Development and validation of an assessment tool for adult simulated ultrasound-guided fascia iliaca block: a prospective monocentric study.

BACKGROUND: Fascia iliaca block (FIB) is an effective technique for analgesia. While FIB using ultrasound is preferred, there is no current standardised training technique or assessment scale. We aimed to create a valid and reliable tool to assess ultrasound-guided FIB. METHOD: This prospective observational study was conducted in the ABS-Lab simulation centre, University of Poitiers, France between 26-29 October and 14-17 December 2021. Psychometric testing included validity analysis and reliability between two independent observers. Content validity was established using the Delphi method. Three rounds of feedback were required to reach consensus. To validate the scale, 26 residents and 24 emergency physicians performed a simulated FIB on SIMLIFE, a simulator using a pulsated, revascularised and reventilated cadaver. Validity was tested using Cronbach's α coefficient for internal consistency. Comparative and Spearman's correlation analysis was performed to determine whether the scale discriminated by learner experience with FIB and professional status. Reliability was analysed using the intraclass correlation (ICC) coefficient and a correlation score using linear regression (R2). RESULTS: The final 30-item scale had 8 parts scoring 30 points: patient positioning, preparation of aseptic and tools, anatomical and ultrasound identification, local anaesthesia, needle insertion, injection, final ultrasound control and signs of local anaesthetic systemic toxicity. Psychometric characteristics were as follows: Cronbach's α was 0.83, ICC was 0.96 and R2 was 0.91. The performance score was significantly higher for learners with FIB experience compared with those without experience: 26.5 (22.0; 29.0) vs 22.5 (16.0; 26.0), respectively (p=0.02). There was a significant difference between emergency residents' and emergency physicians' scores: 20.5 (17.0; 25.0) vs 27.0 (26.0; 29.0), respectively (p=0.0001). The performance was correlated with clinical experience (Rho=0.858, p<0.0001). CONCLUSION: This assessment scale was found to be valid, reliable and able to identify different levels of experience with ultrasound-guided FIB.

Pain Self-Management with Inhaled Methoxyflurane by Emergency Department Trauma Patients: A Prospective, Interventional, Single-Center Study.

The coronavirus disease 2019 (COVID-19) pandemic has led to overcrowding in many emergency departments (EDs). The present single-center, prospective, interventional study (conducted at Bichat University Medical Center (Paris, France)) was designed to assess the impact of self-administered, inhaled, low-dose methoxyflurane on trauma pain in a pre-ED fast-track zone dedicated to the management of lower-acuity non-COVID-19 patients. In the first phase of the study, the control group consisted of patients with mild-to-moderate trauma pain, for whom the triage nurse initiated pain management (based on the World Health Organization (WHO)'s analgesic ladder). In the second phase, the intervention group consisted of similar patients who self-administered methoxyflurane as an adjuvant to the standard analgesic ladder. The primary endpoint was the numerical pain rating scale (NPRS) score (from 0 to 10) recorded at different time points during the patient's care (T0: arrival in the ED, T1: exit from the triage box, T2: in the radiology department, T3: clinical examination, and T4: discharge from the ED). The level of agreement between the NPRS and the WHO analgesic ladder was assessed by the calculation of Cohen's kappa. Pairwise comparisons of continuous variables were performed with Student's t-test or a non-parametric Mann-Whitney U test. Changes over time in the NPRS were analyzed in an analysis of variance (with Scheffe's post hoc test if a pairwise comparison was significant) or a non-parametric Kruskal-Wallis H test. In all, 268 and 252 patients were included in the control and intervention groups, respectively. The two groups had similar characteristics. The level of agreement between the NPRS score and the analgesic ladder was high in both the control and intervention groups (Cohen's kappa: 0.74 and 0.70, respectively). The NPRS score decreased significantly between T0 and T4 in both groups (p < 0.001), but the decrease between T2 and T4 was significantly greater in the intervention group (p < 0.001). The proportion of patients still in pain on discharge was significantly lower in the intervention group than in the control group (p = 0.001). In conclusion, a combination of self-administered methoxyflurane and the WHO analgesic ladder improves pain management in the ED.

Development and Testing of a Hybrid Simulator for Emergent Umbilical Vein Catheter Insertion Simulation Training.

