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International audience; OBJECTIVES: To describe management, and to assess factors associated with antithrombotic prescription thereafter in patients who had epistaxis referred to emergency department (ED). DESIGN: Prospective cohort study. From EDs, clinical, biological and hospital data were collected. The clinical database was linked to the French Health Insurance Database where we retrieved antithrombotic drug deliveries in a 3-month period before and after referral. SETTING: Multicentric population-based cohort study within five well-defined areas. PARTICIPANTS: We considered 306 patients referred for epistaxis with a stable oral antithrombotic regimen before referral. MAIN OUTCOME MEASURES: We considered management, hospital outcome and case fatality. Antithrombotic prescription in a 3-month follow-up period was categorised into three classes: no change, class change, or discontinuation. During follow-up, hospitalisation for epistaxis or ischaemic events was searched. RESULTS: Among 306 adult individuals (mean age: 76 years), 166 took oral anticoagulant and 140 an antiplatelet drug. Blood transfusion was needed in 13.7% of patients and anterior packing alone in 61%. Half of the patients were hospitalised; 301 were discharged alive. Considering antithrombotic prescription thereafter we observed no change in 219 patients (72.8%), class changes in 47 patients (15.6%) and discontinuation in 35 patients (11.6%). We identified four independent predictors for antithrombotic prescription: hospitalisation (vs. returning home, p = .05), age (p = .03), haemoglobin level (p = .03) and oral anticoagulant (vs. antiplatelet agent, p

International audience; Aims: The objective was to compare major bleeding risk of direct oral anticoagulants (DOACs; per type and dose) with vitamin K antagonists (VKAs), irrespective of indication, using real-world data.Methods: A population-based prospective cohort study, using the French national health data system (SNIIRAM), identified 47 469 adults living within 5 well-defined geographical areas, who were new users of oral anticoagulants in the period 2013-2015: 20 205 VKA users, 19 579 rivaroxaban users, 4225 dabigatran users and 3460 apixaban users. From all emergency departments within these areas, clinical data for all adults referred for bleeding was collected and medically validated. The databases were linked for common key variables. The main outcome measure was major bleeding: intracranial haemorrhage, major gastrointestinal bleeding and other major bleeding events. Hazard ratios were derived from adjusted Cox proportional hazard models. We used propensity score weighting as a sensitivity analysis, with separate analyses according to indications (atrial fibrillation or venous thromboembolism).Results: Compared to VKAs, high and low-dose DOACs were associated with a reduced risk of intracranial haemorrhage (adjusted hazard ratio 0.55, 95% confidence interval 0.37-0.82 and 0.54, 0.26-1.12 respectively), and a reduced risk of other major bleeding events (0.41, 0.29-0.58 and 0.41, 0.22-0.79 respectively), irrespective of duration and indication. Neither DOAC dose evidenced any significant difference from VKAs in terms of risk of major gastrointestinal bleeding.Conclusion: There is a clear benefit of using DOACs with regard to intracranial haemorrhage. The study provides new insight into major gastrointestinal and other major bleeding events.

International audience; Purpose Low-dose parenteral anticoagulation has demonstrated its efficacy for venous thromboembolism prophylaxis in randomized trials. However, current practice is not widely documented. In ambulatory settings, we aimed to provide an overview of the clinical use of low-dose parenteral anticoagulation in France and to assess the incidence of major bleeding and death rates. Methods A population-based prospective cohort study using the French national health data system (SNIIRAM) identified 142,815 adults living in five well-defined geographical areas who had a course of low-dose parenteral anticoagulants (a total of 150,389 courses) in the period 2013-2015. The main outcome measures were the types of low-dose parenteral anticoagulant, the duration and the clinical context. Adjusted incidence rate ratios (IRR) were derived from Poisson models. Results Enoxaparin was the most frequently prescribed anticoagulant (58.9%) followed by tinzaparin (27.3%) and fondaparinux (10.9%). Patients receiving unfractionated heparin (N= 766, 0.53%) were older, more frequently had renal disease (48.75%) and had a higher modified HAS-B(L)ED score (>= 3 in 61.6%) than patients receiving low-molecular weight heparin (LMWH). Surgical thrombo-prophylaxis was the most frequent indication (47.6%), followed by medical prophylaxis (29.9%). Course durations were in line with regulatory agency specifications. Only 43 (0.028%) major bleeding events and 478 (0.32%) deaths were observed. Adjusted IRRs for major bleeding or death were not significantly different for dalteparin/nadroparin, tinzaparin or fondaparinux compared to enoxaparin. Conclusion Very low incidence rates of major bleeding and all-cause mortality were observed. Our study confirms the safety of LMWHs and fondaparinux in thrombo-prophylaxis in ambulatory settings.

