Seasonal variations of patients presenting dyspnea to emergency departments in Europe : Results from the EURODEM Study

Background/aim: To describe seasonal variations in epidemiology, management, and short-term outcomes of patients in Europe presenting to an emergency department (ED) with a main complaint of dyspnea. Materials and methods: An observational prospective cohort study was performed in 66 European EDs which included consecutive patients presenting to EDs with dyspnea as the main complaint during 3 72-h study periods. Data were collected on demographics, comorbidities, chronic treatment, prehospital treatment, mode of arrival of patient to ED, clinical signs at admission, treatment in the ED, ED diagnosis, discharge from El), and in-hospital outcome. Results: The study included 2524 patients with a median age of 69 (53-80) years old. Of the patients presented, 991 (39.3%) were in autumn, 849 (33.6%) were in spring, and 48 (27.1%) were in winter. The winter population was significantly older (P <0.001) and had a lower rate of ambulance arrival to ED (P <0.001). In the winter period, there was a higher rate for lower respiratory tract infection (35.1%), and patients were more hypertensive, more hypoxic, and more hyper/hypothermic compared to other seasons. The ED mortality was about 1% and, in hospital, mortality for admitted patients was 7.4%. Conclusion: The analytic method and the outcome of this study may help to guide the allocation of ED resources more efficiently and to recommend seasonal ED management protocols based on the seasonal trend of dyspneic patients.Peer reviewe

The epidemiology of adult fractures according to the AO/OTA fracture classification

BACKGROUND: The epidemiology of adult fractures has been changing timely, in a multifactorial fashion. The aim of this study was to put forward a recent 5-year epidemiological analysis of adult fractures, according to the current AO/OTA fracture classification, in the current decade of action for road safety. METHODS: 5324 adult patients who were diagnosed with at least one fracture related with orthopedics and traumatology in a level-one trauma center were included in this retrospective, epidemiological descriptive study. The patients were grouped according to their ages as; 18-35, 36-55, 56-69, and >= 70. The fractures were examined according to the AO/OTA classification. RESULTS: 5865 fractures were present in 5324 patients. The mean age of the patients was 48.6 +/- 21.5. The number of patients according to the age groups was as follows; 1947 (36.6%), 1636 (30.7%), 881 (16.5%), and 860 (16.2%), respectively. The most frequent three fractures according to the AO/OTA fracture classification were; 7 (hand 19.6%), 23 (distal forearm, 12.1%), and 8 (foot, 11.8%). About 54.4% and 45.4% of the patients were treated non-surgically and surgically, respectively. About 0.2% of the patients preferred an alternative treatment. Overall mortality rate was 0.4%. CONCLUSION: To the best of our knowledge, this study represents the first analysis of adult fractures according to the AO/OTA classification, over a 5-year period. As a future prospect, further multi-centric epidemiological studies are warranted to constitute a sustainable action plan for the prevention of major traumas

The initial analysis of pediatric fractures according to the AO/OTA fracture classification and mechanisms of injuries

BACKGROUND: The epidemiology of pediatric fractures has been changing timely, in a multifactorial fashion. The aim of this study was to put forward a recent 5-year epidemiological analysis of pediatric fractures, according to the current AO/OTA fracture classifi-cation, in the current decade of action for road safety.METHODS: A total of 3261 pediatric patients who were diagnosed with at least one fracture related with orthopedics and trau-matology in a level-one trauma center were included in this retrospective and epidemiological descriptive study. The patients were grouped according to their ages as follows; <2, 2-5.9, 6-9.9, and 10-17.9. The fractures were examined according to the AO/OTA classification. RESULTS: A total of 3396 fractures were present in 3261 patients. The mean age of the patients was 9.8 +/- 4.6 (1-17). The number of patients according to the age groups was as follows; 28 (0.008%), 735 (22.53%), 863 (26.47%), and 1635 (50.99%), respectively. The most frequent three fractures according to the AO/OTA fracture classification were; 23 (radius/ulna distal 22.9%), 13 (humerus distal, 13.3%), and 7 (hand/carpal, 12%). About 68.8% and 31.2% of the patients were treated non-surgically and surgically, respectively. Overall mortality rate was 0.1%.CONCLUSION: To the best of our knowledge, this study represents the first analysis of pediatric fractures according to the AO/ OTA classification, over a 5-year period. As a future prospect, further multicentric epidemiological studies are warranted to constitute a sustainable action plan for the prevention of major traumas

