Impact of antigenic or molecular rapid diagnostic tests on the management of bacterial and viral respiratory infections in paediatric emergencies

Les infections des voies respiratoires basses de l’enfant sont extrêmement fréquentes et potentiellement graves. L’étude des agents étiologiques responsables de ces infections a beaucoup accéléré ces dernières années en raison de l’apparition et de la démocratisation de nouvelles méthodes comme la PCR et les tests antigéniques délocalisables.A travers six articles de recherches scientifiques, nous abordons ici l’impact de l’usage de ces tests en pratiques clinique, ce qu’ils peuvent apporter à la science fondamentale et à l’avenir de la prise en charge de ces malades.Deux articles s’attachent à préciser l’usage d’une PCR multiplex sur les infections respiratoires, une étude épidémiologique confirmant la grande part des infections virales dans ces pathologies et une étude randomisé prospective confirmant l’intérêt d’un tel examen pour adapter la prescription à la réalité étiologique.Quatre articles viennent ensuite apporter des précisions sur l’usage des tests antigéniques aux urgences pédiatriques, en pratique clinique. Un premier propose un algorithme de recherche du pneumocoque – germe commensale également – dans les sécrétions rhinopharyngées de l’enfant. Le deuxième et le troisième identifient l’impact et la performance de test grippe et VRS aux urgences pédiatriques.Enfin, un dernier article traite de la détection du SARS-CoV-2 aux urgences pédiatriques, en période pandémique avec un test dans la sensibilité est déterminée par ce travail.L’ensemble de ces travaux concoure à préciser l’utilité et la pertinence d’un diagnostic étiologique précoce et de qualité pour améliorer la qualité des soins.Lower respiratory tract infections in children are extremely common and potentially serious. The study of the etiological agents responsible for these infections has accelerated considerably in recent years due to the appearance and democratisation of new methods such as PCR and antigenic tests.Through six scientific research articles, we discuss the impact of the use of these tests in clinical practice, what they can bring to basic science and to the future of the management of these patients.Two articles focus on the use of multiplex PCR for respiratory infections, an epidemiological study confirming the large proportion of viral infections in these diseases and a prospective randomised study confirming the interest of such an examination to adapt the prescription to the etiological reality.Four articles then provide details on the use of antigenic tests in paediatric emergencies, in clinical practice. The first proposes an algorithm for the search for pneumococcus - also a commensal germ - in children's nasopharyngeal secretions. The second and third identify the impact and performance of influenza and RSV testing in paediatric emergencies.Finally, a last article deals with the detection of SARS-CoV-2 in paediatric emergencies during a pandemic period with a test whose sensitivity is determined by this work.All of this work contributes to specifying the usefulness and relevance of an early and quality etiological diagnosis to improve the quality of care

Impact des tests de diagnostic rapide antigéniques ou moléculaires sur la prise en charge des infections respiratoires bactériennes et virales aux urgences pédiatriques

Lower respiratory tract infections in children are extremely common and potentially serious. The study of the etiological agents responsible for these infections has accelerated considerably in recent years due to the appearance and democratisation of new methods such as PCR and antigenic tests.Through six scientific research articles, we discuss the impact of the use of these tests in clinical practice, what they can bring to basic science and to the future of the management of these patients.Two articles focus on the use of multiplex PCR for respiratory infections, an epidemiological study confirming the large proportion of viral infections in these diseases and a prospective randomised study confirming the interest of such an examination to adapt the prescription to the etiological reality.Four articles then provide details on the use of antigenic tests in paediatric emergencies, in clinical practice. The first proposes an algorithm for the search for pneumococcus - also a commensal germ - in children's nasopharyngeal secretions. The second and third identify the impact and performance of influenza and RSV testing in paediatric emergencies.Finally, a last article deals with the detection of SARS-CoV-2 in paediatric emergencies during a pandemic period with a test whose sensitivity is determined by this work.All of this work contributes to specifying the usefulness and relevance of an early and quality etiological diagnosis to improve the quality of care.Les infections des voies respiratoires basses de l’enfant sont extrêmement fréquentes et potentiellement graves. L’étude des agents étiologiques responsables de ces infections a beaucoup accéléré ces dernières années en raison de l’apparition et de la démocratisation de nouvelles méthodes comme la PCR et les tests antigéniques délocalisables.A travers six articles de recherches scientifiques, nous abordons ici l’impact de l’usage de ces tests en pratiques clinique, ce qu’ils peuvent apporter à la science fondamentale et à l’avenir de la prise en charge de ces malades.Deux articles s’attachent à préciser l’usage d’une PCR multiplex sur les infections respiratoires, une étude épidémiologique confirmant la grande part des infections virales dans ces pathologies et une étude randomisé prospective confirmant l’intérêt d’un tel examen pour adapter la prescription à la réalité étiologique.Quatre articles viennent ensuite apporter des précisions sur l’usage des tests antigéniques aux urgences pédiatriques, en pratique clinique. Un premier propose un algorithme de recherche du pneumocoque – germe commensale également – dans les sécrétions rhinopharyngées de l’enfant. Le deuxième et le troisième identifient l’impact et la performance de test grippe et VRS aux urgences pédiatriques.Enfin, un dernier article traite de la détection du SARS-CoV-2 aux urgences pédiatriques, en période pandémique avec un test dans la sensibilité est déterminée par ce travail.L’ensemble de ces travaux concoure à préciser l’utilité et la pertinence d’un diagnostic étiologique précoce et de qualité pour améliorer la qualité des soins

