatch centre, in which an out-of-hospital non-traumatic seizure was the chief complaint in patients >18 years, in addition to the paramedics' records of all patients who presented with respiratory or cardiac arrest. The authors also recorded whether the bystander spontaneously mentioned to the dispatcher that the victim was known to have epilepsy. RESULTS: During the 24-month period, the call centre received 561 incoming calls for an out-of-hospital non-traumatic seizure in an adult. Twelve cases were classified as cardiac or respiratory arrest by paramedics. In one case, the caller spontaneously mentioned that the victim had a history of epilepsy. The proportion of cardiac or respiratory arrest among calls for seizure was 2.1%. CONCLUSION: Although these cases are rare, dispatchers should closely monitor seizure patients with the help of bystanders to exclude an out-of-hospital cardiac or respiratory arrest, in which case the dispatcher can offer telephone cardiopulmonary resuscitation advice until the paramedics arrive. Whenever the activity of the centre allows it and no new incoming call is on hold, this can be achieved by staying on the line with the caller or by calling back. A history of epilepsy should not modify the type of monitoring performed by the dispatcher as those patients may also have an arrest together with seizure.
    Tags: *Emergency Medical Service Communication Systems, Adult, Cardiopulmonary Resuscitation, Female, Humans, Male, Needs Assessment, Out-of-Hospital Cardiac Arrest/diagnosis/*epidemiology, Prospective Studies, Respiratory Insufficiency/diagnosis/*epidemiology, Seizures/*complications/diagnosis, Switzerland, Tape Recording.
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  • Messmer, A. S., Kubera, K. M., Buser, P. J., Tamm, M., Muenst, S., Nickel, C. H., and Bingisser, R. “Pulmonary Cavitation In A Patient Presenting With Nonspecific Complaints”. Am J Emerg Med 30, no. 8: 1662 e1-3. doi:10.1016/j.ajem.2011.09.004.
    Abstract: Most commonly, patients with pulmonary embolism present with dyspnea, chest pain, and/or tachypnea to the emergency department (ED). The presence of multiple suggestive symptoms, especially when severe, significantly reduces delay in diagnosis. We report a case of an 86-year-old patient presenting to the ED with nonspecific complaints: she claimed to feel lethargic and "reluctant to prepare meals." She did not complain of either dyspnea or chest pain. As underlying cause, an intrapulmonary cavitation with pulmonary embolism was found. The combination of absence of specific symptoms regarding pulmonary embolism and radiologic findings of an obstructed pulmonary artery supplying the cavitary lung segment is rare. Common etiologies of cavitary lung processes are discussed, and risk factors of pulmonary infarction are highlighted.
    Tags: Aged, 80 and over, Diagnosis, Differential, Female, Humans, Lung/diagnostic imaging/pathology, Pulmonary Embolism/*diagnosis/diagnostic imaging/pathology, Pulmonary Infarction/diagnosis/diagnostic imaging/pathology, Tomography, X-Ray Computed.
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  • Hasler, R. M., Benz, J., Benneker, L., Kleim, B., Dubler, S., Zimmermann, H., and Exadaktylos, A. K. “Do Alpine Skiers And Snowboarders Wear Protective Equipment More Often After An Accident?”. Swiss Med Wkly 141, no. OCTOBER: w13283. doi:10.4414/smw.2011.13283.
    Abstract: QUESTIONS UNDER STUDY/PRINCIPLES: Analysis of changes in the behaviour of wearing protective equipment by alpine skiers and snowboarders after injury, performed at a level I trauma centre in Switzerland. METHODS: We present a study, using a standardised questionnaire, assessing behaviour on ski slopes by adult patients admitted between Oct 2007 and April 2008. Patients were re-interviewed after the 2008/2009 season. McNemar tests were used to analyse differences in protective clothing wearing rates between the two seasons. Multiple logistic regression with age, gender and injury severity score (ISS) as predictors, was used to compare findings in those who started wearing protective equipment and those who did not. RESULTS: A total of 104/132 patients from the 2007/2008 season were questioned about wearing protective equipment in 2008/2009. 20 patients could not be reassessed (7 declined, 13 had abandoned winter sports). A total of 84 patients were reassessed (61 alpine skiers and 23 snowboarders). The median age of participants was 39 years and 70.2% were male. Helmet and back protector wearing rates increased from 40.5% to 78.6% (p <0.001) and from 14.3% to 23.8% (p = 0.021), respectively. Snowboarders more than doubled their helmet wearing rate (39.1% to 82.6%, p = 0.002). Skiers showed a trend towards doubling their back protector wearing rate (6.6% to 14.8%, p = 0.063). Younger skiers started wearing back protectors more often than older skiers. CONCLUSIONS: Sustained injury might provide skiers and snowboards with a potent trigger to change their attitude towards the use of protective equipment. The psychological processes influencing the use of protective equipment require further investigation.
    Tags: *Accidents, Adolescent, Adult, Aged, Aged, 80 and over, Decision Making, Female, Humans, Interviews as Topic, Male, Middle Aged, Protective Clothing/*statistics & numerical data, Skiing/*injuries, United States, Young Adult.