INTRODUCTION: Emergent umbilical venous catheter (eUVC) insertion is the recommended vascular access in neonatal resuscitation. Although the theoretical knowledge can be taught, existing models are either unrealistic (plastic) or train only the steps of the task. This study aimed to develop and test a hybrid simulator for eUVC insertion training that would be realistic, reproducible, easy to build, and inexpensive, thereby facilitating detailed learning of the procedure. METHODS: Development took place in the Poitiers simulation laboratory using a neonatal mannequin into which a real umbilical cord was integrated. In the first phase, pediatric and emergency physicians and residents tested the model. In the second phase, another group of participants tested the hybrid simulator and the same neonatal mannequin associated with an artificial umbilical cord. Participants completed a satisfaction survey. RESULTS: A real umbilical cord connected to an intra-abdominal reservoir containing artificial blood was added to the mannequin, allowing insertion of the eUVC, drawback of blood, and infusion of fluids using the real anatomical structures. The model was easily reproduced and assembled in less than 30 minutes; the cost of construction and use was evaluated at €115. One hundred two participants tested the model, 60 in the first phase and 42 in the second. The success rate was higher in fully trained compared with untrained participants. All were satisfied, 97% found the model realistic, and 78.6% strongly recommended the use of this model. The participants believed that the hybrid simulator allowed better learning and a gain in performance and self-confidence in comparison with the same mannequin with an artificial umbilical cord. CONCLUSIONS: A hybrid simulator was developed for eUVC insertion. Participants were satisfied with this model, which was realistic, reproducible, easy to use, inexpensive, and facilitated an understanding of the anatomy and performance of all steps for successful eUVC insertion.

Predictive models in emergency medicine and their missing data strategies: a systematic review.

In the field of emergency medicine (EM), the use of decision support tools based on artificial intelligence has increased markedly in recent years. In some cases, data are omitted deliberately and thus constitute "data not purposely collected" (DNPC). This accepted information bias can be managed in various ways: dropping patients with missing data, imputing with the mean, or using automatic techniques (e.g., machine learning) to handle or impute the data. Here, we systematically reviewed the methods used to handle missing data in EM research. A systematic review was performed after searching PubMed with the query "(emergency medicine OR emergency service) AND (artificial intelligence OR machine learning)". Seventy-two studies were included in the review. The trained models variously predicted diagnosis in 25 (35%) publications, mortality in 21 (29%) publications, and probability of admission in 21 (29%) publications. Eight publications (11%) predicted two outcomes. Only 15 (21%) publications described their missing data. DNPC constitute the "missing data" in EM machine learning studies. Although DNPC have been described more rigorously since 2020, the descriptions in the literature are not exhaustive, systematic or homogeneous. Imputation appears to be the best strategy but requires more time and computational resources. To increase the quality and the comparability of studies, we recommend inclusion of the TRIPOD checklist in each new publication, summarizing the machine learning process in an explicit methodological diagram, and always publishing the area under the receiver operating characteristics curve-even when it is not the primary outcome.

Effect of real-time feedback device compared to use or non-use of a checklist performance aid on post-training performance and retention of infant cardiopulmonary resuscitation: A randomized simulation-based trial.

INTRODUCTION: This study aims to determine the best method for achieving optimal performance of pediatric cardiopulmonary resuscitation (CPR) during simulation-based training, whether with or without a performance aid. METHODS: In this randomized controlled study, 46 participants performed simulated CPR in pairs on a Resusci Baby QCPR™ mannequin, repeated after four weeks. All participants performed the first simulation without performance aids. For the second simulation, they were randomly assigned to one of three groups with stratification based on status: throughout CPR, Group A (n = 16) was the control group and did not use a performance aid; Group B (n = 16) used the CPR checklist; Group C (n = 14) used real-time visualization of their CPR activity on a feedback device. Overall performance was assessed using the QCPR™. RESULTS: All groups demonstrated improved performance on the second simulation (p < 0.01). Use of the feedback device resulted in better CPR performance than use of the CPR checklist (p = 0.02) or no performance aid (p = 0.04). Additionally, participants thought that the QCPR™ could effectively improve their technical competences. CONCLUSIONS: Performance aid based on continuous feedback is helpful in the learning process. The use of the QCPR™, a real-time feedback device, improved the quality of resuscitation during infant CPR simulation-based training.

The Response of Emergency Departments (EDs) to the COVID-19 Pandemic: The Experience of 5 EDs in a Paris-Based Academic Hospital Trust.