International audience; Among nonagenarians admitted to our emergency department (ED) for ground-level falls, we assessed the impact of pre-injury antithrombotic (AT) treatment on the post-traumatic consequences, and identified risk factors for 1-month mortality. All eligible patients were consecutively included over an 18-month period. Head trauma was attested by reliable medical history, witnesses or recent external signs. Patient characteristics, post-traumatic consequences and outcomes were compared across patients with and without AT. Risk factors for 1-month mortality were assessed using multivariate logistic regression analyses. 1014 consecutive nonagenarians were analysed, 675 (66.6%) with AT and 339 (33.4%) without. Head trauma (n = 429, 42.3%) was significantly more frequent among patients with AT (49.2 vs 28.6%, p < 0.001). Intracranial hemorrhage (ICH, n = 43, 4.2%), mostly subdural hematomas (58%), were more frequently found among patients with AT (p < 0.015). At least one fracture was diagnosed for 23.9% of the population, mostly hip fractures, without any significant association with AT. At 1 month, 103 patients (10.2%) had died. The independent risk factors for 1-month mortality were: ICH associated with head trauma (OR = 5.9, 95% CI 2.5-14), Glasgow coma score = 95 years (OR = 1.6, 95% CI 1.0-2.5). Our results support accurate and regular assessment of the benefit/risk ratio for antithrombotic treatment among elderly people at high risk for falls.

International audience; Background - Major bleedings other than gastrointestinal (GI) and intracranial (ICH) and mortality rates associated with antiplatelet drugs in real-world clinical practice are unknown. The objective was to estimate major bleeding risk and mortality among new users of antiplatelet drugs in real-world clinical practice. Methods and findings - A population-based prospective cohort using the French national health data system (SNIIRAM), identified 69,911 adults living within five well-defined geographical areas, who were new users of antiplatelet drugs in 2013-2015 and who had not received any antithrombotics in 2012. Among them, 63,600 started a monotherapy and 6,311 a dual regimen. Clinical data for all adults referred for bleeding was collected from all emergency departments within these areas, and medically validated. Databases were linked using common key variables. The main outcome measure was time to major bleeding (GI, ICH and other bleedings). Secondary outcomes were death, and event-free survival (EFS). Hazard ratios (HR) were derived from adjusted Cox proportional hazard models. We used Inverse Propensity of Treatment Weighting as a stratified sensitivity analysis according to the antiplatelet monotherapy indication: primary prevention without cardiovascular (CV) risk factors, with CV risk factors, and secondary prevention. We observed 250 (0.36%) major haemorrhages, 81 ICH, 106 GI and 63 other types of bleeding. Incidences were twice as high in dual therapy as in monotherapy. Compared to low-dose aspirin (≤ 100 mg daily), high-dose (> 100 up to 325 mg daily) was associated with an increased risk of ICH (HR = 1.80, 95%CI 1.10 to 2.95). EFS was improved by high-dose compared to low-dose aspirin (1.41, 1.04 to 1.90 and 1.32, 1.03 to 1.68) and clopidogrel (1.30, 0.73 to 2.3 and 1.7, 1.24 to 2.34) respectively in primary prevention with and without CV risk factors. Conclusion - The incidence of major bleeding and mortality was low. In monotherapy, low-dose aspirin was the safest therapeutic option whatever the indication. Trial registration - NCT02886533.

