Emergency Room Of University Hospital Research Articles

Ulcus Vulvae Acutum Lipschütz-UVAL: case series at a Swiss university hospital emergency room.

Ulcus Vulvae Acutum Lipschütz (UVAL) is a largely unknown disease with a broad and complex differential diagnosis. To provide a description of the main characteristics of UVAL, determine the most appropriate diagnostic process and describe the current therapeutic approach. We designed a retrospective, descriptive cohort study using the gynecological-ER database of our institution. Inclusion criteria: female patients aged between 10 and 20 years old with suspicion of a UVAL diagnosis at CHUV's gynecological ER. Data extraction: epidemiological characteristics, clinical presentation, laboratory tests, established diagnostics, treatment, and ulcer outcomes. 15 patients were included for the analysis; average age: 15 years old; 60% of patients were virgo at the time of ulcer onset; all patients had at least one flu-like symptom concomitant with the vulvar lesion; the most-performed serology was for EBV and acute disease was present in only one patient; for diagnostic purposes two biopsies were performed with both inconclusive histopathology analysis; the main prescribed treatments were: oral NSAIDs, Paracetamol, and Lidocaine gel; 93% of cases presented signs of regression; the average follow-up time was 10 days. The diagnostic algorithm of Sadoghi et al: 10 out of 15 cases were retrospectively diagnosed with UVAL by the algorithm; half were diagnosed with UVAL, and the other half received a diagnosis of "ulcers of unknown origin" at the time of the gynecological ER visit. We highly recommend the diagnostic and therapeutic algorithms developed by Sadoghi et al. as valuable tools to guide clinical reasoning and, consequently, improve acute vulvar ulcers management.

Bilateral Carotid Aneurysms Secondary to Catastrophic Antiphospholipid Syndrome in a Patient with Differential Diagnosis of Polyarteritis Nodosa

Background: Extracranial Carotid Artery Aneurysm is considered a therapeutic and diagnostic challenge. In an unprecedented way in the literature, we describe an aneurysm originating from the Catastrophic Antiphospholipid Syndrome. Case Presentation: A 25-year-old male patient came to the Emergency Room of the ABC University Hospital in Sao Bernardo do Campo referring to bilateral neck pain for 1 month, associated with carotid aneurysms. Due to the severity and urgency of the clinical condition, immediate surgical therapy was performed without a definitive etiological diagnosis. The initial morphological analysis of the carotid artery suggested a diagnosis of Polyarteritis Nodosa. After anamnesis, physical examination, the use of a specific primary vasculitis algorithm, and a review of the pathological anatomy was requested, which showed bilateral carotid aneurysms secondary to catastrophic antiphospholipid syndrome. Conclusion: It remains evident that Extracranial Carotid Artery Aneurysm-related morbidity and mortality caused by Catastrophic Antiphospholipid Syndrome are influenced by a quick and correct diagnosis.

Prognostic value of diagnostic scales in community-acquired sepsis mortality at an emergency service. Prognosis in community-adquired sepsis

ObjectivesTo asses the prognostic value of diagnostic scales in mortality of community-adquired sepsis and added value of additional parameters.MethodsProspective observational study of patients with community-adquired sepsis in the Emergency Room of University Hospital. The study population were patients presented in the Emergency Room with confirmed infection and practicians sepsis diagnosis. Demographics, triage vital signs, inhaled oxygen fraction, inflammatory markers, biochemistry, all-cause mortality during hospitalization and three months after were recorded. Prognostic value of qSOFA, NEWS, SOFA, SIRS, and amplified scales were calculated by using logistic regression and ROC curves.Results201 patients, 54% male, average age 77±11,2 years were included. Sixty-three (31.5%) died during hospitalization and 24 (12%) three months after discharge. At the time of admission vital signs related with in-hospital mortality were Glasgow Coma Scale <13, respiratory rate ≥22 bpm, temperature, oxygen desaturation, high flow oxygen therapy and heart rate. Patients dead in-hospital had lower PaCO2, higher lactate, glucose and creatinine. Greater predictive capacity of the scales, from higher to lower, was: qSOFA, NEWS2, SOFA and SIRS. Amplified scales with lactate >2mg/dl, glucose, blood level >190mg/dl and PaCO2 <35mmHg improved predictive value.ConclusionAmplified-qSOFA and amplified-NEWS2 scales at Emergency Department may offer a better prognostic of septic patients mortality.

