EMresearch.ch

Diaz Badial, P., Bothorel, H., Kherad, O., Dussoix, P., Tallonneau Bory, F., and Ramlawi, M. “A New Screening Tool For Sars-Cov-2 Infection Based On Self-Reported Patient Clinical Characteristics: The Cov(19)-Id Score”. Bmc Infect Dis 22, no. 1: 187. doi:10.1186/s12879-022-07164-1.

Abstract: BACKGROUND: While several studies aimed to identify risk factors for severe COVID-19 cases to better anticipate intensive care unit admissions, very few have been conducted on self-reported patient symptoms and characteristics, predictive of RT-PCR test positivity. We therefore aimed to identify those predictive factors and construct a predictive score for the screening of patients at admission. METHODS: This was a monocentric retrospective analysis of clinical data from 9081 patients tested for SARS-CoV-2 infection from August 1 to November 30 2020. A multivariable logistic regression using least absolute shrinkage and selection operator (LASSO) was performed on a training dataset (60% of the data) to determine associations between self-reported patient characteristics and COVID-19 diagnosis. Regression coefficients were used to construct the Coronavirus 2019 Identification score (COV(19)-ID) and the optimal threshold calculated on the validation dataset (20%). Its predictive performance was finally evaluated on a test dataset (20%). RESULTS: A total of 2084 (22.9%) patients were tested positive to SARS-CoV-2 infection. Using the LASSO model, COVID-19 was independently associated with loss of smell (Odds Ratio, 6.4), fever (OR, 2.7), history of contact with an infected person (OR, 1.7), loss of taste (OR, 1.5), muscle stiffness (OR, 1.5), cough (OR, 1.5), back pain (OR, 1.4), loss of appetite (OR, 1.3), as well as male sex (OR, 1.05). Conversely, COVID-19 was less likely associated with smoking (OR, 0.5), sore throat (OR, 0.9) and ear pain (OR, 0.9). All aforementioned variables were included in the COV(19)-ID score, which demonstrated on the test dataset an area under the receiver-operating characteristic curve of 82.9% (95% CI 80.6%-84.9%), and an accuracy of 74.2% (95% CI 74.1%-74.3%) with a high sensitivity (80.4%, 95% CI [80.3%-80.6%]) and specificity (72.2%, 95% CI [72.2%-72.4%]). CONCLUSIONS: The COV(19)-ID score could be useful in early triage of patients needing RT-PCR testing thus alleviating the burden on laboratories, emergency rooms, and wards.

Tags: *covid-19, Artifiicial Intelligence, Covid-19, COVID-19 Testing, Humans, Machine learning, Male, Predictive score, Retrospective Studies, SARS-CoV-2, Screening, Self Report, Self-reported symptoms, Triage.

Bitar, E., Carron, P. N., Khoury, A., and Souaiby, N. “Crisis Within The Crisis: Violence Towards Lebanese Emergency Department Workers”. Eur J Emerg Med 29, no. 2: 93-94. doi:10.1097/MEJ.0000000000000907.

Tags: *Emergency Service, Hospital, *Violence, Humans.

Bretschera, C., Boesiger, F., Kaegi-Braun, N., Hersberger, L., Lobo, D. N., Evans, D. C., Tribolet, P., et al. “Admission Serum Albumin Concentrations And Response To Nutritional Therapy In Hospitalised Patients At Malnutrition Risk: Secondary Analysis Of A Randomised Clinical Trial”. Eclinicalmedicine 45: 101301. doi:10.1016/j.eclinm.2022.101301.

Abstract: BACKGROUND: Historically, admission serum albumin concentrations have been considered useful biochemical markers for nutrition assessment. However, there is a lack of randomised trial data investigating whether low albumin concentrations are helpful for identifying patients benefitting from nutritional support. METHODS: This study was a secondary analysis of the EFFORT trial, a Swiss-wide multicentre, randomised controlled trial comparing individualised nutritional support with usual care nutrition in medical inpatients from April 1, 2014, to February 1, 2018. 1389 of 2028 patients at nutritional risk with available albumin concentrations on admission were included. The primary endpoint was all-cause mortality within 30 and 180 days. Patients were stratified into groups of low or normal albumin based on the albumin cut-off of 30 g/L. ClinicalTrials.gov number, NCT02517476. FINDINGS: 1389 patients (mean age, 73.1 (SD 3.5) years; 747 (53.8%) men) were included and 676 (48.7%) had low serum albumin concentrations at admission (<30 g/L). Mortality at 180 days was significantly increased in the low albumin group compared with patients with normal albumin concentrations (219/676 (32.4%) vs. 162/713 (22.7%), fully adjusted HR 1.4, 95%CI 1.11 to 1.77, p = 0.005]. Effects of nutritional support on 30-day mortality were similar for patients with low compared to patients with normal albumin concentrations (HR 0.68, 95%CI 0.44 to 1.05 vs. HR 0.70, 95%CI 0.41 to 1.20), with no evidence for a subgroup effect (p for interaction=0.97). INTERPRETATION: Based on this secondary analysis of a randomised trial, low admission serum albumin concentrations in hospitalised, non-critically ill, medical patients at nutritional risk had prognostic implications and indicated higher mortality risk but were not helpful in selecting patients for nutritional interventions. FUNDING: The Swiss National Science Foundation (SNSF) (PP00P3_150531) and the Research Council of the Kantonsspital Aarau (1410.000.058 and 1410.000.044) provided funding for the EFFORT trial.

Tags: C-reactive protein, conflicts of interest., fees from Neste Health Science, grants from Abbott Nutrition, personal fees from, Fresenius Kabi (outside the submitted work). All other authors report no, Inflammation, Malnutrition, Nutrition (outside the submitted work). Dr. Stanga reports grants and personal, Nutritional support, Outcomes, Serum albumin.

Guerbaai, R. A., Kressig, R. W., Zeller, A., Troger, M., Nickel, C. H., Benkert, B., Wellens, N. I. H., et al. “Identifying Appropriate Nursing Home Resources To Reduce Fall-Related Emergency Department Transfers”. J Am Med Dir Assoc 23, no. 8: 1304-1310 e2. doi:10.1016/j.jamda.2022.01.063.

Abstract: OBJECTIVES: To describe potentially avoidable fall-related transfers to the emergency department (ED), and to identify infrastructure, training needs, and resources deemed appropriate for implementation in nursing homes (NHs) to decrease fall-related transfers to EDs. DESIGN: A multi-method design, including (1) in-depth case review by an expert panel, (2) structured discussion with NH stakeholders, and (3) appropriateness rating. SETTING AND PARTICIPANTS: Fall-related transfers were identified from the prospective reporting of every unplanned hospital transfer occurring within 21 months, collected during the INTERCARE study in 11 Swiss NHs. METHODS: Eighty-one fall-related transfers were rated for avoidability by a 2-round expert panel. NH stakeholders were consulted to discuss key implementable resources for NHs to mitigate potentially avoidable fall-related transfers. A questionnaire composed of 21 contextually adapted resources was sent to a larger group of stakeholders, to rate the appropriateness for implementation in NHs. chi(2) tests were used to assess whether avoidability was associated with an ED visit and to describe transfers. The RAND/UCLA method for appropriateness was used to determine appropriate resources. RESULTS: One of 4 fall-related transfers were rated as potentially avoidable. A positive association was found between an ED visit and a rating of avoidability (chi(2) (1, N = 81) = 18.0, P < .001). Fourteen resources, including developing partnerships with outpatient clinics to access imaging services and strengthening geriatric expertise in nursing homes through clinical training and advanced nurse practitioners, were rated as appropriate by NH stakeholders for NH implementation to reduce potentially avoidable fall-related ED transfers. CONCLUSIONS AND IMPLICATIONS: Access to diagnostic equipment, geriatric expertise, and clinical training is essential to reduce fall-related potentially avoidable transfers from NHs. Implementing and supporting advanced practice nurses or nurses in extended roles provides NH directors, policymakers, and health care institutions with the possibility of re-engineering resources to limit unnecessary transfers, which are detrimental for resident quality of care and costly for the health system.

Tags: *Accidental Falls/prevention & control, *Patient Transfer, Aged, Emergency department transfers, Emergency Service, Hospital, falls, Hospitalization, hospitalizations, Humans, long-term care, Nursing Homes, potentially avoidable transfers, Prospective Studies.

Luethi, N., Wermelinger, S. D., Haynes, A. G., Roumet, M., Maessen, M., Affolter, B., Muller, M., Schefold, J. C., Eychmueller, S., and Cioccari, L. “Development Of An Electronic Poor Outcome Screening (Epos) Score To Identify Critically Ill Patients With Potential Palliative Care Needs”. J Crit Care 69: 154007. doi:10.1016/j.jcrc.2022.154007.

