The preanalytical process in the emergency department, a European survey.

OBJECTIVES: Clinical decision-making in emergency medicine is under constant pressure from demand and performance requirements, with blood tests being a fundamental part of this. However, the preanalytical process has received little attention. Therefore, this study aimed to investigate the quality of preanalytical phase processes in European emergency departments (EDs) from the perspectives of the three main providers: clinicians, nurses, and laboratory specialists. METHODS: This online survey, distributed among European EDs and laboratories, was supported by the European Society for Emergency Nursing (EUSEN), European Society for Emergency Medicine (EuSEM), and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). The size of the centres, the European region, the responder's profession and the country's economic condition were used as co-variables. RESULTS: We included 376 responses from all ED-related professions from 306 European centres. In 66.9% of all ED visits, at least one blood test was performed. Tests were requested mostly by nurses (44.6%) using electronic Order/Entry systems (65.4%). Only a minority (19%) reported not using laboratory quality indicators (QIs). Most responders defined the TAT starting point "when the laboratory receives the sample" (66.1%), defining the goal to be "less than 60 min" (69.9%), but only 42.4% of the centres estimated achieving this goal. CONCLUSIONS: Our survey illustrates the current situation on preanalytical blood sample processing in European EDs from the clinical and laboratory perspectives. The results emphasise the importance of the IT infrastructure and QI usage in this process and highlight some differences between European regions.

New Scopes for Practice - Interdisciplinary Webinars for Emergency Medicine and Biomedical Informatics - Health Informatics.

This paper presents the early outcomes of the educational cooperation between two European academic associations, namely the European Federation of Medical Informatics (EFMI) and European Society of Emergency Medicine (EUSEM). Two webinars were organized in December 2019 and June 2020 to explore areas where mutual education would be beneficial for interdisciplinary cooperation to advance the digitization of emergency departments for the benefit of patients, health professionals and the health system as a whole. Preliminary findings from the analysis of these two webinars are presented and the steps for further cooperation are outlined.

La especialidad de Medicina de Urgencias y Emergencias en Europa: estamos quedándonos solos / Specialization in emergency medicine in Europe: Spain is in danger of being left behind

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Evaluación de los componentes de la escala de probabilidad clínica de Wells en pacientes con sospecha de trombosis venosa profunda en el servicio de urgencias / Wells clinical prediction criteria in patients suspected of having deep vein thrombosis: evaluation of components and use in the emergency department

Objetivo: Determinar la aplicabilidad y valorar la idoneidad de los componentes de la escala de Wells para la estimación de la probabilidad clínica de trombosis venosa profunda (TVP) en pacientes atendidos en los servicios de urgencias hospitalarios (SUH). Métodos: Estudio multicéntrico prospectivo de cohortes, con inclusión de pacientes consecutivos atendidos en los SUH con sospecha de TVP. Se realizó una ecografía de compresión con Doppler de toda la extremidad a todos los pacientes. Se recogió la existencia de variables relacionadas con el riesgo de desarrollo de TVP y los componentes de las escalas de probabilidad. Finalmente se calculó la probabilidad clínica mediante las escalas de Wells y Oudega. Resultados: Se incluyeron 362 pacientes de 23 SUH (edad media 65 (DE 18) años, 52,8% mujeres). Se diagnosticó TVP a un total de 254 pacientes (70,16%), de los que 171 (47,2%) fueron TVP proximales (TVPP). La distribución de los pacientes según las categorías de probabilidad de la escala de Wells y la prevalencia de TVPP fue: 57 pacientes con probabilidad baja (14 casos con TVP, 24,6%), 124 con probabilidad intermedia (43 casos con TVP, 34,7%) y 181 con probabilidad alta (114 casos con TVP, 63%). Sólo cinco de los componentes de la escala de Wells se asociaron a la presencia de TVPP. Conclusiones: La prevalencia de TVP en las diferentes categorías de probabilidad de la escala de Wells es muy elevada y no corresponde a la señalada en las series de validación. Parece necesario desarrollar escalas adecuadas a la población con sospecha de TVP que acude a los SUH (AU)

Objectives: To determine the applicability of the Wells clinical prediction criteria for deep vein thrombosis (DVT) in patients in hospital emergency departments and to evaluate the relevance of the score’s components. Methods: Prospective multicenter cohort study in consecutive hospital emergency department patients suspected of having DVT. Full-leg Doppler compression ultrasound imaging was performed on all patients. We recorded information on variables related to risk for DVT and the components of clinical prediction scales. Wells and Oudega clinical prediction scores were calculated. Results: We studied 362 patients in 23 hospital emergency departments; the mean (SD) age was 65 (18) years and 52.8% were women. DVT was diagnosed in 254 patients (70.16%); 171 (47.2%) had proximal DVT. The clinical probability of DVT according to the Wells scale and the prevalence of proximal DVT were as follows: low probability, 57 patients (14 with DVT, 24.6%); intermediate probability, 124 (43 with DVT, 34.7%), and high probability, 181 (114 with DVT, 63%). Only 5 of the components of the Wells scale were associated with the presence of proximal DVT. Conclusions: The prevalence of DVT is very high in the 3 categories of clinical probability indicated by the Wells score. The prevalences do not correspond to those of the cohort used to validate the scale. It appears to be necessary to develop scales adjusted for use in hospital emergency departments when DVT is suspected (AU)

