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3. Prevalence and outcomes of fear of falling in older adults with falls at the emergency department: a multicentric observational study

Author

García-Martínez, Ana, García-Rosa, Sergio, Gil-Rodrigo, Adriana, Machado, Victoria Torres, Pérez-Fonseca, Carmen, Nickel, Christian H., Artajona, Lourdes, Jacob, Javier, Llorens, Pere, Herrero, Pablo, Canadell, Naila, Rangel, Carolina, Martín-Sánchez, Francisco Javier, del Nogal, Monserrat Lázaro, and Miró, Òscar

Published
2024
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5. Diagnosis of acute aortic syndromes with ultrasound and d-dimer: the PROFUNDUS study

Author

Ardito, Arianna, Bartalucci, Alice, Calzolari, Gilberto, Giachino, Francesca, Leone, Dario, Locatelli, Stefania, Scategni, Virginia, Tizzani, Maria, Rubiolo, Francesca, Becucci, Alessandro, Bondi, Ernesta, Cavallaro, Gabriele, Caviglioli, Cosimo, Guerrini, Stefania, Haxhiraj, Eriola, Paladini, Barbara, Prota, Alessio, Ronchetti, Mattia, Guerra, Federica, Tavares de Oliveira, Múcio, Jr., Soares, Paulo Rogério, Malacarne, Margerita, Santini, Massimo, Bonzi, Mattia, Bartalucci, Paola, Coppa, Alessandro, Mueller, Christian, Nickel, Christian H., Bingisser, Roland, Fong, Chan Pei, Franceschi, Francesco, Tullo, Gianluca, Ceschi, Ludovica, Schwameis, Michael, Morello, Fulvio, Bima, Paolo, Castelli, Matteo, Capretti, Elisa, de Matos Soeiro, Alexandre, Cipriano, Alessandro, Costantino, Giorgio, Vanni, Simone, Leidel, Bernd A., Kaufmann, Beat A., Osman, Adi, Candelli, Marcello, Capsoni, Nicolò, Behringer, Wilhelm, Capuano, Marialessia, Ascione, Giovanni, Leal, Tatiana de Carvalho Andreucci Torres, Ghiadoni, Lorenzo, Pivetta, Emanuele, Grifoni, Stefano, Lupia, Enrico, and Nazerian, Peiman

Published
2024
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10. Tranexamic Acid for Intracerebral Hemorrhage in Patients on Non-Vitamin K Antagonist Oral Anticoagulants (TICH-NOAC): A Multicenter, Randomized, Placebo-Controlled, Phase 2 Trial

Author

Polymeris, Alexandros A., Karwacki, Grzegorz M., Siepen, Bernhard M., Schaedelin, Sabine, Tsakiris, Dimitrios A., Stippich, Christoph, Guzman, Raphael, Nickel, Christian H., Sprigg, Nikola, Kägi, Georg, Vehoff, Jochen, Barinka, Filip, Thilemann, Sebastian, Maurer, Marina, Wagner, Benjamin, Traenka, Christopher, Gensicke, Henrik, De Marchis, Gian Marco, Bonati, Leo H., Fischer, Urs, Z’Graggen, Werner J., Nedeltchev, Krassen, Wegener, Susanne, Baumgartner, Philipp, Engelter, Stefan T., Seiffge, David J., Peters, Nils, Lyrer, Philippe A., Clarke, Sandra, Falcao, Martina, Avramiotis, Nikolaos S, Dittrich, Tolga, Fisch, Urs, Fladt, Joachim, Hert, Lisa, Schneider, Iris, Wiegert, Martina, Zietz, Annaelle, Beyeler, Morin, Goeldlin, Martina, Kormann, Marianne, Maamari, Basel, McEvoy, Liselotte, Meinel, Thomas R, Müller, Madlaina, Vynckier, Jan, Ardila, Elena, Feuerstein, Ingrid, Gantenbein, Claudine, Müller, Anna, Seljmani, Vjosa, Wagner, Benedikt, Anders, Bettina, Backhaus, Roland, Paliantonis, Asterios, Taheri, Shadi, Thumm, Dennis, van Duinen, Jannie, and Von Bieberstein, Lita

Published
2023
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13. Modification of the Emergency Severity Index Improves Mortality Prediction in Older Patients

Author

Malinovska, Alexandra, Pitasch, Laurentia, Geigy, Nicolas, Nickel, Christian H., and Bingisser, Roland

Subjects
Triage, Emergency Severity Index, Nonspecific Complaints, Geriatric
Abstract

Introduction: Older patients frequently present to the emergency department (ED) with nonspecific complaints (NSC), such as generalized weakness. They are at risk of adverse outcomes, and early risk stratification is crucial. Triage using Emergency Severity Index (ESI) is reliable and valid, but older patients are prone to undertriage, most often at decision point D. The aim of this study was to assess the predictive power of additional clinical parameters in NSC patients.Methods: Baseline demographics, vital signs, and deterioration of activity of daily living (ADL) in patients with NSC were prospectively assessed at four EDs. Physicians scored the coherence of history and their first impression. For prediction of 30-day mortality, we combined vital signs at decision point D (heart rate, respiratory rate, oxygen saturation) as “ESI vital,” and added “ADL deterioration,” “incoherence of history,” or “first impression,” using logistic regression models.Results: We included 948 patients with a median age of 81 years, 62% of whom were female. The baseline parameters at decision point D (ESI vital) showed an area under the curve (AUC) of 0.64 for predicting 30-day mortality in NSC patients. AUCs increased to 0.67 by adding ADL deterioration to 0.66 by adding incoherence of history, and to 0.71 by adding first impression. Maximal AUC was 0.73, combining all parameters.Conclusion: Adding the physicians’ first impressions to vital signs at decision point D increases predictive power of 30-day mortality significantly. Therefore, a modified ESI could improve predictive power of triage in older patients presenting with NSCs.

