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AIM: Blood Sampling Guidelines have been developed to target European emergency medicine-related professionals involved in the blood sampling process (e.g. physicians, nurses, phlebotomists working in the ED), as well as laboratory physicians and other related professionals. The guidelines population focus on adult patients. The development of these blood sampling guidelines for the ED setting is based on the collaboration of three European scientific societies that have a role to play in the preanalytical phase process: EuSEN, EFLM, and EUSEM. The elaboration of the questions was done using the PICO procedure, literature search and appraisal was based on the GRADE methodology. The final recommendations were reviewed by an international multidisciplinary external review group. RESULTS: The document includes the elaborated recommendations for the selected sixteen questions. Three in pre-sampling, eight regarding sampling, three post-sampling, and two focus on quality assurance. In general, the quality of the evidence is very low, and the strength of the recommendation in all the questions has been rated as weak. The working group in four questions elaborate the recommendations, based mainly on group experience, rating as good practice. CONCLUSIONS: The multidisciplinary working group was considered one of the major contributors to this guideline. The lack of quality information highlights the need for research in this area of the patient care process. The peculiarities of the emergency medical areas need specific considerations to minimise the possibility of errors in the preanalytical phase.
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Coleta de Amostras Sanguíneas , Serviço Hospitalar de Emergência , Humanos , Coleta de Amostras Sanguíneas/normas , Coleta de Amostras Sanguíneas/métodos , Medicina de Emergência/normas , Fase Pré-Analítica/normas , Europa (Continente) , Sociedades Médicas , Química Clínica/normas , Química Clínica/métodosRESUMO
BACKGROUND: Acute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients' ED management and short-term outcomes. METHODS: This was a sub-analysis of a European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from European EDs. Patients with ED diagnosis of acute heart failure were categorized into two groups: those using EMS and those self-presenting (non- EMS). The independent association between EMS use and 30-day mortality was evaluated with logistic regression. RESULTS: Of the 500 acute heart failure patients, with information about the arrival mode to the ED, 309 (61.8%) arrived by EMS. These patients were older (median age 80 vs. 75 years, p < 0.001), more often female (56.4% vs. 42.1%, p = 0.002) and had more dementia (18.7% vs. 7.2%, p < 0.001). On admission, EMS patients had more often confusion (14.2% vs. 2.1%, p < 0.001) and higher respiratory rate (24/min vs. 21/min, p = 0.014; respiratory rate > 30/min in 17.1% patients vs. 7.5%, p = 0.005). The only difference in ED management appeared in the use of ventilatory support: 78.3% of EMS patients vs. 67.5% of non- EMS patients received supplementary oxygen (p = 0.007), and non-invasive ventilation was administered to 12.5% of EMS patients vs. 4.2% non- EMS patients (p = 0.002). EMS patients were more often hospitalized (82.4% vs. 65.9%, p < 0.001), had higher in-hospital mortality (8.7% vs. 3.1%, p = 0.014) and 30-day mortality (14.3% vs. 4.9%, p < 0.001). The use of EMS was an independent predictor of 30-day mortality (OR = 2.54, 95% CI 1.11-5.81, p = 0.027). CONCLUSION: Most acute heart failure patients arrive at ED by EMS. These patients suffer from more severe respiratory distress and receive more often ventilatory support. EMS use is an independent predictor of 30-day mortality.
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Serviços Médicos de Emergência , Insuficiência Cardíaca , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar , Humanos , Admissão do PacienteRESUMO
Background/aim: To describe seasonal variations in epidemiology, management, and short-term outcomes of patients in Europe presenting to an emergency department (ED) with a main complaint of dyspnea. Materials and methods: Anobservational prospective cohort study was performed in 66 European EDs which included consecutive patients presenting to EDs with dyspnea as the main complaint during 3 72-h study periods. Data were collected on demographics, comorbidities, chronic treatment, prehospital treatment, mode of arrival of patient to ED, clinical signs at admission, treatment in the ED, ED diagnosis, discharge from ED, and in-hospital outcome. Results: The study included 2524 patients with a median age of 69 (5380) years old. Of the patients presented, 991 (39.3%) were in autumn, 849 (33.6%) were in spring, and 48 (27.1%) were in winter. The winter population was significantly older (P < 0.001) and had a lower rate of ambulance arrival to ED (P < 0.001). In the winter period, there was a higher rate for lower respiratory tract infection (35.1%), and patients were more hypertensive, more hypoxic, and more hyper/hypothermic compared to other seasons. The ED mortality was about 1% and, in hospital, mortality for admitted patients was 7.4%. Conclusion: The analytic method and the outcome of this study may help to guide the allocation of ED resources more efficiently and to recommend seasonal ED management protocols based on the seasonal trend of dyspneic patients.