Summary Background The ability of the pulmonary embolism rule-out criteria (PERC) to exclude pulmonary embolism without further testing remains debated outside the USA, especially in the population with suspected pulmonary embolism who have a high prevalence of the condition. Our main objective was to prospectively assess the predictive value of negative PERC to rule out pulmonary embolism among European patients with low implicit clinical probability. Methods We did a multicentre, prospective, observational study in 12 emergency departments in France and Belgium. We included consecutive patients aged 18 years or older with suspected pulmonary embolism. Patients were excluded if they had already been hospitalised for more than 2 days, had curative anticoagulant therapy in progress for more than 48 h, or had a diagnosis of thromboembolic disease documented before admission to emergency department. Physicians completed a standardised case report form comprising implicit clinical probability assessment (low, moderate, or high) and a list of risk factors including criteria of the PERC rule. They were asked to follow international recommendations for diagnostic strategy, masked to PERC assessment. The primary endpoint was the proportion of patients with low implicit clinical probability and negative PERC who had venous thromboembolic events, diagnosed during initial diagnostic work-up or during 3-month follow-up, as externally adjudicated by an independent committee masked to the PERC and clinical probability assessment. The upper limit of the 95% CI around the 3-month thromboembolic risk was set at 3%. We did all analyses by intention to treat, including all patients with complete follow-up. This trial is registered with ClinicalTrials.gov, number NCT02360540. Findings Between May 1, 2015, and April 30, 2016, 1773 consecutive patients with suspected pulmonary embolism were prospectively assessed for inclusion, of whom 1757 were included. 1052 (60%) patients were classed as having low clinical probability, 49 (4·7%, 95% CI 3·5–6·1) of whom had a venous thromboembolic event. In patients with a low implicit clinical probability, 337 (32%) patients had negative PERC, of whom four (1·2%; 95% CI 0·4–2·9) went on to have a pulmonary embolism. Interpretation In European patients with low implicit clinical probability, PERC can exclude pulmonary embolism with a low percentage of false-negative results. The results of our prospective, observational study allow and justify an implementation study of the PERC rule in Europe. Funding French Ministry of Health.

Introduction Les etudes de validation d’algorithme pour identifier les hemorragies majeures sont rares, et se sont concentres sur les valeurs predictives positives. Methodes Parmi tous les sejours hospitaliers de patients adultes adresses au CHU de Rennes via les urgences en 2014, nous avons identifie les hemorragies majeures selon un algorithme base sur une liste des diagnostics principaux des sejours (CIM-10). A titre de reference, un processus en deux etapes a ete applique : tout d’abord, une requete sur les seuls dossiers de sante informatises des urgences, a l’aide de plusieurs codes de diagnostics lies a l’hemorragie, et des traitements specifiques afin d’ecarter les sejours dont la probabilite de saignement est tres faible ; ensuite, l’examen des dossiers selectionnes a ete effectue par un expert medical en insu du resultat de l’algorithme et chaque sejour hospitalier a ete classe « saignement majeur » ou « pas de saignement majeur », selon des criteres preetablis de localisation et de gravite. Resultats Sur 16 012 sejours a l’hopital, la reference a identifie 736 hemorragies majeures et classe 15 276 sejours comme n’ayant pas la condition cible. L’algorithme a identifie 637 saignements : 293 hemorragies intracrâniennes, 197 hemorragies gastro-intestinales et 147 autres hemorragies. Globalement, la sensibilite etait de 65 % (IC95 % : 62 a 69) et la specificite etait de 99,0 %. Nous avons observe des differences de sensibilite et de specificite d’un type de saignement a l’autre avec les valeurs les plus elevees pour les hemorragies intracrâniennes. Les sensibilites variaient de 58 % (IC95 % : 51 a 64) pour les hemorragies gastro-intestinales a 65 % pour les « autres hemorragies » et 83 % pour les hemorragies intracrâniennes. Discussion/Conclusion La faible sensibilite et des valeurs differentes selon le type de saignements justifient la necessite d’un recueil specifique de donnees et de proceder a une validation medicale plutot que d’utiliser un algorithme base sur la CIM-10 pour evaluer l’incidence des saignements majeurs.

Study objective Efforts to reduce unnecessary and unnecessarily long antibiotic treatment for community-acquired pneumonia have been attempted through use of procalcitonin and through guidelines based on serial clinical assessment. Our aim is to compare guideline-based clinical assessment– and procalcitonin algorithm–guided antibiotic use among patients with community-acquired pneumonia. Methods We performed a pragmatic, randomized, multicenter trial from November 2012 to April 2015 at 12 French hospitals. We included emergency department (ED) patients older than 18 years with community-acquired pneumonia. Patients were randomly assigned to either the procalcitonin-guided or clinical assessment group. In accordance with past studies, we hypothesized that serial clinical assessment would be superior to procalcitonin-guided care. The primary outcome was antibiotic duration, and secondary outcomes included rates of antibiotic duration less than or equal to 5 days, and clinical success and combined serious adverse outcomes at 30 days in the intention-to-treat population. Results Of 370 eligible patients, 285 (77%) were randomly assigned to either clinical assessment– (n=143) or procalcitonin-guided care (n=142). Median age was 67 years (range 18 to 93 years) and 40% of patients were deemed to have Pneumonia Severity Index class IV or V. Procalcitonin algorithm adherence was 76%. Antibiotic duration was not significantly different between clinical assessment– and procalcitonin-guided groups (median 9 versus 10 days, respectively). Clinical success rate was 92% in each group and serious adverse outcome rates were similar (15% versus 20%, respectively). Conclusion Guideline-based serial clinical assessment did not reduce antibiotic exposure compared with procalcitonin-guided care among ED patients with community-acquired pneumonia. The strategies were similar in terms of duration of antibiotic use and clinical outcomes.