Abstract: PURPOSE: To develop and validate an electronic poor outcome screening (ePOS) score to identify critically ill patients with potentially unmet palliative care (PC) needs at 48 hours after ICU admission. MATERIALS AND METHODS: Retrospective single-centre cohort study of 1'772 critically ill adult patients admitted to a tertiary academic ICU in Switzerland between 2017 and 2018. We used data available from electronic health records (EHR) in the first 48 hours and least absolute shrinkage and selection operator (LASSO) logistic regression to develop a prediction model and generate a score to predict the risk of all cause 6-month mortality. RESULTS: Within 6 months of the ICU admission, 598 patients (33.7%) had died. At a cut-off of 20 points, the ePOS score (range 0-46 points) had a sensitivity of 0.81 (95% CI 0.78 to 0.84) and a specificity of 0.51 (0.48 to 0.54) for predicting 6-month mortality and showed good discriminatory performance (AUROC 0.72, 0.67 to 0.77). CONCLUSIONS: The ePOS score can easily be implemented in EHR and can be used for automated screening and stratification of ICU patients, pinpointing those in whom a comprehensive PC assessment should be performed. However, it should not replace clinical judgement.

Tags: *Critical Illness, *Intensive Care Units, Abbott-Nutrition-International, Braun-Medical-AG, CSEM-AG, Edwards-Lifesciences-, Adult, Bard-Medica-S.A., Abbott-AG, Anandic-Medical-Systems, Pan-Gas- AG-Healthcare,, Bracco, Hamilton-Medical-AG, Fresenius-Kabi, Getinge-Group-Maquet-AG, Drager-AG,, Cohort Studies, Covidien, and Nycomed. The money was paid into departmental funds. No personal, Electronics, Eli-Lilly-and-Company, Baxter, Astellas, Astra-Zeneca, CSL-Behring, Novartis,, end-of-life care, financial gain applied., grants outside of the submitted work from Orion-Pharma,, Hospital Mortality, Humans, Intensive care, interests. SW, JCS and LC report (full departmental disclosure) departmental, mortality, Omnicare-Clinical-Research-AG, Nestle, Pierre-Fabre-Pharma-AG, Pfizer,, outcome, Palliative Care, prediction scores, Retrospective Studies, Services-GmbH, Kenta-Biotech-Ltd, Maquet-Critical-Care-AB,, Teleflex-Medical-GmbH, Glaxo-Smith-Kline, Merck-Sharp-and-Dohme-AG,.

Leidi, A., Soret, G., Mann, T., Koegler, F., Coen, M., Leszek, A., Dubouchet, L., et al. “Eight Versus 28-Point Lung Ultrasonography In Moderate Acute Heart Failure: A Prospective Comparative Study”. Intern Emerg Med 17, no. 5: 1375-1383. doi:10.1007/s11739-022-02943-9.

Abstract: Lung ultrasonography (LUS) is an accurate method of estimating lung congestion but there is ongoing debate on the optimal number of scanning points. The aim of the present study was to compare the reproducibility (i.e. interobserver agreement) and the feasibility (i.e. time consumption) of the two most practiced protocols in patients hospitalized for acute heart failure (AHF). This prospective trial compared 8- and 28-point LUS protocols. Both were performed by an expert-novice pair of sonographers at admission and after 4 to 6 days on patients admitted for AHF. A structured bio-clinical evaluation was simultaneously carried out by the treating physician. The primary outcome was expert-novice interobserver agreement estimated by kappa statistics. Secondary outcomes included time spent on image acquisition and interpretation. During the study period, 43 patients underwent a total of 319 LUS exams. Expert-novice interobserver agreement was moderate at admission and substantial at follow-up for 8-point protocol (weighted kappa of 0.54 and 0.62, respectively) with no significant difference for 28-point protocol (weighted kappa of 0.51 and 0.41; P value for comparison 0.74 at admission and 0.13 at follow-up). The 8-point protocol required significantly less time for image acquisition at admission (mean time difference - 3.6 min for experts, - 5.1 min for novices) and interpretation (- 6.0 min for experts and - 6.3 min for novices; P value < 0.001 for all time comparisons). Similar differences were observed at follow-up. In conclusion, an 8-point LUS protocol was shown to be timesaving with similar reproducibility when compared with a 28-point protocol. It should be preferred for evaluating lung congestion in AHF inpatients.

Tags: *Heart Failure/diagnostic imaging/therapy, *Pulmonary Edema/diagnostic imaging, Congestion, Eight, Heart failure, Humans, Lung ultrasonography, Lung/diagnostic imaging, Prospective Studies, Protocol, Reproducibility of Results, Ultrasonography/methods, Ultrasound.

Sasse, N., Ziaka, M., Brockhus, L., Muller, M., Exadaktylos, A. K., and Klukowska-Rotzler, J. “Trampolining Accidents In An Adult Emergency Department: Analysis Of Trampolining Evolution Regarding Severity And Occurrence Of Injuries”. Int J Environ Res Public Health 19, no. 3. doi:10.3390/ijerph19031212.

Abstract: PURPOSE: Only a few studies have been conducted on trampoline-associated injuries in adults, especially in Switzerland. The aim of the present study was to describe the characteristics of trampoline-related injuries in patients older than 16 years of age and track their development over time by comparing two different time periods. METHODS AND MATERIALS: Data were gathered from the emergency department (ED) of Bern University Hospital. A retrospective design was chosen to allow analysis of changes in trampolining accidents between 2003-2020. RESULTS: A total of 144 patients were enrolled. The number of ED presentations due to trampoline-related injury rose significantly over time. The most common injuries were sprains to the extremities (age group 31-62: 58.4% and age group 16-30: 50.8%), followed by fractures (age group 31-62: 33.3% and age group 16-30: 32.5%). Lower extremities appeared to be the most frequently injured body region (age group 31-62: 20.8% and age group 16-30: 10.0%), although the differences were not statistically significant, p = 0.363. BMI was significantly higher for older than for younger patients (p = 0.004). CONCLUSION: Over the last two decades, trampoline-related injuries have become more common in patients older than 16 years of age. These are most common in the lower extremities. While most of the patients in the present study only suffered minor injuries, the occasional severe injury might result in long-term disability. As trampoline-related injuries in adults are becoming more common, prevention strategies in public education and safety instructions must be optimised.

Tags: *Athletic Injuries/epidemiology, *Fractures, Bone/epidemiology, *Sprains and Strains, Accidents, Adult, adults, Emergency Service, Hospital, fractures, Humans, Retrospective Studies, retrospective study, trampoline, trampolining accidents.

Harjola, P., Tarvasmaki, T., Barletta, C., Body, R., Capsec, J., Christ, M., Garcia-Castrillo, L., et al. “The Emergency Department Arrival Mode And Its Relations To Ed Management And 30-Day Mortality In Acute Heart Failure: An Ancillary Analysis From The Eurodem Study”. Bmc Emerg Med 22, no. 1: 27. doi:10.1186/s12873-022-00574-z.

Abstract: BACKGROUND: Acute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients' ED management and short-term outcomes. METHODS: This was a sub-analysis of a European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from European EDs. Patients with ED diagnosis of acute heart failure were categorized into two groups: those using EMS and those self-presenting (non- EMS). The independent association between EMS use and 30-day mortality was evaluated with logistic regression. RESULTS: Of the 500 acute heart failure patients, with information about the arrival mode to the ED, 309 (61.8%) arrived by EMS. These patients were older (median age 80 vs. 75 years, p < 0.001), more often female (56.4% vs. 42.1%, p = 0.002) and had more dementia (18.7% vs. 7.2%, p < 0.001). On admission, EMS patients had more often confusion (14.2% vs. 2.1%, p < 0.001) and higher respiratory rate (24/min vs. 21/min, p = 0.014; respiratory rate > 30/min in 17.1% patients vs. 7.5%, p = 0.005). The only difference in ED management appeared in the use of ventilatory support: 78.3% of EMS patients vs. 67.5% of non- EMS patients received supplementary oxygen (p = 0.007), and non-invasive ventilation was administered to 12.5% of EMS patients vs. 4.2% non- EMS patients (p = 0.002). EMS patients were more often hospitalized (82.4% vs. 65.9%, p < 0.001), had higher in-hospital mortality (8.7% vs. 3.1%, p = 0.014) and 30-day mortality (14.3% vs. 4.9%, p < 0.001). The use of EMS was an independent predictor of 30-day mortality (OR = 2.54, 95% CI 1.11-5.81, p = 0.027). CONCLUSION: Most acute heart failure patients arrive at ED by EMS. These patients suffer from more severe respiratory distress and receive more often ventilatory support. EMS use is an independent predictor of 30-day mortality.

Tags: *Emergency Medical Services, *Heart Failure/therapy, Acute heart failure, Aged, 80 and over, Arrival mode, Emergency medical services, Emergency Service, Hospital, Female, Hospital Mortality, Humans, Management, Patient Admission, Prognosis, Ventilatory support.

Ceruti, S., Minotti, B., Glotta, A., Biggiogero, M., Bona, G., Marzano, M., Greco, P., Spagnoletti, M., Garzoni, C., and Bendjelid, K. “Temporal Changes In The Oxyhemoglobin Dissociation Curve Of Critically Ill Covid-19 Patients”. J Clin Med 11, no. 3. doi:10.3390/jcm11030788.

