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01 juli 2023, Contains fulltext : 296067.pdf (Publisher’s version ) (Open Access), BACKGROUND: Guidelines and textbooks assert that tachycardia is an early and reliable sign of hypotension, and an increased heart rate (HR) is believed to be an early warning sign for the development of shock, although this response may change by aging, pain, and stress. OBJECTIVE: To assess the unadjusted and adjusted associations between systolic blood pressure (SBP) and HR in emergency department (ED) patients of different age categories (18-50 years; 50-80 years; > 80 years). METHODS: A multicenter cohort study using the Netherlands Emergency department Evaluation Database (NEED) including all ED patients ≥ 18 years from three hospitals in whom HR and SBP were registered at arrival to the ED. Findings were validated in a Danish cohort including ED patients. In addition, a separate cohort was used including ED patients with a suspected infection who were hospitalized from whom measurement of SBP and HR were available prior to, during, and after ED treatment. Associations between SBP and HR were visualized and quantified with scatterplots and regression coefficients (95% confidence interval [CI]). RESULTS: A total of 81,750 ED patients were included from the NEED, and a total of 2358 patients with a suspected infection. No associations were found between SBP and HR in any age category (18-50 years: -0.03 beats/min/10 mm Hg, 95% CI -0.13-0.07, 51-80 years: -0.43 beats/min/10 mm Hg, 95% CI -0.38 to -0.50, > 80 years: -0.61 beats/min/10 mm Hg, 95% CI -0.53 to -0.71), nor in different subgroups of ED patient. No increase in HR existed with a decreasing SBP during ED treatment in ED patients with a suspected infection. CONCLUSION: No association between SBP and HR existed in ED patients of any age category, nor in ED patients who were hospitalized with a suspected infection, even during and after ED treatment. Emergency physicians may be misled by traditional concepts about HR disturbances because tachycardia may be absent in hypotension.

Contains fulltext : 286903.pdf (Publisher’s version ) (Open Access)

Item does not contain fulltext, OBJECTIVE: Feedback of patients' medical information among healthcare workers within the acute care could improve the quality of care during an Emergency Department (ED) visit. However, in practice, feedback among healthcare workers leads to juridical discussions. Therefore, this study explores whether ED patients agree with medical information feedback among healthcare workers in the acute care, such as the ambulance staff and ED physicians, and whether this was different from permission for feedback to the general practitioner. METHOD: Multicenter cross-sectional study in three EDs in the Netherlands. Patients ≥18 years old, presented per ambulance between May 3rd and June 12th 2021, filled in a questionnaire asking whether they agree with medical information feedback to ambulance staff and reviewing medical files for follow-up by ED physicians. RESULTS: A total of 369 patients were included with a mean age of 68 years (SD 18). In total, 98,9% of patients agreed with medical information feedback to ambulance staff, which was not significantly different from the 99,2% of patients who agreed with feedback to the general practitioner (p=1.00). CONCLUSION: All but a few ED patients agreed with medical information exchange to ambulance personnel and follow-up by ED-physicians. During ED-visits, medical information feedback to the general practitioner is a standard procedure, with the possibility of an opt-out. In our opinion, feedback and exchange of medical information within the acute care should be arranged similarly.