The coronavirus disease-2019 (COVID-19) pandemic has imposed unforeseen and unprecedented constraints on emergency departments (EDs). In this study, we detail the organizational and managerial tools recently implemented among 5 academic EDs in a French region particularly affected by COVID-19 and analyze how EDs responded to the COVID-19-related disease burden during different phases of the epidemic. Initially, they focused on the early detection of suspected cases by identifying 3 predominant COVID-19 syndromes. During this diagnostic process, patients were placed in respiratory isolation (facial mask before triage) and droplet isolation (ED rooms). A 3-level strategy for triage, clinical pathways in the EDs, and the organization of hospital spaces was based on the real-time polymerase chain reaction (RT-PCR) COVID-19 positivity rate, with ED strategies adapted to the exigencies of each level. This crisis demonstrated hospitals' adaptability and capacity to mobilize in the face of new risks, with hospitals and EDs coordinating their management to reallocate resources, optimize interoperability, and rethink patient pathways. This report on their processes may assist hospitals and EDs in areas currently spared by the new variants.

Impact of a Multidisciplinary Simulation-Based Training Program on the Multiple Techniques of Intraosseous Access: A Prospective Multicentric Study.

OBJECTIVES: The aim of this study was to assess intraosseous (IO) access placement performance during a multidisciplinary simulation-based training (SBT) program according to the professional status, experience of caregivers, and the setting of the course. METHOD: This prospective, multicentric study included emergency physicians, residents, certified registered nurse anesthetists, registered nurses, and students. It was carried out between April 6, 2020 and April 30, 2021 in emergency medical services, an emergency department, and a simulation center. Trainee performance was evaluated by 2 independent observers using a validated scale, before and after SBT. Self-assessment of satisfaction was carried out. Interobserver reproducibility was analyzed by intraclass correlation coefficient. The continuous variables were compared using a Student t test or a nonparametric Mann-Whitney U test. Comparative analysis between the different groups used analysis of variance. Correlation analysis was performed by a nonparametric Spearman test. A P value of 0.05 was considered significant. RESULTS: Ninety-eight participants were included. Intraclass correlation coefficient between the 2 observers was 0.96. Performance significantly increased after training, regardless of the site or device used (for the semiautomatic device, P = 0.004 in tibia and P = 0.001 in humeral; for the manual device, P < 0.001). Simulation-based training significantly reduced time for IO access (P = 0.02). After SBT, no difference was found according to professional status and the setting of the course. Performance was not correlated with professional experience. All trainees were satisfied with the training. CONCLUSIONS: Simulation-based training improved the IO access using a semiautomatic or a manual device, regardless of the experience or status of the trainees. Simulation-based training would work for many disciplines regardless of locations (simulation or clinical facilities).

Use of Artificial Intelligence to Manage Patient Flow in Emergency Department during the COVID-19 Pandemic: A Prospective, Single-Center Study.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, calculation of the number of emergency department (ED) beds required for patients with vs. without suspected COVID-19 represented a real public health problem. In France, Amiens Picardy University Hospital (APUH) developed an Artificial Intelligence (AI) project called "Prediction of the Patient Pathway in the Emergency Department" (3P-U) to predict patient outcomes. MATERIALS: Using the 3P-U model, we performed a prospective, single-center study of patients attending APUH's ED in 2020 and 2021. The objective was to determine the minimum and maximum numbers of beds required in real-time, according to the 3P-U model. Results A total of 105,457 patients were included. The area under the receiver operating characteristic curve (AUROC) for the 3P-U was 0.82 for all of the patients and 0.90 for the unambiguous cases. Specifically, 38,353 (36.4%) patients were flagged as "likely to be discharged", 18,815 (17.8%) were flagged as "likely to be admitted", and 48,297 (45.8%) patients could not be flagged. Based on the predicted minimum number of beds (for unambiguous cases only) and the maximum number of beds (all patients), the hospital management coordinated the conversion of wards into dedicated COVID-19 units. DISCUSSION AND CONCLUSIONS: The 3P-U model's AUROC is in the middle of range reported in the literature for similar classifiers. By considering the range of required bed numbers, the waste of resources (e.g., time and beds) could be reduced. The study concludes that the application of AI could help considerably improve the management of hospital resources during global pandemics, such as COVID-19.

Early diagnosis of sepsis using an E-health application for a clinical early warning system outside of the intensive care unit: a case report.