[Wells clinical prediction criteria in patients suspected of having deep vein thrombosis: evaluation of components and use in the emergency department]. / Evaluación de los componentes de la escala de probabilidad clínica de Wells en pacientes con sospecha de trombosis venosa profunda en el servicio de urgencias.

OBJECTIVES: To determine the applicability of the Wells clinical prediction criteria for deep vein thrombosis (DVT) in patients in hospital emergency departments and to evaluate the relevance of the score's components. MATERIAL AND METHODS: Prospective multicenter cohort study in consecutive hospital emergency department patients suspected of having DVT. Full-leg Doppler compression ultrasound imaging was performed on all patients. We recorded information on variables related to risk for DVT and the components of clinical prediction scales. Wells and Oudega clinical prediction scores were calculated. RESULTS: We studied 362 patients in 23 hospital emergency departments; the mean (SD) age was 65 (18) years and 52.8% were women. DVT was diagnosed in 254 patients (70.16%); 171 (47.2%) had proximal DVT. The clinical probability of DVT according to the Wells scale and the prevalence of proximal DVT were as follows: low probability, 57 patients (14 with DVT, 24.6%); intermediate probability, 124 (43 with DVT, 34.7%), and high probability, 181 (114 with DVT, 63%). Only 5 of the components of the Wells scale were associated with the presence of proximal DVT. CONCLUSION: The prevalence of DVT is very high in the 3 categories of clinical probability indicated by the Wells score. The prevalences do not correspond to those of the cohort used to validate the scale. It appears to be necessary to develop scales adjusted for use in hospital emergency departments when DVT is suspected.

OBJETIVO: Determinar la aplicabilidad y valorar la idoneidad de los componentes de la escala de Wells para la estimación de la probabilidad clínica de trombosis venosa profunda (TVP) en pacientes atendidos en los servicios de urgencias hospitalarios (SUH). METODO: Estudio multicéntrico prospectivo de cohortes, con inclusión de pacientes consecutivos atendidos en los SUH con sospecha de TVP. Se realizó una ecografía de compresión con Doppler de toda la extremidad a todos los pacientes. Se recogió la existencia de variables relacionadas con el riesgo de desarrollo de TVP y los componentes de las escalas de probabilidad. Finalmente se calculó la probabilidad clínica mediante las escalas de Wells y Oudega. RESULTADOS: Se incluyeron 362 pacientes de 23 SUH (edad media 65 (DE 18) años, 52,8% mujeres). Se diagnosticó TVP a un total de 254 pacientes (70,16%), de los que 171 (47,2%) fueron TVP proximales (TVPP). La distribución de los pacientes según las categorías de probabilidad de la escala de Wells y la prevalencia de TVPP fue: 57 pacientes con probabilidad baja (14 casos con TVP, 24,6%), 124 con probabilidad intermedia (43 casos con TVP, 34,7%) y 181 con probabilidad alta (114 casos con TVP, 63%). Sólo cinco de los componentes de la escala de Wells se asociaron a la presencia de TVPP. CONCLUSIONES: La prevalencia de TVP en las diferentes categorías de probabilidad de la escala de Wells es muy elevada y no corresponde a la señalada en las series de validación. Parece necesario desarrollar escalas adecuadas a la población con sospecha de TVP que acude a los SUH.

Comparing emergency medical service systems--a project of the European Emergency Data (EED) Project.

AIM: The aim of this prospective study was the comparison of four emergency medical service (EMS) systems-emergency physician (EP) and paramedic (PM) based-and the impact of advanced live support (ALS) on patients status in preclinical care. METHODS: The EMS systems of Bonn (GER, EP), Cantabria (ESP, EP), Coventry (UK, PM) and Richmond (US, PM) were analysed in relation to quality of structure, process and performance when first diagnosis on scene was cardiac arrest (OHCA), chest pain or dyspnoea. Data were collected prospectively between 01.01.2001 and 31.12.2004 for at least 12 month. RESULTS: Over all 6277 patients were included in this study. The rate of drug therapy was highest in the EP-based systems Bonn and Cantabria. Pain relief was more effective in Bonn in patients with severe chest pain. In the group of patients with chest pain and tachycardia ≥ 120 beats/min, the heart rate was reduced most effective by the EP-systems. In patients with dyspnoea and S(p)O(2) <90% the improvement of oxygen saturation was most effective in Bonn and Richmond. After OHCA significant more patients reached the hospital alive in EMS systems with EPs than in the paramedic staffed (Bonn = 35.6%, Cantabria = 30.1%; Coventry = 11.9%, Richmond = 9.2%). The introduction of a Load Distributing Band chest compression device in Richmond improved admittance rate after OHCA (21.7%) but did not reach the survival rate of the Bonn EMS system. CONCLUSIONS: Higher qualification and greater training and experience of ALS unit personnel increased survival after OHCA and improved patient's status with cardiac chest pain and respiratory failure.

