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1. Diagnostic accuracy of a rapid RT-PCR assay for point-of-care detection of influenza A/B virus at emergency department admission: A prospective evaluation during the 2017/2018 influenza season.

Author

Maxime Maignan, Damien Viglino, Maud Hablot, Nicolas Termoz Masson, Anne Lebeugle, Roselyne Collomb Muret, Prudence Mabiala Makele, Valérie Guglielmetti, Patrice Morand, Julien Lupo, Virginie Forget, Caroline Landelle, and Sylvie Larrat

Subjects
Medicine, Science
Abstract

Study objectiveTo investigate the performance of a rapid RT-PCR assay to detect influenza A/B at emergency department admission.MethodsThis single-center prospective study recruited adult patients attending the emergency department for influenza-like illness. Triage nurses performed nasopharyngeal swab samples and ran rapid RT-PCR assays using a dedicated device (cobas Liat, Roche Diagnostics, Meylan, France) located at triage. The same swab sample was also analyzed in the department of virology using conventional RT-PCR techniques. Patients were included 24 hours-a-day, 7 days-a-week. The primary outcome was the diagnostic accuracy of the rapid RT-PCR assay performed at triage.ResultsA total of 187 patients were included over 11 days in January 2018. Median age was 70 years (interquartile range 44 to 84) and 95 (51%) were male. Nine (5%) assays had to be repeated due to failure of the first assay. The sensitivity of the rapid RT-PCR assay performed at triage was 0.98 (95% confidence interval (CI): 0.91-1.00) and the specificity was 0.99 (95% CI: 0.94-1.00). A total of 92 (49%) assays were performed at night-time or during the weekend. The median time from patient entry to rapid RT-PCR assay results was 46 [interquartile range 36-55] minutes.ConclusionRapid RT-PCR assay performed by nurses at triage to detect influenza A/B is feasible and highly accurate.

Published
2019
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2. Multimodal oral analgesia for non-severe trauma patients: evaluation of a triage-nurse directed protocol combining methoxyflurane, paracetamol and oxycodone

Author

Flore Champel, Cédric Falcon, Maxime Maignan, Prudence Mabiala Makele, Agnès Verdetti, Roselyne Collomb Muret, Alexis Mouthon, Damien Viglino, Caroline Maindet Dominici, and Nicolas Termoz Masson

Subjects
Adult, Male, Radiography, Administration, Oral, Context (language use), 030204 cardiovascular system & hematology, Statistics, Nonparametric, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Methoxyflurane, Prevalence, Internal Medicine, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, Adverse effect, Acetaminophen, Analgesics, business.industry, Emergency department, Middle Aged, Treatment Outcome, Patient Satisfaction, Anesthesia, Emergency Medicine, Wounds and Injuries, Female, Observational study, France, Triage, Emergency Service, Hospital, business, Oxycodone, medicine.drug
Abstract

Insufficient analgesia affects around 50% of emergency department patients. The use of a protocol helps to reduce the risk of oligoanalgesia in this context. Our objective was to describe the feasibility and efficacy of a multimodal analgesia protocol (combining paracetamol, oxycodone, and inhaled methoxyflurane) initiated by triage nurse. We performed a prospective, observational study in an emergency department (Grenoble Alpes University Hospital, France) between December 2017 and April 2018. Adult non-severe trauma patients with a numerical pain rating scale (NRS) score ≥ 4 were included. The primary efficacy criterion was the proportion of patients with an NRS score ≤ 3 at 15 min. Pain intensity was measured for 60 min and during radiography. Data on adverse events and satisfaction were recorded. A total of 200 adult patients were included (median [interquartile range (IQR)] age: 32 [23-49] years; 126 men (63%)). Sixty-six patients (33%) reported an NRS score ≤ 3 at 15 min. The time required to achieve a decrease of at least 2 points in the NRS score was 10 (5-20) min. The median [IQR] pain intensity was 4 [2-5] before radiography and 4 [2-6] during radiography. Adverse events were frequent (n = 128, 64%). No serious adverse events were reported. The patients and caregivers reported good levels of satisfaction. The administration of a nurse-driven multimodal analgesia protocol (combining paracetamol, oxycodone, and methoxyflurane) was feasible on admission to the emergency department. It rapidly produced long-lasting analgesia in adult trauma patients.Trial registration: NCT03380247.

