Evaluation médico-économique de la prescription des groupes sanguins-rhésus-RAI aux urgences adultes du centre hospitalo-universitaire de Bordeaux

INTRODUCTION La prescription des groupes sanguins, Rhésus et RAI dans un service d urgence ne relève d aucune recommandation et représente un budget financier important. L objectif de cette étude est d optimiser la prescription des groupes sanguins-Rhésus-RAI , au sein du service d accueil des urgences du Centre Hospitalier Universitaire de Bordeaux. MATERIEL ET METHODE Il s agit d une étude descriptive, rétrospective, analytique, réalisée sur une période 3 mois du 1er janvier 2013 au 31 mars 2013 au service d accueil des urgences adultes de l hôpital Pellegrin au CHU de Bordeaux. Un recueil exhaustif continu, par l intermédiaire de l EFS, dénombre un total de 1235 patients. 20% des patients de cette population, soit 247 patients, ont été sélectionnés par un échantillonnage aléatoire simple, et constituent la population globale de l étude. Les données de cette population ont été recueillies de façon rétrospective par l intermédiaire du logiciel informatique du service d accueil des urgences DxCare. Elles ont été saisies dans un fichier Excel, puis comparées au protocole réalisé au préalable permettant de juger de la conformité ou non des prescriptions de groupes sanguins. RESULTATS Dans la population globale, 130 prescriptions, soit 52.6% des prescriptions globales, sont justifiées par rapport au protocole et 117 prescriptions, soit 47.4% des prescriptions globales ne son pas justifiées. CONCLUSION Près de la moitié des prescriptions des groupes sanguins ne sont pas justifiées dans le service d accueil des urgences du CHU de Bordeaux. Les bénéfices attendus en cas de réduction des prescriptions sont importants et motivent d autant plus le respect des indications de prescriptions des examens immuno-hématologiques.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Prise en charge des fièvres sans foyer infectieux clinique chez l'enfant de trois mois à trois ans aux urgences pédiatriques de Bordeaux

FORT-DE-FRANCE-CHRU-BU (972332102) / SudocBORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

J Clin Microbiol

The detection of campylobacters in stools is performed essentially by culture, but this technique has a low sensitivity. New detection methods are now available. Among them, immunochromatography tests (ICTs) are very attractive in that they offer a result within 15 min. However, previous studies suggest that these tests have a relatively low specificity. The objective of this study was to evaluate the performance of these tests. During the study period, all patients who consulted the emergency units and had a stool culture were included. Their stool samples were tested with two ICTs, Ridaquick Campylobacter and ImmunoCard STAT! Campy. Stools were also tested by a home-made PCR and two commercially available enzyme-linked immunosorbent assays (ELISAs) when one of the ICTs was positive. The composite reference standard (CRS) was defined as positive if the culture was positive or, in case of a negative culture, if the PCR and one of the ELISAs were positive simultaneously. Three hundred and five patients were included. Among the 50 positive specimens with Ridaquick Campylobacter, 47 were considered true positives by the CRS, corresponding to a positive predictive value (PPV) of 94.0%. Among the 52 positive specimens with ImmunoCard STAT! Campy, 44 were considered true positives by the CRS, corresponding to a PPV of 84.6%. The negative predictive values were estimated at 94.9 and 92.4% for the Ridaquick Campylobacter and ImmunoCard STAT! Campy tests, respectively. ICTs appear to be very efficient and allow a very rapid detection of campylobacters, which is important for treating early campylobacter infections with an adapted antibiotherapy

Eur J Clin Microbiol Infect Dis

Campylobacter enteritis is the most frequent bacterial enteritis including in children. Its diagnosis suffers from the lack of sensitivity and delayed result of culture. Our aim was to test a new PCR-derived method for Campylobacter diagnosis in comparison to a composite reference. Patients presenting to the emergency ward of our hospital with enteric symptoms during the 2016 summer season were included. In addition to culture, an ELISA and an in-house real-time PCR were performed, as well as the new method (Orion GenRead Campylobacter) on all stool specimens. The composite reference used to consider a case positive for Campylobacter was either culture positive and in case of negative culture both the ELISA and real-time PCR positive. One hundred fifty patients were included, 64 being infants or children. There were 29 cases positive by the composite reference, with 19 of the 64 children (29.7%) and 10 of the 86 adults (11.6%). If performed alone, culture would have missed six cases. The Orion GenRead Campylobacter detected all the positives by the composite reference but also 12 cases negative by the composite reference (sensitivity 100%, specificity 90.1%). Given the characteristics of the new method, it can be used as a screening method for Campylobacter detection