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  • Vunda, A., and Vandertuin, L. “Nasopharyngeal Foreign Body Following A Blind Finger Sweep”. J Pediatr 160, no. 2: 353. doi:10.1016/j.jpeds.2011.08.061.
    Tags: *Endoscopy, Airway Obstruction/*etiology/*therapy, Emergency Treatment/methods, Female, Fingers, Foreign Bodies/*diagnostic imaging/therapy, Humans, Infant, Nasopharynx/*diagnostic imaging, Radiography, Treatment Outcome.
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  • Ntougou Assoumou, H. G., Pichot, V., Barthelemy, J. C., Dauphinot, V., Celle, S., Collet, P., Gaspoz, J. M., and Roche, F. “Obesity-Related Autonomic Nervous System Disorders Are Best Associated With Body Fat Mass Index, A New Indicator”. Int J Cardiol 153, no. 1: 111-3. doi:10.1016/j.ijcard.2011.09.031.
    Tags: *Body Mass Index, Adipose Tissue/*physiology, Aged, Autonomic Nervous System Diseases/*epidemiology/*physiopathology, Body Composition/physiology, Cohort Studies, Female, Humans, Longitudinal Studies, Male, Middle Aged, Obesity/*epidemiology/*physiopathology, Prospective Studies.
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  • Saccilotto, R. T., Nickel, C. H., Bucher, H. C., Steyerberg, E. W., Bingisser, R., and Koller, M. T. “San Francisco Syncope Rule To Predict Short-Term Serious Outcomes: A Systematic Review”. Cmaj 183, no. 15: E1116-26. doi:10.1503/cmaj.101326.
    Abstract: BACKGROUND: The San Francisco Syncope Rule has been proposed as a clinical decision rule for risk stratification of patients presenting to the emergency department with syncope. It has been validated across various populations and settings. We undertook a systematic review of its accuracy in predicting short-term serious outcomes. METHODS: We identified studies by means of systematic searches in seven electronic databases from inception to January 2011. We extracted study data in duplicate and used a bivariate random-effects model to assess the predictive accuracy and test characteristics. RESULTS: We included 12 studies with a total of 5316 patients, of whom 596 (11%) experienced a serious outcome. The prevalence of serious outcomes across the studies varied between 5% and 26%. The pooled estimate of sensitivity of the San Francisco Syncope Rule was 0.87 (95% confidence interval [CI] 0.79-0.93), and the pooled estimate of specificity was 0.52 (95% CI 0.43-0.62). There was substantial between-study heterogeneity (resulting in a 95% prediction interval for sensitivity of 0.55-0.98). The probability of a serious outcome given a negative score with the San Francisco Syncope Rule was 5% or lower, and the probability was 2% or lower when the rule was applied only to patients for whom no cause of syncope was identified after initial evaluation in the emergency department. The most common cause of false-negative classification for a serious outcome was cardiac arrhythmia. INTERPRETATION: The San Francisco Syncope Rule should be applied only for patients in whom no cause of syncope is evident after initial evaluation in the emergency department. Consideration of all available electrocardiograms, as well as arrhythmia monitoring, should be included in application of the San Francisco Syncope Rule. Between-study heterogeneity was likely due to inconsistent classification of arrhythmia.
    Tags: *Decision Support Techniques, Arrhythmias, Cardiac/complications/diagnosis, Emergency Service, Hospital, False Negative Reactions, Humans, Prognosis, Risk Assessment, Sensitivity and Specificity, Syncope/*diagnosis/etiology.
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  • Jackson, Y., and Chappuis, F. “Chagas Disease In Switzerland: History And Challenges”. Euro Surveill 16, no. 37: 2. doi:10.2807/ese.16.37.19963-en.
    Abstract: Chagas disease, endemic in Latin America, is an emerging health problem in Europe affecting an estimated 80,000 persons. Around 60,000 Latin American migrants live in Switzerland, and cases of Chagas disease have been reported since 1979. As of June 2011, 258 cases have been diagnosed, mostly adults in the indeterminate phase of the chronic stage of the disease. Vertical transmission has been identified and there is a high potential for blood- and organ-borne transmission in the absence of systematic screening. Major challenges include (i) raising awareness among migrants and healthcare professionals, (ii) developing national protocols for screening and treatment targeting high-risk groups such as pregnant woman, newborns, migrants from highly endemic areas (e.g. Bolivia), and immunocompromised migrants, (iii) preventing blood- and organ-borne transmission by appropriate screening strategies, (iv) taking into account the social vulnerability of individuals at risk in the design and implementation of public health programmes, and (v) facilitating contacts with the communities at risk through outreach programmes, for example in churches and cultural groups.
