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Swiss Emergency Research collection

2022

  • Ackfeld, T., Schmutz, T., Guechi, Y., and Le Terrier, C. “Blood Transfusion Reactions-A Comprehensive Review Of The Literature Including A Swiss Perspective”. J Clin Med 11, no. 10. doi:10.3390/jcm11102859.
    Abstract: Blood transfusions have been the cornerstone of life support since the introduction of the ABO classification in the 20th century. The physiologic goal is to restore adequate tissue oxygenation when the demand exceeds the offer. Although it can be a life-saving therapy, blood transfusions can lead to serious adverse effects, and it is essential that physicians remain up to date with the current literature and are aware of the pathophysiology, initial management and risks of each type of transfusion reaction. We aim to provide a structured overview of the pathophysiology, clinical presentation, diagnostic approach and management of acute transfusion reactions based on the literature available in 2022. The numbers of blood transfusions, transfusion reactions and the reporting rate of transfusion reactions differ between countries in Europe. The most frequent transfusion reactions in 2020 were alloimmunizations, febrile non-hemolytic transfusion reactions and allergic transfusion reactions. Transfusion-related acute lung injury, transfusion-associated circulatory overload and septic transfusion reactions were less frequent. Furthermore, the COVID-19 pandemic has challenged the healthcare system with decreasing blood donations and blood supplies, as well as rising concerns within the medical community but also in patients about blood safety and transfusion reactions in COVID-19 patients. The best way to prevent transfusion reactions is to avoid unnecessary blood transfusions and maintain a transfusion-restrictive strategy. Any symptom occurring within 24 h of a blood transfusion should be considered a transfusion reaction and referred to the hemovigilance reporting system. The initial management of blood transfusion reactions requires early identification, immediate interruption of the transfusion, early consultation of the hematologic and ICU departments and fluid resuscitation.
    Tags: adverse transfusion reactions, anemia treatment, blood cell transfusion, erythrocyte transfusion, pulmonary complications.
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  • Mellhammar, L., Elen, S., Ehrhard, S., Bouma, H., Ninck, L., Muntjewerff, E., Wunsch, D., Bloos, F., Malmstrom, E., and Linder, A. “New, Useful Criteria For Assessing The Evidence Of Infection In Sepsis Research”. Crit Care Explor 4, no. 5: e0697. doi:10.1097/CCE.0000000000000697.
    Abstract: OBJECTIVES: The Sepsis-3 definition states the clinical criteria for sepsis but lacks clear definitions of the underlying infection. To address the lack of applicable definitions of infection for sepsis research, we propose new criteria, termed the Linder-Mellhammar criteria of infection (LMCI). The aim of this study was to validate these new infection criteria. DESIGN: A multicenter cohort study of patients with suspected infection who were admitted to emergency departments or ICUs. Data were collected from medical records and from study investigators. SETTING: Four academic hospitals in Sweden, Switzerland, the Netherlands, and Germany. PATIENTS: A total of 934 adult patients with suspected infection or suspected sepsis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Agreement of infection site classification was measured using the LMCI with Cohen kappa coefficient, compared with the Calandra and Cohen definitions of infection and diagnosis on hospital discharge as references. In one of the cohorts, comparisons were also made to adjudications by an expert panel. A subset of patients was assessed for interobserver agreement. MEASUREMENTS AND MAIN RESULTS: The precision of the LMCI varied according to the applied reference. LMCI performed better than the Calandra and Cohen definitions (kappa = 0.62 [95% CI, 0.59-0.65] vs kappa = 0.43 [95% CI, 0.39-0.47], respectively) and the diagnosis on hospital discharge (kappa = 0.57 [95% CI, 0.53-0.61] vs kappa = 0.43 [95% CI, 0.39-0.47], respectively). The interobserver agreement for the LMCI was evaluated in 91 patients, with agreement in 77%, kappa = 0.72 (95% CI, 0.60-0.85). When tested with adjudication as the gold standard, the LMCI still outperformed the Calandra and Cohen definitions (kappa = 0.65 [95% CI, 0.60-0.70] vs kappa = 0.29 [95% CI, 0.24-0.33], respectively). CONCLUSIONS: The LMCI is useful criterion of infection that is intended for sepsis research, in and outside of the ICU. Useful criteria for infection have the potential to facilitate more comparable sepsis research and exclude sepsis mimics from clinical studies, thus improving and simplifying sepsis research.
    Tags: definitions, diagnosis, infectious disease medicine, interest., sepsis.
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  • Lampart, M., Zellweger, N., Bassetti, S., Tschudin-Sutter, S., Rentsch, K. M., Siegemund, M., Bingisser, R., Osswald, S., Kuster, G. M., and Twerenbold, R. “Clinical Utility Of Inflammatory Biomarkers In Covid-19 In Direct Comparison To Other Respiratory Infections-A Prospective Cohort Study”. Plos One 17, no. 5: e0269005. doi:10.1371/journal.pone.0269005.
    Abstract: BACKGROUND: Inflammatory biomarkers are associated with severity of coronavirus disease 2019 (COVID-19). However, direct comparisons of their utility in COVID-19 versus other respiratory infections are largely missing. OBJECTIVE: We aimed to investigate the prognostic utility of various inflammatory biomarkers in COVID-19 compared to patients with other respiratory infections. MATERIALS AND METHODS: Patients presenting to the emergency department with symptoms suggestive of COVID-19 were prospectively enrolled. Levels of Interleukin-6 (IL-6), c-reactive protein (CRP), procalcitonin, ferritin, and leukocytes were compared between COVID-19, other viral respiratory infections, and bacterial pneumonia. Primary outcome was the need for hospitalisation, secondary outcome was the composite of intensive care unit (ICU) admission or death at 30 days. RESULTS: Among 514 patients with confirmed respiratory infections, 191 (37%) were diagnosed with COVID-19, 227 (44%) with another viral respiratory infection (viral controls), and 96 (19%) with bacterial pneumonia (bacterial controls). All inflammatory biomarkers differed significantly between diagnoses and were numerically higher in hospitalized patients, regardless of diagnoses. Discriminative accuracy for hospitalisation was highest for IL-6 and CRP in all three diagnoses (in COVID-19, area under the curve (AUC) for IL-6 0.899 [95%CI 0.850-0.948]; AUC for CRP 0.922 [95%CI 0.879-0.964]). Similarly, IL-6 and CRP ranged among the strongest predictors for ICU admission or death at 30 days in COVID-19 (AUC for IL-6 0.794 [95%CI 0.694-0.894]; AUC for CRP 0.807 [95%CI 0.721-0.893]) and both controls. Predictive values of inflammatory biomarkers were generally higher in COVID-19 than in controls. CONCLUSION: In patients with COVID-19 and other respiratory infections, inflammatory biomarkers harbour strong prognostic information, particularly IL-6 and CRP. Their routine use may support early management decisions.
    Tags: *COVID-19/diagnosis, *Pneumonia, Bacterial/diagnosis, *Respiratory Tract Infections, Biomarkers, C-Reactive Protein/metabolism, Humans, Interleukin-6, Prospective Studies.
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  • Roberts, I., and Ageron, F. X. “The Role Of Tranexamic Acid In Trauma - A Life-Saving Drug With Proven Benefit”. Nat Rev Dis Primers 8, no. 1: 34. doi:10.1038/s41572-022-00367-5.
    Tags: *Antifibrinolytic Agents/pharmacology/therapeutic use, *Tranexamic Acid/therapeutic use, Hemorrhage, Humans.
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  • Alessandro, O., Rene, W., Stefan, W., Miodrag, F., Martin, S., Oliver, B., and Urs, P. “C-Reactive Protein Elevation Predicts In-Hospital Deterioration After Aneurysmal Subarachnoid Hemorrhage: A Retrospective Observational Study”. Acta Neurochir (Wien) 164, no. 7: 1805-1814. doi:10.1007/s00701-022-05256-0.
    Abstract: BACKGROUND: There is increasing evidence that inflammation plays a role in the pathogenesis of aneurysmal subarachnoid hemorrhage (aSAH) and in the development of delayed cerebral ischemia (DCI). However, the assessment and interpretation of classically defined inflammatory parameters is difficult in aSAH patients. The objective of this study was to investigate the relationship between easily assessable findings (hyperventilation, fever, white blood cell count (WBC), and C-reactive protein (CRP)) and the occurrence of DCI and unfavorable neurological outcome at discharge in aSAH patients. METHODS: Retrospective analysis of prospectively collected data from a single center cohort. We evaluated the potential of clinical signs of inflammation (hyperventilation, fever) and simple inflammatory laboratory parameters CRP and WBC to predict unfavorable outcomes at discharge and DCI in a multivariate analysis. A cutoff value for CRP was calculated by Youden's J statistic. Outcome was measured using the modified Rankin score at discharge, with an unfavorable outcome defined as modified Rankin scale (mRS) > 3. RESULTS: We included 97 consecutive aSAH patients (63 females, 34 males, mean age 58 years) in the analysis. Twenty-one (22%) had major disability or died by the time of hospital discharge. Among inflammatory parameters, CRP over 100 mg/dl on day 2 was an independent predictor for worse neurological outcome at discharge. The average C-reactive protein level in the first 14 days was higher in patients with a worse neurological outcome (96.6, SD 48.3 vs 56.3 mg/dl, SD 28.6) in the first 14 days after aSAH. C-reactive protein on day 2 was an indicator of worse neurological outcome. No inflammatory parameter was an independent predictor of DCI. After multivariate adjustment, DCI, increased age, and more than 1 day of mechanical ventilation were significant predictors of worse neurological outcome. CONCLUSIONS: Early elevated CRP levels were a significant predictor of worse neurological outcome at hospital discharge and may be a useful marker of later deterioration in aSAH.
    Tags: *Brain Ischemia/diagnosis/etiology, *Subarachnoid Hemorrhage/complications/diagnosis, C-Reactive Protein, Cerebral Infarction, Delayed cerebral ischemia, Female, Hospitals, Humans, Hyperventilation/complications, Inflammation, Male, Middle Aged, Retrospective Studies, Subarachnoid hemorrhage.
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  • Foll, S., Lison, A., Maritsch, M., Klingberg, K., Lehmann, V., Zuger, T., Srivastava, D., et al. “A Scalable Risk-Scoring System Based On Consumer-Grade Wearables For Inpatients With Covid-19: Statistical Analysis And Model Development”. Jmir Form Res 6, no. 6: e35717. doi:10.2196/35717.
    Abstract: BACKGROUND: To provide effective care for inpatients with COVID-19, clinical practitioners need systems that monitor patient health and subsequently allow for risk scoring. Existing approaches for risk scoring in patients with COVID-19 focus primarily on intensive care units (ICUs) with specialized medical measurement devices but not on hospital general wards. OBJECTIVE: In this paper, we aim to develop a risk score for inpatients with COVID-19 in general wards based on consumer-grade wearables (smartwatches). METHODS: Patients wore consumer-grade wearables to record physiological measurements, such as the heart rate (HR), heart rate variability (HRV), and respiration frequency (RF). Based on Bayesian survival analysis, we validated the association between these measurements and patient outcomes (ie, discharge or ICU admission). To build our risk score, we generated a low-dimensional representation of the physiological features. Subsequently, a pooled ordinal regression with time-dependent covariates inferred the probability of either hospital discharge or ICU admission. We evaluated the predictive performance of our developed system for risk scoring in a single-center, prospective study based on 40 inpatients with COVID-19 in a general ward of a tertiary referral center in Switzerland. RESULTS: First, Bayesian survival analysis showed that physiological measurements from consumer-grade wearables are significantly associated with patient outcomes (ie, discharge or ICU admission). Second, our risk score achieved a time-dependent area under the receiver operating characteristic curve (AUROC) of 0.73-0.90 based on leave-one-subject-out cross-validation. CONCLUSIONS: Our results demonstrate the effectiveness of consumer-grade wearables for risk scoring in inpatients with COVID-19. Due to their low cost and ease of use, consumer-grade wearables could enable a scalable monitoring system. TRIAL REGISTRATION: Clinicaltrials.gov NCT04357834; https://www.clinicaltrials.gov/ct2/show/NCT04357834.
    Tags: Bayesian survival analysis, Covid-19, digital health, general ward, group of the World Health Organization (WHO) but without competing interests. All, hospital, measurement instrument, measurement tool, other authors declare no competing interest., patient monitoring, remote monitoring, remote patient monitoring, risk score, risk scoring, scalable, smart device, smartwatch, smartwatches, wearable, wearable devices.
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  • Nutbeam, T., Roberts, I., Weekes, L., Shakur-Still, H., Brenner, A., and Ageron, F. X. “Use Of Tranexamic Acid In Major Trauma: A Sex-Disaggregated Analysis Of The Clinical Randomisation Of An Antifibrinolytic In Significant Haemorrhage (Crash-2 And Crash-3) Trials And Uk Trauma Registry (Trauma And Audit Research Network) Data”. Br J Anaesth 129, no. 2: 191-199. doi:10.1016/j.bja.2022.03.032.
    Abstract: BACKGROUND: Women are less likely than men to receive some emergency treatments. This study examines whether the effect of tranexamic acid (TXA) on mortality in trauma patients varies by sex and whether the receipt of TXA by trauma patients varies by sex. METHODS: First, we conducted a sex-disaggregated analysis of data from the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH)-2 and CRASH-3 trials. We used interaction tests to determine whether the treatment effect varied by sex. Second, we examined data from the Trauma and Audit Research Network (TARN) to explore sex differences in the receipt of TXA. We used logistic regression models to estimate the odds ratio for receipt of TXA in females compared with males. Results are reported as n (%), risk ratios (RR), and odds ratios (OR) with 95% confidence intervals. RESULTS: Overall, 20 211 polytrauma patients (CRASH-2) and 12 737 patients with traumatic brain injuries (CRASH-3) were included in our analysis. TXA reduced the risk of death in females (RR=0.69 [0.52-0.91]) and in males (RR=0.80 [0.71-0.90]) with no significant heterogeneity by sex (P=0.34). We examined TARN data for 216 364 patients aged >/=16 yr with an Injury Severity Score >/=9 with 98 879 (46%) females and 117 485 (54%) males. TXA was received by 7198 (7.3% [7.1-7.4%]) of the females and 19 697 (16.8% [16.6-17.0%]) of the males (OR=0.39 [0.38-0.40]). The sex difference in the receipt of TXA increased with increasing age. CONCLUSIONS: Administration of TXA to patients with bleeding trauma reduces mortality to a similar extent in women and men, but women are substantially less likely to be treated with TXA.
