European Journal of Emergency Medicine最新文献

Background: During a pandemic like COVID-19, hospital resources are constrained and accurate severity triage of the patients is required.

Objective: The objective of this study is to estimate the predictive performances of candidate biomarkers for short-term worsening (STW) of COVID-19.

Design: Prospective, multicenter (20 hospitals in Paris) cohort study of consecutive COVID-19 patients with systematic biobanking at admission, during the first waves of COVID-19 in France in 2020 (COVIDeF cohort).

Setting and participants: Consecutive COVID-19 patients were screened for inclusion. They were excluded in presence of severity criteria defined by either an ICU admission, mechanical ventilation (including noninvasive ventilation), acute respiratory distress, or in-hospital death before sampling. Routine blood tests measured during usual care and centralized systematic measurement of creatine kinase, C-reactive protein (CRP), procalcitonin, soluble urokinase plasminogen activator receptor (suPAR), high-sensitive troponin T (TnT-hs), N terminal pro-B natriuretic peptide (NT-proBNP), calprotectin, platelet factor 4, mid-regional pro-adrenomedullin (MR-proADM), and proendothelin were performed.

Outcome measures and analyses: The primary outcome was STW, defined by a severity criteria within 7 days. A backward stepwise logistic regression model and a 'best subset' approach were used to identify independent association, and the area under the receiving operator characteristics (AUROC) was computed.

Results: Five hundred and eleven patients were analyzed, of whom 60 (11.7%) experienced STW. Median time to occurrence of a severity criteria was 3 days. At admission, lower values of eosinophils, lymphocytes, platelets, alanine aminotransferase, and higher values of neutrophils, creatinine, urea, CRP, TnT-hs, suPAR, NT-proBNP, calprotectin, procalcitonin, MR-proADM, and proendothelin were predictive of worsening. Stepwise logistic regression identified three biomarkers significantly associated with worsening: CRP [adjusted odds ratio (aOR): 1.10, 95% confidence interval (95% CI): 1.06-1.15 for a 10-unit increase, AUROC: 0.73 (0.66-0.79)], procalcitonin [aOR: 0.42, 95% CI: 0.22-0.81, AUROC: 0.69 (0.64-0.88)], and MR-proADM [aOR: 2.85, 95% CI: 1.74-4.69, AUROC: 0.75 (0.69-0.81)]. These biomarkers outperformed clinical variables except diabetes and cancer comorbidities.

Conclusion: In this multicenter prospective study that assessed a large panel of biomarkers for COVID-19 patients, CRP, procalcitonin, and MR-proADM were independently associated with the risk of STW.

Trial registration: ClinicalTrials.gov NCT04352348.

Background and importance: Gender bias in healthcare can significantly influence clinical decision-making, potentially leading to disparities in treatment outcomes. This study addresses the impact of patient gender on the decision-making process for establishing a ceiling of care in emergency medicine, particularly the decision to limit tracheal intubation.

Objective: To determine whether patient gender influences emergency physicians' decisions regarding the recommendation for tracheal intubation in critically ill patients.

Design: A European survey-based study was conducted using a standardized clinical scenario to assess physicians' decisions in a controlled setting.

Settings and participants: The survey targeted European emergency physicians over a 2-week period in April 2024. A total of 3423 physicians participated, with a median age of 40 years and a distribution of 46% women. Physicians were presented with a clinical vignette of a 75-year-old patient in acute respiratory distress. The vignettes were randomized to vary only by the patient's gender (woman/man) and level of functional status: (1) can grocery shop alone, (2) cannot grocery shop alone but can bathe independently, or (3) cannot perform either task independently.

Outcome measures and analysis: The primary outcome was the recommendation for intubation, with secondary analyses exploring the influence of patient functional status levels. Multivariable logistic regression was used to adjust for potential confounders, including physician gender, age, experience, and practice setting.

Main results: A total of 3423 physicians responded, mostly from France, Spain, Italy, and the UK (1,532, 494, 247, and 245 respectively). Women patients were less likely to be intubated compared to male patients [67.9% vs. 71.7%; difference 3.81%; 95% confidence interval (CI), 0.7-6.9%]. The likelihood of recommending intubation decreased with lower levels of patient functional status. Women physician gender was also associated with a reduced likelihood of recommending intubation.

Conclusion: This study suggests a significant gender-based disparity in emergency care decision-making, with women patients being less likely to receive recommendations for intubation. However, these results should be interpreted with caution due to potential limitations in the representativity of respondents and the uncertain applicability of survey responses to real-life clinical practice.

Lidocaine patches are commonly prescribed for acute localized pain. Most of the existing evidence is, however, derived from postoperative or chronic pain. The objective of this study is to assess the efficacy and safety of lidocaine patch compared to placebo patch or nonsteroidal anti-inflammatory drugs (NSAIDs) for acute localized pain. This was a systematic review and meta-analysis of trials randomizing patients with acute localized pain to lidocaine patch versus placebo patch or NSAIDs. The outcomes were change in pain score (any validated scale) from baseline to a specific time endpoint (primary efficacy); adverse events (primary harm), and time to exit the study due to reaching a pain relief target (secondary). We used Cochrane revised tool to assess the risk of bias and GRADE to rate the quality of evidence. The meta-analysis was performed using a random-effects model and Cochrane Q test for heterogeneity. Data were summarized as risk ratios and weighted mean differences with 95% confidence interval (CI). We conducted a comprehensive search of MEDLINE, EMBASE, and other major databases, identifying 10 randomized controlled trials with a total of 523 patients. These trials collectively found that lidocaine patches were more effective in controlling both musculoskeletal and neuropathic pain compared to placebo patches. Due to heterogeneity among the studies, we did not pool the efficacy data. The risk of adverse events was similar between the groups (risk ratio: 0.90; 95% CI: 0.48-1.67; moderate-quality evidence). In the two trials comparing lidocaine patches with NSAIDs, there was no statistically significant difference in pain relief between the treatments. Low to moderate-quality evidence from small trials supports the efficacy and safety of lidocaine patch for the treatment of acute localized pain.