Emergency Department Consultations Research Articles

The emergence of the physician assistant role in a Canadian acute care surgery setting

The role of physician assistants (PAs) in surgical care in Canada is expanding. Similarly, the acute care surgery (ACS) model continues to evolve, and PAs are increasingly being considered as members of ACS teams. However, their exact impact and contribution has not been well studied. Our study describes the contribution of a PA who worked full time on weekdays on an ACS team in a Canadian academic tertiary hospital. To quantify the PA's contributions, an ACS database was created in September 2016. Data on the number of ACS patient encounters, the number of ACS surgical consults, the number of ACS admissions, the PA's involvement in the operating room, the number of PA patient encounters and the number of multidisciplinary meetings were prospectively collected. We report data for 365 consecutive days from Dec. 30, 2016, to Dec. 29, 2017. The ACS team had 11 651 patient encounters during the year, with a mean of 31.92 per day. The mean number of surgical consults per day was 5.89, and a mean of 2.08 surgical procedures were performed per day. The PA was involved in 53.5% of all patient encounters, despite working only during daytime hours on weekdays. Multidisciplinary meetings were conducted by the PA 94.9% of the time. Alternate level of care patients were seen by the PA 96.2% of the time. The PA was directly involved in 2.0% of the operating room procedures during the study period. Integrating a PA on an ACS team adds value to patient care by providing consistency and efficient management of ward issues and patient care plans, including multidisciplinary discharge planning, timely emergency department consultations and effective organization of the ACS team members.

How COVID-19 Pandemic Changed Children and Adolescents Use of the Emergency Department: the Experience of a Secondary Care Pediatric Unit in Central Italy.

Italy was the first European country hit by SARS-CoV-2 infection, particularly northern regions. After the beginning of national lockdown (March 9th, 2020), we observed a significant decrease in pediatric emergency department consultations (daily pediatric visits; pre-lockdown, 16 (11–22); lockdown, 3 (1–3); phase 2, 3 (3–5), p < 0.0001). On the other hand, the percentage of children discharged right after pediatric visit significantly decreased from 80% in January to 50% in April. After March 9th, we registered a change in the diagnoses of emergency department visits, with an increase in the percentage of non-infectious acute conditions and a decrease in infectious diseases, with two cases of a noteworthy delayed access to hospital care. We performed a retrospective analysis of consultations requested to our pediatric unit for children and adolescents referred to the general Emergency Department of San Luca Hospital of Lucca (Tuscany, Central Italy) from January 1st to May 31st, 2020. We split data in two different time periods according to consultations performed before (January 1st–March 8th) and after the beginning of lockdown (March 9th–May 31st). Analyzing the number of children hospitalized from January to May 2020 in comparison with the same period in 2019, a decreased hospitalization became evident after March (March − 74.6%, April − 71.6%, May − 58.6%). Nasopharyngeal swabs done in 115 children showed only one case of COVID-19. Even if COVID-19 outbreak more seriously affected Northern Italy, utilization of pediatric emergency services significantly changed also in Central Italy with consequent reduced demand and increased appropriateness.Electronic supplementary materialThe online version of this article (10.1007/s42399-020-00532-5) contains supplementary material, which is available to authorized users.

Effect of Population Lockdown on Pediatric Emergency Room Demands in the Era of COVID-19

Objectives: The aim of this study was to assess the impact of the COVID-19 pandemic and population lockdown on pediatric ED consultations.Methods: A cross-sectional study on pediatric emergency department consultations before and during the current COVID-19 pandemic (March–May 2019 vs. March–May 2020) was performed in two hospitals in the Campania region (Southern Italy) [i.e., Salerno University Hospital (Salerno) and Pediatric Regional Referral Emergency Hub “AORN Santobono-Pausillipon” (Naples)].Results: 29,368 consecutive ED pediatric patients (13,430 females; mean age ± SD = 5.4 ± 4.7 years) were seen in March–May 2019 and 9,133 (4,494 females; mean age ± SD = 5.9 ± 4.2 years) in March–May 2020. Resuscitation/emergency and urgent care pediatric ED consultations were 1,388 (4.7%, 95% CI 4.5–4.9) in the 2019 trimester, while they were 648 (7.1%, 95% CI 6.6–7.6) in the 2020 trimester (p < 0.01). Mean pediatric ED daily consultations were 326.3 (95% CI 299.9–352.7) in the considered period of 2019 and 101.4 (95%CI 77.9–124.9) in the same period of 2020 (p < 0.001). COVID-19 nasal swabs were performed for 385 children; of those, six resulted positive and four of them were hospitalized.Conclusions: This work provides a unique snapshot of the pediatric EDs demands in the era of COVID-19. We witnessed a significant reduction of non-urgent health care demands during the pandemic but an increase of more severe urgent cases. The COVID-19 pandemic and the following lockdown unveiled the inappropriateness of the majority of pediatric ED consultations. Nevertheless, the current scenario highlighted the need for appropriate and timely clinical evaluations in the pediatric primary care to tackle late and more severe diagnoses in EDs.

Epidemiology of pseudomembranous conjunctivitis in a tertiary hospital: A 2-year retrospective study.

To describe the incidence, duration, and complication rate of patients with a clinical diagnosis of pseudomembranous viral conjunctivitis. A retrospective observational study is performed compiling the data of patients diagnosed as pseudomembranous conjunctivitis at the hospital's emergency department from June 2016 to May 2018. Demographic variables, duration of symptoms, and follow-up until resolution of the pseudomembranes and associated complications are collected. The incidence rate of pseudomembranous conjunctivitis is 3.47/10,000 people-year and 0.123% of emergency department consultations. The incidence of pseudomembranous conjunctivitis is approximately 20% of the total adenoviral conjunctivitis, with similar peak incidence rates and annual distribution. The presence of pseudomembranes shows a mean duration of 7.86 days. In this series of pseudomembranous patients, 38.4% had at least one of the following complications: 16.7% subepithelial infiltrates (IC 13.0%-21.1%), 20.81% corneal erosions (SE 0.0218, IC 16.7%-25.5%), 3.5% filamentary keratitis (SE 0.010, IC 1.8%-6.0%), and 6.1% subtarsal fibrosis (SE 0.128, IC 3.8%-9.1%). To the best of our knowledge, this is the first study to investigate the incidence and rate of complications of pseudomembranous conjunctivitis. Complications occurred in almost 4 out of 10 patients. The mean duration of the follow-up in the ED was higher in patients with any complication compared with non-complicated patients. The high complication rate makes a closely follow-up advisable, until pseudomembrane resolution, to assess possible complications and symptomatic treatment.

Trends in otolaryngology consult volume at an academic institution from 2014 to 2018.

ObjectiveTo evaluate changes in emergency department and inpatient consult volumes of an otolaryngology service at an academic medical center from 2014 to 2018.MethodsA retrospective review of all otolaryngology consults in the electronic medical record from March 2014 through December 2018 was completed. The total number of consults was recorded to determine changes in consult volume over time. Additional parameters were analyzed including volume of weekday, night and weekend, adult, pediatric, emergency department, and inpatient consults.ResultsFrom 1 March 2014 to 31 December 2018, a total of 8806 consults were seen by the otolaryngology service. In the first year, a total of 990 consults were seen. In the final year of the time period, a total of 2416 consults were seen. This represents a 144% increase in consults over the examined time period. Similar increasing trends were seen when consults were analyzed by weekday, night/weekend, pediatric, adult, emergency department, and inpatient consults.ConclusionsThis is one of the first studies examining trends in otolaryngology consult volumes at an academic medical center in the United States. Our data show that the volume of consults has increased by 144% in a 4‐year time period, predominantly due to an increase in emergency department consultations. This study demonstrates the increasing burden of emergency department consultations on an otolaryngology service at an academic medical center and highlights a potential role for increasing and improving provider availability.Level of evidence4.

Characteristics and resource needs in patients with vestibular symptoms: a comparison of patients with symptoms of unknown versus determined origin