Beyond the d-dimer – Machine-learning assisted pre-test probability evaluation in patients with suspected pulmonary embolism and elevated d-dimers

IntroductionAcute pulmonary embolism (PE) is a leading cardiovascular cause of death, resembling a common indication for emergency computed tomography (CT). Nonetheless, in clinical routine most CTs performed for suspicion of PE excluded the suspected diagnosis. As patients with low to intermediate risk for PE are triaged according to the d-dimer, its relatively low specifity and widespread elevation among elderly might be an underlying issue.Aim of this study was to find potential predictors based on initial emergency blood tests in patients with elevated d-dimers and suspected PE to further increase pre-test probability. MethodsIn this retrospective study all patients at the local university hospital's emergency room from 2009 to 2019 with suspected PE, emergency blood testing and CT were included. Cluster analysis was performed to separate groups with distinct laboratory parameter profiles and PE frequencies were compared. Machine learning algorithms were trained on the groups to predict individual PE probability based on emergency laboratory parameters. ResultsOverall, PE frequency among the 2045 analyzed patients was 41%. Three clusters with significant differences (p ≤ 0.05) in PE frequency were identified: C1 showed a PE frequency of 43%, C2 40% and C3 33%. Laboratory parameter profiles (e.g. creatinine) differed significantly between clusters (p ≤ 0.0001). Both logistic regression and support-vector machines were able to predict clusters with an accuracy of over 90%. DiscussionInitial blood parameters seem to enable further differentiation of patients with suspected PE and elevated d-dimers to raise pre-test probability of PE. Machine-learning-based prediction models might help to further narrow down CT indications in the future.

Consent for withholding life-sustaining treatment in cancer patients: a retrospective comparative analysis before and after the enforcement of the Life Extension Medical Decision law

BackgroundThe Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of futile life-sustaining treatment, and its enactment caused a big controversy in Korean society. However, no study has evaluated whether the actual implementation of life-sustaining treatment has decreased after the enforcement of this law. This study aimed to compare the provision of patient consent before and after the enforcement of this law among cancer patients who visited a tertiary university hospital's emergency room to understand the effects of this law on the clinical care of cancer patients.MethodsThis retrospective single cohort study included advanced cancer patients aged over 19 years who visited the emergency room of a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the length of hospital stay. The consent rates to perform cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes.ResultsThe length of hospital stay decreased after the law was enforced from 4 to 2 days (p = 0.001). The rates of direct transfers to secondary hospitals and nursing hospitals increased from 8.2 to 21.2% (p = 0.001) and from 1.0 to 9.7%, respectively (p < 0.001). The consent rate for admission to the ICU decreased from 6.7 to 2.3% (p = 0.032). For CPR and CRRT, the consent rates decreased from 1.0 to 0.0% and from 13.9 to 8.8%, respectively, but the differences were not significant (p = 0.226 and p = 0.109, respectively).ConclusionAfter the enforcement of the Life Extension Medical Decision law, the length of stay in the tertiary university hospital decreased in patients who established their life-sustaining treatment plans in the emergency room. Moreover, the rate of consent for ICU admission decreased.

Influenza and pneumococcal vaccinations are not associated to COVID-19 outcomes among patients admitted to a university hospital

In order to reduce the burden on healthcare systems and to support differential diagnosis with COVID-19, influenza and pneumococcal vaccinations were strongly recommended during the COVID-19 pandemic, especially in vulnerable groups. However, no univocal and conclusive evidence on the relationship between influenza and pneumococcal vaccinations and COVID‐19 outcomes exists. We evaluated the association between such vaccinations, COVID-19 hospitalization, intensive care unit admissions and deaths in a cohort (N = 741) of COVID-19 patients who had access to the emergency room of a large Italian University hospital between March 1, 2020 and June 1, 2020. Results show that influenza and pneumococcal vaccinations did not affect hospitalization, intensive care unit admission and deaths in COVID-19 patients in the overall sample and in those ≥65 years. The same pattern of results was confirmed considering timing of influenza vaccine administration, vaccination type, and number of uptakes in the last five vaccination campaigns. In conclusion, our study does not support an impact of influenza and pneumococcal vaccinations on COVID-19 outcomes.