Objective Pain management in the emergency department (ED) is a key issue that must be regularly evaluated. Practice evaluation gold standard remains patient file analysis, but is highly time consuming. The aim of this study is to evaluate the interest of a defined daily dose (DDD) based analysis in the evaluation of pain management in the ED. Methods A local indicator was elaborated based on the DDD concept: the defined dose per admission (DDA). Unlike the DDD that corresponds to a standardised total dose administered over a day, the DDA represents the average total dose administrated to a patient throughout the stay in the ED. A DDA was assigned to every analgesic, from step 1 to step 3. Oral and injectable forms were studied, but transdermal forms were not considered. DDA values were assimilated to the existing DDDs when these were officially established by the WHO. When values were not defined by the WHO, mean values observed in local practice were selected. Annual numbers of patients admitted to the ED and quantities of each analgesic supplied by the pharmacy ward were annually extracted from respective data files. Paediatric patients being treated at a specific separate ED, only adults were considered throughout the study. Raw quantities of analgesics used each year were converted to their equivalent amounts in DDA, and then expressed in numbers of DDA per 100 admissions (DDA/100A). This indicator allowed us to describe relative evolutions of analgesics prescriptions from 2006 to 2017. Results Analgesic overall use rose from 18.4 to 30.2 DDA/100A between 2006 and 2017, representing a prescription increase of 64%. Throughout the study, step 1 analgesics rose from 10.8 to 19.3 DDA/100A (+79%), step 3 from 1.8 to 5.4 (+200%) and step 2 remained stable around 5.6 DDA/100A. The integration of orodispersible paracetamol tablets in 2013 allowed us to halve the consumption of injectable paracetamol in the long term and had no effect on classic paracetamol oral forms such as tablets or capsules. Tramadol increased from 41% to 78% among step 2 analgesics after the withdrawal of dextropropoxyphene in 2011. Codeine use shows a steady decline from 1.9 DDA/100A in 2011 to 0.72 in 2017. Discussion/conclusion The DDA concept appears to be an effective tool for assessing long-term analgesic-use trends at hospital EDs. This tool can also mitigate one major bias at EDs, that is the lack of traceability of analgesic administration in emergency contexts. This tool could be adjusted by integrating the average length of stay in the ED.

Resume Introduction L’osteoporose est un probleme majeur de sante publique dont le depistage notamment apres la survenue d’une fracture demeure insuffisant. Methode Nous avons mene une etude prospective monocentrique d’un depistage systematique et automatise des fractures a bas niveau d’energie adressees au service des urgences du CHU de Rennes sur une periode de 18 mois. Ce depistage faisait suite a l’envoi d’un courrier au patient d’information sur l’osteoporose. L’impact sur la prise en charge etait evalue a six mois. Resultats Nous avons evalue 434 des 1081 patients avec fractures a bas niveau d’energie hospitalisees aux urgences pendant la periode d’etude. Il s’agissait d’une population âgee de 72,7 ± 11,6 ans, dont 80,6 % de femmes, presentant pour 71,2 % des fractures osteoporotiques majeures et pour 50,7 % des fractures osteoporotiques severes. A six mois, plus de 75 % des patients avaient consulte leur medecin generaliste traitant et 55 % avaient beneficie d’une densitometrie osseuse (DMO). Un traitement de l’osteoporose etait plus frequemment instaure lorsqu’a la suite du depistage, les patients avaient consulte leur medecin generaliste traitant (56 % vs 30,3 %, p Conclusion Une information systematique par courrier apres fracture a bas niveau d’energie depistee des les urgences pourrait ameliorer la prise en charge de l’osteoporose. La consultation du medecin generaliste au decours de la fracture a un impact significatif sur la realisation d’une DMO et l’instauration d’un traitement de l’osteoporose.