Abstract: Critical COVID-19 is a life-threatening disease characterized by severe hypoxemia with complex pathophysiological mechanisms that are not yet completely understood. A pathological shift in the oxyhemoglobin curve (ODC) was previously described through the analysis of p50, intended as the oxygen tension at which hemoglobin is saturated by oxygen at 50%. The aim of this study was to analyze Hb-O(2) affinity features over time in a cohort of critically ill COVID-19 patients, through the analysis of ODC p50 behavior. A retrospective analysis was performed; through multiple arterial blood gas (ABG) analyses, each p50 was calculated and normalized according to PaCO(2), pH and temperature; patients' p50 evolution over time was reported, comparing the first 3 days (early p50s) with the last 3 days (late p50s) of ICU stay. A total of 3514 ABG analyses of 32 consecutive patients were analyzed. The majority of patients presented a left shift over time (p = 0.03). A difference between early p50s and late p50s was found (20.63 +/- 2.1 vs. 18.68 +/- 3.3 mmHg, p = 0.03); median p50 of deceased patients showed more right shifts than those of alive patients (24.1 vs. 18.45 mmHg, p = 0.01). One-way ANOVA revealed a p50 variance greater in the early p50s (sigma(2) = 8.6) than in the late p50s (sigma(2) = 3.84), associated with a reduction over time (p < 0.001). Comparing the Hb-O(2) affinity in critically ill COVID-19 patients between ICU admission and ICU discharge, a temporal shift in the ODC was observed.

Tags: Covid-19, dyspnea etiology, hypoxemia, hypoxia etiology, oxyhemoglobin metabolism, SARS-CoV-2, viral pneumonia.

Doulberis, M., Sampsonas, F., Papaefthymiou, A., Karamouzos, V., Lagadinou, M., Karampitsakos, T., Stratakos, G., Kuntzen, T., and Tzouvelekis, A. “High-Flow Versus Conventional Nasal Cannula Oxygen Supplementation Therapy And Risk Of Hypoxia In Gastrointestinal Endoscopies: A Systematic Review And Meta-Analysis”. Expert Rev Respir Med 16, no. 3: 323-332. doi:10.1080/17476348.2022.2042256.

Abstract: BACKGROUND: Gastrointestinal endoscopy (GIE) represents a mainstay diagnostic and therapeutic procedure in clinical practice. Hypoxemia constitutes a major complication for endoscopists. Emerging evidence supports the utilization of high-flow nasal cannula (HFNC) over conventional nasal cannula (CNC) for avoidance of hypoxemia. Our aim was to compare the hypoxemia risk in patients undergoing GIE with HFNC versus CNC oxygen supplementation recruited by randomized controlled trials (RCTs). METHODS: We searched in medical databases PubMed, EMBASE and Cochrane to identify RCTs investigating the abovementioned association. Enrolled studies were evaluated for risk of bias and inserted into a random effects model for meta-analysis; subgroup analyses and publication bias were also assessed. RESULTS: Out of 271 articles, five RCTs were eligible (patients n=2656, HFNC 1299 and CNC 1357). A statistically significant reduced relative risk (RR) of hypoxemia among HFNC patients was revealed (RR=0.18, CI95%: 0.05-0.61), whilst with high heterogeneity (I2:79.94%, p<0.01). Patients undergoing upper GIE with HFNC displayed a significantly lower hypoxemia risk (96%, p<0.001, I2:15.59%), even after exclusion of endoscopic retrograde cholangiopancreatography cases (RR:0.03, CI95%:0.01-0.21), albeit with higher heterogeneity (I2:41.82%). . CONCLUSION: Patients undergoing upper GIE with HFNC experience significantly less hypoxemia burden than CNC counterparts. Further research is warranted to target optimal safety during endoscopy.Abbreviations: ASA, American Society of Anesthesiologists; ASGE, American Society for Gastrointestinal Endoscopy; BMI, Body Mass Index; CI, confidence interval; CNC, conventional nasal cannula; ERCP, endoscopic retrograde cholangiopancreatography; FiO(2,) fraction of inspired O(2); GI, gastrointestinal; GIE, gastrointestinal endoscopies; HFNC, High-Flow nasal cannula; ICU, intensive care unit; PEEP, positive end-expiratory pressure; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis; RCTs, randomized control trials; RR, relative risk (or risk ratio).

Tags: *Cannula/adverse effects, *Oxygen, colonoscopy, digestive endoscopies, Egd, Endoscopy, Gastrointestinal/adverse effects, Ercp, Gastrointestinal endoscopies, Hfnc, high-flow, high-flow nasal cannula, Humans, hypercapnia, hypoxemia, Hypoxia/etiology/therapy, Oxygen Inhalation Therapy/adverse effects/methods.

Banat, M., Wach, J., Salemdawod, A., Bara, G., Shabo, E., Scorzin, J. E., Muller, M., Vatter, H., and Eichhorn, L. “Antithrombotic Therapy In Spinal Surgery Does Not Impact Patient Safety-A Single Center Cohort Study”. Front Surg 8: 791713. doi:10.3389/fsurg.2021.791713.

Abstract: OBJECTIVE: Antithrombotic therapy is common in older patients to avoid thromboembolic events. Careful planning is required, particularly in the perioperative environment. There are no clearly date guidelines on the best timing for interrupting the use of anticoagulation in the case of spinal surgery. This study evaluates early per procedural clinical outcomes in patients whose antithrombotic therapy was interrupted for spinal surgery. METHODS: This is a retrospective cohort study. All patients who underwent dorsal instrumentation from January 1, 2019 to December 31, 2020 were included. In group A, vitamin K antagonists (VKA) were suspended for 5 days and direct oral anticoagulants (DOAC) for 3 days. In group B, antiplatelet agents (APA) were paused for at least 7 days before surgery to prevent perioperative bleeding. Patients not taking anticoagulation medication were gathered into control group C. We analyzed demographic data, ASA status, blood loss, comorbidities, duration of surgery, blood transfusion, length of hospital stay, complications, thromboembolism, and 30 day in-hospital mortality. Multivariate analyses from the three groups were further analyzed and conducted. RESULTS: A total of 217 patients were operated and included. Twenty-eight patients taking VKA/DOAC (group A), 37 patients using APA (group B), and 152 patients without anticoagulation (group C) underwent spinal surgery. Those using anticoagulants were significantly older and often with multimorbidity, but did not differ significantly in procedural bleeding, time of surgery, length of hospital stay, complication rate, thromboembolism, or 30 day in-hospital mortality (p > 0.05). CONCLUSION: Our data show that dorsal instrumentation safely took place in patients whose antithrombotic therapy was interrupted.

Tags: antithrombotic therapy, commercial or financial relationships that could be construed as a potential, conflict of interest., optimizing surgical planning, patient safety, spinal complications, spinal surgery.

Kaier, T. E., Twerenbold, R., Lopez-Ayala, P., Nestelberger, T., Boeddinghaus, J., Alaour, B., Huber, I. M., et al. “A 0/1H-Algorithm Using Cardiac Myosin-Binding Protein C For Early Diagnosis Of Myocardial Infarction”. Eur Heart J Acute Cardiovasc Care 11, no. 4: 325-335. doi:10.1093/ehjacc/zuac007.

Abstract: AIMS: Cardiac myosin-binding protein C (cMyC) demonstrated high diagnostic accuracy for the early detection of non-ST-elevation myocardial infarction (NSTEMI). Its dynamic release kinetics may enable a 0/1h-decision algorithm that is even more effective than the ESC hs-cTnT/I 0/1 h rule-in/rule-out algorithm. METHODS AND RESULTS: In a prospective international diagnostic study enrolling patients presenting with suspected NSTEMI to the emergency department, cMyC was measured at presentation and after 1 h in a blinded fashion. Modelled on the ESC hs-cTnT/I 0/1h-algorithms, we derived a 0/1h-cMyC-algorithm. Final diagnosis of NSTEMI was centrally adjudicated according to the 4th Universal Definition of Myocardial Infarction. Among 1495 patients, the prevalence of NSTEMI was 17%. The optimal derived 0/1h-algorithm ruled-out NSTEMI with cMyC 0 h concentration below 10 ng/L (irrespective of chest pain onset) or 0 h cMyC concentrations below 18 ng/L and 0/1 h increase <4 ng/L. Rule-in occurred with 0 h cMyC concentrations of at least 140 ng/L or 0/1 h increase >/=15 ng/L. In the validation cohort (n = 663), the 0/1h-cMyC-algorithm classified 347 patients (52.3%) as 'rule-out', 122 (18.4%) as 'rule-in', and 194 (29.3%) as 'observe'. Negative predictive value for NSTEMI was 99.6% [95% confidence interval (CI) 98.9-100%]; positive predictive value 71.1% (95% CI 63.1-79%). Direct comparison with the ESC hs-cTnT/I 0/1h-algorithms demonstrated comparable safety and even higher triage efficacy using the 0h-sample alone (48.1% vs. 21.2% for ESC hs-cTnT-0/1 h and 29.9% for ESC hs-cTnI-0/1 h; P < 0.001). CONCLUSION: The cMyC 0/1h-algorithm provided excellent safety and identified a greater proportion of patients suitable for direct rule-out or rule-in based on a single measurement than the ESC 0/1h-algorithm using hs-cTnT/I. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT00470587.