Age-Dependent Differences in the Rate and Symptoms of TIA Mimics in Patients Presenting With a Suspected TIA to a Neurological Emergency Room.

Background: Transient ischemic attack (TIA) needs further diagnostic evaluation to prevent future ischemic stroke. However, prophylaxis can be harmful in elderly if the diagnosis is wrong. We aimed at characterizing differences in TIA mimics in younger and older patients to enhance diagnostic accuracy in elderly patients.Methods: In a dedicated neurological emergency room (nER) of a tertiary care University hospital, patients with transient neurological symptoms suspicious of TIA (<24 h) were retrospectively analyzed regarding their final diagnoses and their symptoms. These parameters were compared between patients aged 18–70 and >70 years using descriptive, univariable, and multivariable statistics.Results: From November 2018 until August 2019, 386 consecutive patients were included. 271 (70%) had cardiovascular risk factors and all patients received cerebral imaging, mostly CT [376 (97%)]. There was no difference in the rate of diagnosed TIA between the age groups [85 (46%) vs. 58 (39%); p = 0.213].TIA mimics in the elderly were more often internal medicine diseases [35 (19%) vs. 7 (5%); p < 0.001] and epileptic seizures [48 (26%) vs. 24 (16%); p = 0.032] but less often migraine [2 (1%) vs. 20 (13%); p < 0.001]. The most frequent symptoms in all patients were aphasia and dysarthria [107 (28%) and 92 (24%)]. Sensory impairments were less frequent in elderly patients [23 (11%) vs. 54 (30%); p < 0.001]. Impaired consciousness and orientation were independent predictors for TIA mimics (p < 0.001) whereas facial palsy (p < 0.001) motor weakness (p < 0.001), dysarthria (p = 0.022) and sensory impairment (p < 0.001) were independent predictors of TIA.Conclusion: TIA mimics in elderly patients are more likely to be internal medicine diseases and epilepsy compared to younger patients. Excluding internal medicine diseases seems to be important in elderly patients. Facial palsy, motor weakness, dysarthria and sensory impairment are associated with TIA.

Post-traumatic stress disorder, burnout and their impact on global functioning in Italian emergency healthcare workers.

Post-traumatic stress disorder (PTSD) and burnout are severe and frequent conditions among emergency healthcare workers exposed to repeated work-related traumatic experiences. The aim of the present study was to investigate PTSD, burnout and global functioning in a sample of emergency healthcare workers (HCWs) of a major university hospital in Italy, exploring possible correlations between the two constructs. The study sample included 137 medical and nursing Emergency Room and Intensive Care Unit staff members of a major University Hospital in Italy (Pisa), all assessed by means of the Trauma and Loss Spectrum - Self Report (TALS-SR), for post-traumatic stress spectrum, the Professional Quality of Life Scale - Revision IV (ProQOL R-IV), for burnout related to work activities, and the Work and Social Adjustment Scale (WSAS), for global functioning. Forty-nine subjects reported a full (18, 14.3%) or partial (31, 24.6%) symptomatological DSM-5 PTSD. HCWs with PTSD reported significantly higher burnout scores and global functioning impairment compared to those without PTSD. Mean to good significant correlations emerged between the TALS-SR total and domains scores, the ProQOL subscales and the WSAS scores. This work, conducted before the COVID-19 pandemic, underlines a positive correlation between burnout and post-traumatic stress spectrum symptoms in emergency HCWs, showing the need for a deeper assessment of work-related post-traumatic stress symptoms in such population in order to improve the well-being and to prevent burnout.