Lipoprotein-associated phospholipase-A2 activity and its diagnostic potential in patients with acute coronary syndrome and acute ischemic stroke

Background: The study examined the Lp-PLA2 activity at the patients presented to the emergency department with acute coronary syndrome (ACS) or acute ischemic stroke (AIS), as well as its diagnostic value. Methods: The prospective study included consecutive male and female patients aged >18 years that presented to the our emergency department with ACS or AIS between November 2009 and January 2010. Blood samples were obtained immediately following diagnosis in the ACS and AIS groups. The diagnostic value of Lp-PLA2 was determined based on receiver operating characteristic curves, sensitivity, specificity, predictive values, likelihood ratios and accuracy rates. Results: In all, 34 ACS and 32 AIS patients were included in the study, and the control group included 35 patients. Lp-PLA2 enzyme activity was significantly lower in the ACS and AIS groups than in the control group (26.7 ± 13.8, 31.4 ± 13.6, and 41.4 ± 8.1 nmol min−1·mL−1, respectively; p < 0.0001, p = 0.022). In the ACS group the area under the curve (AUC) was 0.825 (95%CI: 0.722–0.929), sensitivity was 71% for an optimal Lp-PLA2 cut-off value of 31.4 nmol min−1·mL−1, and specificity was 91%, whereas in the AIS group the AUC was 0.768 (95%CI: 0.652–0.884), sensitivity was 75% for an optimal Lp-PLA2 cut-off value of 38.1 nmol min−1·mL−1, and specificity was 74%. Conclusions: Lp-PLA2 enzyme activity was significantly lower during the early stage of both ACS and AIS. The obtained statistic data suggest that low Lp-PLA2 enzyme activity can be used for diagnostic purposes. Keywords: Lipoprotein-associated phospholipase-A2, Ischemia, Emergency medicin

Rapid Emergency Medicine Score and HOTEL Score in Geriatric Patients Admitted to the Emergency Department

Background: Emergency risk scoring systems have been defined in order to identify the health status of the patients on admission to the emergency department. In this study, we aimed to investigate the prognostic values of Rapid Emergency Medicine Score (REMS), REMS without age and the HOTEL scores in geriatric patients. Methods: This prospective, single-centered, observational study was carried out between the January 15, 2014 February 28, 2014. Patients admitted to the emergency department during the study period and aged 65 years or older were included in the study. Results: In total, 939 patients were included in the study. In predicting the intensive care unit admission, the area under the curve values of the REMS, REMS without age, and HOTEL scores were 0.772, 0.760, and 0.827 (p < 0.001, for all), respectively. The median (interquartile range) REMS and REMS without age scores of the nonsurvivors were statistically significantly higher than those of the survivors {[}10 (6) vs. 6 (3), 5 (6) vs. 1(2), respectively; p < 0.001 for both]. Similarly, the HOTEL scores of the nonsurvivors were also statistically significantly higher than those of the survivors {[}2 (1) vs. 1(1), p < 0.001]. In predicting the in-hospital mortality, the area under the curve values of the REMS, REMS without age and HOTEL scores were 0.833, 0.819, and 0.858 (p < 0.001 for all), respectively. Conclusion: The REMS, REMS without age, and the HOTEL scores cannot be efficiently employed to discriminate geriatric patients requiring hospitalization. Nonetheless, all three scores are proper predictive systems regarding intensive care unit admission and in-hospital mortality in geriatric emergency department patients. Copyright (C) 2015, Taiwan Society of Geriatric Emergency \& Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved