Diagnostic performance of the WHO definition of probable dengue within the first 5 days of symptoms on Reunion Island.

The relevance of the World Health Organization (WHO) criteria for defining probable dengue had not yet been evaluated in the context of dengue endemicity on Reunion Island. The objective of this retrospective diagnostic study was to evaluate the diagnostic performance of the 2009 WHO definition of probable dengue and to propose an improvement thereof. From the medical database, we retrieved the data of subjects admitted to the emergency department of the University Hospital of Reunion Island in 2019 with suspected dengue fever (DF) within a maximum of 5 days post symptom onset, and whose diagnosis was confirmed by a Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). The intrinsic characteristics of probable dengue definitions were reported in terms of sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), using RT-PCR as the gold standard. Of the 1,181 subjects who exhibited a positive RT-PCR, 652 (55%) were classified as probable dengue. The WHO definition of probable dengue yielded a sensitivity of 64% (95%CI 60-67%), a specificity of 57% (95%CI 52-61%), a LR+ of 1.49 (95%CI 1.33-1.67), and a LR- of 0.63 (95%CI 0.56-0.72). The sensitivity and LR- for diagnosing and ruling out probable dengue could be improved by the addition of lymphopenia on admission (74% [95%CI: 71-78%] and 0.54 [95%CI: 0.46-0.63] respectively), at the cost of slight reductions of specificity and LR+ (48% [95%CI: 44-53%] and 1.42 [95%CI: 1.29-1.57], respectively). In the absence of, or when rapid diagnostic testing is unreliable, the use of the improved 2009 WHO definition of probable dengue could facilitate the identification of subjects who require further RT-PCR testing, which should encourage the development of patient management, while also optimizing the count and quarantine of cases, and guiding disease control

Intérêt de l'utilisation d'un protocole basé sur la cétonémie capillaire pour la prise en charge de l'hyperglycémie aux urgences (étude rétrospective sur 3 mois)

Objectif : Evaluer l'intérêt de l utilisation d un protocole de prise en charge de l hyperglycémie, basé sur la cétonémie capillaire aux urgences de Nantes. Méthode : étude rétrospective, comparant 2 périodes, l'une témoin (1/9/2007 au 30/11/2007) et l'autre test (1/1/2008 au 31/3/2008). Respectivement, 124 et 152 patients furent inclus, et présentaient une hyperglycémie capillaire supérieure à 13,7mmol/L. Résultats : 14% d application du protocole. 68% des patients de la période test ont eu une cétonémie capillaire. Elle a été réalisée en moyenne 3h après l entrée du patient.. Le délai d'injection d insuline et la durée de séjour aux urgences des patients au cours de la période test ne sont pas différents de ceux de la période témoin. Conclusion : La cétonémie permet une prise en charge initiale plus précoce du patient hyperglycémique, mais le délai d'injection de l'insuline est par la suite beaucoup trop long. La présence d'un médecin organisateur de l'accueil associé à l infirmière d accueil permettrait d améliorer les délais. Les prescriptions et l injection de l'insuline se feraient dès l'accueil du patient, après avoir effectué la cétonémie capillaire.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Hospitalisation après un passage dans une Structure d'Urgences (étude épidémiologique sur la pertinence des admissions aux Urgences et réflexion sur les possibilités d'hospitalisations directes au CHR Félix Guyon (Saint-Denis, La Réunion))

INTRODUCTION : Devant le nombre croissant d'admissions dans les structures d'Urgences, le personnel soignant peut rencontrer des difficultés à gérer ce flux. La problématique f(engorgement résulte de difficultés rencontrées en amont de l'hôpital et en aval des urgences. Les conséquences pour les patients, pour les professionnels de santé et pour l'économie de santé publique sont non négligeables. Afin de tenter de réduire ce flux, l'objectif de cette thèse est d'analyser les admissions inappropriées aux Urgences du CHR Felix Guyon eet d'étudier l'intérêt et la possibilité d'optimiser la filière d'hospitalisation directe. MATERIEL ET METHODES : Nous avons entrepris une étude rétrospective observationnelle descriptive sur 2 mois, incluant 88 patients adressés par leur médecin traitant aux Urgences puis hospitalisés dans les services de Médecine à des horaires compatibles avec une entrée directe. Les dossiers des patients ont d'abord été analysés d'après les critères de sévérité clinique de la grille AEPf (Apprpriateness Evaluation Protocol français) puis ont été expertisés par 3 médecins afin de juger de la justification ou non de l'admission aux Urgences avant 'hospitalisation. RESULTATS : Après analyse des dossiers par la grille AEPf, 61 % des passages aux Urgences sont considérés comme non pertinents car ne répondant pas aux critères de sévérité clinique. L'expertise des dossiers a révélé que 39 % des 88 patients auraient pu être admis directement dans un service de Médecine sans préjudice pour leur prise en charge. CONCLUSION : Les admissions inappropriées aux Urgences sont nombreuses mais il existe des possibilités afin de réduire les passages non pertinents dont l'optimisation de la filière d'hospitalisation directe au CHR F.G. Pour tenter de résoudre cette problématique, nous proposons de mettre en place une assistance téléphonique dans les services de Médecine ; les médecins généralistes pourront avoir directement un sénior au téléphone pour avoir un avis spécialisé ou programmer une hospitalisation.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Predicting factors for the need of extracorporeal membrane oxygenation for suicide attempts by cardiac medication: a single-center cohort study