Current status of trauma surgery at a Japanese prefectural academic institute: improved organization in a regional prefecture.

Balancing scheduled surgery and trauma surgery is difficult with a limited number of surgeons. To address the issues and systematize education, we analyzed the current situation and the effectiveness of having a trauma team in the ER of a regional hospital. This retrospective study analyzed the demographics, traumatic variables, procedures, postoperative morbidities, and outcomes of 110 patients who underwent trauma surgery between 2012 and 2019. The trauma team was established in 2016 and our university hospital Emergency Room (ER) opened in 2012. Blunt trauma accounted for 82% of the trauma injuries and 39% of trauma victims were transported from local centers to our institute. The most frequently injured organs were in the digestive tract and about half of the interventions were for hemostatic surgery alone. Concomitant treatments for multiple organ injuries were performed in 31% of the patients. The rates of postoperative severe complications (over Clavien-Dindo IIIb) and mortality were 10% and 13%, respectively. Fourteen (12.7%) of 24 patients who underwent damage-control surgery died, with multiple organ injury being the predominant cause of death. Systematic education or training of medical students and general surgeons, as well as the co-operation of the team at the regional academic institute, are necessary to overcome the limited human resources and save trauma patients.

COMPARISON BETWEEN INHALATION AND SYSTEMIC STEROID THERAPY IN ACUTE EXACERBATION OF MODERATE TO SEVERE BRONCHIAL ASTHMA IN CHILDREN

Background: Corticosteroids are by far the most effective controllers used in the treatment of asthma and the only drugs that can effectively suppress the characteristic inflammation in asthmatic airways. They play an important role in the treatment of acute asthma exacerbations in the ED as well as post discharge from the ED. Objectives: To compare the effects of inhaled corticosteroids (ICS) against systemic corticosteroids (SC) in children consulting in emergency department (ED) for acute asthma exacerbation. Methods: This was a prospective study done on children with acute asthma exacerbation coming to the emergency room of Al-Sayed Galal university hospital for evaluation and treatment. The study was carried out from July 2018 to January 2019. Results: 60 children were evaluated; 34 cases (56.7%) were males while 26 cases (43.3%) were females with age ranging between 2 and 14 years. No significant statistical difference was found between inhaled corticosteroids and systemic corticosteroids in treatment of acute exacerbation of moderate to severe bronchial asthma in children. Conclusion: There is no evidence of a difference between ICS and SC in terms of hospital admission rate, return to hospital within week, length of stay in ED and adverse effects in children consulting for asthma exacerbations.

Assessment of the Implementation of Critical Pathway in Stroke Patients: A 10-Year Follow-Up Study.

Background The complications after stroke inhibit functional recovery and worsen the prognosis of patients. The implementation of a critical pathway (CP) can facilitate functional recovery after stroke by enabling comprehensive and systematic structured rehabilitation. Objective To evaluate the effects of the implementation of CP in stroke patients for 10 years. Methods The data were collected from 960 patients who were diagnosed with a stroke at the university hospital emergency room, who were transferred to the rehabilitation center after the acute phase, and who were discharged after undergoing comprehensive rehabilitation. Based on data collected over a period of 10 years, changes in demographic and stroke characteristics, preexisting medical conditions, poststroke complications, and functional states, as well as length of stay (LOS), were evaluated before and after CP implementation. The modified Rankin Scale (mRS) and the Korean version of the Modified Barthel Index (K-MBI) were used to evaluate functional states. Results There were no significant differences in demographic and stroke characteristics before and after CP implementation. For those with preexisting medical conditions, there was no significant difference between before and after CP implementation. The majority of the complications were significantly decreased after the implementation of CP. Except for hemorrhagic stroke patients, the Brunnstrom stage in the ischemic and total stroke patients after CP implementation was significantly increased in the upper and lower extremities. The total hospitalization LOS and rehabilitation center hospitalization times were significantly reduced in ischemic and total stroke patients. There was no statistically significant difference in the functional gain of K-MBI and the efficiency of rehabilitation between before and after CP implementation. Conclusion The implementation of CP allows for better application of evidence- and guideline-based key interventions and helps to provide early, comprehensive, organized, and more specialized care to stroke patients. Despite limited evidence, CP is still recommended as a means of promoting best practices in hospital care for stroke patients.