BACKGROUND: Elderly and frail patients who are unable to call for help in case of vital distress can develop complications during their hospitalization. As a supplement to clinical monitoring by the nursing staff, these patients can also be monitored in real time, with the Sensium E-health technology. An application notifies clinical staff of any change in their vital signs (heart rate, respiratory rate, temperature) outside of normal ranges, suggestive of physiological decline. Nurses and physicians are notified of these abnormal changes by email and also via mobile application (iPhone or iPad), allowing early intervention to prevent further deterioration. CASE PRESENTATION: An 86-year-old Caucasian female, with chronic kidney disease, was hospitalized in our medical unit for pyelonephritis associated with a moderate deterioration of serum creatinine. Remote continuous monitoring allowed us to diagnose clinical deterioration early and adjust her treatment. The treatment improved her clinical condition and amended the secondary sepsis with circulation failure in 2 days. CONCLUSIONS: The prognosis for patients with acute complicated pyelonephritis is much worse than for those with uncomplicated pyelonephritis. Remote continuous monitoring might be helpful to early diagnose urosepsis. This technology leads to improved prognosis of patients without initial vital distress, allowing early treatment and admission to intensive care unit.

Development and validation of the first performance assessment scale for interdisciplinary chest tube insertion: a prospective multicenter study.

PURPOSE: Chest tube insertion requires interdisciplinary teamwork including an emergency surgeon or physician in conjunction with a nurse. The purpose of the study was to validate an interdisciplinary performance assessment scale for chest tube insertion developed from literature analysis. METHODS: This prospective study took place in the simulation center of the University of Paris. The participants included untrained emergency/intensivist residents and trained novice emergency/intensivist physicians with less than 2 years of clinical experience and 6 months following training in thoracostomy, and nursing students. Each interdisciplinary pair participated in a high-fidelity simulation session. Two independent observers (O1 and O2) evaluated 61 items. Internal coherence using the Cronbach's α coefficient, intraclass correlation coefficient (ICC), and correlation of scores by regression analysis (R2) were analyzed. Comparison between O1 and O2 mean scores used a t test and F test for SDs. p Value < 0.05 was significant. RESULTS: From an initial selection of 11,277 articles, 19 were selected to create the initial scale. The final scale comprises 61 items scored out of 80, including 24 items for nursing items, 24 items for medical competence, and 13 mixed items for the competence of both. 40 simulations including 80 participants were evaluated. Cronbach's α = 0.76, ICC = 0.92, R2 = 0.88. There was no difference between the observers' assessments of means (p = 0.82) and SDs (p = 0.92). Score was 51.6 ± 5.9 in the group of untrained residents and nursing student, and 57.2 ± 2.8 in the trained group of novice physicians and nursing students (p = 0.0003). CONCLUSIONS: This first performance assessment scale for interdisciplinary chest tube insertion is valid and reliable.

Predictors of Risk Stratification and Value of Point-of-Care of High-Sensitivity Cardiac Troponin-I in EMS Management of Non-ST-Segment Elevation Myocardial Infarction: A Retrospective Study.

INTRODUCTION: The European Society of Cardiology (ESC) 2020 guidelines propose an algorithm for in-hospital management of non-ST-elevation myocardial infarction (NSTEMI) based on risk stratification according to clinical, electrocardiographic, and biological data. However, out-of-hospital management is not codified. STUDY OBJECTIVE: The objective of the present study was to evaluate the role of high-sensitivity cardiac troponin-I in out-of-hospital management of NSTEMI by Emergency Medical Services (EMS). METHODS: This monocentric, retrospective, observational study analyzed the files of all patients having received a troponin assay in the EMS of Beaujon University Hospital, AP-HP (Paris region, France) from January 1, 2020 through December 31, 2020. Patients were classified as low risk, high risk, or very high risk according to the ESC 2020 algorithm at the time of their hospital treatment. The relationship between troponin in point-of-care and risk level according to time to onset of pain was analyzed using logistic regression. A search for predictors of risk level was performed using multivariate analysis. A P value <.05 was considered significant. RESULTS: Out of 309 patients in the file, 233 were included. Men were 61% and the median age was 63 years. A positive troponin assay was associated with high-risk or very high-risk stratification regardless of the time to onset of pain (P <.0001). Predictive factors for being classified as high or very high risk in hospital were: a history of atrial fibrillation (P = .03), electrocardiogram (ECG) modifications such as negative T wave or ST-segment depression (P <.0001), and positive troponin (P <.0001). CONCLUSION: The use of point-of-care troponin in EMS, combined with clinical and electrical criteria, allows risk stratification of NSTEMI patients from the prehospital management stage and optimization of referral to an appropriate care pathway. Patients classified as low risk should be referred to the emergency department (ED) and patients classified as high risk or very high risk to the cardiac intensive care unit or percutaneous coronary intervention (PCI) center.