    Tags: *Antifibrinolytic Agents/therapeutic use, *Tranexamic Acid/therapeutic use, *Wounds and Injuries/complications/drug therapy, declare., Female, haemorrhage, Hemorrhage/drug therapy, Humans, injuries, Male, multiple trauma, Registries, tranexamic acid, transfusion, trauma, United Kingdom/epidemiology.
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  • Bigdon, S. F., Saldarriaga, Y., Oswald, K. A. C., Muller, M., Deml, M. C., Benneker, L. M., T, M. Ecker, and Albers, C. E. “Epidemiologic Analysis Of 8000 Acute Vertebral Fractures: Evolution Of Treatment And Complications At 10-Year Follow-Up”. J Orthop Surg Res 17, no. 1: 270. doi:10.1186/s13018-022-03147-9.
    Abstract: STUDY DESIGN: This is a retrospective cohort study. OBJECTIVES: This study aims to determine the proportional incidence, clinical characteristics, treatment patterns with complications and changes in treatment of vertebral fractures over 10 years at a Swiss university hospital. METHODS: A retrospective cohort study was performed. All patients with an acute vertebral fracture were included in this study. The extracted anonymized data from the medical records were manually assessed. Demographic data, exact location, etiology, type of treatment and complications related to the treatment were obtained. RESULTS: Of 330,225 treated patients, 4772 presented with at least one vertebral fracture. In total 8307 vertebral fractures were identified, leading to a proportional incidence of 25 vertebral fractures in 1000 patients. Fractures were equally distributed between genders. Male patients were significantly younger and more likely to sustain a traumatic fracture, while female patients more commonly presented with osteoporotic fractures. The thoracolumbar junction (Th11-L2) was the most frequent fracture site in all etiologies. More than two-thirds of vertebral fractures were treated surgically (68.6%). Out of 4622 performed surgeries, we found 290 complications (6.3%). The odds for surgical treatment in osteoporotic fractures were two times higher before 2010 compared to 2010 and after (odds ratio: 2.1, 95% CI 1.5-2.9, p < 0.001). CONCLUSION: Twenty-five out of 1000 patients presented with a vertebral fracture. More than 4000 patients with over 8307 vertebral body fractures were treated in 10 years. Over two-thirds of all fractures were treated surgically with 6.3% complications. There was a substantial decrease in surgeries for osteoporotic fractures after 2009.
    Tags: *Fractures, Compression/surgery, *Osteoporotic Fractures/epidemiology/etiology/surgery, *Spinal Fractures/epidemiology/etiology/surgery, Complications, Epidemiology, Female, Follow-Up Studies, Humans, Male, Osteoporosis, Retrospective Studies, Revision surgery, Spine fractures, Spine surgery, Treatment patterns, Vertebral fractures.
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  • Michel, J., Mettler, A., Muller, M., Hautz, W. E., and Sauter, T. C. “A Utility Framework For Covid-19 Online Forward Triage Tools: A Swiss Telehealth Case Study”. Int J Environ Res Public Health 19, no. 9. doi:10.3390/ijerph19095184.
    Abstract: The SARS-CoV-2 pandemic caused a surge in online tools commonly known as symptom checkers. The purpose of these symptom checkers was mostly to reduce the health system burden by providing worried people with testing criteria, where to test and how to self-care. Technical, usability and organizational challenges with regard to online forward triage tools have also been reported. Very few of these online forward triage tools have been evaluated. Evidence for decision frameworks may be of particular value in a pandemic setting where time frames are restricted, uncertainties are ubiquitous and the evidence base is changing rapidly. The objective was to develop a framework to evaluate the utility of COVID-19 online forward triage tools. The development of the online forward triage tool utility framework was conducted in three phases. The process was guided by the socio-ecological framework for adherence that states that patient (individual), societal and broader structural factors affect adherence to the tool. In a further step, pragmatic incorporation of themes on the utility of online forward triage tools that emerged from our study as well as from the literature was performed. Seven criteria emerged; tool accessibility, reliability as an information source, medical decision-making aid, allaying fear and anxiety, health system burden reduction, onward forward transmission reduction and systems thinking (usefulness in capacity building, planning and resource allocation, e.g., tests and personal protective equipment). This framework is intended to be a starting point and a generic tool that can be adapted to other online forward triage tools beyond COVID-19. A COVID-19 online forward triage tool meeting all seven criteria can be regarded as fit for purpose. How useful an OFTT is depends on its context and purpose.
    Tags: *COVID-19/diagnosis/epidemiology, *Telemedicine, authors have nothing to disclose., Covid-19, evaluation framework, Humans, online forward triage tools, performed, the content of any manuscript or any decision to publish. All other, publish them. TCS holds the endowed professorship for emergency telehealth at the, Reproducibility of Results, SARS-CoV-2, Switzerland, telehealth, Triage, University of Bern, Switzerland. The founder has no influence on research, utility.
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  • Stalder, L., Kaegi-Braun, N., Gressies, C., Gregoriano, C., Tribolet, P., Lobo, D. N., Gomes, F., et al. “Prospective Validation Of Five Malnutrition Screening And Assessment Instruments Among Medical Inpatients: Secondary Analysis Of A Randomized Clinical Trial”. Clin Nutr 41, no. 6: 1307-1315. doi:10.1016/j.clnu.2022.04.025.
    Abstract: BACKGROUND & AIMS: Screening for malnutrition upon hospital admission is the first crucial step for proper nutritional assessment and treatment. While several nutritional screening and assessment instruments exist, there is a lack of head-to-head validation of these instruments. We studied the ability of five different nutrition screening and assessment instruments to predict 1-year mortality and response to nutritional treatment in participants of the EFFORT randomized trial. METHODS: In this secondary analysis of a Swiss-wide multicenter, randomized clinical trial comparing individualized nutritional support with usual care nutrition in medical inpatients, we prospectively classified patients as low, intermediate, and high nutritional risk based on five nutritional screening and assessment instruments (NRS 2002, SGA, SNAQ, MNA and MUST). RESULTS: Overall mortality at 1-year in the 1866 included patients was 30.4%. There were significant correlations and a significant concordance between all instruments with r-values ranging from 0.23 to 0.55 and kappa values ranging from 0.10 to 0.36. While high nutritional risk was associated with higher mortality in all instruments, SGA and MNA showed the strongest association with adjusted odds ratios of 3.17 (95%CI, 2.18 to 4.61, p < 0.001) and 3.45 (95%CI, 2.28 to 5.22, p < 0.001). When comparing mortality in intervention group patients to control group patients stratified by severity of malnutrition, there was overall no clear trend towards more benefit in patients with more severe malnutrition, with NRS 2002 and SGA showing the most pronounced relationship between the severity of malnutrition and reduction in mortality as a response to nutritional support. CONCLUSION: Among all five screening and assessment instruments, higher nutritional risk was associated with higher risk for mortality and adverse clinical outcome, but not with more or less treatment response from nutritional support with differences among scores. Adding more specific parameters to these instruments is important when using them to decide for or against nutritional support interventions in an individual patient. TRIAL REGISTRATION: ClinicalTrials.gov NCT02517476.
    Tags: (SNSF Professorship, PP00P3_150,531) and the Forschungsrat of the Kantonsspital, *Malnutrition/complications/diagnosis/therapy, *Nutrition Assessment, Aarau, Switzerland (1410.000.058 and 1410.000.044). The Institution of P. Schuetz, Assessment, grant from the Swiss National Science Foundation, Switzerland, to P. Schuetz, has previously received unrestricted grant money unrelated to this project from, Humans, Inpatients, institution of Z. Stanga received speaking honoraria and research support from, interest., Kabi, Germany and B.Braun, Germany. All other authors report no conflicts of, Malnutrition, Nestle Health Science, Switzerland, Abbott Nutrition, United States, Fresenius, Nestle Health Science, Switzerland, and Abbott Nutrition, United States. The, Nutritional Status, Nutritional Support, Outcomes, Screening.
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  • Schweizer, L., Sieber, R., Nickel, C. H., and Minotti, B. “Ability Of Pain Scoring Scales To Differentiate Between Patients Desiring Analgesia And Those Who Do Not In The Emergency Department”. Am J Emerg Med 57: 107-113. doi:10.1016/j.ajem.2022.04.046.
    Abstract: BACKGROUND AND IMPORTANCE: Pain is one of the most reasons for a visit to an emergency department (ED). Pain scores as the verbal rating scale (VRS) or numerical rating scale (NRS) are used to determine pain management. While it is crucial to measure pain levels, it is equally important to identify patients who desire pain medication, so that adequate provision of analgesia can occur. OBJECTIVE: To establish the association between pain scores on the NRS and VRS, and the desire for, and provision of, pain medication. DESIGN, SETTINGS AND PARTICIPANTS: Retrospective monocentric observational cohort study of ED patients presenting with painful conditions. OUTCOMES MEASURE AND ANALYSIS: The primary outcome was to establish for each pain score (NRS and/or VRS), those patients who desired, and were ultimately provided with, pain medication, and those who did not. Secondary outcomes included establishing the prediction of pain scores to determine desire of pain medication, and the correlation between NRS and VRS when both were reported. MAIN RESULTS: 130,279 patients were included for analysis. For each patient who desired pain medication, pain medication was provided. Proportion of patients desiring pain medication were 4.1-17.8% in the pain score range 0.5-3.5, 31.9-63.4% in the range 4-6.5, and 65-84.6% in the range 7-10. The prediction probability of pain scores to determine desire for pain medication was represented with an AUROC of 0.829 (95% CI 0.826-0.831). The optimal threshold predicting the desire for pain medication would be a pain score of 4.25, with sensitivity 0.86, and specificity 0.68. For the 7835 patients with both NRS and VRS scores available, the Spearman-Rho coefficient assessing correlation was 0.946 (p < 0.001). CONCLUSIONS: Despite guidelines currently recommending pain medication in patients with a NRS score > 4, we found a discrepancy between pain scores and desire for pain medication. Results of this large retrospective cohort support that the desire for pain medication in the ED might not be derived from a pain score alone.
    Tags: *Analgesia, *Pain Management, Analgesia, Emergency department, Emergency Service, Hospital, Humans, Numerical rating scale, Pain assessment, Pain management, Pain Measurement/methods, Pain/diagnosis/drug therapy, Retrospective Studies, Verbal rating scale.
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  • Nijman, R. G., Bressan, S., Brandenberger, J., Kaur, D., Keitel, K., Maconochie, I. K., Oostenbrink, R., et al. “Update On The Coordinated Efforts Of Looking After The Health Care Needs Of Children And Young People Fleeing The Conflict Zone Of Ukraine Presenting To European Emergency Departments-A Joint Statement Of The European Society For Emergency Paediatrics And The European Academy Of Paediatrics”. Front Pediatr 10: 897803. doi:10.3389/fped.2022.897803.
    Abstract: This joint statement by the European Society for Emergency Paediatrics and European Academy of Paediatrics aims to highlight recommendations for dealing with refugee children and young people fleeing the Ukrainian war when presenting to emergency departments (EDs) across Europe. Children and young people might present, sometimes unaccompanied, with either ongoing complex health needs or illnesses, mental health issues, and injuries related to the war itself and the flight from it. Obstacles to providing urgent and emergency care include lack of clinical guidelines, language barriers, and lack of insight in previous medical history. Children with complex health needs are at high risk for complications and their continued access to specialist healthcare should be prioritized in resettlements programs. Ukraine has one of the lowest vaccination coverages in the Europe, and outbreaks of cholera, measles, diphtheria, poliomyelitis, and COVID-19 should be anticipated. In Ukraine, rates of multidrug resistant tuberculosis are high, making screening for this important. Urgent and emergency care facilities should also prepare for dealing with children with war-related injuries and mental health issues. Ukrainian refugee children and young people should be included in local educational systems and social activities at the earliest opportunity.
    Tags: commercial or financial relationships that could be construed as a potential, conflict of interest., emergency medicine, infectious diseases, mental health, pediatrics, post-traumatic stress disorder, refugee, social medicine, trauma.
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  • Rubinelli, S., Purnat, T. D., Wilhelm, E., Traicoff, D., Namageyo-Funa, A., Thomson, A., Wardle, C., Lamichhane, J., Briand, S., and Nguyen, T. “Who Competency Framework For Health Authorities And Institutions To Manage Infodemics: Its Development And Features”. Hum Resour Health 20, no. 1: 35. doi:10.1186/s12960-022-00733-0.
    Abstract: BACKGROUND: In April 2020, the World Health Organization (WHO) Information Network for Epidemics produced an agenda for managing the COVID-19 infodemic. "Infodemic" refers to the overabundance of information-including mis- and disinformation. In this agenda it was pointed out the need to create a competency framework for infodemic management (IM). This framework was released by WHO on 20th September 2021. This paper presents the WHO framework for IM by highlighting the different investigative steps behind its development. METHODS: The framework was built through three steps. Step 1 included the preparatory work following the guidelines in the Guide to writing Competency Framework for WHO Academy courses. Step 2 was based on a qualitative study with participants (N = 25), identified worldwide on the basis of their academic background in relevant fields of IM or of their professional experience in IM activities at the institutional level. The interviews were conducted online between December 2020 and January 2021, they were video-recorded and analyzed using thematic analysis. In Step 3, two stakeholder panels were conducted to revise the framework. RESULTS: The competency framework contains four primary domains, each of which comprised main activities, related tasks, and knowledge and skills. It identifies competencies to manage and monitor infodemics, to design, conduct and evaluate appropriate interventions, as well as to strengthen health systems. Its main purpose is to assist institutions in reinforcing their IM capacities and implementing effective IM processes and actions according to their individual contexts and resources. CONCLUSION: The competency framework is not intended to be a regulatory document nor a training curriculum. As a WHO initiative, it serves as a reference tool to be applied according to local priorities and needs within the different countries. This framework can assist institutions in strengthening IM capacity by hiring, staff development, and human resources planning.