Epidemiological profiles of otorhinolaryngological disorders in adults admitted to the emergency room of a tertiary university hospital.

The incidence of otorhinolaryngological emergencies has been steadily increasing. With the increasing number of patients admitted to the emergency room, numerous challenges in healthcare have become more prevalent. This study aimed to evaluate the epidemiological profile of otorhinolaryngological disorders in adults admitted to the emergency department of a tertiary university hospital. A total of 7028 adult patients with otorhinolaryngological disorders admitted to the emergency department of a tertiary hospital from January 1 to December 31, 2016, were enrolled in the study. Each patient underwent a comprehensive clinical evaluation by the physicians of the emergency department and was consulted by an otorhinolaryngologist. Age, sex, time of visits, and cost of each patient due to healthcare insurance were recorded. In total, 3098 patients were male (36.6 ± 16.4 years; 44.1%) and 3930 were female (35.4 ± 16.2 years; 55.9%). The most common otorhinolaryngological disorders were pharyngitis (n = 2713; 38.6%), followed by tonsillitis (n = 1302; 18.5%) and rhinitis (n = 1161; 16.5%). These three infectious diagnoses constituted 73.6% of all otorhinolaryngological disorders. The highest number of medical visits due to otorhinolaryngological disorders was in January, whereas the lowest number of visits was in July. When we excluded the three infection-based diagnoses, otorhinolaryngological disorders were stable at approximately 150 patients per month. The main reason for the increase in the number of visits per month due to otorhinolaryngological disorders appeared to be a result of these three infection-based diagnoses. More than 80% of otorhinolaryngological disorders in adults admitted to the emergency department were not truly emergencies requiring attendance at a tertiary hospital emergency room. New policies should be instituted to reduce the workload of the emergency services and to allow more effort to be spent on real emergencies.

Role of ultrasonography in blunt abdominal trauma

Objective The aim of the study was to assess the role of ultrasonography (US) focused assessment with sonography in trauma (FAST) at the time of presentation and ultrasound repeated after 12–24 h in early diagnosis of intra-abdominal injury (IAI) following blunt abdominal trauma (BAT) and for follow-up. Background US was used in patients with IAI. Trauma is the most common cause of mortality. The most common mechanisms resulting in BAT among patients were motor vehicle collisions (73%), motorcycle collisions (7%), auto–pedestrian collisions (6%), and falls (6%). Patients and methods This is a prospective study of 50 patients presented to the Emergency Room of Menoufia University Hospital with BAT who underwent US and FAST examination at the time of presentation and were followed up with US after 12–24 h. Of them, 12 patients were hemodynamically unstable, six patients had severe intra-abdominal hemorrhage and entered the operation theater urgently after FAST examination, and the other six patients entered the ICU for urgent care, FAST findings, and follow-up. US findings were correlated with patients' clinical data. Results US is very useful in the follow-up of patients with minor IAI and it decreases the use of computed tomography. However, ultrasound is operator dependent and could overlook lacerations of solid organs and gastrointestinal injuries. Therefore, contrast-enhanced computed tomography is still considered the gold standard in the evaluation of the exact site and the degree of IAI. Conclusion We concluded that ultrasound is considered the best modality in the initial evaluation of patients with BAT. However, repeated ultrasound in patients of BAT increases the sensitivity of ultrasound for causing intra-abdominal bleeding to 100%.