COVID-19 Preparedness Among Emergency Departments: A Cross-Sectional Study in France.

OBJECTIVES: The aim of this study was to evaluate hospital and emergency department (ED) preparedness in France facing the coronavirus disease 2019 (COVID-19) rapid growth epidemic-phase, and to determine the link between preparedness and responsiveness. METHODS: In this cross-sectional study, from March 7 to March 11, 2020, all heads of ED departments in France were contacted to answer an electronic survey, including 23 questions. Quality, Organization, Training, Resources, Management, Interoperability, and Responsiveness were evaluated by calculating scores (10 points). Multivariate analysis of variance was used to compare scores. Spearman's correlation coefficient and multifaceted regression analysis were performed between Responsiveness and dimensions scores. RESULTS: A total of 287 of 636 French EDs were included (45.1%). Calculated scores showed (median): Quality 5.38; Organization 6.4; Training 4.6; Resources 4.13; Management 2.38; Interoperability 4.0; Responsiveness 6.25; seasonal influenza score was 5. Significant differences between scores as a function of hospital and ED main characteristics were found. Furthermore, we found significant correlations (P < 0.01) between Responsiveness and all preparedness dimensions. Organization (adjusted-R2 0.2897), Management (aR2 0.321), and Interoperability (aR2 0.422) were significantly associated with Responsiveness. CONCLUSIONS: Preparedness in all its dimensions is low, indicating vulnerability. Preparedness and responsiveness face a certain and ongoing risk are close linked, and that Organizational, Management, and Interoperability dimensions are main determinants.

Benefit of Simulation-Based Training in Medical Adverse Events Disclosure in Pediatrics.

INTRODUCTION: Adverse events (AEs) in health care are a public health issue. Although mandatory, error disclosure is experienced by health providers as a difficult task. METHODS: In this prospective study, the primary objective was to assess performance in disclosing AEs to simulated parents using a validated scale before and after training among a pediatric residents' population. Secondary objectives were to assess correlation with year of residency, sex, and previous experience and to analyze gain in knowledge (theoretical pretest/posttest scores) and satisfaction. Two evaluation simulations (simulation [SIM] 1 and SIM 2) were scheduled at 3-week interval. In the intervention group, mastery learning was offered after SIM 1 including a didactic approach and a training session using role-playing games. For the control group, the course was carried out after SIM 2. Assessments were performed by 2 independent observers and simulated parents. RESULTS: Forty-nine pediatric residents performed 2 scenarios of AE disclosure in front of simulated parents. In the intervention group, performance scores on SIM 2 (72.36 ± 5.40) were higher than on SIM 1 (65.08 ± 9.89, P = 0.02). In the control group, there was no difference between SIM 1 and SIM 2 (P = 0.62). The subjective scores from simulated parents showed the same increase on SIM 2 (P < 0.01). There was no correlation with the residents' previous experience or their residency year. There was an increase in self-confidence (P = 0.04) for SIM 2. There was also an increase in posttest theoretical scores (P = 0.02), and residents were satisfied with the training. CONCLUSIONS: This study showed the benefits of simulation-based training associated with mastery learning in AE disclosure among pediatric residents. It is important to train residents for these situations to avoid traumatic disclosure generating a loss of confidence of the family regarding physicians and possible lawsuits.

Assessment of HIV-postexposure prophylaxis prescription quality after a training programme and assistance in decisions provided by a computer-based decision program: a cross-over study.