Am J Emerg Med

OBJECTIVE: We assessed the performance of the ratio of peripheral arterial oxygen saturation to the inspired fraction of oxygen (SpO(2)/FiO(2)) to predict the ratio of partial pressure arterial oxygen to the fraction of inspired oxygen (PaO(2)/FiO(2)) among patients admitted to our emergency department (ED) during the SARS-CoV-2 outbreak. METHODS: We retrospectively studied patients admitted to an academic-level ED in France who were undergoing a joint measurement of SpO(2) and arterial blood gas. We compared SpO(2) with SaO(2) and evaluated performance of the SpO(2)/FiO(2) ratio for the prediction of 300 and 400 mmHg PaO(2)/FiO(2) cut-off values in COVID-19 positive and negative subgroups using receiver-operating characteristic (ROC) curves. RESULTS: During the study period from February to April 2020, a total of 430 arterial samples were analyzed and collected from 395 patients. The area under the ROC curves of the SpO(2)/FiO(2) ratio was 0.918 (CI 95% 0.885-0.950) and 0.901 (CI 95% 0.872-0.930) for PaO(2)/FiO(2) thresholds of 300 and 400 mmHg, respectively. The positive predictive value (PPV) of an SpO(2)/FiO(2) threshold of 350 for PaO(2)/FiO(2) inferior to 300 mmHg was 0.88 (CI95% 0.84-0.91), whereas the negative predictive value (NPV) of the SpO(2)/FiO(2) threshold of 470 for PaO(2)/FiO(2) inferior to 400 mmHg was 0.89 (CI95% 0.75-0.96). No significant differences were found between the subgroups. CONCLUSIONS: The SpO(2)/FiO(2) ratio may be a reliable tool for hypoxemia screening among patients admitted to the ED, particularly during the SARS-CoV-2 outbreak

Int Emerg Nurs

Introduction Recent research suggests that up to 20% of minor trauma patients admitted to the emergency department (ED) will suffer from non-specific chronic conditions over the subsequent several months. Thus, the present study assessed the correlates of symptoms that persisted at 4 months after an ED visit and, in particular, evaluated the associations between these symptoms and self-reported stress levels at ED admission and discharge. Method This study was a prospective observational investigation conducted in the ED of Bordeaux University Hospital that included patients admitted for minor trauma. All participants were contacted by phone 4 months after presentation at the ED to assess the occurrence of post-concussion-like symptoms (PCLS). Results A total of 193 patients completed the follow-up assessment at 4 months; 5.2% of the participants suffered from post-traumatic stress disorder (PTSD) and 24.5% suffered from PCLS. A multivariate analysis revealed an association between PCLS and stress level at discharge from the ED (odds ratios [OR]: 2.85, 95% confidence interval [CI]: 1.10–7.40). Conclusions The risk of PCLS at 4 months after an ED visit for a minor injury increased in association with the level of stress at discharge from the ED. These results may improve the quality of life for the millions of patients who experience a stressful injury event every year

Poisoning by synthetic cathinones: Consumption behaviour and clinical description from 11 cases recorded by the Addictovigilance Centre of Bordeaux

Article cliniqueSynthetic cathinones represent a large class of new popular drugs of abuse in France and in Europe, commonly called new psychoactive substances (NPS). We describe 11 cases of synthetic cathinone abuse reported to the Bordeaux Addictovigilance Centre between January 2014 and December 2015. Cases were described according to the type of substance used, patient's age and gender, type of complications, context of use and year of the event, and, when a toxicological analyse was available, the analytical method of detection and the samples of analyse (blood, urine, powder). All patients were male, with a mean age of 35.9 years old. The synthetic cathinone most frequently reported by users was methylenedioxypyrovalerone (n = 8). There was analytical confirmation of synthetic cathinone use in 6 cases. Nine cases were serious, with neurologic and/or psychiatric complications in most cases. The outcome was favourable in 10 cases but one patient died. Questioning patients about use of NPS is essential, as well as NPS analytical identification when an intake is suspected