    Tags: *Emigration and Immigration, Adolescent, Adult, Aged, Chagas Disease/*diagnosis/ethnology/history/prevention & control/*transmission, Child, Child, Preschool, control, Female, History, 20th Century, Hospitals, University, Humans, Infant, Infant, Newborn, Infectious Disease Transmission, Vertical, Latin America/ethnology, Male, Mass Screening, Middle Aged, Pregnancy, Pregnancy Complications, Parasitic/*diagnosis/ethnology/history/prevention &, Prevalence, Risk Factors, Socioeconomic Factors, Switzerland/epidemiology, Trypanosoma cruzi/*isolation & purification, Young Adult.
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  • Maeder, M. B., Germann, S., Banz, V. M., Amsler, F., Driscoll, P., Zimmermann, H., and Exadaktylos, A. K. “Swiss Multidisciplinary And Multilingual Experience Of The Advanced Trauma Life Support Course: Lessons For Europe”. Eur J Emerg Med 19, no. 4: 220-5. doi:10.1097/MEJ.0b013e32834b0098.
    Abstract: OBJECTIVE: Courses in the Advanced Trauma Life Support are a well-accepted concept throughout the world for training in the emergency treatment of polytraumatized patients. Switzerland, a multilingual country with a long tradition of multidisciplinary collaboration in trauma care, introduced its first student courses in 1998. Unlike some countries where the courses are attended only by surgeons, instructors and students in Switzerland include surgeons, anaesthetists and physicians from other specialties. METHODS: Course evaluation assessments and instructor and student demographic data were analysed retrospectively using univariate analyses (Pearson correlation), multivariate analysis of variance, with post-hoc analysis and Bonferroni correction, and stepwise linear regression analysis. RESULTS: Between 1998 and 2003, 922 students attended 58 courses available for evaluation, with 22 338 ratings of different modules. Students rated practical (r=0.076) instruction significantly better than lectures (r=-0.072), gave better rating for women instructors (r=0.026) and for instructors teaching outside their specialty (r=-0.027). Women and participants in French-speaking courses gave better ratings. Ratings by anaesthetists were more critical than by surgeons and students from other specialties. CONCLUSION: The practical format of Advanced Trauma Life Support courses is appreciated by students, and the involvement of anaesthetists, general practitioners and other specialists as instructors is successful. Course rating was influenced by chosen specialty, sex and language of the students, and this should be taken into consideration when evaluating course modules and instructors.
    Tags: *Clinical Competence, *Curriculum, *Multilingualism, *Patient Care Team, *Wounds and Injuries, Advanced Cardiac Life Support/*education, Analysis of Variance, Cooperative Behavior, Europe, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Retrospective Studies, Statistics as Topic, Surveys and Questionnaires, Switzerland.
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  • Hudelson, P., Perron, N. J., and Perneger, T. “Self-Assessment Of Intercultural Communication Skills: A Survey Of Physicians And Medical Students In Geneva, Switzerland”. Bmc Med Educ 11, no. 1: 63. doi:10.1186/1472-6920-11-63.
    Abstract: BACKGROUND: Physicians working with multicultural populations need to know how to elicit the patient's understanding of the illness; determine the patient's sociocultural context and identify any issues that might affect care; communicate effectively across patient-provider social and cultural differences; and collaborate effectively with an interpreter. Skills self-assessment can contribute to identifying training needs and monitoring skills development in these areas. METHODS: As part of a larger study exploring the knowledge, attitudes and practices of Geneva physicians and medical students regarding the care of immigrant patients, we asked respondents to self-rate their ability to perform a range of common yet challenging intercultural communication tasks. RESULTS: Overall, respondents rated themselves less competent at intercultural tasks than at basic medical skills and less competent at specific intercultural communication skills than at general intercultural skills. Qualified doctors (as opposed to students), those with greater interest in caring for immigrants, and those who rarely encountered difficulties with immigrants rated themselves significantly more competent for all clinical tasks. Having a higher percentage of immigrant patients and previous cultural competence training predicted greater self-rated intercultural communication skills. CONCLUSION: Our self-assessment results suggest that students and physicians should be provided with the opportunity to practice intercultural skills with immigrant patients as part of their cultural competence training. To strengthen the validity of self-assessment measures, they should ideally be combined with more objective methods to assess actual skills.
    Tags: *Communication, *Cultural Competency, *Physicians, *Professional Competence, *Self Efficacy, *Students, Medical, Adult, Aged, Data Collection, Female, Humans, Male, Middle Aged, Switzerland, Young Adult.
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  • Nickel, C. H., Ruedinger, J., Misch, F., Blume, K., Maile, S., Schulte, J., Kohrle, J., Hartmann, O., Giersdorf, S., and Bingisser, R. “Copeptin And Peroxiredoxin-4 Independently Predict Mortality In Patients With Nonspecific Complaints Presenting To The Emergency Department”. Acad Emerg Med 18, no. 8: 851-9. doi:10.1111/j.1553-2712.2011.01126.x.
    Abstract: OBJECTIVES: Patients presenting to emergency departments (ED) with nonspecific complaints (NSCs) such as "not feeling well,""feeling weak,""being tired,""general deterioration," or other similar chief complaints that do not have a readily identifiable probable etiology are a common patient group at risk for adverse outcomes. Certain biomarkers, which have not yet been tested for prognostic value when applied to ED patients with NSCs, have emerged as useful tools for predicting prognosis in patients with a variety of diseases. This study tested the hypothesis that two of these novel markers, copeptin (a C-terminal portion of provasopressin) and/or peroxiredoxin-4 (Prx4), an enzyme that degrades hydrogen peroxide, singly or together are helpful in predicting death in the near term among patients presenting to the ED with NSCs. METHODS: The Basel Non-specific Complaints (BANC) study is a delayed type cross-sectional diagnostic study with a prospective 30-day follow-up. ED patients with NSCs were consecutively enrolled. Patients with vital parameters out of the normal range were excluded. The primary endpoint of this study was the predictive value of copeptin and Prx4 for 30-day mortality in patients with NSCs. Measurement of both copeptin and Prx4 was performed in serum samples with sandwich immunoluminometric assays. RESULTS: On follow-up at 30 days after ED presentation, 28 of 438 patients with NSC had died. Copeptin and Prx4 concentrations were significantly higher in nonsurvivors than in survivors (Kruskal-Wallis test, p = 0.0001 and p < 0.0001, respectively). In univariate models, Prx4 (likelihood ratio [LR] chi(2) = 22.24, p < 0.00001, concordance index [C-index] = 0.749) and copeptin (LR chi(2) = 16.98, p = 0.00004, C-index = 0.724) were both predictive of 30-day mortality, and elevated levels were associated with an increased mortality. The bivariable model, which included both Prx4 and copeptin (LR chi(2) = 28.22, p < 0.00001, C-index = 0.783), allows a significantly better prediction than the univariate Prx4 (p = 0.00025) and copeptin models (p = 0.00099), respectively. Both biomarkers provided independent and additional information to clinical risk scores (Katz Activities of Daily Living [ADL] and Charlson Comorbidity Index [CCI], all p < 0.0005). CONCLUSIONS: Copeptin and Prx4 are new prognostic markers in patients presenting to the ED with NSCs. Copeptin and Prx4 might be valuable tools for risk stratification and decision-making in this patient group.
    Tags: *Mortality, Aged, Aged, 80 and over, Biomarkers/*blood, Cause of Death, Cross-Sectional Studies, Emergency Service, Hospital, Female, Glycopeptides/*blood, Humans, Immunochemistry, Male, Peroxiredoxins/*blood, Prognosis, Risk Assessment/methods, Survival Analysis.
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  • van Olmen, J., Ku, G. M., and Slama, S. “Priority Actions For The Non-Communicable Disease Crisis”. Lancet 378, no. 9791: 566. doi:10.1016/S0140-6736(11)61285-3.
    Tags: *Developing Countries, *Health Priorities, Chronic Disease/epidemiology/*prevention & control, Humans, Risk Factors.
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  • Klenke, F. M., Evangelopoulos, D. S., Zimmermann, H., and Exadaktylos, A. K. “Full-Body Low Radiation Radiography (Lodox)--A Safe Drug Detection Device In Body Packers?”. Injury 43, no. 7: 1231-3. doi:10.1016/j.injury.2011.07.002.
    Tags: Adult, Foreign Bodies/*diagnostic imaging, Humans, Male, Radiation Dosage, Radiography, Whole-Body Irradiation/*instrumentation.
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  • Hasler, R. M., Huttner, H. E., Keel, M. J., Durrer, B., Zimmermann, H., Exadaktylos, A. K., and Benneker, L. M. “Spinal And Pelvic Injuries In Airborne Sports: A Retrospective Analysis From A Major Swiss Trauma Centre”. Injury 43, no. 4: 440-5. doi:10.1016/j.injury.2011.06.193.
    Abstract: BACKGROUND: Adrenalin-seeking airborne sports like BASE-jumping, paragliding, parachuting, delta-gliding, speedflying, and skysurfing are now firmly with us as outdoor lifestyle activities and are associated with a high frequency of severe injuries, especially to the spine. METHODS: Retrospective analysis of all airborne sports-associated spinal and pelvic injuries admitted to a Level I trauma centre in the Swiss Alps between 1st March 2000 and 31st October 2009. Spinal injuries were classified by the Magerl system and pelvic injuries by the AO/OTA scheme modified by Isler and Ganz. Spino-pelvic dissociation fractures in airborne sports were compared to similar injuries in the general trauma population using multiple logistic regression analysis. RESULTS: 181 patients (11 BASE-jumpers, 144 paragliders, 19 parachuters, 1 speedflyer, 4 deltagliders, 2 skysurfer) were included. 161 (89%) were male. Median age was 37.0 years (IQR=29.0-47.0) and ISS 8 (IQR=4-13). 89 (49.2%) patients sustained spinal fractures. Type A fractures were predominant (91.5%), followed by Type C (5.3%) and Type B (3.2%). The level L1 was most often affected (35.1%). 17 patients (9.4%) had pelvic ring fractures. Most frequent were Type C fractures (41.2%), followed by Types A and B (29.4% each). 8 paragliders (4.4%) suffered spino-pelvic dissociation injuries. The odds ratio for sustaining such fractures in paragliders was 21-fold higher (OR 21.04, 95% CI 7.83-56.57, p<0.001) than in the general trauma population. CONCLUSIONS: Serious spinal and pelvic injuries account for most injuries sustained during airborne sporting activities. The thoracolumbar region was most often affected, but the lumbopelvic junction is also especially vulnerable as high impact forces from vertical and horizontal deceleration need to be absorbed. The frequency of spino-pelvic dissociation was very high in paragliding injuries, with a 21-fold higher odds ratio than in the general trauma population.