BACKGROUND: Among the tools for preventing HIV transmission, post-exposureprophylaxis (PEP) is an effective means after potential HIV exposure. OBJECTIVES: To evaluate aPEP training program and acomputer-baseddecision program (CBDP) using simulated patients in emergency department (ED) on the quality of PEP prescription. METHODS: This cross-overstudy, carried out from 7January2019 to 28June2019, included 20 ED physicians from 10 tertiary referral hospitals. Intervention consisted of two parts: Period Aassessed physicians' compliance with PEP prescription guidelines before and after atraining program, using 400 post-exposuremedical records (200 occupational and 200 non-occupational). Period Bconsisted of arandomized crossover study involving 40 simulated patients, with physicians using or not using aCBDP. Sensitivity, specificity, and accuracy of PEP prescription in accordance with the guidelines were assessed. RESULTS: In period A, alpha Cronbach was less than 0.7 whereas it increased after the training to be >0.7. Sensitivity increased, especially for occupational patients ranging from 51.8%-66.6% to 70.4%-90.1%, whereas specificity increased for non-occupationalpatients ranging from 15.5%-51.9% to 52.1%-75.3%. In period B, sensitivity, specificity, and rate of complete assessments significantly increased (p < 0.0001) after the initiation of CBDP. Rate of PEP prescription significantly decreased (p < 0.001) for all subcategories. CONCLUSION: Significant recommendations-discordantprescriptions, mainly overprescription, occurred for patients visiting ED for PEP. Training improved quality of PEP prescription but the reduction was modest. The availability of CBDP improved quality of PEP prescription and allowed for better data collection and reduction of PEP prescription.

Red Blood Cell Transfusion in the Emergency Department: An Observational Cross-Sectional Multicenter Study.

BACKGROUND: We aimed to describe red blood cell (RBC) transfusions in the emergency department (ED) with a particular focus on the hemoglobin (Hb) level thresholds that are used in this setting. METHODS: This was a cross-sectional study of 12 EDs including all adult patients that received RBC transfusion in January and February 2018. Descriptive statistics were reported. Logistic regression was performed to assess variables that were independently associated with a pre-transfusion Hb level ≥ 8 g/dL. RESULTS: During the study period, 529 patients received RBC transfusion. The median age was 74 (59-85) years. The patients had a history of cancer or hematological disease in 185 (35.2%) cases. Acute bleeding was observed in the ED for 242 (44.7%) patients, among which 145 (59.9%) were gastrointestinal. Anemia was chronic in 191 (40.2%) cases, mostly due to vitamin or iron deficiency or to malignancy with transfusion support. Pre-transfusion Hb level was 6.9 (6.0-7.8) g/dL. The transfusion motive was not notified in the medical chart in 206 (38.9%) cases. In the multivariable logistic regression, variables that were associated with a higher pre-transfusion Hb level (≥8 g/dL) were a history of coronary artery disease (OR: 2.09; 95% CI: 1.29-3.41), the presence of acute bleeding (OR: 2.44; 95% CI: 1.53-3.94), and older age (OR: 1.02/year; 95% CI: 1.01-1.04). CONCLUSION: RBC transfusion in the ED was an everyday concern and involved patients with heterogeneous medical situations and severity. Pre-transfusion Hb level was rather restrictive. Almost half of transfusions were provided because of acute bleeding which was associated with a higher Hb threshold.

Development of a Performance Assessment Scale for Simulated Dispatcher-Assisted Cardiopulmonary Resuscitation (Telephone-CPR): A Multi-Center Randomized Simulation-Based Clinical Trial.