Published
2019

3. Diagnostic accuracy of a rapid RT-PCR assay for point-of-care detection of influenza A/B virus at emergency department admission: A prospective evaluation during the 2017/2018 influenza season

Author

Roselyne Collomb Muret, Anne Lebeugle, Valérie Guglielmetti, Sylvie Larrat, Virginie Forget, Prudence Mabiala Makele, Maxime Maignan, Julien Lupo, Damien Viglino, Maud Hablot, Patrice Morand, Nicolas Termoz Masson, Caroline Landelle, Hypoxie : Physiopathologie Respiratoire et Cardiovasculaire (HP2 ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Emergency department [Grenoble], Centre Hospitalier Universitaire [Grenoble] (CHU), Institut de biologie structurale (IBS - UMR 5075 ), Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Laboratoire de Virologie [Grenoble], Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Infection Control Unit [Grenoble], Techniques pour l'Evaluation et la Modélisation des Actions de la Santé (TIMC-IMAG-ThEMAS), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), This work was partly funded by Roche Diagnostics (http://www.roche-diagnostics.fr/), the industrial company that markets the cobas Liat system. MM received this grant., Laboratoire Hypoxie et Physiopathologies cardiovasculaires et respiratoires [Grenoble] (HP2), Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), and Bodescot, Myriam

Subjects
0301 basic medicine, Male, RNA viruses, Viral Diseases, Influenza Viruses, Critical Care and Emergency Medicine, Health Care Providers, Nurses, Artificial Gene Amplification and Extension, medicine.disease_cause, Roche Diagnostics, Pathology and Laboratory Medicine, Polymerase Chain Reaction, Biochemistry, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Interquartile range, Nucleic Acids, Influenza A virus, Medicine and Health Sciences, Medicine, 030212 general & internal medicine, Prospective Studies, Medical Personnel, Prospective cohort study, Aged, 80 and over, Multidisciplinary, Reverse Transcriptase Polymerase Chain Reaction, Middle Aged, 3. Good health, Professions, Infectious Diseases, Molecular Diagnostic Techniques, Medical Microbiology, Viral Pathogens, Viruses, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, France, Seasons, Pathogens, Emergency Service, Hospital, Research Article, Adult, medicine.medical_specialty, Science, Point-of-Care Systems, 030106 microbiology, Research and Analysis Methods, Microbiology, Specimen Handling, 03 medical and health sciences, Internal medicine, Virology, Influenza, Human, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, Humans, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, Molecular Biology Techniques, Molecular Biology, Microbial Pathogens, Point of care, Aged, business.industry, Organisms, Biology and Life Sciences, Emergency department, Reverse Transcriptase-Polymerase Chain Reaction, Triage, Confidence interval, Influenza, Health Care, Influenza B virus, People and Places, Population Groupings, business, Orthomyxoviruses
Abstract

Study objectiveTo investigate the performance of a rapid RT-PCR assay to detect influenza A/B at emergency department admission.MethodsThis single-center prospective study recruited adult patients attending the emergency department for influenza-like illness. Triage nurses performed nasopharyngeal swab samples and ran rapid RT-PCR assays using a dedicated device (cobas Liat, Roche Diagnostics, Meylan, France) located at triage. The same swab sample was also analyzed in the department of virology using conventional RT-PCR techniques. Patients were included 24 hours-a-day, 7 days-a-week. The primary outcome was the diagnostic accuracy of the rapid RT-PCR assay performed at triage.ResultsA total of 187 patients were included over 11 days in January 2018. Median age was 70 years (interquartile range 44 to 84) and 95 (51%) were male. Nine (5%) assays had to be repeated due to failure of the first assay. The sensitivity of the rapid RT-PCR assay performed at triage was 0.98 (95% confidence interval (CI): 0.91-1.00) and the specificity was 0.99 (95% CI: 0.94-1.00). A total of 92 (49%) assays were performed at night-time or during the weekend. The median time from patient entry to rapid RT-PCR assay results was 46 [interquartile range 36-55] minutes.ConclusionRapid RT-PCR assay performed by nurses at triage to detect influenza A/B is feasible and highly accurate.

Published
2019

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