    Tags: *COVID-19/epidemiology, *Infodemic, alone are responsible for the views expressed in this paper, and they do not, are staff of the US Centers for Disease Control and Prevention. These authors, Competencies, Curriculum, Humans, Infodemic, represent the views of their organizations., Staff Development, Workforce, World Health Organization.
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  • Lindner, G., and Ravioli, S. “The Reply”. Am J Med 135, no. 5: e110. doi:10.1016/j.amjmed.2022.01.027.
  • Fuchs, A., Schmucki, R., Meuli, L., Wendel-Garcia, P. D., Albrecht, R., Greif, R., and Pietsch, U. “Helicopter Inter-Hospital Transfer For Patients Undergoing Extracorporeal Membrane Oxygenation: A Retrospective 12-Year Analysis Of A Service System”. Scand J Trauma Resusc Emerg Med 30, no. 1: 33. doi:10.1186/s13049-022-01018-0.
    Abstract: BACKGROUND: Patients undergoing extracorporeal membrane oxygenation (ECMO) are critically ill and show high mortality. Inter-hospital transfer of these patients has to be safe, with high survival rates during transport without potentially serious and life-threatening adverse events. The Swiss Air-Rescue provides 24-h/7-days per week inter-hospital helicopter transfers that include on-site ECMO cannulation if needed. This retrospective observational study describes adverse events of patients on ECMO transported by helicopter, and their associated survival. METHODS: All patients on ECMO with inter-hospital transfer by helicopter from start of service in February 2009 until May 2021 were included. Patients not transported by helicopter or with missing medical records were excluded. Patient demographics (age, sex) and medical history (type of and reason for ECMO), mission details (flight distance, times, primary or secondary transport), adverse events during the inter-hospital transfer, and survival of transferred patients were recorded. The primary endpoint was patient survival during transfer. Secondary endpoints were adverse events during transfer and 28-day survival. RESULTS: We screened 214 ECMO-related missions and included 191 in this analysis. Median age was 54.6 [IQR 46.1-62.0] years, 70.7% were male, and most patients had veno-arterial ECMO (56.5%). The main reasons for ECMO were pulmonary (46.1%) or cardiac (44.0%) failure. Most were daytime (69.8%) and primary missions (n = 100), median total mission time was 182.0 [143.0-254.0] min, and median transfer distance was 52.7 [33.2-71.1] km. All patients survived the transfer. Forty-four adverse events were recorded during 37 missions (19.4%), where 31 (70.5%) were medical and none resulted in patient harm. Adverse events occurred more frequently during night-time missions (59.9%, p = 0.047). Data for 28-day survival were available for 157 patients, of which 86 (54.8%) were alive. CONCLUSION: All patients under ECMO survived the helicopter transport. Adverse events were observed for about 20% of the flight missions, with a tendency during the night-time flights, none harmed the patients. Inter-hospital transfer for patients undergoing ECMO provided by 24-h/7-d per week helicopter emergency medical service teams can be considered as feasible and safe. The majority of the patients (54.8%) were still alive after 28 days.
    Tags: (ILCOR) and Guidelines, and ILCOR Education, Implementation and Team Task Force, *Extracorporeal Membrane Oxygenation/methods, Adverse events, Air-medical transport, Aircraft, Chair. All of the other authors declare that they have no conflicts of interests., Critical Illness, Extracorporeal life support, Extracorporeal membrane oxygenation, Female, Helicopter emergency medical system, Hospitals, Humans, Inter-hospital transfer, Male, Middle Aged, Patient Transfer/methods, Retrospective Studies.
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  • Prendki, V., Garin, N., Stirnemann, J., Combescure, C., Platon, A., Bernasconi, E., Sauter, T., Hautz, W., and group, Octoplus study. “Low-Dose Ct Or Lung Ultrasonography Versus Standard Of Care Based-Strategies For The Diagnosis Of Pneumonia In The Elderly: Protocol For A Multicentre Randomised Controlled Trial (Octoplus)”. Bmj Open 12, no. 5: e055869. doi:10.1136/bmjopen-2021-055869.
    Abstract: INTRODUCTION: Pneumonia is a leading cause of mortality and a common indication for antibiotic in elderly patients. However, its diagnosis is often inaccurate. We aim to compare the diagnostic accuracy, the clinical and cost outcomes and the use of antibiotics associated with three imaging strategies in patients >65 years old with suspected pneumonia in the emergency room (ER): chest X-ray (CXR, standard of care), low-dose CT scan (LDCT) or lung ultrasonography (LUS). METHODS AND ANALYSIS: This is a multicentre randomised superiority clinical trial with three parallel arms. Patients will be allocated in the ER to a diagnostic strategy based on either CXR, LDCT or LUS. All three imaging modalities will be performed but the results of two of them will be masked during 5 days to the patients, the physicians in charge of the patients and the investigators according to random allocation. The primary objective is to compare the accuracy of LDCT versus CXR-based strategies. As secondary objectives, antibiotics prescription, clinical and cost outcomes will be compared, and the same analyses repeated to compare the LUS and CXR strategies. The reference diagnosis will be established a posteriori by a panel of experts. Based on a previous study, we expect an improvement of 16% of the accuracy of pneumonia diagnosis using LDCT instead of CXR. Under this assumption, and accounting for 10% of drop-out, the enrolment of 495 patients is needed to prove the superiority of LDCT over CRX (alpha error=0.05, beta error=0.10). ETHICS AND DISSEMINATION: Ethical approval: CER Geneva 2019-01288. TRIAL REGISTRATION NUMBER: NCT04978116.
    Tags: *Pneumonia/diagnostic imaging/drug therapy, *Standard of Care, Aged, all outside the submitted work. WH has provided paid consultancies to AO, Anti-Bacterial Agents/therapeutic use, foundation Switzerland and MDI International Australia, all outside the submitted, Geriatric medicine, Germany, Isabel Healthcare UK, Mundipharma Medical Switzerland, VisualDx USA, all, Humans, Lung/diagnostic imaging, Multicenter Studies as Topic, Mundipharma Research UK, MDI International Australia, Roche Diagnostics Germany,, outside the submitted work., Randomized Controlled Trials as Topic, Respiratory infections, the Swiss National Science foundation, Zoll foundation, Drager Medical Germany,, Thoracic medicine, Tomography, X-Ray Computed, Ultrasonography/methods, work. WH has received financial support for a congress he chaired from EBSCO.
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  • Ageron, F. X., Hugli, O., Dami, F., Caillet-Bois, D., Pittet, V., Eckert, P., Beysard, N., and Carron, P. N. “Lessons From Covid-19 Syndromic Surveillance Through Emergency Department Activity: A Prospective Time Series Study From Western Switzerland”. Bmj Open 12, no. 5: e054504. doi:10.1136/bmjopen-2021-054504.
    Abstract: OBJECTIVE: We aimed to assess if emergency department (ED) syndromic surveillance during the first and second waves of the COVID-19 outbreak could have improved our surveillance system. DESIGN AND SETTINGS: We did an observational study using aggregated data from the ED of a university hospital and public health authorities in western Switzerland. PARTICIPANTS: All patients admitted to the ED were included. PRIMARY OUTCOME MEASURE: The main outcome was intensive care unit (ICU) occupancy. We used time series methods for ED syndromic surveillance (influenza-like syndrome, droplet isolation) and usual indicators from public health authorities (new cases, proportion of positive tests in the population). RESULTS: Based on 37 319 ED visits during the COVID-19 outbreak, 1421 ED visits (3.8%) were positive for SARS-CoV-2. Patients with influenza-like syndrome or droplet isolation in the ED showed a similar correlation to ICU occupancy as confirmed cases in the general population, with a time lag of approximately 13 days (0.73, 95% CI 0.64 to 0.80; 0.79, 95% CI 0.71 to 0.86; and 0.76, 95% CI 0.67 to 0.83, respectively). The proportion of positive tests in the population showed the best correlation with ICU occupancy (0.95, 95% CI 0.85 to 0.96). CONCLUSION: ED syndromic surveillance is an effective tool to detect and monitor a COVID-19 outbreak and to predict hospital resource needs. It would have allowed to anticipate ICU occupancy by 13 days, including significant aberration detection at the beginning of the second wave.
    Tags: *COVID-19/epidemiology, *Influenza, Human/epidemiology, accident & emergency medicine, Covid-19, Emergency Service, Hospital, Humans, Prospective Studies, public health, SARS-CoV-2, Sentinel Surveillance, Switzerland/epidemiology, Time Factors.
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  • Winkler, N. E., Sebo, P., Haller, D. M., and Maisonneuve, H. “Primary Care Patients' Perspectives On The Use Of Non-Pharmacological Home Remedies In Geneva: A Cross-Sectional Study”. Bmc Complement Med Ther 22, no. 1: 126. doi:10.1186/s12906-022-03564-7.
    Abstract: BACKGROUND: Home remedies are anchored in patients' everyday life, but their use in Western cultures remains scarcely explored. Our objectives were to investigate primary care patients' perspectives and use of non-pharmacological home remedies in Geneva (Switzerland). METHODS: In spring 2020, we conducted a cross-sectional survey among adult primary care patients in randomly selected general practices (N = 15). Patients were recruited in the waiting rooms and asked to complete a questionnaire about their sociodemographic characteristics, their home remedy use, and their expectations and reasons for using (or not using) home remedies. We employed descriptive statistics to summarise the data and logistic regression adjusted for clustering within practices to explore associations between home remedy use and participants' sociodemographic characteristics. RESULTS: Three hundred fourteen of three hundred ninety patients agreed to participate in the study (participation rate 80.5%). Home remedies were used by 64.4% of patients. The main reasons given were for preventive purposes (55.3%), self-care (41.0%), as an alternative to conventional medicine (40.5%) and to avoid or delay a medical consultation (38.5%). One-third of patients considered that it was the GP's role to spontaneously inform them about home remedies (36.4%), another third considered that it was the GP's role to inform them, but only upon specific request (32.3%), and the last third of patients declared that it was not the GP's role to provide information about home remedies (30.3%). Patients living in an urban zone (adjusted OR 2.1; 95%CI 1.0-4.4; p 0.05) and those with a tertiary education background (adjusted OR 1.9; 95%CI 1.0-3.6; p 0.05) believed that it was their GP's role to inform them about home remedies. CONCLUSIONS: Home remedies are used by a majority of primary care patients in Geneva. For a comprehensive and safe healthcare management in the context of patient-oriented medicine, more evidence-based research on efficacy and safety of home remedies as well as their place in primary care consultation is required.
    Tags: *Medicine, Traditional, *Referral and Consultation, Adult, Cross-Sectional Studies, General practitioners, Home remedies, Humans, Minor health problems, Non-pharmacological treatments, Perspectives, Practices, Primary care, Primary Health Care, Surveys and Questionnaires, Views.
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  • Amacher, S. A., Bohren, C., Blatter, R., Becker, C., Beck, K., Mueller, J., Loretz, N., et al. “Long-Term Survival After Out-Of-Hospital Cardiac Arrest: A Systematic Review And Meta-Analysis”. Jama Cardiol 7, no. 6: 633-643. doi:10.1001/jamacardio.2022.0795.
    Abstract: IMPORTANCE: Data on long-term survival beyond 12 months after out-of-hospital cardiac arrest (OHCA) of a presumed cardiac cause are scarce. OBJECTIVE: To investigate the long-term survival of adult patients after surviving the initial hospital stay for an OHCA. DATA SOURCES: A systematic search of the EMBASE and MEDLINE databases was performed from database inception to March 25, 2021. STUDY SELECTION: Clinical studies reporting long-term survival after OHCA were selected based on predefined inclusion and exclusion criteria according to a preregistered study protocol. DATA EXTRACTION AND SYNTHESIS: Patient data were reconstructed from Kaplan-Meier curves using an iterative algorithm and then pooled to generate survival curves. As a separate analysis, an aggregate data meta-analysis was performed. MAIN OUTCOMES AND MEASURES: The primary outcome was long-term survival (>12 months) after OHCA for patients surviving to hospital discharge or 30 days after OHCA. RESULTS: The search identified 15 347 reports, of which 21 studies (11 800 patients) were included in the Kaplan-Meier-based meta-analysis and 33 studies (16 933 patients) in an aggregate data meta-analysis. In the Kaplan-Meier-based analysis, the median survival time for patients surviving to hospital discharge was 5.0 years (IQR, 2.3-7.9 years). The estimated survival rates were 82.8% (95% CI, 81.9%-83.7%) at 3 years, 77.0% (95% CI, 75.9%-78.0%) at 5 years, 63.9% (95% CI, 62.3%-65.4%) at 10 years, and 57.5% (95% CI, 54.8%-60.1%) at 15 years. Compared with patients with a nonshockable initial rhythm, patients with a shockable rhythm had a lower risk of long-term mortality (hazard ratio, 0.30; 95% CI, 0.23-0.39; P < .001). Different analyses, including an aggregate data meta-analysis, confirmed these results. CONCLUSIONS AND RELEVANCE: In this comprehensive systematic review and meta-analysis, long-term survival after 10 years in patients surviving the initial hospital stay after OHCA was between 62% and 64%. Additional research is needed to understand and improve the long-term survival in this vulnerable patient population.
    Tags: *Cardiopulmonary Resuscitation/methods, *Out-of-Hospital Cardiac Arrest/therapy, Adult, Humans, Patient Discharge, Survival Rate.
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  • Bigdon, S. F., Hecht, V., Fairhurst, P. G., Deml, M. C., Exadaktylos, A. K., and Albers, C. E. “Injuries In Alpine Summer Sports - Types, Frequency And Prevention: A Systematic Review”. Bmc Sports Sci Med Rehabil 14, no. 1: 79. doi:10.1186/s13102-022-00468-4.