    Tags: *Sports, Adult, Female, Humans, Male, Middle Aged, Pelvic Bones/*injuries, Radiculopathy, Retrospective Studies, Sex Factors, Spinal Injuries/*epidemiology/pathology, Switzerland/epidemiology, Trauma Centers/*statistics & numerical data, Trauma Severity Indices.
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  • Osterwalder, J. J., and Braun, D. “Strengths And Weaknesses Of Chest Compression Training: A Preliminary Retrospective Study”. Swiss Med Wkly 141, no. JULY: w13221. doi:10.4414/smw.2011.13221.
    Abstract: BACKGROUND: High quality chest compression is one of the key factors in successful resuscitation. A high standard of training is therefore decisive. We aimed to investigate the strengths and weaknesses of teaching chest compression in a study designed to highlight where targeted improvements in the quality of our chest compression training can and must be made. METHODS: Retrospective analysis of prospectively documented data with 234 participants, and recording and analysis of chest compression variables before and after a BLS training course. RESULTS: The results after the course were good for compression depth (94% correct), moderate for compression frequency (83% correct) and decompression (82% correct), unsatisfactory for hand positioning (74% correct) and poor for the compression/decompression ratio (32% correct). Practical instruction brought about improvements of between 9% and 48%. The greatest improvement was seen for hand positioning (48%), followed by compression depth (32%), compression rate (32%), and the compression/decompression ratio (20%). Training had only a slight effect on the degree of decompression (9%). Significant deteriorations were also noted after the course, for compression rate (11%) and the compression/decompression ratio (12%). CONCLUSIONS: Chest compression training showed weakness for four out of five variables. Only the end results for compression depth were satisfactory. The deficits observed in the training on chest compression were relevant and must be remedied. One possibility would be initial step-by-step training and assessment of each component of chest compression, concentrating in particular on hand positioning and compression/decompression ratio.
    Tags: Adult, Cardiopulmonary Resuscitation/*education/*methods/standards, Heart Massage/*methods/standards, Humans, Male, Pressure, Quality Indicators, Health Care, Retrospective Studies, Teaching/*methods.
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  • Guessous, I., Bochud, M., Bonny, O., and Burnier, M. “Calcium, Vitamin D And Cardiovascular Disease”. Kidney Blood Press Res 34, no. 6: 404-17. doi:10.1159/000328332.
    Abstract: The relationship between calcium and cardiovascular diseases (CVD) has been explored for a long time. Studies exploring the effect of calcium intake or calcium supplementation on cardiovascular risk suggest that systolic blood pressure increases under low calcium intake and decreases with calcium supplementation. A lower calcium intake has been associated with an increased risk of stroke. However, the impact of calcium supplementation on stroke risk remains unclear. Calcium supplementation may increase the risk of myocardial infarction. The relationship between vitamin D and CVD has been explored more recently. Negative correlations between vitamin D levels and the risk of hypertension, myocardial infarction, and stroke have been reported in several observational studies. The effect of vitamin D supplementation on blood pressure is still unclear and no effect of vitamin D supplementation on coronary heart disease or stroke has been clearly demonstrated. There is a lack of randomized clinical trials primarily addressing the effect of these parameters on CVD. Therefore, the real impact of calcium and vitamin D on cardiovascular outcomes remains to be documented by appropriate experimental data.
    Tags: Animals, Blood Pressure/drug effects/physiology, Calcium, Dietary/*administration & dosage/adverse effects/blood, Calcium/blood, Cardiovascular Diseases/blood/chemically induced/*prevention & control, Dietary Supplements/adverse effects, Humans, Hypertension/blood/chemically induced/prevention & control, Randomized Controlled Trials as Topic/methods, Vitamin D/*administration & dosage/adverse effects/blood.
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  • Bodmer, M., Brauchli, Y. B., Jick, S. S., and Meier, C. R. “Diabetes Mellitus And The Risk Of Cholecystectomy”. Dig Liver Dis 43, no. 9: 742-7. doi:10.1016/j.dld.2011.04.014.
