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Rose Gagnon,1,2 Kadija Perreault,1,2 Jason R Guertin,3,4 Simon Berthelot,4– 6 Bertrand Achou,7 Luc J Hébert1,2,8 1Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de La Capitale-Nationale, Quebec City, Quebec, Canada; 2Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada; 3Department of Social and Preventive Medicine, Université Laval, Quebec City, Quebec, Canada; 4Centre de recherche du CHU de Québec – Université Laval, Quebec City, Quebec, Canada; 5Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Quebec, Canada; 6CHU de Québec – Université Laval, Quebec City, Quebec, Canada; 7HEC Montreal, Montreal, Quebec, Canada; 8Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Quebec, CanadaCorrespondence: Luc J Hébert, Cirris, CIUSSS de la Capitale-Nationale, 525 Boulevard Wilfrid-Hamel, H-1410, Quebec City, Quebec, G1M 2S8, Canada, Tel +1 418 529-9141 ext 6579, Email lucj.hebert@fmed.ulaval.caBackground: Musculoskeletal disorders (MSKDs) are among the most disabling and costly non-fatal health conditions. They may lead to long-term consequences such as chronic pain, physical limitations, and poorer quality of life. They also account for a significant proportion of emergency department visits, representing between 18% and 25% of all visits, depending on country.Purpose: To assess the health-related quality of life of patients presenting to the emergency department with a MSKD, to convert their answers to utility scores and to explore the association between diverse socio-demographic and clinical variables and patients’ health-related quality of life.Patients and Methods: This is an analysis of cross-sectional data obtained during the baseline assessment performed as part of a 6-month pragmatic randomized controlled trial conducted in an academic emergency department. We included patients aged 18– 80 years with a minor MSKD. The main outcome measures were health-related quality of life (five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and utility scores (− 0.148 – worse than death, 0 – dead, 0.949 – perfect health) measured with the EQ-5D-5L. Possible associations were explored by comparing scores across subgroups based on certain socio-demographic (eg, age, gender, triage score) and clinical factors (eg, pain interference on function, pain intensity) and with reference values using descriptive statistics (mean, median), rankFD ANOVAs, and χ2 tests.Results: Sixty-nine participants completed the EQ-5D-5L. Mean and median utility scores were, respectively, 0.536 (95% CI: 0.479– 0.594) and 0.531 (IQR: 0.356– 0.760). Participants with higher levels of pain (< 4/10: 0.741, 95% CI: 0.501– 0.980; 4– 7/10: 0.572, 0.500– 0.644; > 7/10: 0.433, 0.347– 0.518) or pain interference on function (< 4/10: 0.685, 95% CI: 0.605– 0.764; 4– 7/10: 0.463, 0.394– 0.533; > 7/10: 0.294, 0.126– 0.463) presented significantly lower utility scores. No significant differences were found for other socio-demographic characteristics.Conclusion: In patients with MSKDs who present to the emergency department, higher levels of pain or pain interference are associated with decreased health-related quality of life. These findings need to be confirmed on a larger scale.Keywords: EQ-5D-5L, quality of life, pain, emergency services, musculoskeletal disorders

Antoine Lapointe,1 Nikyel Royer Moreau,1 David Simonyan,2 François Rousseau,2 Viviane Mallette,1 Frédérique Préfontaine-Racine,1 Caroline Paquette,1 Myriam Mallet,2 Annie St-Pierre,1 Simon Berthelot1,2 1Département de médecine familiale et de médecine d’urgence, Université Laval, Québec, Canada; 2Centre de recherche du CHU de Québec - Université Laval, Québec, CanadaCorrespondence: Antoine LapointeDépartement de médecine familiale et de médecine d’urgence, Université Laval, 1050 Avenue de la Médecine, Québec G1V0A6, CanadaTel +1 418-656-5245Email Antoine.lapointe.1@ulaval.caPurpose: With rising healthcare costs limiting access to care, the judicious use of diagnostic tests has become a critical issue for many jurisdictions. Calcium, magnesium and phosphorus serum levels are regularly performed tests in the emergency department, but their clinical relevance have come into question. Authors sought to determine risk factors that could predict abnormal calcium, magnesium and phosphorus serum levels, as well as identify patients who may need corrective interventions.Methods: A retrospective cohort study was conducted in two academic hospitals in Québec City. Demographic and clinical characteristics of 1008 patients who had serum calcium and/or magnesium and/or phosphorus levels drawn by an emergency physician were collected. Multivariate logistic regression models were fitted to obtain adjusted odds ratios for each risk factor for abnormal calcium or magnesium or phosphorus blood levels, and for a required intervention.Results: Among patients for whom calcium, magnesium and phosphorus were tested in the Emergency Department, the most significant risk factors (OR> 2) for electrolytic abnormality were as follows: hypocalcemia – respiratory distress, diuretics (excluding loop and thiazide), anti-neoplastic medication, long QTc, chronic kidney disease (CKD); hypercalcemia – bone pain, vitamin D, hallucinations; hypomagnesemia – diabetes, corticosteroids; hypermagnesemia – poor extremity perfusion, CKD, furosemide; hypophosphatemia – seizure; hyperphosphatemia – phosphate-binders, CKD, peripheral vascular atherosclerotic disease. Of all patients tested, 3.4% received a corrective intervention initiated by the emergency physician. Predictors of intervention on an electrolyte abnormality include poor peripheral perfusion, nausea and chronic obstructive pulmonary disease (COPD).Conclusion: Emergency physicians can potentially reduce the unnecessary testing of calcium, magnesium and phosphorus blood levels by targeting patients with high-acuity conditions or chronic comorbidities such as CKD, diabetes and COPD.Keywords: emergency medicine, metabolic, electrolyte, biochemistry