    Abstract: INTRODUCTION: Summer alpine sports, including mountain biking, hiking and airborne pursuits, have experienced a recent surge in popularity. Accordingly, trauma associated with these activities has increased. There is a scarcity of literature exploring clinical aspects surrounding injuries. Specifically, no single article provides a general overview, as individual studies tend to focus on one particular sport. In the present study, we performed a systematic literature review to summarize existing knowledge and explore the potential for prevention and clinical decision making in this group. METHOD: Literature searches were performed using the PubMed and Scopus database for the most commonly ventured sports associated with injury: mountain biking, climbing, airborne sports, paragliding, and base jumping. From this search, studies were identified for qualitative and quantitative analyses. These searches were done according to PRISMA guidelines for systematic reviews. Studies were then analyzed regarding epidemiology of injuries, relevant anatomical considerations and prevention strategies were discussed. RESULTS: A broad spectrum of injury sites and mechanisms are seen in mountain biking, climbing or airborne sports. Mountain biking related injuries commonly involve the upper extremity, with fractures of the clavicle being the most common injury, followed by fractures of the hand and wrist. Scaphoid fractures remain of paramount importance in a differential diagnosis, given their often subtle clinical and radiological appearance. Paragliding, skydiving, and base jumping particularly affect transition areas of the spine, such as the thoracolumbar and the spinopelvic regions. Lower limb injuries were seen in equal frequency to spinal injuries. Regarding relative risk, mountain biking has the lowest risk for injuries, followed by climbing and airborne sports. Male alpinists are reported to be more susceptible to injuries than female alpinists. Generally, the literature surrounding hiking and water-related mountain sports is insufficient, and further work is required to elucidate injury mechanisms and effective preventative measures. A helmet seems to decrease the likelihood of face and head injuries in mountain sports and be a meaningful preventive measurement.
    Tags: Airborne sport, Alpine injuries, Alpine sport, Mountain bike, Summer sports, Trauma.
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  • Ravioli, S., Lindner, G., and Haidinger, M. “Gender Distribution In Presidents And Board Members Of European Nephrology Societies”. Clin Kidney J 15, no. 5: 1017-1018. doi:10.1093/ckj/sfab259.
  • Minotti, B., Mansella, G., Sieber, R., Ott, A., Nickel, C. H., and Bingisser, R. “Intravenous Acetaminophen Does Not Reduce Morphine Use For Pain Relief In Emergency Department Patients: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial”. Acad Emerg Med 29, no. 8: 954-962. doi:10.1111/acem.14517.
    Abstract: BACKGROUND: Pain is one of the main reasons to present to emergency departments (EDs). Opioids are indispensable for acute pain management but are associated with side effects, misuse, and dependence. The aim of this study was to test whether a single dose of intravenous (IV) acetaminophen (paracetamol) can reduce the use of morphine for pain relief and/or morphine-related adverse events (AEs). METHODS: ED patients >18 years with acute pain (i.e., Numeric Rating Scale [NRS] > 4) were screened for eligibility. Patients with analgesia in the past 6 h, chronic pain, or clinical instability were excluded. Patients were randomized in a 1:1 ratio to receive either morphine 0.1 mg/kg and 1 g acetaminophen IV or morphine 0.1 mg/kg and placebo IV. The intervention was double-blinded. Additional morphine 0.05 mg/kg IV was administered every 15 minutes until pain relief (defined as NRS < 4) and whether the pain recurred. The primary outcome was the mean morphine dose for pain relief. Secondary outcomes were the total amount of morphine given, time to achieve pain relief, and AEs. RESULTS: A total of 220 patients were randomized and 202 evaluated for the primary outcome. The mean morphine dose for pain relief was similar in both groups (acetaminophen 0.15 mg +/- 0.07 mg/kg, placebo 0.16 +/- 0.07 mg/kg). There were no differences in the total amount of morphine given (acetaminophen 0.19 +/- 0.09 mg/kg, placebo 0.19 +/- 0.1 mg/kg), the time to achieve pain relief (acetaminophen 30 min [95% CI 17-31 min], placebo 30 min [95% CI 30-35 min]), and the frequency of AEs (overall 27.4%). Time to pain recurrence did not differ significantly between the groups (hazard ratio 1.23 [0.76-1.98], p = 0.40). CONCLUSIONS: In ED patients, acetaminophen had no additional effect on pain control or morphine-sparing effect at the time of first morphine administration. Titrated morphine with the algorithm used was highly effective, with 80% of all patients reporting pain relief within 60 min of starting therapy.
    Tags: *Acute Pain/diagnosis/drug therapy, *Analgesics, Non-Narcotic, Acetaminophen/therapeutic use, Analgesics, Opioid/therapeutic use, Double-Blind Method, Emergency Service, Hospital, Humans, Morphine, Pain Management, Pain Measurement, Treatment Outcome.
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  • Ribeiro, A. I., Fraga, S., Severo, M., Kelly-Irving, M., Delpierre, C., Stringhini, S., Kivimaki, M., et al. “Association Of Neighbourhood Disadvantage And Individual Socioeconomic Position With All-Cause Mortality: A Longitudinal Multicohort Analysis”. Lancet Public Health 7, no. 5: e447-e457. doi:10.1016/S2468-2667(22)00036-6.
    Abstract: BACKGROUND: Few studies have examined the interactions between individual socioeconomic position and neighbourhood deprivation and the findings so far are heterogeneous. Using a large sample of diverse cohorts, we investigated the interaction effect of neighbourhood socioeconomic deprivation and individual socioeconomic position, assessed using education, on mortality. METHODS: We did a longitudinal multicohort analysis that included six cohort studies participating in the European LIFEPATH consortium: the CoLaus (Lausanne, Switzerland), E3N (France), EPIC-Turin (Turin, Italy), EPIPorto (Porto, Portugal), Melbourne Collaborative Cohort Study (Melbourne, VIC, Australia), and Whitehall II (London, UK) cohorts. All participants with data on mortality, educational attainment, and neighbourhood deprivation were included in the present study. The data sources were the databases of each cohort study. Poisson regression was used to estimate the mortality rates and associations (relative risk, 95% CIs) with neighbourhood deprivation (Q1 being least deprived to Q5 being the most deprived). Baseline educational attainment was used as an indicator of individual socioeconomic position. Estimates were combined using pooled analysis and the relative excess risk due to the interaction was computed to identify additive interactions. FINDINGS: The cohorts comprised a total population of 168 801 individuals. The recruitment dates were 2003-06 for CoLaus, 1989-91 for E3N, 1992-98 for EPIC-Turin, 1999-2003 for EPIPorto, 1990-94 for MCCS, and 1991-94 for Whitehall II. We use baseline data only and mortality data obtained using record linkage. Age-adjusted mortality rates were higher among participants residing in more deprived neighbourhoods than those in the least deprived neighbourhoods (Q1 least deprived neighbourhoods, 369.7 per 100 000 person-years [95% CI 356.4-383.2] vs Q5-most deprived neighbourhoods 445.7 per 100 000 person-years [430.2-461.7]), but the magnitude of the association varied according to educational attainment (relative excess risk due to interaction=0.18, 95% CI 0.08-0.28). The relative risk for Q5 versus Q1 was 1.31 (1.23-1.40) among individuals with primary education or less, but less pronounced among those with secondary education (1.12; 1.04-1.21) and tertiary education (1.16; 1.07-1.27). Associations remained after adjustment for individual-level factors, such as smoking, physical activity, and alcohol intake, among others. INTERPRETATION: Our study suggests that the detrimental health effect of living in disadvantaged neighbourhoods is more pronounced among individuals with low education attainment, amplifying social inequalities in health. This finding is relevant to policies aimed at reducing health inequalities, suggesting that these issues should be addressed at both the individual level and the community level. FUNDING: The European Commission, European Regional Development Fund, the Portugese Foundation for Science and Technology.
    Tags: *Neighborhood Characteristics, *Residence Characteristics, Cohort Studies, Humans, Smoking/epidemiology, Socioeconomic Factors.
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  • Zimmermann, T., du Fay de Lavallaz, J., Nestelberger, T., Gualandro, D. M., Lopez-Ayala, P., Badertscher, P., Widmer, V., et al. “International Validation Of The Canadian Syncope Risk Score : A Cohort Study”. Ann Intern Med 175, no. 6: 783-794. doi:10.7326/M21-2313.
    Abstract: BACKGROUND: The Canadian Syncope Risk Score (CSRS) was developed to predict 30-day serious outcomes not evident during emergency department (ED) evaluation. OBJECTIVE: To externally validate the CSRS and compare it with another validated score, the Osservatorio Epidemiologico della Sincope nel Lazio (OESIL) score. DESIGN: Prospective cohort study. SETTING: Large, international, multicenter study recruiting patients in EDs in 8 countries on 3 continents. PARTICIPANTS: Patients with syncope aged 40 years or older presenting to the ED within 12 hours of syncope. MEASUREMENTS: Composite outcome of serious clinical plus procedural events (primary outcome) and the primary composite outcome excluding procedural interventions (secondary outcome). RESULTS: Among 2283 patients with a mean age of 68 years, the primary composite outcome occurred in 7.2%, and the composite outcome excluding procedural interventions occurred in 3.1% at 30 days. Prognostic performance of the CSRS was good for both 30-day composite outcomes and better compared with the OESIL score (area under the receiver-operating characteristic curve [AUC], 0.85 [95% CI, 0.83 to 0.88] vs. 0.74 [CI, 0.71 to 0.78] and 0.80 [CI, 0.75 to 0.84] vs. 0.69 [CI, 0.64 to 0.75], respectively). Safety of triage, as measured by the frequency of the primary composite outcome in the low-risk group, was higher using the CSRS (19 of 1388 [0.6%]) versus the OESIL score (17 of 1104 [1.5%]). A simplified model including only the clinician classification of syncope (cardiac syncope, vasovagal syncope, or other) variable at ED discharge-a component of the CSRS-achieved similar discrimination as the CSRS (AUC, 0.83 [CI, 0.80 to 0.87] for the primary composite outcome). LIMITATION: Unable to disentangle the influence of other CSRS components on clinician classification of syncope at ED discharge. CONCLUSION: This international external validation of the CSRS showed good performance in identifying patients at low risk for serious outcomes outside of Canada and superior performance compared with the OESIL score. However, clinician classification of syncope at ED discharge seems to explain much of the performance of the CSRS in this study. The clinical utility of the CSRS remains uncertain. PRIMARY FUNDING SOURCE: Swiss National Science Foundation & Swiss Heart Foundation.
    Tags: *Emergency Service, Hospital, *Syncope/diagnosis/therapy, Aged, Canada, Cohort Studies, Humans, Prospective Studies, Risk Assessment, Risk Factors.
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  • Muller, M., Sagesser, N., Keller, P. M., Arampatzis, S., Steffens, B., Ehrhard, S., and Leichtle, A. B. “Urine Flow Cytometry Parameter Cannot Safely Predict Contamination Of Urine-A Cohort Study Of A Swiss Emergency Department Using Machine Learning Techniques”. Diagnostics (Basel) 12, no. 4. doi:10.3390/diagnostics12041008.
    Abstract: BACKGROUND: Urine flow cytometry (UFC) analyses urine samples and determines parameter counts. We aimed to predict different types of urine culture growth, including mixed growth indicating urine culture contamination. METHODS: A retrospective cohort study (07/2017-09/2020) was performed on pairs of urine samples and urine cultures obtained from adult emergency department patients. The dataset was split into a training (75%) and validation set (25%). Statistical analysis was performed using a machine learning approach with extreme gradient boosting to predict urine culture growth types (i.e., negative, positive, and mixed) using UFC parameters obtained by UF-4000, sex, and age. RESULTS: In total, 3835 urine samples were included. Detection of squamous epithelial cells, bacteria, and leukocytes by UFC were associated with the different types of culture growth. We achieved a prediction accuracy of 80% in the three-class approach. Of the n = 126 mixed cultures in the validation set, 11.1% were correctly predicted; positive and negative cultures were correctly predicted in 74.0% and 96.3%. CONCLUSIONS: Significant bacterial growth can be safely ruled out using UFC parameters. However, positive urine culture growth (rule in) or even mixed culture growth (suggesting contamination) cannot be adequately predicted using UFC parameters alone. Squamous epithelial cells are associated with mixed culture growth.
    Tags: automated urine sediment analyser, culture growth, flow cytometry, mixed urine culture, prediction, squamous epithelial cell, Uf-4000, urinary tract infection, urine analysis.
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  • Krieger, C. S., Vesa, D. V., Ziegenhorn, S., Exadaktylos, A. K., Klukowska-Rotzler, J., and Brodmann Maeder, M. “Injuries In Outdoor Climbing: A Retrospective Single-Centre Cohort Study At A Level 1 Emergency Department In Switzerland”. Bmj Open Sport Exerc Med 8, no. 1: e001281. doi:10.1136/bmjsem-2021-001281.
    Abstract: OBJECTIVES: Outdoor rock climbing has become popular in recent years. However, few data have been published on climbing accidents in Switzerland, even though the Swiss Alps are a major climbing resort.To analyse data on accidents related to outdoor climbing treated in the Emergency Department (ED) of University Hospital Bern, Switzerland. METHODS: A retrospective database search for accidents related to outdoor climbing was conducted in the clinical reporting system E.care of the ED of University Hospital Bern for the period April 2012-December 2018. RESULTS: 78 patients were treated after an accident related to outdoor climbing, which accounted for 1 per 3571 (0.028%) of all ED visits during this period. Mean age was 35.8+/-10.4 years. 76% of patients were male. Falls were the most common mechanism of injury (64%), followed by rock or ice falling on the climber (21%). Injuries affected multiple body regions (38%) or only the lower limbs (22%). Most injuries were fractures (68%). Mean ISS was 7.5 (1-38), and grade 3 UIAA MedCom injuries were most common (45%). 11 cases of polytrauma occurred and one fatality. 44 patients needed inpatient admission. Mean duration of inpatient stay was 7 days. Mean costs per patient were 12 283 CHF. CONCLUSIONS: Accidents related to outdoor climbing accounted for a small number of patients seen in the University ED Bern. Further research should be on a nationwide basis, with collection of specific climbing data like use of a helmet and experience of climbing to inform injury prevention strategies. This should shed further light on this topic, as would a prospective study using the International Alpine Trauma Register.
    Tags: Injuries, Rock climbing, Sporting injuries.