Published
2019

18. Mechanical Thrombectomy Versus Best Medical Treatment in the Late Time Window in Non-DEFUSE-Non-DAWN Patients: A Multicenter Cohort Study

Author

Dittrich, Tolga D., Sporns, Peter B., Kriemler, Lilian F., Rudin, Salome, Nguyen, Anh, Zietz, Annaelle, Polymeris, Alexandros A., Tränka, Christopher, Thilemann, Sebastian, Wagner, Benjamin, Altersberger, Valerian L., Piot, Ines, Barinka, Filip, Müller, Susanne, Hänsel, Martin, Gensicke, Henrik, Engelter, Stefan T., Lyrer, Philippe A., Sutter, Raoul, Nickel, Christian H., Katan, Mira, Peters, Nils, Kulcsár, Zsolt, Karwacki, Grzegorz M., Pileggi, Marco, Cereda, Carlo, Wegener, Susanne, Bonati, Leo H., Fischer, Urs, Psychogios, Marios, and De Marchis, Gian Marco

Published
2023
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19. Diagnostic and prognostic value of cardiac troponins in emergency department patients presenting after a fall: A prospective, multicenter study

Author

Espejo, Tanguy, primary, Terhalle, Lukas, additional, Malinovska, Alexandra, additional, Riedel, Henk B., additional, Arntz, Laura, additional, Hafner, Livia, additional, Delport‐Lehnen, Karen, additional, Zuppinger, Joanna, additional, Geigy, Nicolas, additional, Leuppi, Jörg, additional, Somasundaram, Rajan, additional, Bingisser, Roland, additional, and Nickel, Christian H., additional

Published
2024
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22. The Neurocardiogenic Spectrum in Subarachnoid Hemorrhage: A Case Report and Review of the Literature

Author

Mansella, Gregory, Jeger, Raban, Bingisser, Roland, and Nickel, Christian H.

Abstract

A 36-year-old man was brought to our emergency department after successful resuscitation ofout-of-hospital cardiac arrest with the whole spectrum of neurocardiogenic effects in subarachnoidhemorrhage: electrocardiographic changes, regional wall motion abnormalities, and elevationsof cardiac enzymes. Coronary angiography revealed normal coronary arteries but showed themidventricular type of Takotsubo cardiomyopathy in the left ventriculography. Subsequently, cerebralcomputed tomography revealed diffuse subarachnoid hemorrhage and generalized cerebraledema with brain herniation. Brain death was diagnosed. This case highlights the possibility of anacute cerebral illness (especially subarachnoid hemorrhage) as an underlying cause of cardiacabnormalities mimicking myocardial ischemia.

Published
2017

24. A European Research Agenda for Geriatric Emergency Medicine: a modified Delphi study

Author

Mooijaart, Simon P., Nickel, Christian H., Conroy, Simon P., Lucke, Jacinta A., van Tol, Lisa S., Olthof, Mareline, Blomaard, Laura C., Buurman, Bianca M., Dundar, Zerrin D., de Groot, Bas, Gasperini, Beatrice, Heeren, Pieter, Karamercan, Mehmet A., McNamara, Rosa, Mitchell, Aine, van Oppen, James D., Martin Sanchez, F. Javier, Schoon, Yvonne, Singler, Katrin, Spode, Renan, Skúldóttir, Sigrun, Thorrsteindottir, Thordis, van der Velde, Marije, and Wallace, James

Published
2021
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25. Service provision for Frailty in European Emergency Departments (FEED): a survey of operational characteristics.

Author

Fehlmann, Christophe A., Mc Loughlin, Kara, Cosgriff, Emma Jane, Ferrick, John Francis, van Oppen, James David, Coats, Timothy, Conroy, Simon, de Groot, Bas, Heeren, Pieter, Lim, Stephen, Lucke, Jacinta, Mooijaart, Simon, Nickel, Christian H., Penfold, Rose, Singler, Katrin, Steenebruggen, Françoise, Sterckx, Valerie, Brdar, Ivan, Libicherová, Pavla, and Balen, Frédéric

