Temporal Trends in the Use of Computed Tomographic Pulmonary Angiography for Suspected Pulmonary Embolism in the Emergency Department : A Retrospective Analysis.

BACKGROUND: Recently, validated clinical decision rules have been developed that avoid unnecessary use of computed tomographic pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) in the emergency department (ED). OBJECTIVE: To measure any resulting change in CTPA use for suspected PE. DESIGN: Retrospective analysis. SETTING: 26 European EDs in 6 countries. PATIENTS: Patients with CTPA performed for suspected PE in the ED during the first 7 days of each odd month between January 2015 and December 2019. MEASUREMENTS: The primary end points were the CTPAs done for suspected PE in the ED and the number of PEs diagnosed in the ED each year adjusted to an annual census of 100 000 ED visits. Temporal trends were estimated using generalized linear mixed regression models. RESULTS: 8970 CTPAs were included (median age, 63 years; 56% female). Statistically significant temporal trends for more frequent use of CTPA (836 per 100 000 ED visits in 2015 vs. 1112 in 2019; P < 0.001), more diagnosed PEs (138 per 100 000 in 2015 vs. 164 in 2019; P = 0.028), a higher proportion of low-risk PEs (annual percent change [APC], 13.8% [95% CI, 2.6% to 30.1%]) with more ambulatory management (APC, 19.3% [CI, 4.1% to 45.1%]), and a lower proportion of intensive care unit admissions (APC, -8.9% [CI, -17.1% to -0.3%]) were observed. LIMITATION: Data were limited to 7 days every 2 months. CONCLUSION: Despite the recent validation of clinical decision rules to limit the use of CTPA, an increase in the CTPA rate along with more diagnosed PEs and especially low-risk PEs were instead observed. PRIMARY FUNDING SOURCE: None specific for this study.

COVID-19 as a window of opportunity for cycling: Evidence from the first wave.

Across the world, the COVID-19 pandemic has forced people to reconsider their habits in terms of how they work, how they interact with each other, and of their mobility. During lockdowns, mobility was in general significantly reduced. Means of collective transportation were used much less, and people preferred means of individual transport. Evidence from some cities suggests that people turned to cycling as a resilient and reliable option with a small risk of contagiousness. This spike in demand led some governments to respond by opening additional bike lanes, reducing the fees of bike-sharing systems, banning cars on selected streets, or giving monetary incentives for the purchase of new bikes. We analyze the bike traffic in Basel and Zurich, two major Swiss cities. Throughout the pandemic, no specific measure to promote cycling was implemented in any of the two cities; we can thus see latent demand patterns exposed when conditions change. As cycling depends on the season and weather, we incorporate these data and correct the traffic counts hereby. We can identify a distinct change in cycling traffic over the course of the day. During the lockdown period, relatively more traffic is observed in the afternoon, possibly associated with leisure activities. Furthermore, there is a short-term drop in the corrected cycling traffic and a fast recovery, demonstrating cycling as a resilient transport mode. Soon bike traffic reached pre-lockdown levels, but no significant increase could be identified, possibly attributed to the absence of explicit policy measures. We furthermore survey a panel of bike policy experts to identify policy actions that could be taken in Basel and Zurich to increase bike usage. The COVID-19 pandemic disrupts life as we know it, leading people to reconsider their travel choices. Given authorities' desire to increase bike usage, it represents a window of opportunity to test new policy measures, increase bike trips of active cyclists, and attract new cyclists. As long as this window is open, people are susceptible to policy measures to reconsidering past choices. However, if no policy measures are conducted during the pandemic, as in the case study, it is likely that bike usage is not increased in the long run. Authorities are well-advised to take this opportunity to strengthen cycling and to lead to a more resilient, accessible, safe, and sustainable urban transport system.

Early Diagnosis of Acute Myocarditis in the ED: Proposal of a New ECG-Based Protocol.