Características y manejo de los pacientes con dolor torácico no traumático en los servicios de urgencias hospitalarios. Resultados del estudio EVICURE II / Nontraumatic chest pain in hospital emergency departments: characteristics and management in the EVICURE II study

Objetivo: La identificación de los pacientes que padecen síndrome coronario agudo(SCA) entre la población de pacientes que consultan en los servicios de urgencias hospitalario(SUH) por dolor torácico no traumático constituye un procedimiento complejo a pesar de las guías establecidas. Es objetivo del estudio describir el proceso de discriminación con el propósito de identificar áreas de mejora. Diseño: Estudio observacional, multicéntrico, prospectivo, con inclusión de pacientes consecutivos con dolor torácico no traumático sugestivo de cardiopatía isquémica. Resultados: Se registran 1.440 casos, con una prevalencia de SCA de 23,5% con una relación SCAEST/SCASEST de 1/3 basados en el diagnóstico de urgencias. Más del 70%del primer electrocardiograma (ECG) se clasificó como no diagnóstico y fue necesario hacer más de un ECG en el 40% de los casos. La demora en acceder al SUH tenía una mediana de 169 minutos y algo más del 40% de los pacientes tenían el primer ECG realizado en 10 minutos. La concordancia diagnóstica global para SCA fue del 0,64 de índice de Kappa, entre los pacientes ingresados. Conclusión: Los resultados muestran, junto con la complejidad del proceso discriminativo, la identificación de áreas de posible mejora (AU)

Objective: Identifying patients with acute coronary syndrome (ACS) attending emergency services with nontraumaticchest pain is a complex process in spite of current guidelines. This study aimed to describe the assessment process in order to identify aspects in need of improvement. Design: A prospective, observational multicenter study enrolling consecutive patients with nontraumatic chest pain suggestive of ischemic heart disease. Results: In a total of 1440 patients studied, the prevalence of ACS was 23.5%, with a ratio of ST-elevation myocardial infarction (STEMI) to non-STEMI cases of 1:3 according to emergency service diagnoses. The first electrocardiogram(ECG) was classified as inconclusive in over 70% of the cases. More than 1 ECG was required in 40%. The median delay in reaching emergency services was 169 minutes and the first ECG was then performed in less than 10 minutes in slightly more than 40% of the patients. The overall agreement on a diagnosis of ACS for admitted patients was 0.64 (kappa index).Conclusion: The results reveal the complexity of this diagnostic process and identify areas for possible improvement (AU)

Congresos de la Sociedad Española de Medicina de Urgencias y Emergencias (y II): evolución de 20 años de actividad científica / Conferences of the Spanish Society of Emergency Medicine, Part II: progress over 20 years of scientific activity

Se analiza la evolución de las comunicaciones a los congresos nacionales de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) en base a los últimos 11 congresos de SEMES (de 1998 a 2008). Se han presentado un promedio de 726por congreso, sin cambios significativos (ni globalmente ni por estamentos) en la tendencia durante estos 11 años. La aceptación global se ha situado en el 85%, con un incremento significativo de los porcentajes durante este período. La calidad de las comunicaciones es baja: un 65% corresponden a series de casos meramente descriptivas, y sólo un 3% a estudios caso-control. Además, el 27% son de escaso interés, el 46%son poco novedosas, el 10% presentan una escasa concordancia entre los diferentes apartados y el 16% presentan un redactado poco claro. Sería, pues, deseable que en los próximos años existiera una mejora en la calidad de las comunicaciones aceptadas a los congresos de SEMES a la vez que en el proceso de selección se primase más la calidad que la cantidad (AU)

Abstracts presented at national conferences of the Spanish Society of Emergency Medicine (SEMES) over the past 11 years (1998through 2008) were quantified and analyzed. There was a mean of 726 abstracts per conference, with no significant changes in the numbers over these 11 years either for the conference as a whole or between professional groups. The overall percentage of acceptance was 85%, and this increased significantly over the study period. The quality of the communication type was low: 65% just involved descriptive case series and only 3% were case-control studies. Furthermore, 27% of the communications accepted were of low interest value, 46% showed little novelty, 10% presented poor concordance between information given in the different sections of the abstract, and 16% were poorly written. It would therefore be desirable to require higher quality before accepting abstracts for future SEMES conferences and to develop a selection process that focuses more on quality than on quantity (AU)