Resume Objectif Evaluer les performances diagnostiques et le benefice en terme de prise en charge de la tomodensitometrie (TDM) faible dose pour le bilan d’imagerie de la colique nephretique (CN) aux urgences. Patients et methodes Deux cent quatre-vingt-onze patients admis aux urgences pour CN ont ete inclus dans cette etude. Quatre-vingt-sept ont eu une TDM faible dose et 40 un abdomen sans preparation (ASP) et une echographie (ASPE). Differents parametres evaluant la performance diagnostique et l’efficacite de la prise en charge ont ete compares entre les deux groupes. Les variables quantitatives et qualitatives ont ete comparees par le test t de Student et le test de χ 2 , respectivement. Resultats La TDM et l’ASPE ont confirme le diagnostic de CN chez 76 % et 54 % des patients, respectivement ( p = 0,013). Les durees moyennes de sejour etaient de 408 minutes versus 520 ( p = 0,013) dans les groupes TDM et ASPE, respectivement. La TDM etait obtenu plus rapidement (139 minutes versus 224, p = 0,002). Il y avait plus de demandes d’avis specialise (30 % versus 20 %, p = 0,18) et de gestes endo-urologiques (9,5 % versus 5 %, p = 0,31) dans le groupe TDM par rapport au groupe ASPE. Enfin, les patients du groupe TDM ont eu moins de recidives douloureuses (6 % versus 12,5 %, p = 0,18) et moins d’examens d’imagerie de seconde intention (0 % versus 30 %, p Conclusion La TDM faible dose a ete plus performante que le couple ASPE pour diagnostiquer une CN. Elle a optimise la prise en charge des patients aux urgences en diminuant leur duree de sejour, leur temps d’attente et le taux de deuxiemes consultations.

Resume Objectif Etudier les caracteristiques des effets indesirables medicamenteux (EIM) ayant motive l’entree des sujets âges dans des Services d’Accueil des Urgences (SAU) francais. Methodes Les donnees de deux etudes prospectives menees en 1999 et 2003 selon un protocole identique ont ete regroupees. La part des EIM dans les motifs d’admission, leur gravite et leur degre d’evitabilite ont ete evalues chez les patients ≥ 70 ans (groupe A) et compares a ceux observes chez des patients Resultats Sur les 2907 patients inclus, 1158 (39,8 %) avaient ≥ 70 ans. Dans ce groupe, l’incidence des EIM atteignait 17,1 % vs . 13,2 % dans le groupe B (p = 0,004). Les EIM apparaissaient plus severes dans le groupe A que dans le groupe B. La proportion d’EIM evitables ne differait pas significativement entre le groupe A (48,9 %) et le groupe B (43,7 %). Conclusion Les EIM sont une cause frequente – souvent evitable – d’admission aux SAU, en particulier dans la population âgee.

Various studies have shown that adverse drug events (ADE) are a substantial cause of hospital admissions. However, little is known about the incidence and severity of ADE resulting in hospital visits. To address this issue, we conducted a prospective survey in 10 primary care and emergency departments of French public hospitals. This study was performed over two periods of one week, one in June 1999 and one in December 1999, in primary care and emergency departments of five university hospitals and five general hospitals throughout France. Out of a total of 1,937 patients consulting, 1,562 were taking at least one drug during the previous week and were included for analysis according to the protocol. Altogether, 328 (21%; 95% confidence interval 19% to 23%) of these patients receiving at least one drug consulted because of an ADE. The sex ratio (M/F) was the same in both groups with or without ADE (1.04 vs 1.02, respectively, P = 0.83). Patients with ADE were older than those without (63.5 vs 54.8 years, P < 0.0001). Furthermore, ADR patients were more likely to have a higher severity score than no-ADE group (P = 0.019). The outcome seemed to be worse in patients with an ADE. The percentage of patients treated with 2 or more drugs and the number of drug exposures were significantly higher in patients with ADE than in those without (90.9% vs 75.0%, P < 0.0001, and 5.17 vs 3.82, P < 0.0001, respectively). The most frequent causes of visits for ADE-patients were digestive (n = 53, 16.2%), neurological (n = 52, 15.9%), cardiovascular (n = 49, 14.9%) and malaise (n = 49, 14.9%) events. In total, 410 drugs were incriminated in the occurrence of 328 ADE. The most frequently incriminated drug classes were (1) psychotropic agents, including anxiolytics and/or hypnotics, antidepressants and antipsychotics (n = 84, 20.5%), (2) diuretics (n = 48, 11.7%), (3) anticoagulants (n = 38, 9.3%), (4) other cardiovascular drugs (n = 63, 15.4%), and (5) analgesics, including non steroidal antiinflammatory agents (n = 57, 13.9%). The avoidability of ADE could be estimated by an external expert panel in 280 of the 328 cases. In 106 cases (37.9%), ADE was considered to be preventable because a contra-indication or a warning about drug use had not been respected.