Impact des tests de diagnostic rapide antigéniques ou moléculaires sur la prise en charge des infections respiratoires bactériennes et virales aux urgences pédiatriques

Lower respiratory tract infections in children are extremely common and potentially serious. The study of the etiological agents responsible for these infections has accelerated considerably in recent years due to the appearance and democratisation of new methods such as PCR and antigenic tests.Through six scientific research articles, we discuss the impact of the use of these tests in clinical practice, what they can bring to basic science and to the future of the management of these patients.Two articles focus on the use of multiplex PCR for respiratory infections, an epidemiological study confirming the large proportion of viral infections in these diseases and a prospective randomised study confirming the interest of such an examination to adapt the prescription to the etiological reality.Four articles then provide details on the use of antigenic tests in paediatric emergencies, in clinical practice. The first proposes an algorithm for the search for pneumococcus - also a commensal germ - in children's nasopharyngeal secretions. The second and third identify the impact and performance of influenza and RSV testing in paediatric emergencies.Finally, a last article deals with the detection of SARS-CoV-2 in paediatric emergencies during a pandemic period with a test whose sensitivity is determined by this work.All of this work contributes to specifying the usefulness and relevance of an early and quality etiological diagnosis to improve the quality of care.Les infections des voies respiratoires basses de l’enfant sont extrêmement fréquentes et potentiellement graves. L’étude des agents étiologiques responsables de ces infections a beaucoup accéléré ces dernières années en raison de l’apparition et de la démocratisation de nouvelles méthodes comme la PCR et les tests antigéniques délocalisables.A travers six articles de recherches scientifiques, nous abordons ici l’impact de l’usage de ces tests en pratiques clinique, ce qu’ils peuvent apporter à la science fondamentale et à l’avenir de la prise en charge de ces malades.Deux articles s’attachent à préciser l’usage d’une PCR multiplex sur les infections respiratoires, une étude épidémiologique confirmant la grande part des infections virales dans ces pathologies et une étude randomisé prospective confirmant l’intérêt d’un tel examen pour adapter la prescription à la réalité étiologique.Quatre articles viennent ensuite apporter des précisions sur l’usage des tests antigéniques aux urgences pédiatriques, en pratique clinique. Un premier propose un algorithme de recherche du pneumocoque – germe commensale également – dans les sécrétions rhinopharyngées de l’enfant. Le deuxième et le troisième identifient l’impact et la performance de test grippe et VRS aux urgences pédiatriques.Enfin, un dernier article traite de la détection du SARS-CoV-2 aux urgences pédiatriques, en période pandémique avec un test dans la sensibilité est déterminée par ce travail.L’ensemble de ces travaux concoure à préciser l’utilité et la pertinence d’un diagnostic étiologique précoce et de qualité pour améliorer la qualité des soins

Impact des tests de diagnostic rapide antigéniques ou moléculaires sur la prise en charge des infections respiratoires bactériennes et virales aux urgences pédiatriques

