Predictive value of S100-B and copeptin for outcomes following seizure: the BISTRO International Cohort Study.

OBJECTIVE: To evaluate the performance of S100-B protein and copeptin, in addition to clinical variables, in predicting outcomes of patients attending the emergency department (ED) following a seizure. METHODS: We prospectively included adult patients presented with an acute seizure, in four EDs in France and the United Kingdom. Participants were followed up for 28 days. The primary endpoint was a composite of seizure recurrence, all-cause mortality, hospitalization or rehospitalisation, or return visit in the ED within seven days. RESULTS: Among the 389 participants included in the analysis, 156 (40%) experienced the primary endpoint within seven days and 195 (54%) at 28 days. Mean levels of both S100-B (0.11 μg/l [95% CI 0.07-0.20] vs 0.09 μg/l [0.07-0.14]) and copeptin (23 pmol/l [9-104] vs 17 pmol/l [8-43]) were higher in participants meeting the primary endpoint. However, both biomarkers were poorly predictive of the primary outcome with a respective area under the receiving operator characteristic curve of 0.57 [0.51-0.64] and 0.59 [0.54-0.64]. Multivariable logistic regression analysis identified higher age (odds ratio [OR] 1.3 per decade [1.1-1.5]), provoked seizure (OR 4.93 [2.5-9.8]), complex partial seizure (OR 4.09 [1.8-9.1]) and first seizure (OR 1.83 [1.1-3.0]) as independent predictors of the primary outcome. A second regression analysis including the biomarkers showed no additional predictive benefit (S100-B OR 3.89 [0.80-18.9] copeptin OR 1 [1.00-1.00]). CONCLUSION: The plasma biomarkers S100-B and copeptin did not improve prediction of poor outcome following seizure. Higher age, a first seizure, a provoked seizure and a partial complex seizure are independently associated with adverse outcomes

Video-based feedback of oral clinical presentations reduces the anxiety of ICU medical students: a multicentre, prospective, randomized study

International audienceBackground: Oral presentations of clinical cases by medical students during medical rounds in hospital wards are a source of anxiety and little is known about how this anxiety can be alleviated. The objective of this study was to investigate whether video-based feedback of public oral presentations can reduce anxiety in 4th year medical students. Methods: Multicentre randomized study conducted in six intensive care units (ICU) and emergency departments (ED) in France over a 9-month period in 2012. One hundred and forty two 4th year medical students were randomized to two groups: intervention and control. Students in the intervention group were recorded while making an oral presentation of a patient during morning ward rounds, followed by video-based feedback. Students in the control group conducted presented classical oral presentations without being filmed and with no formal feedback. Anxiety levels during a public oral presentation were assessed using the Spielberger State Anxiety Inventory (STAI-S). The primary outcome was the difference in STAI-S scores between groups at the beginning and at the end of a 3-month ICU or ED internship. Results: Seventy four students were randomized to the 'video-based feedback' group and 68 were randomized to the control group. In both groups, STAI-S scores were significantly lower after 3 months of internship. However, the reduction in STAI-S scores was significantly greater in the " video-based feedback " group than in controls (−9.2 ± 9.3 vs. –4.6 ± 8.2, p = 0.024. Compared to the control group, significantly fewer students with high-level anxiety were observed in the " video-based feedback " group after 3 months of internship (68 vs. 28%, p <0.001). Conclusions: Compared to " usual practice " , video-assisted oral feedback reduced anxiety and significantly decreased the proportion of students experiencing severe anxiety

Outcomes and follow up of the study cohort.

<p>ED, emergency department, ICU, intensive care unit; IQR, 25–75% interquartile range.</p><p>Outcomes and follow up of the study cohort.</p

Median of S100B and copeptin, with their 25%-75% interquartile range.

<p>ICU: Intensive Care Unit.</p><p>Median of S100B and copeptin, with their 25%-75% interquartile range.</p

Diagnostic performances of S100-B and Copeptin, and 95% confidence interval.

<p>PPV, positive predictive value; NPV, negative predictive value; LR+, positive likelihood ratio; LR-, negative LR.</p><p>Diagnostic performances of S100-B and Copeptin, and 95% confidence interval.</p

Flow chart ED: emergency department.

<p>Composite endpoint of recurrence, hospitalization or death at day seven.</p

Characteristics of study cohort.

<p>SD, standard deviation; IQR, 25–75% interquartile range; ED, emergency department; GCS, Glasgow coma scale; WBC, white blood cells. All laboratory results were obtained from venous blood.</p><p>Characteristics of study cohort.</p

Receiving operator characteristics curve for Copeptin and S100B.

<p>Area under the curve 0.57 [95% CI 0.51–0.64] for S100B, p = 0.01, and 0.59 [95% CI 0.54–0.64] for copeptin, p = 0.02.</p

S100B and copeptin values in the two groups.

<p>Box plot with median, interquartile range, and 5^th and 95^th centile. Composite endpoint of recurrence, hospitalization or death at day seven.</p