Abstract

Background: The observational Frailty in European Emergency Departments (FEED) study found 40% of older people attending for care to be living with frailty. Older people with frailty have poorer outcomes from emergency care. Current best practice calls for early identification of frailty and holistic multidisciplinary assessment. This survey of FEED sites explores variations in frailty-attuned service definitions and provision. Methods: This cross-sectional survey included study sites across Europe identified through snowball recruitment. Site co-ordinators (healthcare professionals in emergency and geriatric care) were surveyed online using Microsoft Forms. Items covered department and hospital capacity, frailty and delirium identification methods, staffing, and frailty-focused healthcare services in the ED. Descriptive statistics were reported. Results: A total of 68 sites from 17 countries participated. Emergency departments had median 30 (IQR 21–53) trolley spaces. Most defined "older people" by age 65+ (64%) or 75+ (25%). Frailty screening was used at 69% of sites and mandated at 38%. Night-time staffing was lower compared to day-time for nursing (10 [IQR 8–14] vs. 14 [IQR 10–18]) and physicians (5 [IQR 3–8] vs. 10 [IQR 7–15]). Most sites had provision for ED frailty specialist services by day, but these services were rarely available at night. Sites mostly had accessible facilities; however, hot meals were rarely available at night (18%). Conclusion: This survey demonstrated variability in case definitions, screening practices, and frailty-attuned service provision. There is no unanimous definition for older age, and while the Clinical Frailty Scale was commonly used, this was rarely mandated or captured in electronic records. Frailty services were often unavailable overnight. Appreciation of the variation in frailty service models could inform operational configuration and workforce development. [ABSTRACT FROM AUTHOR]

Published
2024
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26. Community-acquired and hospital-acquired respiratory tract infection and bloodstream infection in patients hospitalized with COVID-19 pneumonia

Author

Søgaard, Kirstine K., Baettig, Veronika, Osthoff, Michael, Marsch, Stephan, Leuzinger, Karoline, Schweitzer, Michael, Meier, Julian, Bassetti, Stefano, Bingisser, Roland, Nickel, Christian H., Khanna, Nina, Tschudin-Sutter, Sarah, Weisser, Maja, Battegay, Manuel, Hirsch, Hans H., Pargger, Hans, Siegemund, Martin, and Egli, Adrian

Published
2021
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30. Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction

Author

Twerenbold, Raphael, Costabel, Juan Pablo, Nestelberger, Thomas, Campos, Roberto, Wussler, Desiree, Arbucci, Rosina, Cortes, Marcia, Boeddinghaus, Jasper, Baumgartner, Benjamin, Nickel, Christian H., Bingisser, Roland, Badertscher, Patrick, Puelacher, Christian, du Fay de Lavallaz, Jeanne, Wildi, Karin, Rubini Giménez, Maria, Walter, Joan, Meier, Mario, Hafner, Benjamin, Lopez Ayala, Pedro, Lohrmann, Jens, Troester, Valentina, Koechlin, Luca, Zimmermann, Tobias, Gualandro, Danielle M., Reichlin, Tobias, Lambardi, Florencia, Resi, Silvana, Alves de Lima, Alberto, Trivi, Marcelo, and Mueller, Christian

Published
2019
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31. Prevalence of Frailty in European Emergency Departments (FEED): an international flash mob study.

Author

European Taskforce on Geriatric Emergency Medicine (ETGEM) collaborators, Coats, Timothy, Conroy, Simon, de Groot, Bas, Heeren, Pieter, Lim, Stephen, Lucke, Jacinta, Mooijaart, Simon, Nickel, Christian H., Penfold, Rose, Singler, Katrin, van Oppen, James D., Polyzogopoulou, Effie, Kruis, Arina, McNamara, Rosa, Castejon-Hernandez, Santiago, Miro, Oscar, Karamercan, Mehmet Akif, Dündar, Zerrin Defne, and Pavletić, Martina

Abstract

Key summary points: Aim: To determine the prevalence of frailty among older people attending emergency care. Findings: Across 14 European countries, 40% of older people using emergency care were living with at least mild frailty. 14% of all adult users were older people with frailty. Message: The high prevalence of frailty in emergency care indicates the need to accordingly configure healthcare systems and plan workforces. Introduction: Current emergency care systems are not optimized to respond to multiple and complex problems associated with frailty. Services may require reconfiguration to effectively deliver comprehensive frailty care, yet its prevalence and variation are poorly understood. This study primarily determined the prevalence of frailty among older people attending emergency care. Methods: This cross-sectional study used a flash mob approach to collect observational European emergency care data over a 24-h period (04 July 2023). Sites were identified through the European Task Force for Geriatric Emergency Medicine collaboration and social media. Data were collected for all individuals aged 65 + who attended emergency care, and for all adults aged 18 + at a subset of sites. Variables included demographics, Clinical Frailty Scale (CFS), vital signs, and disposition. European and national frailty prevalence was determined with proportions with each CFS level and with dichotomized CFS 5 + (mild or more severe frailty). Results: Sixty-two sites in fourteen European countries recruited five thousand seven hundred eighty-five individuals. 40% of 3479 older people had at least mild frailty, with countries ranging from 26 to 51%. They had median age 77 (IQR, 13) years and 53% were female. Across 22 sites observing all adult attenders, older people living with frailty comprised 14%. Conclusion: 40% of older people using European emergency care had CFS 5 +. Frailty prevalence varied widely among European care systems. These differences likely reflected entrance selection and provide windows of opportunity for system configuration and workforce planning. [ABSTRACT FROM AUTHOR]

Published
2024
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38. Bacterial genome wide association study substantiates papGII of Escherichia coli as a patient independent driver of urosepsis

Author

Cuenod, Aline, primary, Agnetti, Jessica, additional, Seth-Smith, Helena, additional, Waelchli, Denise, additional, Scherbakov, Dimitri, additional, Akbergenov, Rashid, additional, Tschudin-Sutter, Sarah, additional, Bassetti, Stefano, additional, Siegemund, Martin, additional, Nickel, Christian H., additional, Moran-Gilad, Jacob, additional, Keys, Timothy G., additional, Pflueger, Valentin, additional, Thomson, Nicholas R, additional, and Egli, Adrian, additional