Tags: *Myocardial Infarction/diagnosis, *Non-ST Elevated Myocardial Infarction/diagnosis, Algorithms, Apace, Biomarkers, Cardiac myosin-binding protein C, Carrier Proteins, cMyC, Early Diagnosis, Humans, Myocardial infarction, Prospective Studies, Troponin I, Troponin T.

Aeschimann, E., Sanchez, O., Birraux, J., Wildhaber, B. E., and Manzano, S. “How Useful Is A Complete Urinary Tract Ultrasound In Orchiepididymitis?”. Plos One 17, no. 2: e0263934. doi:10.1371/journal.pone.0263934.

Abstract: Orchiepididymitis (OE) is a frequent cause of pediatric emergency department attendance in boys presenting with acute scrotum. The etiology of most episodes of OE remains unclear and there is no consensus regarding the correlation between OE and underlying genitourinary malformations. Whether imaging evaluation should comprise complete urinary tract ultrasonography (US) or voiding cystography is a subject of debate. The aim of this retrospective, single-center study was to analyze i) the number/type of urinary tract malformations detected by US following a first episode of OE in boys with no previously known malformation and ii) the frequency of associated urinary tract infection (UTI). We reviewed the records of 495 boys <16 years presenting to our pediatric emergency department with acute scrotum between January 2012 and December 2017. Patients with incomplete radiological data were excluded. Of 119 boys with a radiologically-confirmed first episode of OE, 99 had a complete urinary tract US and were included in the study. No genitourinary malformation was detected (0%). Urinary cultures showed UTI in 3/98 (3.1%) patients. Mean age at presentation was 9.7 years (standard deviation, 3.9) with a three-peak incidence of OE at 10-13 years, 4-5 years, and during infancy. Conclusion: Complete urinary tract US does not appear to be useful during a first episode of OE in countries with an antenatal US screening rate similar to Switzerland. The very low UTI rate suggests that a urinalysis is sufficient to investigate a first episode of OE and antibiotics should be reserved for positive urinalysis only.

Tags: Adolescent, Child, Child, Preschool, Cystography, Epididymitis/*diagnostic imaging/etiology, Humans, Infant, Male, Orchitis/*diagnostic imaging/etiology, Retrospective Studies, Switzerland/epidemiology, Urinalysis, Urinary Tract Infections/complications/*epidemiology, Urinary Tract/abnormalities/*diagnostic imaging.

Rueegg, M., Nissen, S. K., Brabrand, M., Kaeppeli, T., Dreher, T., Carpenter, C. R., Bingisser, R., and Nickel, C. H. “The Clinical Frailty Scale Predicts 1-Year Mortality In Emergency Department Patients Aged 65 Years And Older”. Acad Emerg Med 29, no. 5: 572-580. doi:10.1111/acem.14460.

Abstract: OBJECTIVE: To validate the Clinical Frailty Scale (CFS) for prediction of 1-year all-cause mortality in the emergency department (ED) and compare its performance to the Emergency Severity Index (ESI). METHODS: Prospective cohort study at the ED of a tertiary care center in Northwestern Switzerland. All patients aged >/=65 years were included from March 18 to May 20, 2019, after informed consent. Frailty status was assessed using CFS, excluding level 9 (palliative). Acuity level was assessed using ESI. Both CFS and ESI were adjusted for age, sex and presenting condition in multivariable logistic regression. Prognostic performance was assessed for discrimination and calibration separately. Estimates were internally validated by Bootstrapping. Restricted mean survival time (RMST) was determined for all levels of CFS. RESULTS: In the final study population of 2191 patients, 1-year all-cause mortality was 17% (n = 372). RMST values ranged from 219 days for CFS 8 to 365 days for CFS 1. The adjusted CFS model had an area under receiver operating characteristic of 0.767 (95% confidence interval [CI]: 0.741-0.793), compared to 0.703 (95% CI: 0.673-0.732) for the adjusted ESI model. CONCLUSION: The CFS predicts 1-year all-cause mortality for older ED patients and predicts survival time in a graded manner. The CFS is superior to the ESI when adjusted for age, sex, and presenting condition.

Tags: *Frailty/diagnosis, Emergency Service, Hospital, Hospital Mortality, Humans, Prospective Studies.

Pietsch, U., Mullner, R., Theiler, L., Wenzel, V., Meuli, L., Knapp, J., Sollid, S. J. M., and Albrecht, R. “Airway Management In A Helicopter Emergency Medical Service (Hems): A Retrospective Observational Study Of 365 Out-Of-Hospital Intubations”. Bmc Emerg Med 22, no. 1: 23. doi:10.1186/s12873-022-00579-8.

Abstract: BACKGROUND: Airway management is a key skill in any helicopter emergency medical service (HEMS). Intubation is successful less often than in the hospital, and alternative forms of airway management are more often needed. METHODS: Retrospective observational cohort study in an anaesthesiologist-staffed HEMS in Switzerland. Patient charts were analysed for all calls to the scene (n = 9,035) taking place between June 2016 and May 2017 (12 months). The primary outcome parameter was intubation success rate. Secondary parameters included the number of alternative techniques that eventually secured the airway, and comparison of patients with and without difficulties in airway management. RESULTS: A total of 365 patients receiving invasive ventilatory support were identified. Difficulties in airway management occurred in 26 patients (7.1%). Severe traumatic brain injury was the most common indication for out-of-hospital Intubation (n = 130, 36%). Airway management was performed by 129 different Rega physicians and 47 different Rega paramedics. Paramedics were involved in out-of-hospital airway manoeuvres significantly more often than physicians: median 7 (IQR 4 to 9) versus 2 (IQR 1 to 4), p < 0.001. CONCLUSION: Despite high overall success rates for endotracheal intubation in the physician-staffed service, individual physicians get only limited real-life experience with advanced airway management in the field. This highlights the importance of solid basic competence in a discipline such as anaesthesiology.

Tags: *Air Ambulances, *Emergency Medical Services/methods, Aircraft, Airway Management, Difficult airway management, Difficult intubation, Hems, Hospitals, Humans, Intubation, Intratracheal, Out-of-hospital intubation, Retrospective Studies.

Paal, P., Lott, C., Brugger, H., Falk, M., Rousson, V., and Pasquier, M. “Reply To Wallner B Et Al. Prognostication Of Outcome For Hypothermic Avalanche Victims In Cardiac Arrest”. Resuscitation 171: 123-125. doi:10.1016/j.resuscitation.2021.12.034.

Tags: *Avalanches, *Heart Arrest/therapy, *Hypothermia/complications/diagnosis/therapy, been involved with derivation and validation of the HOPE score., Humans.

Hafner, C., Schneider, J., Schindler, M., and Braillard, O. “Visual Aids In Ambulatory Clinical Practice: Experiences, Perceptions And Needs Of Patients And Healthcare Professionals”. Plos One 17, no. 2: e0263041. doi:10.1371/journal.pone.0263041.

Abstract: This study aims to explore how visual aids (VA) are used in ambulatory medical practice. Our research group (two doctors, one graphic designer and one sociologist) have led a qualitative study based on Focus Groups. A semi-structured guide and examples of VA were used to stimulate discussions. Participants were healthcare professionals (HP) working in ambulatory practice in Geneva and French-speaking outpatients. After inductive thematic analysis, the coding process was analyzed and modified to eventually reach consensus. Six focus groups gathered twenty-one HP and fifteen patients. Our study underlines the variety of purposes of use of VA and the different contexts of use allowing the distinction between "stand-alone" VA used out of consultation by patients alone and "interactive" VA used during a consultation enriched by the interaction between HP and patients. HP described that VA can take the form of useful tools for education and communication during consultation. They have questioned the quality of available VA and complained about restricted access to them. Patients expressed concern about the impact of VA on the interaction with HP. Participants agreed on the beneficial role of VA to supplement verbal explanation and text. Our study emphasizes the need to classify available VA, guarantee their quality, facilitate their access and deliver pertinent instructions for use.

Tags: *Communication, *Referral and Consultation, Adult, Aged, Ambulatory Care Facilities/*statistics & numerical data, Audiovisual Aids/*statistics & numerical data, Delivery of Health Care/*standards, Female, Health Personnel/*psychology, Humans, Male, Middle Aged, Needs Assessment/*statistics & numerical data, Qualitative Research.

Darocha, T., Debaty, G., Ageron, F. X., Podsiadlo, P., Hutin, A., Hymczak, H., Blancher, M., et al. “Hypothermia Is Associated With A Low Etco(2) And Low Ph-Stat Paco(2) In Refractory Cardiac Arrest”. Resuscitation 174: 83-90. doi:10.1016/j.resuscitation.2022.01.022.