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  • Planegger, A., Uyulmaz, S., Poskevicius, A., Zbinden, A., Muller, N. J., and Calcagni, M. “Cutaneous Invasive Fungal Infections With Saksenaea Species In Immunocompetent Patients In Europe: A Systematic Review And Case Report”. Plast Reconstr Surg Glob Open 10, no. 4: e4230. doi:10.1097/GOX.0000000000004230.
    Abstract: Invasive fungal infections from Saksenaea, a fungus belonging to the Mucorales, have been rarely reported in central European climate zones. This study aims to raise awareness of invasive cutaneous infections with Saksenaea species. The first case of a cutaneous infection was diagnosed in Switzerland in an immunocompetent 79-year-old patient. A minor skin trauma of her left lower leg led to a fulminant infection causing necrosis and extensive loss of tissue. The combination of surgical debridement and administration of antifungal agents averted a prolonged course with a possible worse outcome. A pedicled hemisoleus muscle flap was used to reconstruct the defect and treatment was continued for 63 days. METHODS: A systematic review in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis guidelines was conducted to identify all European cases of infection with Saksenaea species in immunocompetent hosts. The epidemiology, clinical presentation, microbiological diagnosis, and management of cases reported in Europe were summarized and analyzed. CONCLUSIONS: The prognosis of soft tissue infections with Saksenaea species. depends on early diagnosis and appropriate antifungal and surgical treatment. Reconstruction can be successful under ongoing antifungal treatment.
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  • Surke, C., Kunzli, M., Vogelin, E., Garcia, D., and Lollgen, R. M. “An Analysis Of Finger And Hand Injuries In Children In A Tertiary Paediatric Emergency Department”. Swiss Med Wkly 152, no. 13-14: w30134. doi:10.4414/smw.2022.w30134.
    Abstract: AIMS OF THE STUDY: This study set out to examine the association between current subspecialty (paediatric and hand surgery) consultation practice for children with hand and finger injuries presenting to a tertiary paediatric emergency department and length of stay in the paediatric emergency department. Also, incidence and injury pattern of hand and finger injuries in this patient group were analysed. METHODS: This was a retrospective cross-sectional study, which was undertaken as a clinical audit service. All patients under 17 years presenting to our paediatric emergency department with hand and finger injuries over a 17-month period were included in the analysis. We studied incidence and injury mechanism, current subspecialty referral practice, as well as paediatric emergency department and hospital length of stay. RESULTS: We identified 929 children for inclusion in the analysis. The most frequent reasons for presentation were hand contusions (25.5%) and fractures (20.8%). Paediatric emergency medicine physicians alone managed 845 patients (90.6%), paediatric surgery referral occurred in 50 (5.4%) and hand surgery consultation in 37 (4.0%) cases. Mean length of stay in the paediatric emergency department was 154 min and significantly longer when subspecialty review occurred. Hospital admission occurred in 87 cases (9.3%). CONCLUSIONS: Involvement of subspecialties in the care of hand and finger injuries was associated with significantly increased length of stay in the paediatric emergency department. We discuss obstacles and enablers for timely patient referral and management. We suggest the implementation of referral guidelines, tailored to the individual emergency department, to reduce unnecessary patient journey delays and to ensure higher quality repair of complex hand injuries by the appropriate surgeon, with better outcomes. Making use of the emergence of multiple surgical subspecialties for targeted treatment of paediatric finger and hand injuries might be desirable.
    Tags: *Emergency Service, Hospital, *Hand Injuries/epidemiology/surgery, Child, Cross-Sectional Studies, Humans, Referral and Consultation, Retrospective Studies.
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  • Meihandoest, T., Studt, J. D., Mendez, A., Alberio, L., Fontana, P., Wuillemin, W. A., Schmidt, A., et al. “Accuracy Of A Single, Heparin-Calibrated Anti-Xa Assay For The Measurement Of Rivaroxaban, Apixaban, And Edoxaban Drug Concentrations: A Prospective Cross-Sectional Study”. Front Cardiovasc Med 9: 817826. doi:10.3389/fcvm.2022.817826.
    Abstract: BACKGROUND: Applying a single anti-Xa assay, calibrated to unfractionated heparin to measure rivaroxaban, apixaban, and edoxaban would simplify laboratory procedures and save healthcare costs. AIM: We hypothesized that a heparin-calibrated anti-Xa assay would accurately measure rivaroxaban, apixaban, and edoxaban drug concentrations and correctly predict clinically relevant drug levels. METHODS: This analysis is part of the Simple-Xa study, a prospective multicenter cross-sectional study conducted in clinical practice. Patients treated with rivaroxaban, apixaban, or edoxaban were included. Anti-Xa activity was measured using the Siemens INNOVANCE((R)) Heparin assay. Drug concentrations were determined using ultra-high performance liquid chromatography-tandem mass spectrometry (LC-MS/MS). Cut-off levels were determined in a derivation dataset (50% of patients) and sensitivities and specificities were calculated in a verification dataset (50% of patients). RESULTS: Overall, 845 patients were available for analysis. Correlation coefficients (r (s) ) between the heparin-calibrated anti-Xa assay and drug concentrations were 0.97 (95% CI 0.97, 0.98) for rivaroxaban, 0.96 (0.96, 0.97) for apixaban, and 0.96 (0.94, 0.99) for edoxaban. The area under the receiver operating characteristics curve (ROC) was 0.99 for all clinically relevant drug concentrations. In the verification dataset, the sensitivity was 94.2% (95% CI 90.8-96.6) for 30 mug L(-1), 95.8% (92.4-98.0) for 50 mug L(-1), and 98.7% (95.5-99.9) for 100 mug L(-1). Specificities were 86.3% (79.2-91.7), 89.8% (84.5-93.7), and 88.7% (84.2-92.2), respectively. CONCLUSION: In a large prospective study in clinical practice, a strong correlation of heparin-calibrated anti-Xa measurements with LC-MS/MS results was observed and clinically relevant drug concentrations were predicted correctly.
    Tags: accredited continuing medical education program from Alnylam, grants, personal, accredited continuing medical education program from Axonlab, and from Thermo, anti-Xa assay, declare that the research was conducted in the absence of any commercial or, diagnostic accuracy, direct oral anticoagulants, fees and funding for accredited continuing medical education program from Pfizer,, financial relationships that could be construed as a potential conflict of, Fisher Scientific, during the conduct of the study, funding for accredited continuing medical education program from Bayer, Bristol, grants from Bayer, CSL-Behring, Novartis, Novo Nordisk, Roche, Sobi, and Takeda., interest., laboratory monitoring, lecture honoraria from Bayer Healthcare, and Daiichi Sankyo. LAl reports research, Mitsubishi Tanabe Pharma, outside the submitted work. The remaining authors, Myers Squibb, Daiichi Sankyo, Takeda, Octapharma, SOBI, Janssen, Novo Nordisk,, personal fees and funding for, Pfizer, and from Alexion Pharma GmbH, all outside the submitted work. J-DS, reports lecture fees and advisory honoraria from Bayer Healthcare, Pfizer,, rivaroxaban, Sanofi, and honoraria for participating in scientific advisory boards from Bayer,, Takeda, Siemens, and Sanofi. TS holds an endowed professorship supported by the, Touring Club Switzerland. BG reports non-financial support and funding for, WW reports research grants from Bayer Healthcare, BMS-Pfizer, Daiichi Sankyo and.
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  • Jegerlehner, S., Suter-Riniker, F., Jent, P., Bittel, P., and Nagler, M. “Diagnostic Accuracy Of Sars-Cov-2 Saliva Antigen Testing In A Real-Life Clinical Setting”. Int J Infect Dis 119: 38-40. doi:10.1016/j.ijid.2022.03.037.
    Abstract: BACKGROUND: SARS-CoV-2 antigen tests with saliva facilitate examination in settings that lack trained personnel. However, little is known about the diagnostic accuracy in real-life clinical settings. Therefore, we studied the diagnostic accuracy of a saliva antigen test in diagnosing SARS-CoV-2 infection in a primary/secondary care testing facility. METHODS: Individuals who presented at a COVID-19 testing facility affiliated with a Swiss university hospital were prospectively recruited (n=377). Saliva specimen was obtained, and the PCL Inc. COVID19 Gold antigen test was conducted in parallel with 2 real-time polymerase chain reaction (RT-PCR) assays from a nasopharyngeal swab. RESULTS: RT-PCR results were positive in 53 individuals, corresponding to a prevalence of 14.1% (missing material in 1 individual). The PCL saliva antigen test was positive in 22 individuals (5.8%) and negative in 354 (93.9%). The sensitivity of the saliva antigen test was 30.2% (95% confidence interval 18.3, 44.3), both overall and in symptomatic individuals. The specificity was 98.1% (96.0, 99.3). CONCLUSIONS: The diagnostic accuracy of a SARS-CoV-2 saliva antigen test in a primary/secondary care testing facility was remarkably lower than that reported in the manufacturer's specifications.
    Tags: *COVID-19/diagnosis, *SARS-CoV-2, COVID-19 diagnostic testing [Supplementary Concept], COVID-19 Testing, Humans, Infections/*epidemiology/transmission, Nasopharynx, of the present work. The other authors declare no conflict of interest., Saliva, Sensitivity and Specificity, severe acute respiratory syndrome coronavirus 2 [Supplementary Concept], Specimen Handling.
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  • Born, Jannis, Wiedemann, Nina, Cossio, Manuel, Buhre, Charlotte, Brändle, Gabriel, Leidermann, Konstantin, Goulet, Julie, et al. “Erratum: Born Et Al. Accelerating Detection Of Lung Pathologies With Explainable Ultrasound Image Analysis. Appl. Sci. 2021, 11, 672”. Applied Sciences 12, no. 8. doi:10.3390/app12083869.
    Abstract: The authors wish to make the following corrections to this paper [1]: The Authorship (Add One New Author) In the original paper [1], Julie Goulet was not included as an author in the published article. Julie Goulet should be listed as the seventh author. The author’s affiliation is: 7 Physik Department T35 and Bernstein Center for Computational Neuroscience, Technische Universität München, 85747 Garching bei München, Germany; julie@ph.tum.de Author Contributions: Conceptualization, J.B., N.W., M.C., G.B. and J.G.; methodology, J.B., N.W. and G.B.; software, J.B. and N.W.; validation, C.B., G.B., A.A., B.R. and K.B.; formal analysis, J.B. and N.W.; investigation, J.B. and N.W.; resources, J.B.; data curation, N.W., M.C., C.B., G.B., K.L. and J.G.; writing—original draft preparation, J.B., N.W. and M.C.; writing—review and editing, J.B., N.W., M.M., B.R. and K.B.; visualization, J.B. and N.W.; supervision, B.R. and K.B.; project administration, B.R. and K.B. All authors have read and agreed to the published version of the manuscript. © 2022, MDPI. All rights reserved.
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  • Ebneter, A. S., Sauter, T. C., Christen, A., and Eychmueller, S. “Feasibility, Acceptability And Needs In Telemedicine For Palliative Care”. Swiss Med Wkly 152, no. 9-10. doi:10.4414/smw.2022.w30148.
    Abstract: BACKGROUND: Telemedicine in palliative care was initially developed in countries where geography or resources limit access to care services. Recently, largely owing to the COVID-19 pandemic, this technology is being increasingly used in highly urbanised countries such as Switzerland. However, there is still scepticism regarding whether these tools can be used effectively in palliative care, a relationship-based speciality that is generally highly dependent on compassion, communication and direct human interaction. The objective of this review was to analyse the needs, elements of feasibility, and reasons for acceptance or possible barriers before the implementation of a telemedicine intervention in Switzerland. METHODS: The method used was a scoping review, following the PRISMA-ScR reporting guidelines. We searched the PubMed, Ovid SP, Medline, Cochrane and Scopus databases for relevant reports. Charting and analyses of the data were done by a single researcher. A total of 520 records were screened and assessed for eligibility. Finally, 27 studies and 4 registry entries were included. Main reasons for exclusion were wrong population and intervention. RESULTS: The prevailing study type was the single-arm intervention study. Most studies originated from countries with geographic barriers to access. Feasibility was good in 69% of all studies. Good acceptability (84.1-100%) was confirmed in the majority of the studies. The needs of the patients or the healthcare professionals were directly addressed in only five (16%) studies. Three needs were consistently reported: communication, coordination and technical reliability. CONCLUSION: Despite a broad range of studies on telemedicine in palliative care, patients' needs are rarely addressed. Therefore, especially in countries such as Switzerland, a needs assessment is recommended before the implementation of a new telemedicine intervention, to guarantee high feasibility and acceptability.
    Tags: *COVID-19/therapy, *Telemedicine, Feasibility Studies, Humans, Palliative Care/methods, Pandemics, Reproducibility of Results.
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  • Simma, L., Fornaro, J., Stahr, N., Lehner, M., Roos, J. E., and Lima, T. V. M. “Optimising Whole Body Computed Tomography Doses For Paediatric Trauma Patients: A Swiss Retrospective Analysis”. J Radiol Prot 42, no. 2. doi:10.1088/1361-6498/ac6274.
    Abstract: We aimed to evaluate the impact of a low-dose whole-body computed tomography (WBCT) protocol on radiation doses in paediatric major trauma patients. Retrospective cohort study of paediatric trauma patients (<16 years) at a national level 1 paediatric trauma centre (PTC) over a 6 year period prior and post introduction of a low-dose WBCT protocol (2014-2019). Demographic data, patient characteristics, CT device, and exposure information including scan range, dose-length product, and volume CT dose index were collected. Effective dose (ED) and exposure parameters were compared before and after protocol introduction. Forty-eight patients underwent WBCT during the study period. Prior to introduction of the low-dose protocol (n= 18), the ED was 20.6 mSv (median 20.1 +/- 5.3 mSv [range 12.5-30.7]). After introduction of the low-dose WBCT protocol (n= 30), mean ED was 4.8 mSv (median 2.6 +/- 5.0 [range: 0.8-19.1]). This resulted in a reduction of 77% in mean ED (pvalue <0.001). Significant radiation dose reduction of 77% can be achieved with low-dose WBCT protocols in PTCs.
    Tags: *Multiple Trauma, *Whole Body Imaging/methods, Child, computed tomography, Humans, major trauma, paediatric radiology, pediatric emergency department, protocol tailoring, Radiation Dosage, Retrospective Studies, Switzerland, Tomography, X-Ray Computed/methods.
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  • Vasiloglou, M. F., Marcano, I., Lizama, S., Papathanail, I., Spanakis, E. K., and Mougiakakou, S. “Multimedia Data-Based Mobile Applications For Dietary Assessment”. J Diabetes Sci Technol 17, no. 4: 1056-1065. doi:10.1177/19322968221085026.
    Abstract: Diabetes mellitus (DM) and obesity are chronic medical conditions associated with significant morbidity and mortality. Accurate macronutrient and energy estimation could be beneficial in attempts to manage DM and obesity, leading to improved glycemic control and weight reduction, respectively. Existing dietary assessment methods are subject to major errors in measurement, are time consuming, are costly, and do not provide real-time feedback. The increasing adoption of smartphones and artificial intelligence, along with the advances in algorithms and hardware, allowed the development of technologies executed in smartphones that use food/beverage multimedia data as an input, and output information about the nutrient content in almost real time. Scope of this review was to explore the various image-based and video-based systems designed for dietary assessment. We identified 22 different systems and divided these into three categories on the basis of their setting for evaluation: laboratory (12), preclinical (7), and clinical (3). The major findings of the review are that there is still a number of open research questions and technical challenges to be addressed and end users-including health care professionals and patients-need to be involved in the design and development of such innovative solutions. Last, there is a clear need that these systems should be validated under unconstrained real-life conditions and that they should be compared with conventional methods for dietary assessment.
    Tags: *Mobile Applications, Ai, apps, Artificial Intelligence, Chronic Disease, dietary assessment, Humans, mHealth, Multimedia, nutrition, Nutrition Assessment, Obesity, research, authorship, and/or publication of this article., smartphones.
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  • Rauch, S., Koppenberg, J., Josi, D., Meuli, L., Strapazzon, G., Pasquier, M., Albrecht, R., Brugger, H., Zweifel, B., and Pietsch, U. “Avalanche Survival Depends On The Time Of Day Of The Accident: A Retrospective Observational Study”. Resuscitation 174: 47-52. doi:10.1016/j.resuscitation.2022.03.023.
    Abstract: INTRODUCTION: We aimed to investigate the relationship between the time of the day and the probability of survival of completely buried avalanche victims. We explored the frequency of avalanche burials occurring after sunset, and described victims' characteristics, duration of burial and rescue circumstances compared to daytime avalanches. METHODS: In this retrospective, observational study, we analysed avalanche data from the registry of the Swiss Institute for Snow and Avalanche Research, from 1998 to 2020. RESULTS: A total of 3892 avalanche victims were included in the analysis, with 72 of the accidents (1.85%) occurring in the nighttime. Nearly 50% of the victims involved in nighttime avalanche accidents were completely buried, compared to about 25% of victims in daytime avalanches. Completely buried victims were rescued by a companion less often at night than in the daytime (15% vs. 51%, p <.001). The search and rescue of completely buried avalanche victims took longer during the nighttime compared to the daytime (median 89 min vs 20 min, p =.002). The probability of survival decreased as the day progressed; it was highest at around midday (63.0%), but decreased at sunset (40.4%) and was the lowest at midnight (28.7%). CONCLUSIONS: Avalanche accidents at night are a rare event, and probability of survival after complete burial is lower during the nighttime compared to the daytime. The most relevant reason for this is the longer duration of burial, which is explained in part by the lower rate of companion rescue and the lower rate of victim localisation with an avalanche transceiver.
    Tags: *Avalanches, Accidents, Avalanche, Cpr, Humans, Night, Resucitation, Retrospective Studies, Time Factors, Triage.
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  • Lindner, G., Herschmann, S., Funk, G. C., Exadaktylos, A. K., Gygli, R., and Ravioli, S. “Sodium And Potassium Disorders In Patients With Copd Exacerbation Presenting To The Emergency Department”. Bmc Emerg Med 22, no. 1: 49. doi:10.1186/s12873-022-00607-7.
    Abstract: BACKGROUND: Electrolyte disorders are common in the emergency department. Hyponatremia is known to be associated with adverse outcome in community-acquired pneumonia (CAP) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD). No studies investigating the prevalence and influence of hypernatremia or potassium disorders in patients with AECOPD exist. METHODS: In this retrospective cohort analysis, the prevalence of sodium and potassium disorders was investigated in patients with AECOPD presenting to an emergency department (ED) between January 1(st) 2017 and December 31(st) 2018 and compared to all ED patients with electrolyte measurements and patients presenting with CAP. Exclusion criteria were age younger than 18 years, written or verbal withdrawal of consent and outpatient treatment. Additionally, the influence of dysnatremias and dyskalemias on outcome measured by ICU admission, need for mechanical ventilation, length of hospital stay, 30-day re-admission, 180-day AECOPD recurrence and in-hospital mortality and their role as predictors of disease severity measured by Pneumonia Severity Index (PSI) were investigated in patients with AECOPD. RESULTS: Nineteen point nine hundred forty-eight ED consultations with measurements of sodium and potassium were recognized between January 1(st) 2017 and December 31(st) 2018 of which 102 patients had AECOPD. Of these 23% had hyponatremia, 5% hypernatremia, 16% hypokalemia and 4% hyperkalemia on admission to the ED. Hypo- and hypernatremia were significantly more common in patients with AECOPD than in the overall ED population: 23 versus 11% (p = 0.001) for hypo- and 5% versus 0.6% (p < 0.001) for hypernatremia. In the logistic regression analysis, no association between the presence of either sodium or potassium disorders and adverse outcome were found. CONCLUSION: Dysnatremias and dyskalemias are common in patients with AECOPD with as many as 1 in 5 having hyponatremia and/or hypokalemia. Hypo- and hypernatremia were significantly more common in AECOPD than overall. No significant association was found for dysnatremias, dyskalemias and adverse outcomes in AECOPD.
    Tags: *Community-Acquired Infections, *Hypernatremia/epidemiology, *Hypokalemia/epidemiology/etiology, *Hyponatremia/epidemiology, *Pneumonia, *Pulmonary Disease, Chronic Obstructive/complications/epidemiology, Adolescent, Copd, Electrolyte disorders, Electrolytes, Emergency, Emergency Service, Hospital, Humans, none were declared., Potassium, Retrospective Studies, Sodium, travel grants from GSK, Pierre Fabre, Otsuka, Bayer. For the remaining authors.
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  • Ehrler, F., Tuor, C., Trompier, R., Berger, A., Ramusi, M., Rey, R., and Siebert, J. N. “Effectiveness Of A Mobile App In Reducing Therapeutic Turnaround Time And Facilitating Communication Between Caregivers In A Pediatric Emergency Department: A Randomized Controlled Pilot Trial”. J Pers Med 12, no. 3. doi:10.3390/jpm12030428.
    Abstract: For maintaining collaboration and coordination among emergency department (ED) caregivers, it is essential to effectively share patient-centered information. Indirect activities on patients, such as searching for laboratory results and sharing information with scattered colleagues, waste resources to the detriment of patients and staff. Therefore, we conducted a pilot study to evaluate the initial efficacy of a mobile app to facilitate rapid mobile access to central laboratory results and remote interprofessional communication. A total of 10 ED residents and registered nurses were randomized regarding the use of the app versus conventional methods during semi-simulated scenarios in a pediatric ED (PED). The primary outcome was the elapsed time in minutes in each group from the availability of laboratory results to their consideration by participants. The secondary outcome was the elapsed time to find a colleague upon request. Time to consider laboratory results was significantly reduced from 23 min (IQR 10.5-49.0) to 1 min (IQR 0-5.0) with the use of the app compared to conventional methods (92.2% reduction in mean times, p = 0.0079). Time to find a colleague was reduced from 24 min to 1 min (i.e., 93.0% reduction). Dedicated mobile apps have the potential to improve information sharing and remote communication in emergency care.
    Tags: an interest in the submitted work in the previous years. F.E. and J.N.S. declare, clinical laboratory information systems, communication, currently not available on the commercial Google Play Store or App Store (Apple)., digital technology, emergency department, emergency service, F.E. and J.N.S. declare no support from commercial entities for the submitted, hospital, interests in connection with the app, research, authorship, and/or publication of, mHealth, mobile application, no other relationships or activities that could appear to have influenced the, pediatrics, submitted work. The rest of the authors declare no potential conflict of, text messaging, this article., work and no financial relationships with any commercial entities that might have.
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  • Desgranges, F., Tadini, E., Munting, A., Regina, J., Filippidis, P., Viala, B., Karachalias, E., et al. “Post‑Covid‑19 Syndrome In Outpatients: A Cohort Study”. J Gen Intern Med 37, no. 8: 1943-1952. doi:10.1007/s11606-021-07242-1.
    Abstract: BACKGROUND: After mild COVID-19, some outpatients experience persistent symptoms. However, data are scarce and prospective studies are urgently needed. OBJECTIVES: To characterize the post-COVID-19 syndrome after mild COVID-19 and identify predictors. PARTICIPANTS: Outpatients with symptoms suggestive of COVID-19 with (1) PCR-confirmed COVID-19 (COVID-positive) or (2) SARS-CoV-2 negative PCR (COVID-negative). DESIGN: Monocentric cohort study with prospective phone interview between more than 3 months to 10 months after initial visit to the emergency department and outpatient clinics. MAIN MEASURES: Data of the initial visits were extracted from the electronic medical file. Predefined persistent symptoms were assessed through a structured phone interview. Associations between long-term symptoms and PCR results, as well as predictors of persistent symptoms among COVID-positive, were evaluated by multivariate logistic regression adjusted for age, gender, smoking, comorbidities, and timing of the survey. KEY RESULTS: The study population consisted of 418 COVID-positive and 89 COVID-negative patients, mostly young adults (median age of 41 versus 36 years in COVID-positive and COVID-negative, respectively; p = 0.020) and healthcare workers (67% versus 82%; p = 0.006). Median time between the initial visit and the phone survey was 150 days in COVID-positive and 242 days in COVID-negative patients. Persistent symptoms were reported by 223 (53%) COVID-positive and 33 (37%) COVID-negative patients (p = 0.006) and proportions were stable among the periods of the phone interviews. Overall, 21% COVID-positive and 15% COVID-negative patients (p = 0.182) attended care for this purpose. Four surveyed symptoms were independently associated with COVID-19: fatigue (adjusted odds ratio 2.14, 95% CI 1.04-4.41), smell/taste disorder (26.5, 3.46-202), dyspnea (2.81, 1.10-7.16), and memory impairment (5.71, 1.53-21.3). Among COVID-positive, female gender (1.67, 1.09-2.56) and overweight/obesity (1.67, 1.10-2.56) were predictors of persistent symptoms. CONCLUSIONS: More than half of COVID-positive outpatients report persistent symptoms up to 10 months after a mild disease. Only 4 of 14 symptoms were associated with COVID-19 status. The symptoms and predictors of the post-COVID-19 syndrome need further characterization as this condition places a significant burden on society.
    Tags: *COVID-19/complications/epidemiology, Adult, Cohort Studies, Female, Humans, obesity, Outpatients, Post-Acute COVID-19 Syndrome, Post-COVID-19 syndrome, Prospective Studies, SARS-CoV-2, Young Adult.
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  • Bruningk, S. C., Klatt, J., Stange, M., Mari, A., Brunner, M., Roloff, T. C., Seth-Smith, H. M. B., et al. “Determinants Of Sars-Cov-2 Transmission To Guide Vaccination Strategy In An Urban Area”. Virus Evol 8, no. 1: veac002. doi:10.1093/ve/veac002.
    Abstract: Transmission chains within small urban areas (accommodating approximately 30 per cent of the European population) greatly contribute to case burden and economic impact during the ongoing coronavirus pandemic and should be a focus for preventive measures to achieve containment. Here, at very high spatio-temporal resolution, we analysed determinants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in a European urban area, Basel-City (Switzerland). We combined detailed epidemiological, intra-city mobility and socio-economic data sets with whole-genome sequencing during the first SARS-CoV-2 wave. For this, we succeeded in sequencing 44 per cent of all reported cases from Basel-City and performed phylogenetic clustering and compartmental modelling based on the dominating viral variant (B.1-C15324T; 60 per cent of cases) to identify drivers and patterns of transmission. Based on these results we simulated vaccination scenarios and corresponding healthcare system burden (intensive care unit (ICU) occupancy). Transmissions were driven by socio-economically weaker and highly mobile population groups with mostly cryptic transmissions which lacked genetic and identifiable epidemiological links. Amongst more senior population transmission was clustered. Simulated vaccination scenarios assuming 60-90 per cent transmission reduction and 70-90 per cent reduction of severe cases showed that prioritising mobile, socio-economically weaker populations for vaccination would effectively reduce case numbers. However, long-term ICU occupation would also be effectively reduced if senior population groups were prioritised, provided there were no changes in testing and prevention strategies. Reducing SARS-CoV-2 transmission through vaccination strongly depends on the efficacy of the deployed vaccine. A combined strategy of protecting risk groups by extensive testing coupled with vaccination of the drivers of transmission (i.e. highly mobile groups) would be most effective at reducing the spread of SARS-CoV-2 within an urban area.
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  • Lehmann, B., Koeferli, U., Sauter, T. C., Exadaktylos, A., and Hautz, W. E. “Diagnostic Accuracy Of A Pragmatic, Ultrasound-Based Approach To Adult Patients With Suspected Acute Appendicitis In The Ed”. Emerg Med J 39, no. 12: 931-936. doi:10.1136/emermed-2019-208643.