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Dispneia/epidemiologia , Dispneia/terapia , Serviço Hospitalar de Emergência , Estações do Ano , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ambulâncias/estatística & dados numéricos , Antibacterianos/uso terapêutico , Broncodilatadores/uso terapêutico , Estudos de Coortes , Comorbidade , Diuréticos/uso terapêutico , Dispneia/fisiopatologia , Europa (Continente)/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/métodos , Estudos ProspectivosRESUMO
BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) are common in emergency departments (ED). Guidelines recommend administration of inhaled bronchodilators, systemic corticosteroids and antibiotics along with non-invasive ventilation (NIV) for patients with respiratory acidosis. AIM: To determine compliance with guideline recommendations for patients treated for COPD in ED in Europe (EUR) and South East Asia/Australasia (SEA) and to compare management and outcomes. METHODS: In each region, an observational prospective cohort study was performed that included patients presenting to ED with the main complaint of dyspnoea during three 72-h periods. This planned sub-study included those with an ED primary discharge diagnosis of COPD. Data were collected on demographics, clinical features, treatment, disposition and in-hospital mortality. We determined overall compliance with guideline recommendations and compared treatments and outcome between regions. RESULTS: A total of 801 patients was included from 122 ED (66 EUR and 46 SEA). Inhaled bronchodilators were administered to 80.3% of patients, systemic corticosteroids to 59.5%, antibiotics to 44 and 60.6% of patients with pH <7.3 received NIV. The proportion administered systemic corticosteroids was higher in SEA (EUR vs SEA for all comparisons; 52 vs 66%, P < 0.001) as was administration of antibiotics (40 vs 49%, P = 0.02). Rates of NIV and mechanical ventilation were similar. Overall in-hospital mortality was 4.2% (SEA 3.9% vs EUR 4.5%, P = 0.77). CONCLUSION: Compliance with guideline recommended treatments, in particular administration of corticosteroids and NIV, was sub-optimal in both regions. Improved compliance has the potential to improve patient outcome.
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Tratamento de Emergência , Guias de Prática Clínica como Assunto , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Idoso de 80 Anos ou mais , Australásia , Serviço Hospitalar de Emergência , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnósticoRESUMO
BACKGROUND AND IMPORTANCE: Patient safety in healthcare is one of the cornerstones of quality of care. The emergency department (ED) is by its very nature a place where errors and safety issues are liable to occur. OBJECTIVE: The aim of the study was to assess health professionals' perception of the level of safety in EDs and to identify in which work domains safety appears most at risk. DESIGN AND PARTICIPANTS: Between 30 January and 27 February 2023, a survey addressing the main domains of safety was distributed to ED health care professionals through the European Society of Emergency Medicine contact network. It addressed five main domains: teamwork, safety leadership, physical environment and equipment, staff/external teams, and organisational factors and informatics, with a number of items for each domain. Further questions about infection control and team morale were added. The Cronbach's alpha measure was calculated to assure internal consistency. MEASURES AND ANALYSIS: A score was developed for each domain by adding the question's value using the following ranking: never (1), rarely (2), sometimes (3), usually (4), and always (5) and was aggregated in three categories. The calculated sample size needed was 1000 respondents. The Wald method was used for analysis of the questions' consistency and X2 for the inferential analysis. MAIN RESULTS: The survey included 1256 responses from 101 different countries; 70% of respondents were from Europe. The survey was completed by 1045 (84%) doctors and 199 (16%) nurses. It was noted that 568 professionals (45.2%) had less than 10 years' experience. Among respondents, 80.61% [95% confidence interval (CI) 78.42-82.8] reported that monitoring devices were available, and 74.7% (95% CI 72.28-77.11) reported that protocols for high-risk medication and for triage (66.19%) were available in their ED. The area of greatest concern was the disproportionate imbalance between needs and the availability of staff at times of greatest flow, considered sufficient by only 22.4% (95% CI 20.07-24.69) of doctors and 20.7% (95% CI 18.41-22.9) of nurses. Other critical issues were overcrowding due to boarding and a perceived lack of support from hospital management. Despite these difficult working conditions, 83% of the professionals said they were proud to work in the ED (95% CI 81.81-85.89). CONCLUSION: This survey highlighted that most health professionals identify the ED as an environment with specific safety issues. The main factors appeared to be a shortage of personnel during busy periods, overcrowding due to boarding, and a perceived lack of support from hospital management.