Abstract: AIMS: The end-tidal carbon dioxide (ETCO(2)) is frequently measured in cardiac arrest (CA) patients, for management and for predicting survival. Our goal was to study the PaCO(2) and ETCO(2) in hypothermic cardiac arrest patients. METHODS: We included patients with refractory CA assessed for extracorporeal cardiopulmonary resuscitation. Hypothermic patients were identified from previously prospectively collected data from Poland, France and Switzerland. The non-hypothermic CA patients were identified from two French cohort studies. The primary parameters of interest were ETCO(2) and PaCO(2) at hospital admission. We analysed the data according to both alpha-stat and pH-stat strategies. RESULTS: We included 131 CA patients (39 hypothermic and 92 non-hypothermic). Both ETCO(2) (p < 0.001) and pH-stat PaCO(2) (p < 0.001) were significantly lower in hypothermic compared to non-hypothermic patients, which was not the case for alpha-stat PaCO(2) (p = 0.15). The median PaCO(2)-ETCO(2) gradient was greater for hypothermic compared to non-hypothermic patients when using the alpha-stat method (46 mmHg vs 30 mmHg, p = 0.007), but not when using the pH-stat method (p = 0.10). Temperature was positively correlated with ETCO(2) (p < 0.01) and pH-stat PaCO(2) (p < 0.01) but not with alpha-stat PaCO(2) (p = 0.5). The ETCO(2) decreased by 0.5 mmHg and the pH-stat PaCO(2) by 1.1 mmHg for every decrease of 1 degrees C of the temperature. The proportion of survivors with an ETCO(2) </= 10 mmHg at hospital admission was 45% (9/25) for hypothermic and 12% (2/17) for non-hypothermic CA patients. CONCLUSIONS: Hypothermic CA is associated with a decrease of the ETCO(2) and pH-stat PaCO(2) compared with non-hypothermic CA. ETCO(2) should not be used in hypothermic CA for predicting outcome.

Tags: *Cardiopulmonary Resuscitation, *Heart Arrest, *Hypothermia, Induced, *Hypothermia/therapy, Accidental, Capnography, Capnometry, Carbon Dioxide, Cardiac arrest, competing financial interests or personal relationships that could have appeared, Etco(2), Extracorporeal Life Support, Humans, Hydrogen-Ion Concentration, Hypothermia, Resuscitation, to influence the work reported in this paper., Triage.

Wildi, K., Boeddinghaus, J., Nestelberger, T., Lopez-Ayala, P., Yufera Sanchez, A., Okamura, B., Shrestha, S., et al. “0/2 H-Algorithm For Rapid Triage Of Suspected Myocardial Infarction Using A Novel High-Sensitivity Cardiac Troponin I Assay”. Clin Chem 68, no. 2: 303-312. doi:10.1093/clinchem/hvab203.

Abstract: BACKGROUND: We aimed to derive and validate a 0/2 h-algorithm using the new high-sensitivity cardiac troponin I (hs-cTnI)-VITROS assay (VITROS(R) Immunodiagnostic Products hs-Troponin I Reagent Pack, Ortho Clinical Diagnostics) for rapid rule-out/in of non-ST-segment elevation myocardial infarction (NSTEMI). METHODS: The final diagnosis was centrally adjudicated by 2 independent cardiologists according to the fourth universal definition of myocardial infarction (MI) among 1888 patients presenting to the emergency department with acute chest pain. hs-cTnI-VITROS concentrations were measured at presentation and at 2 h in a blinded fashion. The optimal assay-specific thresholds for the hs-cTnI-VITROS 0/2 h-algorithm were derived in a randomly selected 70% of the cohort and validated in the remaining 30%. RESULTS: NSTEMI was the final diagnosis in 216/1322 (16.3%) patients of the derivation cohort. Rule-out was defined as baseline hs-cTnI concentrations of <1 ng/L in patients presenting with chest pain onset >3 h or a baseline hs-cTnI concentration of <2 ng/L and an absolute change of <3 ng/L within 2 h. Thresholds for rule-in were either >/=40 ng/L at presentation or an absolute change within 2 h of >/= 5ng/L. In the derivation cohort, these thresholds ruled-out 50.8% of patients with a negative predictive value (NPV) and sensitivity of 99.7% (95% Confidence Interval (CI), 98.8-99.9%) and 99.1% (95% CI, 96.7-99.9%), and ruled-in 17.9% with a positive predictive value (PPV) of 79.2% (95% CI, 74.3-83.5%). In the validation cohort, NSTEMI was the final diagnosis in 91/566 (16.1%) patients. The derived 0/2 h-algorithm ruled-out 46.3% of patients with a NPV and sensitivity of 100% (95% CI, 95.6-100%) and 100% (95% CI, 96.0-100%), and ruled-in 18.9% with a PPV of 73.8% (95% CI, 66.1-80.3%) in the validation cohort. CONCLUSION: hs-cTnI-VITROS concentrations at presentation combined with absolute changes within the first 2 h allowed safe rule-out and accurate rule-in of NSTEMI in two-thirds of unselected patients presenting with acute chest pain to the emergency department. TRIAL REGISTRATION: www.clinicaltrials.gov: NCT0047058.

Tags: 0/2 h-algorithm, diagnosis of acute myocardial infarction, high-sensitivity cardiac troponin I, rule-in, rule-out.

Slankamenac, K., Temperli, E., and Keller, D. I. “Willingness To Donate Organs - An Anonymised Survey In The Emergency Department”. Swiss Med Wkly 152, no. 1-2: w30100. doi:10.4414/smw.2022.w30100.

Abstract: BACKGROUND: In Switzerland, 519 patients received an organ in 2020. In total, 2124 patients were on the donor organ waiting list in 2020. There are many more people who need an organ than people willing to donate one. Therefore, 43 organs had to be imported from outside of Switzerland and this number was still not sufficient. This disproportion of patients needing an organ and available donor organs is the subject of ongoing discussion. A solution to this problem might be provided by a popular initiative proposing that every single resident of Switzerland should be an organ donor, unless a person explicitly rejects organ donation. We surveyed the patients in a single tertiary care emergency department (ED) to determine whether they had an organ donor card or were registered in the Swiss National Organ Donor Registry (NODR), the frequency of willingness to donate organs and which factors were associated with being an organ donor. METHODS: In a prospective anonymised survey during July 2019, we enrolled patients who visited a Swiss tertiary care ED, during one week from 8:00 to 18:00, two weeks from 14:00 to 23:00 and one week from 23:00 to 8:00. The patients completed a written, standardised and self-administrated questionnaire during the waiting time in the ED. Descriptive, uni- and multivariable logistic regression analysis were performed. RESULTS: We enrolled 307 ED patients, of whom 62 (20.2%) were donor card holders or were registered in the Swiss NODR. Of these, 53 (85.5%) would be willing to donate organs. The remaining nine (14.5%) were not willed to donate an organ; the reasons for this were very heterogeneous. In contrast, the two leading reasons for willingness to donate organs were: to help after death (94.3%) and to free relatives from the task of making the decision (43.4%). From the 245 (79.8%) participants who did not have an organ donor card or were not registered, 84 respondents (34.3%) lacked knowledge of this topic, 65 (26.5%) had not yet thought about the topic and 51 (20.8%) had not yet had time to take care of this issue. Blood donation (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.1-3.9; p = 0.018) or receiving a transplant in the past (OR 6.1, 95% CI 1.3-29.1; p = 0.023) and having a university degree (OR 1.8, 95% CI 1.0-3.2; p = 0.049) were factors associated with being an organ donor card holder. CONCLUSIONS: Only one in five ED patients had a fully completed organ donor card or were registered in the Swiss NODR. Of these, the great majority were willing to donate organs. Most of the ED patients who did not have an organ donor card or were not registered in the NODR lacked knowledge and information about the topic, had not yet thought about it or had not had time to deal with this issue. Factors such as a positive history of blood donation, organ transplantation in the past or having a university degree were associated with having an organ donor card. In order to increase the willingness to donate organs in the future, it is of immense importance to provide better information and more details and knowledge about this important topic.

Tags: *Tissue and Organ Procurement, Emergency Service, Hospital, Health Knowledge, Attitudes, Practice, Humans, Prospective Studies, Surveys and Questionnaires, Tissue Donors.

Gross, S., Beck, K., Becker, C., Gamp, M., Mueller, J., Loretz, N., Amacher, S. A., et al. “Perception Of Physicians And Nursing Staff Members Regarding Outside Versus Bedside Ward Rounds: Ancillary Analysis Of The Randomised Bedside-Outside Trial”. Swiss Med Wkly 152, no. 3-4: w30112. doi:10.4414/smw.2022.w30112.

Abstract: BACKGROUND: We recently compared the effects of bedside and outside the room ward rounds on patients' knowledge about their medical care. Here, we report preferences of medical and nursing staff members regarding outside versus bedside ward rounds. METHODS: Within this ancillary project of a large multicentre randomised controlled trial, we prospectively conducted a survey of medical and nursing staff members participating in the weekly consultant ward rounds in the internal medicine division of three Swiss teaching hospitals between July 2017 and October 2019. Participants were asked about their preferences on outside versus bedside ward rounds. The primary endpoint was satisfaction of healthcare workers with the ward round measured with a visual analogue scale from 0 to 100. RESULTS: Between July 2017 and October 2019, 919 patients were included in the trial, and we received 891 survey responses (nurses 15.6%, residents 26.8%, attending physicians 29.6%, consultants 7.8% and chief physicians 20.2%. In the overall analysis, mean (+/- standard deviation) satisfaction of healthcare workers was higher with outside the room than bedside ward rounds (78.03 +/- 16.96 versus 68.25 +/- 21.10 respectively; age-, gender- and centre-adjusted difference of -10.46, 95% confidence interval [CI] -12.73 to -8.19; p <0.001). Healthcare workers reported better time management, more discussion of sensitive topics and less discomfort when case presentations were conducted outside the room. A stratified subgroup analysis considering the profession, however, showed strong differences, with nurses being more satisfied with bedside rounds (69.20 +/- 20.32 versus 65.32 +/- 20.92, respectively; adjusted difference 4.35, 95% CI -1.79 to 10.51; p <0.001), whereas attending physicians showed higher satisfaction with outside the room rounds (82.63 +/- 13.87 versus 66.59 +/- 21.82; adjusted difference -16.51, 95% CI -20.29 to -12.72; p = 0.002). CONCLUSIONS: While bedside ward rounds are considered more patient centred and are preferred by the nursing staff, physicians prefer outside the room presentation of patients during ward rounds because of the perceived better discussion of sensitive topics, better time management and less staff discomfort. Continuous training including medical communication techniques may help to increase satisfaction of physicians with bedside ward rounds. Trial registration: https://clinicaltrials.gov/ct2/show/NCT03210987.