    Abstract: BACKGROUND: Systematic imaging reduces the rate of missed appendicitis and negative appendectomies in patients with suspected acute appendicitis (AA). Little is known about the utility of ultrasound as a first diagnostic measure in patients with suspected AA. The aim of this retrospective study is to determine whether ultrasound, performed by emergency physicians or radiologists, can be used as first diagnostic measure in suspected cases to rule out AA and to avoid unnecessary CT. METHODS: We performed a retrospective analysis at the ED of the University Hospital Bern, Switzerland, from 2012 to 2014. Our standard protocol is that all adult patients suspected of appendicitis receive an ultrasound as their first imaging test, either by an emergency physician or a radiologist. The test characteristics of conclusive and inconclusive ultrasound exams were compared with a pragmatic gold standard. RESULTS: The study included 508 patients with suspected AA. 308 patients (60.4%) had a conclusive ultrasound. Among these, sensitivity for appendicitis was 89.6% (95% CI 82.1% to 94.3%), specificity 93.8% (89.1% to 96.6%), the positive predictive value was 87.98 (80.84 to 92.71) and the negative predictive value was 94.65 (91.18 to 96.80). The remaining 200 (39.4%) patients had an inconclusive ultrasound exam. 29% (59/200) of these patients ultimately had appendicitis. Less experienced emergency physician sonographers came to a definitive conclusion in 48.1% (95% CI 36.9% to 59.5%), experienced emergency physician sonographers in 76.0% (68.4% to 82.5%) and radiologists in 52.4% (44.5% to 60.2%). CONCLUSION: A conclusive ultrasound of the appendix performed by either emergency physicians or radiologists is a sensitive and specific exam to diagnose or exclude AA in patients with suspected AA. Because of 6% false negative exams, clinical follow-up is mandatory for patients with negative ultrasound. An inconclusive ultrasound warrants further imaging or a follow-up visit, since 29% of patients with inconclusive ultrasound had an AA.
    Tags: *Appendicitis/diagnostic imaging, abdomen, Acute Disease, Adult, diagnosis, Emergency Service, Hospital, Humans, Retrospective Studies, Sensitivity and Specificity, ultrasonography, Ultrasonography/methods.
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  • Vittoria de Martini, I., Kobe, A. R., Roeren, C., Manka, R., Euler, A., Keller, D. I., Ruschitzka, F., Alkadhi, H., and Eberhard, M. “Diagnosis Of Acute Heart Failure In Ct Pulmonary Angiography: Feasibility And Accuracy”. Eur Radiol 32, no. 8: 5287-5296. doi:10.1007/s00330-022-08676-9.
    Abstract: OBJECTIVES: To evaluate the feasibility and accuracy of diagnosing acute heart failure (HF) with CT pulmonary angiography (CTPA) in emergency department patients. METHODS: In this retrospective single-center study, we evaluated 150 emergency department patients (mean age 65 +/- 17 years) undergoing CTPA with a fixed scan (100 kVp) and contrast media protocol (60 mL, 4 mL/s) who had no pulmonary embolism (PE). Patients were subdivided into training cohort (n = 100) and test cohort (n = 50). Three independent, blinded readers measured the attenuation in the right ventricle (RV) and left ventricle (LV) on axial images. The ratio (HU(ratio)) and difference (HU(diff)) between RV and LV attenuation were calculated. Diagnosis of acute HF was made on the basis of clinical, laboratory, and echocardiography data. Optimal thresholds, sensitivity, and specificity were calculated using the area under the curve (AUC) from receiver operating characteristics analysis. RESULTS: Fifty-nine of the 150 patients (40%) were diagnosed with acute HF. Attenuation measurements showed an almost perfect interobserver agreement (intraclass correlation coefficient: 0.986, 95%CI: 0.980-0.991). NT-pro BNP exhibited moderate correlations with HU(ratio) (r = 0.50, p < 0.001) and HU(diff) (r = 0.50, p < 0.001). In the training cohort, HU(ratio) (AUC: 0.89, 95%CI: 0.82-0.95) and HU(diff) (AUC: 0.88, 95%CI: 0.81-0.95) showed a very good performance to diagnose HF. Optimal cutoff values were 1.42 for HU(ratio) (sensitivity 93%; specificity 75%) and 113 for HU(diff) (sensitivity 93%; specificity 73%). Applying these thresholds to the test cohort yielded a sensitivity of 89% and 89% and a specificity of 69% and 63% for HU(ratio) and HU(diff), respectively. CONCLUSION: In emergency department patients undergoing CTPA and showing no PE, both HU(ratio) and HU(diff) have a high sensitivity for diagnosing acute HF. KEY POINTS: * Heart failure is a common differential diagnosis in patients undergoing CT pulmonary angiography. * In emergency department patients undergoing CT pulmonary angiography and showing no pulmonary embolism, attenuation differences of the left and right ventricle have a high sensitivity for diagnosing acute heart failure.
    Tags: (University Hospital of Zurich/University of Zurich) reports research,, *Heart Failure/diagnostic imaging, *Pulmonary Embolism/diagnostic imaging, activities, such as participation as steering committee member of clinical trials, Aged, Aged, 80 and over, and member of the Pfizer Research Award selection committee in Switzerland, was, Angiography/methods, authors of this manuscript declare no relationships with any companies whose, Boehringer Ingelheim, Boston Scientific, Bracco, Cardinal Health Switzerland,, Computed tomography, Computed Tomography Angiography, Daiichi, Diatools AG, Edwards Lifesciences, Guidant Europe NV (BS), Hamilton, Dyspnea, educational, and/or travel grants from Abbott, Amgen, AstraZeneca, Bayer, Berlin, Feasibility Studies, Health Sciences, Kaneka Corporation, Kantar, Labormedizinisches Zentrum,, Heart failure, Heart, B. Braun, Biosense Webster, Biosensors Europe AG, Biotronik, BMS,, Humans, made directly to the University of Zurich). The Department of Cardiology, Medtronic, MSD, Mundipharma Medical Company, Novartis, Novo Nordisk, Orion,, Middle Aged, or device manufacturers in the last 3 years (remuneration for the time spent in, Pfizer, Quintiles Switzerland Sarl, Sahajanand IN, Sanofi, Sarstedt AG, Servier,, products or services may be related to the subject matter of the article., Pulmonary embolism, Retrospective Studies, Sensitivity and Specificity, SIS Medical, SSS International Clinical Research, Terumo Deutschland, Trama, Solutions, V- Wave, Vascular Medical, Vifor, Wissens Plus, and ZOLL. All other, Tomography, X-Ray Computed/methods.
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  • Rochat, J., Ehrler, F., Siebert, J. N., Ricci, A., Garretas Ruiz, V., and Lovis, C. “Usability Testing Of A Patient-Centered Mobile Health App For Supporting And Guiding The Pediatric Emergency Department Patient Journey: Mixed Methods Study”. Jmir Pediatr Parent 5, no. 1: e25540. doi:10.2196/25540.
    Abstract: BACKGROUND: Patient experience in emergency departments (EDs) remains often suboptimal and can be a source of stress, particularly in pediatric settings. In an attempt to support patients and their families before, during, and after their visit to a pediatric ED, a mobile health (mHealth) app was developed by a multidisciplinary team based on patient-centered care principles. OBJECTIVE: This study aims to evaluate the usability (effectiveness, efficiency, and satisfaction) of a new mHealth app, InfoKids, by potential end users through usability testing. METHODS: The app was assessed through an in-laboratory, video-recorded evaluation in which participants had to execute 9 goal-oriented tasks, ranging from account creation to the reception of a diagnostic sheet at the end of the emergency care episode. Effectiveness was measured based on the task completion rate, efficiency on time on task, and user satisfaction according to answers to the System Usability Scale questionnaire. Think-aloud usability sessions were also transcribed and analyzed. Usability problems were rated for their severity and categorized according to ergonomic criteria. RESULTS: A total of 17 parents participated in the study. The overall completion rate was 97.4% (149/153). Overall, they reported good effectiveness, with the task successfully completed in 88.2% (135/153) of cases (95% CI 83%-93%). Each task, with the exception of the first, created difficulties for some participants but did not prevent their completion by most participants. Users reported an overall good to excellent perceived usability of the app. However, ergonomic evaluation identified 14 usability problems occurring 81 time. Among these, 50% (7/14) were serious as their severity was rated as either major or catastrophic and indicated areas of improvements for the app. Following the suggested usability improvements by participants, mitigation measures were listed to further improve the app and avoid barriers to its adoption. CONCLUSIONS: Usability of the InfoKids app was evaluated as good to excellent by users. Areas of improvement were identified, and mitigation measures were proposed to inform its development toward a universal app for all ED patients visiting a digitalized institution. Its contribution could also be useful in paving the way for further research on mobile apps aimed at supporting and accompanying patients in their care episodes, as research in this area is scarce.
    Tags: affected by the research reported in the enclosed paper. FE has fully disclosed, conflicts arising from that involvement., emergency service, hospital, information systems, mobile apps, mobile phone, pediatrics, those interests and has in place an approved plan for managing any potential, usability, user-centered design.
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  • Kaegi-Braun, N., Boesiger, F., Tribolet, P., Gomes, F., Kutz, A., Hoess, C., Pavlicek, V., et al. “Validation Of Modified Glim Criteria To Predict Adverse Clinical Outcome And Response To Nutritional Treatment: A Secondary Analysis Of A Randomized Clinical Trial”. Clin Nutr 41, no. 4: 795-804. doi:10.1016/j.clnu.2022.02.009.
    Abstract: BACKGROUND & AIMS: The Global Leadership Initiative on Malnutrition (GLIM) recently suggested specific criteria to standardize the diagnosis of malnutrition. There is need for validation of these criteria regarding response to nutrition treatment. Our aim was to validate modified GLIM (mGLIM) criteria among medical inpatients at risk of disease related malnutrition for prediction of outcome and response to nutritional therapy. METHODS: This is a secondary analysis of the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a multicenter randomized controlled trial conducted between April 2014 and February 2018. Adult medical inpatients at nutritional risk (Nutrition Risk Score 2002 >/= 3 points) were randomly assigned to receive nutritional therapy according to an algorithm based on individualized nutritional requirements (intervention group) or standard hospital food (control group). We included all participants with available information regarding mGLIM criteria. The primary outcome was adverse clinical outcome, which was a composite of 30-day all-cause mortality, ICU-admission, rehospitalization rate, major complications and decline in functional status. RESULTS: Of 1917 eligible participants at nutritional risk, 1181 (61.6%) met the diagnosis of malnutrition based on mGLIM criteria. The incidence of adverse clinical outcome was significantly higher in mGLIM-positive participants compared with mGLIM-negative participants [330/1181 (27.9%) versus 140/736 (19.0%); multivariable adjusted odds ratio [OR] 1.53; 95% CI 1.22-1.93; p < 0.001]. Regarding the effect of nutritional therapy, the reduction in adverse clinical outcomes was higher in mGLIM-positive participants [180/581 (31.0%) vs. 150/600 (25.0%), OR 0.69; 95% CI 0.53-0.9, p = 0.007], compared with mGLIM-negative participants [75/379 (19.8%) versus 65/357 (18.2%), OR 0.95; 95% CI 0.65-1.40, p = 0.797], a finding that was, however, not significant in interaction analysis (p for interaction = 0.217). CONCLUSION: Data from this secondary analysis of a multicenter randomized trial involving medical inpatients at nutritional risk validate the strong prognostic value of mGLIM criteria regarding adverse clinical outcomes and other long-term outcomes. However, further research is needed to improve the ability of GLIM criteria to predict therapeutic response to nutritional interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02517476.
    Tags: *Leadership, *Malnutrition/complications/diagnosis/therapy, Adult, Glim, Hospitalization, Humans, Malnutrition, Mortality, Nutrition Assessment, Nutritional Status, Nutritional Support, Nutritional therapy, Outcomes.
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  • Durr, D., Carron, P. N., Ageron, F. X., Stanga, Z., Schneider, A., Maudet, L., and Beysard, N. “Basic Life Support Knowledge Among Swiss Conscripts: A National Multicentre Survey”. Swiss Med Wkly 152, no. 9-10: w30147. doi:10.4414/smw.2022.w30147.
    Abstract: BACKGROUND: Basic life support (BLS) is the first link in the chain of survival and should be performed by every lay rescuer. Although international studies have suggested that BLS knowledge was poor among the overall population, Swiss data are scarce. Our objective in this study was to evaluate BLS knowledge among Swiss conscripts, a semi-representative sample of Swiss young adults, during the recruitment process and to identify potential characteristics related to performance. METHODS: A short online voluntary anonymous survey was proposed to Swiss conscripts called to duty in the six national recruiting centres of the Swiss Armed Forces during an 8-month period (2 February 2019 to 27 September 2019). The survey was available in three official languages (French, German, and Italian). Considered outcome was BLS knowledge evaluated on a Likert scale from 1 (very bad) to 6 (excellent). Univariate and multivariate ordinal logistic regression analyses were performed to assess the relationship between BLS knowledge and participants' characteristics. RESULTS: Among the 19,247 conscripts called to service during the study period, 737 replied to the survey. Among them, 735 were included in the analyses (mean age 19.8 years [+/- 2.1]). Of these, 144 (20%) had never received any BLS training. The BLS knowledge survey was completely answered by 670 participants (91%). 157 participants (23%) reached a BLS knowledge score >/=5. Out of 695 answers, 142 (20%) did not know the Swiss emergency phone number. Out of 670 answers, 364 (54%) believed that CPR could worsen the health status of a person in cardiac arrest, whereas 413 (62%) agreed that BLS training should be mandatory in secondary school. German as native language (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.0-.8)], receipt of BLS training (OR 3.1, 95% CI 2.0-4.8), and female gender were associated with a higher BLS knowledge score. Time since the last BLS training of >/=3 years (OR 0.5, 95% CI 0.4-0.7) and unemployment (OR 0.3, 95% CI 0.1-0.9) were associated with a lower BLS knowledge score. We found substantial agreement between conscripts' scores and their self-assessments (weighted kappa with 74% agreement). DISCUSSION AND CONCLUSION: Knowledge of the emergency phone number and BLS principles was poor among Swiss conscripts participating in the study. However, their awareness and motivation is high. The effect of training during boot camp should be evaluated in further studies. Focusing on BLS training is essential and should be promoted in educational and professional contexts.
    Tags: *Cardiopulmonary Resuscitation/education, Adult, Female, Health Knowledge, Attitudes, Practice, Humans, Motivation, Surveys and Questionnaires, Switzerland, Young Adult.
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  • Coscia, T., Nestelberger, T., Boeddinghaus, J., Lopez-Ayala, P., Koechlin, L., Miro, O., Keller, D. I., et al. “Characteristics And Outcomes Of Type 2 Myocardial Infarction”. Jama Cardiol 7, no. 4: 427-434. doi:10.1001/jamacardio.2022.0043.