BackgroundVestibular symptoms are a frequent reason for presenting at the emergency department (ED). Underlying conditions range in severity from life-threatening to benign, but often remain undiagnosed despite extensive investigations. We aimed to identify clinical characteristics that are associated with ED consultations by patients with vestibular symptoms of unknown origin (VUO) and to quantify the ED resources consumed during the investigations.MethodsThis retrospective one-year, single-centre, cross-sectional study assessed ED consultations with patients whose chief complaint was ‘vestibular symptoms’. Data on risk factors, clinical characteristics, management and ED resources were extracted from the administrative database and medical records. Consultations were grouped according to the discharge diagnosis as either VUO or non-VUO. We determined clinical factors associated with VUO and compared ED resource consumption by the two patient groups using multivariable analysis.ResultsA total of 1599 ED consultations were eligible. Of these, 14.3% (n = 229) were consultations with patients with VUO. Clinical characteristics included in the final multivariable model to determine associations with VUO were sensory disorders, aural fullness, improvement at rest, absence of situational provocation, pre-existing neurological conditions, and age < 65 years. Patients with VUO had higher total ED resource consumption in terms of physicians’ work and radiology resources, as a result of more use of computed tomography and magnetic resonance imaging.ConclusionOne in seven emergency patients with vestibular symptoms is dismissed without a diagnosis. Clinical characteristics of VUO patients are distinct from patients in whom a diagnosis was made in the ED. VUO triggers higher ED resource consumption, which can be justified if appropriately indicated.

Comparison of chest X-ray interpretation by Emergency Department clinicians and radiologists in suspected COVID-19 infection: a retrospective cohort study.

Objectives:We describe the inter-rater agreement between Emergency Department (ED) clinicians and reporting radiologists in the interpretation of chest X-rays (CXRs) in patients presenting to ED with suspected COVID-19.Methods:We undertook a retrospective cohort study of patients with suspected COVID-19. We compared ED clinicians’ and radiologists’ interpretation of the CXRs according to British Society of Thoracic Imaging (BSTI) guidelines, using the area under the receiver operator curve (ROC area).Results:CXRs of 152 cases with suspected COVID-19 infection were included. Sensitivity and specificity for ‘classic’ COVID-19 CXR findings reported by ED clinician was 84 and 83%, respectively, with a ROC area of 0.84 (95%CI 0.77 to 0.90). Accuracy improved with ED clinicians’ experience, with ROC areas of 0.73 (95%CI 0.45 to 1.00), 0.81 (95%CI 0.73 to 0.89), 1.00 (95%CI 1.00 to 1.00) and 0.90 (95%CI 0.70 to 1.00) for foundation year doctors, senior house officers, higher speciality trainees and ED consultants, respectively (p < 0.001).Conclusions:ED clinicians demonstrated moderate inter-rater agreement with reporting radiologists according to the BSTI COVID-19 classifications. The improvement in accuracy with ED clinician experience suggests training of junior ED clinicians in the interpretation of COVID-19 related CXRs might be beneficial. Large-scale survey studies might be useful in the further evaluation of this topic.Advances in knowledge:This is the first study to examine inter-rater agreement between ED clinicians and radiologists in regards to COVID-19 CXR interpretation.Further service configurations such as 24-hr hot reporting of CXRs can be guided by these data, as well as an ongoing, nationwide follow-up study.

Diagnostic concordance between pediatric emergency department physicians and dermatologists in a tertiary hospital in Mexico.

Skin diseases are a common reason for emergency department (ED) consultations; however, few studies have focused on pediatric patients. Diagnostic consistency between ED physicians and dermatologists varies from 43% to 58%, meaning many patients seeking emergency care may receive incorrect diagnoses and treatments. We aimed to determine the diagnostic concordance between ED physicians and pediatric dermatologists. We conducted a prospective study including all pediatric patients (<18years) who were seen for a skin condition at the ED from December 1, 2017, to June 1, 2018, and consented to participate. We classified diagnoses according to their etiology. Patients were diagnosed by ED trainees and attending physicians, followed by blinded pediatric dermatology trainees and attending physicians. We evaluated concordance using Fleiss's kappa coefficient (κ) with a 95% confidence interval. We further stratified the data by level of training. We included 185 patients. Inflammatory conditions were the most common reason for consultation, followed by infections; 10 patients required hospitalization. Concordance between diagnoses given at the ED and at the dermatology clinic was moderate (κ 0.472, 95% CI: 0.389-0.455) with 62.7% agreement. Concordance between different diagnostic categories was lowest for autoimmune disorders and drug reactions (κ 0.392 with 95% CI: 0.248-0.536 and κ 0.258 with 95% CI: 0.114-0.402). Diagnostic concordance between ED physicians and dermatologists was moderate and differed according to training level and diagnoses. Dermatological education for ED providers, specifically focusing on autoimmune disorders and drug reactions, may improve diagnostic accuracy and patient care.