Published
2023
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40. Sex differences in mortality of older adults with falls after emergency department consultation: FALL‐ER registry

Author

Miró, Òscar, primary, Gil‐Rodrigo, Adriana, additional, García‐Martínez, Ana, additional, Aguiló, Sira, additional, Alemany, Xavier, additional, Nickel, Christian H., additional, Jacob, Javier, additional, Llorens, Pere, additional, Herrero, Pablo, additional, Torres‐Machado, Victoria, additional, Cenjor, Raquel, additional, Coll‐Vinent, Blanca, additional, Martínez‐Nadal, Gemma, additional, del Nogal, Montserrat Lázaro, additional, Peacock, Frank, additional, and Martín‐Sánchez, Francisco Javier, additional

Published
2023
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42. A tale of two continents: The performance of six early warning scores in two emergency departments.

Author

Lo, Ronson Sze Long, Lyngholm, Le Elias, Brabrand, Mikkel, Leung, Ling Yan, Hung, Kevin Kei Ching, Laugesen, Sune, Posth, Stefan, Cooksley, Tim, Graham, Colin A, and Nickel, Christian H

Subjects
EARLY warning score, HOSPITAL emergency services, PHYSIOLOGY, MORTALITY, CLINICAL deterioration
Abstract

Background: Several early warning scores have been designed to optimize acute care by identifying patients at risk of deterioration. Methods: In this post hoc dual center study, we analyzed the performance of six clinical scores (the Goodacre score, Groarke, Worthing Physiological Score, Rapid Acute Physiology Score, Rapid Emergency Medicine Score, United Kingdom National Early Warning Score. The primary outcome is 30-day all-cause mortality after inclusion and data were obtained from previous studies performed at two different emergency departments on two continents (Denmark, Europe, and Hong Kong, Asia). Results: We included 2952 people; 1482 (50.2%) were male, mean age (standard deviation) was 65.7 (18.3) years, and 109 (3.7%) died within 30 days. Mortality rate increased steadily with increasing scores for all six scoring systems in Hong Kong while this was less obvious in Denmark. In all patients, Rapid Acute Physiology Score had the lowest discriminatory power while National Early Warning Score had the highest. National Early Warning Score performed best in Hong Kong while Worthing performed marginally better in Denmark. Discussion: Surprisingly, the performance of the scoring systems varied considerably, but were largely unaffected by location, and none of them performed close to what clinicians would normally require for predicting 30-day all-cause mortality Conclusion: All scores performed similarly across both centers, with poor prediction of 30-day all-cause mortality. Based on these findings, we believe that clinical scores must be supplemented by either biochemical values or global markers of physiological reserve to reflect reality and to be of true value. [ABSTRACT FROM AUTHOR]

Published
2023
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45. Bacterial genome-wide association study substantiates papGII of Escherichia coli as a major risk factor for urosepsis

Author

Cuénod, Aline; https://orcid.org/0000-0002-8522-6134, Agnetti, Jessica, Seth-Smith, Helena M B, Roloff, Tim, Wälchli, Denise, Shcherbakov, Dimitri, Akbergenov, Rashid, Tschudin-Sutter, Sarah, Bassetti, Stefano, Siegemund, Martin, Nickel, Christian H, Moran-Gilad, Jacob, Keys, Timothy G, Pflüger, Valentin, Thomson, Nicholas R, Egli, Adrian, Cuénod, Aline; https://orcid.org/0000-0002-8522-6134, Agnetti, Jessica, Seth-Smith, Helena M B, Roloff, Tim, Wälchli, Denise, Shcherbakov, Dimitri, Akbergenov, Rashid, Tschudin-Sutter, Sarah, Bassetti, Stefano, Siegemund, Martin, Nickel, Christian H, Moran-Gilad, Jacob, Keys, Timothy G, Pflüger, Valentin, Thomson, Nicholas R, and Egli, Adrian

Abstract

BACKGROUND Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, often caused by uropathogenic Escherichia coli. Multiple bacterial virulence factors or patient characteristics have been linked separately to progressive, more invasive infections. In this study, we aim to identify pathogen- and patient-specific factors that drive the progression to urosepsis by jointly analysing bacterial and host characteristics. METHODS We analysed 1076 E. coli strains isolated from 825 clinical cases with UTI and/or bacteraemia by whole-genome sequencing (Illumina). Sequence types (STs) were determined via srst2 and capsule loci via fastKaptive. We compared the isolates from urine and blood to confirm clonality. Furthermore, we performed a bacterial genome-wide association study (bGWAS) (pyseer) using bacteraemia as the primary clinical outcome. Clinical data were collected by an electronic patient chart review. We concurrently analysed the association of the most significant bGWAS hit and important patient characteristics with the clinical endpoint bacteraemia using a generalised linear model (GLM). Finally, we designed qPCR primers and probes to detect papGII-positive E. coli strains and prospectively screened E. coli from urine samples (n = 1657) at two healthcare centres. RESULTS Our patient cohort had a median age of 75.3 years (range: 18.00-103.1) and was predominantly female (574/825, 69.6%). The bacterial phylogroups B2 (60.6%; 500/825) and D (16.6%; 137/825), which are associated with extraintestinal infections, represent the majority of the strains in our collection, many of which encode a polysaccharide capsule (63.4%; 525/825). The most frequently observed STs were ST131 (12.7%; 105/825), ST69 (11.0%; 91/825), and ST73 (10.2%; 84/825). Of interest, in 12.3% (13/106) of cases, the E. coli pairs in urine and blood were only distantly related. In line with previous bGWAS studies, we identified the gene papGII (p-value < 0.001), which en