    Abstract: IMPORTANCE: In contrast to type 1 myocardial infarction (T1MI) caused by atherothrombosis, characteristics and outcomes of type 2 myocardial infarction (T2MI) caused by supply-demand mismatch are incompletely understood. OBJECTIVE: To explore the characteristics and outcomes of patients with T2MI compared with those with T1MI. DESIGN, SETTING, AND PARTICIPANTS: In a prospective, international, multicenter cohort study including 12 emergency departments (EDs) in 5 European countries, unselected patients presenting with acute chest discomfort were enrolled from April 2006 to April 2018. Follow-up was done by telephone or in written form 3, 12, and 24 months after hospital discharge. Data were analyzed from April 2006 to April 2020. INTERVENTIONS: The final diagnoses of T2MI and T1MI were centrally adjudicated according to the Fourth Universal Definition of Myocardial Infarction by 2 independent cardiologists, including the pathophysiological trigger of T2MI. MAIN OUTCOMES AND MEASURES: Patient characteristics and outcomes, including 2-year all-cause and cardiovascular mortality and future T2MI and T1MI events. RESULTS: Of 6253 included patients, 2078 (33.2%) were women, and the median (IQR) age was 61 (48-74) years. Among 6253 patients with acute chest discomfort, the final adjudicated diagnosis was T2MI in 251 patients (4.0%), with tachyarrhythmia and hypertension responsible for two-thirds of cases, and T1MI in 1027 patients (16.4%). All-cause and cardiovascular mortality were comparable at 2 years (T2MI: adjusted hazard ratio, 1.0; 95% CI, 0.7-1.5; T1MI: adjusted hazard ratio, 0.7; 95% CI, 0.4-1.1). Patients with tachyarrhythmia or hypertension as their underlying trigger of T2MI had a lower mortality compared with patients with hypotension, hypoxemia, or anemia. Future T2MI was more likely among patients with index T2MI compared with patients with index T1MI (hazard ratio, 3.2; 95% CI, 1.4-7.5). Similarly, future T1MI was more likely to occur among patients with index T1MI (hazard ratio, 3.0; 95% CI, 1.2-7.4). CONCLUSIONS AND RELEVANCE: Among patients with T2MI, tachyarrhythmia and hypertension were responsible for more than two-thirds of T2MI cases. While T2MI and T1MI had comparable all-cause and cardiovascular mortality at 2 years, patients with tachyarrhythmia or hypertension as their underlying trigger of T2MI had a lower mortality compared with patients with hypotension, hypoxemia, or anemia. Future T2MI occurred 3-fold more frequently among patients with T2MI vs T1MI as the index event. Improved understanding of the specifics of patients with T2MI should help improve management strategies. QUESTION: What are the characteristics and outcomes of type 2 myocardial infarction (T2MI) compared with type 1 myocardial infarction (T1MI) in patients presenting to the emergency department (ED) with acute chest discomfort? FINDINGS: In this cohort study 6253 patients, 251 patients (4.0%) and 1027 patients (16.4%) were diagnosed with T2MI and T1MI, respectively, and had comparable all-cause and cardiovascular mortality at 2 years. Tachyarrhythmia and hypertension were responsible for more than two-thirds of patients with T2MI and had lower mortality compared with patients with hypotension, hypoxemia, or anemia. MEANING: Improved understanding of the specifics of patients with T2MI should help improve management strategies. eng This cohort study explores the characteristics and outcomes of patients with type 2 myocardial infarction compared with those with type 1 myocardial infarction. eng from the Swiss National Science Foundation, the Prof Dr Max Cloetta Foundation, the Margarete und Walter Lichtenstein-Stiftung, and the University Hospital Basel as well as personal fees from Beckman Coulter, Bayer, Ortho Clinical Diagnostics, and Orion Pharma outside the submitted work. Dr Boeddinghaus received research grants from the University of Basel, the University Hospital of Basel and the Division of Internal Medicine, the Swiss Academy of Medical Sciences, and the Gottfried and Julia Bangerter-Rhyner-Foundation and personal fees from Siemens, Roche Diagnostics, Ortho Clinical Diagnostics, and Quidel Corporation outside of the submitted work. Dr Lopez-Ayala has received research support from the Swiss Heart Foundation and personal fees from Quidel paid to his institution outside the submitted work. Dr Koechlin received a research grant from the University of Basel, the Swiss Academy of Medical Sciences and the Gottfried and Julia Bangerter-Rhyner Foundation as well as the Freiwillige Akademische Gesellschaft Basel. Dr Martin-Sanchez has received personal fees from Novartis, Merck Sharp & Dohme, Bristol Myers Squibb, Pfizer, The Medicines Company, Otsuka, Thermo Fisher, Cardiorentis, and Sanofi and research grants from the Spanish Ministry of Health and Fondo Europeo de Desarrollo Regional, Mapfre, Novartis, Bayer, Merck Sharp & Dohme, Abbott, and Orion Pharma outside the submitted work. Dr Twerenbold has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the Swiss Society of Cardiology, the Cardiovascular Research Foundation Basel, the University of Basel and the University Hospital Basel and personl fees from Abbott, Amgen, AstraZeneca, Roche, Siemens, Singulex, and Thermo Scientific BRAHMS outside the submitted work. Dr Rubini Gimenez has received research grants from the Swiss Heart Foundation and Swiss National Science Foundation as well as personal fees from Abbott, Ortho Clinical Diagnostics, Roche, and Siemens outside the submitted work. Dr Wildi has received research funding from the Freiwillige Akademische Gesellschaft Basel, the Julia und Gottfried Bangerter-Rhyner-Stiftung, the Prince Charles Hospital Foundation, The Wesley Medical Research Foundation, and the CRE Action fund as well as a PhD scholarship from the University of Queensland. Dr Mueller has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the Kommission fur Technologie und Innovation (KTI), the European Union, the University of Basel, the University Hospital Basel, Abbott, Beckman Coulter, Idorsia, Ortho Cinical Diagnostics, Quidel, Roche, Siemens, Singulex, and Sphingotec as well as personal fees from Acon, Amgen, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Idorsia, Novartis, Osler, Roche, and Sanofi outside of the submitted work. No other disclosures were reported.
    Tags: *Myocardial Infarction/therapy, Humans, Risk Factors.
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  • Boyer, M. S., Widmer, D., Cohidon, C., Desvergne, B., Cornuz, J., Guessous, I., and Cerqui, D. “Representations Of Personalised Medicine In Family Medicine: A Qualitative Analysis”. Bmc Prim Care 23, no. 1: 37. doi:10.1186/s12875-022-01650-w.
    Abstract: BACKGROUND: The promise of personalised medicine (PM) to transform healthcare has sparked great enthusiasm in the last years. Yet, its lack of consensus around the nature and scope of the concept has ended in terminological confusion amongst the users in primary care. We aimed to investigate the perceptions of doctors and their patients in response to this evolving concept. This present article focuses on the general understanding of personalised medicine, underlining the confusion over the concept. METHODS: Semi-structured comprehensive interviews were conducted with 10 general practitioners (GPs) and 10 of their patients. The purposive sampling took into account the doctor's age, sex, and place of practice (rural/urban); each doctor recruited one patient of the same age and sex. Each interview began with the same open-ended question about the participant's knowledge of the topic, after which a working definition was provided to continue the discussion. Using the grounded theory method, the analysis consisted of open coding, axial coding and selective coding. RESULTS: From our present analysis focusing on the general understanding of PM, three main themes representing the concept emerged. The first two representations being "centred on the person as a whole" and "focused on alternative and complementary methods", in which the therapeutic relationship was stated as key. The third theme "medicine open to innovation" involved the few participants who had a good understanding of the concept and could associate personalised medicine with genomics. For those who value therapeutic relationship, the risks of accepting innovation could result in "fast-food" medicine and interpersonal barriers. DISCUSSION: PM is predominantly unfamiliar in family medicine. It is misinterpreted as a holistic or integrative type of medicine. This semantic confusion probably lies in the choice of the label "personalised" or from the lack of a uniform definition for the term.
    Tags: *Family Practice, *General Practitioners, Conceptual confusion, Definition, Family medicine, Grounded Theory, Health concept, Humans, Personalised medicine, Precision Medicine, Representation.
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  • Siebert, J. N., Gosetto, L., Sauvage, M., Bloudeau, L., Suppan, L., Rodieux, F., Haddad, K., et al. “Usability Testing And Technology Acceptance Of An Mhealth App At The Point Of Care During Simulated Pediatric In- And Out-Of-Hospital Cardiopulmonary Resuscitations: Study Nested Within 2 Multicenter Randomized Controlled Trials”. Jmir Hum Factors 9, no. 1: e35399. doi:10.2196/35399.
    Abstract: BACKGROUND: Mobile apps are increasingly being used in various domains of medicine. Few are evidence-based, and their benefits can only be achieved if end users intend to adopt and use them. To date, only a small fraction of mobile apps have published data on their field usability and end user acceptance results, especially in emergency medicine. OBJECTIVE: This study aims to determine the usability and acceptance of an evidence-based mobile app while safely preparing emergency drugs at the point of care during pediatric in- and out-of-hospital cardiopulmonary resuscitations by frontline caregivers. METHODS: In 2 multicenter randomized controlled parent trials conducted at 6 pediatric emergency departments from March 1 to December 31, 2017, and 14 emergency medical services from September 3, 2019, to January 21, 2020, the usability and technology acceptance of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app were evaluated among skilled pediatric emergency nurses and advanced paramedics when preparing continuous infusions of vasoactive drugs and direct intravenous emergency drugs at pediatric dosages during standardized, simulation-based, pediatric in- and out-of-hospital cardiac arrest scenarios, respectively. Usability was measured using the 10-item System Usability Scale. A 26-item technology acceptance self-administered survey (5-point Likert-type scales), adapted from the Unified Theory of Acceptance and Use of Technology model, was used to measure app acceptance and intention to use. RESULTS: All 100% (128/128) of nurses (crossover trial) and 49.3% (74/150) of paramedics (parallel trial) were assigned to the mobile app. Mean total scores on the System Usability Scale were excellent and reached 89.5 (SD 8.8; 95% CI 88.0-91.1) for nurses and 89.7 (SD 8.7; 95% CI 87.7-91.7) for paramedics. Acceptance of the technology was very good and rated on average >4.5/5 for 5 of the 8 independent constructs evaluated. Only the image construct scored between 3.2 and 3.5 by both participant populations. CONCLUSIONS: The results provide evidence that dedicated mobile apps can be easy to use and highly accepted at the point of care during in- and out-of-hospital cardiopulmonary resuscitations by frontline emergency caregivers. These findings can contribute to the implementation and valorization of studies aimed at evaluating the usability and acceptance of mobile apps in the field by caregivers, even in critical situations. TRIAL REGISTRATION: ClinicalTrials.gov NCT03021122; https://clinicaltrials.gov/ct2/show/NCT03021122. ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-019-3726-4.
    Tags: (Pediatric Accurate Medication in Emergency Situations) app. The app is currently, an interest in the submitted work in the previous 3 years., cardiopulmonary resuscitation, commercially available on Google Play Store and Apple App Store for research and, completed the International Committee of Medical Journal Editors uniform, disclosure form and declare no support from commercial entities for the submitted, drugs, educational purposes. JNS, CL, AG, FE, and SM declare individual intellectual, emergency medical services, indirect institutional rewarding through its commercialization (ie, without, medication errors, mobile apps, mobile health, mobile phone, out-of-hospital cardiac arrest, paramedics, pediatrics, personal enrichment). The authors declare no other relationships or activities, property rights on this app and, as employees of Geneva University Hospitals,, smartphone, System Usability Scale, that could appear to have influenced the submitted work. All authors have, Unified Theory of Acceptance and Use of Technology, work and no financial relationships with any commercial entities that might have.
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  • Ryser, B., Rudenko, A., Haidinger, M., Exadaktylos, A. K., Ravioli, S., and Lindner, G. “Gender Distribution In Speakers At Emergency Medicine Conferences”. In, 53:161-162, 2022. doi:10.1016/j.ajem.2022.01.023.
  • Niedermeier, S., Wania, R., Lampart, A., Stahl, R., Trumm, C., Kammerlander, C., Bocker, W., et al. “Incidental Ct Findings In The Elderly With Low-Energy Falls: Prevalence And Implications”. Diagnostics (Basel) 12, no. 2. doi:10.3390/diagnostics12020354.
    Abstract: BACKGROUND: Computed tomography (CT) is commonly used in trauma care, with increasing implementation during the emergency work-up of elderly patients with low-energy falls (LEF). The prevalence of incidental findings (IFs) resulting from CT imaging and requiring down-stream actions in this patient cohort is unknown. We have investigated the prevalence and urgency of IFs from emergency CT examinations in these patients. METHODS: A total of 2871 patients with LEF and emergency CT examinations were consecutively included in this retrospective cohort study. The primary endpoint was the prevalence of IFs; the secondary endpoint was their urgency. RESULTS: The median age was 82 years (64.2% were women). IFs were identified in 73.9% of patients, with an average of 1.6 IFs per patient. Of all IFs, 16.4% were classified as urgent or relevant, predominantly in the abdomen, chest and neck. Increasing age was associated with the prevalence of an IF (odds ratio: 1.053, 95% confidence interval: 1.042-1.064). Significantly more IFs were found in female patients (75.2% vs. 71.5%). CONCLUSION: IFs resulting from CT examinations of the elderly are frequent, but in more than 8 out of 10, they are harmless or currently asymptomatic. For the benefit of an accurate diagnosis of traumatic lesions, concerns about IFs with respect to disease burden, further work-up and resource utilisation might be disregarded.
    Tags: computed tomography, emergency imaging, incidental findings, low-energy fall, older adult.
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  • Nickel, C. H., and Nissen, S. K. “Still Under Our Radar: Elder Mistreatment”. Eur J Emerg Med 29, no. 2: 97-98. doi:10.1097/MEJ.0000000000000911.
    Tags: *Elder Abuse/diagnosis, Aged, Humans, Radar, Risk Factors.
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