Lower respiratory tract infections in children are extremely common and potentially serious. The study of the etiological agents responsible for these infections has accelerated considerably in recent years due to the appearance and democratisation of new methods such as PCR and antigenic tests.Through six scientific research articles, we discuss the impact of the use of these tests in clinical practice, what they can bring to basic science and to the future of the management of these patients.Two articles focus on the use of multiplex PCR for respiratory infections, an epidemiological study confirming the large proportion of viral infections in these diseases and a prospective randomised study confirming the interest of such an examination to adapt the prescription to the etiological reality.Four articles then provide details on the use of antigenic tests in paediatric emergencies, in clinical practice. The first proposes an algorithm for the search for pneumococcus - also a commensal germ - in children's nasopharyngeal secretions. The second and third identify the impact and performance of influenza and RSV testing in paediatric emergencies.Finally, a last article deals with the detection of SARS-CoV-2 in paediatric emergencies during a pandemic period with a test whose sensitivity is determined by this work.All of this work contributes to specifying the usefulness and relevance of an early and quality etiological diagnosis to improve the quality of care.Les infections des voies respiratoires basses de l’enfant sont extrêmement fréquentes et potentiellement graves. L’étude des agents étiologiques responsables de ces infections a beaucoup accéléré ces dernières années en raison de l’apparition et de la démocratisation de nouvelles méthodes comme la PCR et les tests antigéniques délocalisables.A travers six articles de recherches scientifiques, nous abordons ici l’impact de l’usage de ces tests en pratiques clinique, ce qu’ils peuvent apporter à la science fondamentale et à l’avenir de la prise en charge de ces malades.Deux articles s’attachent à préciser l’usage d’une PCR multiplex sur les infections respiratoires, une étude épidémiologique confirmant la grande part des infections virales dans ces pathologies et une étude randomisé prospective confirmant l’intérêt d’un tel examen pour adapter la prescription à la réalité étiologique.Quatre articles viennent ensuite apporter des précisions sur l’usage des tests antigéniques aux urgences pédiatriques, en pratique clinique. Un premier propose un algorithme de recherche du pneumocoque – germe commensale également – dans les sécrétions rhinopharyngées de l’enfant. Le deuxième et le troisième identifient l’impact et la performance de test grippe et VRS aux urgences pédiatriques.Enfin, un dernier article traite de la détection du SARS-CoV-2 aux urgences pédiatriques, en période pandémique avec un test dans la sensibilité est déterminée par ce travail.L’ensemble de ces travaux concoure à préciser l’utilité et la pertinence d’un diagnostic étiologique précoce et de qualité pour améliorer la qualité des soins

Epidémiologie et étiologies des pneumopathies aiguës communautaires aux urgences pédiatriques du CHU de Saint-Etienne au cours de l'hiver 2012-2013

Les agents infectieux impliqués dans les pneumopathies aiguës communautaires (PAC) en pédiatrie ont sensiblement évolué depuis l'apparition de nouvelles méthodes diagnostiques utilisant la biologie moléculaire. La proportion des infections d'origine virale apparait beaucoup plus importante qu'initialement estimée. Nous avons conduit une étude prospective visant à rechercher l'étiologie des PAC chez des enfants se présentant aux urgences pédiatriques, hospitalisés ou non, au cours de l'hiver 2012-2013. Le bilan étiologique effectué sur des prélèvements rhinopharyngés comportait au minimum des tests PCR biplex identifiant neuf groupes de virus (adénovirus, virus respiratoire syncytial, métapneumovirus humain, bocavirus, rhinovirus/entérovirus, coronavirus, virus grippaux A et B, virus parainfluenza) et deux bactéries atypiques (Mycoplasma pneumoniae et Chlamydophila pneumoniae), et des cultures bactériologiques. Sur 85 cas de PAC inclus, 81 ont été associés à au moins un agent pathogène, parmi lesquels 53 infections virales, 4 infections bactériennes et 24 co-infections bactériennes et virales. Parmi les 53 infections virales, 43% ont présenté la présence concomitante d'au moins deux virus. En revanche, le taux des infections bactériennes probables est relativement faible (32.9%). Ces résultats remettent en question la pratique d'une antibiothérapie probabiliste de première intention devant toute PAC de l'enfant admise aux urgences et incitent à conduire des études prospectives randomisées évaluant d'autres stratégies.ST ETIENNE-BU Médecine (422182102) / SudocSudocFranceF

The Impact of a Tablet App on Adherence to American Heart Association Guidelines During Simulated Pediatric Cardiopulmonary Resuscitation: Randomized Controlled Trial

Evidence-based best practices are the cornerstone to guide optimal cardiopulmonary arrest resuscitation care. Adherence to the American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite advances in resuscitation science and survival improvement over the last decades, only approximately 38% of children survive to hospital discharge after in-hospital cardiac arrest and only 6%-20% after out-of-hospital cardiac arrest

Emergency Department Admissions Overflow Modeling by a Clustering of Time Evolving Clinical Diagnoses