Published
2023

46. Tranexamic Acid for Intracerebral Hemorrhage in Patients on Non-Vitamin K Antagonist Oral Anticoagulants (TICH-NOAC): A Multicenter, Randomized, Placebo-Controlled, Phase 2 Trial

Author

Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Siepen, Bernhard M; https://orcid.org/0000-0003-0240-4191, Schaedelin, Sabine, Tsakiris, Dimitrios A; https://orcid.org/0009-0009-3135-4630, Stippich, Christoph, Guzman, Raphael, Nickel, Christian H; https://orcid.org/0000-0001-6619-9284, Sprigg, Nikola; https://orcid.org/0000-0002-5871-8168, Kägi, Georg; https://orcid.org/0000-0001-7749-8060, Vehoff, Jochen; https://orcid.org/0000-0001-9531-8262, Barinka, Filip; https://orcid.org/0000-0002-5823-0656, Thilemann, Sebastian; https://orcid.org/0000-0002-2735-0794, Maurer, Marina, Wagner, Benjamin; https://orcid.org/0000-0001-9330-1790, Traenka, Christopher; https://orcid.org/0000-0002-7600-1005, Gensicke, Henrik; https://orcid.org/0000-0002-0949-2422, De Marchis, Gian Marco; https://orcid.org/0000-0002-0342-9780, Bonati, Leo H; https://orcid.org/0000-0003-1163-8133, Fischer, Urs; https://orcid.org/0000-0003-0521-4051, Z'Graggen, Werner J; https://orcid.org/0000-0002-5684-4419, Nedeltchev, Krassen, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Baumgartner, Philipp; https://orcid.org/0000-0003-1525-2019, Engelter, Stefan T; https://orcid.org/0000-0003-3855-6234, Seiffge, David J; https://orcid.org/0000-0003-3890-3849, Peters, Nils; https://orcid.org/0000-0001-8451-7389, Lyrer, Philippe A; https://orcid.org/0000-0002-1435-1114, TICH-NOAC Investigators, Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Siepen, Bernhard M; https://orcid.org/0000-0003-0240-4191, Schaedelin, Sabine, Tsakiris, Dimitrios A; https://orcid.org/0009-0009-3135-4630, Stippich, Christoph, Guzman, Raphael, Nickel, Christian H; https://orcid.org/0000-0001-6619-9284, Sprigg, Nikola; https://orcid.org/0000-0002-5871-8168, Kägi, Georg; https://orcid.org/0000-0001-7749-8060, Vehoff, Jochen; https://orcid.org/0000-0001-9531-8262, Barinka, Filip; https://orcid.org/0000-0002-5823-0656, Thilemann, Sebastian; https://orcid.org/0000-0002-2735-0794, Maurer, Marina, Wagner, Benjamin; https://orcid.org/0000-0001-9330-1790, Traenka, Christopher; https://orcid.org/0000-0002-7600-1005, Gensicke, Henrik; https://orcid.org/0000-0002-0949-2422, De Marchis, Gian Marco; https://orcid.org/0000-0002-0342-9780, Bonati, Leo H; https://orcid.org/0000-0003-1163-8133, Fischer, Urs; https://orcid.org/0000-0003-0521-4051, Z'Graggen, Werner J; https://orcid.org/0000-0002-5684-4419, Nedeltchev, Krassen, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Baumgartner, Philipp; https://orcid.org/0000-0003-1525-2019, Engelter, Stefan T; https://orcid.org/0000-0003-3855-6234, Seiffge, David J; https://orcid.org/0000-0003-3890-3849, Peters, Nils; https://orcid.org/0000-0001-8451-7389, Lyrer, Philippe A; https://orcid.org/0000-0002-1435-1114, and TICH-NOAC Investigators

Abstract

BACKGROUND: Evidence-based hemostatic treatment for intracerebral hemorrhage (ICH) associated with non-vitamin K antagonist oral anticoagulants (NOACs) is lacking. Tranexamic acid (TXA) is an antifibrinolytic drug potentially limiting hematoma expansion. We aimed to assess the efficacy and safety of TXA in NOAC-ICH. METHODS: We performed a double-blind, randomized, placebo-controlled trial at 6 Swiss stroke centers. Patients with NOAC-ICH within 12 hours of symptom onset and 48 hours of last NOAC intake were randomized (1:1) to receive either intravenous TXA (1 g over 10 minutes followed by 1 g over 8 hours) or matching placebo in addition to standard medical care via a centralized Web-based procedure with minimization on key prognostic factors. All participants and investigators were masked to treatment allocation. Primary outcome was hematoma expansion, defined as ≥33% relative or ≥6 mL absolute volume increase at 24 hours and analyzed using logistic regression adjusted for baseline hematoma volume on an intention-to-treat basis. RESULTS: Between December 12, 2016, and September 30, 2021, we randomized 63 patients (median age, 82 years [interquartile range, 76-86]; 40% women; median hematoma volume, 11.5 [4.8-27.4] mL) of the 109 intended sample size before premature trial discontinuation due to exhausted funding. The primary outcome did not differ between TXA (n=32) and placebo (n=31) arms (12 [38%] versus 14 [45%]; adjusted odds ratio, 0.63 [95% CI, 0.22-1.82]; P=0.40). There was a signal for interaction with onset-to-treatment time (P$_{interaction}$=0.024), favoring TXA when administered within 6 hours of symptom onset. Between the TXA and placebo arms, the proportion of participants who died (15 [47%] versus 13 [42%]; adjusted odds ratio, 1.07 [0.37-3.04]; P=0.91) or had major thromboembolic complications within 90 days (4 [13%] versus 2 [6%]; odds ratio, 1.86 [0.37-9.50]; P=0.45) did not differ. All thromboembolic events occurred at least 2 weeks after study