The diagnosis of acute myocarditis (AM) is based on a multi-parametric assessment including clinical presentation, ECG, imaging and biomarkers. Fragmented QRS (fQRS) might be an additional diagnostic sign in patients with proven AM. The main objective of this study was to assess the diagnostic yield of fQRS in patients with suspected AM presenting to the emergency department (ED). Patients admitted between January 2016 and March 2021 with a proven diagnosis of AM, according to clinical, cardiac magnetic resonance (CMR) and/or histologic criteria, were included in the analysis. In total, 51 patients were analyzed (41 men, 78%), with a median age of 36 (29-45) years. Thirty-three (65%) patients had prodromal flu-like symptoms. Patients presented to the ED mostly complaining of chest pain (68%) and palpitations (21%). Seven (14%) patients experienced cardiac arrest, one of whom died. At presentation, 40 patients (78%) displayed fQRS, and 10 (20%) presented ventricular arrhythmias. All the surviving patients underwent CMR and displayed late gadolinium enhancement (LGE). ECG leads showed that fQRS matched the LGE distribution in 38 patients (95%). The presence of fQRS is a simple clinical bedside tool to support the initial suspect of AM in the emergency department and to guide the most appropriate clinical workup.

The impact of COVID-19 pandemic on public transport usage and route choice: Evidences from a long-term tracking study in urban area.

The COVID-19 pandemic strongly affected mobility around the world. Public transport was particularly hindered, since people may perceive it as unsafe and decide to avoid it. Moreover, in Switzerland, several restrictions were applied at the beginning of the first pandemic wave (16/03/2020), to reduce the contagion. This study observes how the pandemic affected travel behaviour of public transport users, focusing on route choice and recurrent trips. We conducted a travel survey based on GPS tracking during the first pandemic wave, following 48 users for more than 4 months. The very same users were also tracked in spring 2019, allowing a precise comparison of travel behaviour before and during the pandemic. We analyse how the pandemic affected users, in terms of travel distance, mode share and location during the day. We specifically focus on recurrent trips, commuting and non-commuting, observing how mode and route changed between the two different periods. Finally, we estimate a route choice model for public transport (Mixed Path Size Logit), based on trips during the two different years, to identify how the route choice criteria changed during the pandemic. The main differences identified in travel behaviour during the pandemic are a different perception of costs of transfers and of travel time in train, and that users no longer have a clear preferred route for a recurrent trip, but often choose different routes.

Association Between Pulmonary Embolism and COVID-19 in Emergency Department Patients Undergoing Computed Tomography Pulmonary Angiogram: The PEPCOV International Retrospective Study.

BACKGROUND: There have been reports of procoagulant activity in patients with COVID-19. Whether there is an association between pulmonary embolism (PE) and COVID-19 in the emergency department (ED) is unknown. The aim of this study was to assess whether COVID-19 is associated with PE in ED patients who underwent a computed tomographic pulmonary angiogram (CTPA). METHODS: A retrospective study in 26 EDs from six countries. ED patients in whom a CTPA was performed for suspected PE during a 2-month period covering the pandemic peak. The primary endpoint was the occurrence of a PE on CTPA. COVID-19 was diagnosed in the ED either on CT or reverse transcriptase-polymerase chain reaction. A multivariable binary logistic regression was built to adjust with other variables known to be associated with PE. A sensitivity analysis was performed in patients included during the pandemic period. RESULTS: A total of 3,358 patients were included, of whom 105 were excluded because COVID-19 status was unknown, leaving 3,253 for analysis. Among them, 974 (30%) were diagnosed with COVID-19. Mean (±SD) age was 61 (±19) years and 52% were women. A PE was diagnosed on CTPA in 500 patients (15%). The risk of PE was similar between COVID-19 patients and others (15% in both groups). In the multivariable binary logistic regression model, COVID-19 was not associated with higher risk of PE (adjusted odds ratio = 0.98, 95% confidence interval = 0.76 to 1.26). There was no association when limited to patients in the pandemic period. CONCLUSION: In ED patients who underwent CTPA for suspected PE, COVID-19 was not associated with an increased probability of PE diagnosis. These results were also valid when limited to the pandemic period. However, these results may not apply to patients with suspected COVID-19 in general.