International audienceEmergency Department (ED) of hospitals are greatly impacted by winter epidemics due to respiratory diseases and patient flow has long been essential to detect the underlying overcrowding. In this paper we propose to model the admission flow corresponding to clinical diagnoses encoded with ICD-10 which are more likely linked with respiratory diseases. To achieve this, clustering algorithms are applied on time evolving diagnosis in the adult ED of Saint-Etienne and benchmarked regarding a time series of laboratory-confirmed influenza data. For both K-Means and Hierarchical algorithms, the cluster containing the laboratory-confirmed series is composed of ICD-10 codes representing respiratory diseases and diseases linked with cardiac disorders, showing that these diseases present similar variations overtime. The information contained in such a cluster allow to plot the average number of arrivals and the average length of stay of the patients in ED only with these diagnoses

Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice

Procedural sedation and analgesia outside the operating theater have become standard care in managing pain and anxiety in children undergoing diagnostic and therapeutic procedures. The objectives of this study are to describe the current pediatric procedural sedation and analgesia practice patterns in European emergency departments, to perform a needs assessment-like analysis, and to identify barriers to implementation. A survey study of European emergency departments treating children was conducted. Through a lead research coordinator identified through the Research in European Pediatric Emergency Medicine (REPEM) network for each of the participating countries, a 30-question questionnaire was sent, targeting senior physicians at each site. Descriptive statistics were performed. One hundred and seventy-one sites participated, treating approximately 5 million children/year and representing 19 countries, with a response rate of 89%. Of the procedural sedation and analgesia medications, midazolam (100%) and ketamine (91%) were available to most children, whereas propofol (67%), nitrous oxide (56%), intranasal fentanyl (47%), and chloral hydrate (42%) were less frequent. Children were sedated by general pediatricians in 82% of cases. Safety and monitoring guidelines were common (74%), but pre-procedural checklists (51%) and capnography (46%) less available. In 37% of the sites, the entire staff performing procedural sedation and analgesia were certified in pediatric advanced life support. Pediatric emergency medicine was a board-certified specialty in 3/19 countries. Physician (73%) and nursing (72%) shortages and lack of physical space (69%) were commonly reported as barriers to procedural sedation and analgesia. Nurse-directed triage protocols were in place in 52% of the sites, mostly for paracetamol (99%) and ibuprofen (91%). Tissue adhesive for laceration repair was available to 91% of children, while topical anesthetics for intravenous catheterization was available to 55%. Access to child life specialists (13%) and hypnosis (12%) was rare

Evaluating the Increased Burden of Cardiorespiratory Illness Visits to Adult Emergency Departments During Flu and Bronchiolitis Outbreaks in the Pediatric Population: Retrospective Multicentric Time Series Analysis

International audienceBackground: Cardiorespiratory decompensation (CRD) visits have a profound effect on adult emergency departments (EDs). Respiratory pathogens like respiratory syncytial virus (RSV) and influenza virus are common reasons for increased activity in pediatric EDs and are associated with CRD in the adult population. Given the seasonal aspects of such challenging pathology, it would be advantageous to predict their variations. Objective: The goal of this study was to evaluate the increased burden of CRD in adult EDs during flu and bronchiolitis outbreaks in the pediatric population. Methods: An ecological study was conducted, based on admissions to the adult ED of the Centre Hospitalier Universitaire (CHU) of Grenoble and Saint Etienne from June 29, 2015 to March 22, 2020. The outbreak periods for bronchiolitis and flu in the pediatric population were defined with a decision-making support tool, PREDAFLU, used in the pediatric ED. A Kruskal-Wallis variance analysis and a Spearman monotone dependency were performed in order to study the relationship between the number of adult ED admissions for the International Classification of Diseases (ICD)-10 codes related to cardiorespiratory diagnoses and the presence of an epidemic outbreak as defined with PREDAFLU. Results: The increase in visits to the adult ED for CRD and the bronchiolitis and flu outbreaks had a similar distribution pattern (CHU Saint Etienne: χ 2 3 =102.7, P<.001; CHU Grenoble: χ 2 3 =126.67, P<.001) and were quite dependent in both hospital settings (CHU Saint Etienne: Spearman ρ=0.64; CHU Grenoble: Spearman ρ=0.71). The increase in ED occupancy for these pathologies was also significantly related to the pediatric respiratory infection outbreaks. These 2 criteria gave an idea of the increased workload in the ED due to CRD during the bronchiolitis and flu outbreaks in the pediatric population. Conclusions: This study established that CRD visits and bed occupancy for adult EDs were significantly increased during bronchiolitis and pediatric influenza outbreaks. Therefore, a prediction tool for these outbreaks such as PREDAFLU can be used to provide early warnings of increased activity in adult EDs for CRD visits