Dificuldades do enfermeiro no gerenciamento da unidade de pronto–socorro hospitalar

Objetivo: identificar as dificuldades do enfermeiro no gerenciamento da unidade de Pronto-socorro. Método: estudo descritivo, qualitativo, documental. Foi desenvolvido por meio dos portfólios de residentes de enfermagem sobre o trabalho gerencial do enfermeiro entre abril a junho de 2016 na unidade de Pronto-socorro de um hospital de ensino público do interior do Paraná, Brasil. Aos registros dos portfólios, empregou-se Análise de Conteúdo na modalidade temática. Resultados: emergiram três categorias, que se relacionam às dificuldades na dinâmica de funcionamento da unidade, na gestão de pessoas e no gerenciamento de recursos materiais. Conclusão: as dificuldades enfrentadas ratificam a contingência e a complexidade da gerência, algumas vezes superando a governabilidade do enfermeiro. Entretanto, especialmente no manejo de recursos, é necessário que o profissional se utilize mais racionalmente dos meios e instrumentos gerenciais em prol do cuidado qualificado.

The influence of coagulation dysfunction to the prognosis in the critically ill patients of emergency room

Objective This research investigated the coagulation of critically ill patients for predicting the prognosis of 28 day in a university hospital emergency room. Methods A prospective investigation was done in the emergency room of Beijing Chao-Yang Hospital, Capital Medical University from June 2015 to May 2016, and 28-day mortality was recorded. Whole blood cell analysis, blood gas analysis and clotting test were done and repeated after patients in hospital. Results A total of 1 992 patients were enrolled, and divided into two groups: survival (n=1 522) and dead (n=470). No significant difference of age, gender, body mass index and disease composition were found between the two groups(P>0.05). APACHE Ⅱ of the survival and dead groups were (12.11±4.12 )and (21.15±5.55)respectively. D-dimer and platelet account of the dead group were M(Qr)265(0, 718) μg/L and(208.16±89.87)×109/L-1 respectively, significant differences were found between the two groups (P<0.05). Coagulation was found deteriorated progressively in the dead group, whereas improved in the survival group. The risk factors of poor prognosis, which were the increased APACHE Ⅱ and D-dimer, were detected by Logistic analysis and ROC curve, especially the D-dimer. Conclusions Coagulation abnormalities were found in the critically ill patients of emergency room. The increasing of D-dimer is one of the risk factors of poor prognosis. Key words: Coagulation; D-dimer; APACHE Ⅱ; Blood platelet; Fibrinogen; Emergency; Critically ill; Prognosis

A case report of comorbid Munchausen type factitious disorder with bipolar II disorder

We present an uncommon case of a 46-year-old woman suffering from Munchausen type factitious disorder comorbid with bipolar II disorder.The patient was diagnosed with major depression disorder 4 years ago during her hospitalization in the internal medicine department after a suicide attempt and SSRI was prescribed.Since the onset of the disorder the patient started complaining for physical symptoms, migrating from hospital to hospital seeking pathological and surgical interventions, fabulating her medical history. In the last 3 years, the patient visited the emergency room of university hospital of Ioannina 85 times and she was hospitalized in internal medicine or surgical clinics 16 times, performing 19CR, 11 CT and 4MRI.Many times, she turned to the police suing the treating doctors. During her hospitalizations she refused psychiatric evaluation. Twelve months ago the patient finally visited a psychiatrist, bipolar II disorder was diagnosed and administrated quetiapine with good results to both, mood and ER visits (7 visits in one year and 1 hospitalization).During the analysis of her mood switches, we observed non-euphoric hypomanic episodes and association of the hypomanic phase with the factitious behavior.This case report reinforces the importance of maintaining a clinical suspicion of major psychopathology coexistence with factitious disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A prospective study of the use of antibiotics in the Emergency Department of a Chinese University Hospital.

Antibiotics are one of the most widely misused group of medicines. The aim of this study was to investigate the use of antibiotics in one of the paediatric emergency departments in China. We performed a prospective, cross-sectional study of antibiotic use in the paediatric emergency room of West China Second University Hospital. A total of 500 consecutive patients from March 25 to April 3 2013 were included. Clinical details of the patients were also collected in order to analyse antibiotic use. The median age of patients was 2years 2months. The five most common conditions seen in the emergency department were wheezy bronchitis, upper respiratory tract infections, tonsillitis, pneumonia and diarrhoea. A total of 311 children (62%) received antibiotics. The antibiotics prescribed were predominantly cephalosporins and penicillins. More than one antibiotic was used in 51 patients. In total, 75% of the antibiotics prescribed were cephalosporins. More than three-quarters of the young children with wheezy bronchitis received antibiotics. Antibiotic use for children with an upper respiratory tract infections or tonsillitis was greater than the 20% maximum recommended by the European Surveillance of Antimicrobial Consumption. The majority of children attending the emergency department received antibiotics. For many of the conditions, the use of antibiotics was inappropriate.

