Search

Background: The COVID-19 pandemic has imposed significant challenges on hospital capacity. While mitigating unnecessary crowding in hospitals is favourable to reduce viral transmission, it is more important to prevent readmissions with impaired clinical status due to initially inappropriate level of care. A validated predictive tool to assist clinical decisions for patient triage and facilitate remote stratification is of critical importance., Methods: We conducted a retrospective study in patients with confirmed COVID-19 stratified into two levels of care, namely ambulatory care and hospitalization. Data on socio-demographics, clinical symptoms, and comorbidities were collected during the first ( N  = 571) and second waves ( N  = 174) of the pandemic in Belgium (2 March to 6 December 2020). Univariate and multivariate logistic regressions were performed to build and validate the prediction model., Results: Significant predictors of hospitalization were old age (OR = 1.08, 95%CI:1.06-1.10), male gender (OR = 4.41, 95%CI: 2.58-7.52), dyspnoea (OR 6.11, 95%CI: 3.58-10.45), dry cough (OR 2.89, 95%CI: 1.54-5.41), wet cough (OR 4.62, 95%CI: 1.93-11.06), hypertension (OR 2.20, 95%CI: 1.17-4.16) and renal failure (OR 5.39, 95%CI: 1.00-29.00). Rhinorrhea (OR 0.43, 95%CI: 0.24-0.79) and headache (OR 0.36, 95%CI: 0.20-0.65) were negatively associated with hospitalization. A receiver operating characteristic (ROC) curve was constructed and the area under the ROC curve was 0.931 (95% CI: 0.910-0.953) for the prediction model (first wave) and 0.895 (95% CI: 0.833-0.957) for the validated dataset (second wave)., Conclusion: With a good discriminating power, the prediction model might identify patients who require ambulatory care or hospitalization and support clinical decisions by Emergency Department staff and general practitioners.

Background: The Trauma-Induced Coagulopathy Clinical Score (TICCS) was developed to be calculable on the site of injury to discriminate between trauma patients with or without the need for damage control resuscitation and thus transfusion. This early alert could then be translated to in-hospital parameters at patient arrival. Base excess (BE) and ultrasound (FAST) are known to be predictive parameters for emergent transfusion. We emphasize that adding these two parameters to the TICCS could improve the scoring system predictability., Methods: A retrospective study was conducted in the University Hospital of Liège. TICCS was calculated for every patient. BE and FAST results were recorded and points were added to the TICCS according to the TICCS.BE definition (+ 3 points if BE < - 5 and + 3 points in case of a positive FAST). Emergent transfusion was defined as the use of at least one blood product in the resuscitation room. The capacity of the TICCS, the TICCS.BE and the Trauma-Associated Severe Hemorrhage (TASH) to predict emergent transfusion was assessed., Results: A total of 328 patients were included. Among them, 14% needed emergent transfusion. The probability for emergent transfusion grows with the TICCS and the TICCS.BE values. We did not find a significant difference between the TICCS (AUC 0.73) and the TICCS.BE (AUC 0.76). The TASH proved to be more predictive (AUC 0.89). 66.6% of the patients with a TICCS ≥ 10 and 81.5% with a TICCS.BE ≥ 14 required emergent transfusion., Conclusion: Adding BE and FAST to the original TICCS does not significantly improve the scoring system predictability. A prehospital TICCS > 10 could be used as a trigger for emergent transfusion activation. TASH could then be used at hospital arrival. Prehospital TASH calculation may be possible but should be further investigated., Level of Evidence: Diagnostic test, level III.