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Pessoal de Saúde , Segurança do Paciente , Humanos , Inquéritos e Questionários , Atitude do Pessoal de Saúde , Serviço Hospitalar de EmergênciaRESUMO
OBJECTIVE: Lower respiratory tract infection (LRTI) is a frequent cause of dyspnoea in EDs, and is associated with considerable morbidity and mortality. We described and compared the management of this disease in Europe and Oceania/South-East Asia (SEA) cohorts. METHODS: We conducted a prospective cohort study with three time points in Europe and Oceania/SEA. We included in this manuscript patients presenting to EDs with dyspnoea and a diagnosis of LRTI in ED. We collected comorbidities, chronic medication, clinical signs at arrival, laboratory parameters, ED management and patient outcomes. RESULTS: A total of 1389 patients were included, 773 in Europe and 616 in SEA. The European cohort had more comorbidities including chronic heart failure, obesity, chronic obstructive pulmonary disease and smoking. Levels of inflammatory markers were higher in Europe. There were more patients with inflammatory markers in Europe and more hypercapnia in Oceania/SEA. The use of antibiotics was higher in SEA (72.2% vs 61.8%, P < 0.001) whereas intravenous diuretics, non-invasive and invasive ventilation were higher in Europe. Intensive care unit admission rate was 9.9% in Europe cohort and 3.4% in Oceania/SEA cohort. ED mortality was 1% and overall in-hospital mortality was 8.7% with no differences between regions. CONCLUSIONS: More patients with LRTI in Europe presented with cardio-respiratory comorbidities, they received more adjunct therapies and had a higher intensive care unit admission rate than patients from Oceania/SEA, although mortality was similar between the two cohorts.
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Dispneia , Infecções Respiratórias , Dispneia/epidemiologia , Dispneia/etiologia , Serviço Hospitalar de Emergência , Humanos , Estudos Prospectivos , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Resultado do TratamentoRESUMO
The 2019 novel coronavirus acute respiratory epidemic is creating a stressed situation in all the health systems of the affected countries. Emergency medical systems and specifically the emergency departments as the front line of the health systems are suffering from overload and severe working conditions, the risk of contagion and transmission of the health professionals adds a substantial burden to their daily work. Under the perspective of European Society For Emergency Medicine, the recommendations provided by the health authorities are reviewed focus on the emergency department's activity.
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Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Medicina de Emergência/normas , Serviço Hospitalar de Emergência/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Betacoronavirus , COVID-19 , Humanos , Controle de Infecções , Pandemias , Isolamento de Pacientes , Equipamento de Proteção Individual/provisão & distribuição , SARS-CoV-2 , TriagemRESUMO
This paper provides an update on the European Society of Cardiology task force report on the management of chest pain. Its main purpose is to provide an update on the decision algorithms and diagnostic pathways to be used in the emergency department for the assessment and triage of patients with chest pain symptoms suggestive of acute coronary syndromes.
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Síndrome Coronariana Aguda/diagnóstico , Dor no Peito/diagnóstico , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Doença Aguda , Algoritmos , Biomarcadores/metabolismo , Cardiologia , Dor no Peito/epidemiologia , Tomada de Decisões , Serviço Hospitalar de Emergência/estatística & dados numéricos , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Administração dos Cuidados ao Paciente/normas , Intervenção Coronária Percutânea/métodos , Medição de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Sociedades Médicas/organização & administração , Triagem , Troponina/sangueRESUMO
In 2018 the Surviving Sepsis Campaign issued new guidance with a revised version of their sepsis bundle. Instead of the 2016 3-hour sepsis bundle, the Surviving Sepsis Campaign now recommends that blood cultures, lactate measurement, broad-spectrum antibiotic therapy and 30 ml/kg crystalloid fluid administration should be initiated within 1 hour after triage. The European Society of Emergency Medicine wishes to express its concerns regarding the low level of evidence that underlies this guidance, and the potential implications from an emergency physician point of view.