Tags: *Nursing Staff, *Physicians, *Teaching Rounds/methods, Humans, Patient Satisfaction, Perception.

Messmer, A. S., Moser, M., Zuercher, P., Schefold, J. C., Muller, M., and Pfortmueller, C. A. “Fluid Overload Phenotypes In Critical Illness-A Machine Learning Approach”. J Clin Med 11, no. 2. doi:10.3390/jcm11020336.

Abstract: BACKGROUND: The detrimental impact of fluid overload (FO) on intensive care unit (ICU) morbidity and mortality is well known. However, research to identify subgroups of patients particularly prone to fluid overload is scarce. The aim of this cohort study was to derive "FO phenotypes" in the critically ill by using machine learning techniques. METHODS: Retrospective single center study including adult intensive care patients with a length of stay of >/=3 days and sufficient data to compute FO. Data was analyzed by multivariable logistic regression, fast and frugal trees (FFT), classification decision trees (DT), and a random forest (RF) model. RESULTS: Out of 1772 included patients, 387 (21.8%) met the FO definition. The random forest model had the highest area under the curve (AUC) (0.84, 95% CI 0.79-0.86), followed by multivariable logistic regression (0.81, 95% CI 0.77-0.86), FFT (0.75, 95% CI 0.69-0.79) and DT (0.73, 95% CI 0.68-0.78) to predict FO. The most important predictors identified in all models were lactate and bicarbonate at admission and postsurgical ICU admission. Sepsis/septic shock was identified as a risk factor in the MV and RF analysis. CONCLUSION: The FO phenotypes consist of patients admitted after surgery or with sepsis/septic shock with high lactate and low bicarbonate.

Tags: (Martin Muller) has nothing to disclose., Abbott AG, Baar, Switzerland, Abbott Nutrition International, Baar, Switzerland, AG, Basel, Switzerland, Allschwil, Switzerland, Anandic Medical Systems,, and Nycomed, Zurich, Switzerland outside the submitted work. The, Astellas, Wallisellen, Switzerland, Astra Zeneca, Baar, Switzerland, B., Bard Medica S.A., Allschwil,, Baxter, Opfikon, Switzerland, Bern, Switzerland, Bracco, Lausanne, Switzerland, Braun Medical AG, Melsungen, Germany, Covidien, Munchenbuchsee,, CSEM AG, Zurich, Switzerland, CSL Behring,, Drager AG, Liebefeld, Switzerland, Edwards, Eli Lilly and Company, Vernier, Switzerland, Feuertalhalen, Switzerland, fluid overload, fluid resuscitation, Fresenius Kabi, Kriens, Switzerland, Getinge Group Maquet AG, Rastatt, Germany, Glaxo Smith Kline, Brentford, UK, Hamilton Medical AG, Bonaduz, Switzerland, intensive care, Kenta Biotech Ltd., Bern,, Lifesciences Services GmbH, Nyon, Switzerland, Maquet Critical Care AB, Solna, Sweden, Merck Sharp and Dohme AG, Lucerne, Switzerland, money was paid into departmental funds, Nestle, Vevey, Switzerland, no personal financial gain applied. M.M., Novartis, Basel, Switzerland, Omnicare Clinical Research, Pan Gas AG Healthcare, Dagmersellen, Switzerland, Pfizer, Zurich, Switzerland, Pharma, Zug, Switzerland, Pierre Fabre Pharma AG,, risk factors, Switzerland, Teleflex Medical GmbH, Belp, Switzerland.

Kliem, P. S. C., Tisljar, K., Baumann, S. M., Grzonka, P., De Marchis, G. M., Bassetti, S., Bingisser, R., Hunziker, S., Marsch, S., and Sutter, R. “First-Response Abcde Management Of Status Epilepticus: A Prospective High-Fidelity Simulation Study”. J Clin Med 11, no. 2. doi:10.3390/jcm11020435.

Abstract: Respiratory infections following status epilepticus (SE) are frequent, and associated with higher mortality, prolonged ICU stay, and higher rates of refractory SE. Lack of airway protection may contribute to respiratory infectious complications. This study investigates the order and frequency of physicians treating a simulated SE following a systematic Airways-Breathing-Circulation-Disability-Exposure (ABCDE) approach, identifies risk factors for non-adherence, and analyzes the compliance of an ABCDE guided approach to SE with current guidelines. We conducted a prospective single-blinded high-fidelity trial at a Swiss academic simulator training center. Physicians of different affiliations were confronted with a simulated SE. Physicians (n = 74) recognized SE and performed a median of four of the five ABCDE checks (interquartile range 3-4). Thereof, 5% performed a complete assessment. Airways were checked within the recommended timeframe in 46%, breathing in 66%, circulation in 92%, and disability in 96%. Head-to-toe (exposure) examination was performed in 15%. Airways were protected in a timely manner in 14%, oxygen supplied in 69%, and antiseizure drugs (ASDs) administered in 99%. Participants' neurologic affiliation was associated with performance of fewer checks (regression coefficient -0.49; p = 0.015). We conclude that adherence to the ABCDE approach in a simulated SE was infrequent, but, if followed, resulted in adherence to treatment steps and more frequent protection of airways.

Tags: 10531C_182422), the Bangerter-Rhyner Foundation (8472/HEG-DSV), and the Swiss, and Thermo Fisher GmbH. He received, aspiration, Bangerter-Rhyner-Stiftung, Basel and University of Basel, convulsive status epilepticus, disclosures. Gian Marco De Marchis was and is supported by the Swiss National, disclosures. Raoul Sutter received research grants from the Swiss National, emergency medicine, epilepsy, Ettore Balli, European hospitals, owned by the University Hospital Basel. Sabina Hunziker is, Fondazione, Foundation (No 320030_169379), the Research Fund of the University Basel, the, guidelines, Jubilaumsstiftung for Medical Research, manuscript, or the decision to publish the results., medstandards.com, a symptom-based medical decision-support tool licensed to 150, neurology, prospective study, received personal grants from UCB-pharma and holds stocks from Alcon, Novartis,, Roche, and Johnson & Johnson. The funders had no role in the design of the study,, Science Foundation, Science Funds (Wissenschaftsfonds) of the University Hospital, Scientific Society Basel, and the Gottfried Julia Bangerter-Rhyner Foundation. He, seizure, Society of General Internal Medicine (SSGIM). Stephan Marsch reports no, Stefano Bassetti reports no disclosures. Roland Bingisser is an editor of, supported by the Swiss National Foundation (SNF) (Ref 10001C_192850/1 and, Swiss Neurological Society, Swisslife, the collection, analysis, or interpretation of data, the writing of the, the De Quervain research grant, travel honoraria from Bayer and speaker honoraria from Medtronic and BMS/Pfizer..

Storz, M. A., Lederer, A. K., and Heymann, E. P. “Medical Students From German-Speaking Countries On Abroad Electives In Africa: Destinations, Motivations, Trends And Ethical Dilemmas”. Hum Resour Health 20, no. 1: 9. doi:10.1186/s12960-022-00707-2.

Abstract: BACKGROUND: International medical electives are one the highlights of medical training. Literature about international electives is scarce, and understanding what made a student choose one destination over another is unclear. Many medical students based in Europe travel to Africa each year for their elective, however, students' expectations and motivations are yet largely unexplored. METHODS: To gain insights into the factors driving students to travel to Africa, we analyzed two large international elective databases based in Germany. We reviewed elective testimonies and extrapolated geographical data as well as the choice of discipline for electives completed in Africa. Based on pre-defined categories, we also investigated students' motivations and expectations. RESULTS: We identified approximately 300 elective reports from medical students from German-speaking countries who chose to travel to Africa for their elective. Students commonly reported destinations in Southern and East Africa, with the Republic of South Africa and Tanzania being the most frequently selected destinations. Surgical disciplines were the most commonly reported choice. Diverse motivations were identified, including the desire to improve knowledge and clinical examination skills. A large proportion of students reported a link between destination choice and the potential to partake in surgical procedures not feasible at home; whether these surgeries were not or no longer practiced at home, or whether students could not partake due to level of training, was not ascertainable from the data. A trend-analysis revealed a growing interest in travelling to Africa for electives within the last 15 years. We observed a sharp decline in reports in 2020, a phenomenon most likely related to SARS-CoV-2-related travel restrictions. CONCLUSIONS: This study suggests that medical electives in Africa are commonly reported by medical students from German-speaking countries, with diverse motivations for the choice of destination. A non-neglectable proportion of students identified the possibility to engage in surgical procedures as one of the main reasons for choosing Africa. This poses a series of ethical dilemmas, and well-structured pre-departure trainings may be a solution to this. The recent dip in overseas electives should be seen as a unique opportunity for medical schools and universities to restructure their international elective programs.