Introduction Evidence supporting the use of Thromboelastography (TEG®) and rotational thromboelastometric (ROTEM®) in the trauma setting remains limited. We present the results of a practical evaluation of the potential interest of ROTEM® in the diagnosis of acute coagulopathy and the need for emergent blood product transfusion in the general trauma population of a non-trauma Belgian emergency department. Methods Extracting a convenience cohort from the initial prospective TICCS study, we performed a retrospective analysis to test the following hypothesis: ROTEM® might be helpful to discriminate trauma patients with or without acute coagulopathy. Fifty patients were included and ROTEM® results were compared to conventional coagulation tests results, blood transfusion need and outcome. Results With a negative predictive value of 97.6% and a positive predictive value of 42.9%, a strictly normal ROTEM® profile at the time of admission seems to be able to exclude the presence of acute coagulopathy. ROTEM® also seems to be accurate in identifying patients without the need for emergent blood product transfusions. Conclusion In a population of trauma patients of a Belgian general emergency department, a strictly normal coagulation profile evaluated by ROTEM® at hospital entry is associated with a normal coagulation profile evaluated by INR and fibrinogen levels and the absence of any indication of blood product transfusion. ROTEM® may be useful for preselection of trauma patients at risk for coagulopathy within the global trauma population. This, however, would need confirmation in further investigations., Trial Registration: clinicaltrials.gov NCT02132208 Registered 6 May 2014.

Medical regulation represents an essential tool for emergency medical assistance. Even if it is essentially based on a 1964 law, our medical regulation is constantly evolving to meet the present needs and to follow the medical and technological advances. In this article, we shall outline its major components and evoke some long-awaited developments in the field of public health.

Objectives: Early bystander cardiopulmonary resuscitation (CPR) is a key factor in improving survival from out-of-hospital cardiac arrest (OHCA). The ALERT (Algorithme Liégeois d'Encadrement à la Réanimation par Téléphone) algorithm has the potential to help bystanders initiate CPR. This study evaluates the effectiveness of the implementation of this protocol in a non-Advanced Medical Priority Dispatch System area., Methods: We designed a before and after study based on a 3-month retrospective assessment of victims of OHCA in 2009, before the implementation of the ALERT protocol in Liege emergency medical communication centre (EMCC), and the prospective evaluation of the same 3 months in 2011, immediately after the implementation., Results: At the moment of the call, dispatchers were able to identify 233 OHCA in the first period and 235 in the second. Victims were predominantly male (59%, both periods), with mean ages of 64.1 and 63.9 years, respectively. In 2009, only 9.9% victims benefited from bystander CPR, this increased to 22.5% in 2011 (p<0.0002). The main reasons for protocol under-utilisation were: assistance not offered by the dispatcher (42.3%), caller physically remote from the victim (20.6%). Median time from call to first compression, defined here as no flow time, was 253s in 2009 and 168s in 2011 (NS). Ten victims were admitted to hospital after ROSC in 2009 and 13 in 2011 (p=0.09)., Conclusion: From the beginning and despite its under-utilisation, the ALERT protocol significantly improved the number of patients in whom bystander CPR was attempted., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Due to the recent interest in hands-only protocols for dispatcher-assisted cardiopulmonary resuscitation (CPR) and the lack of any validated algorithms in French, our primary objective was to evaluate a new French-language protocol in terms of its efficacy to help previously untrained volunteers in performing basic life support efforts of appropriate quality, and secondarily to investigate its potential utility in subjects with previous training., Methods: Untrained volunteers were recruited among adults in a public movie centre and previously trained volunteers among undergraduate nursing students. Participants were randomly assigned to 'phone CPR' versus 'no phone CPR' by drawing sets of envelopes. Primary outcome measures were the results of the Cardiff evaluation test; the secondary measures were global scoring of a complete 5min period of CPR, in a manikin model of cardiac arrest., Results: Out of 146 volunteers assessed for eligibility, 36 previously untrained candidates declined participation. 110 participants, distributed into four groups, completed the study: the previously untrained non-guided group (group A, n=30), the previously untrained guided group (group B, n=30), the previously trained non-guided group (group C, n=25) and the previously trained guided group (group D, n=25). Results of the Cardiff test and global evaluation of CPR performance revealed a significant improvement in group B as compared with group A, approaching the level of the group C. Previously trained guided bystanders had the best CPR scores, notably because of an improvement in the quality of airway management., Conclusion: When used by dispatchers, this new French-language algorithm offers the opportunity to help previously untrained bystanders initiate CPR. The same protocol may serve to guide volunteers with prior basic life support training to reach their best CPR performance., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Objective: Virulent airborne diseases can be a real burden to a nation's health system. The most recent threat is the fear of a mutation-induced H5N1-influenza pandemic. We studied whether Belgian hospitals are able to deal with H5N1-influenza infected patients in the case of a pandemic. Many patients, including children, may require artificial ventilation within 48 h after admission., Methods: A survey aimed at determining 'availability and preparedness' was sent by e-mail to the different Belgian Emergency Departments., Results and Discussion: Sixty-five hospitals were finally included. The amount of patients being potentially admitted is limited, owing to the reduced number of intensive care beds equipped with automatic ventilators. Furthermore, the number of available intensive care beds for children is still lower than for adult patients. The number of mortuary places, in the case of a catastrophe, is also insufficient. Although most hospitals set up a disaster plan on H5N1, there are only limited stocks of antiviral medication to protect the hospital staff in the acute phase. A separate triage area is only available in a limited number of hospitals. We conclude that Belgian hospitals and emergency departments are not equipped to deal with potential pandemic situations.

