Search

Summary Objectives Legionnaires' disease (LD) is a severe disease associated with community and hospital-acquired pneumonia, frequently under diagnosed. The main aim of our study was to determine the value of PCR for the diagnosis of LD in routine clinical practice. Methods In a prospective study, from March 2007 to April 2010, the value of PCR on non-invasive respiratory specimens (NIRS) was compared to those of the other available tools for LD diagnosis in patients hospitalized for pneumonia. Results Among 254 consecutive cases of pneumonia included, 24 cases were LD (19 confirmed and 5 probable) representing the first documented microbiological etiology. Molecular diagnosis of LD was performed on NIRS by using 16S rRNA PCR, and secondarily mip PCR, with no discrepant results between the 2 methods: it was found positive in 14 cases and led to identify 2 supplementary probable cases of LD. Based on clinical and at least 2 positive LD tests, PCR yielded a better diagnostic value than antigen urinary test (12 vs 10 cases). Conclusion These results revealed that molecular diagnosis of LD on NIRS is reliable and may contribute to better identify cases of LD.

Summary Objective To analyse the factors influencing the time of admission of patients presenting an acute ischaemic stroke (AIS) to the emergency department. Patients and methods Between May 2006 and July 2007, all patients with suspected stroke admitted to the emergency department were included. Patients’ characteristics and the nature and timing of the events following symptom detection were recorded in the emergency department. The symptoms observed, the person telephoning for help, the person or establishment contacted, the measures implemented (attendance of a physician, medical or paramedical intervention) and the means of transport to the hospital were noted. The overall population was analysed descriptively and patients admitted within 3 hours of symptom onset (group I) were compared with those admitted after a longer interval (group II). The final diagnosis of AIS was confirmed on patient discharge. The results were expressed as the mean (± SD) or median (interquartile range), Mann-Whitney and Chi 2 tests being used to analyse differences between the two groups (threshold of statistical significance: P Results Among the 678 patients admitted with suspected stroke, 536 were diagnosed as having experienced an AIS, 65 a haemorrhagic stroke, 3 a cerebral venous thrombosis and 74 an event other than an acute neurovascular event. The results therefore concern 536 patients (median age: 75 years), of whom 166 (31%, group I) were admitted within 3 hours of symptom onset and 370 after a longer interval (group II). The median time between symptom onset and the call for help was 15 min (1–26) in group I and 300 min (60–960) in group II ( P P P P Conclusion In the event of a suspected stroke, these results favour contacting the emergency medical call centre and immediate transfer of the patient to an appropriate hospital establishment without waiting for prior medical intervention.

Objectif Evaluer l’administration systematique de diuretiques chez les patients âges de plus de 70 ans ayant recu une transfusion de globules rouges (CGR) aux urgences. Methode Il s’agit d’une etude retrospective conduite entre janvier 2015 et fevrier 2016 chez les patients admis aux urgences ayant recu une transfusion de CGR. N’ont pas ete inclus les patients presentant des signes d’insuffisance cardiaque a l’admission aux urgences. Ont ete recueillis les caracteristiques des patients, l’indication de la transfusion, ses modalites (nombre de CGR, debit transfusionnel), le diagnostic de sortie des urgences et la mortalite hospitaliere. Deux groupes ont ete compares : patients ayant recu un traitement diuretique per transfusionnel (groupe 1) et ceux sans traitement diuretique (groupe 2). Resultats 210 patients ont ete inclus dont 97 (46 %) dans le groupe 1. L’âge median etait de 84 [78–88] et 84 [77–87] ans dans les groupes 1 et 2, respectivement. Il n’existait pas de differences statistiquement significatives entre les 2 groupes concernant les comorbidites cardiovasculaires (18,6 vs. 19,5 %). Le taux d’anemie d’origine aigue ou chronique etait similaire entre les 2 groupes. Chez les patients ayant recu un traitement diuretique, la posologie mediane de furosemide a ete de 40 mg. Le nombre moyen de CGR recus a ete similaire entre les 2 groupes (2,4 vs. 1,9). Quel que soit le groupe, aucune complication a type de surcharge pulmonaire n’a ete identifiee. La mortalite a ete nulle dans chacun des groupes. Discussion La frequence des accidents de surcharge au cours de la transfusion de CGR se situe entre 2 et 10 %. L’administration de diuretique pre-transfusionnel a titre systematique n’est pas recommandee mais cette recommandation ne repose pas sur un haut niveau de preuve. Conclusion Cette etude ne nous a pas permis de mettre en evidence une evolution differente des patients en fonction de l’administration ou non de diuretiques per-transfusionnelle a titre systematique.

