Healthcare-associated adverse events and readmission to the emergency departments within seven days after a first consultation.

Introduction: The use of emergency hospital service has become increasingly frequent with a rise of approximately 3.6%. in annual emergency department visits. The objective of this study was to describe the reasons for reconsultations to emergency departments and to identify the risk and protective factors of reconsultations linked to healthcare-associated adverse events. Materials and methods: A retrospective, descriptive, multicenter study was performed in the emergency department of Troyes Hospital and the Sainte Anne Army Training Hospital in Toulon, France from January 1 to December 31, 2019. Patients over 18 years of age who returned to the emergency department for a reconsultation within 7 days were included. Healthcare-associated adverse events in the univariate analysis (p < 0.10) were introduced into a multivariate logistic regression model. Model performance was examined using the Hosmer-Lemeshow test and calculated with c-statistic. Results: Weekend visits and performing radiology examinations were risk factors linked to healthcare associated adverse events. Biological examinations and the opinion of a specialist were protective factors. Discussion: Numerous studies have reported that a first consultation occurring on a weekend is a reconsultation risk factor for healthcare-associated adverse events, however, performing radiology examinations were subjected to confusion bias. Patients having radiology examinations due to trauma-related pathologies were more apt for a reconsultation. Conclusion: Our study supports the need for better emergency departments access to biological examinations and specialist second medical opinions. An appropriate patient to doctor ratio in hospital emergency departments may be necessary at all times.

S100ß protein for non-traumatic subarachnoid hemorrhage diagnosis.

INTRODUCTION: The S100ß protein (PS100ß) is a biomarker, which has demonstrated its importance in diagnoses ruling out intracranial hemorrhages in people with light head traumas This study aims to evaluate if the PS100ß presents an interest in the diagnostic strategy for subarachnoid hemorrhages (SAH). METHODS: Prospective non-randomized multicentric study in three hospitals from October 2018 to January 2020. Every patient who came into the emergency department for an intense non-traumatic headache lasting less than 3 h received an PS100ß assay and a non-injected head computed tomography (CT) scan. The primary endpoint was the number of patients with a diagnosis of SAH on the head CT scan with a PS100ß level of under 0.10 µg/L. RESULTS: 60 patients were included and five patients had a SAH. Four patients had an SAH with a PS100ß level lower than 0.10 µg/L and one patient had an SAH with a PS100ß level higher than 0.10 µg/L. The negative predictive value for the PS100ß with a discriminating threshold less than or equal to 0,10 µg/L in the diagnosis ruling out SAH was 93% [IC 95%: 0,86-1]. CONCLUSION: S100ß protein assay with a discriminating threshold of 0,10 µg/L does not demonstrate any interest in the diagnostic strategy for non-traumatic SAH.

Long-term consequences of electrical injury without initial signs of severity: The AFTER-ELEC study.

BACKGROUND: There is no specificity of emergency or long-term management of benign electrical injuries (EI). The main objective of our work was to describe the occurrence of long-term complications of EI considered as benign. METHODS: Single-center retrospective study of a cohort of adult patients who consulted for EI without initials signs of severity in an emergency department between 2012 and 2019. All included patients were secondarily contacted by telephone at least one year after their EI to complete a questionnaire. RESULTS: 76 adult patients visited the emergency department and 48 of them could be contacted by phone. 82% of the recalled patients had at least one complication following their EI. The main long-term complications were neurological (65%), psychological (58%) and cardiological (31%). Patients recalled eight years after EI had higher rates of neuropsychological complications than those recalled one year after EI. Only the time spent in the emergency department was statistically longer in patients who developed long-term complications compared to those who did not. DISCUSSION: The occurrence of long-term neuropsychological complications predominates. The knowledge and management of these long-term consequences must be particularly well known by emergency physicians because they are often the first medical contact of the patient. Our results also seem to show a crescendo in time of the occurrence of long-term complications. CONCLUSION: all health professionals involved in the care of victims of a EI must be made widely aware of the occurrence of these long-term complications, particularly neuropsychological ones, in order to improve the long-term patient care.

What's the hospitalisation's impact on background treatments of patients over 65 years.

As our population aging increases, it requires a particular attention from the health system. Indeed, elderly are often frail, with several diseases and presenting high risk of adverse drug accident. Prescribing appropriately to the elderly has become an important matter. Hospitalization and consultation with the general practitioner are key moments for drug prescription. However, their real impact on background treatments of this population has been barely evaluated. A retrospective descriptive study was conducted with 300 patients over 65 years old, hospitalized at the Laveran military hospital in Marseille. Treatment modifications, consecutive to hospitalization and to the first consultation with the general practitioner, were identified and analyzed. We found an average prescription of 5.93 drugs in prehospital period and 66% of the patients with polypharmacy. Drugs for cardiovascular system were the most prescribed and the most modified. Hospitalization generated a rate of modification by prescription of 28.5% and the consultation with the general practitioner following this hospitalization led to further change in 48% of cases. Beside the important prevalence of patients with polypharmacy, this study shows that hospitalization entails a significant change in background treatments in that population at risk. Therefore, it is important to have a consensus in the re-evaluation of these treatments, in order to prevent the iatrogenic risk.

A 78-year-old woman with an acute eosinophilic gastroenteritis.

Eosinophil accumulation in the gastrointestinal tract is a common feature of numerous disorders including mainly parasitic infection, drug-induced allergic reactions, inflammatory bowel disease, and various connective tissue disorders. Digestive tissue eosinophilia requires thorough searching for secondary causes that may be specifically treated with antibiotics, dietary and drug elimination or immunosuppressive therapy. Frequency, prognosis and therapeutic implications must guide the diagnostic course. An acute eosinophilic gastroenteritis in a 78-year-old asthmatic woman receiving celecoxib is reported. She presented later with neurologic and cutaneous features and was finally treated by methylprednisolone and cyclophosphamide. The diagnostic approach leading to a Churg-Strauss syndrome (CSS) assertion is described. We discuss the pathogenesis, the management and the potential enhancing role of celecoxib in CSS gastrointestinal involvement.