Seguimiento de las vías clínicas en la infección por el virus varicela zóster / Follow-up of a clinical pathway for varicella-zoster virus infection

Objetivos: La implantación de una vía clínica precisa de la evaluación de su seguimiento y del nivel de aceptación por los profesionales. Tras la implantación de la vía clínica para las infecciones por el virus varicela-zóster (VVZ) se investiga el grado de aplicación y aceptación. Método: Se realiza un estudio observacional, multicéntrico con la participación de 49servicios de urgencias hospitalarios (SUH) de referencia, intermedios y comarcales. Se incluyen como casos los pacientes mayores de 14 años con el diagnóstico clínico de varicela y herpes, atendidos durante el periodo de estudio de febrero a julio 2007. Se registran las características de los pacientes y el grado de seguimiento de la vía, el grado de aceptación por los profesionales se evalúa mediante encuesta. Resultados: Se registraron 929 casos de herpes y 427 de varicela. En la presente serie se registró, tanto en los casos de varicela como en los de herpes, un mayor porcentaje de ingresos y complicaciones que en las publicaciones existentes. El grado general de seguimiento de la vía del herpes fue del 75% y de la varicela el 85%. Únicamente en el apartado de tratamiento fue superior el seguimiento del herpes (82%) con respecto ala varicela (73,4%) (p < 0,001). El 95% de las encuestas valoraron como útil o muy útil el contenido y el tratamiento. El aspecto mejor valorado de la vía fue la información. Se detectaron mayores grados de seguimiento tanto para el herpes como la varicela en los SUH comarcales (87,7%) y de referencia (95%) con respecto a los intermedios(72,9%) con p < 0,001.Conclusiones: La vía clínica para infecciones VVZ en general presenta un buen seguimiento y aceptación. El perfil de los pacientes atendidos en urgencias tiene una mayor gravedad, por lo que habría que adaptar las recomendaciones (AU)

Background: Evaluation, follow-up and healthcare professional acceptance are critical issues in the implementation of a clinical pathway (CP).Aims: To evaluate the performance of a varicella-zoster virus (VZV) pathway in different Emergency Departments (ED).Design: Observational prospective multicenter study in 49 EDs (local, reference and intermediate EDs). The subjects of the study were patients older than 14 years with a clinical diagnosis of varicella or herpes who were assisted at all EDs during the whole study period (Feb-Jul 2007). Data on demographic, clinical characteristics and application of CP we rerecorded. Acceptance of CP was assessed by survey. Results: The study included 929 herpes and 427 varicella patients. Our VZV cases had a higher admission and complication rates than the cases reported on previous publications, which reflects higher severity. CP recommendations were applied in 75% of varicella and 85,3% of herpes cases. Reference and local EDs had higher rates of CP application(95%, 87.7%) than intermediate EDs (72.9%) (P < 0.01). Ninety five percent of responders evaluated information and treatment on CP as “useful or very useful”. The most appreciated feature of CP was information. Conclusions: The level of acceptance of VZV CP is high. The severity of certain cases requires to adjust the recommendations (AU)

European Emergency Data Project (EED Project): EMS data-based health surveillance system.

Emergency Medical Services (EMS) constitute a unique component of health care at the interface between primary and hospital care. EMS data within the pre-hospital setting represents an unparalleled source of epidemiological and health care information that have so far been neglected for public health monitoring. The European Emergency Data Project (EED Project) thus intends to identify common indicators for European EMS systems and to evaluate their suitability for integration into a comprehensive public health monitoring strategy. The article provides a brief overview on objectives and methodology in the form of a progress report.

Unidades de dolor torácico y urgencias / Chest pain units and emergency departments

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Terrorism in Spain: emergency medical aspects.

A terrorism movement has been active in Spain during the last 20 years, with a painful number of victims. Civil Defense is in charge of the coordination of all the structures that are implicated in a terrorist incident. There are three typical patterns of attacks: (1) individual attacks; (2) group attacks; and (3) mass attacks. The individual attacks are done with guns, usually 9 mm, fired from a short distance; victims die from serious intracranial damage. Collective attacks are done using explosives under vehicles, tramp bombs, or "bomb vehicles;" victims are of different severity with wounds, burns, and blast injuries. With mass attacks with "bomb vehicles" in buildings or crowded public places, the numbers of victims are elevated and produce brutal social consequences. Emergency Medical Services integrated in to "Civil Defense" try to minimize the damage by initializing treatment on-scene and with the rapid provision of definitive care. During the last year, post-traumatic stress disorder treatment groups have been providing care to the victims and personnel. Chemical or biological weapons have not been used, although this is a great concern to the authorities.