    Abstract: BACKGROUND: Whether diabetes mellitus is associated with an increased risk of cholecystectomy remains controversial. AIMS: To explore the association between diabetes mellitus and the risk of cholecystectomy. METHODS: Population-based case-control analysis using UK-based General Practice Research Database. Cases of cholecystectomy and up to four controls per case, matched on age, sex, BMI, general practice, calendar time, and years of history in the database were identified between 1994 and 2008. Conditional logistic regression was used to estimate the risk of cholecystectomy in diabetics compared to non-diabetics. Odds ratios (ORs) were calculated, adjusted for smoking, alcohol consumption, statin use, and additional confounders. RESULTS: Amongst 22,574 cases with cholecystectomy and 72,476 controls, 1068 (4.7%) and 3270 (4.5%) had diabetes, respectively, yielding an adjusted OR for developing gallstone disease followed by cholecystectomy of 0.88, 95% CI 78-1.00, p=0.05) in association with diabetes mellitus. Neither glycaemic control, nor increasing diabetes duration or oral antidiabetic therapies were associated with an altered risk of cholecystectomy. Use of statins was protective in patients with (adj. OR 0.66, 95% CI 0.54-0.80, p<0.0001) or without diabetes (adj. OR 0.70, 95% CI 0.62-0.78, p<0.0001). CONCLUSIONS: Diabetes mellitus was not associated with an altered risk of cholecystectomy.
    Tags: Adult, Aged, Case-Control Studies, Cholecystectomy/*statistics & numerical data, Cholelithiasis/*complications/*surgery, Diabetes Mellitus, Type 1/blood/*complications/drug therapy, Diabetes Mellitus, Type 2/blood/*complications/drug therapy, Female, Glycated Hemoglobin/metabolism, Humans, Logistic Models, Male, Middle Aged, Odds Ratio, Time Factors, United Kingdom.
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  • Schnuriger, B., Exadaktylos, E., Sauter, T., Buhl, D., and Zimmermann, H. “Highly Sensitive Cardiac Troponin In Blunt Chest Trauma: After The Gathering Comes The Scattering?”. J Trauma 70, no. 3: 766-7. doi:10.1097/TA.0b013e31820b8b81.
    Tags: Biomarkers/blood, Heart Injuries/blood/*diagnosis, Humans, Predictive Value of Tests, Sensitivity and Specificity, Thoracic Injuries/blood/*diagnosis, Troponin/*blood, Wounds, Nonpenetrating/blood/*diagnosis.
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  • Sieber, R., Jermini-Gianinazzi, I., and Del Grande, F. “Mediastinal Pancreatic Pseudocyst And Pleural Effusion”. Eur J Emerg Med 18, no. 3: 180-1. doi:10.1097/MEJ.0b013e3283413094.
    Tags: Dyspnea/etiology, Humans, Male, Mediastinum/*pathology, Middle Aged, Pancreatic Pseudocyst/*diagnosis/pathology, Pleural Effusion/*diagnosis/pathology.
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  • Tabbara, M., Evangelopoulos, D. S., Zimmermann, H., and Exadaktylos, A. “Full Body Low Radiation Radiography Using Lodox Statscan”. Br J Hosp Med (Lond) 72, no. 2: 86-9. doi:10.12968/hmed.2011.72.2.86.
    Abstract: Lodox Statscan provides high-speed, high-quality, low radiation, full body imaging in a single scan, combined with three-dimensional reconstructive and zooming functionality. Several trauma centres have incorporated it into their advanced trauma life support protocol. This review gives a brief overview of the system.
    Tags: *Radiation Dosage, Adult, Child, Humans, Radiography, Reproducibility of Results, Sensitivity and Specificity, Trauma Centers, Whole-Body Irradiation/*instrumentation, Wounds and Injuries/*diagnostic imaging.
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  • Wolff, H., Gaspoz, J. M., and Guessous, I. “Health Care Renunciation For Economic Reasons In Switzerland”. Swiss Med Wkly 141, no. FEBRUARY: w13165. doi:10.4414/smw.2011.13165.
    Abstract: BACKGROUND: Most societies elaborate ways to contain increasing health care expenditures. In Switzerland out of pocket payments and cuts in the catalogue of reimbursed services are used as cost-containment measures. The aims of the study were to estimate the extent of health care renunciation for economic reasons and to identify associated factors. METHODS: A population-based cross-sectional survey (2008-2009) of a representative sample in the Canton of Geneva, Switzerland. Health care underuse, income level categories (<CHF 3000/month, 3000-4999, 5000-6999, 7000-9499, 9500-13000, >13000), education, occupation, insurance status and cardiovascular comorbidities were collected using self-rated questionnaires. RESULTS: 765 men and 814 women aged 35-74 years participated. 14.5% (229/1579) (95% CI 12.7-16.2) renounced health care for economic reasons. Among those who renounced (N=229), 74% renounced dental care, 37% physician consultation (22% specialist, 15% general practitioner), 26% health devices, 13% medication, and 5% surgery. Income was negatively correlated with renouncement (r=-0.18, p<.0001). Each decrease in income level category provided a 48% increased risk of renouncing health care for economic reasons (OR 1.48, 1.31-1.65). This association remained when dental care was excluded from the definition of health care renunciation. CONCLUSIONS: In a region of Switzerland with a high cost of living, such as Geneva, socioeconomic status may influence the use of the health care system, and renunciation for economic reasons was not uncommon. More than 30% of the lowest income group renounced health care for economical reasons in the previous year. Health care underuse and renunciation may worsen the health status of a substantial part of society.