Lack of Diuretic Efficiency (but Not Low Diuresis) Early in An Acutely Decompensated Heart Failure Episode Is Associated with Increased 180-Day Mortality

Introduction: The assessment of the amount of urine produced by the dose of administered diuretic has been proposed as the main signal of interest in diuretic responsiveness - diuretic efficiency (DE). The main aim of our study is to determine if a low DE is associated with 180-day all-cause mortality (ACM). Methods: During a 3-year period, we retrospectively studied patients with acutely decompensated heart failure (ADHF) and respiratory insufficiency admitted to the emergency room of a tertiary university hospital in Porto, Portugal. A total of 170 patients (age 76.2 ± 10.3 years) were included. The outcome of ACM occurred in 43 (25.3%) patients during the 180-day follow-up period. DE was evaluated for a maximum of 3 h after emergency room admission. The lowest DE was defined as ≤140 mL of diuresis per 40 mg of furosemide equivalents. Results: No significant differences in age, comorbidities, baseline HF symptoms, or disease-modifying medication were found between the lowest and highest DE groups. The lowest DE group had higher blood urea and lower estimated glomerular filtration rate (eGFR) levels (41.3 ± 24.5 vs. 56.7 ± 23.2 mL/min/1.73 m², p < 0.001). The patients with the lowest DE had significantly higher rates of ACM during the 180-day follow-up, even after adjustment for other clinically relevant variables: hazard ratio (HR) [95% CI] = 2.31 [1.16-4.58], p = 0.016. The lowest diuresis (≤300 mL) and the highest intravenous furosemide dose (>80 mg) alone were not significantly associated with the outcome. After adjustment for N-terminal prohormone of brain natriuretic peptide, the association between the lowest DE and the outcome lost strength (HR [95% CI] = 1.53 [0.75-3.13], p = 0.240). Conclusion: A low DE (≤140 mL/40 mg of furosemide) in the first 3 h after an ADHF episode was associated with increased mid-term mortality rates.

Analysis of Death Certificate Errors of a University Hospital Emergency Room

Analysis of Death Certificate Errors of a University Hospital Emergency Room

Inappropriate prescription of antibiotics in pediatric practice

Misuse of antibiotics is largely responsible for the emergence of bacterial resistance. Children represent a subset of the population who frequently receive antibiotics. The objectives were to calculate the frequency of antibiotic prescriptions that do not comply with best practice recommendations in paediatrics primary care and to examine the thoughts and feelings of physicians and parents about antibiotic prescription and recommendations from the national health authorities. We included children admitted at the paediatric emergency room (PER) of the NANTES university hospital between June 2011 and October 2012 and who were under antibiotic drugs. Two independent experts evaluated the compliance with the national recommendations. Parents and general practitioner (GP) who prescribed the antibiotic before admission to PER were called to collect their thoughts and feeling about antibiotic prescription. The median age of the 88 included children was 2.8 years. The upper respiratory tract infection motivated the prescription of antibiotic in 59%. Seventy-six per cent of the prescriptions analysed were inappropriate, 72% of the antibiotics had a too broad spectrum, and one-third was not indicated. Ninety-one per cent of the interviewed parents thought that the antibiotic prescribed to their child was adequate. Among the 77 prescribing GP who were called, 33% agreed that they lacked time during consultation to explain to parents that no antibiotics were required. Antibiotic prescriptions were too often inadequate in this sample of children admitted in a French PER. Efforts have to be made with physicians and general public to optimize the antibiotic drug use.