Tags: *covid-19, *Education, Medical, Undergraduate, *Students, Medical, Africa, Global Health, Humans, International elective, Medical education, Medical elective, Medical ethics, Motivation, Overseas elective, SARS-CoV-2, South Africa, Surgery, Tanzania, Travel medicine.

Kusen, J. Q., Beeres, F. J. P., van der Vet, P. C. R., Poblete, B., Geuss, S., Babst, R., Knobe, M., Wijdicks, F. J. G., and Link, B. C. “Inter-Rater Agreement In Ppossum Scores Of Geriatric Trauma Patients: A Prospective Evaluation”. Arch Orthop Trauma Surg 142, no. 12: 3869-3876. doi:10.1007/s00402-021-04275-3.

Abstract: PURPOSE: Risk prediction models are widely used in the perioperative setting to identify high-risk patients who may benefit from additional care and to aid clinical decision-making. pPOSSUM is such a prediction model, however, little is known about the inter-rater agreement when scoring subjective parameters. This study assessed the inter-rater agreement between clinicians of different specialties and work-level when scoring 30 clinical case reports of geriatric hip fracture patients with pPOSSUM. METHODS: Eighteen clinicians of the department of Surgery (three specialists, four residents), Anaesthesiology (four specialists, two residents) and Emergency Medicine (three specialists, two residents) who were familiar with the pPOSSUM scoring system were asked to calculate the scores. The kappa statistic and the statistical method of Fleiss were used to analyse inter-rater agreement. RESULTS: The response rate was 100%. Among surgeons, Anaesthesiologists and Emergency department doctors (ED), the overall mean kappa values were 0.42, 0.08 and 0.20, respectively. Among surgery, anaesthesiology and ED residents the overall mean kappa values were 0.21, 0.33 and 0.37, respectively. Within the department of Surgery, Anaesthesiology and Emergency Medicine the overall mean kappa values were 0.23, 0.12 and 0.22, respectively. An overall mean kappa value of 0.19 was seen among all specialists. All residents had an overall mean kappa value of 0.21 and all clinicians had an overall mean kappa value of 0.21. CONCLUSION: The overall inter-rater agreement of clinicians and interdisciplinary agreement when scoring geriatric hip fracture patients with pPOSSUM was low and prone to subjectivity in our study. A higher work-experience level did not lead to better agreement. When pPOSSUM is calculated without clinical assessment by the same clinician, caution is advised to prevent over-reliance on the pPOSSUM risk prediction model. LEVEL OF EVIDENCE: III.

Tags: *Fractures, Bone, Aged, Geriatric trauma care, Humans, Inter-rater agreement, Observer Variation, pPossum, Predicting tool, Reproducibility of Results.

Paal, P., Pasquier, M., Darocha, T., Lechner, R., Kosinski, S., Wallner, B., Zafren, K., and Brugger, H. “Accidental Hypothermia: 2021 Update”. Int J Environ Res Public Health 19, no. 1. doi:10.3390/ijerph19010501.

Abstract: Accidental hypothermia is an unintentional drop of core temperature below 35 degrees C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature < 30 degrees C in young and healthy patients and <32 degrees C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure < 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient arrests, continuous cardiopulmonary resuscitation (CPR) should be performed. In hypothermic patients, the chances of survival and good neurological outcome are higher than for normothermic patients for witnessed, unwitnessed and asystolic cardiac arrest. Mechanical CPR devices should be used for prolonged rescue, if available. In severely hypothermic patients in cardiac arrest, if continuous or mechanical CPR is not possible, intermittent CPR should be used. Rewarming can be accomplished by passive and active techniques. Most often, passive and active external techniques are used. Only in patients with refractory hypothermia or cardiac arrest are internal rewarming techniques required. ECLS rewarming should be performed with extracorporeal membrane oxygenation (ECMO). A post-resuscitation care bundle should complement treatment.

Tags: *Cardiopulmonary Resuscitation, *Extracorporeal Membrane Oxygenation, *Heart Arrest/therapy, *Hypothermia/therapy, accidental hypothermia, Aged, cardiac arrest, cardiopulmonary resuscitation, emergency medicine, extracorporeal life support, Humans, Rewarming.

Malinovska, A., Malinovska, L., Nickel, C. H., and Bingisser, R. “Prevalence And Prognosis Of Fever Symptoms, Hypo-, And Hyperthermia In Unselected Emergency Patients”. J Clin Med 11, no. 1. doi:10.3390/jcm11010024.

Abstract: Assessments of history and body temperature are cornerstones of the diagnostic workup in all patients presenting to emergency departments (ED). Yet, the objective measurement of temperature and the subjective perception of fever can differ. This is a secondary exploratory analysis of a consecutive all-comer study, performed at an adult ED in Switzerland. Trained medical students interviewed all patients if fever was present. Altered temperature (>38.0 degrees C/<36.0 degrees C) measured at triage using an ear thermometer was used as the reference standard for diagnostic performance. In case of a disagreement between fever symptoms and altered temperature, discordance was noted. Outcome measures for case severity (acute morbidity, hospitalization, intensive care, and in-hospital mortality) were extracted from the electronic health records. Odds ratios (OR) for discordance between signs and symptoms and outcomes were calculated. Among 2183 patients, 325 patients reported fever symptoms. The sensitivity of fever symptoms as a test for altered temperature was 36.3%. Specificity was 91.5%. The negative predictive value was 84.1%, positive likelihood ratio was 4.2 and negative likelihood ratio was 0.7. The adjusted OR for discordance between fever symptoms and altered temperature was 1.71 (95% CI: 1.2-2.44) for acute morbidity, 1.56 (95% CI: 1.13-2.15) for hospitalization, and 1.12 (95% CI: 0.64-1.59) for intensive care. Unadjusted OR for mortality was 1.5 (95% CI: 0.69-3.25). Fever symptoms and altered temperature broadly overlap, but presentations can be stratified according to concordance between signs and symptoms. In case of discordance, the odds for acute morbidity and hospitalization are increased. Discordance may therefore be further investigated as a red flag for a serious outcome.

Tags: diagnostic, emergency department, fever, hyperthermia, hypothermia, in-hospital mortality, prognostic, risk stratification, symptoms, temperature.

Hostettler, K. E., Casanas Quintana, E., Tamm, M., Savic Prince, S., Sommer, G., Chen, W. C., Nordmann, T. M., Lundberg, P., Stehle, G. T., and Daikeler, T. “Case Report: Opposite Effects Of Braf Inhibition On Closely Related Clonal Myeloid Disorders”. Front Oncol 11: 779523. doi:10.3389/fonc.2021.779523.

Abstract: Langerhans cell histiocytosis (LCH) commonly co-occurs with additional myeloid malignancies. The introduction of targeted therapies, blocking "driver" mutations (e.g., BRAF V600E), enabled long-term remission in patients with LCH. The effect of BRAF inhibition on the course and the prognosis of co-existing clonal hematopoiesis is poorly understood. We report on a 61-year-old patient with systemic BRAF V600E positive LCH and concomitant BRAF wild-type (wt) clonal cytopenia of unknown significance (CCUS) with unfavorable somatic mutations including loss of function (LOF) of NF1. While manifestations of LCH improved after blocking BRAF by dabrafenib treatment, the BRAF wt CCUS progressed to acute myeloid leukemia (AML). The patient eventually underwent successful allogeneic hematopoietic stem cell transplantation (HSCT). We performed an in-depth analyzes of the clonal relationship of CCUS and the tissue affected by LCH by using next-generation sequencing (NGS). The findings suggest activation of the mitogen-activated protein (MAP) kinase pathway in the CCUS clone due to the presence of the RAS deregulating NF1 mutations and wt BRAF, which is reportedly associated with paradoxical activation of CRAF and hence MEK. Patients with LCH should be carefully screened for potential additional clonal hematological diseases. NGS can help predict outcome of the latter in case of BRAF inhibition. Blocking the MAP kinase pathway further downstream (e.g., by using MEK inhibitors) or allogeneic HSCT may be options for patients at risk.

Tags: acute myeloid leukemia, AML-acute myeloid leukemia, BRAF inhibition, case report, commercial or financial relationships that could be construed as a potential, conflict of interest., hematopoietic stem cell transplantation, Langerhans cell histiocytosis.

Kosinski, S., Podsiadlo, P., Darocha, T., Pasquier, M., Mendrala, K., Sanak, T., and Zafren, K. “Prehospital Use Of Ultrathin Reflective Foils”. Wilderness Environ Med 33, no. 1: 134-139. doi:10.1016/j.wem.2021.11.006.