    Tags: Adult, Aged, Cardiovascular Diseases/etiology, Confidence Intervals, Cross-Sectional Studies, Deductibles and Coinsurance/economics/*legislation & jurisprudence, Female, Financing, Personal/*economics, Health Services/*statistics & numerical data, Humans, Male, Middle Aged, Risk Factors, Social Class, Switzerland.
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  • Vunda, A., and Gervaix, A. “The Story Behind The Name: From The Mayor's Scarf To The "Mayo Clinic" Or The Strange Semantic Journey Of A Flexible Immobilization Device”. Orthop Traumatol Surg Res 97, no. 2: 225-6. doi:10.1016/j.otsr.2010.07.013.
    Tags: *Arm, Equipment Design, France, History, 18th Century, History, 19th Century, History, 20th Century, Humans, Language, Orthotic Devices/*history, Semantics, United States.
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  • Hasler, R. M., Gyssler, L., Benneker, L., Martinolli, L., Schotzau, A., Zimmermann, H., and Exadaktylos, A. K. “Protective And Risk Factors In Amateur Equestrians And Description Of Injury Patterns: A Retrospective Data Analysis And A Case - Control Survey”. J Trauma Manag Outcomes 5, no. 1: 4. doi:10.1186/1752-2897-5-4.
    Abstract: BACKGROUND: In Switzerland there are about 150,000 equestrians. Horse related injuries, including head and spinal injuries, are frequently treated at our level I trauma centre. OBJECTIVES: To analyse injury patterns, protective factors, and risk factors related to horse riding, and to define groups of safer riders and those at greater risk METHODS: We present a retrospective and a case-control survey at conducted a tertiary trauma centre in Bern, Switzerland.Injured equestrians from July 2000 - June 2006 were retrospectively classified by injury pattern and neurological symptoms. Injured equestrians from July-December 2008 were prospectively collected using a questionnaire with 17 variables. The same questionnaire was applied in non-injured controls. Multiple logistic regression was performed, and combined risk factors were calculated using inference trees. RESULTS: RETROSPECTIVE SURVEY: A total of 528 injuries occured in 365 patients. The injury pattern revealed as follows: extremities (32%: upper 17%, lower 15%), head (24%), spine (14%), thorax (9%), face (9%), pelvis (7%) and abdomen (2%). Two injuries were fatal. One case resulted in quadriplegia, one in paraplegia. CASE-CONTROL SURVEY: 61 patients and 102 controls (patients: 72% female, 28% male; controls: 63% female, 37% male) were included. Falls were most frequent (65%), followed by horse kicks (19%) and horse bites (2%). Variables statistically significant for the controls were: Older age (p = 0.015), male gender (p = 0.04) and holding a diploma in horse riding (p = 0.004). Inference trees revealed typical groups less and more likely to suffer injury. CONCLUSIONS: Experience with riding and having passed a diploma in horse riding seem to be protective factors. Educational levels and injury risk should be graded within an educational level-injury risk index.
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  • Vunda, A., Vandertuin, L., and Gervaix, A. “Urethral Prolapse: An Overlooked Diagnosis Of Urogenital Bleeding In Pre-Menarcheal Girls”. J Pediatr 158, no. 4: 682-3. doi:10.1016/j.jpeds.2010.11.050.
    Tags: Child, Preschool, Female, Hemorrhage/*etiology, Humans, Physical Examination, Prolapse, Urethral Diseases/*complications/*diagnosis, Urologic Diseases/etiology.
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  • Evangelopoulos, Dimitrios S., Deyle, Simone, Zimmermann, Heinz, and Exadaktylos, Aristomenis K. “Full-Body Radiography (Lodox Statscan) In Trauma And Emergency Medicine: A Report From The First European Installation Site”. Trauma 13, no. 1: 5-15. doi:10.1177/1460408610382493.
    Abstract: Lodox Statscan is a whole-body, skeletal and soft-tissue, low-dose X-ray scanner with digital enhancement and enlargement capabilities. Ten years ago it was introduced as a screening device for the examination of trauma patients. Its incorporation into the Emergency Room enabled anterior-posterior and lateral thoraco-abdominal studies to be performed in 3—5 min with only about one-third of the radiation required for conventional radiography. Since its approval by the Food and Drug Administration in the USA, several trauma centres have incorporated this technology into their Advanced Trauma Life Support protocols. This review provides an overview of the system, and reports on the authors’ own experience with the system and that of others over the past 10 years, based on a literature search for all review articles, original articles, conference proceedings, case reports and short reports related to the Lodox Statscan device. © 2011, SAGE Publications. All rights reserved.