J Psychiatr Res

Up to 20% of patients presenting at an emergency room (ER) after a stressful event will for several months suffer from very diverse long-lasting symptoms and a potentially significant decline in quality of life, often described as post concussion-like symptoms (PCLS). The objectives of our randomized open-label single-center study were to assess the feasibility of psychologist-led interventions in the context of the ER and to compare the effect of eye movement desensitization and reprocessing (EMDR) with reassurance and usual care. Conducted in the ER of Bordeaux University Hospital, the study included patients with a high risk of PCLS randomized in three groups: a 15-min reassurance session, a 60-min session of EMDR, and usual care. Main outcomes were the proportion of interventions that could be carried out and the prevalence of PCSL and post-traumatic stress disorder (PTSD) three months after the ER visit. One hundred and thirty patients with a high risk of PCLS were randomized. No logistic problem or patient refusal was observed. In the EMDR, reassurance and control groups, proportions of patients with PCLS at three months were 18%, 37% and 65% and those with PTSD were 3%, 16% and 19% respectively. The risk ratio for PCLS adjusted for the type of event (injury, non-injury) for the comparison between EMDR and control was 0.36 [95% CI 0.20-0.66]. This is the first randomized controlled trial that shows that a short EMDR intervention is feasible and potentially effective in the context of the ER. The study was registered at ClinicalTrials.gov (NCT03194386)

Recommandations de pratique clinique sur la prise en charge du patient adulte à présentation psychiatrique dans les structures d’urgences

De nombreux patients consultant aux urgences souffrent de pathologies psychiatriques préexistantes ou ont une symptomatologie évocatrice d’une pathologie psychiatrique. En effet, les troubles psychiatriques touchent un adulte sur quatre, et 75%des affections psychiatriques débutent avant l’âge de 25 ans. Le parcours de soins d’un patient adulte à présentation psychiatrique dans les structures d’urgences concerne de multiples intervenants. La complexité inhérente à ces patients complexes ainsi qu’à l’interdisciplinarité induite dans la prise en charge impose un cadre de prise en charge clair et consensuel. Des experts de la psychiatrie, de la gérontopsychiatrie et de la médecine d’urgence se sont réunis pour émettre ces recommandations de bonnes pratiques. Le choix de présenter des recommandations de bonnes pratiques et non des recommandations formalisées d’experts a été fait devant l’insuffisance de littérature de fort niveau de preuve dans certaines thématiques et de l’existence de controverses. À travers ces recommandations de bonnes pratiques cliniques, ils se sont attachés à décrire la prise en charge de ses patients aussi bien en préqu’en intrahospitalier. Les objectifs de ces recommandations sont de présenter les éléments indispensables à l’organisation du parcours de soins de ces patients, la gestion de l’agitation ainsi que la prise en charge pharmacologique ou non. Une partie spécifique est consacrée aux aspects réglementaires.Many patients who come to the emergency department suffer from pre-existing psychiatric pathologies, or have a symptomatology suggestive of a psychiatric pathology. Indeed, psychiatric disorders affect one adult in four and 75% of psychiatric disorders begin before the age of 25 years. The care pathway of an adult patient with a psychiatric presentation in emergency facilities involves multiple stakeholders. The inherent complexity of these complex patients, as well as the interdisciplinary nature of their care, requires a clear and consensual framework for care. Experts in psychiatry, geronto-psychiatry and emergency medicine have come together to produce these recommendations for good practice. The choice to present good practice recommendations rather than formalized expert recommendations was made in view of the lack of literature with a high level of evidence in certain areas and the existence of controversies. Through these recommendations of good clinical practice, they have endeavoured to describe the management of these patients both in the pre-hospital and in the in-hospital setting. The objectives of these recommendations are to present the essential elements for the organization of the care of these patients, the management of agitation as well as the pharmacological or non-pharmacological management. A specific part is devoted to the regulatory aspects