Specialist care in rural hospitals: From Emergency Department consultation to hospital discharge

In urban and rural hospitals, congested Emergency Departments (EDs) are filled with patients boarding in the ED awaiting admission to inpatient wards. We study this problem beyond the walls of the ED, examining the multi-departmental process managed by specialists. In rural hospitals, an Internal Medicine Specialist (Internist) commonly serves simultaneously as both the Intensive Care Unit (ICU) physician and Internist on call. We develop a stochastic dynamic programming framework for specialists’ workflow decisions and apply it to data sets developed from two rural hospitals. One uses the dual role approach and the other, similar to urban hospitals, staffs the ICU with another physician, each with a single role. Our empirical results show that, excluding an overnight batch, arrivals of ED consultation requests for rural specialists follow a homogeneous Poisson process. Our models help identify better policies and determine how much better off a hospital is with two rather than one Internist on call. Although current guidelines suggest an early inpatient discharge strategy, we find that specialists should give higher priority to ED consultations unless a threshold number of patients are boarding in the ED or until a threshold time of day when specialists should give higher priority to inpatient discharges.

Patient and clinician experiences with an emergency department-based mental health liaison nurse service in a metropolitan setting.

As part of a larger multi-site translational research project this study explored patient and staff experiences, perspectives, and recommendations in relation to a mental health liaison nursing (MHLN) team established in the emergency department (ED) of a metropolitan hospital in New South Wales, Australia. Semi-structured interviews were conducted with a sample of ED patients (n=26), ED nurses (n=10), ED consultants (n=9), and members of the consultation-liaison psychiatry team (n=5). Data were analysed thematically. Patients emphasized the numerous therapeutic qualities of the MHLN role, the promptness with which they were seen and the value of follow-up. Privacy was identified as important, and some negative experiences were reported. Staff identified that the MHLN team are able to respond to a variety of ED presentations in a timely manner. There was recognition that the MHLN team needs to be integrated within the ED as a specialist resource that builds ED capacity. Consistent staffing of the MHLN team with designated clinicians was also considered essential. Integrating a nurse practitioner-led MHLN team within the ED has demonstrated multiple benefits for patients, ED staff, and overall service provision. Incorporating a specialist mental health nursing service within the ED builds confidence in ED clinicians. Members of the psychiatry team also acknowledge the value of aligning the clinical governance of the MHLN team within the ED and the reduced workload this model of care has on their service provision to ED, freeing them up to concentrate on their broader general hospital role.

Rib Somatic Dysfunction Among General Surgical Patients.

Upper abdominal or chest pain, tenderness, or sensation of the presence of a mass may lead to general surgery (GS) service referral. These symptoms may be related to rib somatic dysfunction (SD). To describe rib SD in the GS setting and help build a foundation for additional osteopathic manipulative treatment (OMT) research in surgical care. The authors retrospectively reviewed and analyzed the electronic medical records of patient encounters in a GS outpatient clinic or private office in Bronx, New York. Included patients had emergency department or inpatient GS consultations with the diagnosis of rib SD (ICD-9 739.8 or ICD-10 M99.08) initially made by the GS service from February 1, 2016, to January 31, 2019. Six-month follow-up data were also reviewed. Twelve patients had rib SD as the underlying cause of their chief concern upon presentation to the GS service. Only 1 also had an underlying operative GS disease. The GS service treated 11 patients (91.7%) with OMT; 1 patient refused OMT. Time spent on OMT ranged from 5 to 30 minutes, with a median of 10 minutes and a mean (SD) of 12.7 (9.05) minutes. The OMT techniques used included balanced ligamentous tension, counterstrain, muscle energy, myofascial release, rib-raising, and soft tissue. All patients who received OMT demonstrated improvement, and 3 patients required osteopathic manipulative medicine/neuromuscular medicine follow-up. Rib somatic dysfunction may contribute to patient referral to a GS service, and OMT performed by general surgeons may help provide optimal surgical care.

Assessment of the impact of a new sequential approach to antimicrobial use in young febrile children in the emergency department (DIAFEVERCHILD): a French prospective multicentric controlled, open, cluster-randomised, parallel-group study protocol

IntroductionFever is one of the most common reasons for consultation in the paediatric emergency department (ED). Because of fear of bacterial infection in parents and caregivers, clinicians often overprescribe laboratory...

What role does the GP play for emergency department utilizers? A qualitative exploration of respiratory patients\u2019 perspectives in Berlin, Germany

BackgroundWhile motives for emergency department (ED) self-referrals have been investigated in a number of studies, the relevance of general practitioner (GP) care for these patients has not been comprehensively evaluated. Respiratory symptoms constitute an important utilization trigger in both EDs and in primary care. In this qualitative study, we aimed to explore the role of GP care for patients visiting EDs as outpatients for respiratory complaints and the relevance of the relationship between patient and GP in the decision making process leading up to an ED visit.MethodsQualitative descriptive study. Semi-structured, face-to-face interviews with a sample of 17 respiratory ED patients in Berlin, Germany. Interviews were recorded and transcribed verbatim. Qualitative content analysis was performed. The study was embedded into the EMACROSS (Emergency and Acute Care for Respiratory Diseases beyond Sectoral Separation) cohort of ED patients with respiratory symptoms, which is part of EMANet (Emergency and Acute Medicine Network for Health Care Research).ResultsThree patterns of GP utilization could be differentiated: long-term regular consulters, sporadic consulters and patients without GP. In sporadic consulters and patients without GP, an ambivalent or even aversive view of GP care was prevalent, with lack of confidence in GPs’ competence and a deficit in trust as seemingly relevant influencing factors. Regardless of utilization or relationship type, patients frequently made contact with a GP before visiting an ED.ConclusionsWith regard to respiratory symptoms, our qualitative data suggest a hypothesis of limited relevance of patients’ primary care utilization pattern and GP-patient relationship for ED consultation decisions.

Estimates of Total Burned Surface Area by Emergency Department Clinicians and Burn Specialists.

IntroductionCorrectly assessing burn size is extremely important since it is directly associated with a patient’s subsequent management. Further, an accurate assessment of the total body surface area (TBSA) involved is crucial to decide if specialty care in a burn unit is necessary, whereby overestimation has the potential to lead to unnecessary patient transfers and undesirable burdens on the healthcare system and inconvenience to patients. The goal of this study was to identify whether burn injury estimates of TBSA percentage correlate between emergency department (ED) clinician and burn specialists.MethodsThis was a retrospective study conducted between February 1, 2018 and July 31, 2019 of patients with a burn injury who were evaluated by both an ED clinician and a burn specialist during the same ED visit. Charts were reviewed to identify the documentation of TBSA by pre-hospital personnel, ED nursing staff, ED mid-level providers (MLP), ED attending physicians, burn consultant MLPs, and burn consultant attending physicians.ResultsDuring the study period, 189 subjects with both an ED and burn consultant. The median age was 11 years [interquartile range (IQR) 1-49], and 103 (54%) were males. More than half of the subjects (n=106, 56%) were under the age of 18. There was a statistically significant correlation between estimates of TBSA between ED and burn consultants overall (p<0.0001). Furthermore, there was a statistically significant correlation between ED and burn MLPs (p<0.0001) as well as ED and burn attending physicians (p<0.0001). When adjusted for MLP and attending sex, there was still a correlation among all groups (p<0.0001).ConclusionsIn this study, there was a statistically significant correlation between estimates of TBSA between ED and burn consultants

Association between non-attendance to outpatient clinics and emergency department consultations, hospitalizations and mortality in a Health Maintenance Organization.

Non-attendance to scheduled medical appointments in outpatient clinics is a problem that affects patient health and health-care systems. Evaluate association of non-attendance to scheduled appointments in outpatient clinics and Emergency Department (ED) visits, hospitalizations and mortality. Retrospective cohort study of outpatients enrolled in 2015 to 2016 in the Hospital Italiano de Buenos Aires HMO with over five scheduled appointments. Individual non-attendance proportion was obtained by dividing missed over scheduled appointment numbers in the 365 days prior to index date. Outcomes were evaluated with a Cox proportional-hazards or Fine and Gray model for competing risks. We adjusted by several variables. Sixty-five thousand two hundred sixty-five adults were included. Mean age was 63.6 years (SD 18.16), 29.9% male. Outpatients had average 10.18 (SD 5.59) appointments. Non-attendance the year before the index appointment had a median of 20%. A 10% increase in non-attendance was significantly associated with ED visits (asHR 1.19; 95%CI 1.08-1.32, P < .001) and all-cause mortality (aHR 7.57; 95%CI 4.88-11.73, P < .001). In the matched subcohort analysis we observed a crude significant association of non-attendance with ED visits (P < .001) and all-cause mortality (P < .001). Our findings show non-attendance could be a marker of health events that lead to emergency department evaluations and/or death.

Emergency consultations in obstetrics: identification of decisive, contributing and associated factors.

Psychosocial and biological factors influence the perception of physical changes during pregnancy. Some pregnant women present to the obstetric emergency department (ED) with diverse symptoms not requiring urgent medical action. These visits result in over-consultation, tying up resources and inflating health care expenses. This study outlines factors associated with multiple ED visits during pregnancy, measures the prevalence of anxiety and depression, and explores the choice of maternity clinic for delivery aiming to elucidate options for care strategies. This prospective, cross-sectional, questionnaire-based bicentric study was performed in the obstetric outpatient departments of two university hospitals in Germany and recruited pregnant women between 12/2016 and 11/2017. The questionnaire included socio-demographics, obstetric history, anxiety (GAD-7), depression (PHQ-9), and health status (WHO-5, SF-12). This analysis included 496 women and showed that women with numerous ED visits were significantly younger (p < 0.0001), less educated (p = 0.0002), and more likely to be unemployed and single. Different prevalences for anxiety and depression were detected correlating with the number of ED visits although each showing only low effect sizes (0.024 resp. 0.015). Pregnant women attending the ED more often might benefit from health education, psychosomatic interventions, and social support to overcome their depression and anxiety to avoid non-urgent ED consultations. Further prospective studies are needed to support these findings.

Screening for hypertension in adults during emergency department consultation: a systematic review.

A large proportion of patients affected with hypertension go undetected. A systematic review was conducted to assess the performance of a screening strategy in adults using blood pressure measurement at the time of an emergency department consultation. A systematic literature search on Embase, CINHAL and Medline was carried out. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Diagnostic Test Accuracy. Intervention studies with adults including at least one blood pressure measurement for all participants were included. A repeat blood pressure assessment had to have been carried out to assess the validity of the elevated blood pressure value within the next few days after the emergency department initial visit. Out of 1030 articles identified, published between 1985 and 2018, 10 articles met the inclusion criteria. There were no randomized clinical trials. Mean age of participants was 51.6 years. A single study reports that blood pressure screening was measured according to hypertension guidelines referred to in the study. The average follow-up rate was 61.9% (95% confidence interval 45.5-78.3). For diagnostic confirmation, four studies used a blood pressure measurement method based on the reported guidelines. Half of the patients (50.2%) with elevated blood pressure during the emergency department visit had blood pressure corresponding to uncontrolled elevated blood pressure at follow-up measurement. The contribution of emergency department to the screening for hypertension, by recognizing the presence of elevated blood pressure and then making a referral for diagnostic confirmation, could provide an opportunity to detect a large number of people with hypertension.

Predictors of High Resource Consumption in Alcohol Intoxicated Patients in the Emergency Department.

Background: previous studies have reported that the incidence of alcohol-related visits to emergency departments (ED) has increased, but little is known about how the necessary resources per visit have changed, or about the predictors and reasons for resource consumption. Methods: a retrospective analysis was performed of all consultations with a primary or secondary diagnosis of acute alcohol intoxication admitted to the ED of Bern University Hospital, Switzerland, between 1 June 2012, and 31 May 2017. Clinical characteristics and resource consumption were extracted and analysed over time. Results: in all, 196,045 ED consultations included 2586 acute alcohol intoxications, corresponding to 1.3% of the total. The incidences of acute alcohol intoxications have tended to increase over the last five years, and a growing number of visits have consumed high resources (consultations above the 75th percentile for total resource consumption). High resource consumption was associated with greater age and the male gender (p < 0.001). The main predictors of resource consumption were fractures (Odds ratio (OR): 3.9, 95% CI 2.8–5.3, p < 0.001), dislocations (OR 3.7, 95%: 1.5–9.1, p < 0.001), and traumatic brain injury (3.5, 2.5–5.1, p < 0.001). Consultations consuming high resources mostly required radiology resources (45%); consultations consuming low or normal resources mostly required physicians’ work (45%) or nurses’ work (27%). Conclusions: the number of alcohol intoxications consuming high resources has increased over the last five years. Acute alcohol intoxication associated with trauma is resource intensive, especially with regard to radiology resources. This underlines the need for further efforts to prevent alcohol-related traffic accidents, for examples.

Type I Interferon in Children with Viral or Bacterial Infections.

Fever is one of the leading causes of consultation in the pediatric emergency department for patients under the age of 3 years. Distinguishing between bacterial and viral infections etiologies in febrile patients remains challenging. We hypothesized that specific host biomarkers for viral infections, such as type I-interferon (IFN), could help clinicians' decisions and limit antibiotic overuse. Paxgene tubes and serum were collected from febrile children (n = 101), age from 7 days to 36 months, with proven viral or bacterial infections, being treated at pediatric emergency departments in France. We assessed the performance of an IFN signature, which was based on quantification of expression of IFN-stimulated genes using the Nanostring® technology and plasma IFN-α quantified by digital ELISA technology. Serum concentrations of IFN-α were below the quantification threshold (30 fg/mL) for 2% (1/46) of children with proven viral infections and for 71% (39/55) of children with bacterial infections (P < 0.001). IFN-α concentrations and IFN score were significantly higher in viral compared to bacterial infection (P < 0.001). There was a strong correlation between serum IFN-α concentrations and IFN score (p-pearson = 0.83). Both serum IFN-α concentration and IFN score robustly discriminated (Area Under the Curve >0.91 for both) between viral and bacterial infection in febrile children, compared to C-reactive protein (0.83). IFN-α is increased in blood of febrile infants with viral infections. The discriminative performance of IFN-α femtomolar concentrations as well as blood transcriptional signatures could show a diagnostic benefit and potentially limit antibiotic overuse. clinicaltrials.gov (NCT03163628).

LO86: Lack of association between four biomarkers and the presence of persistent post-concussion symptoms after a mild traumatic brain injury

Introduction: Mild Traumatic Brain Injury (mTBI) is a common problem: each year in Canada, its incidence is estimated at 500-600 cases per 100 000. Between 10 and 56% of mTBI patients develop persistent post-concussion symptoms (PPCS) that can last for more than 90 days. It is therefore important for clinicians to identify patients who are at risk of developing PPCS. We hypothesized that blood biomarkers drawn upon patient arrival to the Emergency Department (ED) could help predict PPCS. The main objective of this project was to measure the association between four biomarkers and the incidence of PPCS 90 days post mTBI. Methods: Patients were recruited in seven Canadian ED. Non-hospitalized patients, aged ≥14 years old with a documented mTBI that occurred ≤24 hrs of ED consultation, with a GCS ≥13 at arrival were included. Sociodemographic and clinical data as well as blood samples were collected in the ED. A standardized telephone questionnaire was administered at 90 days post ED visit. The following biomarkers were analyzed using enzyme-linked immunosorbent assay (ELISA): S100B protein, Neuron Specific Enolase (NSE), cleaved-Tau (c-Tau) and Glial fibrillary acidic protein (GFAP). The primary outcome measure was the presence of persistent symptoms at 90 days after mTBI, as assessed using the Rivermead Post-Concussion symptoms Questionnaire (RPQ). A ROC curve was constructed for each biomarker. Results: 1276 patients were included in the study. The median age for this cohort was 39 (IQR 23-57) years old, 61% were male and 15% suffered PPCS. The median values (IQR) for patients with PPCS compared to those without were: 43 pg/mL (26-67) versus 42 pg/mL (24-70) for S100B protein, 50 pg/mL (50-223) versus 50 pg/mL (50-199) for NSE, 2929 pg/mL (1733-4744) versus 3180 pg/mL (1835-4761) for c-Tau and 1644 pg/mL (650-3215) versus 1894 pg/mL (700-3498) for GFAP. For each of these biomarkers, Areas Under the Curve (AUC) were 0.495, 0.495, 0.51 and 0.54, respectively. Conclusion: Among mTBI patients, S100B protein, NSE, c-Tau or GFAP during the first 24 hours after trauma do not seem to be able to predict PPCS. Future research testing of other biomarkers is needed in order to determine their usefulness in predicting PPCS when combined with relevant clinical data.