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2010

  • Hugli, O., Righini, M., Le Gal, G., Roy, P. M., Sanchez, O., Verschuren, F., Meyer, G., Bounameaux, H., and Aujesky, D. “The Pulmonary Embolism Rule-Out Criteria (Perc) Rule Does Not Safely Exclude Pulmonary Embolism”. J Thromb Haemost 9, no. 2: 300-4. doi:10.1111/j.1538-7836.2010.04147.x.
    Abstract: BACKGROUND: The Pulmonary Embolism Rule-out Criteria (PERC) rule is a clinical diagnostic rule designed to exclude pulmonary embolism (PE) without further testing. We sought to externally validate the diagnostic performance of the PERC rule alone and combined with clinical probability assessment based on the revised Geneva score. METHODS: The PERC rule was applied retrospectively to consecutive patients who presented with a clinical suspicion of PE to six emergency departments, and who were enrolled in a randomized trial of PE diagnosis. Patients who met all eight PERC criteria [PERC((-))] were considered to be at a very low risk for PE. We calculated the prevalence of PE among PERC((-)) patients according to their clinical pretest probability of PE. We estimated the negative likelihood ratio of the PERC rule to predict PE. RESULTS: Among 1675 patients, the prevalence of PE was 21.3%. Overall, 13.2% of patients were PERC((-)). The prevalence of PE was 5.4% [95% confidence interval (CI): 3.1-9.3%] among PERC((-)) patients overall and 6.4% (95% CI: 3.7-10.8%) among those PERC((-)) patients with a low clinical pretest probability of PE. The PERC rule had a negative likelihood ratio of 0.21 (95% CI: 0.12-0.38) [corrected] for predicting PE overall, and 0.63 (95% CI: 0.38-1.06) in low-risk patients. CONCLUSIONS: Our results suggest that the PERC rule alone or even when combined with the revised Geneva score cannot safely identify very low risk patients in whom PE can be ruled out without additional testing, at least in populations with a relatively high prevalence of PE.
    Tags: Aged, Diagnosis, Differential, Enzyme-Linked Immunosorbent Assay, Female, Humans, Male, Middle Aged, Pulmonary Embolism/*diagnosis.
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  • Zumstein, M. A., Moser, M., Mottini, M., Ott, S. R., Sadowski-Cron, C., Radanov, B. P., Zimmermann, H., and Exadaktylos, A. “Long-Term Outcome In Patients With Mild Traumatic Brain Injury: A Prospective Observational Study”. J Trauma 71, no. 1: 120-7. doi:10.1097/TA.0b013e3181f2d670.
    Abstract: BACKGROUND: Mild traumatic brain injury (MTBI) is common; up to 37% of adult men have a history of MTBI. Complaints after MTBI are persistent headaches, memory impairment, depressive mood disorders, and disability. The reported short- and long-term outcomes of patients with MTBI have been inconsistent. We have now investigated long-term clinical and neurocognitive outcomes in patients with MTBI (at admission, and after 1 and 10 years). METHODS: Patients of a previous study investigating MTBI short-term outcome were prospectively reassessed after +/-10 year using the same standardized data entry form and validated questionnaire (Beltztest with Beltz Score [BeSc]) for evaluation of Quality of life (QoL) and neurocognitive outcome (higher scores indicate lower QoL). RESULTS: Eighty-six of 176 patients (49%) could be reassessed (n = 75 lost to follow-up; n = 8 second brain trauma; n = 7 death), 10.4 +/- 2 years after initial evaluation. Over time, overall BeSc was significantly increased (5.92 +/- 10.3 [admission] vs. 10.7 +/- 12.8 [1 year] vs. 20.86 +/- 17.1 [10 year]; p < 0.0001); only 54 of 86 patients (62.8%) presented with a normal BeSc. Long-term complaints were fatigue, insomnia, and exhaustion. Ten of eighty-six patients (11.6%) had intracranial injury (ICI) and initial BeSc was almost twofold higher in patients with ICI than in patients without ICI (10.0 +/- 8.4 vs. 5.3 +/- 9.6; p = 0.007). This difference was not seen after 1 year or after 10 years (10.3 +/- 11.6 vs. 10.3 +/- 10.1 and 21.4 +/- 17.3 vs. 16.1 +/- 16.4, respectively). Eight of eighty-six patients (9.3%) lost their jobs because of persistent complaints after MTBI. CONCLUSION: BeSc deteriorates over time; our data suggest a decline in general health and QoL in a substantial proportion of patients (37.2%) 10 years after MTBI. Patients without ICI appear to have a better long-term outcome with regard to subjective complaints and QoL.
    Tags: *Health Status, *Quality of Life, Adolescent, Adult, Aged, Aged, 80 and over, Brain Injuries/epidemiology/*therapy, Female, Follow-Up Studies, Humans, Incidence, Intensive Care Units, Male, Middle Aged, Prognosis, Prospective Studies, Surveys and Questionnaires, Survival Rate/trends, Switzerland/epidemiology, Time Factors, Trauma Severity Indices, Young Adult.
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