Evaluation of the aid of an emergency mobile unit to transfer monitorized patients to a University hospital, in the political context of regional care network offering highly qualified but restricted tertiary area centres, and an open prospective study conducted over the 5 first months in 2006. The call regulation was assessed by the emergency physician of the transfer team and all missions were concluded with an evaluating report. An amount of 197 requests were taken into account from which 80 % were addressed between 8 am and 8 pm. The mean average time interval for missions was 59 minutes (base to base) and the distance covered was 20.7 km as a mean. In essence, indications for medical secondary transfer regarded patients in need for acute coronary care (42.6%), specific intensive care (26.4%) and neurosurgical interventions (19.3%). We noted that endotracheal intubation occurred in only one case. Mortality during such a transfer activity was absent. Medical transfer unit allows the development of specific high qualified network resources owing to the secondary addressee of patients. However, the weak incidence of complication questions the practice of systematic medical accompanying during such transfers.

Recent international guidelines about emergency situations (ILCOR / ERC) pointed to the need of the whole "chain of survival". ALS, Advanced Life Support (the last and "medical" part of the chain ) is important and influences survival rate. If no doubt exists about "what" and "when" to do in such situations, there is no consensus in industrialized countries about "who" should be in charge of such out-of-hospital acute diagnosis and treatment: emergency physicians, emergency nurses, emergency medical technicians (EMT), other "new" professionals ? ... A description of the MICU system in Belgium is given.

Almost twenty years ago, Trunkey showed that deaths due to trauma followed a trimodal distribution over time. Half of these deaths were delayed by at least one to two hours after the initiating insult. This interval (the "golden hour") can be exploited, especially in specialized trauma centers (where the most severely injured patients are cared for), to aggressively treat these patients, thereby reducing morbidity and mortality. In Belgium, this hierarchy of trauma care centers is non-existent; patients are distributed within the healthcare system randomly, depending on the localisation of the accident and the directives of the unified "100" call centre. Because this limits the number of cases any one centre treats, this type of arrangement acts to inhibit the acquisition of competency in the handling of these complex patients. The relative lack of experience of individual emergency departments leads to difficulties in establishing diagnostic and treatment priorities for the most severely injured trauma victims. The approach to these patients must follow very precise guidelines, established scientifically in order to minimize the impact of the injury on life and maximize chances of satisfactory functional recovery. In this paper, we describe the general principles of the initial approach to victims of complex multiple trauma.

Objective: Our study was to assess the validity of SAPS II (New Simplified Acute Physiology Score) to predict the probability of in hospital mortality, in a cohort of patient admitted to a medical intensive care unit., Study Design: Prospective study., Patients and Methods: Out of 467 the 525 patients admitted were included. SAPS score and in hospital mortality prediction were calculated for each of them., Results: In this group, SAPS II offered a satisfactory discrimination power with an area under the curve of 0.843. However, calibration showed a lack of fit (chi 2 = 28.5, P < 0.001), with an overall under prediction of mortality (observed versus expected ratio of 1.12)., Conclusion: This SAPS II lower predicting accuracy in a specific population and for individual outcome prediction may reduce its interest in clinical decision-making.