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Medicina de Emergência , Sepse , Hemocultura , Hidratação , Humanos , TriagemRESUMO
OBJECTIVE: The primary objective of this study was to describe the epidemiology and management of dyspneic patients presenting to emergency departments (EDs) in an international patient population. Our secondary objective was to compare the EURODEM and AANZDEM patient populations. PATIENTS AND METHODS: An observational prospective cohort study was carried out in Europe and the Asia-Pacific region. The study included consecutive patients presenting to EDs with dyspnea as the main complaint. Data were collected on demographics, comorbidities, chronic treatment, clinical signs and investigations, treatment in the ED, diagnosis, and disposition from ED. RESULTS: A total of 5569 patients were included in the study. The most common ED diagnoses were lower respiratory tract infection (LRTI) (24.9%), heart failure (HF) (17.3%), chronic obstructive pulmonary disease (COPD) exacerbation (15.8%), and asthma (10.5%) in the overall population. There were more LRTI, HF, and COPD exacerbations in the EURODEM population, whereas asthma was more frequent in the AANZDEM population. ICU admission rates were 5.5%. ED mortality was 0.6%. The overall in-hospital mortality was 5.0%. In-hospital mortality rates were 8.7% for LRTI, 7.6% for HF, and 5.6% for COPD patients. CONCLUSION: Dyspnea as a symptom in the ED has high ward and ICU admission rates. A variety of causes of dyspnea were observed in this study, with chronic diseases accounting for a major proportion.
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Asma/epidemiologia , Dispneia/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Insuficiência Cardíaca/epidemiologia , Pneumonia/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Ásia/epidemiologia , Asma/diagnóstico , Estudos de Coortes , Comorbidade , Dispneia/diagnóstico , Europa (Continente)/epidemiologia , Feminino , Insuficiência Cardíaca/diagnóstico , Mortalidade Hospitalar/tendências , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Ilhas do Pacífico/epidemiologia , Pneumonia/diagnóstico , Prevalência , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Índice de Gravidade de Doença , Distribuição por SexoRESUMO
OBJECTIVE: Asthma exacerbations are common presentations to ED. Key guideline recommendations for management include administration of inhaled bronchodilators, systemic corticosteroids and titrated oxygen therapy. Our aim was to compare management and outcomes between patients treated for asthma in Europe (EUR) and South East Asia/Australasia (SEA) and compliance with international guidelines. METHODS: In each region, prospective, interrupted time series studies were performed including adult (age >18 years) patients presenting to ED with the main complaint of dyspnoea during three 72 h periods. This was a planned sub-study that included those with an ED primary diagnosis of asthma. Data was collected on demographics, clinical features, treatment in ED, diagnosis, disposition and in-hospital outcome. The results of interest were differences in treatment and outcome between EUR and SEA cohorts. RESULTS: Five hundred and eighty-four patients were identified from 112 EDs (66 EUR and 46 SEA). The cohorts had similar demographics and co-morbidity patterns, with 89% of the cohort having a previous diagnosis of asthma. There were no significant differences in treatment between EUR and SEA patients - inhaled beta-agonists were administered in 86% of cases, systemic corticosteroids in 66%, oxygen therapy in 44% and antibiotics in 20%. Two thirds of patients were discharged home from the ED. CONCLUSION: The data suggests that compliance with guideline-recommended therapy in both regions, particularly corticosteroid administration, is sub-optimal. It also suggests over-use of antibiotics.
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Asma/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Resultado do Tratamento , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sudeste Asiático/epidemiologia , Asma/epidemiologia , Australásia/epidemiologia , Broncodilatadores/uso terapêutico , Estudos de Coortes , Serviço Hospitalar de Emergência/organização & administração , Europa (Continente)/epidemiologia , Feminino , Guias como Assunto , Humanos , Análise de Séries Temporais Interrompida , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Estudos ProspectivosAssuntos
Síndrome Coronariana Aguda/epidemiologia , Dor no Peito/diagnóstico , Dor no Peito/epidemiologia , Síndrome Coronariana Aguda/diagnóstico , Biomarcadores , Causalidade , Comorbidade , Diagnóstico Diferencial , Eletrocardiografia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Fatores de Risco , Espanha/epidemiologiaRESUMO
No published information is available about myocardial infarction management in Spanish emergency departments. The EVICURE is a prospective, multicenter, observational study involving 35 hospitals that for a 3-week period collected all the cases of patients requiring care in which the final diagnosis of the cause of symptoms was ischemic heart disease. The study included 2,216 patients, of which 600 (27.1%) with acute myocardial infarction formed the study population. Fifteen patients died in the emergency department (2.5%) and 80 (13.3%) diagnosed as myocardial infarction were admitted to the ward instead of the coronary care unit. The median time before patients were admitted to the coronary care unit was 32 minutes versus a median time of 111 minutes for all patients. Before leaving the emergency room, 461 patients (76.5%) received aspirin and 93 (15.5%) underwent fibrinolysis. We concluded that there is room for improvement in light of current standards of care.