Published
2023

47. Mechanical Thrombectomy Versus Best Medical Treatment in the Late Time Window in Non-DEFUSE-Non-DAWN Patients: A Multicenter Cohort Study

Author

Dittrich, Tolga D; https://orcid.org/0000-0002-9987-3631, Sporns, Peter B; https://orcid.org/0000-0002-3028-0539, Kriemler, Lilian F, Rudin, Salome, Nguyen, Anh; https://orcid.org/0000-0002-9343-8276, Zietz, Annaelle; https://orcid.org/0000-0002-4362-2497, Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Tränka, Christopher, Thilemann, Sebastian; https://orcid.org/0000-0002-2735-0794, Wagner, Benjamin; https://orcid.org/0000-0001-9330-1790, Altersberger, Valerian L; https://orcid.org/0000-0002-0610-9328, Piot, Ines; https://orcid.org/0000-0001-8502-7453, Barinka, Filip; https://orcid.org/0000-0002-5823-0656, Müller, Susanne; https://orcid.org/0000-0002-5638-722X, Hänsel, Martin; https://orcid.org/0000-0001-9300-1130, Gensicke, Henrik; https://orcid.org/0000-0002-0949-2422, Engelter, Stefan T; https://orcid.org/0000-0003-3855-6234, Lyrer, Philippe A; https://orcid.org/0000-0002-1435-1114, Sutter, Raoul; https://orcid.org/0000-0002-6575-356X, Nickel, Christian H, Katan, Mira; https://orcid.org/0000-0002-9265-8066, Peters, Nils, Kulcsár, Zsolt; https://orcid.org/0000-0002-6805-5150, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Pileggi, Marco; https://orcid.org/0000-0002-7691-8999, Cereda, Carlo; https://orcid.org/0000-0002-6479-1476, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Bonati, Leo H; https://orcid.org/0000-0003-1163-8133, Fischer, Urs; https://orcid.org/0000-0003-0521-4051, Psychogios, Marios; https://orcid.org/0000-0002-0016-414X, et al, Dittrich, Tolga D; https://orcid.org/0000-0002-9987-3631, Sporns, Peter B; https://orcid.org/0000-0002-3028-0539, Kriemler, Lilian F, Rudin, Salome, Nguyen, Anh; https://orcid.org/0000-0002-9343-8276, Zietz, Annaelle; https://orcid.org/0000-0002-4362-2497, Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Tränka, Christopher, Thilemann, Sebastian; https://orcid.org/0000-0002-2735-0794, Wagner, Benjamin; https://orcid.org/0000-0001-9330-1790, Altersberger, Valerian L; https://orcid.org/0000-0002-0610-9328, Piot, Ines; https://orcid.org/0000-0001-8502-7453, Barinka, Filip; https://orcid.org/0000-0002-5823-0656, Müller, Susanne; https://orcid.org/0000-0002-5638-722X, Hänsel, Martin; https://orcid.org/0000-0001-9300-1130, Gensicke, Henrik; https://orcid.org/0000-0002-0949-2422, Engelter, Stefan T; https://orcid.org/0000-0003-3855-6234, Lyrer, Philippe A; https://orcid.org/0000-0002-1435-1114, Sutter, Raoul; https://orcid.org/0000-0002-6575-356X, Nickel, Christian H, Katan, Mira; https://orcid.org/0000-0002-9265-8066, Peters, Nils, Kulcsár, Zsolt; https://orcid.org/0000-0002-6805-5150, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Pileggi, Marco; https://orcid.org/0000-0002-7691-8999, Cereda, Carlo; https://orcid.org/0000-0002-6479-1476, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Bonati, Leo H; https://orcid.org/0000-0003-1163-8133, Fischer, Urs; https://orcid.org/0000-0003-0521-4051, Psychogios, Marios; https://orcid.org/0000-0002-0016-414X, and et al