Introduction : Dans le certificat de synthese clinique et therapeutique (fin de second cycle), une unite d'integration multidisciplinaire d'enseignement a ete creee en utilisant une methode d'enseignement sous forme de seances d'apprentissage a la resolution de problemes clinique. Methode : Il s'agit d'une application de la methode d'apprentissage par problemes (APP) permettant de resoudre des problemes diagnostiques et therapeutiques complexes. Chaque dossier reprenant chacun un processus physiopathologique comporte un scenario clinique evolutif avec des questions correspondant a des objectifs d'apprentissage et un document de referentiels. Pendant 10 semaines, les etudiants, repartis en petits groupes, preparent un dossier par semaine avant la seance et doivent satisfaire aux objectifs generaux d'integration des connaissances acquises anterieurement, et de developpement de strategie de raisonnement. L'appreciation de cette methode par les etudiants et par les enseignants a ete faite sur les 3 premieres annees. Resultats : La methode a ete jugee positive tant de la part des etudiants que des enseignants moniteurs sur l'appreciation generale, l'acquisition des connaissances, l'amelioration du raisonnement medical, et la qualite du fonctionnement des groupes d'enseignements. La methode a ete qualifiee de formatrice, interessante et utile par tous les intervenants, et astreignante par les enseignants. Conclusion : Cette methode pedagogique apparait bien adaptee a ce niveau d'etude. Elle nous encourage a modifier la methode pedagogique de tout le second cycle des etudes medicales.

Enteroviruses (EVs) are the most common identifiable cause of the aseptic meningitis syndrome. Widespread seasonal outbreaks of EV meningitis result in a high financial cost to the community, in part because of the difficulty of discriminating between viral and bacterial meningitis. During a nationwide outbreak of EV meningitis due to echovirus 30 in France we tested the hypothesis that a management strategy including early testing of cerebrospinal fluid (CSF) by means of EV PCR in all adult patients with acute aseptic meningitis on admission might reduce the duration of hospitalization and thus the expenditure on health resources. We compared the characteristics of adult patients with acute aseptic meningitis seen in our institution before (n = 21) and after (n = 27) implementation of this strategy. The strategy was cost-effective in that it significantly reduced (i) the mean duration of hospital stay (from 103 to 80 h; p = 0.04); and (ii) the mean duration of antibacterial treatment (from 115 to 69 h; p = 0.02). Systematic testing of CSF in adult patients with aseptic meningitis by means of EV PCR may be cost-effective during an outbreak of EV meningitis.

ObjectivesTo describe all adverse events occurring during plasma exchange sessions in adult patients with the Guillain-Barre syndrome. To analyze these events with regard to the technical modalities and biological changes induced by sessions, and to try to identify a population at high risk for adve

International audience; BACKGROUND: Adverse drug events (ADEs) are a substantial cause of hospital admissions. However, little is known about the incidence, preventability and severity of ADEs resulting in emergency department visits. To address this issue, we conducted a prospective survey in emergency departments of French public hospitals. METHODS: This study was performed over two periods of 1 week each, one in June 1999 and one in December 1999, in emergency departments of five university hospitals and five general hospitals throughout France. All patients aged>or=15 years presenting with medical complaints were included in the study. Trauma patients, those with gynaecological conditions and those with alcohol intoxication or intentional drug poisoning were excluded from the study. Each patient was assessed by two local emergency physicians to determine whether the visit was the result of an ADE. All medical records were subsequently validated by an independent group of medical lecturers in iatrogenic disorders. RESULTS: Out of a total of 1937 patients consulting, 1562 were taking at least one drug during the previous week and were included for analysis; 328 (21%; 95% CI 19, 23) of these patients consulted an emergency physician because of an ADE. Patients with ADEs were older than those without (mean age 63.5 vs 54.8 years; p

Cessation of massive hemoptysis after iatrogenic balloon catheter rupture of the pulmonary artery was observed after a 2-ml inflation of the balloon. A wedge angiogram showed a small cavity near the rupture. Secondary lobectomy was performed; however, the patient died 1 month later. Therapeutic approaches of this life-threatening complication are presented.