International audienceBACKGROUND: Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascularfailure. In order to decrease the mortality rate, the most severe patients should be transferred as quicklyas possible to an extracorporeal membrane oxygenation (ECMO) center. However, the predictive factorsshowing the need for venous-arterial ECMO (VA-ECMO) had never been evaluated.METHODS: A retrospective, descriptive, and single-center cohort study. All consecutive patientsadmitted in the largest ICU of Reunion Island (Indian Ocean) between January 2013 and September2018 for beta-blockers (BB), calcium channel blockers (CCB), renin-angiotensin-aldosterone systemblockers, digoxin or anti-arrythmic intentional poisonings were included. ECMO implementation wasthe primary outcome.RESULTS: A total of 49 consecutive admissions were included. Ten patients had ECMO,39 patients did not have ECMO. Three patients in ECMO group died, while no patients in theconventional group died. The most relevant ECMO-associated factors were pulse pressure andheart rate at first medical contact and pulse pressure, heart rate, arterial lactate concentration, liverenzymes and left ventricular ejection fraction (LVEF) at ICU-admission. Only pulse pressure at firstmedical contact and LVEF were significant after logistic regression.CONCLUSION: A transfer to an ECMO center should be considered for a pulse pressure < 35mmHg at first medical contact or LVEF < 20% on admission to ICU

Early diagnosis of dengue: Diagnostic utility of the SD BIOLINE Dengue Duo rapid test in Reunion Island.

BackgroundIn Reunion Island, dengue outbreaks have been occurring since 2018. The healthcare facilities are facing the problem of managing a massive influx of patients and a growing care burden. The aim of this study was to evaluate the performance of the SD Bioline Dengue Duo rapid diagnostic test in adults consulting at an emergency department during the 2019 epidemic.Methodology/principal findingsThis retrospective study of diagnostic accuracy included patients over 18 years old, suspected of dengue, who were admitted to emergency units of the University Hospital of Reunion between the 1st of January and 30th of June, 2019, and were tested for dengue fever with the SD Bioline Dengue Duo rapid diagnostic test and reverse transcriptase polymerase chain reaction. Over the study period, 2099 patients were screened retrospectively. Of them, 671 patients matched the inclusion criteria. The overall rapid diagnostic test performance was 42% for sensitivity and 15% for specificity. The non-structural 1 antigen component had a good specificity of 82% but a low sensitivity of 12%. The immunoglobulin M component had a sensitivity of 28% and a specificity of 33%. Sensitivities were slightly improved beyond the 5th day of illness compared to the early stage for all components, but only the non-structural 1 antigen component had a better specificity of 91%. Furthermore, predictive values were low and post-test probabilities never improved pre-test probabilities in our setting.Conclusions/significanceThese results suggest that the SD Bioline Dengue Duo RDT did not achieve sufficient performance levels to rule in, or discard, an early point of care dengue diagnosis in the emergency department during the 2019 epidemic in Reunion

Description of the study population on the variables retained by the optimal classification tree.

Description of the study population on the variables retained by the optimal classification tree.</p

Diagnostic performance of probable dengue definitions.

Diagnostic performance of probable dengue definitions.</p

Independent predictive factors for RT-PCR (Reverse Transcriptase Polymerase Chain Reaction) positivity.

Independent predictive factors for RT-PCR (Reverse Transcriptase Polymerase Chain Reaction) positivity.</p

STARD flow diagram 2009 WHO probable dengue definition.

WHO, World Health Organization; RT-PCR, Reverse Transcriptase Polymerase Chain Reaction.</p