Abstract

Background: We assessed the efficacy and safety of mechanical thrombectomy (MT) in adult stroke patients with anterior circulation large vessel occlusion presenting in the late time window not fulfilling the DEFUSE-3 (Thrombectomy for Stroke at 6 to 16 Hours With Selection by Perfusion Imaging trial) and DAWN (Thrombectomy 6 to 24 Hours After Stroke With a Mismatch Between Deficit and Infarct trial) inclusion criteria. Methods: Cohort study of adults with anterior circulation large vessel occlusion admitted between 6 and 24 hours after last-seen-well at 5 participating Swiss stroke centers between 2014 and 2021. Mismatch was assessed by computer tomography or magnetic resonance imaging perfusion with automated software (RAPID or OLEA). We excluded patients meeting DEFUSE-3 and DAWN inclusion criteria and compared those who underwent MT with those receiving best medical treatment alone by inverse probability of treatment weighting using the propensity score. The primary efficacy end point was a favorable functional outcome at 90 days, defined as a modified Rankin Scale score shift toward lower categories. The primary safety end point was symptomatic intracranial hemorrhage within 7 days of stroke onset; the secondary was all-cause mortality within 90 days. Results: Among 278 patients with anterior circulation large vessel occlusion presenting in the late time window, 190 (68%) did not meet the DEFUSE-3 and DAWN inclusion criteria and thus were included in the analyses. Of those, 102 (54%) received MT. In the inverse probability of treatment weighting analysis, patients in the MT group had higher odds of favorable outcomes compared with the best medical treatment alone group (modified Rankin Scale shift: acOR, 1.46 [1.02–2.10]; P=0.04) and lower odds of all-cause mortality within 90 days (aOR, 0.59 [0.37–0.93]; P=0.02). There were no significant differences in symptomatic intracranial hemorrhage (MT versus best medical treatment alone: 5% versus 2%, P=0.63). Conclusio

Published
2023

48. Comparing the utility of clinical risk scores and integrated clinical judgement in patients with suspected acute coronary syndrome

Author

Meier, Mario; https://orcid.org/0000-0003-4832-2095, Boeddinghaus, Jasper; https://orcid.org/0000-0003-4404-4956, Nestelberger, Thomas; https://orcid.org/0000-0003-2173-5738, Koechlin, Luca; https://orcid.org/0000-0002-2929-8600, Lopez-Ayala, Pedro; https://orcid.org/0000-0002-7787-0640, Wussler, Desiree; https://orcid.org/0000-0002-1793-5297, Walter, Joan Elias, Zimmermann, Tobias; https://orcid.org/0000-0002-6862-5205, Badertscher, Patrick; https://orcid.org/0000-0001-9751-0557, Wildi, Karin, Giménez, Maria Rubini, Puelacher, Christian; https://orcid.org/0000-0003-3206-6349, Glarner, Noemi; https://orcid.org/0000-0001-9651-8848, Magni, Jan, Miró, Òscar; https://orcid.org/0000-0002-7924-9751, Martin-Sanchez, Francisco Javier, Kawecki, Damian; https://orcid.org/0000-0003-4445-9721, Keller, Dagmar I, Gualandro, Danielle M, Twerenbold, Raphael; https://orcid.org/0000-0003-3814-6542, Nickel, Christian H; https://orcid.org/0000-0001-6619-9284, Bingisser, Roland; https://orcid.org/0000-0001-8223-9792, Mueller, Christian; https://orcid.org/0000-0002-1120-6405, Meier, Mario; https://orcid.org/0000-0003-4832-2095, Boeddinghaus, Jasper; https://orcid.org/0000-0003-4404-4956, Nestelberger, Thomas; https://orcid.org/0000-0003-2173-5738, Koechlin, Luca; https://orcid.org/0000-0002-2929-8600, Lopez-Ayala, Pedro; https://orcid.org/0000-0002-7787-0640, Wussler, Desiree; https://orcid.org/0000-0002-1793-5297, Walter, Joan Elias, Zimmermann, Tobias; https://orcid.org/0000-0002-6862-5205, Badertscher, Patrick; https://orcid.org/0000-0001-9751-0557, Wildi, Karin, Giménez, Maria Rubini, Puelacher, Christian; https://orcid.org/0000-0003-3206-6349, Glarner, Noemi; https://orcid.org/0000-0001-9651-8848, Magni, Jan, Miró, Òscar; https://orcid.org/0000-0002-7924-9751, Martin-Sanchez, Francisco Javier, Kawecki, Damian; https://orcid.org/0000-0003-4445-9721, Keller, Dagmar I, Gualandro, Danielle M, Twerenbold, Raphael; https://orcid.org/0000-0003-3814-6542, Nickel, Christian H; https://orcid.org/0000-0001-6619-9284, Bingisser, Roland; https://orcid.org/0000-0001-8223-9792, and Mueller, Christian; https://orcid.org/0000-0002-1120-6405

Abstract

Aims The utility of clinical risk scores regarding the prediction of major adverse cardiac events (MACE) is uncertain. We aimed to directly compare the prognostic performance of five established clinical risk scores as well as an unstructured integrated clinical judgement (ICJ) of the treating emergency department (ED) physician. Methods and results Thirty-day MACE including all-cause death, life-threatening arrhythmia, cardiogenic shock, acute myocardial infarction (including the index event), and unstable angina requiring urgent coronary revascularization were centrally adjudicated by two independent cardiologists in patients presenting to the ED with acute chest discomfort in an international multicentre study. We compared the prognostic performance of the HEART score, GRACE score, T-MACS, TIMI score, and EDACS, as well as the unstructured ICJ of the treating ED physician (visual analogue scale to estimate the probability of acute coronary syndrome, ranging from 0 to 100). Among 4551 eligible patients, 1110/4551 patients (24.4%) had at least one MACE within 30 days. Prognostic accuracy was high and comparable for the HEART score, GRACE score, T-MACS, and ICJ [area under the receiver operating characteristic curve (AUC) 0.85–0.87] but significantly lower and only moderate for the TIMI score (AUC 0.79, P < 0.001) and EDACS (AUC 0.74, P < 0.001), resulting in sensitivities for the rule-out of 30-day MACE of 93–96, 87 (P < 0.001), and 72% (P < 0.001), respectively. Conclusion The HEART score, GRACE score, T-MACS, and unstructured ICJ of the treating physician, not the TIMI score or EDACS, performed well for the prediction of 30-day MACE and may be considered for routine clinical use. Trial registration ClinicalTrials.gov number NCT00470587