Abstract: Ultrathin reflective foils (URFs) are widely used to protect patients from heat loss, but there is no clear evidence that they are effective. We review the physics of thermal insulation by URFs and discuss their clinical applications. A conventional view is that the high reflectivity of the metallic side of the URF is responsible for thermal protection. In most circumstances, the heat radiated from a well-clothed body is minimal and the reflecting properties of a URF are relatively insignificant. The reflection of radiant heat can be impaired by condensation and freezing of the moisture on the inner surface and by a tight fit of the URF against the outermost layer of insulation. The protection by thermal insulating materials depends mostly on the ability to trap air and increases with the number of covering layers. A URF as a single layer may be useful in low wind conditions and moderate ambient temperature, but in cold and windy conditions a URF probably best serves as a waterproof outer covering. When a URF is used to protect against hypothermia in a wilderness emergency, it does not matter whether the gold or silver side is facing outward.

Tags: *Emergency Medical Services, *Hypothermia/prevention & control, Body Temperature Regulation, Cold Temperature, heat exchange, Humans, hypothermia, insulation, space blankets, survival blankets, Wind.

Birnie, E., James, A., Peters, F., Olajumoke, M., Traore, T., Bertherat, E., Trinh, T. T., et al. “Melioidosis In Africa: Time To Raise Awareness And Build Capacity For Its Detection, Diagnosis, And Treatment”. In, 106:394-397, 2022. doi:10.4269/ajtmh.21-0673.

Abstract: Melioidosis is a tropical infectious disease caused by the soil-dwelling bacterium Burkholderia pseudomallei with a mortality of up to 50% in low resource settings. Only a few cases have been reported from African countries. However, studies on the global burden of melioidosis showed that Africa holds a significant unrecognized disease burden, with Nigeria being at the top of the list. The first World Health Organization African Melioidosis Workshop was organized in Lagos, Nigeria, with representatives of health authorities, microbiology laboratories, and clinical centers from across the continent. Dedicated hands-on training was given on laboratory diagnostics of B. pseudomallei. This report summarises the meeting objectives, including raising awareness of melioidosis and building capacity for the detection, diagnosis, biosafety, treatment, and prevention across Africa. Further, collaboration with regional and international experts provided a platform for sharing ideas on best practices. © 2023 Authors. All rights reserved.

Michel, J., Sauter, T. C., and Tanner, M. “What Does A Pandemic Proof Health System Look Like?”. Glob Health Action 14, no. 1: 1927315. doi:10.1080/16549716.2021.1927315.

Abstract: Switzerland is currently in a lockdown and other lockdowns are looming world-wide. Many countries in the West are now experiencing a third COVID-19 wave. While some scientists are aiming for Zero Covid, calls to learn to live with the virus are becoming prominent as anti-lockdown protests spread across Europe. A health system is defined as all organizations, institutions and resources that produce actions whose primary purpose is to improve health. A health care system on the other hand, is defined as institutions, people and resources involved in delivering health care to individuals. Many countries that have health systems previously thought to be world class, have also been tested, pushed to the edge and in some ways found wanting. The pandemic took all countries by some surprise and the discussion on appropriate national and global strategies is very diverse. Lessons from similar earlier outbreaks seem to suggest, that living and learning to live with the virus could be the way forward. Others argue that the virus is new, not like any other we have fought before, calling for novel ways of containing the virus. Irrespective of standpoint, being a high-, middle- or low-income country, pandemic fatigue is setting in, while new variants are being discovered. It is urgent and unprecedented. The pandemic is here and more pandemics are expected to follow. What does, 'living with the virus,' mean in practical terms? The purpose of this viewpoint is to stimulate debate on how we can move towards pandemic proof health care systems.

Tags: *covid-19, *Pandemics, Communicable Disease Control, Covid-19, Delivery of Health Care, Health care system, Humans, pandemic proof, SARS-CoV-2, science vs social media, societal issues.

Giannone, B., Hedrich, N., and Schlagenhauf, P. “Imported Malaria In Switzerland, (1990-2019): A Retrospective Analysis”. Travel Med Infect Dis 45: 102251. doi:10.1016/j.tmaid.2021.102251.

Abstract: BACKGROUND: Malaria is a life-threatening, mosquito-borne parasitic disease, caused by Plasmodium spp. It is a major public health issue. Malaria in Switzerland is primarily "imported" by infected international travellers, migrants, and asylum-seekers. METHOD: We investigated the epidemiology and characteristics of imported malaria in Switzerland in the period between 1990 and 2019 using data from the Swiss Federal Office of Public Health (BAG). We also obtained traveller statistics from the World Tourism Organization (UNWTO). RESULTS: During the last thirty years a total of 8'439 malaria cases and 52 deaths were reported in Switzerland. The main origin of infection was West Africa, followed by Central Africa and East Africa. The profile of malaria in migrants in Switzerland has changed, reflecting variation in migrant flows. The estimated risk of malaria in travellers sank significantly over the time frame of the study (p < 0.001, 95% CI -0.076 to -0.043). CONCLUSIONS: Travel medicine should focus on West Africa, the main source of malaria in Switzerland. Despite most cases and all but one death being caused by Plasmodium falciparum, Plasmodium vivax remains a threat for travellers and is associated with complex prevention and therapy regimens. Public health authorities need to pre-empt the need for malaria screening, prevention and treatment based on the profile of migrant waves from malaria endemic areas including Eritrea and Afghanistan arriving in Europe.

Tags: *Malaria/diagnosis/epidemiology, *Plasmodium, Animals, Humans, Plasmodium vivax, Retrospective Studies, Switzerland/epidemiology, Travel.

Schnüriger, Beat, and Hautz, Wolf E. “Trauma System And Rescue Strategies”: 29-39. doi:10.1007/978-3-030-95906-7_4.

Abstract: A trauma system is a prearranged approach to trauma patients in a defined geographical area that provides full and optimal care. Trauma care systems are most effective, when they incorporate routine system evaluation, quality management, and are based on a needs assessment. Triaging polytraumatized patients to hospitals that are incapable of providing definitive care is associated with increased mortality. Therefore, it is of paramount importance to accurately select trauma victims, that will benefit the most from the resources of a Level I trauma center. Especially patients with occult hemorrhagic shock, elderly patients with more co-morbidities, and patients with traumatic brain injury who require operative intervention are susceptible for undertriage. Currently, no single field triage score has been accepted as the gold standard and there is need for improvement of the prehospital triage protocol. In the prehospital setting, a trauma victim may be assessed by a provider able to provide basic life support (BLS) or advanced life support (ALS). While prehospital ALS has theoretical advantages, the evidence supporting its effectiveness for trauma is limited, however, with the trials having methodological problems. Nevertheless, it is vital that the prehospital trauma care providers always consider the delay to definitive care against the potential benefit from the field treatment such as endotracheal intubation or administration of i.v. Fluids. © Springer Nature Switzerland AG 2011, 2016, 2022, corrected publication 2022.

Morand, O., Larribau, R., Safin, S., Pages, R., and Rizza, C. “Research Update – Using Sara App And Video Feedback For Dispatchers To Improve The Out-Of-Hospital Cardiac Arrest Handling”. Australasian Journal Of Disaster And Trauma Studies 26, no. Special Issue: 209-219. https://www.scopus.com/inward/record.uri?eid=2-s2.0-85148575804&partnerID=40&md5=db130ffd76c1a2aba6b90a1a689f318c.

Abstract: Survival of out-of-hospital cardiac arrest (OHCA) is significantly improved by using an external defibrillator and performing cardiopulmonary resuscitation within the first minutes of the arrest (Perkins, Handley, et al., 2015). Dedicated mobile applications enable any bystander of an emergency to report it or to be called to perform first aid on victims (Ciravegna et al., 2016; Garcia et al., 2015). This paper presents the SARA app, which allows call centres to guide the person calling to enact first aid gestures through video. However, even if rescue community recognize the primary role played by citizens in emergencies by the rescue community, barriers still exist to an optimal collaboration. Citizens expressed a fear of hurting the victim and the health professional are reluctant to rely on non-expert. We also have to measure the usability of the app and evaluate the pertinence of video guidance © The Author(s) 2022. (Copyright notice)

Eyer, Gian-Carlo, Heidemeyer, Kristine, Exadakltylos, Aristomenis, and Ziaka, Mairi. “Fuchs Syndrome With Isolated Oral Mucosa Lesions Due To Severe Herpes Simplex Cheilitis In A Patient With Idiopathic Thrombocytopenic Purpura”. European Journal Of Case Reports In Internal Medicine 9, no. 4. doi:10.12890/2021_003278.

Abstract: Stevens-Johnson syndrome (SJS) is a severe dermatological disease classically characterized by erythematous target lesions and mucosal involvement. Fuchs syndrome is an incomplete presentation of SJS which has oral, conjunctival and genital manifestations but no skin lesions. To the best of our knowledge, our case of Fuchs syndrome in an 80-year-old man is the first such case related to herpes simplex virus (HSV)-1 infection to be described. Our patient quickly recovered following IVIG therapy, although specific treatment is still a topic of discussion. Research is required on this poorly understood dermatological disease to determine optimum therapy. © EFIM 2022.

Swiss Emergency Research collection

2022

2021