INTRODUCTION: Dispatchers should be trained to interrogate bystanders with strict protocols to elicit information focused on recognizing cardiac arrest and should provide telephone cardiopulmonary resuscitation (CPR) instructions in all cases of suspected cardiac arrest. While an objective assessment of training outcomes is needed, there is no performance assessment scale for simulated dispatcher-assisted CPR. STUDY OBJECTIVE: The aim of the study was to create a valid and reliable performance assessment scale for simulated dispatcher-assisted CPR. METHODS: In this prospective, randomized, controlled, multi-centric simulation-based trial (registration number TCTR20210130002), the scale was developed according to the European Resuscitation Council (ERC) and American Heart Association (AHA) Guidelines 2015 and revised by experts. The performance of 48 dispatchers' telephone-CPR and of 48 bystanders carrying out CPR on a manikin was assessed by two independent evaluators using the scale and using a SkillReporter (PC) software to provide CPR objective performance. Continuous variables were described as mean (SD) and categorical variables as numbers and percentage (%). Comparative analysis between two groups used a Student t-test or a non-parametric test of Mann-Whitney. The internal structure of the scale was evaluated, including internal consistency using α Cronbach coefficient, and reproducibility using intraclass correlation coefficient (ICC) and linear correlation coefficient (R2) calculation. RESULTS: The scale included three different parts: two sections for dispatchers' (32 items) and bystanders' CPR performance (15 items) assessment, and a third part recording times. There was excellent internal consistency (α Cronbach coefficient = 0.77) and reproducibility (ICC = 0.93; R² = 0.86). For dispatchers' performance assessment, α Cronbach coefficient = 0.76; ICC = 0.91; R2 = 0.84. For bystanders' performance assessment, α Cronbach coefficient = 0.75; ICC = 0.93; R2 = 0.87. Reproducibility was excellent for nine items, good for 19 items, and moderate for 19 items. No item had poor reproducibility. There was no significant difference between dispatch doctors' and medical dispatch assistants' performances (33.0 [SD = 4.7] versus 32.3 [SD = 3.2] out of 52, respectively; P = .70) or between trained and untrained bystanders to follow the instructions (14.3 [SD = 2.0] versus 13.9 [SD = 1.8], respectively; P = .64). Objective performance (%) was significantly higher for trained bystanders than for untrained bystanders (67.4 [SD = 14.5] versus 50.6 [SD = 19.3], respectively; P = .03). CONCLUSION: The scale was valid and reliable to assess performance for simulated dispatcher-assisted CPR. To the authors' knowledge, no other valid performance tool currently exists. It could be used in simulated telephone-CPR training programs to improve performance.

Analysis of the Feasibility of a Vaccination Campaign against Influenza Epidemic and COVID-19 Pandemic in French Emergency Departments: A National Survey.

BACKGROUND: Vaccination is one of the most effective ways to fight the influenza epidemic and the coronavirus disease 2019 (COVID-19) pandemic, which represent a major public issue. The objective was to investigate the adherence of heads of French emergency departments (ED) and nursing departments on a potential vaccination campaign of healthcare workers (HCW) and patients in ED. METHOD: In February 2021, ED and nursing department heads were asked to answer a national survey. It included 24 questions designed to cover some dimensions, including characteristics of the hospital and emergency departments (ED) and questions on vaccination. RESULTS: 414 responses out of 800 questionnaires (51.8%) were collected. Scores out of 10 were, respectively, 7 (6-8) and 8 (6-9) for vaccination against influenza and COVID-19 for HCW and 2 (2-3) and 2 (2-4) for ED patients (H = 989.3; p < 0.0001). Multivariate logistic regression found that the existence of a vaccine program in the hospital and the use of point of care influenza PCR in ED were positively associated with the acceptance of influenza vaccination campaign for HCW (p = 0.003) and patients (p = 0.015). Factors limiting adherence to a vaccination program of HCW and patients were lack of medical staff (p = 0.041 for HCW and p < 0.0001 for patients), overcrowded ED (p < 0.001), and the inability to follow up with patients after the ED visit (p < 0.0001). CONCLUSIONS: There have been many missed opportunities for influenza vaccination, and there is pressure to vaccinate against COVID-19 as soon as possible. Vaccination campaigns in ED could help to improve vaccination coverage. ED staff are more likely to vaccinate HCW than patients. There are factors that support the implementation of such programs, which can be grouped into a culture of diagnosis, control, and prevention of viral infectious diseases within the hospital and ED. On the other hand, there are limiting factors, such as overcrowding and lack of personnel.

Optimal combination of early biomarkers for infection and sepsis diagnosis in the emergency department: The BIPS study.

OBJECTIVE: To define the best combination of biomarkers for the diagnosis of infection and sepsis in the emergency room. METHODS: In this prospective study, consecutive patients with a suspicion of infection in the emergency room were included. Eighteen different biomarkers measured in plasma, and twelve biomarkers measured on monocytes, neutrophils, B and T-lymphocytes were studied and the best combinations determined by a gradient tree boosting approach. RESULTS: Overall, 291 patients were included and analysed, 148 with bacterial infection, and 47 with viral infection. The best biomarker combination which first allowed the diagnosis of bacterial infection, included HLA-DR (human leukocyte antigen DR) on monocytes, MerTk (Myeloid-epithelial-reproductive tyrosine kinase) on neutrophils and plasma metaloproteinase-8 (MMP8) with an area under the curve (AUC) = 0.94 [95% confidence interval (IC95): 0.91;0.97]. Among patients in whom a bacterial infection was excluded, the combination of CD64 expression, and CD24 on neutrophils and CX3CR1 on monocytes ended to an AUC = 0.98 [0.96;1] to define those with a viral infection. CONCLUSION: In a convenient cohort of patients admitted with a suspicion of infection, two different combinations of plasma and cell surface biomarkers were performant to identify bacterial and viral infection.