Published
2023

49. Association of accompanying dyspnea with diagnosis and outcome of patients presenting with acute chest discomfort

Author

Boeddinghaus, Jasper; https://orcid.org/0000-0003-4404-4956, Nestelberger, Thomas; https://orcid.org/0000-0003-2173-5738, Koechlin, Luca; https://orcid.org/0000-0002-2929-8600, Lopez-Ayala, Pedro; https://orcid.org/0000-0002-7787-0640, Wussler, Desiree; https://orcid.org/0000-0002-1793-5297, Mais, Maximilian, Zwimpfer, Luca; https://orcid.org/0000-0003-3269-5786, Zimmermann, Tobias; https://orcid.org/0000-0002-6862-5205, Wildi, Karin, Rubini Giménez, Maria; https://orcid.org/0000-0003-2384-8250, Strebel, Ivo; https://orcid.org/0000-0001-9976-4112, Miró, Òscar; https://orcid.org/0000-0002-7924-9751, Martín-Sánchez, F Javier, Parenica, Jiri, Keller, Dagmar I, Gualandro, Danielle Menosi; https://orcid.org/0000-0001-9041-6250, Nickel, Christian H; https://orcid.org/0000-0001-6619-9284, Bingisser, Roland; https://orcid.org/0000-0001-8223-9792, Christ, Michael, Mueller, Christian; https://orcid.org/0000-0002-1120-6405, APACE investigators, Boeddinghaus, Jasper; https://orcid.org/0000-0003-4404-4956, Nestelberger, Thomas; https://orcid.org/0000-0003-2173-5738, Koechlin, Luca; https://orcid.org/0000-0002-2929-8600, Lopez-Ayala, Pedro; https://orcid.org/0000-0002-7787-0640, Wussler, Desiree; https://orcid.org/0000-0002-1793-5297, Mais, Maximilian, Zwimpfer, Luca; https://orcid.org/0000-0003-3269-5786, Zimmermann, Tobias; https://orcid.org/0000-0002-6862-5205, Wildi, Karin, Rubini Giménez, Maria; https://orcid.org/0000-0003-2384-8250, Strebel, Ivo; https://orcid.org/0000-0001-9976-4112, Miró, Òscar; https://orcid.org/0000-0002-7924-9751, Martín-Sánchez, F Javier, Parenica, Jiri, Keller, Dagmar I, Gualandro, Danielle Menosi; https://orcid.org/0000-0001-9041-6250, Nickel, Christian H; https://orcid.org/0000-0001-6619-9284, Bingisser, Roland; https://orcid.org/0000-0001-8223-9792, Christ, Michael, Mueller, Christian; https://orcid.org/0000-0002-1120-6405, and APACE investigators

Abstract

AIM: The presence of accompanying dyspnea is routinely assessed and common in patients presenting with acute chest pain/discomfort to the emergency department (ED). We aimed to assess the association of accompanying dyspnea with differential diagnoses, diagnostic work-up and outcome. METHODS: We enrolled patients presenting to the ED with chest pain/discomfort. Final diagnoses were adjudicated by independent cardiologists using all information including cardiac imaging. The primary diagnostic endpoint was the final diagnosis. The secondary diagnostic endpoint was the performance of high-sensitivity cardiac troponin (hs-cTn) and the European Society of Cardiology (ESC) 0/1h-algorithms for the diagnosis of myocardial infarction (MI). The prognostic endpoints were cardiovascular and all-cause mortality at two years. RESULTS: Among 6045 patients, 2892/6045 (48%) had accompanying dyspnea. The prevalence of ACS in patients with versus without dyspnea was comparable (MI 22.4% vs. 21.9%, p = 0.60, unstable angina 8.7% vs. 7.9%, p = 0.29). In contrast, patients with dyspnea more often had cardiac, non-coronary disease (15.3% vs. 10.2%, p < 0.001). Diagnostic accuracy of hs-cTnT/I concentrations was not affected by the presence of dyspnea (area under the curve 0.89-0.91 in both groups) and the safety of the ESC 0/1h-algorithms was maintained with negative predictive values >99.4%. Accompanying dyspnea was an independent predictor for cardiovascular and all-cause death at two years (Hazard Ratio [HR] 1.813 [95%CI, 1.453-2.261, p < 0.01]). CONCLUSION: Accompanying dyspnea was not associated with a higher prevalence of ACS but with cardiac, non-coronary disease. While the safety of the diagnostic work-up was not affected, accompanying dyspnea was an independent predictor for cardiovascular and all-cause death.

Published
2023

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