Objective The aim of this study was to evaluate the usefulness of various laboratory results for differential diagnosis of bacterial (BM) and nonbacterial meningitis (NBM) with negative initial Gram stain. Design and Setting A prospective multicenter study was conducted in the emergency departments of 3 teaching hospitals. Participants and Methods Consecutive adult patients with a diagnosis of meningitis based on compatible clinical features and cerebrospinal fluid (CSF) culture findings with a CSF leukocyte count greater than 5/mm 3 were included in the study. Symptoms, examination findings, data from laboratory results, including CSF results and serum C-reactive protein (CRP) levels, and clinical outcome were assessed. Results One hundred fifty-one patients (age, 35 ± 15 years) with confirmed meningitis were admitted: 133 with NBM and 18 with BM. CRP and procalcitonin (PCT) levels, CSF white cell and absolute neutrophil counts, and CSF glucose/blood glucose and CSF protein levels were significantly higher in the BM group. However, as diagnostic indicators of BM, none of these variables except PCT was more efficient than that of the emergency physician. Values of the area under the receiver operating characteristic curve were 0.59 (95% confidence interval [CI], 0.21-0.82), 0.79 (95% CI, 0.47-0.92), 0.18 (95% CI, 0.0-0.43), 0.70 (95%CI, 0.30-0.89), 0.81 (95% CI, 0.58-0.92), and 0.98 (95% CI, 0.83-1.0) for CSF leukocyte count, percentage of CSF leukocyte, CSF/blood glucose ratio, CSF protein level, serum CRP, and serum PCT ( P Conclusion CSF results have a modest role in distinguishing BM from NBM in a negative Gram stain for bacteria. PCT serum levels seem to be an excellent predictor of BM.

Summary Objective The objective of this study was to assess the utility of determining serum cardiac troponin I (TcI) levels in the elderly. Methods During the nine-month study period, all patients older than 70 years admitted to the emergency department presenting rhabdomyolysis (defined by creatine kinase > 500 IU/L) were included in this prospective descriptive study, except for those with acute coronary syndrome or pulmonary embolism. Patients were classified into two groups according to their serum TcI level: > 0.15 or ≤ 0. 15 ng/mL. The groups were compared for clinical, laboratory and treatment variables at inclusion and for mortality at six months. Results The study included 67 patients: 30 in the group with TcI > 0.15 ng/mL group and 37 in the other group. Clinical and laboratory indicators were similar in the two groups. In contrast, significantly more patients in the TcI > 0.15 ng/mL group had been treated with a curative dose of heparin (14 versus 2, p = 0.01). This difference between the two groups was noted in both the emergency department and other hospital units. Serum TcI levels were not correlated with creatine kinase levels. Concordance between emergency department diagnosis and discharge diagnosis was 95%. No patient was discharged with a diagnosis of acute coronary syndrome; one patient, with a serum TcI level ≤ 0.15 ng/mL, was diagnosed with a pulmonary embolism. Fewer than half the patients underwent cardiac ultrasonography. Segmental hypokinesia was observed in only a few cases (6% in the TcI > 0. 15 ng/mL group versus 8% in the other group). Mortality at six months was higher among patients with an elevated serum TcI level, but the difference was not significant (23% versus 8%, p = 0.07). Conclusion This study indicated a trend toward higher mortality among patients with elevated serum TcI levels, although the factors underlying these increased concentrations remain unclear.

Introduction La douleur aigue au sein des services d’urgence reste insuffisamment traitee. L’objectif de ce travail a ete de determiner l’efficacite d’une association de paracetamol et tramadol, per os , chez des patients presentant un traumatisme. Materiel et methodes Etude prospective conduite durant 2 mois consecutifs, incluant tous les patients presentant un score superieur ou egal a 5 mesure a l’aide d’une echelle numerique (EN) et un traumatisme datant de moins de 4 heures. N’etaient pas inclus les patients ayant beneficie d’un traitement antalgique avant l’admission, les patients allergiques au paracetamol/tramadol et les patients ne comprenant pas la methode d’evaluation. Le protocole a ete le suivant : selection des patients des leur admission par l’infirmiere d’accueil, prise du traitement dans les 5 minutes suivant l’admission, realisation du score EN a 60 minutes apres l’admission. Une EN et une question sur le soulagement (reponse oui/non) ont ete realisees lors de la sortie du service. Le critere principal d’evaluation a ete le score EN inferieur a 3 a 60 minutes. Le critere secondaire a ete le soulagement ressenti par le patient a la sortie du service. Les resultats ont ete exprimes par la moyenne et ds ou la mediane et interquartile, les comparaison ont ete effectuees a l’aide du test t et de Friedman (pour mesures repetees). Resultats Quatre-vingt trois patients, d’âge moyen 34 ans, ont ete inclus. La duree moyenne de sejour dans le service d’urgence a ete de 99 minutes. Les diagnostics retenus a la sortie du service ont ete une entorse ou luxation (cheville, genou, poignet) pour 35 patients, une fracture pour 17 patients, et une simple contusion pour 31 patients. Une immobilisation a ete realisee chez 51 % des patients, avec pour 3 % d’entre eux une immobilisation avant la premiere heure. Le score EN median a l’admission etait de 7 [6-8]. A la 1 re heure, 48 % des patients avaient un score EN inferieure a 3, tandis que 52 % des patients ont repondu avoir ete soulage a la sortie du service. Conclusion Ces resultats preliminaires encouragent l’utilisation de traitement per os , des l’admission aux urgences, meme pour des douleurs intenses avec un protocole simple et facile d’execution.