Características de la exposición al VIH y factores predictores del tiempo de acceso a la profilaxis posexposición: estudio observacional prospectivo / Characteristics of human immunodeficiency virus exposure and predictors of time until access to postexposure prophylaxis: a prospective observational study

OBJETIVOS: La eficacia de la profilaxis posexposición al virus de la inmunodeficiencia humana (VIH) depende de un tiempo inferior a 4 horas entre la exposición y la administración del tratamiento. Este estudio evalúa los factores predictores del tiempo entre la exposición al VIH y la llegada a urgencias. MÉTODOS: Estudio observacional, prospectivo, realizado en el Hospital Universitario de Bichat (París, Francia). Se incluyeron todas las consultas en urgencias en 2016 y 2017 por exposición al VIH -ocupacional y no ocupacional-. RESULTADOS: Se incluyeron 1.475 pacientes, de los que 598 completaron una encuesta de seguimiento. El retraso ($4horas) entre la exposición al VIH y la consulta en urgencias se asoció con el tipo de exposición al VIH: trabajadores sanitarios, otras exposiciones y sexuales (p < 0,001). Se encontraron diferencias entre la exposición sexual y otras: conocimiento del circuito de PEP: 65,2% y 46,9% (p < 0,001), uso previo de PEP: 23,9% y 13,1% (p = 0,001), uso de alcohol: 36,2% y 18,5% (p < 0,001), uso de drogas: 34,6% y 8,6% (p < 0,001), y chemsex: 26,1% y 0% (p < 0,001).En la exposición sexual, los siguientes factores predicen el retraso: conocimiento y uso previo del circuito de PEP(p < 0,001) disminuyen el riesgo de retraso > 4 horas, y uso de drogas (p = 0,03) y chemsex (p < 0,001) lo aumentan; en la exposición ocupacional, el conocimiento del programa PEP lo disminuye y el uso de drogas lo aumenta(p < 0,001). CONCLUSIÓN:El retraso en la consulta posexposición al VIH es mayor en la exposición sexual. El conocimiento del programa de PEP y su uso previo determinaban un retraso menor. En la exposición sexual, el consumo de alcohol, drogas y chemsex, implican un retraso mayor, en especial en hombres que tienen relaciones sexuales con hombres

BACKGROUND AND OBJECTIVE: The efficacy of postexposure prophylaxis (PEP) after human immunodeficiency virus (HIV)contact relies on administering the treatment within 4 hours of contact with the virus. This study aimed to evaluate predictors of the time that elapses between HIV exposure and emergency department arrival. METHODS: Prospective observational study carried out at Hôpital Bichat, a university teaching hospital in Paris, France. All emergency visits for occupational or non occupational exposure to HIV in 2016 and 2017 were included. RESULTS: A total of 1475 cases were studied; 598 patients responded to the follow-up survey. A delay of 4 hours or more between HIV exposure and the emergency department visit was associated with type of contact: health care occupational exposure, other occupational exposure, or sexual intercourse (P< .001). We found significant differences between individuals exposed during sexual contact versus occupational exposure with respect to knowledge of the PEP program pathway (65.2%vs 46.9%, respectively), previous use of PEP (23.9%vs 13.1%), alcohol intake (36.2%vs 18.5%), drug use (34.6%vs 8.6%), and chemsex (sexualized drug use) (26.1%vs 0%) (P< .001, all comparisons).Predictors of time until start of PEP among individuals exposed during sexual intercourse were knowledge and prioruse of the PEP pathway (P< .001), drug use (P= .03), and chemsex (P< .001). Predictors among occupationally exposed individuals were prior knowledge of the PEP pathway and drug use (P< .001). CONCLUSIONS: Delay in seeking PEP after HIV exposure is greater among individuals exposed during sexual intercourse. Knowledge of the PEP program and prior use of it are associated with less delay. Exposure during sexual intercourse, alcohol and drug use, and chemsex are associated with longer delays, especially in men who have sex with men